Cutaneous mucinosis of infancy: is it a real entity or the paediatric form of lichen myxoedematosus (papular mucinosis)?

We describe a girl presenting with a childhood dermal mucinosis in which we had the unique opportunity to find all the transitional histological features of lichen myxoedematosus (papular mucinosis), from its early focal mucin deposition in the reticular dermis to its late findings of interstitial mucin deposition, dermal fibrosis and fibroblast proliferation. Her father reported having had similar lesions when he was a child, which completely disappeared during adolescence. This case, and a re-evaluation of the literature, suggests that cases of cutaneous mucinosis of infancy that are not hamartomatous conditions such as mucinous naevi are in fact the infantile presentation of lichen myxoedematosus (papular mucinosis) and, in addition to other cases in the literature, suggests a genetic and familial factor in lichen myxoedematosus (papular mucinosis).

[Prospective detection of important bacterial pathogens in pyoderma and their in vitro antibiotic susceptibility]. / Prospektive Erfassung wichtiger bakterieller Erreger von Pyodermien und deren In-vitro-Antibiotikaempfindlichkeit.

BACKGROUND AND OBJECTIVE: For rational therapeutic recommendations the spectrum and resistance of bacteria in skin diseases were investigated. PATIENTS/METHODS: Within 4 months 911 swabs of dematoses possibly caused by bacteria were taken prospectively (481 outpatients, 430 inpatients) and the material cultured on standard media. The positive cultures including resistance screening of 210 swabs of 168 outpatients and of 175 swabs of 85 inpatients could be evaluated, the remaining cultures were sterile. RESULTS: Staphylococcus aureus was the most frequent pathogen (outpatient 67%, inpatient 61% of all positive cultures), followed by streptococci (groups A and B; 25%). In patients Pseudomonas aeruginosa was the most common pathogen in leg ulcers and between the toes (45% and 70% respectively). 13% of the Staphylococcus aureus isolates were resistant to tetracyclines and erythromycin; one strain proved to be methicillin resistant. CONCLUSIONS: Cephalosporins (I. generation), penicillins with beta-lactamase-inhibitors, and to a lesser extent isoxazoyl-penicillin and clindamycin can be recommended for the treatment of skin infections. Oral quinolones are suited for infections with gram-negative bacteria (such as bewteen the toes). The indications for systemic antibiotic therapy of leg ulcers should be restricted.

[The UV record. Document for quality control, therapy planning and risk assessment in dermatologic photo- and photochemotherapy]. / Der UV-Pass. Instrument der Qualitätskontrolle, Therapieplanung und Risikoabschätzung bei dermatologischer Photo- und Photochemotherapie.

Ultraviolet (UV-) radiation therapy as a mono- or combination therapy (UV-A, UV-A1, UV-B, SUP, UV-B311) or as photochemotherapy with photosensitization (systemic PUVA-, bath PUVA-, topical PUVA-therapy) are successfully used for the treatment of several dermatological disorders. Long-term side effects of natural UV (sun light) include photoaging and induction of skin tumors. At present, the relevance of in-vitro findings of potential tumor induction in animals through therapeutic levels of UV radiation is a matter of debate. To assess these risks, information on treated location, kind of UV radiation and cumulative UV doses are required. Practically this information is barely accessible. This makes decisions on possible therapies difficult. To solve this problem we propose to use an "UV pass". At the end of each UV radiation cycle, the body location, the type of radiation and the cumulative dose are documented and this pass is given to the patient. This will improve the information transfer if the doctor is changed, as well as facilitating decisions about certain therapies and calculation of long-term risks of UV radiation. Finally it will improve the quality of UV photo- and photochemotherapy.

Chlamydia trachomatis and male infertility: chlamydia-IgA antibodies in seminal plasma are C. trachomatis specific and associated with an inflammatory response.

BACKGROUND: There is controversy over the role of asymptomatic genital tract infection by Chlamydia trachomatis, its optimal diagnosis, and its place in the etiology of male infertility. OBJECTIVE: Comparison of direct detection of Chlamydia trachomatis in semen with the presence of chlamydia-antibodies in seminal plasma and serum, together with parameters of the spermatogram, in men of infertile relationships. STUDY DESIGN: Prospective clinical study. SETTING: University hospital tertiary referral center. SUBJECTS AND METHODS: Two groups of consecutive andrological patients (n = 89 and n = 36) were investigated as follows: semen analysis, including concentration of granulocyte-elastase; detection of C. trachomatis in semen samples and first void urine by polymerase chain reaction (PCR) and antigen-ELISA (Celisa); detection of chlamydia antibodies in serum and seminal plasma by recombinant antibody-enzyme-linked immunosorbent assay (rELISA) and of Chlamydia trachomatis specific antibodies by the ImmunoComb-Chlamydia-Bivalent test. RESULTS: In 2/125 (1.6%) semen samples Chlamydia trachomatis DNA was detected by PCR. Genus specific anti-chlamydia-IgA was found in 12/122 (9%) of the seminal plasmas. This IgA appeared to be specific for C. trachomatis. Seminal plasmas with chlamydia-IgA antibodies showed higher PMN-elastase levels than IgA negative samples (P < 0.04). Chlamydia-IgG antibodies were present in 27/89 (30%) of the sera, but in only five of these 27 sera (19%) were the antibodies detected specific for C. trachomatis. There were no associations between any of these variables and the parameters of the routine semen analysis. CONCLUSION: IgA-chlamydial antibodies in seminal plasma appeared to be specific against C. trachomatis and were associated with an inflammatory response in the male genital tract.

Discontinuous electrokinetic chromatography of parabens using different substituted resonances as pseudostationary phases.

Resorcarene derivatives, negatively charged even at moderate pH, were synthesized and employed as pseudostationary phases to achieve mobilities exceeding that of the electroosmotic flow. Under these conditions, a discontinuous electrolyte system was developed which allows the separation of four uncharged homologous 4-hydroxybenzoic esters (parabens) within a zone of resorcarene electrolyte, and the detection of these UV active compounds in a resorcarene-free zone, free from the high UV background absorbance of the resorcarenes. Resorcarenes, with differently charged functionalities (carboxylate and phosphate groups) to provide the electrophoretic mobility and with alkyl residues of different chain lengths responsible for the chromatographic interactions with the analytes, were tested and compared in terms of mobility and selectivity. Only the resorcarene phosphates exhibited sufficient mobilities at low pH exceeding the mobility of the electroosmotic flow (EOF). Retention factors of the parabens were found to increase with increasing chain length of the alkyl residues attached to the resorcarene. However, maximum selectivity was observed for an intermediate chain length (C8). An equation for the calculation of retention factors in discontinuous electrokinetic chromatography (EKC) is presented.

CD 45/67 immunobead preparation of human semen activates granulocytes.

In human semen reactive oxygen species (ROS) produced by spermatozoa or leukocytes can impair spermatozoa functions. The objective of this study was to assess the effects of CD 45- and/or CD 67 immunobead preparation on the chemiluminescence (CL) of seminal plasma free ejaculate cells (= original cell suspension), as well as of the spermatozoa and leukocyte fractions. The original cell suspensions of 68 infertile and 8 fertile men were incubated with CD 45 or CD 67 immunobeads. After separation in a magnetic field the luminol chemiluminescence of the original cell suspensions, the spermatozoa and the leukocyte fractions were recorded on a luminometer. Spermatozoa fractions did not contain any leukocytes as no increase in CL-counts occurred after addition of FMLP. The number of peroxidase-positive cells (per 10(7) spermatozoa) correlated with the CL of the original cell suspensions (r = 0.7; P < 0.0001) as well as the CL of the spermatozoa and the leukocyte fractions after CD 45 or CD 67-preparation (r = 0.64; P < 0.0001). The CL of the spermatozoa and of the leukocyte fractions after CD 45 immunobead incubation were significantly correlated (r = 0.091; P < 0.0001). According to these data contaminating leukocytes could be eliminated by immunobead preparation. However, incubation of original cell suspensions with CD 45 or CD 67 immunobeads stimulated leukocytes to release soluble products resulting in elevated CL signals both in the leukocyte and the spermatozoa fractions. These effects have to be taken into account when using immunobeads for the preparation of human semen.

Prevalence of hepatitis C virus antibodies and evaluation of hepatitis C virus genotypes in patients with lichen planus.

BACKGROUND: Several cases of lichen planus (LP) associated with hepatitis C virus (HCV) infection have been described. The reported prevalence rates of anti-HCV in patients with LP show wide geographical variations. An association of HCV-associated disorders with certain HCV geno/subtypes has not been investigated so far. OBJECTIVE: The aim of the present study was to define the prevalence rate of anti-HCV in German patients with LP and to determine the distribution of HCV geno/subtypes. METHODS: All patients with LP of the present study (n = 84) were tested for anti-HCV antibodies by an enzyme-immunoassay (second generation). HCV RNA was detected by reverse-transcription polymerase chain reaction (RT-PCR) and HCV geno/subtyping was performed by the reverse hybridization assay. Serum samples of 87 patients with various cutaneous diseases excluding LP served as control group. RESULTS: Anti-HCV antibodies were detected in 13/84 patients with LP (16%), and 12/13 anti-HCV-positive patients were viraemic as assessed by the presence of HCV RNA. Most patients were infected with subtype HCV-1b (10/12 patients), while the 2 remaining patients were infected with HCV-2b and HCV-3a, respectively. In the control group, anti-HCV antibodies were only observed in 1/87 patients (1.1%), infected with subtype HCV-1b. CONCLUSION: The statistically significant (p < 0.002) high prevalence of HCV RNA in patients with LP is suggestive of an aetiological role of HCV in the pathogenesis of LP. Compared to the geno/subtype distribution of patients with chronic hepatitis C without LP of the same geographical area, no convincing correlation between geno/subtype and the presence of LP was obtained.

Clastogenic factors in plasma of HIV-1 infected patients.

The objective of this study was to investigate the clastogenic activity of plasma ultrafiltrates from HIV-1 infected patients. Clastogenic factors are chromosome-damaging agents with low molecular weight (< 10,000 daltons) which cause chromosome aberrations, sister chromatid exchanges, DNA strand breakage, and gene mutation. They have first been described in the plasma of irradiated persons, but they are also found in hereditary breakage syndromes and chronic inflammatory diseases with autoimmune reactions. Their formation and their clastogenic effects are modulated by superoxide anion radicals. We analyzed a total of 22 HIV-1 positive patients in comparison to 20 reference plasma samples from healthy HIV negative blood donors of similar age. The plasma ultrafiltrates (filter cutoff 10,000 daltons) from patients induced a statistically significant increase in chromosomal breakage in the cytogenetic test system (20.5 +/- 6.8 aberrations per 100 cells), while no increase was observed in test cultures exposed to plasma ultrafiltrates from healthy blood donors (6.3 +/- 2.9 aberrations per 100 cells). The breakage values were slightly, but not significantly, lower in the 10 patients with more than 200 T-helper cells/ml (18 +/- 4 aberrations per 100 cells), than in the 12 patients with less than 200 T-helper cells/ml (22.3 +/- 7.9 aberrations per 100 cells). HIV patients with high clastogenic activity (induction of more than 20 aberrations per 100 cells, range 20 to 39) showed higher plasma levels for malondialdehyde than those with lower clastogenic activity (less than 20 aberrations per 100 cells, range 12 to 18). However, the difference was statistically not significant. Another lipid peroxidation product, 4-hydroxynonenal, was increased equally in both groups. There were no significant differences in water- and lipid-soluble plasma antioxidants between the low- and high-breakage group. In agreement with previous findings, the clastogenic effects of plasma ultrafiltrates in the test cultures were reduced by the antioxidant enzyme superoxide dismutase. The presence of clastogenic factors in the plasma of HIV patients is further evidence for a prooxidant state in these persons. Since clastogenic factor formation appears to occur at an early stage of the disease, it may be significant for virus release or activation, because of the superoxide anion stimulating effects of clastogenic factors. From a practical standpoint, clastogenic factors may be useful for evaluation of promising drugs.

Modern topical glucocorticoids and anti-infectives for superinfected atopic eczema: do prednicarbate and didecyldimethylammoniumchloride form a rational combination?

The addition of an anti-infective to a topical glucocorticoid preparation for superinfected atopic eczema is still controversial. To address this question in the context of the topical glucocorticoids of the non-halogenated double-ester type 0.25% prednicarbate cream was compared to the identical preparation incorporating the same amount of the disinfectant didecyldimethylammoniumchloride in patients suffering from atopic eczema carrying Staphylococcus aureus at a density of more than 10(6) colony-forming units per cm2. One of the preparations was used twice daily over 5 days according to a random plan in a blind fashion. Thereafter treatment was based on either prednicarbate cream or the corresponding vehicle according to clinical needs. Clinical and microbiological evaluation were scheduled for days 0, 6 and 34. Various clinical parameters were addressed individually as well as over all improvement using scores. A total of 143 patients was recruited. The patients of both groups improved rapidly with respect to clinical and microbiological findings. Essentially, there was no difference between the groups. Hence, the addition of an anti-infective to a topical prednicarbate preparation is not to be generally recommended.

Chemiluminescence in semen of infertile men.

Luminol-dependent chemiluminescence (CL) can be used to determine the production of reactive oxygen species (ROS) by cells. Enhanced formation of ROS in human semen was reported to be of pathological significance for a disturbed sperm function. To investigate incidence of elevated CL-signals in semen samples and their correlation to conventional semen parameters, CL-signals in the semen of both 49 consecutive infertile men and 20 controls were measured. Semen was analysed according to WHO-criteria including bovine mucus-penetration- and water-test. A CL-signal of 1.5 x 10(5) counts min-1/2 x 10(6) spermatozoa was considered to be the upper normal limit. The CL in infertile men's semen was elevated with statistically significant differences in oligozoospermia patients/controls (P < 0.0001) and normozoospermia patients/controls (P < 0.05). In the group with elevated CL-signals, a higher percentage of spermatozoa with a pathologic morphology was detected (P = 0.05). In the groups with pathologic results of eosin- and water-tests, the CL-counts were elevated (P < 0.006; P < 0.03). The spermatozoa motility in the group with elevated CL-counts was significantly reduced after 4 h (P < 0.05). The CL-signals correlated inversely with the results of the bovine mucus-penetration-test (r = -0.67), P < 0.0001). In conclusion, semen samples of 28% of our patients showed elevated CL-signals; these were associated with pathological results of membrane integrity-tests. The negative correlation of CL with the results of Penetrak-test reflects its importance to depict the functional capacity of spermatozoa.

[Vitiligo therapy with phenylalanine/UV A. Catamnestic studies after five years]. / Vitiligo-Therapie mit Phenylalanin/UV A. Katamnestische Untersuchungen nach fünf Jahren.

Since 1983 the administration of phenylalanine combined with UVA exposure (PAUVA) has been a well-known therapy for vitiligo. We have found no retrospective studies on this therapy. To document the long-term results and side effects, we performed a retrospective study on 41 patients who had received PAUVA therapy about 5 years ago. Examination was possible in 25 of the 41 patients, and 11 of them (44%) had permanent repigmentation. Depigmentation either during or after PAUVA therapy was recognized in 16 of the 25 patients (64%). In 52% of cases the patients were satisfied with the therapy and would repeat it; 68% would recommend it. Positive features in prognosis, i.e. indicative of good repigmentation, were vitiligo extending over less than 25% of the body surface, onset of vitiligo before the age of 21, generalized and symmetrical distribution and a long duration of UV therapy. None of our patients developed long-term side effects. PAUVA therapy is demonstrably a therapeutic alternative for certain patients.

[Lupus vulgaris vegetans by auto-inoculation in open pulmonary tuberculosis]. / Lupus vulgaris vegetans durch Autoinokulation bei offener Lungentuberkulose.

Lupus vulgaris is now a rare dermatological disease. However, in view of the increase in risk factors (immigration from areas endemic for tuberculosis, multiply drug-resistant strains of Mycobacterium tuberculosis, HIV), cutaneous tuberculosis should always be considered in the differential diagnosis. We report on a case of lupus vulgaris vegetans of the nose, which developed by way of autoinoculation of the patient with Mycobacterium tuberculosis from reactivated, pulmonary tuberculosis and responded well to tuberculostatic therapy.

Antioxidant inhibition of skin inflammation induced by reactive oxidants: evaluation of the redox couple dihydrolipoate/lipoate.

Reactive oxygen species play an important role in mediating skin inflammation, and antioxidants may provide protection. We investigated the anti-inflammatory activity of natural antioxidants, such as superoxide dismutase, catalase, trolox (a water-soluble tocopherol analog) and the redox couple dihydrolipoate/lipoate in skin. Furthermore we compared the anti-inflammatory potency of natural R and racemic dihydrolipoate, as well as R and S lipoate. Skin inflammation in hairless mice was induced by intradermal injection of the hydrogen peroxide producing enzyme glucose oxidase (GOD) or by topical application of the prooxidant drug anthralin. Intradermal injection of the antioxidants inhibited skin inflammation caused by GOD (catalase, dihydrolipoate) and anthralin (trolox, superoxide dismutase, dihydrolipoate). There was no statistically significant difference between the anti-inflammatory activity of the natural R and racemic dihydrolipoate. R or S lipoate did not inhibit skin inflammation when injected intradermally. In feeding experiments, however, R lipoate significantly inhibited GOD-mediated skin inflammation, while S lipoate was only marginally protective. We conclude that (1) several natural antioxidants such as catalase, superoxide dismutase and dihydrolipoate have anti-inflammatory properties in dermatitis induced by reactive oxidants, (2) lipoate (oxidized dihydrolipoate) has skin anti-inflammatory activity when administered orally and (3) naturally occurring R lipoate is a more potent anti-inflammatory agent than the non-physiological S lipoate.

Studies on lipoate effects on blood redox state in human immunodeficiency virus infected patients.

Several investigators have implicated that human immunodeficiency virus (HIV) infected patients have a compromised antioxidant defense system. Blood antioxidants are decreased and peroxidation products of lipids and proteins are increased in the patients. This may have pathophysiological implications, because antioxidants, such as glutathione, and reactive oxidants are involved in the regulation of the human immunodeficiency virus. Consequently it was suggested that HIV infected patients may benefit from antioxidant supplementation therapy. In a open and unblinded pilot study the short term effect of the natural antioxidant lipoate (Thioctacid) on blood antioxidants and peroxidation products was investigated in HIV positive patients (CDC IV). In the majority of the patients, lipoate increased plasma ascorbate (9 of 10 patients) total glutathione (7 of 7 patients), total plasma thiol groups (8 of 9 patients); T helper lymphocytes and T helper/suppressor cell ratio (6 of 10 patients), while the lipid peroxidation products malondialdehyde (8 of 9 patients) and 4-hydroxynonenal (7 of 9 patients) were decreased. The results of this pilot study indicate that lipoate supplementation changes the blood redox state of HIV infected patients. A prospective and longitudinal therapy study is warranted to investigate the long term effects of lipoate therapy on blood redox state, disease progression and incidence of opportunistic infections in HIV infected patients.

Nitroxide radical biostability in skin.

Nitroxide radicals are important chemical tools in dermatologic research (e.g., for studying biophysical properties of skin lipids and epidermal membranes with the method of electron paramagnetic resonance, EPR, spectroscopy). However, nitroxides may loose their paramagnetic properties in biological tissues, which could limit their usefulness in biomedical applications. We analyzed the biostability of various chemical types of nitroxide radicals in keratinocytes, epidermis homogenate, and intact skin. EPR signal loss of imidazoline, pyrrolidine, piperidine, and oxazolidine nitroxides is attributed to their reduction to the corresponding hydroxylamine. The rate of nitroxide reduction in skin varies considerably with nitroxide ring structure and substitution. The order of nitroxide stability in isolated human keratinocytes, mouse epidermis homogenate, and intact mouse and human skin is imidazoline > pyrrolidine > di-t-butylnitroxide (DTBN) > piperidine > oxazolidine. Cationic nitroxides are reduced much faster than neutral or anionic probes, presumably due to transmembrane electron shuttle or internalization. The results indicate that imidazoline- and pyrrolidine-type nitroxides should be used when high biostability of nitroxides is needed. Piperidine-type nitroxides are versatile probes for studying one-electron transfer reactions in skin.

[Current therapeutic possibilities in cutaneous larva migrans]. / Aktuelle Therapiemöglichkeiten bei Larva migrans cutanea.

The recommendations for the treatment of cutaneous larva migrans are not uniform, and the recommended methods are neither always available nor always effective. If only the skin is affected, primarily topical therapy is indicated. Topical thiabendazole combines efficacy with missing systemic side-effects. In Germany the pure substance has to be used or Mintezol tablets must be purchased from abroad. Topical mebendazole and freezing with liquid nitrogen are less effective and involve side-effects. If topical treatment fails, systemic therapy is required. The recognized treatment with oral thiabendazole (2 days) is associated with numerous side-effects. There are now two new, safer drugs that should be preferred: albendazole (400 mg/day for 3 days), available in Germany as Eskazole, or ivermectin (single dose of 200 micrograms/kg). The latter can be ordered from the manufacturer under the trade name of Mectizan.