[Patch testing in patients with leg ulcers with special regard to modern wound products]. / Epikutantestung bei Patienten mit Ulcus cruris unter besonderer Berücksichtigung moderner Wundprodukte.

BACKGROUND: Patients with leg ulcers often have contact sensitizations. Modern wound care products claim low allergic potential. OBJECT: To analyze the patch test results in leg ulcer patients with focus on modern care wound products. MATERIAL AND METHODS: 95 leg ulcer patients were tested with the standard German patch test series as well as frequently used wound care products. RESULTS: 61% of the patients had at least one positive reaction. Most frequent reactions were seen with tert-butylhydroquinone, povidone iodine, balsam of Peru, a hydrogel, fragrance mix I and II, Amerchol L101 and gentamicin. There were 14 reactions to modern wound care products with highest sensitization rates for hydrocolloids and hydrogels. Patients sensitized to wound care products had significantly more positive patch test reactions. CONCLUSION: There are sensitisations against modern wound care products, especially hydrogels. That should be considered in patch test of leg ulcer patients.

Expression of human beta-defensins in patients with mycosis fungoides.

The human beta-defensins (hBDs) are peptides with a strong antimicrobial activity. Patients with atopic dermatitis (AD) and mycosis fungoides (MF) are prone to skin infections. We aimed to investigate the mRNA expression of hBDs in lesional and non-lesional skin of MF patients, and to compare the data with hBD levels found in AD patients and healthy controls. In this prospective pilot study, 13 patients with MF were recruited. Punch biopsies were harvested from the centre of the tumour (lesional) as well as a healthy skin site (non-lesional controls). In addition to the specimens of MF patients, skin samples (healthy controls) were obtained from healthy subjects (n = 15) and patients with acute AD (n = 14). In order to detect mRNA of hBDs, we performed quantitative real-time reverse transcriptase polymerase chain reaction. As compared to healthy controls, skin of patients with MF (non-lesional and lesional) and AD patients showed significantly lower hBD-1 mRNA expression and significantly higher hBD-2 and hBD-3 mRNA expression. HBD-1 mRNA levels of lesional skin were significantly lower than those of non-lesional skin. By contrast, significantly increased hBD-2 and hBD-3 mRNA expression was found in lesional skin of MF patients when compared to non-lesional skin. HBD mRNA expression in lesional skin of MF patients did not significantly differ from hBD expression that was observed in AD lesions. We observed an identical pattern of hBD expression in MD and AD suggesting a common regulatory mechanism that might mainly be driven by T helper 2 lymphocytes.

Unilateral generalized morphea is a rare variant of localized scleroderma.

Localized scleroderma (LS) is a rare connective tissue disorder generally involving the entire dermis and usually limited to the subcutaneous tissue. However, it may progress to large indurated plaques, growth retardation, muscle atrophy, and even to flexion deformities or poorly healing ulcerations. LS has been classified as plaque, generalized, bullous, linear, and deep forms exhibiting different clinical subtypes. Recently, an unusual case of unilateral generalized morphea (UGM) in childhood extending from the middle dermis to the subcutaneous fat tissue has been reported. We here describe four young patients exhibiting a similar subtype of LS. All patients demonstrated a prominent unilateral skin involvement starting in childhood or adolescence. Histology revealed prominent accentuation of intradermal involvement. Except for positive anti-nuclear antibodies, no specific antibody pattern could be observed. In presenting these clinically homogenous cases we hereby introduce UGM as an extreme variant of the linear form of LS in childhood. As the onset of UGM usually occurs in pediatric patients, pediatricians should be cognizant of the presentation of this uncommon condition. Treatment with combined low-dose methotrexate and pulsed high-dose corticosteroid therapy might represent a promising treatment option for UGM.