Steroid-induced dermal atrophy. Investigations on discontinuous application.

In this study several schedules of discontinuous application (DA) were tested, using various weak and strong topical corticosteroids (CS). The purpose of this study was to measure the influence of corticosteroids on skin thickness by means of a mechanical method. In a first experiment, betamethasone 17,21-dipropionate (Bet) and fluprednidene 21-acetate (Flu) were applied to the skin of the volar side of the forearm at a rhythm of 1:1 (1 day CS, 1-day interval) and 1:2 under occlusive dressing. The investigation period was 8 weeks. For comparison, Bet and Flu were applied continuously (CA) for 3 weeks. Flu thinned the skin to a lesser extent than Bet. With DA the skin was thinned to the same extent as with CA. In a second experiment, hydrocortisone 17-butyrate, betamethasone 17-valerate, desoxymethasone and hydrocortisone were tested. Here the treatment regimen was 5:9. The CS preparations were tested for 3 months on the volar side of the forearms under occlusive dressing. Skin thinning occurred during the 5 days of CS action and, in the beginning, receded again in the CS-free interval. However, this regressive process became weaker each time. At the end of the experiment the skin thinning persisted. With the exception of hydrocortisone, all CS tested produced statistically significant skin thinning after DA. The results of the investigation presented here show that thinning of the skin must also be expected with discontinuous application of topical CS.

The use of a dynamometer in nutritional assessment.

Standard anthropometric techniques may be unreliable in patients with subcutaneous edema or dehydration. In order to circumvent this dilemma, 98 male subjects were studied utilizing a hand-held dynamometer in conjunction with other nutritional assessment techniques. Following a nutritional assessment using anthropometric measurements, patients were characterized as being well-nourished or malnourished using three definitive measures: percentage of ideal body weight, triceps skinfold, and midarm muscle circumference. Once malnutrition was assessed, no attempt was made to distinguish between marasmus, hypoalbuminemia, or mixed marasmus types of malnutrition. A correlation matrix done between the two groups revealed no statistically significant correlation between any of the measured parameters. Analysis of variance revealed statistically significant correlations between patients in both groups (independent variables) with respect to midarm muscle circumference and dynamometer reading in the dominant arm (dependent variables). Further validation of this technique is required before it can become a standard component of nutritional assessment.

[Determination of lean body mass by skin fold measurements (author's transl)]. / Untersuchungen zur Bestimmung der Hautfaltendicke mit verschiedenen Kalipern

Skin folds were measured on 12 different body sites of 32 boys, aged 9--12, by using the calipers of Best, Lange, Harpenden and Holtain successively. We compared the measurements of the biceps, triceps, scapula, suprailiaca, abdominal and thigh skin folds. The results depended on body sites as well as on the type of caliper used. Therefore, conversion is recommendable only when absolute values of body fat must be taken into consideration, as when investigating population parameters in terms of functional performance capacity. Moreover conversion is necessary when using those nomograms which are built up mainly by measurements with an unusual caliper. Conversions must be omitted when comparing data by means of rank-correlations.