Dermatography as a treatment after periocular surgery.

Dermatography is the application of tattooing techniques in medicine. In the past, several techniques have been tried but none of these led to reproducible results. Over the last 17 years, dermatography has been developed into a technique that is both generally applicable and reproducible. It is a suitable treatment modality for disturbing skin discolorations and scars. With dermatography these can be permanently camouflaged. In this paper, the use of dermatography as a treatment after periocular interventions is discussed.

[Dermatography. An effective method for pacemaker marking after spinal cord injuries and implantation of a Brindley stimulator for neurogenic bladder]. / Dermatographie. Eine effektive Methode zur Pacemakermarkierung nach Rückenmarkverletzungen und Anlage eines Brindley-Stimulators für neurogene Blase.

In our department, two spinal cord lesion patients suffering from neurogenic bladder dysfunction were selected for the implantation of a Brindley stimulator, as they could not be managed by conservative treatment. Accurate positioning of the external transmitter block over the subcutaneous receiver block, which is essential for the Brindley stimulator to function correctly, posed problems for the relatives who had to apply the external transmitter. In order to facilitate positioning, dermatography was used to mark the exact spot where the external transmitter should be placed. A 3-year follow-up showed that this marking solved the problem completely and that recurrent urinary tract infections stopped.

Dermatography as a new treatment for alopecia areata of the eyebrows.

BACKGROUND: Alopecia areata is considered to be an autoimmune disease. It consists of patchy hair loss of the scalp and the eyebrows, making it a disfiguring condition. This 10-year study was designed to assess the usefulness of the treatment of the eyebrows with dermatography as a relatively quick and simple method to obtain a cosmetically satisfactory result. MATERIALS AND METHODS: The eyebrow areas were covered with a halftone pattern of tiny dots of color pigments, using a Van der Velden Derma-injector, without anesthesia. On average, two to three dermatography sessions of 1 h were required. The follow-up was 4 years. RESULTS: Thirty three patients, most of whom had been previously treated with a sensitizer such as dinitrochlorobenzene (DNCB), were treated with dermatography. Four patients had also been treated by a beautician with a crude form of tattooing. The results in 30 patients were excellent. In three patients the results were good. CONCLUSIONS: Dermatography is a technique offering a good alternative for time-consuming, troublesome treatment modalities that often have considerable side-effects. With dermatography, no side-effects were found.

Dermatography with bleomycin as a new treatment for verrucae vulgaris.

BACKGROUND: Common warts are caused by infection with human papillomaviruses (HPVs). Many, largely ineffective, treatment modalities have been tried in the past. The cytostatic drug bleomycin has been found to selectively affect squamous cell and reticuloendothelial tissue, but the method of its delivery directly into affected tissue such as warts has been of little efficacy. This study assessed the efficacy of a new mode of intralesional administration of bleomycin by dermatography. METHODS: The warts of patients were treated with increasing concentrations of bleomycin using the van der Velden Derma-Injector, a modified tattooing machine, under local or block anesthesia. The effects of the procedure were evaluated 1, 24, and 48 h later and the patients followed for up to 2 years. RESULTS: Thirteen patients with warts on the hands and/or feet, resistant to conventional therapy, were entered into the study, and two patients dropped out. Of the 11 remaining patients, seven went into full remission that was maintained for at least 2 years. One patient showed moderate progress and in three patients little progress was noted and dermatography was stopped. The dosage of bleomycin varied between 0.1 and 1.0 mg/mL. CONCLUSIONS: Dermatography proved to be an effective technique for intralesional administration of bleomycin in more than two-thirds of patients resistant to conventional therapy. Treatment failures in this study could in part be explained by a defective immune system in the patients. Dermatography is a technique that can be learned by any skillful dermatologist or plastic surgeon.

[Use of dermatography as treatment method in various medical specialties]. / Anwendung von Dermatographie als Behandlungsmethode in verschiedenen medizinischen Fachbereichen.

Dermatography is the application of tattooing techniques in medicine. In the past, several techniques were tried but none led to reproducible results. Dermatography has been improved over the last ten years, providing techniques which are both generally applicable and reproducible. It is a suitable treatment modality for permanently camouflaging disturbing discolorations and scars. This paper covers technical and medical aspects of dermatography, as well the indications.

Dermatography: a method for permanent repigmentation of achromic burn scars.

Dermatography, a refined elaborate tattooing technique, has been used successfully in 52 patients suffering from postburn depigmentation. Materials and methods are simple and safe. Over a 5-year follow-up no adverse reactions or complications were noticed. The cosmetic results were very satisfactory both to the surgeons and to the patients. Dermatography is suggested as an alternative for treating localized achromasia, particularly when other medical therapeutic attempts have failed in repigmenting this often disfiguring condition.

Cutaneous adverse reactions after intra-articular injection of triamcinolone acetonide.

A patient is described with a disseminated morbilliform and partially persistent urticarial dermatitis following intra-articular injections of triamcinolone acetonide. A delayed-type hypersensitivity to triamcinolone acetonide was observed after patch and intradermal testing. However, an immediate-type hypersensitivity to this drug was not observed. A delayed-type sensitization to betamethasone, dexamethasone and prednisolone, but not to hydrocortisone was also observed after patch testing. Intradermal tests with these representatives of corticosteroids were all negative. Although little is known yet about the relationship between immediate and delayed-type hypersensitivity and the side-effects of oral use of corticosteroids, the absence of positive skin tests to corticosteroids other than triamcinolone acetonide may indicate a safe use of these drugs orally or via injection.

Dermatography--a new discipline with a wide range of applications.

Dermatography is the application of tattooing techniques in medicine. In the past, several techniques were tried but none led to reproducible results. Dermatography has been developed over the last 10 years into a technique which is both generally applicable and reproducible. It is a suitable treatment modality for disturbing discolorations and scars of the skin which can be permanently camouflaged.

Development and evaluation of a monoclonal antibody inhibition enzyme linked immunosorbent assay to diagnose syphilis.

A highly specific inhibition enzyme linked immunosorbent assay (ELISA) using murine monoclonal antibodies to treponemes has been developed to diagnose syphilis. The monoclonal antibodies used in this study were reactive to antigens of both Treponema pallidum and Treponema pertenue and not to antigens of non-pathogenic treponemes. Inhibition of the binding of monoclonal antibody to the treponemal antigens was successful with serum antibodies of patients with syphilis in an inhibition ELISA using monoclonal antibodies raised against T pallidum antigens with molecular weights of 42 and 47 kilodaltons. In contrast, the binding of monoclonal antibodies obtained by immunising mice with treponemal membrane protein TmpB, derived from recombinant DNA was not inhibited by serum antibodies from patients with syphilis. The sensitivity of the inhibition ELISA using monoclonal antibody against the 47 kilodalton T pallidum antigen was 93% in 58 serum samples from patients with untreated syphilis. The sensitivity was 79% if the monoclonal antibody against the 42 kilodalton T pallidum antigen was used. By a combination of the test results obtained in these two inhibition assays a sensitivity of 97% in the 58 serum samples from untreated patients and 64% in 64 from treated patients was obtained. The specificity of the inhibition ELISA performed with either monoclonal antibody was 100% in 500 serum samples from non-infected people. The specificity in 432 non-infected patients attending a sexually transmitted disease clinic was 98.8% for the monoclonal antibody against the 42 kilodalton antigen, 99.5% for the monoclonal antibody against the 47 kilodalton antigen, and 98.4% for the combined antibodies. The sensitivity and specificity of the inhibition ELISA using the combination of test results obtained by the application of the monoclonal antibodies against the 42 kilodalton treponemal membrane protein, TmpA, and against the 47 kilodalton T pallidum antigen were comparable with those of the Treponema pallidum haemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTA-ABS) test for diagnosing early untreated disease. The inhibition ELISA offers the potential for additional confirmation of early untreated syphilis. Its use for confirming late untreated syphilis is still under investigation. The test is highly specific for pathogenic treponemes and does not need sorbens.

Overproduction and purification of Treponema pallidum recombinant-DNA-derived proteins TmpA and TmpB and their potential use in serodiagnosis of syphilis.

We report the construction of expression plasmids carrying two Treponema pallidum genes encoding for the 42-kilodalton membrane protein TmpA (treponemal membrane protein A) and the 34-kilodalton membrane protein TmpB. Using the leftward promoter of bacteriophage lambda, which is controlled by a thermosensitive repressor, we obtained a high level of heat-inducible synthesis of TmpA and TmpB in Escherichia coli K-12. Both proteins were purified to near homogeneity, and the presence of antibodies to TmpA and TmpB in human sera was determined by an enzyme-linked immunosorbent assay. Whereas in all 44 serum samples from untreated patients in the secondary and early latent stages of syphilis, high levels of anti-TmpA antibodies were detected, only 34 serum samples contained anti-TmpB antibodies. As has been previously observed for TmpA, a correlation was found between the presence of anti-TmpB antibodies and anti-cardiolipin antibodies, suggesting that the level of antibodies to TmpB drops soon after successful antibiotic treatment. We concluded that, in contrast to TmpA, TmpB is not suitable for serodiagnostic purposes as a single antigen, because a significant fraction of sera from syphilitic patients was nonreactive with TmpB.

Line immunoassay and enzyme-linked line immunofiltration assay for simultaneous detection of antibody to two treponemal antigens.

Two enzyme immunoassays, the line immunoassay (LIA) and the enzyme-linked line immunofiltration assay (ELLIFA), were studied for suitability in the serodiagnosis of syphilis. In both assays, antibody to treponemes was detected using the recombinant DNA derived treponemal protein TmpA and the purified axial filament derived from the Reiter treponeme. The antigens were applied in parallel lines onto nitrocellulose membranes. The sensitivity and specificity of both assays were compared with that of the Treponema pallidum hemagglutination assay (TPHA), the fluorescent treponemal antibody absorption test, and the axial filament and TmpA enzyme-linked immunosorbent assays. The sensitivity and specificity of the LIA and the ELLIFA were found to be comparable to that of the TPHA using serum samples from 65 untreated syphilitic patients, 95 patients treated for syphilis and 60 blood donors, except in the case of the LIA using axial filament. This latter test was slightly less sensitive in primary and early latent syphilis than the TPHA. In the LIA procedure, serum antibodies to two antigens could be detected simultaneously within two hours. This assay may be useful for fieldwork. In the ELLIFA procedure, antibodies to the two antigens could be detected simultaneously within 15 minutes. The ELLIFA procedure may provide a multiple antigen test with a very short assay operation time.

An IgM capture enzyme linked immunosorbent assay to detect IgM antibodies to treponemes in patients with syphilis.

A new IgM capture enzyme linked immunosorbent assay (ELISA) was compared with the 19S(IgM) fluorescent treponemal antibody absorption (19S(IgM)FTA-ABS) test for detecting IgM antibodies to treponemes. Serum samples from 180 people, 109 with various stages of untreated syphilis, 45 with treated syphilis, and 26 non-infected, were investigated. In all diagnostic groups of syphilis the reactivity of the IgM capture ELISA was similar to that of the 19S(IgM)FTA-ABS test except in untreated neurosyphilis, for which the IgM capture ELISA was significantly less sensitive. The IgM capture ELISA was very sensitive in congenital (100%, 5/5) and primary (82%, 18/22) syphilis, but less sensitive in secondary (60%, 12/20), latent (53%, 16/30), neurosyphilis (34%, 11/32), and treated (11%, 5/45) syphilis. False positive IgM capture ELISA results were not found in five people who gave false positive Venereal Disease Research Laboratory (VDRL) reactions or in 21 neonates born to mothers adequately treated for syphilis before or during pregnancy. This indicated that the IgM capture ELISA was very specific. The course of antitreponemal IgM reactivity after treatment of early infectious syphilis was followed up in six patients. The quantity of IgM antibody declined in nearly all patients after treatment, but still remained detectable in five patients up to six months after treatment. In contrast, non-treponemal antibodies measured by the VDRL test disappeared in four out of six patients within five months from starting treatment. In conclusion, the IgM capture ELISA may be useful for easy and sensitive detection of IgM antibodies to treponemes in patients with congenital and primary syphilis. A positive test result in these cases indicates that patients should receive treatment if they have not been treated recently. The test is not, however, recommended to replace the VDRL test to monitor patients treated for syphilis.

Optimizing the solid-phase immunofiltration assay. A rapid alternative to immunoassays.

The technical variables of the solid-phase immunofiltration assay (SPIA) for the detection of antibodies bound to antigens on a solid-phase filter have been investigated. The binding to solid-phase filters of 125I-labelled axial filament proteins derived from Treponema phagedenis and the optimal conditions for blocking non-specific protein binding were analysed. Axial filament was applied to nitrocellulose, Hybond Nylon and Zeta Probe. After extensive rinsing, the highest amount (68%) of axial filament was observed bound to Zeta Probe. However, blocking non-specific protein binding by pre-wetting the filter with rinsing buffer containing 0.5% Tween 20, prevented the binding of protein to the filter only when nitrocellulose was used as solid phase. Tween 20 (0.5%) in the rinsing and incubation solutions was found to be necessary for the reduction of non-specific binding of contaminants in turbid sera. However, the use of such solutions resulted in a substantial leakage of antigen (47%) during rinsing procedures. Binding of antigen-specific antibody was analysed using 125I-labelled protein A. The maximal possible binding of the antibody occurred within 5 min when the antibody solution was filtered. For optimal binding of 125I-labelled protein A an incubation time of 1 h was needed. It is suggested that solid-phase immunofiltration may provide a rapid alternative for radioimmunoassays or enzyme immunoassays for the detection of specific antibodies.

Sensitivity and specificity of an enzyme-linked immunosorbent assay using the recombinant DNA-derived Treponema pallidum protein TmpA for serodiagnosis of syphilis and the potential use of TmpA for assessing the effect of antibiotic therapy.

The recombinant DNA-derived Treponema pallidum membrane protein TmpA, purified from Escherichia coli K-12, was used in an enzyme-linked immunosorbent assay (ELISA) to evaluate its suitability in a screening test for syphilis and to monitor the effect of antibiotic treatment. The sensitivity of the TmpA ELISA was 76% for primary syphilis, 100% for secondary syphilis, and 98% for early latent syphilis. All except 1 of 15 serum samples positive for yaws were positive in this test. A specificity of 99.6% was found by testing more than 938 donor samples. The sensitivity and specificity of the TmpA ELISA are comparable to that of the T. pallidum hemagglutination assay, and therefore the test may be useful for the diagnosis of untreated syphilis. After antibiotic treatment, the level of anti-TmpA antibodies in sera of syphilis patients dropped sharply within 1 year. Thus, TmpA might be a useful antigen for monitoring successful treatment of syphilis.

Enzyme-linked immunofiltration assay for rapid serodiagnosis of syphilis.

A new rapid technique for detection of serum treponemal antibodies is described which is based on an enzyme-linked immunoassay using nitrocellulose as solid phase. With this technique antigen-antibody binding is accelerated by the filtration of the antibody solution through the antigen-coated nitrocellulose filter instead of its remaining over the solid phase for incubation. Test results are available in less than 15 min. Serum specimens from 255 syphilitics and 829 non-infected subjects were investigated. The sensitivity and specificity of the Treponema pallidum enzyme-linked immunofiltration assay were comparable to those of the Treponema pallidum haemagglutination assay and the fluorescent treponemal antibody absorption test.