Randomized controlled trial comparing 35% trichloroacetic acid peel and 5-aminolaevulinic acid photodynamic therapy for treating multiple actinic keratosis.

BACKGROUND: Photodynamic therapy (PDT) and chemical peels with trichloroacetic acid (TCA) can be applied to large skin areas and thus are suitable treatment options for patients with multiple actinic keratosis (AK). However, despite its long use, TCA has been investigated only rarely in this indication. OBJECTIVES: This randomized, observer-blinded, intrapatient comparative study sought to investigate the efficacy and safety of 35% TCA vs. aminolaevulinic acid 20% (ALA) PDT in patients with extensive field cancerization and multiple AKs in the face or on the scalp. METHODS: Twenty-eight patients with at least five AKs in two comparable anatomical areas on the head were treated with 35% TCA and ALA PDT randomly assigned to each area. Their therapeutic efficacy, adverse events and cosmetic outcome were assessed by a blinded investigator at 1, 3, 6 and 12 months after treatment. RESULTS: After 12-months' follow-up TCA and ALA PDT reduced the total lesion count, the primary outcome, by 31% and 58%, respectively (P = 0·006). Complete clearance of pre-existing AKs were 49% for TCA and 74% for ALA PDT (P = 0·011). Treatment failure (number of AKs greater than 50% of the baseline count) was observed in seven patients (25%) after TCA and in two patients (7%) after PDT treatment. Treatment-related pain was significantly higher for ALA PDT (visual analogue scale 7·5 ± 2·3 vs. TCA: 5·1 ± 2·6; P = 0·04), whereas scarring (n = 6, 21%) was seen only in TCA treated patients. CONCLUSIONS: ALA PDT provided better clinical results than TCA in the treatment of patients with extensive field cancerization and multiple AKs.

Effects of RYGB on energy expenditure, appetite and glycaemic control: a randomized controlled clinical trial.

OBJECTIVES: Increased energy expenditure (EE) has been proposed as an important mechanism for weight loss following Roux-en-Y gastric bypass (RYGB). However, this has never been investigated in a controlled setting independent of changes in energy balance. Similarly, only few studies have investigated the effect of RYGB on glycaemic control per se. Here, we investigated the effect of RYGB on EE, appetite, glycaemic control and specific signalling molecules compared with a control group in comparable negative energy balance. SUBJECTS/METHODS: Obese normal glucose-tolerant participants were randomized to receive RYGB after 8 (n=14) or 12 weeks (n=14). The protocol included a visit at week 0 and three visits (weeks 7, 11 and 78) where 24-h EE, appetite and blood parameters were assessed. Participants followed a low-calorie diet from weeks 0-11, with those operated at week 12 serving as a control group for those operated at week 8. RESULTS: Compared with controls, RYGB-operated participants had lower body composition-adjusted 24-h EE and basal EE 3 weeks postoperatively (both P<0.05) but EE parameters at week 78 were not different from preoperative values (week 7). Surgery changed the postprandial response of glucagon-like peptide-1 (GLP-1), peptide YY3-36 (PYY), ghrelin, cholecystokinin, fibroblast growth factor-19 and bile acids (all P<0.05). Particularly, increases in GLP-1, PYY and decreases in ghrelin were associated with decreased appetite. None of HOMA-IR (homeostasis model assessment-estimated insulin resistance), Matsuda index, the insulinogenic index, the disposition index and fasting hepatic insulin clearance were different between the groups, but RYGB operated had lower fasting glucose (P<0.05) and the postprandial glucose profile was shifted to the left (P<0.01). CONCLUSIONS: Our data do not support that EE is increased after RYGB. More likely, RYGB promotes weight loss by reducing appetite, partly mediated by changes in gastrointestinal hormone secretion. Furthermore, we found that the early changes in glycaemic control after RYGB is to a large extent mediated by caloric restriction.

Short-term spatial memory responses in aged Japanese quail selected for divergent adrenocortical stress responsiveness.

Stress-induced glucocorticoids can dampen learning and spatial memory via neuronal damage to the hippocampus. Cognition losses can be transient (associated with acute stress episodes) or permanent as in aged individuals who show chronic glucocorticoid-induced accelerated brain aging and neurodegeneration (dementia). Thus, chronic versus acute stress effects on spatial memory responses of quail selected for reduced (low stress, LS) or exaggerated (high stress, HS) plasma corticosterone (B) response to brief restraint were assessed. Aged food-motivated male LS and HS quail were tested for 10 min in a feed-baited 8-arm radial arm maze (RAM) 1) at 255 d of age (quail who had experienced lifelong management stressors but who were otherwise never intentionally stressed; that is, chronically stressed birds), 2) on the next day post-acute stressor treatment (5 min of restraint), and 3) on the next day without treatment (acute stress recovery). The RAM tests used the win-shift procedure in which visited arms were not rebaited. Radial arm maze performance was measured by determination of the total number of arm choices made, the number of correct entries made into baited arms out of the first 8 choices, the time required to make a choice, and the number of pellets eaten. Line effects (P < 0.001 in all cases) were detected for total number of arm choices made (HS < LS), number of correct entries made into baited arms out of the first 8 choices (HS < LS), time required to make a choice (HS > LS), and number of pellets eaten (HS < LS). However, neither the effects of day of RAM testing nor its interaction with line further influenced these variables. Thus, although selection for divergent plasma B responsiveness to an acute stressor was found to be associated with severe impairment of spatial memory in aged male HS compared with LS quail, the observed spatial memory impairments (HS > LS) could not be further altered by acute stressor treatment. Line differences in cognition may reflect lifelong management-induced stress episodes that periodically produce higher plasma B responses in HS than LS quail, which underlie HS quail memory deficits, or other etiologies, or both.

Influence of maternal corticosterone treatment on incubation length of eggs laid by Japanese quail hens selected for divergent adrenocortical stress responsiveness.

1. Previous studies have shown that more yolk corticosterone is found in the eggs of random bred Japanese quail hens implanted with corticosterone during egg formation; both unstressed and stressed quail hens selected for exaggerated (high stress) rather than reduced (low stress) plasma corticosterone response to brief restraint deposit more corticosterone into their egg yolks. The length of egg incubation is also known to be shorter in eggs laid by high than low stress hens. 2. Here we investigated the interactive effects of quail stress line (low vs. high stress) with maternal corticosterone treatment (empty implant controls vs. corticosterone-implants) during egg formation on length of egg incubation. 3. Mean (+/-SEM) length of egg incubation for high stress control eggs (3973 +/- 04 h) was similarly shorter (by about 4.5 h) than that found for low stress control eggs (3928 +/- 02 h). In addition, on average, the incubation length of eggs laid by corticosterone-implanted hens (3929 +/- 05 h) was nearly 3 h shorter than that found for eggs laid by control hens (3958 +/- 02 h) regardless of stress line. 4. Line x hen-implant treatment effects on mean (+/-SEM) length of egg incubation partitioned in rank order as follows: low stress control (3978 +/- 05 h) > low stress corticosterone-implant (3959 +/- 07 h) > high stress control (3938 +/- 03 h) > high stress corticosterone-implant (3912 +/- 04 h). 5. Our original contention that selection for exaggerated adrenocortical responsiveness is associated with a reduction in the length of egg incubation was supported. Because maternal stress-induced elevations of yolk B are known to occur, the present findings of further shortenings of the hatching times of eggs of corticosterone-treated hens of both stress lines are also important to the poultry industry because they warn producers that unless stress in hens during egg formation is minimised, abbreviated egg incubation periods may result beyond the effects that a hen's genetic predisposition to adrenocortical stress responsiveness has on the length of egg incubation.

Effect of the density of conspecifics on runway social reinstatement behavior of male Japanese quail genetically selected for contrasting adrenocortical responsiveness to stress.

Runway tests are considered indicative of underlying sociality in birds and their ability to make social discriminations and establish interactions among conspecifics. Herein, social reinstatement behavior in male juvenile Japanese quail selected for a reduced (LS, low stress) or exaggerated (HS, high stress) adrenocortical response to brief mechanical restraint was evaluated. Individual males were given the choice to reinstate with either 2 (low density, LD) or 8 (high density, HD) unfamiliar randombred conspecifics placed in goal boxes at opposite ends of a two-choice runway (TCRW). Then, the same males were individually retested in a single goal box runway wherein they were exposed to a goal box containing either a LD or a HD of males. In the TCRW, a higher (P < 0.01) number of HS males started their ambulation toward the goal box containing the HD as opposed to LD of conspecifics. The HS males also spent more (P < 0.01) time in close proximity (within a 10-cm close zone; CZ) to the HD (218 s) rather than LD (57 s) of conspecifics. In contrast, the LS males did not differ in their initial direction of travel and they spent similar average amounts of times in the CZ of their stimulus LD (141 s) and HD (124 s) conspecifics. Similar to the TCRW results, in the single goal box runway, HS males spent more (P < 0.01) time in the CZ of HD rather than LD conspecifics, whereas LS quail spent similar amounts of time in the CZ of LD and HD males. Considering that runways are novel (and therefore frightening) environments, our findings suggest that HS quail may find better shelter (i.e., more comfort) in close proximity to a larger rather than smaller group of conspecifics, whereas LS birds find groups of varying conspecific density equally attractive. The results suggest that LS quail possess favorable social adaptive qualities because they appear to be better suited to cope with situations where the density of conspecifics is variable.

Maternal corticosterone reduces egg fertility and hatchability and increases the numbers of early dead embryos in eggs laid by quail hens selected for exaggerated adrenocortical stress responsiveness.

Quail hens selected for exaggerated (HS, high stress) rather than reduced (LS, low stress) plasma corticosterone (B) response to brief restraint deposit more B into their egg yolks than do LS hens. Female progeny of HS hens implanted with B also show reduced egg production when compared with female offspring of LS- and HS-control and LS-B-implanted hens. Herein, LS and HS hens were implanted (s.c.) with empty (controls, CON) or B-filled silastic tubes to assess the interactive influences of maternal B-treatment with quail stress line on egg fertility (FERT), total egg hatchability (TOTHATCH) and fertile egg hatchability, and the percentages of embryonic mortality (early dead, ED; late dead) and pipped eggs. Mean FERT was dramatically reduced in eggs of HS compared with LS hens and B-implanted compared with CON-treated hens (P < 0.0001, both cases). Line x implant treatment FERT outcomes partitioned (P < 0.05) as follows: LS-B = LS-CON > HS-CON > HS-B. In addition, TOTHATCH was also affected by line (LS > HS; P < 0.0001) and implant treatment (CON > B-implant; P < 0.0002) and line x implant treatment TOTHATCH means differed (P < 0.05) as follows: LS-CON = LS-B = HS-CON > HS-B. Fertile egg hatchability was reduced (P < 0.05) in HS-B-treated hen eggs when compared with LS-B and HS-CON hen eggs and more (P < 0.05) ED embryos were found in eggs laid by HS-B-implanted hens than in any other treatment group. Late dead and pipped egg percentages were unaffected by any treatment. The findings are important to avian geneticists because they further emphasize the benefits that selection for reduced adrenocortical responsiveness has on hen reproductive performance. The maternal B findings also warn poultry and hatchery managers that unless hen stress during egg formation is avoided, negative consequences in FERT, TOTHATCH, and ED can result, particularly in hens genetically predisposed toward exaggerated adrenal stress responsiveness.

Length of incubation and hatchling body weight in quail selected for reduced or exaggerated adrenocortical responsiveness to brief restraint.

1. While changes in corticosterone (B) during late embryogenesis are thought to play a role in the hatching process, only a scant and controversial literature exists concerning the effects of in ovo B on the length of incubation and chick body weight at hatching. Because female Japanese quail selected for exaggerated (high stress, HS) rather than reduced (low stress, LS) plasma B response to brief mechanical restraint deposit more B into their eggs, these stress lines provide an excellent model to study the relationship between embryonic B and incubation length and hatchling body weight. 2. Differences in the duration of incubation and chick body weight at emergence were assessed using eggs laid by LS and HS quail. 3. On average, eggs from HS hens hatched 3.7 h sooner than did eggs from LS hens while mean body weight at emergence was similar in hatchlings of both lines. Thus, selection for exaggerated adrenocortical responsiveness is associated with a reduction in the length of egg incubation without altering hatchling body weight. 4. This finding is important to the poultry industry because it warns layer, breeder farm and hatchery managers that unless stress in hens during egg formation is avoided, an abbreviated incubation period may result.

Open-field temporal pattern of ambulation in Japanese quail genetically selected for contrasting adrenocortical responsiveness to brief manual restraint.

Japanese quail selected for a low-stress (LS), rather than a high-stress (HS), plasma corticosterone response to brief restraint have been shown to possess lower fearfulness and a nonspecific reduction in stress responsiveness. Detrended fluctuation analysis provides information on the organization and complexity of temporal patterns of behavior. The present study evaluated the temporal pattern of ambulation of LS and HS quail in an open field that represented a novel environment. Time series of 4,200 data points were collected for each bird by registering the distance ambulated every 0.5 s during a 35-min test period. Consistent with their known reduced fearfulness, the LS quail initiated ambulation significantly sooner (P < 0.02) and tended to ambulate more (P < 0.09) than did their HS counterparts. Detrended fluctuation analyses showed a monofractal series (i.e., a series with similar complexity at different temporal scales) in 72% of the birds. These birds initiated their ambulatory activity in less than 600 s. Among these birds, a lower (P < 0.03) autosimilarity coefficient (alpha) was found in the LS quail than in their HS counterparts (alpha = 0.76 +/- 0.03 and 0.87 +/- 0.03, respectively), suggesting a more complex (less regular) ambulatory pattern in the LS quail. However, when the patterns of ambulation were reexamined by considering only the active period of the time series (i.e., after the birds had initiated their ambulatory activity), monofractal patterns were observed in 97% of the birds, and no differences were found between the lines. Collectively, the results suggest that during the active period of open-field testing, during which fear responses are likely less strong and other motivations are the driving forces of ambulation, the LS and HS lines have similar ambulatory organization.

Influences of maternal corticosterone and selection for contrasting adrenocortical responsiveness in Japanese quail on developmental instability of female progeny.

Differences in developmental instability were assessed in female offspring of Japanese quail hens selected for reduced (low stress, LS) or exaggerated (high stress, HS) plasma corticosterone (B) response to stress and treated with a placebo or B during egg formation. Hens of each line were implanted (s.c.) with either a silastic tube containing no B (controls) or one filled with B. Female chicks hatched from each of the 4 line x implant treatment combinations were retained for examination of 3 bilateral traits at 130 d of age: length of the tibiotarsus, middle toe length, and distance between the auditory canal and the nares (face length, FL). Greater bilateral trait size variances were associated with measurement of tibiotarsus length (P < 0.04) and middle toe length (P < 0.06) in the HS line, supporting our previous findings in the opposite sex that developmental instability (i.e., fluctuating asymmetry, FA) of certain morphological traits is more pronounced in HS than LS adult quail. The HS quail are also known to exhibit greater adrenocortical responsiveness to a wide range of stressors, and they are more easily frightened than LS birds. Therefore, the line differences in FA (HS > LS) found previously in males and herein in females may simply reflect the differential responsiveness of the birds to chronic social and physical environmental stressors. In addition, the present study detected more (albeit marginally so, P < 0.06) bilateral variability (i.e., heightened FA) in FL of quail hatched from mothers treated with B, a finding entirely due to the very high FL variance observed in the female offspring of B-treated HS hens. Because others have found in ovo B treatment to be associated with heightened FA in chick tarsus bone length and because we have also demonstrated that greater yolk B deposition occurs in eggs from both unstressed and stressed HS quail hens than their LS counterparts, the present maternal B treatment may be acting independently, or in combination with HS genomic effects, to adversely affect developmental stability.

Fear responses of offspring from divergent quail stress response line hens treated with corticosterone during egg formation.

Increased fearfulness has been associated with adrenocortical activation. Maternal corticosterone (B) treatment increases egg B, and elevated B in ovo enhances chick avoidance of humans. Quail selected for exaggerated (high stress, HS) rather than reduced (low stress, LS) plasma B response to stress are more fearful, and more B is found in HS hen eggs. Thus, we used tonic immobility (TI) and hole-in-the-wall box (HWB) emergence tests to assess fear in chicks hatched from eggs of LS and HS hens implanted with B or no B (CON). The number of inductions required to attain TI, latency to first alert head movement, and duration of TI were determined in one study and the latency until first vocalization (LATVOC), numbers of vocalizations (VOCS), proportions of chicks vocalizing, and the latencies to head (HE) and full-body (FE) emergence from a HWB were assessed in another. The LS chicks required less inductions (P < 0.0005) and had shorter latency to first alert head movement (P < 0.02) than HS chicks, although the duration of TI was unaffected by any of the treatments. During the acclimation period of the HWB tests, more (proportions of chicks vocalizing; P < 0.0001) HS chicks alarm-called sooner (LATVOC; P < 0.0001) and more often (VOCS; P < 0.0001) than did LS chicks, and, although maternal implant treatment did not affect LATVOC, progeny of B-implanted hens showed a tendency toward less (P < 0.07) VOCS than the CON. Chicks hatched from eggs of B-implant mothers also took longer to achieve HE (P < 0.06) and FE (P < 0.05) from the HWB than did their CON counterparts. Stress line, implantation treatment, and their interaction did not alter HE or FE responses. The data suggest that quail stress line genome may or may not be affecting certain fear and alarm responses in chicks via the same mechanism(s) that underlies how elevating maternal B increases egg levels of B that in turn alters the fear behavior of progeny.

A prospective, randomized, double-blind, placebo-controlled study on the influence of a hormone replacement therapy on skin aging in postmenopausal women.

BACKGROUND: There is mounting evidence that menopause affects some functions of the skin. Hormone replacement therapy (HRT) appears to limit some of the climacteric aspects of cutaneous aging. OBJECTIVE: In the light of a growing interest in the endocrinological influence of skin, we performed a study evaluating the effects of HRT on skin aging in postmenopausal women. METHODS: Forty non-hysterectomized, postmenopausal women were included in this prospective, randomized, double-blind, placebo-controlled study on the influence of oral sequential treatment with a combination of 2 mg 17beta-estradiol/10 mg dydrogesterone (Femoston) for seven 28-day cycles. Skin elasticity, skin surface lipids, skin hydration and skin thickness were measured by non-invasive methods, and both adverse-event profile and clinical-dermatological status were evaluated. RESULTS: After 7 months of HRT, skin elasticity increased significantly at the right ramus of the mandible, while skin hydration tended to improve significantly at the right upper arm (inner side); skin thickness improved significantly but skin surface lipids did not. Absolute effects did not differ significantly between HRT and placebo patients. A dermatological evaluation was largely consistent with measurement results. Safety and tolerability of HRT were positive. CONCLUSION: The results showed improvements in the parameters involved in skin aging in the HRT group as compared to baseline. While skin aging is no indication for systemic hormone supplementation, a positive effect on aging skin can be observed.

Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study.

BACKGROUND: For many years topical progesterone has been prescribed by gynaecologists as an antiageing and skin-firming treatment, without any clinical scientific evidence of its effects, tolerability and safety when applied to skin. OBJECTIVES: To evaluate the influence of 2% progesterone cream on function and texture of the skin in peri- and postmenopausal women. METHODS: A double-blind, randomized, vehicle-controlled study was conducted in 40 subjects. Objective methods for measuring skin elasticity, epidermal hydration and skin surface lipids, clinical monitoring and self-assessment, and determination of blood hormone levels (luteinizing hormone, follicle-stimulating hormone, oestrogen and progesterone) were used to determine effects and side-effects of this treatment at four visits over a 16-week period. RESULTS: The study demonstrated a significant (P < or = 0.05) increase of the elastic skin properties in the treatment group, as demonstrated by objective measurements of three skin elasticity parameters, whereas in the control group no such effect was observed. This effect in the treatment group was further paralleled by the results of the clinical monitoring, where the 2% progesterone cream yielded consistent superiority over vehicle in counteracting different signs of ageing in the skin of peri- and postmenopausal women. Clinical monitoring showed a greater reduction in wrinkle counts (29.10% vs. 16.50%) and wrinkle depth (9.72% vs. 7.35%) around the right eye, a greater decrease in nasolabial wrinkle depth (9.72% vs. 6.62%) and a significantly higher (P < 0.05) increase in skin firmness (23.61% vs. 13.24%) in the treatment group. Epidermal hydration and skin surface lipids did not change significantly in either group during the study. Progesterone was well absorbed in the systemic circulation: mean blood levels rose minimally, but statistically significantly (P = 0.001), by 0.53 ng mL(-1). No serious side-effects of the treatment were observed. CONCLUSIONS: The results of this study demonstrate that topical 2% progesterone acts primarily in increasing elasticity and firmness in the skin of peri- and postmenopausal women. These effects in combination with good tolerability make progesterone a possible treatment agent for slowing down the ageing process of female skin after onset of the menopause.

Clinical evidence of the endocrinological influence of a triphasic oral contraceptive containing norgestimate and ethinyl estradiol in treating women with acne vulgaris. A pilot study.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy of a triphasic combination oral contraceptive (OC) containing norgestimate and ethinyl estradiol in the treatment of women with acne vulgaris. METHODS: 12 female patients were included and 10 completed the trial. Over a period of 6 months, efficacy was assessed by means of facial acne lesion counts, by an investigator's global assessment, by patients' self-assessments and by measuring epidermal moisture and skin surface lipids. In addition, a photo documentation was compiled and hormone levels were measured. RESULTS: After 6 months of therapy, the number of acne counts improved. The success of treatment was rated positively both by the investigator and by all patients but one who did not report any changes. Skin surface lipids were significantly reduced while skin hydration showed no significant change. Testosterone and progesterone decreased, and sex-hormone-binding globulin increased, significantly. CONCLUSION: Our data show that an OC containing norgestimate and ethinyl estradiol is a good therapeutic option for women of fertile age suffering from mild to moderate acne vulgaris.

Objective assessment of photoageing effects using high-frequency ultrasound in PUVA-treated psoriasis patients.

BACKGROUND: Skin ageing can be differentiated into intrinsic (chronological) ageing, and photoageing due to chronic sun exposure. Photoageing is the superimposition of photodamage on the ageing process. OBJECTIVES: The aim of the study was to investigate possible differences between the skin of photochemotherapy (PUVA)-treated psoriasis patients and of untreated normal subjects using a high-frequency ultrasound system. METHODS: A total of 124 volunteers (aged 21-88 years, median 52 years, 62 female, 62 male), 62 psoriasis patients who had received PUVA therapy and 62 healthy controls, were investigated. Skin thickness and a subepidermal low-echogenic band (SLEB), a parameter for photodamage, were measured in 12 different areas. RESULTS: Female skin is thinner than male skin. The skin thickness values of PUVA patients were more markedly decreased than those of the controls for the older patients. There was a clear dependence of the occurrence of SLEB on PUVA therapy in psoriasis patients. CONCLUSIONS: Long-term PUVA treatment in psoriasis patients accelerates thinning of the skin in comparison to age-matched controls. The results show that ultrasonography is a sensitive method to investigate the effects of PUVA-induced skin ageing.

Design and synthesis of 4-substituted benzamides as potent, selective, and orally bioavailable I(Ks) blockers.

Multiple delayed rectifier potassium currents, including I(Ks), are responsible for the repolarization and termination of the cardiac action potential, and blockers of these currents may be useful as antiarrhythmic agents. Modification of compound 5 produced 19(S) that is the most potent I(Ks) blocker reported to date with >5000-fold selectivity over other cardiac ion channels. Further modification produced 24A with 23% oral bioavailability.

[Measurement of skin thickness by high-frequency ultrasound to objectify the effects of hormone replacement therapy in the perimenopause]. / Messung der Hautdicke mittels Hochfrequenzultraschall zur Objektivierung einer Hormonersatztherapie in der Perimenopause.

AIM: The aim of this study was to show the influence of three different hormone replacement therapy regimes (HRT) by comparing the changes in skin thickness. METHOD: Skin thickness was measured using a high-frequency ultrasound system on the inner side of the left upper arm of perimenopausal women with a low oestradiol level (< 45 pg/ml). The patients were allocated to different groups: Group1 (n = 6) received oestradiol merely transdermally; Group 2 (n = 7) was given transdermal oestradiol as well as progesterone vaginally; Group 3 (n = 8) took oral oestradiol and vaginal progesterone; Group 4 (n = 3) served as the control group without therapy. RESULTS: The median value of skin thickness in all HRT-groups increased highly significantly (0.15 mm) after six months (0.91 mm before therapy versus 1.06 mm after six months of HRT), but there was no significant change in the control group. CONCLUSIONS: The study shows that HRT leads to an increase of skin thickness which can be demonstrated by a high-frequency ultrasound.

The influence of hormone replacement therapy on skin ageing: a pilot study.

OBJECTIVES: We studied the effect of hormonal treatment on skin ageing in menopausal women. METHODS: Twenty-four patients (45-68 years; mean age, 54.9 years) without hormone treatment for at least 6 months were included. Patients were assigned to three therapy groups: 1, oestrogen only (Estraderm TTS 50) (n=6); 2, transdermal oestrogen and progesterone (Estraderm TTS 50 and 0.4 mg progesterone vaginal suppository) (n=7); and 3, oral oestrogen and progesterone (2 mg Progynova and 0.4 mg progesterone vaginal suppository) (n=8). One group without therapy was included as a control group (n=3). Treatment was continued for 6 months. Three patients, one from group 2 and two from group 3, discontinued therapy before the study endpoint. The following skin parameters were measured at monthly intervals during treatment: skin surface lipids, epidermal skin hydration, skin elasticity and skin thickness. Concomitant clinical evaluation included a subjective clinical evaluation form, a patient questionnaire and laboratory tests for oestradiol, progesterone and follicle stimulating hormone. RESULTS: Mean levels of epidermal skin moisture, elasticity and skin thickness were improved at the end of treatment based on both subjective and objective evaluation in patients with hormone replacement therapy (HRT). Skin surface lipids were increased during combined HRT, which may reflect stimulatory effects of the progestagen component on sebaceous gland activity, while oestrogen alone has a sebum-suppressive action. In the HRT groups, the questionnaire for climacteric complaints demonstrated significant improvements, while laboratory tests showed increases in oestradiol and progesterone and decreases in FSH. CONCLUSIONS: HRT with the mentioned regimes significantly improved parameters of skin ageing.

Punctate keratoderma-like lesions on the palms and soles in a patient with chloracne: a new clinical manifestation of dioxin intoxication?

We report what we believe to be a novel skin manifestation of dioxin intoxication. A 30-year-old woman with 2,3,7, 8-tetrachlorodibenzo-p-dioxin levels of 144,000 pg g-1 blood fat presented with severe chloracne that affected the entire integument. She also exhibited acral granuloma annulare-like lesions and distal onycholysis and, at a later time point, showed signs of hypertrichosis, as well as brownish-grey hyperpigmentation of the face. In addition, she developed punctate keratoderma-like lesions on the palms and soles. These lesions were negative for human papillomavirus and histologically characterized by cone-shaped hyperkeratoses invaginating, but not penetrating, into the dermis. Squamous syringometaplasia of the eccrine glands was observed in the immediate vicinity of these lesions. Both clinically and histologically these alterations are essentially indistinguishable from what is described as keratosis punctata palmaris et plantaris (KPPP). Although a fortuitous coincidence of chloracne and KPPP cannot be formally excluded, the possibility exists that in our patient toxic levels of dioxin were causally involved in this disorder of keratinization.

Tretinoin-iontophoresis in atrophic acne scars.

BACKGROUND: Atrophic acne scars are a frequent problem after acne. Hitherto, mainly invasive treatment measures were possible. In a recent paper, we demonstrated the positive effects of iontophoresis with 0.025% tretinoin gel vs. estriol 0.03%. OBJECTIVE: In this further study, the recording of the clinical effects of iontophoresis with 0.025% tretinoin gel in atrophic acne scars was supplemented by immunohistochemistry investigations of collagen I and III, proliferation markers, and the estimation of epidermal thickness. METHODS: The treatment was performed twice weekly in 32 volunteer patients for a period of 3 months by application of the substance under a constant direct current of 3 mA for 20 min. Skin biopsies prior to and at the end of treatment were performed in 32 voluntary patients in order to investigate collagen I/III and proliferation markers by immunohistochemistry methods. RESULTS: Clinically, at the end of treatment, in 94% of patients a significant decrease in the scar depth was observed. Neither epidermal thickness nor proliferation markers revealed a significant increase at the end of treatment. Furthermore, collagen I and collagen III showed no common trend, as expressed statistically by a lack of significance. In some cases, increases in collagen III became evident at the end of treatment. CONCLUSIONS: Tretinoin-iontophoresis is an effective, noninvasive treatment of atrophic acne scars without causing disturbing side-effects.

Generalized pustular psoriasis of pregnancy (impetigo herpetiformis).

A 17-year-old woman had a sudden eruption of pustules in her intertriginous areas as well as of erythematosquamous plaques on the scalp, elbows, palms and soles in the third trimester of her first pregnancy. Histopathological evaluation of a biopsy revealed typical changes of pustular psoriasis with parakeratosis and abscesses of neutrophils (Kogoj's spongiform pustules). The diagnosis of pustular psoriasis was established by the typical clinical and histopathological findings. Laboratory parameters showed a highly elevated blood sedimentation rate, hypoferric anemia and decreased albumin levels. Serum concentrations of parathormone and its metabolites were normal. After systemic treatment with glucocorticosteroids and antibiotics, the lesions improved but did not clear. After delivery of a healthy boy, therapy was switched to retinoid photochemotherapy with isotretinoin and PUVA that resulted in rapid and complete clearing of the eruption. The coincidence of plaque-type psoriasis and a pustular eruption as described previously in impetigo herpetiformis supports the view that this dermatosis of pregnancy is a variant of generalized pustular psoriasis.