[Potassium hydroxide 5 % solution in actinic keratosis : A novel therapeutic approach in the lesion-directed treatment]

Hintergrund

Die aktinische Keratose (AK) ist ein epitheliales Carcinoma in situ der Haut. Aufgrund des Risikos einer malignen Transformation besteht ein frühzeitiger Behandlungsbedarf. Gerade die initiale Therapie sollte neben der Wirksamkeit eine gute Verträglichkeit und Anwenderfreundlichkeit aufweisen. Kaliumhydroxid (KOH)-Lösung ist als keratolytische Behandlungsoption bei hyperkeratotischen Hauterkrankungen, wie z. B. Mollusca contagiosa, bereits etabliert.

Methodik

Wirksamkeit und Verträglichkeit von KOH-5 %-Lösung zur Behandlung der leichten bis moderaten AK wurden in einer prospektiven, einarmigen, multizentrischen Medizinproduktestudie (Treatment of AK with KOH [TAKKOH]) untersucht. Die KOH-Lösung wurde 2‑mal täglich über 14 Tage aufgetragen mit anschließender Behandlungspause von 14 Tagen (≙ 1 Behandlungszyklus) für maximal 3 Behandlungszyklen oder mindestens bis zum Behandlungserfolg. Das primäre Zielkriterium „Behandlungserfolg“ wurde als komplette Remission (CR) aller AK-Läsionen eines Patienten definiert. Sekundäre Zielkriterien beinhalteten die Beurteilung der partiellen Remission (PR), der Anzahl an AK-Läsionen in Remission, die Wirksamkeitsbeurteilung anhand von Schulnoten durch Prüfärzte und Patienten sowie sicherheitsrelevante Endpunkte.

Ergebnisse

Es wurden 73 Patienten in die Studie eingeschlossen. Eine CR wurde von 54,9 % der Patienten erreicht, eine PR von 64,8 % bei einer Reduktion der Gesamtzahl an Läsionen um 69,9 %. Bei 46,6 % der Patienten wurden unerwünschte Ereignisse beobachtet. Diese überwiegend unerwünschten Wirkungen (82,6 %) stellten ausnahmslos transiente und milde lokale Hautreaktionen dar.

Schlussfolgerung

Die Studie liefert Hinweise auf die Wirksamkeit und Sicherheit von KOH-5 %-Lösung zur läsionsgerichteten topischen Therapie der AK.

Topical hydrocortisone 17-butyrate 21-propionate in the treatment of inflammatory skin diseases: pharmacological data, clinical efficacy, safety and calculation of the therapeutic index

Hydrocortisone 17-butyrate 21-propionate (hydrocortisone buteprate, HBP) is a medium potent, non-halogenated double-ester of hydrocortisone with a favorable benefit/risk ratio for the treatment of inflammatory skin disorders. HBP is available as a 0.1% cream or ointment formulation. Good results were obtained with a once-daily topical treatment. HBP is characterized by a strong topical anti-inflammatory activity and weak systemic action. It is considered to have potency comparable to that of betamethasone 17-valerate (BV), but its systemic effects are less pronounced. HBP was shown to have a good efficacy in the treatment of various oozing and lichenified eczematous skin diseases including atopic dermatitis (AD) and in the treatment of psoriasis vulgaris. Even in very young children, HBP proved successful as an effective and safe drug. A therapeutic index of 2.0 can be attributed to this glucocorticoid. In this respect, there is no difference between topical HBP and other topical glucocorticoids with increased benefit/risk ratio, e.g. prednicarbate (PC), methylprednisolone aceponate (MPA) and mometasone furoate (MM).

Gianotti-Crosti-Syndrom nach Impfung

Four infants developed Gianotti-Crosti syndrome (GCS) 6 to 8 days after immunization. Subsequent booster vaccinations were well tolerated. Different types of viral infections have been implicated in the pathogenesis of GCS. The occurrence of GCS after vaccination is rarely described in literature. We suggest that vaccination may be a relevant etiologic factor and should be considered in infants presenting with GCS.

Onychomycosis

The guideline on onychomycosis, as passed by the responsible German medical societies, is presented in the present study.

Tinea capitis: ringworm of the scalp

The guideline tinea capitis, as passed by three German medical societies, is presented in the present study.

Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis

BACKGROUND

A reduction of symptoms of atopic dermatitis (AD) in small infants by the administration of Lactobacillus rhamnosus has been reported in a few studies. One study with older children and adolescents failed to show any effect.

OBJECTIVES

We conducted a prospective study to reassess the efficacy of orally administered L. rhamnosus strain GG (LGG) in infants with AD.

METHODS

In a randomized, double-blind, placebo-controlled study, 54 infants aged 1-55 months with moderate to severe AD were randomized to daily 10 x 10(9) colony-forming units of LGG or to placebo during an 8-week intervention phase. Emollients, class I-II topical corticosteroids and antihistamines were permitted.

RESULTS

The treatment with LGG was well tolerated. At the end of treatment there were no significant differences between the groups with respect to clinical symptoms (SCORAD, pruritus, sleep loss), the use of topical corticosteroids and antihistamines, immunological parameters, or health-related quality of life of the parents.

CONCLUSIONS

Our results could not confirm LGG as an effective treatment of AD in infancy.

Antiseptic efficacy of a low-dosed topical triclosan/chlorhexidine combination therapy in atopic dermatitis

The topical application of triclosan as an antistaphylogenic antiseptic has proven beneficial in atopic dermatitis. Especially in lipophilic carriers, triclosan is applied in a concentration range between 1 and 5%, usually 2%. However, as a phenol, triclosan is not undisputed and may result in local exacerbation of the disease by eliciting irritative secondary reactions, especially in high concentrations. Chlorhexidine is also an antiseptic which is very effective against Staphylococci and nearly equivalent to triclosan with respect to its antistaphylogenic efficacy. In light of this, the combination of the two active substances in very low concentrations offers a possible option of using the additive effects of the two substances to minimize the risk of side effects. In a uniform W/O emulsion carrier alternatively containing 0.3% triclosan combined with 0.34% chlorhexidine dihydrochloride or 2.0% triclosan, the antibacterial efficacy against Gram-positive skin bacteria could be proven in a preclinical comparison with a reference preparation containing fusidic acid. Subsequently, the pathogen-reducing effect was examined in a clinical study of the influence on clinical severity in patients with atopic dermatitis. Both investigation methods showed that the two test preparations were slightly inferior to the reference preparation, but result in the same degree of pathogen reduction and improvement in the severity of existing atopic dermatitis in direct comparison. The overall results support the conclusion that a combination of triclosan and chlorhexidine in low concentrations as well as the existing antiseptic standard of a 2% triclosan preparation are suitable for pathogen reduction and thus for improving atopic dermatitis.

Efficacy and functionality of silver-coated textiles in patients with atopic eczema

BACKGROUND

Microbial skin colonization with Staphylococcus aureus is known to play an important role in atopic eczema (AE). Recently, an antibacterial effect of silver-coated textiles on S. aureus colonization has been demonstrated.

OBJECTIVES

To investigate clinical efficacy and functionality of silver-coated textiles in AE, a multicentre, double-blind, placebo-controlled trial was conducted.

PATIENTS/METHODS

From November 2001 to August 2002, 68 consecutive outpatients clinically diagnosed with generalized AE were included in the study. Inclusion criteria were the clinical diagnosis of AE with a moderate severity as measured by the scoring of atopic dermatitis (SCORAD) index with at least 20. Patients were instructed to wear either silver-coated (verum, 35 patients + 2 dropouts) or cotton garments (placebo, 22 patients + 9 dropouts) directly on the skin for 2 weeks. Only basic skin care and ongoing therapy with topical steroids or oral antihistamines was permitted. Clinical severity was assessed using the 'SCORAD' before, during and at the end of study. Quality of life (QOL), wearing comfort (WC) and functionality (FU) of study clothes were measured in parallel. Patients documented their subjective and objective symptoms daily.

RESULTS

In the verum group, eczema improved significantly after 1 week with further enhancement until the end of study (P = 0.03 and P < 0.001). Silver-coated textiles were comparable to cotton in WC and FU. Pruritus and self-assigned skin condition improved significantly more than with placebo (P < 0.001 and P = 0.003).

CONCLUSIONS

In conclusion, silver-coated textiles are able to improve objective and subjective symptoms of AE significantly within 2 weeks, showing a good wearing comfort and functionality comparable to cotton.

Successful UVA1 phototherapy in a patient with scleredema adultorum

Scleredema adultorum is a rare connective tissue disorder of unknown cause. Both bath-PUVA and cream-PUVA therapy were reported to be effective. We describe a patient with scleredema adultorum who showed a striking clinical improvement with a medium-dose UVA1 phototherapy (single dose, 50 J/cm(2); 35 treatments).

Disseminated granuloma annulare--treatment with fumaric acid esters

BACKGROUND

The therapy of disseminated granuloma annulare has often limited success. Treatment of granuloma annulare with fumaric acid esters (FAE) has recently been reported to be effective in 2 patients.

OBJECTIVES

To assess the efficacy of a systemic therapy with FAE in consecutive patients with disseminated granuloma annulare.

METHODS

Eight patients with disseminated granuloma annulare were treated with FAE in tablet form according to the standard therapy regimen used in psoriasis. The colour and the elevation of the skin lesions were assessed by a visual analogue scale before and after therapy.

RESULTS

Systemic therapy with FAE induced a significant clinical improvement in elevation and colour of skin lesions, with remission in 3 and partial remission in 4 patients. One patient remained unchanged. Side-effects associated with the therapy were seen in 6 patients.

CONCLUSIONS

Systemic therapy with FAE can be effective in patients suffering from disseminated forms of granuloma annulare, but side-effects of FAE have to be taken into consideration.

UVA1 phototherapy for disseminated granuloma annulare

BACKGROUND/PURPOSE

Disseminated granuloma annulare is a benign granulomatous skin disease of unknown etiology. Recently, UVA1 (340-400 nm) phototherapy has been found effective in a small series of four patients. The purpose of this two-center study was to determine the rate and duration of clinical response to UVA1 phototherapy in a larger cohort of 20 patients with disseminated granuloma annulare.

METHODS

Twenty patients with long-standing, stable disease (median 42 months, 95% CI 23-105) underwent UVA1 phototherapy. Sixteen patients were treated with a high-dose regimen (median single dose 110 J/cm2, 95% CI 103-121) and four patients with a medium-dose regimen (median single dose 50 J/cm2, CI 50-50). The clinical response was graded on a 5-point scale [0 = none, 1 = poor, 2 = moderate, 3 = substantial, 4 = (near) complete]. After cessation of therapy, patients with a clinical score of 3 or 4 were followed up to evaluate the duration of clinical improvement.

RESULTS

At the end of treatment, five patients each had substantial improvement or (near) complete clearance. Another five patients had a moderate response, three patients were considered as poor responders and two patients as treatment failures. Out of the 10 patients with good or excellent response nine were available for follow up. Of these, two patients were still clear after 3 and 6 months, and seven patients relapsed after a median of 3 months (95% CI 1.68-6.46).

CONCLUSIONS

UVA1 phototherapy provided good or excellent results in half of our 20 patients with disseminated granuloma annulare. In the majority of patients with a satisfactory response, however, discontinuation of treatment was followed by early recurrence of disease.

The effects of foot disease on quality of life: results of the Achilles Project

BACKGROUND

Foot diseases have a high prevalence in the general population, but their impact on quality of life has not been assessed in large-scale studies. The Achilles Project surveyed foot disease in patients visiting their primary care physician or dermatologist.

METHODS

A total of 43 593 patients were asked about the impact of their condition on their quality of life: pain, discomfort in walking, limitations in daily activities, and embarrassment.

RESULTS

Overall, 52.5% of patients had some aspect of their quality of life affected by their foot disease. More specifically, 30.7% of patients experienced pain, 40.3% had discomfort in walking, 19.6% had their daily activities limited, and 27.3% were embarrassed. The survey indicated a larger impact of foot disease on the quality of life of women vs. men in all categories, except for daily activities. Similarly, the elderly (> or = 65 years) were more affected by their foot disease, although they suffered no more embarrassment than other age groups. Participation in sports seemed to lower the proportion of patients who had their quality of life adversely affected. Non-fungal foot diseases, particularly ulcer and gangrene, are more likely to cause pain, discomfort in walking and limit daily activities, than fungal diseases.

CONCLUSIONS

In general, non-fungal foot diseases caused pain, discomfort in walking and limitations in daily activities in more patients than fungal foot diseases, but a higher proportion of patients with fungal foot diseases were embarrassed by their condition than patients with non-fungal foot diseases. The study found that the impact of foot disease on quality of life may be greater than previously suggested. Given that effective treatments are available, routine examination of patients' feet by dermatologists and primary care physicians may help to reduce the burden of these foot conditions.

High prevalence of foot diseases in Europe: results of the Achilles Project

OBJECTIVE

To provide an insight into the prevalence of foot disease in Europe, and to include an assessment of the prevalence of predisposing factors and their correlation with foot disease.

DESIGN

Large population-based survey conducted in 16 European countries.

SETTING

The project consisted of two parts (study I and study II), in which all patients presenting to general practitioners and dermatologists over a defined time period were invited to participate. Patients. In study I, 70,497 patients presenting to dermatologists or general practitioners were recruited, and in study II 19,588 patients presenting to dermatologists were recruited.

MAIN OUTCOME MEASURE

The feet of all participants were examined for signs of foot disease. The assessors also recorded relevant details such as the age and sex of patients, and the presence of predisposing factors for foot disease. In addition, patients in study II were offered a free mycological examination of the toenails and skin on the feet.

RESULTS

In study I, 57.0% of patients had at least one foot disease. In study II, 61.3% had at least one foot disease. The proportions of patients with fungal foot disease and non-fungal foot disease in study I were 34.9% and 38.4%, respectively, and in study II were 40.6% and 41.7%, respectively. Orthopedic conditions and metatarsal corns were the most frequently reported non-fungal foot diseases, and onychomycosis and tinea pedis were the most frequently observed fungal infections.

CONCLUSIONS

This large-scale survey suggests that the prevalence of fungal and non-fungal foot disease is higher than previously estimated.

[Atopic eczema. Spectrum of provocation factors and possibilities for their effective reduction and elimination]

Atopic eczema forms together with extrinsic bronchial asthma and allergic rhinoconjunctivitis the classical atopic triad. Genetic predisposition is the crucial pathogenetic factor. The combination of genetic disposition and provocation factors leads to the clinical appearance of skin disease. In addition to therapy adjusted to the stage of the disease, modern management should include a search for relevant trigger factors and then their avoidance to reduce or even prevent flares of the disease. The spectrum of provocation factors ranges from simple measures such as appropriate clothing up to specific measures such as indoor aeroallergen reduction measures.

[Tinea capitis et corporis due to Microsporum canis in an immunocompromised female adults patient]

Tinea capitis as well as tinea corporis in adults may occur under conditions of immunosuppression. If suspected clinically, direct microscopy and examination by culture is indispensable. Therapeutic intervention should start without delay. A proven fungal infection of scalp hairs warrants immediate initiation of systemic treatment. Hereby prevention of disfiguring hair loss, permanent formation of scar tissue, spread of fungal organisms to other cutaneous regions as well as infection of other persons is possible.

Improved risk-benefit ratio for topical triamcinolone acetonide in TransfersomeR in comparison with equipotent cream and ointment: a randomized controlled trial

BACKGROUND

Transfersome is a drug delivery technology based on highly deformable, ultraflexible lipid vesicles which penetrate the skin when applied non-occlusively.

OBJECTIVES

To assess the advantages of this carrier-based formulation in humans, the efficacy and the atrophogenic potential of triamcinolone acetonide (TAC) in Transfersome was compared with commercially available TAC-containing cream and ointment.

METHODS

Healthy volunteers were enrolled in double-blind, placebo-controlled clinical trials with random study medication assignment to the test areas.

RESULTS

A 10-fold lower dose of TAC in Transfersome(R) (2.5 micro g cm-2) was bioequivalent to 25 micro g cm-2 TAC in conventional formulations as measured by erythema suppression (cream: P = 0.01, ointment: P < 0.001). A skin blanching assay revealed different kinetics of the formulations, with a delayed onset of action of the Transfersome and ointment preparations. Ultrasonic measurements revealed a significantly reduced atrophogenic potential. There was a 12.1% reduction in skin thickness given by TAC in Transfersome compared with a 21.1% reduction given by a bioequivalent dose in TAC cream after a 6-week treatment period (P = 0.007).

CONCLUSIONS

Transfersome may significantly improve the risk-benefit ratio of topically applied glucocorticosteroids.

High prevalence of superantigens associated with the egc locus in Staphylococcus aureus isolates from patients with atopic eczema

The present study was aimed at identifying a possible correlation between disease severity and colonization with superantigen-producing Staphylococcus aureus strains in patients with atopic eczema. To this end, Staphylococcus aureus strains from 91 patients with atopic eczema were screened for various staphylococcal superantigens such as SEA, SEB, SEC, SED, TSST1, the recently described enterotoxin gene cluster egc (which encodes the enterotoxins SEG, SEI, SEK, SEM, and SEO), and the see, seh, and sej loci. Swabs were taken from seven different sites in each patient. The rate of colonization with Staphylococcus aureus was 87.9%. Of those patients colonized, 35% were colonized with more than one different strain. Of the 120 genetically different strains investigated, the egc locus was found in 48.3% and the sej locus in 7.5%. The see and seh loci were not found in any strain. The presence of the classical superantigens SEA-SED or TSST1 was found in 38.3%. Overall, 71.3% of the Staphylococcus aureus-positive patients harbored at least one superantigen-producing strain on their skin. There was no difference in the prevalence of superantigens between atopic eczema patients and healthy volunteers. Moreover, there was no difference in the extent of disease expression between patients colonized by superantigen-positive Staphylococcus aureus strains and those with superantigen-negative strains as measured by the SCORAD system. However, patients colonized with Staphylococcus aureus had a significantly higher SCORAD score than those not colonized.

[Palmoplantar vesicular lesions in childhood]

BACKGROUND AND OBJECTIVE

Palmoplantar vesicles in children have various underlying causes, requiring different therapies. We evaluated the most common underlying diseases and determined simple criteria for differentiation.

PATIENTS/METHODS

Within a two years period all children up to 14 years of age who presented with acral vesicles were included in this study.

RESULTS

The most common causes of acral vesicles in a group of 32 patients, were dyshidrotic eczema with (n=11) or without atopic diathesis (n=11) and scabies (n=7). Rarely, the cause of vesicular lesion was tinea (n=2) or infantile acropustulosis (n=1). While dyshidrotic eczema was a disease of late childhood, palmoplantar lesions caused by scabies developed in younger children up to the age of 4 years. Scabies in contrast to infantile acropustulosis tend to present with more generalized lesions, not being restricted to acral location. Dyshidrotic eczema revealed lesions bilaterally and in case of atopy, additional body areas were involved. Unilateral presentation was a clue for tinea.

CONCLUSIONS

Acral vesicles in childhood can be diagnostically discriminated by the age of the patient and the distribution of the lesions.

[Pediatric dermatotherapy]

Dermatological therapy of children differs considerably from treatment of adults and poses a special challenge. Dermatological diseases often form idiosyncratic entities with a prognosis different from adults and must be treated appropriately. Consideration should also be given to the fact that children occasionally experience adverse reactions to drugs, which are not observed in adults. A selection of dermatological diseases and typical drug reactions are presented to illustrate the special features and differences between pediatric dermatotherapy and treatment of adults.

[Tinea capitis. Therapeutic options in the post-griseofulvin era]

Tinea capitis is the most common dermatophyte infection during childhood. In Germany, only griseofulvin is approved for therapy by regulatory agencies. In recent years, several newer antifungal agents such as itraconazole, fluconazole and terbinafine have broadened the therapeutic armamentarium and are used for the treatment of childhood tinea capitis. Itraconazole and terbinafine seem to be equally or more effective in treatment of tinea capitis within a shorter period of time than griseofulvin. Fluconazole is probably also effective for this indication, although supporting data is limited. Encountered side effects as well as interactions with other drugs appear to be well within acceptable limits for all three drugs. In conclusion, systemic therapy of scalp ringworm with itraconazole and terbinafine, as well as perhaps fluconazole, seems to be an equivalent or a superior therapeutic approach as compared to the use of griseofulvin. For the future, regulatory approval for the use of these newer antifungal agents in tinea capitis of childhood is recommended.

UV-induced skin changes due to regular use of commercial sunbeds

BACKGROUND/AIM

Increased pigmentation and thickening of the epidermis are the most important photoprotective skin reactions induced by ultraviolet (UV) radiation. The present study was designed to find out what changes are induced by regular use of commercial sunbeds twice weekly over a period of 6 weeks.

METHODS

The parameters analysed were skin pigmentation measured by chromametry, minimal erythema dose (MED) as a parameter of light sensitivity, epidermal thickening as determined by histology, induction of keratinocyte apoptosis as determined by TUNEL staining and antioxidant metabolism as measured by changes of cis- and trans-urocanic acid (UCA) content of the skin.

RESULTS

As expected, chromametry confirmed the clinically obvious increased skin pigmentation. However, no increase in MED was observed. In addition, neither epidermal thickening nor sunburn cells were seen. Significant detectable changes in proportion of the UCA isomer content of the UV-exposed skin were seen. The total UCA and cis-UCA content increased significantly between nearly all points of measurement. The amount of trans-UCA first decreased, then increased significantly between the different time points.

CONCLUSION

Our data indicate that sunbed-induced tanning is non-protective, which has to be addressed for persons looking for this effect before planning a stay in a sunny climate. However, sunbed-induced tanning may influence immunological reactions.

[Keratosis lichenoides chronica. Bath PUVA therapy]

We describe the case of a 51-year-old male patient with characteristic lesions of keratosis lichenoides chronica confined to the back of his hands and feet. The lichenoid papules, linear hyperkeratotic ridges and erythematosquamous plaques appeared first in early childhood and recurred after a short episode of spontaneous remission. They didn't respond to various topical treatment modalities over the years. After a local PUVA therapy all lesions disappeared with no recurrence for over two years now. Our case report indicates a new promising indication for bath-PUVA-therapy.

Dihydroxyacetone in a new formulation--a powerful therapeutic option in vitiligo

BACKGROUND

Most treatment protocols for vitiligo require a long treatment duration and usually do not result in complete repigmentation. Therefore, cosmetically acceptable and easily to handle alternatives are warranted.

OBJECTIVE

To evaluate the properties of dihydroxyacetone (DHA) in a new formulation for the treatment of vitiligo on exposed areas.

METHODS

We treated 10 patients suffering from vitiligo affecting the face and/or hands with a newly introduced, commercially available self-bronzing cream containing DHA 5%. DHA was applied every second day.

RESULTS

The characteristic pigmentation showed very satisfactory cosmetic results in 8 out of 10 patients after 2 weeks of treatment.

CONCLUSION

The new DHA formulation is a practical and well-accepted treatment modality.

Invasion of human keratinocytes by Staphylococcus aureus and intracellular bacterial persistence represent haemolysin-independent virulence mechanisms that are followed by features of necrotic and apoptotic keratinocyte cell death

BACKGROUND

Colonization of human skin by Staphylococcus aureus is a characteristic feature of several inflammatory skin diseases, which is often followed by tissue invasion and severe cell damage. A crucial role has been attributed to staphylococcal haemolysins in the cytotoxicity to epidermal structures.

OBJECTIVES

To investigate haemolysin-independent virulence to human keratinocytes.

METHODS

The stable alpha-haemolysin, beta-haemolysin double-negative S. aureus mutant DU 5720 was compared with the fully virulent parent strain 8325-4 and with its isogenic fibronectin-binding protein A/B-negative variant DU 5883 in an invasion model.

RESULTS

This assay showed dose-dependent internalization of all the strains investigated by human HaCaT keratinocytes, with reduced internalization of DU 5883. Transmission electron microscopy revealed adhesion of staphylococci to cellular pilus-like extrusions, followed by the embedding of the bacteria in cellular grooves. Following attachment to the keratinocytes the staphylococci were engulfed into vesicles within the cytoplasm where some bacteria persisted for 24-48 h. Addition of cytochalasin D strongly reduced the bacterial uptake, suggesting an active keratinocyte process. Bacterial invasion was followed by severe keratinocyte cell damage showing the morphological changes of cytotoxic and, to a lesser extent, apoptotic cell death as determined by the trypan blue exclusion test and the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labelling assay. The highest levels of lethal cytotoxicity were observed in haemolysin-producing strains, whereas the induction of apoptosis seemed to depend on internalization.

CONCLUSIONS

Staphylococcal invasion of human keratinocytes represents a potent staphylococcal virulence factor, which, independently of alpha- and beta-haemolysins, leads to necrotic and apoptotic cell damage.

[Recurrent palmoplantar hidradenitis in childhood]

We describe five cases of recurrent palmoplantar hidradenitis in children. The pathogenesis of this highly characteristic disease presenting with painful erythematous papules and nodules involving palms of the hands, soles of the feet, or both is not clear at the moment. One possible mechanism is a temporal relationship between exposure to dampness and cold, which also applied in four of these children. The self-limited disease tends to reappear. After thoroughly informing the children and their parents on avoiding provoking factors, all children experienced freedom from the disease during a 12-month follow-up.

Internet advice in dermatology and allergy: 1 year analysis of telerequests and answers

The purpose of this study was to analyze the content and objectives of questions asked by internet users who accessed the homepage of the Department of Dermatology and Allergy Biederstein at the Technical University of Munich. Users were offered the opportunity to ask free questions on the Web site. The results of lay and medical individuals seeking advice were collected over a 12 month period and the answers given were reviewed. We received inquiries from 279 laypersons and 31 physicians. The majority of questions (53.8%) asked by non-medical users dealt with dermatology-related problems. Inquiries related to hair (13.3%) and acne or rosacea (11.3%) were most common. 46.2% of e-mail requests were allergy-related. Most of the interest focused on food allergy and adverse food reactions (22.5%) or hay fever and perennial rhinoconjunctivitis (19.4%). Previous consultation of a physician was reported in 40.9%. 13.6% had consulted an allergist or dermatologist. The majority of questions asked by physicians concerned allergy-related topics (64.6%). Most questions were answered by a short letter giving advice and encouraging the non-medical user to visit a dermatologist and/or allergist (72.4%). In 27.6% we felt that the inquiries were answered completely.

[Confluent and reticulate papillomatosis. Successful therapy with azithromycin]

Confluent and reticulated papillomatosis is a fairly rare dermatosis of still unknown origin affecting mostly female young adults. The lesions are mainly localized in the midline of the trunk. Systemic treatment is the treatment of choice because the disease is resistant to topical therapy and recurrences are often seen. In recent publications retinoids and minocycline have been reported as the favourite therapeutic approaches. We successfully treated a 19-year-old-girl with azithromycin resulting in a complete healing of all skin lesions. The patient has been free of disease for five months. Based on our own case and data in literature, azithromycin is an effective, reasonable and safe therapeutic alternative.

Transonychial water loss in healthy and diseased nails

The objective of this study was to determine the transonychial water loss (TOWL) in both healthy and affected nails in different diseases and to compare it with the transepidermal water loss (TEWL). TOWL was measured by a new evaporimetric method: Plasticine was used to fix the protection cover of the evaporimeter probe to the nails. The TOWL behaved contrary to the TEWL. Affected nails in patients with atopic eczema (p <0.01), psoriasis (p<0.05) and onychomycosis (p<0.001) showed a significantly lower TOWL than did nails of healthy test subjects. The decrease in TOWL in diseased nails in comparison to healthy nails could be due to the formation of a stratum granulosum in atopic, psoriatic or fungus-affected nails, as this layer is normally absent in healthy nails.

[What's new in diagnosis and therapy of dermatomycoses in childhood]

Mycotic infections in childhood are caused in the majority of cases by dermatophytes. If an oral treatment is indicated, itraconazole and terbinafine are superior to griseofulvin and are nowadays drugs of first choice although an official registration for treatment of children is missing in Germany. Yeasts in infections of childhood are the causative organisms in Pityrosporum-folliculitis and act as an important co-factor in diaper dermatitis.