[Squamous cell carcinoma arising in oral lichen planus : Report of two cases]. / Plattenepithelkarzinom auf dem Boden eines oralen Lichen planus : Bericht zweier Fälle.

Lichen planus is a chronic inflammatory, immunologically mediated mucocutaneous dermatosis. Lichen planus mucosae predominantly affects the oral cavity. Various trigger factors such as bacterial or viral infections, drugs or physical stimuli are discussed in the development of the disease. An association with human papillomavirus infections has also been described, but is not sufficiently proven. Lichen planus mucosae is considered as a premalignant condition, but the malignant transformation rate is low. The risk of malignant transformation is significantly increased in patients with oral lichen planus who smoke, drink alcohol or have hepatitis C. We describe two patients with locally advanced squamous cell carcinoma that developed on a longstanding oral lichen planus. Both cases were successfully treated with radical tumor resection, subsequent tissue reconstruction, and adjuvant radiation/radiochemotherapy.

Human Papillomavirus Type 16 Induced Squamous Cell Carcinoma (In situ) of the Toes.

is missing (Short communication).

[Atypical variant of hand-foot-mouth disease]. / Atypische Hand-Fuß-Mund-Krankheit.

An atypical variant of hand-foot-mouth disease (HFMD) has sporadically been reported in recent years, with outbreaks in Europe, Asia, the USA and South America. A new lineage of Coxsackie virus A6 has been identified as the causative agent, a virus-type belonging to the group of enteroviruses. HFMD is transmitted through droplet infection or through faecal-oral transmission. The disease may begin with a prodromal stage and is often accompanied by fever and malaise. Typical skin findings include a papular and vesiculobullous exanthema that might be accompanied by confluent blisters (bullae), crusting, and ulceration. In contrast to "classic" HFMD, predilection sites include the dorsal aspects of the hands and feet, forearms, lower legs, neck and trunk. Oral lesions may be present, but are less often seen compared to "classic" HFMD. The course of the disease is self-limiting, with complete resolution usually within 7-14 days after disease onset. The treatment of atypical HFMD is usually symptomatic. A diagnosis of atypical HFMD might be challenging due to the polymorphous presentation of the disease. This review describes a rarely reported but more frequently diagnosed viral condition.

Cytokine and chemokine ligand expression in cutaneous lupus erythematosus.

There is increasing evidence that cytokines as well as chemokines are important players in the pathogenesis of lupus erythematosus (LE). We aimed to compare cytokine and chemokine profiles in different types of cutaneous LE. We investigated lesional mRNA and protein expression of various cytokines and chemokines in patients with chronic discoid LE (CDLE, n=15), subacute cutaneous LE (SCLE, n=11), and lupus erythematosus tumidus (LET, n=21). TNF-α, INF-γ, TGF-ß, IL-6, IL-10, IL-12p40, CXCL9, and CXCL10 mRNA expression were significantly increased in SCLE when compared to CDLE. Moreover, LET also showed significantly increased mRNA expression of TNF-α, TGF-ß, IL-10, IL-12p40 and CXCL9, as compared to CDLE. In all LE subtypes, CXCL9 and CXCL10 mRNA expression significantly correlated with INF-γ mRNA expression, as indicated by r-values ranging from 0.71 - 0.87. Immunohistochemistry for TNF-α, INF-γ, and IL-10 gave support to our RT-PCR results. In conclusion, our results suggest that T helper 1, as well as T helper 2 cytokines are differentially expressed in CDLE, SCLE, and LET. Compared to CDLE, the highest cytokine and chemokine ligand profiles are found in SCLE followed by LET. Our correlation studies also support the importance of an IFN-driven inflammation in cutaneous LE.

Expression of antimicrobial peptides in different subtypes of cutaneous lupus erythematosus.

BACKGROUND: Antimicrobial peptides (AMPs) are small effector molecules of the innate immune system with well-known antimicrobial activity. Skin infections rarely occur in patients with cutaneous lupus erythematosus (CLE), and AMP expression in CLE has not been previously evaluated. OBJECTIVES: We aimed to determine the expression of several important AMPs in 3 different subtypes of CLE. METHODS: Skin lesions were analyzed for the gene and protein expression of human ß-defensin (hBD)-1, -2, and -3; RNase-7; the cathelicidin LL-37; and psoriasin (S100A7) using real-time reverse transcriptase polymerase chain reaction and immunohistochemistry. RESULTS: Skin biopsy specimens of 96 study participants including 47 patients with CLE (15 patients with discoid lupus erythematosus [LE], 11 patients with subacute CLE, and 21 patients with LE tumidus), 34 patients with psoriasis, and 15 healthy control subjects were evaluated in this study. HBD-2, hBD-3, LL-37, and psoriasin were significantly more highly expressed in CLE as compared with healthy controls, and most AMPs were significantly more highly induced in subacute CLE as compared with discoid LE and LE tumidus. AMP gene expression paralleled well with AMP protein expression in CLE and controls. Subacute CLE and discoid LE showed a similar correlation of AMP gene expression (significant correlations between hBD-1 and RNase-7, hBD-2 and hBD-3, hBD-2 and psoriasin, and hBD-3 and psoriasin). LIMITATIONS: The relatively small number of samples and the lack of analysis of the lesional bacterial colonization are a limitation. CONCLUSIONS: Several AMPs are increased in CLE at both gene and protein levels. This could explain the low prevalence of skin infections in CLE. It remains to be elucidated whether AMPs play a pathogenic role in CLE.

Upregulation of cathepsin S in psoriatic keratinocytes.

Cathepsin S (CATS) is a cysteine protease, well known for its role in MHC class II-mediated antigen presentation and extracellular matrix degradation. Disturbance of the expression or metabolism of this protease is a concomitant feature of several diseases. Given this importance we studied the localization and regulation of CATS expression in normal and pathological human/mouse skin. In normal human skin CATS-immunostaining is mainly present in the dermis and is localized in macrophages, Langerhans, T- and endothelial cells, but absent in keratinocytes. In all analyzed pathological skin biopsies, i.e. atopic dermatitis, actinic keratosis and psoriasis, CATS staining is strongly increased in the dermis. But only in psoriasis, CATS-immunostaining is also detectable in keratinocytes. We show that cocultivation with T-cells as well as treatment with cytokines can trigger expression and secretion of CATS, which is involved in MHC II processing in keratinocytes. Our data provide first evidence that CATS expression (i) is selectively induced in psoriatic keratinocytes, (ii) is triggered by T-cells and (iii) might be involved in keratinocytic MHC class II expression, the processing of the MHC class II-associated invariant chain and remodeling of the extracellular matrix. This paper expands our knowledge on the important role of keratinocytes in dermatological disease.

Impact of ultraviolet radiation on the expression of marker proteins of gap and adhesion junctions in human epidermis.

AIMS/BACKGROUND: We aimed to investigate the impact of ultraviolet B (UVB) as well as UVA1 on the epidermal expression of specific markers of gap and adhesion junctions. METHODS: Twelve healthy subjects were enrolled in the study. The back of the subjects was irradiated with three MED-UVB as well as three MED-UVA1. Twenty-four hours later, punch biopsies were taken from irradiated and non-irradiated skin. Immunohistochemical procedures were used for the detection of connexin 43, E-cadherin, involucrin, Ki-67 using specific antibodies. RESULTS: Staining intensity of connexin 43 in UVB-exposed skin was significantly increased when compared with non-exposed and UVA1-exposed sites. By contrast, staining intensity of E-cadherin in UVB-exposed skin was significantly decreased when compared with non-exposed and UVA1-exposed sites. Involucrin and Ki-67 staining of keratinocytes was significantly increased in UVB-exposed sites as compared with non-exposed and UVA1-irradiated sites. CONCLUSIONS: UVB significantly alters the epidermal expression of gap and adhesion junction proteins possibly indicating a role of these proteins in the regulation of UV-induced inflammation and development and progression of skin cancer.

[Frequent Skin Findings in Daily Routine of the General Practitioner]. / Häufige Hautbefunde in der Praxis.

Diseases of the skin are the cause of approximately one fifth of outpatient visits to general practitioners (GPs) in Germany. GPs are expected to be competent in both knowledge and skills required to manage dermatological diseases, but making the correct diagnosis can be challenging facing the broad clinical spectrum of dermatological disorders. Knowledge of morphological characteristics is essential in the accurate diagnosis of a dermatological condition and to ensure optimal patient care. The objective of this dossier is to provide an overview of common dermatological diseases in daily routine, with a focus on acute and chronic-inflammatory dermatoses. The most important dermatological diseases were sorted by three anatomic regions (face, trunk and lower leg), and an overview on the respective differential diagnoses is provided.

[Cutaneous involvement in chronic myelomonocytic leukemia--a possible indicator for transition into acute leucaemia]. / Kutane Beteiligung bei chronischer myelomonozytärer Leukämie: Ein möglicher Indikator für einen Übergang in eine akute Leukämie.

ANAMNESIS AND CLINICAL FINDINGS: A 83-year old patient with "myelodysplastic / myeloproliferative neoplasia", type chronic myelomonocytic leukemia (CMML), presented at our clinic with an intermittent bleeding, growing tumour located at the glabella. The tumour occurred after a trauma, and thus the suspected diagnosis was pyogenic granuloma. In the context of outpatient care, a severe and persistent bleeding occurred, so that the patient was hospitalized. EXAMINATIONS AND DIAGNOSES: Histopathological analyses of the excized tumour nodule revealed specific cutaneous leukemic infiltrates. Laboratory check-up showed thrombocytopenia with thrombocytopathy and hypofibrinogenaemia. THERAPY AND CLINICAL COURSE: Despite appropriate intraoperative hemostasis, sustained post-treatment bleeding occurred, necessitating the application of several erythrocyte concentrates as well as substitution of prothrombin, fibrinogen, and factor XIII. After stationary dismissal, the patient experienced a transition into acute myelomonocytic leukemia and died a short time thereafter. CONCLUSIONS: Skin lesions are frequent in "myelodysplastic / myeloproliferative neoplasias" and myelodysplastic syndromes. Specific cutaneous infiltrates associated with CMML may be a clinical indicator for a transition into acute leukemia.