Transonychial water loss in healthy and diseased nails.

The objective of this study was to determine the transonychial water loss (TOWL) in both healthy and affected nails in different diseases and to compare it with the transepidermal water loss (TEWL). TOWL was measured by a new evaporimetric method: Plasticine was used to fix the protection cover of the evaporimeter probe to the nails. The TOWL behaved contrary to the TEWL. Affected nails in patients with atopic eczema (p <0.01), psoriasis (p<0.05) and onychomycosis (p<0.001) showed a significantly lower TOWL than did nails of healthy test subjects. The decrease in TOWL in diseased nails in comparison to healthy nails could be due to the formation of a stratum granulosum in atopic, psoriatic or fungus-affected nails, as this layer is normally absent in healthy nails.

Immunohistochemical characterization of the perivascular infiltrate cells in tissues adjacent to stainless steel implants compared with titanium implants.

Metallic orthopaedics implants are composed of elements that are known to be skin sensitizers in the general population. In this study, we analyzed the cells of perivascular infiltration in the tissue adjacent to titanium (n = 23) and steel (n = 8) implants after explantation of the metals by immunohistochemical methods. The following panel of monoclonal antibodies were used as parameters: CD 1a (Langerhans cells), CD 4 (T-helper cells), CD 8 (T-suppressor cells), CD 11c (monocytes and macrophages), CD 45 RO (memory cells), CD 45 RA (naive cells), eosinophil cationic proteins (ECP), neutrophil elastase, and HLA-DR. The number of perivascular total cells did not differ significantly. All cells were identified in both metal subgroups, but a statistical difference was not seen in the above-mentioned parameters. We conclude that sensitization to metals is possible in the tissue adjacent to steel and titanium implants, because all cells which play an important role in allergic delayed-type hypersensitivity (type IV) reactions are present. This phenomenon may be called a 'pre-sensitization' phase, because no sensitization or allergic reactions were seen in our cases. Second, in the present study, a statistical difference was not seen in the number of infiltrate cells in the tissue adjacent to steel compared with titanium implants.

The 'atopy patch test' in evaluating the role of aeroallergens in atopic eczema.

The atopy patch test (APT) is a procedure involving epicutaneous patch tests with allergens known to elicit IgE-mediated reactions and the evaluation of eczematous skin lesions. APT can be performed on normal uninvolved skin without artificial manipulations such as tape stripping or use of irritants. APT has been standardized regarding the use of vehicle and dose response relationships. In several studies, approximately two thirds of patients with atopic eczema (AE) showed positive APT reactions to aeroallergens, most frequently to house dust mite. Positive APT reactions were significantly more frequent in patients with a typical air-exposed eczematous distribution pattern. Using evaporimetry to study transepidermal water loss, allergen-induced disturbance of epidermal barrier functions was found to be significantly more pronounced on APT reactions compared to classical contact allergy patch test sites in the same individual. It has been shown that with APT eczematous skin lesions can be elicited by skin contact with aeroallergens, at least in a subgroup of patients with AE, and thereby, that IgE-mediated allergy does play a role in the etiopathophysiology of this disease. Future studies should help to bring this test into clinical routine in order to establish an equivalent for 'skin provocation' comparable to nasal and bronchial provocation tests in respiratory allergy.

The early phase of epidermal barrier regeneration is faster in patients with atopic eczema.

BACKGROUND: Altered epidermal barrier function as determined by transepidermal water loss (TEWL) is a typical feature in patients with atopic eczema (AE). OBJECTIVE: The purpose of this study was to assess the kinetics of epidermal regeneration after barrier perturbation induced by two different stimuli, namely acetone treatment (removal of stratum corneum lipids) and tape stripping (removal of the nonviable stratum corneum). METHODS: Fifteen patients with AE and 12 nonatopic healthy controls were investigated. An area of 9.0 cm2 of clinically normal skin of the forearm flexural side was treated by acetone or tape stripping in a way that an increase in TEWL of 3.5-4.0 times the pretreatment value was achieved. TEWL was recorded directly after perturbation (tO), after 15 min (tl), 3 h (t2), 6 h (t3), 24 h (t4), 48 h (t5), 72 h (t6) and 96 h (t7). RESULTS: The speed of epidermal regeneration was faster after acetone treatment, both in the patient and the control groups, with no significant difference between the two. However, after tape stripping at points t2, t5 and t6, TEWL values relative to tO were significantly lower in atopic skin as compared to normal skin (p < 0.05). CONCLUSION: The faster regeneration of barrier function after tape stripping in patients with AE may be the result of a persisting mild disturbance of barrier function. It may be speculated that repair mechanisms are permanently activated, and therefore barrier recovery is faster. However, a complete restoration of the epidermal barrier function is not achieved, perhaps because of the decreased content of ceramides in atopic skin.

The disturbance of epidermal barrier function in atopy patch test reactions in atopic eczema.

Atopic eczema (AE) is a common skin disorder. Eczematous lesions showing macroscopic, microscopic and immunopathological resemblance to lesional AE can be induced by aeroallergens by epicutaneous testing (atopy patch test, APT). Altered epidermal barrier function, as determined by transepidermal water loss (TEWL), is a typical feature of patients with AE. The present investigation was performed to define the differences in the epidermal barrier function between positive APT reactions to aeroallergens and positive patch test reactions to contact allergens in AE patients. Allergen extracts from grass pollen, birch pollen, cat dander and house dust mite (Dermatophagoides pteronyssinus) were applied in large Finn chambers on Scanpor for 48 h on the clinically unaffected and untreated skin of the back, in 11 patients with AE. The same procedure was done with 27 contact allergens of a standard test battery. Test reactions were read and TEWL was measured after 48 and 72 h. Eight of the 11 patients developed positive APT reactions to D. pteronyssinus, two to cat dander and one to birch pollen. Seven of the 11 patients showed positive patch test reactions to nickel sulphate, two to potassium dichromate, one to thiuram-mix and one to paraphenylenediamine. Vehicle controls were negative. The TEWL of the positive APT reactions was significantly higher, both after 48 h (mean +/- standard deviation 10.0 +/- 6.5 g/m2h) and after 72 h (9.7 +/- 5.4 g/m2h) as compared with the control site (48/72h: 4.4 +/- 1.5/4.1 +/- 1.4 g/m2h) (P < 0.01). In contrast, TEWL of the positive patch test reactions to contact allergens (48/72 h: 5.4 +/- 2.2/5.4 +/- 1.9 g/m2h) was similar to that of the control site (48/72 h: 5.2 +/- 2.1/5.0 +/- 1.8 g/m2h) (not significant). The relative TEWL at 48 h and 72 h, expressed as the ratio between the positive patch test and the control site, was significantly higher in the positive APT reactions (48/72 h: 218.8 +/- 80.4%/232.0 +/- 85.9%) compared with positive patch test reactions to contact allergens (48/72 h: 102.1 +/- 12.0%/107.1 +/- 9.5%) (P < 0.01). It is concluded that the epidermal barrier function in AE patients is altered only in positive APT reactions, in contrast to positive patch test reactions to contact allergens. As a consequence of this aeroallergen-induced altered epidermal barrier function, further allergens can more easily penetrate the skin, inducing a vicious circle and perpetuating the eczematous lesions.

[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.

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.

Cross-sectional study of peripheral microcirculation in diabetic patients with microangiopathy: influence of pancreatic and kidney transplantation.

Diabetic vascular lesions and peripheral autonomic neuropathy are both closely linked to long-term metabolic control of diabetes. Transcutaneous oxygen tension (PtcO2) measurements were made to elucidate whether autonomic neuropathy disturbs the cutaneous microcirculatory blood flow, and whether long-term glucose normalization ameliorates such impairment. Twenty-eight type 1 (insulin-dependent) diabetic patients in whom clinically significant macroangiopathy had been excluded by angiography were studied, subdivided into group A (n = 14; before simultaneous pancreas/kidney transplantation (SPKT); mean age 35 years, range 22-51 years; mean duration of diabetes 24 years, (range 15-32) years and group B (n = 14; mean 31 months, range 2-101 months, after successful SPKT; mean age 35 years, range 19-56 years; mean duration of diabetes 22 years, range 14-29 years). On addition there was a group (group C) of age- and sex-matched healthy control subjects (n = 14; mean age 35 years, range 23-62 years). PtcO2 measurements included basal recordings at 44 degrees C on the leg and the foot, functional recordings at 44 degrees C after arterial occlusion of the limb for 4 min, measurements during breathing 5 l oxygen per minute and finally while standing up (stand up dP20/dt). All subjects underwent extensive cardiac autonomic testing. In this cross-sectional study the recordings of basal values and of the functional parameters after arterial occlusion and during breathing oxygen did not differ significantly between groups A, B and C.(ABSTRACT TRUNCATED AT 250 WORDS)