[Skin aging and evidence-based topical strategies]. / Hautalterung und evidenzbasierte topische Anti-Aging-Strategien.

Anti-aging in dermatology primarily focuses on the prevention of skin aging with UV protection (clothing and sunsceens), free radical scavengers (synthetic or botanic), and cell-protecting agents such as vitamin B3. For the correction of signs of early skin aging, retinoic acid derivatives in dermatological prescriptions are the best studied substances. Topical hormonal prescriptions are also an option if UV damage has not been the leading culprit for aging. Chemical peeling leads to a marked increase in collagen formation, the deaper the better. Ingredients in cream preparations can reduce superficial skin folds (polyphenols, amino acid peptides). Modulators of regular pigmentation are important for anti-aging preparations. Growth factors (plant extracts, recombinant growth factors) are not thoroughly studied regarding the cost-benefit and risk ratio. Complex precedures such as photodynamic therapy have an impact on the appearance of aged skin.

[Undesirable pigmentation]. / Unerwünschte und erwünschte Pigmentierung.

BACKGROUND: Homogenous pigmentation can be induced by α-melanocyte-stimulating hormone (MSH) homologues. Cosmetically inacceptable pigmentation is mostly located on the face. OBJECTIVES: Although afamelatonide is a prescription drug for the orphan disease erthropoetic protoporphyria, structurally related α-MSH derivatives are available via the internet. Preventive and therapeutical options are necessary for postinflammatory hyperpigmentation, melasma, and lentigines. METHODS: Case reports address activation of dysplastic naevi by melanotan I. Wood's lamp is of some use in analyzing the level of hyperpigmentation. However, no guidelines have been established; thus, a summary of current studies is presented. RESULTS: Melanotan I leads to the activation of dysplastic nevi. The gold standard for hyperpigmentation is triple therapy with hydrochinon, tretinoin, and steroids, which can cause irritation and lead to ochronosis in some individuals. Tyrosinase inhibitors, substances that increase the cell turnover, and plant derivatives are less efficient but more tolerable. CONCLUSIONS: Melanotan I and bleaching creams, which may possibly contain mercury, are dangerous. Hyperpigmentation is best treated using a combination therapy that inhibits melanocyte activity and melanin synthesis, removes melanin, destroys melanin granules, and includes UV protection. Especially in Fitzpatrick skin types IV-VI, cryotherapy and laser are not the first line treatment options due to renewed posttreatment hyperpigmentation.

[Acne therapy in pregnancy]. / Aknetherapie in der Schwangerschaft.

Acne should be treated during pregnancy to prevent worsening, scarring, secondary infection or psychological impairment of the mother. Safe products must be chosen. Systemic tetracycline, doxycycline, minocycline or isotretinoin can not be used. Topical benzoyl peroxide or topical azelaic acid are safe therapeutic options. According to the guidelines, systemic corticosteroids or systemic erythromycin (the latter not in lactation) can be employed beginning in the second trimester for severe flares of acne and should be started in cooperation with the patient's gynecologist. Oral zinc is another option, but not for longer than 3 months. Accessory cosmetic measures may be useful, including mechanical peeling or chemical peeling with glycolic or alpha-hydroxy-acids. In contrast, salicylic acid, trichloracetic acid or phenol peels should not be performed in pregnancy. Camouflage makeup can clearly lower the psychological stress.

[Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]. / Phlebologie an deutschen Hautkliniken. Eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Phlebologie.

BACKGROUND: Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS: To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS: In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS: Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

Cutaneous reactions to anticoagulants. Recognition and management.

Anticoagulant-induced skin reactions appear as allergic or necrotic responses to vitamin K antagonists or heparins. Cutaneous allergy has been reported with danaparoid sodium and flush reactions have been seen with hirudins. The pathogenesis of the reactions differs between drugs. Generally, they occur between days 3 to 10 after the start of treatment, but may also occur later. In patients experiencing necrosis with a vitamin K antagonist, concomitant protein C deficiency, protein S deficiency or lupus anticoagulant has been described, whereas the precise mechanism of the other reactions is unknown. In patients with allergic reactions to heparins, cutaneous tests may help to identify alternative anticoagulants. Such a test cannot be performed in patients with skin necrosis. In patients with heparin-induced skin reactions danaparoid sodium may be used after negative intracutaneous testing in some patients and a hirudin may be used without testing in all patients. Heparin-induced skin necrosis has been reported to be mediated by immunologic mechanisms and to be associated with a high frequency of heparin-induced thrombocytopenia type II. Surgical excision of the necrosis may be required. If further anticoagulation is indicated in any patient, extreme caution has to be taken when restarting oral anticoagulants. Because a large number of anticoagulants available today, safe treatment of all patients experiencing anticoagulant-induced skin reactions is feasible.

Heat shock protein HSP 27 is expressed in all types of basal cell carcinoma in low and high risk UV exposure groups.

HSP 27, a marker of differentiation and proliferation, helps the cell in repair processes after environmental stress such as heat, UV-irradiation and oxidative stress. So far, its role on carcinogenesis is not yet understood. HSP 27 was studied immunohistochemically in different types of primary, untreated basal cell carcinoma (BCC) in two populations with different UV exposure habits: descendents from Germany, "Pommern", living in Brazil (Pommeranos, n = 15), rural workers with high UV exposure and Germans from the region Baden-Württemberg with indoor jobs (n = 14). Age distribution and type of BCC were similar between the Pommeranos and the Germans. Specimens of BCC (n = 15 solid, n = 6 keratotic, n = 4 adenoid, n = 4 fibrotic) were evaluated in cryostat and paraffin sections for HSP 27, HSP 72 and bcl-2. In Pommeranos in Brazil (UV high risk group) versus (vs) inhabitants from Baden-Württemberg (UV low risk group), HSP 27 was expressed in 93% vs 79% in all histological subclasses, HSP 72 in 20% vs 21% and bcl-2 in 93 % in both groups. Antibodies against HSP 27, but not HSP 72, labeled BCC of all types. In contrast to the lack of HSP 27 in squamous cell carcinoma reported in the literature, we found HSP 27 and bcl-2 positive cells in BCC which might characterize the tumour as relatively benign and slow progressing.

Parental understanding of basic infant nutrition: misinformed feeding choices.

To assess mothers' knowledge of good infant nutritional practices, a survey was conducted by the Institute of Pediatric Nutrition. The survey addressed issues related to breast-feeding, the use of iron-fortified formula, frequent spitting up, the introduction of cow's milk into the infant diet, and the nutritional value of fruit juice. Mothers who responded to the survey had difficulty identifying the most appropriate choices. This article presents the survey results and discusses the implications for health care providers who care for children and their families.

[Tyrothricin powder in the treatment of cutaneous lesions]. / Tyrothricin-Puder bei Hautverletzungen. Reduktion des Wundradius bei infizierten und infektionsgefährdeten Wunden--Eine randomisierte, placebokontrollierte Doppelblind-Studie.

BACKGROUND AND OBJECTIVES: The efficacy and tolerance of an antiseptic wound powder based on the antibiotic tyrothricin was investigated in a prospective, randomized multicenter trial in patients with posttraumatic and surgical cutaneous lesions. PATIENTS AND METHODS: In 5 centers, 131 male and female patients from 18-85 years were included with posttraumatic or surgical cutaneous lesions with infection or in danger of infection (area > or = 200 mm2). In a double-blind study, tyrothricin (n = 62; 0.1 g tyrothricin per 100 g of vehicle) or placebo powder (n = 69) was applied to the wound twice daily for 9 days. The primary aim was to evaluate the average daily reduction of the radius from the lesion area between the start and end of the randomized treatment (alpha = 0.025; one-sided). Secondly, a wound index (range 0-15) was calculated from the assessments of rubor, crusting, exudation, pain and functional impairment. RESULTS: The treatment groups were comparable at baseline. During randomized treatment, the radius of the lesions was reduced at an average of 0.55 +/- 0.31 mm/day (mean +/- SD) for tyrothricin and 0.47 +/- 0.30 mm/day for placebo (p = 0.016; one-sided; intention-to-treat data set). The wound index decreased at an average of 4.2 +/- 1.7 and 3.3 +/- 1.9 points for tyrothricin and placebo, respectively (p = 0.0048; one-sided). 4 adverse events occurred in each group. A causal relationship with the investigational drug could not be excluded in 3 of the placebo group. CONCLUSION: The results confirm the tendency to an acceleration of wound healing by tyrothricin powder (Tyrosur Powder) in case of infection or danger of infection. A superior efficacy compared to placebo was demonstrated. Due to its good tolerability and the absence of a systemic effects tyrothricin powder is appropriate for the treatment of superficial skin lesions.

[Hematogenous contact dermatitis after intravesicular instillation of mitomycin C]. / Hämatogenes Kontaktekzem nach intravesikaler Instillation von Mitomycin C.

Mitomycin C is an alkylating chemotherapeutic agent which is instilled intravesically to prevent recurrence of superficial bladder carcinomas. After several cycles of mitomycin C, our patient developed a pruritic genital dermatitis and palmar desquamation. Following exclusion of a fungal infection, we performed patch tests using the standard series, the major basic ointment ingredients, disinfectants, and mitomycin C in concentrations of 0.001 to 0.1%; the resulting diagnosis was allergic contact dermatitis due to delayed-type hypersensitivity to mitomycin C. The skin rash rapidly resolved with application of topical steroids, and the intravesical chemotherapy was changed to doxorubicin. Eczematous skin reactions are quite common side effects after intravesical instillation of mitomycin C. In the majority of cases, they are caused by delayed-type hypersensitivity reactions, presumably elicited by hematogenous spread of the allergen, and not by irritation. The sensitization most likely occurs via the bladder mucosa. In order to differentiate between allergic and toxic contact dermatitis, patch tests with the above-mentioned mitomycin C concentrations are useful. In cases of mild allergic contact dermatitis the intravesical chemotherapy might be continued with concomitant topical steroids.

Functional eicosanoid test and typing (FET) in acetylsalicylic acid intolerant patients with urticaria.

One of the common side effects of acetylsalicylic acid (ASA) is the induction of pseudoallergic reactions that range from urticarial wheals to anaphylactic shock. At present there is no reliable detection method available for the diagnosis of ASA-hypersensitivity and its relation to clinical symptoms. The purpose of the present study was to evaluate the functional eicosanoid typing (FET) score taking into account several parameters of the equilibrium between prostaglandins (PG) and peptido-leukotriens (pLT). A total eicosanoid pattern score (TEP) ranging from 0.0 to 3.0, was defined that exhibited significant differences (p

Neonatal mastocytosis with pachydermic bullous skin without c-Kit 816 mutation.

BACKGROUND: Bullous mastocytosis is an unusual variant of mast cell disease with widespread bullae as the main cutaneous feature induced by mast cell proteases that cause dermoepidermal separation. CASE REPORT: A rare case of diffuse cutaneous bullous mastocytosis with pachydermia and unusually extensive skin folding is described in a 3-week-old girl. The diagnosis was confirmed by immunohistochemistry with Giemsa stain, the naphthol ASD chloroacetate esterase reaction and elevated blood levels for tryptase, histamine in serum and histamine and 1.4-methylimidazol acetic acid in the 24-hour urine. Blood cell count was normal, as were thrombocytosis and leukocytosis. FACS analysis of the bone marrow aspiration material showed 1% mast cells. No c-Kit 816 [Asp-->Val] somatic mutation was found. Systemic involvement of other organs was excluded. DISCUSSION: The prognosis of c-Kit-negative diffuse bullous mastocytosis is not known. Regular blood controls are mandatory, and screening for germ cell ovarian cancer and bone marrow controls should be performed as well.

[Allergic contact dermatitis from colophony and turpentine in resins of untreated pine wood]. / Allergische Kontaktdermatitis durch Kolophonium und Terpentin in Harzen unbehandelter Kiefernholzmöbel.

Pine wood is one of the most used raw products in furniture manufacturing in Europe. High concentrations of colophony and turpentine can be extracted from pine resins. A 45-year-old woman developed a contact dermatitis of the face and hands due to a sensitization to colophony and turpentine after she had bought untreated pine chairs. The increased use of untreated pine in the furniture industry might result in an increase of colophony and turpentine-induced contact allergies. Therefore, the slogan "untreated=harmless" should be considered critically in such cases.

[Topical treatment of skin aging]. / Topische Externa in der Hautalterung.

Safe levels of UV exposure and UV protection are the most important measures to protect the skin from epithelial skin cancer and skin aging. This report reviews noninvasive topical methods to counteract skin wrinkling and irregular pigmentation of aging skin. Furthermore, information is provided about the effects of UV protection by using sunscreens and topical antioxidants. The effect of vitamin A acid derivatives, chemical peeling, and bleaching agents is considered. Newly developed substances are presented.

[Angiogenic factors in external auditory canal cholesteatoma-fibroblast cell culture]. / Angiogene Faktoren in der Fibroblastenzellkultur des Gehörgangcholesteatoms.

BACKGROUND: The external auditory canal cholesteatoma (EACC) is characterized by hyperproliferation of the epithelial and subepithelial tissue. Compared to normal meatal skin, strong expression of FGF-2 and VEGF had previously been detected. Many authors reported that FGF-2 acts via VEGF and is induced by hypoxia. Hypoxia seems to be pivotal for establishing EACC. Therefore, human EACC fibroblasts were investigated by incubating with FGF-2 and determining VEGF. PATIENTS AND METHODS: We harvested fibroblasts from human EACC and normal meatal skin and incubated the fibroblast culture with 50 ng/ml FGF-2 and determined VEGF concentrations after 1-4 days. RESULTS: Compared to untreated fibroblast cultures, there was a significant increase of VEGF concentration (p<0.05). However, there was no significant difference between the proliferation quantities. CONCLUSION: VEGF and FGF-2 are possibly involved in a cascade of growth factor activities, which modulates their concentration in human-derived EACC fibroblast culture. Exogenous FGF-2 increased fibroblast expression for VEGF, which is a major autocrine mediator of FGF-2-induced angiogenesis and proliferation.