[Subungual keratoacanthoma]. / Subunguales Keratoakanthom.

Subungual keratoacanthomas (SKA) differ in clinical presentation, biological behaviour and the therapy needed from keratoacanthomas in other localizations. Against the backdrop of two personal observations and a review of the literature, the authors describe clinical and histological features and also the differential diagnosis and therapy and this rare benign neoplasm. Patients present with a rapidly growing, painful subungual mass, which causes destruction of the underlying bone and usually does not regress spontaneously. Histological differentiation from squamous cell carcinoma is essential as the prognosis and treatment are different. SKA is treated by local excision and curettage. Erosions of the underlying distal phalanx usually heal spontaneously. However, persistent recurrences after subtotal excision often necessitate amputation of the distal phalanx.

[Chloroacetophenone allergy]. / Chloracetophenonallergie.

Chloroacetophenone (CN) is used as a tear gas for riot control and as a kind of chemical Mace against small groups or individuals. Among other side-effects, CN can evoke toxic and allergic contact dermatitis, and more rarely exanthematous or anaphylactic reactions. It is difficult to distinguish between toxic and allergic reactions both in the clinical picture of dermatitis as well as on the basis of skin test reactions. We report on a patient with allergic contact dermatitis, which first appeared 5 days after exposure to CN as a sign of primary sensitization, leading to an intense eczematous reaction in skin tests. Allergy to CN does not appear to represent a handicap in normal daily life because it is solely used as tear gas and is of little significance as regards "cross-allergies" to substances in the environment.

Thymopentin treatment of herpes simplex infections. An open, monitored, multicenter study.

Twenty-seven patients suffering from long-standing, severe, recurrent herpes simplex (14 labial and 13 genital) who had not responded adequately to prior therapy were recruited for this open, monitored study. They were treated with thymopentin 50 mg subcutaneously three times weekly for a period of 6 weeks. Clinical controls were performed once a week and then again 6 weeks after cessation of therapy; laboratory investigations were done at time points 0, 3, and 6 weeks. Additionally, information was collected with regard to the clinical course during the following year. Thirteen of 14 patients with labial infection and 10 of the 13 with genital herpes improved markedly (p less than 0.05) as shown by decrease in the relapse rate of at least 50%, shorter relapse episodes, and improvement of symptoms such as pain and itching. Fourteen of these 27 patients experienced no relapse for a period longer than 4 months after cessation of therapy. These favorable results were paralleled by a statistically significant increase in the T cell helper/suppressor ratio. This finding indicates that thymopentin acts as an immunodomulator; it is assumed that the activation of T helper cells induces-presumable via interleukin 2-the proliferation of cytotoxic T lymphocytes and natural killer cells which play a major role in the natural immune defense. No serious side effects of thymopentin were recorded.

[Anti-inflammatory effect and tachyphylaxis of systemic and combined systemic-topical treatment with corticosteroids in the pyrexal erythema test]. / Antientzündlicher Effekt und Tachyphylaxie bei systemischer und kombinierter systemisch-topischer Kortikosteroidbehandlung im Pyrexal-Erythem-Test.

On account of clinical experience as well as experimental findings, we noticed subsiding anti-inflammatory and antiproliferative effects of topical corticosteroids after regularly repeated application. Following four-day's oral therapy with methylprednisolone 40 mg daily, the pyrexal erythema test did not reveal any decrease of anti-inflammatory effect in six volunteers. The efficacy of this therapy was similar to that of occlusive topical therapy with 0.25% desoxymethasone ointment. The anti-inflammatory effect of systemic steroid treatment could even be slightly increased by additional topical steroid therapy.

[Eprazinone exanthema with subcorneal pustulosis]. / Eprazinonexanthem mit subkornealer Pustelbildung.

A drug eruption with subcorneal pustulation is presented, occurring in a patient during treatment with eprazinone . The biopsy of the initial lesions showed changes as in pustulosis subcornealis . The aetiopathogenetic relationship between administration of eprazinone and the pustular eruption was confirmed by patch test.

The effect of thymopentin treatment on the relapse rate in frequently relapsing herpes simplex virus infections.

Twenty-four patients suffering from longstanding severe recurrent herpes simplex, who had not responded to prior therapy, were treated with s.c. thymopentin injections 50 mg, three times weekly, over a period of six weeks. They were followed up at weekly intervals over this period and then six weeks later. Moreover, the longest relapse-free period observed in the year after the treatment was recorded in the investigator's documentation. Thirteen of the 14 patients with labial herpes simplex and 10 of the 13 patients with genital herpes simplex improved markedly as shown by a decrease in the relapse rate of at least 50%, shorter episodes of relapse and improvement of symptoms such as pain and itching. Fourteen of these 27 patients experienced no relapse for a period longer than four months after cessation of the therapy. No serious side-effects were observed. Laboratory examinations before, during and after thymopentin did not reveal significant alterations except for an increase in the T-helper/T-suppressor ratio. The effect of thymopentin is assumed to be due to T-helper cell activation resulting in enhanced interleukin-2 production with subsequent proliferation of cytotoxic T lymphocytes and natural killer cells which are capable of producing immune interferon.

[Pathogenesis of acrokeratosis Bazex]. / Pathogenetischer Beitrag zur Akrokeratose Bazex.

A 67-year-old male patient with typical signs of acrokeratosis Bazex is presented. The psoriasiform skin lesions appeared 9 months after diagnosis of an oesophagus neoplasm. Clinically there was a marked hepatopathy but no signs of metastases. Histological, immunofluorescence-histological, and ultrastructural findings revealed a capillaritis with humoral as well as cellular inflammation. With treatment of the neoplasm the paraneoplasia regressed under additional treatment with topical steroids. The vitamin A deficit could not be normalized by oral or parenteral vitamin A substitution. We discuss some mechanisms in formal pathogenesis.

Hyperparathyoidism: influence of glomerular filtration rate on urinary excretion of cyclic AMP.

Urinary cyclic AMP excretion per 24 h or per g creatinine in primary hyperparathyroidism (1 degrees HPT) has been evaluated by several authors with conflicting results. In 50 patients with 1 degrees HPT, 25 patients with secondary (2 degrees) HPT and 35 healthy control persons we determined urinary cyclic AMP per 24 h or per g creatinine. These parameters did not satisfactorily discriminate patients from controls, especially when glomerular filtration rate (GFR) as determined by creatinine clearance was reduced. Since urinary cyclic AMP is derived from plasma by glomerular filtration and from kidney by tubular production-the amount of tubules is reflected by GFR-the cyclic nucleotide was related to GFR. In controls urinary cyclic AMP correlated better with GFR than with creatinine excretion. Additionally, in 45 of 50 patients with 1 degrees HPT and in all with 2 degrees HPT, urinary cyclic AMP/GFR was raised. In 1 degrees HPT serum levels of parathyroid hormone correlated closer with urinary cyclic AMP/GFR than with urinary cyclic AMP/g creatinine. The ratio cyclic AMP/GFR decreased to normal or subnormal values after removal of adenomatous or hyperplastic glands in 1 degrees HPT and during infusion of calcium in 2 degrees HPT. In 50 patients with renal lithiasis caused by diseases other than 1 degrees HPT (anatomical variations, pyelonephritis, immobilization after tetraplegia) the ratio cyclic AMP/GFR was not raised. Urinary cyclic AMP/GFR, therefore, reflects parathyroid hormone excess more reliably than cyclic AMP/g creatinine.