Feasibility of Flat Panel Detector CT in Perfusion Assessment of Brain Arteriovenous Malformations: Initial Clinical Experience.

The different results from flat panel detector CT in various pathologies have provoked some discussion. Our aim was to assess the role of flat panel detector CT in brain arteriovenous malformations, which has not yet been assessed. Five patients with brain arteriovenous malformations were studied with flat panel detector CT, DSC-MR imaging, and vessel-encoded pseudocontinuous arterial spin-labeling. In glomerular brain arteriovenous malformations, perfusion was highest next to the brain arteriovenous malformation with decreasing values with increasing distance from the lesion. An inverse tendency was observed in the proliferative brain arteriovenous malformation. Flat panel detector CT, originally thought to measure blood volume, correlated more closely with arterial spin-labeling-CBF and DSC-CBF than with DSC-CBV. We conclude that flat panel detector CT perfusion depends on the time point chosen for data collection, which is triggered too early in these patients (ie, when contrast agent appears in the superior sagittal sinus after rapid shunting through the brain arteriovenous malformation). This finding, in combination with high data variability, makes flat panel detector CT inappropriate for perfusion assessment in brain arteriovenous malformations.

Small global effect on terrestrial net primary production due to increased fossil fuel aerosol emissions from East Asia since the turn of the century.

The global terrestrial carbon sink has increased since the start of this century at a time of growing carbon emissions from fossil fuel burning. Here we test the hypothesis that increases in atmospheric aerosols from fossil fuel burning enhanced the diffuse light fraction and the efficiency of plant carbon uptake. Using a combination of models, we estimate that at global scale changes in light regimes from fossil fuel aerosol emissions had only a small negative effect on the increase in terrestrial net primary production over the period 1998-2010. Hereby, the substantial increases in fossil fuel aerosol emissions and plant carbon uptake over East Asia were effectively canceled by opposing trends across Europe and North America. This suggests that if the recent increase in the land carbon sink would be causally linked to fossil fuel emissions, it is unlikely via the effect of aerosols but due to other factors such as nitrogen deposition or nitrogen-carbon interactions.

Drought sensitivity of Amazonian carbon balance revealed by atmospheric measurements.

Feedbacks between land carbon pools and climate provide one of the largest sources of uncertainty in our predictions of global climate. Estimates of the sensitivity of the terrestrial carbon budget to climate anomalies in the tropics and the identification of the mechanisms responsible for feedback effects remain uncertain. The Amazon basin stores a vast amount of carbon, and has experienced increasingly higher temperatures and more frequent floods and droughts over the past two decades. Here we report seasonal and annual carbon balances across the Amazon basin, based on carbon dioxide and carbon monoxide measurements for the anomalously dry and wet years 2010 and 2011, respectively. We find that the Amazon basin lost 0.48 ± 0.18 petagrams of carbon per year (Pg C yr(-1)) during the dry year but was carbon neutral (0.06 ± 0.1 Pg C yr(-1)) during the wet year. Taking into account carbon losses from fire by using carbon monoxide measurements, we derived the basin net biome exchange (that is, the carbon flux between the non-burned forest and the atmosphere) revealing that during the dry year, vegetation was carbon neutral. During the wet year, vegetation was a net carbon sink of 0.25 ± 0.14 Pg C yr(-1), which is roughly consistent with the mean long-term intact-forest biomass sink of 0.39 ± 0.10 Pg C yr(-1) previously estimated from forest censuses. Observations from Amazonian forest plots suggest the suppression of photosynthesis during drought as the primary cause for the 2010 sink neutralization. Overall, our results suggest that moisture has an important role in determining the Amazonian carbon balance. If the recent trend of increasing precipitation extremes persists, the Amazon may become an increasing carbon source as a result of both emissions from fires and the suppression of net biome exchange by drought.

Fast high-resolution brain imaging with balanced SSFP: Interpretation of quantitative magnetization transfer towards simple MTR.

Magnetization transfer (MT) reflects the exchange of magnetization between protons bound to macromolecules, such as lipids and proteins, and protons in free liquid, and thus might be an early marker for subtle and undetermined pathologic changes in tissue. Detailed analysis of the entire MT phenomenon, however, commonly requires extensive data acquisition and scanning time, and hence is only of limited clinical interest. Therefore, in practice, magnetization transfer effects are commonly confined into a simple ratio measure, the so-called magnetization transfer ratio (MTR), calculated from a MT-weighted and a non-MT-weighted image. However, subtle physiologic and pathologic changes in tissue, invaluable for specific diagnostic imaging, may be lost since MTR-values depend not only on quantitative magnetization transfer (qMT) parameters but also on sequence parameters and relaxation properties. In order to evaluate and assess the diagnostic specificity of MTR versus qMT, high-resolution whole brain MT data was collected from twelve healthy volunteers using balanced steady-state free precession (bSSFP). In contrast to common MT imaging based on spoiled gradient echo (SPGR) sequences, whole brain qMT imaging can be performed with MT-sensitized bSSFP within a clinically feasible acquisition time. Hence, MT-sensitized bSSFP provides access to both MTR and qMT parameters within a clinical setting. The reliability and possible diagnostic value of MTR are analyzed for twelve white matter (WM) and eleven gray matter (GM) structures of the normal appearing brain. Strong correlations were found within and between longitudinal and transverse relaxation times (T1, T2) and MT parameters (ratio between macromolecular and water protons, F, and magnetization exchange rate, kf), whereas weaker correlations were observed between MTR-values and relaxation times or MT parameters. Structures with highly similar MTR-values, such as the crus cerebri and the anterior commissure in the WM, or the pallidum and the amygdala in the GM, however, were also found that showed significant differences in most quantitative parameters. This observation was confirmed from simulations revealing that the overall effect on MTR from an increase (decrease) in relaxation times may be counterbalanced with a decrease (increase) in MT parameters. These findings corroborate the expectation that qMT is superior to MTR imaging, especially for the evaluation and assessment of pathologic or physiological changes in healthy and pathologic brain tissue.

Intrascanner and interscanner variability of magnetization transfer-sensitized balanced steady-state free precession imaging.

Recently, a new and fast three-dimensional imaging technique for magnetization transfer ratio (MTR) imaging has been proposed based on a balanced steady-state free precession protocol with modified radiofrequency pulses. In this study, optimal balanced steady-state free precession MTR protocol parameters were derived for maximum stability and reproducibility. Variability between scans was assessed within white and gray matter for nine healthy volunteers using two different 1.5 T clinical systems at six different sites. Intrascanner and interscanner MTR measurements were well reproducible (coefficient of variation: c(v) < 0.012 and c(v) < 0.015, respectively) and results indicate a high stability across sites (c(v) < 0.017) for optimal flip angle settings. This study demonstrates that balanced steady-state free precession MTR not only benefits from short acquisition time and high signal-to-noise ratio but also offers excellent reproducibility and low variability, and it is thus proposed for clinical MTR scans at individual sites as well as for multicenter studies.

Characterization of normal appearing brain structures using high-resolution quantitative magnetization transfer steady-state free precession imaging.

Compared to standard spoiled gradient echo (SPGR)-methods, balanced steady-state free precession (bSSFP) provides quantitative magnetization transfer (qMT) images with increased resolution and high signal-to-noise ratio (SNR) in clinically feasible acquisition times. The aim of this study was to acquire 3D high-resolution qMT-data to create standardized qMT-values of many single brain structures that might serve as a baseline for the future characterization of pathologies of the brain. QMT parameters, such as the fractional pool size (F), exchange rate (kf) and relaxation times of the free pool (T1, T2) were assessed in a total of 12 white matter (WM) and 11 grey matter (GM) structures in 12 healthy volunteers with MT-sensitized bSSFP. Our results were compared with qMT-data from previous studies obtained with SPGR-methods using MT-sensitizing preparation pulses with significantly lower resolution. In general, qMT-values were in good accordance with prior studies. As expected, higher F and kf and lower relaxation times were observed in WM as compared to GM structures. However, many significant differences were observed within WM and GM regions and also between different regions of the same structure like in the internal capsule where the posterior limb showed significant higher kf than the anterior limb. Significant differences for all parameters were observed between subjects. In contrast to previous studies, bSSFP allowed assessment of even small brain structures due to its high resolution. The observed differences from previous studies can partly be explained by the reduced partial volume effects. MT-sensitized bSSFP is an ideal candidate for qMT-analysis in the clinical routine as it provides high-resolution 3D qMT-data of even small brain structures in clinically feasible acquisition times. The present qMT-data can serve as a reference for the characterization of cerebral diseases.

Quantitative magnetization transfer imaging using balanced SSFP.

It is generally accepted that signal formation in balanced steady-state free precession (bSSFP) is a simple function of relaxation times and flip angle only. This can be confirmed for fluids, but for more complex substances, magnetization transfer (MT) can lead to a considerable loss of steady-state signal. Thus, especially in tissues, the analytical description of bSSFP requires a revision to fully take observed effects into account. In the first part of this work, an extended bSSFP signal equation is derived based on a binary spin-bath model. Based on this new model of bSSFP signal formation, quantitative MT parameters such as the fractional pool size, corresponding magnetization exchange rates, and relaxation times can be explored. In the second part of this work, model parameters are derived in normal appearing human brain. Factors that may influence the quality of the model, such as B(1) field inhomogeneities or off-resonances, are discussed. Overall, good correspondence between parameters derived from two-pool bSSFP and common quantitative MT models is observed. Short repetition times in combination with high signal-to-noise ratios make bSSFP an ideal candidate for the acquisition of high resolution isotropic quantitative MT maps, as for the human brain, within clinically feasible acquisition times.

[Heifer breeding farms as a source for spreading the BVD virus?]. / Aufzuchtbetriebe als Verbreitungsquelle des BVD-Virus?

It is well known that, in Switzerland, communal grazing of livestock on alpine pastures plays an important role in the spread of BVD virus. Analogously, we might expect that the communal raising on farms specialising in raising heifers of animals born on different farms would also favour the spread of BVDV. This study investigated whether a persistently infected (PI) breeding heifer kept on this type of farm over a period of 26 months would put the other animals at risk of being infected. The PI-animal was in contact with 75 heifers (here defined as contact animals) on this farm. Thirty-two of the contact animals that were probably pregnant (animals at risk of giving birth to a PI-calf) were moved to 8 different breeding farms (here defined as farms at risk). On these 8 farms, 246 calves were found to be at risk of being infected with BVDV. We examined 78 calves and investigated whether the move of the pregnant animals from their original farm had permitted the virus to spread to these 8 other farms. The contact animals had a seroprevalence of 92% and the animals at risk a seroprevalence of 100%. Only one PI-animal was found on the farms at risk. This BVD infection, however, occurred independently of the PI-breeding animal. Seropositive calves were found only on 2 farms. This study did not provide any proof for a spread of BVDV with the PI-breeding animal as a source; likewise, no persistent infection was proven to exist on the farms at risk. This result is likely to be representative for the endemic situation of BVD in Switzerland. Thus, PI-animals present on heifer raising farms infect calves well before servicing. Hence, no new PI-animals are generated, and the infection becomes self-limiting. When we reconstructed the animal movements between the farms and determined the animals to be examined with the aid of the Swiss national animal traffic database (TVD) we found the data of 37% of the heifers to be incomplete and failed to successfully establish the whereabouts of 3 animals.

How do dermatological vehicles influence the horny layer?

Emulsifying agents in aqueous solution lead to dehydration of the horny layer of the epidermis and damage to the barrier. This is only partly true if emulsifying agents are constituents of emulsions. Water-in-oil (W/O) emulsions cause an improvement in the hydration of the horny layer and barrier function. In the case of an additional effect of wash solutions, a partial or complete abolition of the drying out and barrier-damaging effect of the wash solution results. Oil-in-water (O/W) emulsions without glycerol have no effect on the moisture of the horny layer or indeed increase it, but they lead to considerable damage to the barrier and irritation. In wash tests, they do not induce any protective effect. With micro-emulsions this is still more the case and, moreover, they can also lead to exsiccation. As a result of the addition of glycerol, the barrier-damaging effect can be abolished. Also in stress tests with wash solutions, the damage to the horny layer is reduced by glycerol-containing O/W emulsions. Whereas the penetration-promoting effect of O/W emulsions without glycerol is best, only W/O emulsions or glycerol-containing O/W emulsions are suitable for atopic dermatitis. A hydrating effect on the stratum corneum was also found in a propylene glycol ointment.

O/W emulsions compromise the stratum corneum barrier and improve drug penetration.

BACKGROUND: W/O emulsions improve the stratum corneum barrier, while microemulsions tend to compromise it. We, therefore, were interested to explore the effects of O/W emulsions on the stratum corneum barrier. METHODS: Aqueous Cream BP 2001, Clioquinol Cream BP 1999 without clioquinol, Nonionic Hydrophilic Cream DAB 2001 without glycerol, Hydrophilic Skin Emulsion Base NRF S. 25., point of time 2001, without glycerol, and Base Cream DAC were tested versus untreated controls in 29 healthy volunteers for 7 days. Outcome measures included transepidermal water loss (TEWL), skin redness (chromametry a*-value) and erythrocyte circulation in the subpapillary vessels (laser Doppler). Barrier compromise was subsequently explored by performing the hydrocortisone blanching test using Hydrocortisone Cream 0.5% NRF 11.36. (outcome measure: a*-value) in 15 subjects and the sodium lauryl sulfate (SLS) irritation test (outcome measures: TEWL, a*-value, laser Doppler) in 14 subjects. RESULTS: Pretreatment with the test emulsions produced increases in TEWL (statistically significant for all test emulsions), a*-value (statistically significant for Aqueous Cream BP 2001 and Base Cream DAC), and laser Doppler value (statistically significant for all emulsions except Base Cream DAC). Hydrocortisone penetration was statistically significantly increased with all test emulsions versus untreated contols. SLS irritation was mostly statistically significantly increased versus untreated controls when analyzing the study endpoint-baseline difference. CONCLUSIONS: O/W emulsions may compromise the stratum corneum barrier and improve drug penetration.

Keratolytic activity of microemulsions.

OBJECTIVE: To compare the keratolytic activities of a drug-free hydrophilic microemulsion (ME) and a drug-free lipophilic ME with water, and with regard to the hydrophilic ME also with a 5% salicylic acid gel on the sole of the foot. METHODS: Twenty healthy volunteers had their plantar forefoot, midfoot, and rearfoot stratum corneum blackened with silver nitrate and a photographic developer, and a chromameter was used to determine the extent of removal of this black dye by a* value and L value measurement at 24 and 48 h. RESULTS: Both drug-free MEs produced significantly greater increases in a* value and L value than water, and the hydrophilic ME was also more effective than 5% salicylic acid gel. CONCLUSION: The irritating effect of MEs is rather negligible on the sole of the foot because of the thick plantar stratum corneum. Both MEs therefore appear suitable for the elimination or prevention of plantar desquamative and hyperkeratotic skin changes.

[Effects of emulsions on the stratum corneum barrier and hydration]. / Eigenwirkungen von Emulsionen auf die Hornschichtbarriere und -hydratation.

The appearance of the skin depends greatly on the hydration of the stratum corneum which is regulated by water binding substances of the corneocytes and also by the quality of the stratum corneum lipids. Furthermore these lipids are responsible for the barrier function. In patients with atopic dermatitis, the water binding capacity and the barrier function of the stratum corneum are reduced even in clinically healthy skin areas. Emollients can damage the stratum corneum and lead to desiccation and a disturbance of the barrier. This effect is a result of an increased permeability of the barrier lipids and direct damage to the keratinocytes and corneocytes. The degree of damage of the barrier caused by emollients in dermatological vehicles has not been sufficiently investigated. As suggested by hypothetical considerations, such an effect is not expected and cannot be demonstrated in water-in-oil-emulsions. Oil-in-water-emulsions without glycerol as well as lipophilic and hydrophilic microemulsions do damage the barrier function. Both types of microemulsions additionally lead to a dehydration of the stratum corneum. The damaging effect of oil-in-water-emulsions can be reduced by the addition of glycerol and urea.

Propionibacterium acnes resistance: a worldwide problem.

Antibiotic therapy directed against Propionibacterium acnes has been a mainstay of treatment for more than 40 years. Despite years of widespread use of systemic tetracyclines and erythromycin, change in P. acnes sensitivity to antibiotics was not seen until the early 1980s. The first clinically relevant changes in P. acnes antibiotic sensitivity were found in the USA shortly after the introduction of topical formulations of erythromycin and clindamycin. By the late 1980s, P. acnes strains with very high MIC levels for erythromycin and elevated MICs for tetracycline were increasingly found in the UK and the USA. Mutations in the genes encoding the 23S and 16S subunits of ribosomal RNA were first identified in the UK and also seen in a recent survey from clinics in Europe, Japan, Australia and the USA. In addition, strains were found in which these known mutations could not be identified, indicating that as yet unidentified resistance mechanisms have evolved. These findings indicate the need to develop strategies to minimize the use of antibiotics in acne therapy.

Inhibition of lipase activity in antibiotic-resistant propionibacterium acnes strains.

BACKGROUND AND OBJECTIVE: Erythromycin-sensitive and/or clindamycin-sensitive strains of Propionibacterium acnes show a reduced lipase production at levels below the minimal growth-inhibitory concentration (MIC). The objective of this study was to determine whether erythromycin and clindamycin concentrations far below the MIC inhibit lipase production in P. acnes strains resistant to these antibiotics. METHODS: Of 42 P. acnes strains, 10 showed an MIC >256 micro g/ml for erythromycin. Two strains showed MICs of 0.19 and 0.25 micro g/ml, while the MIC of the remaining strains was 256 micro g/ml were also tested for lipase inhibition by clindamycin. While this method fails to differentiate between inhibition of lipase production and inhibition of lipase activity, the absence of inhibition of lipase activity rules out inhibition of lipase production. RESULTS: Inhibition of lipolysis by sub-MIC concentrations was demonstrated only for clindamycin in 3 P. acnes strains. However, lipase inhibition was seen only at the dilution level immediately below the MIC. CONCLUSIONS: Resistant P. acnes strains with high erythromycin and/or clindamycin MICs can be ruled out to show in vitro inhibition of lipase production at antibiotic concentrations far below the MIC.

[Triclosan, a topical dermatologic agent. In vitro- and in vivo studies on the effectiveness of a new preparation in the New German Formulary]. / Triclosan, ein dermatologisches Lokaltherapeutikum In-vitro- und In-vivo-Untersuchungen zur antibakteriellen Wirksamkeit einer neuen Arzneibuchrezeptur.

BACKGROUND AND OBJECTIVE: Triclosan (2,4,4'-trichloro-2'-hydroxydiphenyl ether) is an antiseptic suitable for formulation as a W/O emulsion. The objective of the present study was to explore its potential utility in atopic dermatitis and prophylactic skin care following leg eczema and leg ulcer treatment. SUBJECTS AND METHODS: We performed in vitro susceptibility testing using the agar diffusion test on 602 isolates from swabs of our institution's Division of Dermatology. Additionally in an in vivo study with 15 healthy volunteers, the occlusion test and the expanded flora test were performed following the application of Hydrophobic Triclosan Cream 2% NRF (New German Formulary) 11.122. (TC) versus untreated, triclosan-free vehicle, 1% chlorhexidine digluconate solution, and ethanol 70%. RESULTS: In vitro susceptibility testing showed excellent activity against Staphylococcus aureus, Klebsiella species, and Proteus species. TC had little or no effect on Pseudomonas, beta-hemolytic streptococci, enterococci, and Candida species. In the in vivo study, TC produced a highly significant, quantitatively substantial reduction in aerobic bacterial counts versus untreated and versus vehicle. The 1% chlorhexidine digluconate solution was significantly more effective than TC in the expanded flora test. CONCLUSIONS: As S. aureus is a relevant pathogen in atopic dermatitis, and gram-negative organisms, including Klebsiella and Proteus species, as well as S. aureus play a major role in the prophylactic skin care after leg eczema and leg ulcer treatment, TC appears to be suitable for maintenance therapy in these indications.

Age dependence of ultraviolet light-induced erythema following narrow-band UVB exposure.

BACKGROUND/PURPOSE: A report in the literature suggests longer duration and greater intensity of late phase UVB erythema in older people. The aim of this study was to identify differences in minimum erythema dose (MED) and intensity of UV-induced erythema after narrow band UVB exposure between older and younger individuals in the late phase of UVB erythema. METHODS: Using the UVA/TL 01 UV skin tester (Waldmann Medizintechnik, Villingen-Schwenningen, Germany), MED was determined for narrow-band UVB exposure in 20 young subjects aging from 20-40, and 20 elderly subjects over 70 years of age. The intensity of UV-induced erythema was measured by chromametry (a*-value and L-value) and laser Doppler 48 h after irradiation. Minimum erythema dose (MED) was additionally assessed visually. RESULTS: Elderly subjects showed no statistical different MED compared to younger subjects. However, the erythema intensity 48 h after narrow-band UVB exposure was significantly greater in the elderly. CONCLUSIONS: Narrow-band UVB therapy may, in case of over dosage, produce more intense erythema in the late phase of UVB erythema in old people than in younger individuals.

Antiseptic effect of a topical dermatological formulation that contains Hamamelis distillate and urea.

OBJECTIVE: To determine the antimicrobial activity of a distillate of Hamamelis (Aqua Hamamelidis ), United States Pharmacopoeia (USP) 23, and urea formulated as a topical dermatological preparation that contains both active ingredients. METHODS: Using the simple occlusion test and expanded flora test, we conducted in vivo studies in 15 healthy volunteers. We also performed in vitro studies using the agar diffusion test. RESULTS: The occlusion test and expanded flora test demonstrated significant antimicrobial activity for a product containing the Hamamelis distillate (90%) and urea (5%) among other ingredients. The expanded flora test demonstrated significant antimicrobial activity for both Hamamelis distillate and urea. The simple occlusion test showed the same tendency, but results were not significant. The agar diffusion test showed inhibition of Staphylococcus aureus and Candida albicans, among other organisms. Comparison with earlier studies of chlorhexidine digluconate and fuchsine using the same method showed that the antimicrobial activities of Hamamelis distillate and urea were relatively weak. This finding is supported by the weak inhibitory activity observed in the agar diffusion test (using 100% of the finished dosage form). CONCLUSION: Formulations of Hamamelis distillate and urea are mainly used for their antiinflammatory, hydrating, and barrier-stabilizing effects in dermatitis maintenance therapy. As bacterial colonization has a central role in the pathogenesis of atopic dermatitis and intertrigo, the antimicrobial activity of such products is considered a welcome, added benefit.

Do urea/ammonium lactate combinations achieve better skin protection and hydration than either component alone?

Twenty subjects with healthy skin were treated with the following formulations for two weeks: drug-free W/O vehicle, 5% ammonium lactate (CAS 52003-58-4) in W/O vehicle, 5% urea (CAS 57-13-6) in W/O vehicle, 3% ammonium lactate + 3% urea in W/O vehicle, 5% ammonium lactate + 5% urea in W/O vehicle. These formulations were applied in randomized order to 6 test areas on the forearms; one area was left untreated. Repetitive washings were additionally performed in the second treatment week. TEWL, stratum corneum water content (corneometry-determined electrical capacitance), and cutaneous blood flow (laser Doppler) were measured at baseline, day 7, and day 14. 5% urea and both ammonium lactate/urea combinations produced significant stratum corneum hydration and improved stratum corneum barrier function; there were no significant differences between these three treatments.

Anti-irritative effect of methylrosaniline chloride (Gentian violet).

BACKGROUND: There are no published studies of the effect of methylrosaniline chloride (MRC) on inflammation when used at the concentration recommended in the New German Formulary. A tissue-damaging effect has been described in animal studies and at higher concentrations in humans. OBJECTIVE: To determine whether 0.5% MRC increases or reduces skin damage in irritative dermatitis. METHODS: The study was carried out on the sodium lauryl sulfate (SLS) skin irritation model in 18 healthy volunteers. The impact of intermittent treatment with 0.5% MRC or drug-free vehicle on three SLS exposure effects was determined: reduction of stratum corneum water content (corneometry), increase in subpapillary blood flow (laser Doppler method) and barrier damage (transepidermal water loss). RESULTS: MRC produced significant reductions in all three SLS exposure effects. CONCLUSIONS: Treatment of irritative dermatitis with 0.5% MRC is expected to produce a high clinical efficacy not only because of the compound's established antimicrobial activity, but also because of its anti-irritative effect.

Testing for irritation with a multifactorial approach: comparison of eight non-invasive measuring techniques on five different irritation types.

BACKGROUND: Non-invasive bioengineering methods are widely used in the assessment of irritant skin reactions. OBJECTIVES: To assess the ability of eight non-invasive measurement techniques to distinguish changes in skin conditions over time, these changes being induced by five different irritants. METHODS: The following techniques were compared in a multivariate analysis: laser-Doppler perfusion imaging (LDI), laser-Doppler flowmetry (LDF), transepidermal water loss (TEWL), visual scoring (VS), colorimetric measurements (Chromameter CR 200 a* and L* scales), Mexameter Hb scale (Mexa Hb) and capacitance (Corneometer CM 820). Irritants tested were sodium lauryl sulphate 2% (SLS), tape stripping (TS), tretinoin 0.05% (TRET), ultraviolet (UV) exposure to 30 W m(-2) UVB/95 W m(-2) UVA, and dithranol 0.5% (DIT). Measurements were performed at baseline and after 24, 48 and 72 h. The study was conducted on the upper back of 11 healthy volunteers of both sexes aged 27-51 years. RESULTS: For DIT it was possible to discriminate over time with CR 200 a* and L*, VS, LDI, LDF and Mexa Hb. In SLS discrimination over time was seen with TEWL and LDF. Discrimination in TS was demonstrated for TEWL, VS, CR 200 a*, CM 820, LDF, LDI and Mexa Hb. In TRET discrimination ability was seen for LDI, LDF, Mexa Hb and VS. For UV it was possible to discriminate using VS, TEWL, LDF, LDI and Mexa Hb. CONCLUSIONS: Different irritation patterns need different measurement modalities in order to give optimal discrimination over time.