Cicatricial Alopecia Related to Folliculotropic Mycosis Fungoides.

Folliculotropic mycosis fungoides (FMF) is a particular subtype of mycosis fungoides (MF), characterized by an infiltration of neoplastic CD4+ T cells in the epidermis which can spread to all follicular structures, sebaceous glands, sweat glands and hair follicles. Clinically, FMF can exhibit various cutaneous symptoms. However, these symptoms often occur on the scalp, face and neck, which are rarely affected by conventional MF. We report cicatricial alopecia in a patient with FMF as alopecia lymphomatica. This peculiar symptom should be kept in mind as a critical differential diagnosis of scarring alopecia, leading to further investigation. Thus, an early diagnosis of FMF may be obtained.

[Sarcoidosis, myasthenia gravis and anterior ischaemic optic neuropathy: severe side effects of adjuvant interferon-alpha-therapy in malignant melanoma?]. / System-sarkoidose, Myasthenia gravis und anteriore ischämische Optikusneuropathie: schwere Nebenwirkungen unter adjuvanter Interferon-alpha-Therapie bei malignem Melanom?

In dermato-oncology, interferon-alpha is widely used as treatment of cutaneous lymphoma and as adjuvant therapy in high risk malignant melanoma. With increasingly wide administration of interferon-alpha (IFN-alpha), not only early-onset side effects, such as influenza-like symptoms, but also uncommon late-onset side effects are being recognized. We present three patients with melanoma who developed rare side effects in the course of adjuvant IFN-alpha-therapy: sarcoidosis, myasthenia gravis and anterior ischaemic optic neuropathy. Based on current knowledge a causal relationship between these diseases and the administration of IFN-alpha can neither be affirmed or absolutely ruled out. Therefore special attention should be paid to such coincidences.

[Photodynamic therapy with methylaminooxopentanoate (Metvix) and a broad band light source (PhotoDyn 501): practical experiences in problem-patients with actinic keratoses and basal cell carcinomas]. / Photodynamische Therapie mit Methylaminooxopentanoat (Metvix) und einer Breitbandlichtquelle (PhotoDyn 501): Praktische Erfahrungen bei Problem-patienten mit Aktinischen Keratosen und Basalzellkarzinomen.

BACKGROUND: Actinic keratoses (AK) and basal cell carcinomas (BCC) may represent a therapeutic challenge because of special subtypes, location, previous therapy or accompanying diseases. Photodynamic therapy (PDT) offers a semi-conservative treatment option for selected indications. PATIENTS AND METHODS: 28 outpatients who had been admitted as complicated dermato-oncologic cases because of AK (n = 22) and BCC (n = 6) were treated with PDT, using methylaminooxopentanoate (MAOP, Methyl-Ala, Metvix) and a broad band light source (PhotoDyn 501). The treatment was evaluated for efficacy and subjective tolerance (local discomfort and pain). RESULTS: A complete remission (CR) was achieved in 11/22 AK (50%) and 4/6 BCC (67%) cases. All three cases of a superficial BCC subtype underwent a CR. Among responders, tolerance was good in 12/15 cases (80%), as compared to 4/13 cases (31%) in non-responders. Focusing on 16/28 patients with good tolerance (57%), there was a CR in 12 cases (75% rate), whereas for the 12/28 patients with moderate to poor tolerance a CR was achieved in only 3 cases (25% rate). In a subgroup of 8 patients who, partly due to secondary diseases, were taking systemic retinoids or immunosuppressive-cytostatic medications, a CR was achieved in 3/8 cases (38%) with a good tolerance in only 1/8 cases (13%). CONCLUSION: These observations confirm a good efficacy and tolerance of PDT in > or = 50% of a AK/BCC problem patient cohort. We found indications for 1) a positive correlation between efficacy and subjective tolerance as well as 2) the presumptive existence of a retinoid-dependent cutaneous PDT hyperalgesia. Effective pain control seems to be an essential cofactor for the success of PDT.