[Lichenoid drug reactions]. / Lichenoide Arzneimittelreaktionen.

Lichenoid drug reactions are rare compared to typical morbilliform drug exanthema or urticaria. They are associated with specific drugs or drug families like gold, antimalarial drugs, ß­blockers and angiotensin-converting-enzyme inhibitors. Recent observations included associations with novel drugs such as biologics (e. g. tumour necrosis factor antagonists) and immune checkpoint inhibitors (anti-programme cell death protein 1 antibodies). Lichenoid drug reactions most often resemble lichen planus mainly in areas of ultraviolet-light exposed skin, but also mucosal lichen planus and even bullous lesions may occur.

[Porphyria cutanea tara]. / Porphyria cutanea tarda.

Porphyria cutanea tara (PCT) has a prevelance of about 40 new diagnoses per 1 million people per year and is the most frequently occurring type of porphyria worldwide. Inhibition of the uroporphyrinogen decarboxylase (UROD) is the main cause of the disease, which can be the result of a heterozygous or homozygous mutation of the UROD gene; however, xenobiotics or other diseases may play an important role for the precipitation of the disease. Risk factors include alcohol, estrogen, iron overload, and hemochromatosis, hepatitis C or poisoning, e.g., with polyhalogenated aromatic compounds such as hexachlorobenzene. Signs and symptoms are blisters, skin fragility, erosions hyperpigmentation, sclerodermoid plaques. Therapy includes sun protection, prevention of risk factors, phlebotomy, and chloroquine.

[Post-vaccination granulomas caused by delayed-type reaction to aluminum salts]. / Impfgranulom bei Spättypallergie gegen Aluminiumsalze.

BACKGROUND: Aluminium salts are common adjuvants in all established inactivated vaccines. They are necessary to activate the humoral immune system. In the 1990s a Swedish study on an acellular vaccination against pertussis was started. Until 2013, 745 of 760,000 children with pruritic subcutaneous nodules were identified. In 77 % of these children a contact allergy to aluminium could be proven. Contact allergy to aluminium induced by vaccines causes pruritic subcutaneous nodules at the vaccination site. During infections of the upper respiratory tract the pruritus often escalates with inflammatory, erythematous and urticarial plaques. CONCLUSIONS: The use of solutions containing aluminium salts for specific immunotherapy is contraindicated in the case of contact allergy to aluminium. Intramuscular injections of inactivated vaccines can be employed to avoid granuloma formation.

Improving topical non-melanoma skin cancer treatment: In vitro efficacy of a novel guanosine-analog phosphonate.

Actinic keratosis, a frequent carcinoma in situ of non-melanoma skin cancer (NMSC), can transform into life-threatening cutaneous squamous cell carcinoma. Current treatment is limited due to low complete clearance rates and asks for novel therapeutic concepts; the novel purine nucleotide analogue OxBu may be an option. In order to enhance skin penetration, solid lipid nanoparticles (SLN, 136-156 nm) were produced with an OxBu entrapment efficiency of 96.5 ± 0.1%. For improved preclinical evaluation, we combined tissue engineering with clinically used keratin-18 quantification. Three doses of 10(-3) mol/l OxBu, dissolved in phosphate-buffered saline as well as loaded to SLN, were effective on reconstructed NMSC. Tumour response and apoptosis induction were evaluated by an increase in caspase-cleaved fragment of keratin-18, caspase-7 activation as well as by reduced expression of matrix metallopeptidase-2 and Ki-67. OxBu efficacy was superior to equimolar 5-fluorouracil solution, and thus the drug should be subjected to the next step in preclinical evaluation.

[Retinoids in dermatopharmacology]. / Retinoide in der Dermatopharmakologie.

BACKGROUND: Retinoids are important in regulating cell proliferation and differentiation and play an important role in the body, including the skin. OBJECTIVES: Our objective is to review the current medical literature regarding use, effects and side-effects of topical and systemic retinoids used for therapy. METHODS: Pubmed/Medline electronic database was searched for relevant German and English literature. RESULTS: The group of retinoids used for therapeutic purposes includes both naturally occurring and chemically synthesized vitamin A derivates. Because of their influence on keratinization and epithelial differentiation, as well on the proliferation of benign and malignant keratinocytes, retinoids have found a wide application in the field of dermatopharmacology. CONCLUSION: Retinoids are among the most efficacious drugs used in the treatment of dermatological disorders and have a wide range of biological effects. Thorough knowledge about side-effects and comprehensive information for the patient are essential for safe treatment with retinoids.

[Eccrine poroma]. / Ekkrines porom.

A 42-year-old man presented with a rapidly growing nodule on his right cheek. Except for some itching, it was asymptomatic. The tumor was excised with 3-4 mm safety margin. The clinical differential diagnostic considerations included pyogenic granuloma, amelanotic melanoma, basal cell carcinoma and eccrine poroma. An eccrine poroma is a rare tumor derived from the eccrine sweat gland. Hormonal disturbances, trauma, immunosuppression, actinic damages and radiotherapy have been suggested as possible etiologic factors; however, the exact pathophysiology remains unclear.

[Modern light protection from the view of occupational dermatology]. / Moderner Lichtschutz aus berufsdermatologischer Sicht.

UV-light induced skin cancer is being more and more accepted in Germany as an occupational disease for several jobs with increased UV-light exposure. Over the past 100 years sunscreens with filters against UVB- and UVA-light have been developed. Another development is the use of antioxidants such as vitamin E, vitamin C and herbal agents for additional photoprotection. The evidence supporting these products in their topical and systemic formulation is very variable. The recent changes in the recognition of UV-induced skin cancers as occupational diseases increases the need for preventive strategies which are supported by appropriate clinical studies.

[Extensive fibromata pendulantia. Hydrosurgery as a therapy option using the Versajet technique]. / Flächenhafte Fibromata pendulantia. Hydrochirurgie als Therapieoption mittels Versajet-Technik.

Fibromata pendulantia often appear as small filiform skin tags with a narrow pedicle in the neck, axilla and groin areas. Hitherto, extensive fibromata pendulantia were resected either surgically (curette, scissors, scalpel) or by laser. The present case study of an adipose patient with disseminated fibromata pendulantia in the axillary region in the setting of pseudoacanthosis nigricans introduces the Versajet hydrosurgery technique as an alternative method. It is able to remove tissue and rinse the wound simultaneously by means of a high-pressure water jet.

Dexpanthenol modulates gene expression in skin wound healing in vivo.

Topical application of dexpanthenol is widely used in clinical practice for the improvement of wound healing. Previous in vitro experiments identified a stimulatory effect of pantothenate on migration, proliferation and gene regulation in cultured human dermal fibroblasts. To correlate these in vitro findings with the more complex in vivo situation of wound healing, a clinical trial was performed in which the dexpanthenol-induced gene expression profile in punch biopsies of previously injured and dexpanthenol-treated skin in comparison to placebo-treated skin was analyzed at the molecular level by Affymetrix® GeneChip analysis. Upregulation of IL-6, IL-1ß, CYP1B1, CXCL1, CCL18 and KAP 4-2 gene expression and downregulation of psorasin mRNA and protein expression were identified in samples treated topically with dexpanthenol. This in vivo study might provide new insight into the molecular mechanisms responsible for the effect of dexpanthenol in wound healing and shows strong correlations to previous in vitro data using cultured dermal fibroblasts.

[Iodine allergy]. / Jodallergie.

We report on a patient with an iodine allergy. He developed a delayed cutaneous reaction after receiving an iodinated radiographic contrast media and at the same time topical disinfection with povidone-iodine. In the patch- and intradermal tests he showed positive results with various radiographic contrast media, povidone- iodine and iodine, but not with povidone.

[In vitro diagnosis and monitoring of Hymenoptera venom hyposensitization]. / In-vitro-Diagnostik und Monitoring bei Insektengifthyposensibilisierung.

Specific immunotherapy (SIT) of hymenoptera venom allergy, in particular, has become an example for the effectiveness of the treatment of IgE-mediated allergic diseases. In vitro diagnostic procedures and the measurement of serum tryptase for risk assessment are well-established in the process of diagnose finding and therapy preparation. For monitoring and validation of the effectiveness of the SIT, however, in vitro diagnostic procedures remain controversial. Potentially useful approaches include detection of specific IgE, specific IgG4, basophile activation - represented by the CD 63 expression - and the lymphocyte proliferation and its IL10 release. Preliminary data suggest that the latter method appear appropriate, whereas the detection of basophile activation did not produce definite results.

[Pharmacogenetics]. / Pharmakogenetik.

Allergic reactions to drugs belong to the group of B-reactions, which are characterized not only by the pharmacologic profile of the drug but also by individual risk factors. Pharmacogenetic approaches facilitate identifying these risk factors. The most important example for Caucasian patients is NIDR (non-immediate drug reaction) to abacavir. Chinese patients possess risk factors for NIDR to allopurinol and anticonvulsants and the HLA locus on chromosome 6. Another potentially important area is assessing risk factors to prevent allergic reactions to antibiotics, especially with regard to the effective treatment of MRSA.

Photodynamic therapy of multiple actinic keratoses: reduced pain through use of visible light plus water-filtered infrared A compared with light from light-emitting diodes.

BACKGROUND: Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is an effective treatment for multiple actinic keratoses (AKs). Pain, however, is a major side-effect. OBJECTIVES: To compare pain intensity, efficacy, safety and cosmetic outcome of MAL PDT with two different light sources in an investigator-initiated, randomized, double-blind study. METHODS: Eighty patients with multiple AKs grade I-II were assigned to two groups: group 1, MAL PDT with visible light and water-filtered infrared A (VIS+wIRA); group 2, MAL PDT with light from light-emitting diodes (LEDs), with a further division into two subgroups: A, no spray cooling; B, spray cooling on demand. MAL was applied 3 h before light treatment. Pain was assessed before, during and after PDT. Efficacy, side-effects, cosmetic outcome and patient satisfaction were documented after 2 weeks and 3, 6 and 12 months. Where necessary, treatment was repeated after 3 months. RESULTS: Seventy-six of the 80 patients receiving MAL PDT completed the study. Patient assessment showed high efficacy, very good cosmetic outcome and high patient satisfaction. The efficacy of treatment was better in the group of patients without spray cooling (P=0·00022 at 3 months, P=0·0068 at 6 months) and showed no significant differences between VIS+wIRA and LED. VIS+wIRA was significantly less painful than LED: the median of maximum pain was lower in the VIS+wIRA group than in the LED group for PDT without spray cooling. Pain duration and severity assessed retrospectively were less with VIS+wIRA than with LED, irrespective of cooling. CONCLUSIONS: All treatments showed high efficacy with good cosmetic outcome and high patient satisfaction. Efficacy of treatment was better without spray cooling. VIS+wIRA PDT was less painful than LED PDT for PDT without spray cooling.

Tacrolimus modulates dendritic cell activation in the sensitization phase of allergic contact dermatitis.

BACKGROUND: Knowledge of the effect of topically applied calcineurin antagonists such as tacrolimus on the sensitization phase of allergic contact dermatitis is currently limited. OBJECTIVE: To investigate tacrolimus-dependent immunomodulation on gene expression alterations in human antigen-presenting cells which are stimulated with small-molecular-weight contact allergens. METHODS: Monocyte-derived dendritic cells (moDC) and THP-1 cells were stimulated with the contact sensitizer cinnamic aldehyde (CAld) and compared with the very strong experimental sensitizer 2,4,6-trinitrobenzene sulfonic acid (TNBS) in vitro. Quantitative PCR analysis was used to detect gene expression changes, particularly of interleukin (IL) 8, as an indicator of differential dendritic cell (DC) gene expression after sensitizer stimulation in the absence or presence of tacrolimus and betamethasone at two different concentrations. RESULTS: DC activation was clearly demonstrated by a significant IL-8 upregulation after 24 h, whereas tacrolimus or betamethasone alone did not affect IL-8 baseline expression. Betamethasone and, to a lesser extent, tacrolimus led to a marked reduction of chemical-induced IL-8 expression by TNBS and CAld. CONCLUSION: The results of the present study support the hypothesis that the calcineurin inhibitor tacrolimus has modulatory effects on human antigen-presenting cells during the sensitization phase of allergic contact dermatitis. In addition, moDC as well as THP-1 cells may serve as a system to study immune-modulating effects of drugs such as glucocorticoids or calcineurin antagonists.

[Aspects of occupational skin diseases in hair dressers]. / Berufsdermatologische Aspekte des Friseurberufes.

Hairdressers are exposed to a broad variety of substances known for their strong sensitizing and irritant capacities. Especially wet work and handling of hair-care products causes a high risk for occupational skin disease. Lately, due to new regulations regarding substances and techniques used as well as improved skin protection, the prevalence of occupational skin disease in hairdressers has significantly declined. It is of great importance to fulfill and extent these requirements to further minimize the risk of occupational skin disease in this profession.

Association between TNFA-308 G/A polymorphism and sensitization to para-phenylenediamine: a case-control study.

BACKGROUND: Para-phenylenediamine (PPD) and related chemicals are common contact sensitizers, frequently causing allergic contact dermatitis (ACD). The cytokine tumor necrosis factor-alpha (TNF-alpha) plays a key role in contact sensitization. METHODS: In this case-control study, we evaluated the distribution of variations in the regulatory region of the gene for TNF-alpha (TNFA-308 G/A) in 181 Caucasian individuals with a history of ACD and sensitization to PPD and 161 individuals with no history of sensitization to PPD. RESULTS: The frequency of GA or AA TNFA genotypes was significantly higher in individuals sensitized to PPD than in age- and gender-matched controls giving an odds ratio (OR) of 2.16 (95% confidence interval, CI: 1.35-3.47; P = 0.0016). This relation was even more pronounced when restricting cases to females over 45 years (OR = 3.71; 95% CI: 1.65-8.31; P = 0.0017) vs younger females (less than or equal to 45 years; OR = 2.41; 95% CI: 1.03-5.65; P = 0.044) or males (OR = 1.05; 95% CI: 0.449-2.47; P = 1.0). In addition, a logistic regression model revealed a significant effect for TNFA-308 AA and AG vs GG genotype (point estimate = 2.152; 95% Wald CI: 1.332-3.477). CONCLUSIONS: These findings suggest a possible role for the TNFA-308 genetic polymorphism as a susceptibility factor for chemically induced ACD.

[Basophil activation test as in vitro assay for cisplatin allergy]. / Basophilenaktivierungstest als In-vitro-Assay bei Platinsalzallergie.

During chemoembolization with gemcitabine, mitomycin and cisplatin of a cholangiocellular carcinoma and after receiving iodide contrast media, a 49-year-old patient developed a grade III anaphylactic reaction. We were asked to verify an adverse reaction to contrast media. Using the basophil activation test, we demonstrated a hypersensitivity reaction to cisplatin with distinct induction of CD63-expression on basophilic granulocytes.