Effective treatment of frontal hyperhidrosis with botulinum toxin A.

BACKGROUND: Focal hyperhidrosis is a common condition mostly confined to the axillae, palms and soles. In some individuals, predominantly men, increased sweating of the forehead may be the major complaint and may interfere with the person's quality of life. Botulinum toxin A has been shown to be a very effective treatment for focal hyperhidrosis of the axillae and palms. OBJECTIVES: To assess the response in 10 men suffering from frontal hyperhidrosis treated with botulinum toxin A. METHODS: Botulinum toxin A Botox was injected at multiple sites evenly distributed over the forehead (mean dose 86 mouse units). RESULTS: The mean +/- SEM amount of sweat was significantly reduced, 4 weeks after treatment, from 173.8 +/- 38.6 mg min(-1) to 53.7 +/- 17.6 mg min(-1). The effect lasted at least 5 months in nine of the 10 patients. All patients subjectively judged the treatment as very effective. Minor side-effects included painful injections and a transient weakness of forehead muscles without ptosis. CONCLUSIONS: In this study, we provide evidence that botulinum toxin A is an effective and safe treatment for frontal hyperhidrosis.

Increase in NGF content and nerve fiber sprouting in human allergic contact eczema.

There is increasing evidence for an intimate interaction of the skin and the nervous system. As known from animal studies, nerve growth factor (NGF) is essential for the innervation density and functional properties of sensory neurons of the skin during embryogenesis and in adulthood, and possibly during cutaneous inflammation. This study examined NGF content and sprouting of nerves during the elicitation phase of contact allergy in human skin. Skin biopsies from patients (n=14) undergoing patch-testing were taken from positive test sites and control back skin 96 h after antigen application. NGF content was measured by enzyme-linked immunofluorescence assay. Immunohistochemistry was performed for protein gene product 9.5 (PGP9.5), a marker that stains all neuronal elements, and growth-associated protein 43 (GAP43), a marker for axonal growth cones. The NGF content was significantly increased in lesional skin in comparison with normal skin (4.2+/-0.6 pg to 2.9+/-0.5 pg NGF per mg wet weight). The length of epidermal PGP9.5-immunoreactive (ir) fibers in lesional skin significantly increased from 3.4+/-0.9 mm in normal skin to 5.3+/-1.0 mm in contact eczema, whereas dermal fibers were unaltered (11.1+/-2.7 mm vs 9.5+/-2.1 mm, respectively). GAP43-ir nerve endings were significantly increased in both epidermis (1.6+/-0.3 mm to 2.6+/-0.4 mm) and dermis (0.5+/-0.1 mm to 1.8+/-0.2 mm) in contact eczema. Thus, we have provided evidence for an NGF-mediated nerve-fiber sprouting in human contact eczema. This may have a functional impact on skin-associated immune cells, in particular mast cells and Langerhans cells.

Localization of ionotropic glutamate receptors in peripheral axons of human skin.

Recent observations suggest that glutamate is important in sensory transduction in the periphery, contributing to peripheral sensitization of nociceptors and the hyperalgesia that accompanies inflammation. This study examined the presence of ionotropic glutamate receptors N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methylisoxazolone-4-propionic acid (AMPA) and kainate (KA) in normal human hairy skin (n=6) using immunohistochemistry at the electron microscopic level. Analysis of labeled axons at the dermal-epidermal junction demonstrated that 26. 9+/-2, 19.5+/-3 and 18.5+/-1% of the axons analyzed were labeled for subunits of the NMDA, AMPA or KA receptors, respectively. An occasional Schwann cell process was labeled for either NMDA or KA receptors. The findings support the hypothesis that glutamate and its ionotropic receptors may play a role in the periphery in sensory processing in humans.

Postnatal loss of Merkel cells, but not of slowly adapting mechanoreceptors in mice lacking the neurotrophin receptor p75.

Merkel cells are specialized epidermal cells which are abundantly found in touch-sensitive areas and which are innervated by slowly adapting mechanosensitive afferent fibres with large myelinated (Abeta) axons. The role of Merkel cells in mechanosensation, their developmental regulation and their influence on sensory neuron function are, however, incompletely understood. Here, we used mice lacking the neurotrophin receptor p75 which is expressed on Merkel cells to investigate their postnatal development and that of their innervating sensory neurons. Using morphological studies we now show that Merkel cells develop normally in both hairy and glabrous skin in these animals until 2 weeks old, but are progressively lost thereafter and have almost completely disappeared 2 months after birth. Using standard extracellular electrophysiological recording techniques we find that despite the profound loss of Merkel cells there is no corresponding reduction in the number of myelinated slowly adapting afferent fibres. Moreover, the mean mechanical threshold of these neurons and their average stimulus response function to suprathreshold mechanical stimuli does not change during the time period when more than 99% of Merkel cells are lost. We conclude that Merkel cells require p75 during the late postnatal development. However, neither the survival nor the mechanical sensitivity of slowly adapting mechanoreceptive Abeta-fibres depends on the presence of Merkel cells.

Loss of distal axons and sensory Merkel cells and features indicative of muscle denervation in hindlimbs of P0-deficient mice.

Mice lacking the major Schwann cell myelin component P0 show a severe dysmyelination with pathological features reminiscent of the Déjérine-Sottas syndrome in humans. Previous morphological and electrophysiological studies on these mice did not only demonstrate a compromised myelination and myelin maintenance, but were suggestive of an impairment of axons as well. Here, we studied the axonal pathology in P0-deficient mice by quantitative electron microscopy. In addition, we investigated epidermal receptor end organs by immunocytochemistry and muscle pathology by histochemistry. In proximal sections of facial and femoral nerves, axon calibers were significantly reduced, whereas the number of myelin-competent axons was not diminished in 5- and 17-month-old P0-deficient mice. However, in distal branches of the femoral and sciatic nerve (digital nerves innervating the skin of the first toe) the numbers of myelin-competent axons were reduced by 70% in 6-month-old P0-deficient mice. Immunolabeling of foot pads revealed a corresponding loss of Merkel cells by 75%, suggesting that survival of these cells is dependent on the presence or maintenance of their innervating myelinated axons. In addition, quadriceps and gastrocnemius muscles showed pathological features indicative of denervation and axonal sprouting. These findings demonstrate that loss of an important myelin component can initiate degenerative mechanisms not only in the Schwann cell but also in the distal portions of myelinated axons, leading to the degeneration of specialized receptor end organs and impairment of muscle innervation.

[Model of a special consultation for patients with atopic eczema]. / Modell einer Sondersprechstunde für Patienten mit atopischem Ekzem.

Due to its high prevalence, atopic dermatitis is an important problem in the dermatologic practice. The chronicity of the disease together with numerous triggering factors of varying individual impact create a complex situation which is difficult to manage under the current circumstances in our health care system. We describe the concept of an outpatient clinic especially for atopic dermatitis as established in our Department of Dermatology. A high degree of standardization is combined with a high measure of individual care. The aims of this clinic are an optimized outpatient management of atopic dermatitis, the gathering of epidemiologic data, the performance of controlled studies, and potentially the reduction of costs.