[Tattoos and permanent make-up: background and complications]. / Das sollten lhre Patienten vor der Tätowierung wissen. Cave: Tabus bei Tattoos.

Tattoos and permanent make-up have enjoyed great popularity during recent years. However, a careful consideration of the risks is made only rarely before each procedure. Above all the undefined pigment compositions create unforeseeable health and appearance problems. The family physician should be familiar with the techniques, materials, as well as the possible risks of tattoos and permanent make-up when advising patients. Medical complications include, among other things, infections, allergies, keloid and granuloma formation.

Mechanical properties of keloids in vivo during treatment with intralesional triamcinolone acetonide.

The mechanical properties of 17 keloids in 9 patients before and during treatment with intralesional triamcinolone acetonide were studied using a recently developed noninvasive suction device for measuring skin elasticity in vivo. Each keloid was treated with intralesional injections of 10 mg/ml triamcinolone acetonide without local anaesthetic at intervals of 3 weeks. A total of four measurements per keloid were performed, before treatment and 3 weeks after the first, second and third treatments. The parameters used were: immediate distension (Ue), delayed distension (Uv), immediate retraction (Ur) and final distension (Uf). Relative parameters independent of skin thickness were calculated: Uv/Ue, the ratio between the viscous and the elastic deformation of the skin, and Ur/Uf, representing the ability of the skin to return to its initial position after deformation (biological elasticity). After three injections of triamcinolone acetonide a marked decrease in Uv/Ue and a less-pronounced increase in Ur/Uf compared with baseline values was observed. These findings indicate that the main effect of intralesional steroids on the connective tissue of keloids is a decrease in viscosity due to a loss of ground substance. This method provides a noninvasive quantitative assessment of the mechanical properties of scars and is well suited to comparative studies on the efficacy of various scar therapies.

An unusual cutaneous T cell lymphoma presenting as leonine facies.

We report an unusual case of a cutaneous T cell lymphoma with the clinical picture of leonine facies as the only skin symptom appearing during the first years of the disease. Small atypical lymphocytes with partly pleomorphic, partly indented cerebriform nuclei are present in the facial skin as well as in the peripheral blood and in the bone marrow. The lymphoma shows an indolent clinical behaviour without rapid progression of the disease. It shares features with both pleomorphic small/medium-sized T cell lymphoma and mycosis fungoides, but cannot be classified according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC) Classification for Primary Cutaneous Lymphomas. At present the lymphoma has to be ranged among the group of so-called unspecified peripheral T cell lymphomas according to the proposal of the International Lymphoma Study Group.

[Modern methods of acne therapy]. / Moderne Methoden der Aknetherapie.

Today the treatment of acne vulgaris offers a broad spectrum of topic and systemic therapeutics. With these a optimal therapy in different acne-phases is practicable, and the possibility of scar formation is inhibited. The particular groups of substances are discussed regarding indication, action and contraindication.

[Halo eczema and nevus cell nevi (Meyerson nevi)]. / Halo-Ekzeme um Nävuszellnävi (Meyerson-Nävi).

In the same way as a halo of depigmentation surrounds a sutton naevus, a halo of eczema can appear around a naevocellular naevus. This phenomenon was first described in 1971 by Meyerson, but publications on the topic are relatively sparse. We report a patient who consulted us because of such lesions. A review of literature is appended.

[Congenital osteoma of the skin. Attempt at diphosphonate therapy]. / Kongenitales Osteoma cutis. Versuch einer Diphosphonat-Therapie.

Plaque-like congenital osteoma cutis was treated with disodium etidronate. We could not prove, however, any definitely positive effect.

[Autosomal dominant genetic dermatoses and their association with internal cancers]. / Autosomal dominante Genodermatosen und ihre Assoziation mit internen Karzinomen.

In this short review we attempt to high-light a number of syndromes in which the observant physician can occasionally diagnose a cancer-associated syndrome prior to development of internal malignancy and aid the patient and his physician in appropriate management, be it closer monitoring or therapeutic interventions.

[Association of idiopathic acropustuloses to HLA antigens and their relation to psoriasis]. / Assoziation der idiopathischen Akropustulosen zu HLA-Antigenen und deren Beziehung zur Psoriasis.

Immunogenetical findings can contribute to the understanding of diseases of unknown etiology. It has, however, become difficult to define the borderlines between related diseases, since a vast amount of individual facts have been reported. For this reason, immunogenetical findings should only be seen as a part of general pathology. Our study, which makes use of HLA markers, is an attempt to provide a better definition of idiopathic acropustulosis, and to differentiate it more clearly from psoriasis.

[Osteoma cutis. Pathogenesis and therapeutic possibilities]. / Osteoma cutis. Pathogenese und therapeutische Möglichkeiten.

No efficacious therapy for the treatment of increasing and spreading cutaneous ossification is yet established. We report a 52 year old white female with multiple miliary osteomas of the skin involving face, chest and back. The patient has a history of acne vulgaris. A therapeutic trial with a diphosphonate (etidronate disodium) was started in order to stop marked progression and appearance of new lesions. In accordance with the two previously described cases of the literature we failed to achieve any improvement. Clinical features, etiology, classification and therapy of osteoma cutis are discussed.

[Stewart-Bluefarb syndrome]. / Das Stewart-Bluefarb-Syndrom.

We describe a 17-year-old Turkish girl with painful ulcerative pseudo-Kaposi lesions on the left foot and partial giant growth of the same leg. Stewart-Bluefarb syndrome is discussed with reference to this case.

[Paraffinoma of the penis]. / Paraffinome des Penis.

Paraffinomas of the male genitalia are now rare. We report on a Russian patient with subcutaneous nodules of the penis and the prepuce. Injections of exogenous lipids into the male genitalia are still performed in many Eastern European countries. Thus, a paraffinoma should be considered in the differential diagnosis of subcutaneous nodules of the male genitalia in patients from these areas.

[Congenital, plaque-like osteoma of the skin in an infant]. / Angeborenes plattenartiges Osteoma cutis bei einem Säugling.

A plaque-like cutaneous osteoma in a male infant is described and compared with 12 remarkably similar cases from the literature. An important differential diagnosis is that of pseudohypoparathyroidism and it has to be excluded by the examination of the calcium and phosphorus metabolism. There are two possible explanations for the etiologie of osteoma cutis, an osseous hamartom, or a metaplasia of mesenchym cells. Because of some important reasons we prefer the hamartom concept.

Effectiveness of LPG treatment in morphea.

BACKGROUND: The LPG technique, also known as Endermology treatment, is a noninvasive technique consisting of a tissue mobilization process in which a skin fold is created between two rollers, stretching the underlying tissue and mobilizing the fold. The LPG technique is very effective in treating scars. Because the lesions of morphea or circumscribed scleroderma are similar to atrophic scars, it seemed reasonable to treat them with a method proven helpful for scars. MATERIALS AND METHODS: We treated 17 lesions of 10 patients (four males and six females) with the diagnosis of morphea ranging in age from 17 to 78 years (mean age 55 years) and investigated and documented the evolution of their lesions and changes in their quality of life. RESULTS: In all patients there was a large improvement in the clinical appearance of the lesions, the induration and the pain. Elasticity was particularly increased, not only based on clinical findings but also as documented with objective assessment. The acceptability of the treatment was good and the patients reported an improved quality of life. CONCLUSION: The LPG technique (Endermology) is an adjunctive treatment for morphea. It cannot eliminate the disease but can relieve the pain, soften the skin and improve the quality of life for these patients.

Seasonal variations in the severity of acne vulgaris.

BACKGROUND AND OBJECTIVE: The improvement of acne in summertime or the aggravation of acne in winter is a traditional dermatologic opinion. Ultraviolet rays are thought to be beneficial in the treatment of acne. In the existing literature there is no proof of this. The purpose of this study was to find out whether or not acne generally worsens in winter. PATIENTS AND METHOD: One hundred and thirty-nine patients were asked if their acne worsens in winter or in summertime, whether it improves seasonally, or if they didn't notice any change with the seasons. RESULTS: About one-third of the patients reported an aggravation of their acne in winter, but also approximately one-third of the patients complained about an aggravation of their acne in summer. Another third did not notice any change. CONCLUSIONS: Sun-bathing may be beneficial for psychologic reasons and may produce euphoric effects, but we do not see any reason to treat acne with ultraviolet radiation because of all its negative effects on the skin.

Which direction do nevus cells move? Abtropfung reexamined.

In 1893, Unna published his theory of Abtropfung in which he suggested that melanocytic nevus cells originate in the epidermis and drop off into the dermis. We studied 3,534 nevi from patients of all ages to reassess this almost sacred concept. If Unna was correct, one would expect that in childhood most nevi would be junctional, while in late adult life almost all nevi would be intradermal. In our series, no child under age 10 had a purely junctional nevus, 52% had compound nevi, and 48% had dermal nevi. In patients older than age 60, 12% had junctional nevi, 23% had compound nevi, and 65% had dermal nevi. Our data fail to support the concept of Abtropfung; they fit better with the contradictory theory of upward migration of nevus cells.

Abnormal cutaneous nerves in incontinentia pigmenti.

Cutaneous nerves showed multiple ultrastructural abnormalities in a patient with incontinentia pigmenti. Fetal nerve bundles were seen both in the dermis and entering the epidermis. A cell with some Schwann cell features was identified above the basal layer amid keratinocytes. Dermal melanophages were in close apposition to Schwann cells. All of these features suggest that neural structures may be abnormal in incontinentia pigmenti and play a role in transfer of melanin from epidermis to dermis.