[Physical forces in blister formation. II. Examination of total osmolality in blister fluid of suction blisters, "naturally" developed blisters and in serum (author's transl)]

Total osmotic pressure does not differ significantly in suction blister fluid or in serum of healthy persons from blister fluid, suction blister fluid or serum of patients with dermatitis herpetiformis, bullous contact dermatitis and pemphigus vulgaris. The average values reach about 293 mOsmol/kg. This results from direct measurement of total osmolality with an electronic semimicroosmometer based on the principle of freezing point reduction. In opposite to colloid osmotic pressure the total osmotic pressure does not take part in blister formation of human skin in spite of the different concentrations of the single electrolytes in the fluids of various blisters.

Physical forces in blister formation. The role of colloid osmotic pressure and of total osmolality in fluid migration into the rising blister

The physical forces operative in the fluid migration from the interstitial spaces into the blister cleft have not been directly measured until now. The colloid osmotic pressure and the total osmolality were determined in suction blister fluid after mild suction blister production by a modified "Dermovac" and in blister fluid of patients with dermatitis herpetiformis, bullous allergic contact dermatitis and pemphigus vulgaris and in the sera of healthy persons. The colloid osmotic pressure was measured by means of a recently developed osmometer with a semipermeable membrane between 2 chambers, one of them filled with Ringer solution, the other with the blister fluid or serum sample. The negative pressure in the first chamber was determined. The colloid osmotic pressure of suction blister fluid averages approximately 7 cm H2O, the values reach about 20 cm H2O in bullous diseases and about 38 cm H2O in the normal sera. The blister fluid colloid osmotic pressure has to rise to about 15 cm H2O or more to cause the fluid transport from the interstitial spaces of the surrounding tissue into the blister because of the negative interstitial fluid pressure and the colloid osmotic pressure of the interstitial fluid. Otherwise the blister fluid is reabsorbed back into the interstitial spaces. The total osmolality does not differ in the serum and in the blister fluid. It does not seem to be etiologically connected with the fluid transport into the rising blister.

[Juvenile papulous dermatitis]

Juvenile papular dermatitis is a rare and harmless disease of childhood, which is scarcely known in Germany. The clinical and histological signs of the disease are described and a case of a 6-year-old patient is presented. In most patients the clinical difference of the other numerous papular eruptions of childhood and etiological aspects are discussed.

[Physical forces in blister formation. I. Direct measurement of blister fluid colloid osmotic pressure in suction blisters and in bullous diseases (author's transl)]

The physical forces operative in the fluid migration from the interstitial spaces into the blister cleft have not been directly measured until now. The colloid osmotic pressure was determined in suction blister fluid after mild suction blister production by a modified "Dermovac" and in blister fluid of patients with dermatitis herpetiformis, bullous allergic contact dermatitis and pemphrigus vulgaris and in the sera of healthy persons. The colloid osmotic pressure was measured by means of a recently developed osmometer with a semipermeable membrane between two chambers, one of them filled with Ringer solution, the other with the blister fluid sample. The negative pressure in the first chamber was determined. The colloid osmotic pressure of suction blister fluid averages approximately 7 cm H2O, the values reach about 20 cm H2O in bullous diseases and about 38 cm H2O in the normal sera. The blister fluid colloid osmotic pressure has to rise to about 15 cm H2O or more to cause the fluid transport from the interstitial spaces of the surrounding tissue into the blister because of the negative interstitial fluid pressure and the colloid osmotic pressure of the interstitial fluid. Otherwise the blister fluid is reabsorbed back into the interstitial spaces.

[Diffuse melanosis in malignant melanoma]

A patient with widely metastasized malignant melanoma assocaited with diffuse melanosis is presented. The widespread metastases in liver; skin and tonsilla are remarkable. The cutaneous melanosis in the form of the slate-blue colour caused by the increased dermal melanin deposits can arise in two different ways. One possibility is that melanin or precursors can be released from liver or other metastases and reach the dermis via the circulation. On the other hand a diffuse direct haematogenic single cell metastatic formation in the dermis with melanin formation and release can occur. In the case of the described patient the first etiopathology is dominating as it is shown by the light and electron microscopical results presented here.

[Multiple skin plasmocytomas, increased serum IgA and lack of bone marrow lesions (author's transl)]

Extramedullary plasmocytomas of the skin are rare, especially if a participation of the bone marrow is lacking. A 76-year-old patient developed multiple skin tumours within 2 months. In addition he showed an increase of serum immunoglobulin A. Histopathologically the tumours resembled reticulum cell sarcoma with few plasma cells, partly immature.

[Defective polymorphonuclear leukocyte function in chronic granulomatous muco-cutaneous candidiasis (author's transl)]

Chronic granulomatous muco-cutaneous candidiasis is reported in a 12-year-old boy who died of pulmonal cryptococcosis. Chemotactic and phagocytic functions of the neutrophilic polymorphonuclear leukocytes were deficient while the cell mediated immunity was not disturbed and no decrease of immunoglobulins and complement factors--especially C3 and C5--was found in the serum. The possibility is considered that the disturbance of lymphocyte mediated immune response is the normal, but not only fundamental aetiological factor of chronic muco-cutaneous candidiasis.

[Ultrastructure of nuclear bodies in connective tissue cells of psoriatic lesions (author's transl)]

Electron microscopic observations were made in 6 psoriatic lesions of the skin. All specimens showed an increased number of nuclear bodies containing glycogen and lipids in the nuclear plasma of connective tissue cells. The results indicate an activation of connective tissue cell metabolism. They are discussed in connection with previously described signs of the participation of mesenchymal tissue in the psoriatic skin reaction. The increased metabolism could be part of a "nonspecific mesenchymal tissue reaction".