Influence of skin cleansing preparation acidity on skin surface properties

Synopsis Two long-term trials were conducted each over eight weeks to compare the effect of the regular application of skin cleansing preparations of pH 5.5 and pH 8.5 and pH 5.5 and pH 7.0 respectively on the surface pH, roughness and transepidermal water loss (TEWL) of normal human forehead and forearm skin. Both trials were based on a cross-over design: five healthy volunteers started with a pH 5.5 preparation and switched to the other after four weeks, five additional volunteers used the preparations in the opposite order. While the skin surface pH was markedly lower in those individuals using the pH 5.5 preparation at each examination, as compared to those using the pH 8.5 or pH 7.0 preparation, no such difference could be established with respect to skin roughness and TEWL. Hence the skin irritancy of a cleansing preparation does not seem to be linked to its pH within the pH ranges tested.

Interferon gamma in survivors of the Chernobyl power plant accident: new therapeutic option for radiation-induced fibrosis

BACKGROUND

One of the remarkable clinical consequences of the Chernobyl accident was skin involvement, leading to extensive cutaneous fibrosis. Apart from surgery, no established treatment is available.

METHODS

A group of survivors, working in or present at the accident site on April 26, 1986, and a few days thereafter, were examined, treated, and followed-up in 6-month intervals from September 1991 to November 1995. Eight individuals were identified as suffering from excessive cutaneous fibrosis. Skin thickness was measured with high-frequency (20 MHz) ultrasound in a clinically well-defined target skin lesion, in addition to histologic confirmation of radiation fibrosis. Interferon gamma was scheduled for all patients on a low-dose regimen (3 x 50 microg/week s.c.). In 2 patients, interferon was discontinued after the first injection, due to withdrawal of consent. In 6 patients, interferon was continued for 30 months, with 1 injection weekly for a further 6 months. Treatment was discontinued in November 1994. Four patients in the treated group and 1 of the 2 patients treated only once ("untreated patients") were reexamined 1 year later.

RESULTS

In all individuals treated for 36 months, a significant (p < 0.005) reduction of radiation fibrosis could be determined, in contrast to a significant (p < 0.005) increase in the 2 untreated patients. Follow-up 1 year after discontinuation of the interferon treatment demonstrated significant (p < 0.005) recurrence of fibrosis.

CONCLUSION

Low-dose interferon appears to be a safe and effective treatment of cutaneous radiation fibrosis following accidental exposure to high doses of ionizing radiation. Long-term supportive therapy may be required.

Palpable migratory arciform erythema. Clinical morphology, histopathology, immunohistochemistry, and response to treatment

BACKGROUND

Palpable migratory arciform erythema is clinically characterized by sharply circumscribed, infiltrated erythematous patches that tend to spread irregularly, resulting in arciform morphologic features. The histopathologic features are characterized by a patchy inflammatory perivascular and periadnexal T-lymphocytic infiltrate throughout the dermis. The disease runs a chronic course and is rarely described in the literature.

OBSERVATION

Three middle-aged patients of both sexes had palpable migratory arciform erythema with 1, several, or multiple lesions on the trunk. There was a dense perivascular and periadnexal, predominantly lymphocytic infiltrate of the reticular dermis without any interstitial distribution of inflammatory cells. Absence of mucin deposits and plasma cells was a striking feature. The immunohistochemical profile showed an infiltrate dominated by T cells of polyclonal origin. In addition, polyclonal B cells and histiocytes were present in small numbers. In all 3 cases, oral antibacterial treatment resulted in a complete (2 patients) or temporary (1 patient) resolution of skin lesions.

CONCLUSIONS

Palpable migratory arciform erythema shows distinctive differences in clinical and pathological features and treatment in contrast to other diseases with cutaneous lymphocytic infiltrates, including lymphocytic infiltration of Jessner and Kanof. Therefore, it is likely a distinct disease entity.

[The value of oil baths for adjuvant basic therapy of inflammatory dermatoses with dry, barrier-disrupted skin]

The therapeutic value of oil baths for the treatment of dry skin with disturbed barrier function in atopic eczema, atopic xerosis, dry aged skin, exsiccation eczematid and psoriasis vulgaris is presented with special regard to modern concepts of epidermal barrier function. The use of oil baths with emollients as an integral and indispensable constitutent of maintenance therapy in dry skin conditions, atopic eczema and inflammatory dermatoses is reviewed.

The influence of the pH-value on the growth of Brevibacterium epidermidis in continuous culture

Brevibacterium epidermidis is a major component of the bacterial flora of certain skin surface biotopes, characterized by a comparatively high pH-value. The presence of Brevibacterium epidermidis seems to be linked to the production of malodour. Skin surface pH has been found to be a major factor of bacterial growth on the skin. In order to find out if this might also apply to Brevibacterium epidermidis, this microorganism was grown in vitro in continuous culture using a chemostat. Specific growth rate and density of colony forming units were well correlated. While the organism grew readily from pH 5.5 to 8.5, this was not the case with a pH of 5.0. Thus pH-shifts induced by cosmetic procedures can only prevent unpleasant body odour due to abundant growth of bacteria if the pH-value is decreased to 5.0 or less.

[The tuberculid concept from the current viewpoint]

The concept of tuberculid was introduced by Darier in 1896. In contrast to "true" cutaneous tuberculosis, properties of the tuberculids were explained by an hyperergic response to myobacteria or their fragments released from a different site of manifest or passed tuberculous infection. Key features include a strongly positive tuberculin skin test, evidence of concomitant manifest or past tuberculosis, and prompt response to antituberculous therapy. The inability to culture M. tuberculosis or to demonstrate it microscopically from lesional biopsies, together with reports on tuberculid-like eruptions after BCG vaccination, supports this concept. Clinical manifestations are lichen scrophulosorum, papulo-necrotic tuberculids and erythema induratum of Bazin. The existence of tuberculids has been questioned, however, because the clinical and histological appearances are not always specific. An increasing number of case reports on tuberculids, new immunological tests and molecular biology-based techniques for the detection of mycobacteria have shed new light on the tuberculid concept.

The influence of the regular use of a soap or an acidic syndet bar on pre-acne

The role of regular skin cleansing with soap or syndet in pre-acne is ill-defined. The intention of this study was to assess the relative value of an acidic syndet bar and a conventional soap bar in the prevention of acne lesions in acne-prone patients. In a randomized, open, comparative trial the three months' application of either an acidic syndet bar or a conventional soap to facial skin for 1 min each in the morning and in the evening was compared in 120 adolescents and young adults with inflammatory acne grade I or II according to the Plewig and Kligman classification. It was a confirmatory trial with the number of inflammatory lesions being the prime parameter of concern. In addition, non-inflammatory acne lesions were analyzed as were parameters of safety such as itching, redness and scaling. While the number of inflammatory acne lesions, i.e., papulopustules, did not differ in the two trial groups composed of 57 evaluable cases each, this was the case from 4 weeks of application onward: in the group using soap the mean number of inflammatory lesions increased from 14.6 (+/- 5.3) to 15.3 (+/- 6.0), while it decreased in the other group from 13.4 (+/- 5.2) to 10.4 (+/- 5.8) (p < 0.0001). Symptoms or signs of irritation were seen in 40.4% of individuals belonging to the former and 1.8% belonging to the latter group. The number of papulopustules characteristic of inflammatory acne thus is clearly lower when a syndet bar of the acidic type is regularly used for cleansing the face as compared to a (necessarily alkaline) soap.(ABSTRACT TRUNCATED AT 250 WORDS)

Late irradiation damage to the skin caused by soft X-ray radiation therapy of cutaneous tumors

BACKGROUND

Although radiotherapy of skin tumors has lost its former preeminence, there is still need for this modality. The aim of this study was, therefore, to determine the frequency of radiogenic ulcers and tumors following soft x-ray therapy of skin lesions.

STUDY DESIGN

A total of 612 radiation sites in 522 patients were retrospectively analyzed by means of medical records. All patients received at least a total dose of more than 12 Gy and had a minimum follow-up time of 10 years. The average radiation dose was about 80 Gy, ranging from 56 to 184 Gy. Determined was occurrence of radiogenic tumors after more than 10 years and of ulcers during the entire follow-up period. The frequency of radiogenic tumors and ulcers was related to the total dose applied and the patient's age at the time of irradiation.

RESULTS

In the 612 radiation fields used, 58 ulcers (9.4%), 12 basal cell carcinomas (2%), and nine squamous cell carcinomas (1.5%) were observed. There was no relationship between the total dose of radiation and the frequency of tumors; in contrast, radiogenic ulcers increased with a higher total dose. Radiogenic ulcers occurred more often in patients who were of a younger age at the time of irradiation.

CONCLUSIONS

The risk of developing radiogenic ulcers and tumors after soft x-ray therapy is not very high. Since most of the ulcers can be prevented by modern dose recommendation (time dose fractionation factor), soft x-ray therapy can be considered as a safe and effective means of therapy, especially in older patients.

Modern topical glucocorticoids and anti-infectives for superinfected atopic eczema: do prednicarbate and didecyldimethylammoniumchloride form a rational combination?

The addition of an anti-infective to a topical glucocorticoid preparation for superinfected atopic eczema is still controversial. To address this question in the context of the topical glucocorticoids of the non-halogenated double-ester type 0.25% prednicarbate cream was compared to the identical preparation incorporating the same amount of the disinfectant didecyldimethylammoniumchloride in patients suffering from atopic eczema carrying Staphylococcus aureus at a density of more than 10(6) colony-forming units per cm2. One of the preparations was used twice daily over 5 days according to a random plan in a blind fashion. Thereafter treatment was based on either prednicarbate cream or the corresponding vehicle according to clinical needs. Clinical and microbiological evaluation were scheduled for days 0, 6 and 34. Various clinical parameters were addressed individually as well as over all improvement using scores. A total of 143 patients was recruited. The patients of both groups improved rapidly with respect to clinical and microbiological findings. Essentially, there was no difference between the groups. Hence, the addition of an anti-infective to a topical prednicarbate preparation is not to be generally recommended.

Chronic cutaneous damage after accidental exposure to ionizing radiation: the Chernobyl experience

BACKGROUND

The hazards of acute radiation exposure are well known. Bone marrow failure from total body gamma or neutron irradiation is the most clinically relevant aspect of acute radiation disease. With nonhomogeneous exposure, as is characteristic in accidents, other organ systems, such as the skin, may be more important in determining clinical prognosis. This became obvious in the two worst radiation accidents since 1945, the Chernobyl accident in April 1986 and the Goiania accident in September 1987.

OBJECTIVE

Our purpose was to describe the characteristic chronic sequelae of accidental cutaneous radiation in a group of patients who survived the Chernobyl nuclear power plant accident.

METHODS

Fifteen patients with the delayed type of the cutaneous radiation syndrome were examined between September 1991 and January 1992. All patients had a history of acute radiation disease. The exposure pattern was characterized by partial body exposure with high doses of beta and gamma irradiation from radioactive water, steam, or dust.

RESULTS

Radiation-induced lesions were confined primarily to the legs and distal arms, but sometimes involved up to 50% of the total body surface. In addition to telangiectases, radiation keratoses, and radiation ulcers, hemangiomas, hematolymphangiomas, splinter hemorrhages in the distal nail bed, lentiginous hyperpigmentation, and severe subcutaneous fibrosis were noted. No malignant transformation could be detected. Associated diseases included cataracts, chronic hepatitis, and recalcitrant bacterial and herpesvirus infections.

CONCLUSION

After accidental partial body exposure to high doses of beta and gamma irradiation, the predominant involvement of the skin, described as the cutaneous radiation syndrome, can become the characteristic feature. This causes longlasting, serious diagnostic and therapeutic problems.

The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions

BACKGROUND

The difficulties in accurately assessing pigmented skin lesions are ever present in practice. The recently described ABCD rule of dermatoscopy (skin surface microscopy at x10 magnification), based on the criteria asymmetry (A), border (B), color (C), and differential structure (D), improved diagnostic accuracy when applied retrospectively to clinical slides.

OBJECTIVE

A study was designed to evaluate the prospective value of the ABCD rule of dermatoscopy in melanocytic lesions.

METHODS

In 172 melanocytic pigmented skin lesions, the criteria of the ABCD rule of dermatoscopy were analyzed with a semiquantitative scoring system before excision.

RESULTS

According to the retrospectively determined threshold, tumors with a score higher than 5.45 (64/69 melanomas [92.8%]) were classified as malignant, whereas lesions with a lower score were considered as benign (93/103 melanocytic nevi [90.3%]). Negative predictive value for melanoma (True-Negative divided by [True-Negative+False-Negative]) was 95.8%, whereas positive predictive value (True-Positive divided by [True-Positive+False-Positive]) was 85.3%. Diagnostic accuracy for melanoma (True-Positive divided by [True-Positive+False-Positive+False-Negative]) was 80.0%, compared with 64.4% by the naked eye. Melanoma showed a mean final dermatoscopy score of 6.79 (SD, +/- 0.92), significantly differing from melanocytic nevi (mean score, 4.27 +/- 0.99; p < 0.01, U test).

CONCLUSION

The ABCD rule can be easily learned and rapidly calculated, and has proven to be reliable. It should be routinely applied to all equivocal pigmented skin lesions to reach a more objective and reproducible diagnosis and to obtain this assessment preoperatively.

Comparative efficacy and safety of bifonazole 1% cream and the corresponding base preparation in the treatment of seborrhoeic dermatitis

Seborrhoeic dermatitis is a common entity that conventionally is difficult to treat. Recently, topical ketoconazole has been proven successful. To determine if other azoles, and in particular the more modern ones, are also helpful in this condition, a double-blind multicentre randomized controlled trial was performed in patients suffering from seborrhoeic dermatitis involving individuals 16 years and older without human immunodeficiency virus (HIV) infection. One hundred patients were enrolled and treated according to a random plan with either bifonazole 1% cream or the corresponding vehicle once daily for 4 weeks. All patients were evaluated at the beginning of the study, as well as after 2 and 4 weeks, i.e. the treatment period proper, and after 6 weeks of follow-up. Clinical evaluation was based on scores of 0-3 for the following parameters: erythema, papules, infiltration, scaling, itch. In addition, mycological evaluation was performed using adequate contact plates for quantitative determination of Malassezia furfur. In the end, 92 patients were at least partially evaluable. In general, the verum preparation tended to be more efficacious, e.g. the score for erythema amounted to 0.75 after 4 weeks as compared with 0.88 in the control group, the baseline values being 2.18 and 2.04 respectively. With itch, the corresponding figures were 0.17 and 0.33 as compared with 1.42 and 1.38 before treatment. While in statistical terms there was significant difference in these parameters, such a difference was demonstrated by clinical judgement at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for the phagocytosis of intact oligolamellar liposomes by human keratinocytes in vitro and consecutive intracellular disintegration

While there is evidence for the use of liposomes as drug carriers upon topical application to the skin, the underlying mechanisms are far from being clear. Therefore human keratinocytes grown in vitro were exposed to large oligolamellar liposomes. After attachment and invagination these particles can be found unchanged within the cytoplasm both inside and outside of lysosomes. If incorporated into lysosomes the structural lipids can be disintegrated and spread within the entire phagolysosome. Gold labeling adds further to the hypothesis of intact uptake of liposomes by the living cells of the human epidermis.

Erythema induratum of Bazin. Evidence of T-lymphocyte hyperresponsiveness to purified protein derivative of tuberculin: report of two cases and treatment

BACKGROUND AND DESIGN

Erythema induratum of Bazin, a chronic form of nodular vasculitis, may be associated with chronic infections by Mycobacterium tuberculosis. However, the true origin of the disease is a subject of speculation and remains elusive. Two female patients (58 years old and 33 years old) with a minimum 10-year history of chronic tender ulcerating nodules on the lower aspects of the legs were studied both clinically and in the response of their peripheral T cells to purified protein derivative of tuberculin.

RESULTS

Both patients with no previous history of tuberculosis had strongly positive skin test results at a Mantoux 10(-4) dilution (1 unit of purified protein derivative). In response to full-course triple-agent (isoniazid, rifampicin, and ethambutol) chemotherapy, a complete remission of clinical symptoms was seen in both cases and no relapse occurred after discontinuation of therapy. A marked increase in peripheral T-lymphocyte response to purified protein derivative was found before onset of and during successful therapy.

CONCLUSIONS

The present clinical observations together with the pronounced cellular response to purified protein derivative suggest a tuberculous origin of erythema induratum of Bazin.

Male reproductive system in patients exposed to ionizing irradiation in the Chernobyl accident

Twelve men with different forms and stages of chronic radiation dermatitis caused by accidental exposure to beta and gamma irradiation during and after the Chernobyl atomic power plant accident were examined. Two patients had impotentia coeundi, and the others reported various impairments of sexual function. One patient had aspermia, two patients had azoospermia, one had oligospermia, and four had normal sperm counts. In three samples abnormal forms of spermatozoa were increased. Sperm motility was decreased in 3 samples and was normal in another. Hormonal analyses demonstrated low testosterone plasma levels in two patients, an increase of follicle stimulating hormone (FSH) levels in six patients, and a decrease of luteinizing hormone (LH) in one patient. In one patient who showed an increase of plasma prolactin level, associated with low testosterone and LH, a microadenoma of the pituitary gland (prolactinoma) was detected. It would appear that there is an association between accidental exposure to ionizing radiation of varying severity and the impairment of exocrine and endocrine testicular function, sometimes resulting in long-lasting physiological and psychological problems.

[Historical development of skin surface microscopy]

Within the last decade, skin surface microscopy has been rediscovered as an useful technique for preoperative diagnosis of pigmented skin lesions. This method was originally developed early this century as one component of "functional diagnosis" in constitutional pathology.

[Clinical aspects and therapy of Bureau-Barrière syndrome. Observations of 17 cases with review of the literature]

Bureau-Barrière syndrome can affect various organ systems. It is defined by the triad: painless ulcers at mechanically irritated and hyperkeratotic plantar areas of the feet, sensitive polyneuropathy of the lower legs and osteolysis in the forefoot area. The condition mainly affects middle-aged men suffering from alcoholism, liver disease, obesity or metabolic disorders such as diabetes mellitus. Successful treatment of the Bureau-Barrière syndrome requires an interdisciplinary approach.

Topical tiacrilast, a potent mast cell degranulation inhibitor, does not improve adult atopic eczema

Tiacrilast is a potent mast cell degranulation inhibitor in vitro and in animal studies. Since mast cells and their mediators are possibly involved in atopic eczema, we have studied a topically applied 3% hydrogel formulation of tiacrilast against vehicle in a multicenter, double-blind, placebo-controlled trial. Drug or vehicle were applied on involved skin for 28 days. Efficacy was assessed weekly using a 4-point scale for erythema, scaling, induration, exudation and pruritus. An overall assessment of the sites for efficacy and site preference was performed at the end of treatment. In the 32 patients evaluable for efficacy, > 33% improvement was noted on 78% of the drug- and 75% of the vehicle-treated sites, with no statistically significant differences for any of the parameters tested. Treatment was generally well tolerated by all patients. These data suggest that mast cells may not play a major role in the maintenance of atopic eczema lesions.

In-use tolerability of two new syndet bars with sodium cocoyl isethionate, disodium lauryl sulfosuccinate and wheat starch as major ingredients in differing relations: results of a cross-over trial

Synopsis In a cross-over trial two different new syndet bars differing in their content of sodium cocoyl isethionate, disodium lauryl sulfosuccinate and wheat starch as major components were compared in the cleansing of hand skin of 72 healthy volunteers. The preparation designated 'T'containing a higher amount of wheat starch turned out to be less irritant as judged from the parameters itching and erythema (p < 0.05, Wilcoxon's test for matched pairs). The present trial design looks appropriate to differentiate the irritancy potential of two chemically similar syndet bar preparations.

[Erythema nodosum and non-Hodgkin lymphoma]

A 36-year-old woman presenting with erythematous painful tender inflammatory nodular lesions on both knees, shins and ankles is reported. Erythema nodosum (EN) was diagnosed. Further clinical examination revealed hilar lymphadenopathy. A lymph node was removed for histological examination, and a centroblastic non-Hodgkin lymphoma was diagnosed. Remarkably, in this patient EN occurred before the haematological malignancy was detected.

[Extracutaneous malignant melanomas: clinical aspects and biology]

Approximately 5% of all malignant melanomas originate from primarily non-cutaneous sites. They are preferentially distributed along the choroid, the meninges, the subserous space of the oesophagus and the intestinal tract, at transitional areas of mucous membranes, and along organ capsules, the periadventitial tissues of major blood vessels, and, occasionally, muscle fasciae. Little is known about their biological behaviour; the prognosis, however, generally has to be considered less favourable than that of primary cutaneous malignant melanomas, probably at least in part because they are often not discovered until they are in advanced stages. There are no specific clinical signs suggestive for non-cutaneous malignant melanomas; symptoms vary with the site of manifestation of the tumours. Interpretation of these clinical data based on results from comparative anatomical studies leads to the conclusion that extracutaneous malignant melanomas in humans are residuals of phylogenetically old, extensive and well-developed non-cutaneous pigment cell patterns demonstrable in a variety of lower vertebrates, which result from interactions between organogenesis and pigment cell development during ontogeny. This demonstrates that consideration of fundamental principles of developmental biology can give diagnostic clues to the localizations at which primary non-cutaneous malignant melanomas may be suspected and can thus facilitate decisions about what diagnostic procedures are necessary.

[Erosive pustular dermatosis of the scalp after zoster ophthalmicus and trauma]

Erosive pustular dermatosis of the scalp (EPDS), first described in 1979, is a rare, chronic, pustular condition with scarring alopecia, and nonspecific histological findings. While the initial responded to steroids is good, it can be treated successfully by oral administration of zinc sulphate. Local trauma has recently been suggested to play a role in the pathogenesis of EPDS. The differential diagnosis of EPDS includes folliculitis decalvans, sterile eosinophilic pustulosis Ofuji, pustular psoriasis vulgaris, trichophytosis, Perifolliculitis capitis abscedens et suffodiens, pemphigus vulgaris and cicatricial pemphigoid. We present the cases of a 74-year-old woman suffering from EPDS following herpes zoster ophthalmicus and of a 54-year-old man in whom EPDS followed a head injury.

Ultrastructural immunogold studies in two cases of linear IgA dermatosis. Are there two distinct types of this disease?

It has been suggested that patients with homogeneous linear IgA deposits at the basement membrane zone constitute a distinct bullous disorder called linear IgA dermatosis (LAD) of adults or children. The results of the present ultrastructural immunogold study in two patients with LAD suggest that LAD is not a single disease entity. LAD in a 10-year-old girl was found to be ultrastructurally similar to an IgA-type pemphigoid. IgA was detected in the uppermost lamina lucida underlying the basal cell plasma membrane. In a second patient, an 86-year-old man, IgA deposits were present within the lamina densa and the anchoring plaques. The distribution of IgA in this patient was ultrastructurally identical with that of IgG in epidermolysis bullosa acquisita skin and with that of the non-collagenous globular terminus of collagen VII within the basement membrane zone of normal skin. By using the immunogold technique, we could distinguish two distinct types of LAD according to the IgA binding sites in the diseased skin. We suggest that different labelling patterns may correspond to different clinical pictures.

Quantitative assessment of the efficacy of oral ketoconazole for oral candidosis in HIV-infected patients

Fifteen male patients with manifest oral candidosis due to Candida albicans, suffering from AIDS-related complex (ARC) or full-blown AIDS, were investigated both clinically and microbiologically before and about 1 and 4 weeks after 7 to 10 days of treatment with 200 mg ketoconazole p.o. per day. Candida albicans was quantitated in mouthwash fluid. The antimicrobial susceptibility of the Candida albicans isolates was assessed using the IC30 test. In the short term, clinical cure was obtained in 87%, mycological cure in 53%. In the long term, the corresponding figures were 56 and 9%, respectively. Eradication of Candida albicans was not possible if IC30 values exceeded 256 micrograms ml-1. While pretreatment counts of Candida albicans in those patients also taking zidovudine did not differ from those in the rest of the study population, both the clinical and the mycological efficacy of ketoconazole seem to be higher both in the short and the long term when administered together with zidovudine. In consideration of the high relapse rate after about 4 weeks, an interval treatment protocol with oral ketoconazole is proposed.

Folliculitis decalvans. Long-lasting response to combined therapy with fusidic acid and zinc

In 3 patients, the diagnosis of folliculitis decalvans was based on clinical, histopathological and laboratory criteria. All patients responded to a combination therapy consisting of oral and topical fusidic acid and oral zinc sulphate. The follow-up period exceeded more than one year.

Reticulate porokeratosis--successful treatment with CO2-laser vaporization

A 35-year-old male patient affected with extensive, itching skin lesions of reticulate porokeratosis is reported. He was successfully treated by CO2-laser vaporization.

Treatment of systemic sclerosis with gamma-interferon

Numerous drugs have been recommended for the treatment of systemic sclerosis, but without any significant effect on the fibrotic stage of this disorder. Because recombinant gamma-interferon (gamma-IFN) is a potent and selective inhibitor of fibroblast proliferation and collagen production by human dermal fibroblasts in vitro, we assessed the effects of gamma-IFN treatment on the skin and on pulmonary function in patients with systemic sclerosis. Fourteen patients entered the study, and nine completed the 12-month trial. Fifty micrograms/day of gamma-IFN was administered subcutaneously 3 days per week. At the end of the 12-month treatment period a significant improvement was observed in total skin score, and blood gas analysis showed a significant increase in Pa O2 during therapy with gamma-interferon. Other clinical parameters (dysphagia, Raynaud's phenomenon, cardiac involvement) were not altered significantly. No serious adverse effects were noted. These results suggest a beneficial effect of gamma-IFN on the cutaneous fibrotic abnormalities and on lung fibrosis in systemic sclerosis.

In situ localization of IgG in epidermolysis bullosa acquisita by immunogold technique

BACKGROUND

Epidermolysis bullosa acquisita (EBA) is an immunologically mediated mechanobullous dermatosis. Recently, serum antibodies in patients with EBA have been reported to bind to the carboxyl terminus of type VII collagen, the disease antigen. However, the precise localization of immunoglobulins in diseased skin has not been demonstrated.

OBJECTIVE

In the present study skin samples taken from a 59-year-old man with EBA were processed for immunoelectron microscopy.

METHODS

A preembedding immunogold ultrastructural technique was applied.

RESULTS

Gold particles, indicative of IgG binding, were deposited within the anchoring plaques and within the lamina densa in some perilesional skin sections. In a similar distribution, IgG-containing amorphous aggregates were detected within the basement membrane zone of perilesional and lesional skin. In some places these immunoglobulin deposits covered the whole region of anchoring fibrils.

CONCLUSION

These results demonstrate the precise localization of IgG within the basement membrane zone of EBA skin that corresponds to the carboxyl terminus of collagen VII in normal skin.

Ultrastructural binding sites of endomysium antibodies from sera of patients with dermatitis herpetiformis and coeliac disease

The ultrastructural binding sites of endomysium antibodies, specific serological markers of gluten sensitive enteropathy, were investigated in the rabbit oesophagus using the immunogold technique. Endomysium antibodies from sera of patients with dermatitis herpetiformis and with coeliac disease bound in an identical manner in a non-fibrillar material closely associated with fine collagenous-reticulin fibrils and also with similar fibrils connecting smooth muscle cells and elastic tissue in the endomysial connective tissue. These observations suggest that IgA antibodies in sera from patients with dermatitis herpetiformis and coeliac disease recognise a common antigen in an amorphous component associated with the reticular connective tissue of oesophageal lamina muscularis mucosae and thus confirm the probable identity of IgA class endomysium and jejunal antibodies.

[Multiple primary malignant tumors in patients with malignant melanoma of the skin]

The incidence of further malignant tumors was analyzed by means of a retrospective study in 2335 melanoma patients. During the follow up 85 patients (3.64%) developed a second malignant tumor: 29 patients multiple primary malignant melanomas (mm), 49 a mm and a further nonmelanocytic malignant tumor, and 7 multiple primary mm and an additional non-melanocytic malignant tumor. Statistical calculations revealed that female melanoma patients have a 20 fold, and male melanoma patients a 30 fold increased risk to develop further malignant melanomas. In contrast, there was no increased incidence of non-melanocytic malignant tumors, breast carcinoma included. A total skin examination has therefore to be performed during follow up investigations of melanoma patients for early detection of further malignant melanomas.

Ultrastructural basis for antigen mapping using sodium chloride-separated skin

In many cases of autoimmune blistering skin diseases indirect immunofluorescence with serum of patients on 1 M NaCl-separated skin represents a rapid diagnostic tool before the use of more complicated immunoelectron microscopy. The present study demonstrates that in skin samples from five adults, separated using 1 M NaCl, 0.15 M NaCl and 0.01 M phosphate buffered saline (PBS), the split formed within the lamina lucida at an identical ultrastructural level. The sub-basal dense plate (SDP) with a wreath of anchoring filaments remained on the epidermal side of the split adjacent to the hemidesmosomal part of the plasma membrane of basal keratinocytes. The base of the split blister was constituted from the lamina densa, with a remote possibility of some anchoring filaments attached. We demonstrate that antigens on the roof of the NaCl- or PBS-split blister may be associated, beside intracellular hemidesmosomal structures, with the SDP and basement membrane components between the SDP and the basal keratinocytes as well as with anchoring filaments attached to the SDP. The observations reported here allow a more precise mapping of antigen determinants in blistering skin diseases.

Ultrastructural discrimination between malignant melanomas and benign nevocytic nevi using high-resolution image and multivariate analyses

Prompted by the well-known difficulties of reliable and objective histologic differentiation between initial malignant melanoma (MM) and benign nevocytic nevi (NN), ultrastructural high-resolution image and multivariate analyses were evaluated for their diagnostic efficiency. Thirty-seven different features describing morphometry (area, circumference, and shape factor), amount of heterochromatin and euchromatin, chromatin homogeneity, and presence of smaller dark chromatin aggregations were determined by a MICROVAX 3500 computer in each of 1840 intraepidermal melanocytic nuclei of 17 MM and 20 NN. A strategy for the classification of cases based on the identification of markedly atypical melanocytic cells (MACS) was developed. MACS, selected in multivariate analysis with a linear combination of the eight most important features for cell classification, were found in 39.4% of the melanoma cells, but only in 0.3% of nevocytic nevus cells. The presence of MACS allowed a clear differentiation between MM and NN. All cases of MM had more than four MACS, whereas 17 cases of nevocytic nevi were MACS negative, and in each of the remaining three cases only one MAC was present. The percentage of MACS detected within intraepidermal parts of MM by using computerized high-resolution image analysis was found to be a highly efficient diagnostic marker. The new classification strategy has the potential of saving considerable time in subsequent studies, because preselected sampling and the calculation of only a few criteria have proven sufficient for correct classification of malignant melanomas.

[Recent findings in physiology and pathology of endothelial cells of the skin]

Perivascular cell infiltrates with concomitant changes of the endothelium represent a histological hallmark of numerous inflammatory dermatoses. Therefore, the pathophysiology of dermal endothelial cells is of particular importance for the understanding of inflammatory processes within the skin. In recent years, the development and refinement of endothelial cell culture techniques have facilitated investigations in cell biology and molecular biology, which complement histological observations, so leading to sounder knowledge of endothelial cell pathophysiology. The following review will discuss characteristic features of endothelial cells as well as in-vitro culture techniques. Focussing on endothelial cell interactions with leukocytes and with the extracellular matrix, recent developments in this area of research will be presented.

Herpes gestationis: ultrastructural identification of the extracellular antigenic sites in diseased skin using immunogold techniques

Using a direct immunogold technique, we studied the level of immunological events in the skin basement membrane in a patient with herpes gestationis during blister formation. Within the lamina lucida, IgG and C3 were localized beneath the basement membrane of basal keratinocytes, 30-40 nm above the lamina densa. In many areas of blister formation sub-basal dense plates, but probably also the upper parts of the hemidesmosomes were separated from the roof of the blister. In the perilesional lamina lucida and in the blister, IgG and C3 containing amorphous grains, most probably immunocomplex aggregates, were detected. They covered the basement membrane of keratinocytes and left free a 30-40 nm band above the lamina densa. Our study indicates that in herpes gestationis the cleavage, accompanied by IgG, C3 and immunocomplex deposition, occurs at the level of the sub-basal dense plate. However, cleavage through upper hemidesmosomal structures can occur in parallel. These data further support the involvement of hemidesmosomes in the pathogenesis of the disease and therefore in its relationship to bullous pemphigoid.