An objective assessment of melanin in vitiligo skin treated with Balneo PUVA therapy.

BACKGROUND: Visual clinical methods of skin color evaluation for diagnostic purposes are so far mostly subjective and thus inaccurate. We present a modified method of melanin amount measurement based on diffuse reflectance spectroscopy (DRS). This method is non-invasive and objective, and allows easy quantification and comparison of melanin levels. MATERIAL AND METHODS: Skin pigmentation was measured by DRS method in 0-18 year old patients at the Department of Pediatric Dermatovenerology, School of Medicine Comenius University Bratislava. Patients were treated for their vitiligo by Balneo PUVA treatment twice weekly. Each patient had measured his remittance spectra from the treated vitiliginous skin before the treatment was started, after 10 irradiations of Balneo PUVA and at the end of the treatment after 25 irradiations of Balneo PUVA. In our study as a reference skin for spectroscopic assessment of melanin in vivo was used the averaged remittance spectra (measured on the inner arm) from the sample of 10 albino patients. The remittance spectra obtained from the vitiligo patients were ratioed against the newly described remittance reference albino skin. We exploited the linear behavior of the spectral curve in the 620-720 nm interval (significant for melanin absorption) and used the slope of the regression line to compute the quantification index α. RESULTS: By clinical examination before the Balneo PUVA therapy, after the 10th dose of Balneo PUVA therapy as well as at the end of the complete course of Balneo PUVA therapy (after 25 irradiations) we recorded a marked increase of pigmentation in all treated patients for their vitiligo. In each patient the values of melanin quantification angle α were calculated. Statistically we found a significant difference between the melanin quantification angle α in vitiliginous skin before, during the 10th dose of treatment and after the treatment. Similar significant difference was also observed between treated and non-involved skin. We could confirm a clear association between clinical visual examination of treated vitiligo lesions, objective data collected by DRS and melanin quantification angle α. CONCLUSIONS: By using a new standard for the reference skin (albino skin) we could more exactly compare melanin levels in different subjects. Our proposed melanin quantification angle α expresses the extent of the difference in melanin levels between the examined skin lesions. We successfully used this index to quantify the variations of melanin (progress of repigmentation) throughout different stages of treatment of the same lesion and also to objectively evaluate the final effect of the therapy. In the present study, we showed that the diffuse reflectance spectroscopy (DRS) may be suitable method to measure skin colour and the content of human skin melanin in vivo.

2014 European guideline on the management of syphilis.

BACKGROUND: Syphilis remains a major public health problem in Europe (both in Eastern Europe since the 1990's and in Western Europe since the re-emergence of the disease in the late 1990's-early 2000's). METHODS: This guideline is an update of the IUSTI: 2008 European guideline on the management of syphilis and is produced by the European Guideline Editorial Board (http://www.iusti.org/regions/Europe/pdf/2013/Editorial_Board.pdf) and EDF Guideline Committee. RESULTS: It provides recommendations concerning the diagnosis and management of syphilis in Europe. Major advances include (1) broader use of PCR, immunohistochemistry, subtyping of the etiological agent Treponema pallidum subspecies pallidum, new treponemal tests, and rapid-point-of-care (POC) tests detecting both treponemal and non-treponemal antibodies, (2) more flexible options for screening (TT-treponemal test- first or NTT -non treponemal test- first or both TT and NTT), and (3) procaine penicillin is no longer the first line therapy option in any phase of the disease, i.e. long acting penicillin G (i.e. benzathine penicillin G-BPG) is the only first line therapy regimen in early syphilis and in late latent syphilis. CONCLUSIONS: Syphilis is a disease that is relatively easy to detect by appropriate serological tests, however, all laboratory results should be considered together with clinical data and sexual risk anamnesis. Syphilis is also easy to treat with BPG. A major concern about the supply of BPG in many European countries could threaten the efficacy of the policies of eradication of the disease in Europe.

In vivo skin imaging for hydration and micro relief-measurement.

THE AIM: We present the results of our work with device used for measurement of skin capacitance before and after application of moisturizing creams and results of experiment performed on cellulose filter papers soaked with different solvents. METHODS AND RESULTS: The measurements were performed by a device built on capacitance sensor, which provides an investigator with a capacitance image of the skin. The capacitance values are coded in a range of 256 gray levels then the skin hydration can be characterized using parameters derived from gray level histogram by specific software. The images obtained by device allow a highly precise observation of skin topography. CONCLUSION: Measuring of skin capacitance brings new, objective, reliable information about topographical, physical and chemical parameters of the skin. The study shows that there is a good correlation between the average grayscale values and skin hydration. In future works we need to complete more comparison studies, interpret the average grayscale values to skin hydration levels and use it for follow-up of dynamics of skin micro-relief and hydration changes (Fig. 6, Ref. 15).

[Methods and means for pigmentation and depigmentation. Sense or nonsense?]. / Methoden und Mittel zur Pigmentierung und Depigmentierung. Sinn oder Unsinn?

Treatment of hyperpigmentation disorders can be a lengthy process. There are several topical treatment options and hydroquinone is the most frequently used. Both combination and monotherapy are employed. These treatment options apply primarily to epidermal hyperpigmentation disorders. Dermal hyperpigmentation disorders cannot yet be effectively managed with currently available therapeutic approaches. Cosmetic disfigurement caused by hypomelanosis, especially vitiligo, can constitute a serious impairment for the patient. So far there is no definitive remedy. Better cosmetic results are generally reported for combination therapies.

Confocal laser-scanning capillaroscopy: a novel approach to the analysis of skin capillaries in vivo.

BACKGROUND: New techniques for diagnostics and therapy in dermatology are becoming increasingly non-invasive, among which confocal laser-scanning microscopy (CLSM) is the most prevalent. It allows visualization of cellular structures of the skin up to a depth of 300 microm in vivo. Until now, most studies have been conducted on pathologically altered skin, mostly oncologic lesions. We now present a detailed analysis of capillaries located in the upper dermal papillae. METHODS: Multiple measurements were performed on the dorsal and ventral surface of the right forearm of 30 healthy volunteers (22-88 years) under standard conditions (room temperature, body position, time of day). Images were obtained with the Vivascope 1500 (Lucid) under standard settings and analyzed using the freeware ImageJ with a customwritten macro plugin. The following parameters of the capillaries in vivo were measured: area, perimeter, circularity and maximum diameter. RESULTS: Statistical analysis showed that all four parameters were constant within a narrow range, regardless of the body site, sex and age. In this physiological study, we can clearly demonstrate that by confocal laser-scanning capillaroscopy (CLSC), it is possible to visualize and measure skin capillaries at the extremities in a reproducible manner. CONCLUSION: This new approach offers a considerable advantage compared with nailfold capillaroscopy, which can only be performed at the proximal nail segment, and over histological analysis, which can be hampered by fixation artifacts resulting in altered size and shape of the vessels to be analyzed. CLSC could allow for precise analysis of in vivo skin vasculature in systemic and proliferative diseases of the skin.

[Adverse effects and side-effects of antimycotic agents]. / Neziaduce a vedl'ajsie úcinky antimykotík.

The study lays emphasis on the significance and actuality of infections, especially in coincidence with immunodeficient states. Candidosis, mycotic diseases caused by moulds, systemic mycoses, and onychomycoses represent the major problems of modern mycology. They require usually a long-term therapy by means of highly active antimycotics. Consequently, an entire series of undesirable side-effects supervene. External applications result most frequently in contact eczemas and therefore often require preventive patch tests. Oral administration results in general hepatic, renal, hematologic and other impairments which require the monitoring of the latter parameters during therapy. Finally a considerable significance is ascribed to interaction with other simultaneously applied drugs with the antimycotics. (Tab. 1, Ref. 83.)

[Vitiligo--an enigmatic disease. II. Therapy of vitiligo]. / Vitiligo--záhadná choroba. II. Liecba vitiliga.

The work gives a review of therapeutic methods of vitiligo. PUVA therapy, application of cortisonoids, khellin (including UVA), phenylalanine (including UVA), melagenina, and laser therapy represent non-surgical methods. Surgical methods include application of fluorouracil following dermabrasion, of autologous epidermal grafting transplantation of in vitro cultured epidermis, in vitro cultured melanocytes and micropigmentation by pigment. Auxiliary methods are represented by administration of carotene, using sunscreens and if necessary cosmetic treatment. Entire depigmentation is done in accordance with the extent of vitiligo, unsuccessful repigmentation and the age of the patient. The conclusion points out psychosocial aspects and the necessity of mutual cooperation of both, physician and patient. (Ref. 53.)

Long-term trends of the incidence of syphilis and gonorrhoea in the Slovak Republic during 1947-1994, with special regard to young age groups.

During the Second World War and after the War venereal diseases (Syphilis and Gonorrhoea) were wide-spread. By a single census in October 1947 were notified 2960 syphilitic patients. In the years 1949-1951 intensive and effective preventive measures were introduced as compulsatory notification system of venereal diseases, sexual contact-tracing investigations, correct and rapid diagnosis of venereal diseases, rapid and efficient therapy of patients with syphilis, followup (post-treatment observations) for all patients, routine serological tests for syphilis, in expectant mothers at ante-natal clinics, periodical screening of high-risk groups, patients in each calendar year at their hospitalization, to taking up a post and a special drive against syphilis ("PN-action"). The results of these measures are manifested by substantial fall in the number of cases of syphilis and gonorrhoea. In the years 1948-1955 18,151 patients suffering from syphilis were notified. The changes of the incidence of syphilis and gonorrhoea are illustrated by statistical data (Tab. 1-9). Syphilis congenita occurs sporadicly, there is a substantial fall in the number of syphilitic pregnant. After 1989 there has been a greater group mobility and a substantial rise in active and passive tourisms and occupational travel activity, especially abroad. Changes of the sexual behaviour were expressed, especially a greater tolerance whether heterosexual or homosexual, sexual freedom, sexual promiscuity and especially prostitution.

Development of cutaneous tolerance to ultraviolet B during ultraviolet B phototherapy for psoriasis.

During a schedule of multiple exposures to ultraviolet B radiation (UVB, 280-320 nm), skin develops a reduced sensitivity, variously called tolerance, photoadaptation, accommodation or acclimatization. In this study we have investigated the development of tolerance in the normal skin of a group of psoriatic patients during the course of UVB therapy. Tolerance was assessed by phototests carried out on non-lesional skin as frequently as possible throughout the treatment. Maximum tolerance was developed by the group of individuals most sensitive to UVB, which was twice that of the least sensitive group. The minimal perceptible erythema dose (MPE) increased rapidly in the first 2 weeks (220% per week) and reached a plateau by the eighth week of 800% above the baseline MPE dose. For the more sensitive patients there was a further increase in sensitivity (decrease in MPE dose) after the ninth week of continuous treatment. Tolerance to UVB also involves pigmentation in the first few weeks, but in these patients there was no evidence of hyperpigmentation by the end of treatment. While epidermal hyperplasia is most likely to play a leading role in the development of tolerance to UV, there is no reason to expect this protection to decrease under conditions of continuous exposure. Thus, accommodation to ultraviolet radiation (UVR) is not a monotonically increasing process but appears to alter the accepted reactions of human skin to UVR.