[Travel and skin diseases]. / Reisen und Hautkrankheiten.

The problem "travelling and dermatological diseases" is presented as a temporary change of place with associated changes in ecological conditions. Latent dermatoses may be provoked--but full-blown dermatoses may also improve with no specific treatment (climatic therapy of neurodermatitis). Physiological changes at the surface of the skin brought about by, for example, temperature or the effects of solar radiation, may allow fungal, bacterial or viral infections to develop. Direct contact with the living environment on land or in the water, in particular in the tropics, can lead to the development of diseases. Some dermatoses have a lengthy latency and develop only later at home. Recommendations for general and specific prophylaxis and treatment are made.

[Results and consequences of long-term urea therapy for clinical practice]. / Ergebnisse und Konsequenzen einer langfristigen Harnstofftherapie für die medizinische Praxis.

In the development of clinical symptoms of atopic constitutional neurodermatitis, the application of urea can 1. regulate corneal layer lipids by hydrating the corneal layer and influencing transepidermal water loss, 2. reduce itching via inhibition of tryptic enzymes in the skin and, 3. diminish the susceptibility of the skin to infection by directly acting on the cell membranes of bacteria and fungi. In the present study, the combination of urea and hydrocortisone was used for acute attacks and urea ointment for chronic therapy. The study comprised 1905 patients ranging from small children to adults and was conducted by dermatologists as well as pediatricians. Medical monitors supervised the course of the study. Statistical assessment of the results obtained consolidated previous knowledge and led to new results and epidemiological insights which will be presented at the Neurodermatitis Symposium. Urea therapy in the form of a hydrocortisone-urea ointment represents an effective and low-side effect therapy of this type of chronic dermatosis. 84% of the patients showed very good to good results. Local therapy with other corticosteroids was only reported as necessary in 16% of the cases. The antiinflammatory value of hydrocortisone and its high tolerability became particularly evident. In addition to its special properties in the therapy of neurodermatitis, urea also ranks high as a physiological substitution.

Permeation of the human skin by heparin and mucopolysaccharide polysulfuric acid ester.

Punched samples of different specimens of human skin were treated with 5 mg/cm2 of commercially available topical preparations of heparin (50,000 IU/100 g, i.e. 0.35% w/w) or mucopolysaccharide polysulfuric acid ester (MPS, 1.4 and 0.45% w/w, respectively; active ingredient of Hirudoid). Heparin and MPS were labelled with tritium. The skin samples were fixed into a perfusion chamber. Perfusion fluid and skin were analysed 180 to 360 min later. The concentrations found in the corium varied from 0.005 to 0.1 IU heparin per g (i.e. 0.03 to 0.64 micrograms/g) and from 1.05 to 3.14 micrograms/g of MPS. While in normal skin the single administration of heparin and MPS resulted in levels of the same relative magnitude, skin with thinner epidermis and decreased horny layer (keloids) absorbed MPS to a higher degree. Repeated administration of a 1.4% MPS cream (0 and 90 min, measurement after 180 min) resulted in markedly enhanced levels, which were out of proportion especially in the deeper skin layers. This effect was confirmed with a 0.45% MPS cream. The direct comparison to the heparin cream resulted in higher heparin levels in the epidermis but higher MPS levels in all deeper skin layers, when calculated to the same concentration in the cream. The heparin in the dermal layers and in the perfusion chamber fluid was determined by molecular binding to protamine loaded sepharose 4B.

Senescence in the skin.

No difference was found between groups of senescent subjects and younger adults in the control of skin temperature, heat radiation and transcutaneous oxygen pressure. Although capillary numbers decline in elderly skin, transcutaneous oxygen pressure at 43 degrees C in elderly skin is no lower than in young subjects. Topical tretinoin (0.05%) increases heat radiation from the skin, but there is no correlation with an improvement in superficial wrinkles. No conclusion is possible regarding the effects of topical tretinoin on transcutaneous oxygen diffusion due to a wide variability in results; sometimes it is increased and sometimes it is decreased. In different regions of the skin, such as the face and thigh, increased skin radiation and skin contact temperature are not associated with increased transcutaneous oxygen diffusion.

[The physiology of aging of light-protected and light-exposed skin]. / Die Physiologie des Alterns der lichtgeschützten und lichtexponierten Haut.

We discuss the senescence of the skin considering both intrinsic aging and photoaging; special regard is paid to the various layers, the microcirculation, and the adnexa of the skin. In particular, the barrier function and microcirculation of the skin has been pointed out.

[Heparin and mucopolysaccharide polysulfuric acid ester permeate human skin]. / Heparin und Mucopolysaccharidpolyschwefelsäureester (MPS) permeieren die menschliche Haut.

After topical application of commercial preparations containing heparin and heparinoids (MPS) in concentrations of 30,000 up to 150,000 IE/100 g, the individual layers of the skin show more or less increased heparinization, which can be traced by means of the permeation chamber technique. The average concentration of heparin and MPS in the dermal layers containing capillaries is about 0.1-0.5 IE/ml and 400-40,000 ng/ml, respectively, depending on the quality of the horny layer. We did not find any evidence for the permeation being activated either by DMSO, urea, or other accelerators. Repeated exposition to the preparation within 4 hours, however, resulted in increased permeation of heparin and MPS. The amount of the gel or ointment applied was of no significance.

[Promoting penetration of locally applied substances by urea]. / Penetrationsförderung lokal applizierter Wirkstoffe durch Harnstoff.

These studies indicate that urea alters the physical and chemical properties of keratin so that permeation of monosubstances in urea-altered keratin is increased. The permeation kinetics of keratin can be influenced by splitting and/or altering the surface structure of keratin, which enhances the permeation of steroids, dithranol, and other substances. The regulation of permeation kinetics in the horny layer also applies to urea. The permeation of urea in and through the horny layer can lead to an alteration in the binding capacity within this layer (reservoir capacity). Thus, the penetration of substances such as oxiconazol through the horny layer can be decreased and their retention time increased. Nevertheless, urea is not always the stimulator of permeation processes.

Penetration and permeation into human skin of fusidic acid in different galenical formulation.

The penetration into the horny layer and permeation through the skin of fusidic acid, incorporated in different bases, e.g., cream, ointment and a gel (Fucidine), was investigated in vitro in a penetration chamber, using human skin. Whereas the horny layer offers a marked barrier to penetration in normal skin, this barrier can be greatly reduced by damaging the horny layer by adhesive tape stripping. Fusidic acid showed penetration into the different layers of skin which was related to the duration of application, including the penetration chamber fluid, i.e., there was penetration of the entire skin thickness. In the presence of spontaneous changes in the horny layer, as in seborrhoeic warts and similar conditions, fusidic acid penetrated well into the deeper layers of the skin. Fusidic acid is thus a substance which permeates better in regions where the horny layer is damaged, and where it can attain high levels, which in practice are antimicrobial. Penetration into the skin is thus a function of damage to the horny layer and the quality of the horny layer itself. From this point of view the amount of absorption in dermatoses depends on the area of skin with damage to the horny layer. Penetration through normal skin can be disregarded.

The present status of anti-inflammatory agents in dermatology.

Many classes of drugs exert anti-inflammatory activity through mechanisms which affect all or part of the inflammatory process. Some of these agents are beneficial in the practice of dermatology, while others, such as penicillamine, mast cell blockers and serotonin antagonists, find little or no application. Corticosteroids, for example, are nonspecific in their anti-inflammatory effects and remain a mainstay of therapy, despite their side effect profile. Other drugs, such as the non-steroidal anti-inflammatory agents or gold, can be used in the treatment of diseases associated with rheumatic or autoimmune states. Moreover, antihistamines play an important role in the control of itching, but are mainly indicated in controlling non-dermatological allergic sequelae. Interestingly, chloroquine and dapsone, which were originally developed for use in malaria prophylaxis and leprosy, respectively, have value in treating a wide range of dermatological conditions via mechanisms which include the inhibition of P-450 isoenzymes. In diseases characterised by disturbed cornification (e.g. psoriasis pustulosa), retinoids are of particular value. These drugs are thought to act by inhibition of collagenases, proteases and granulocyte migration. Undoubtedly, further investigation of drug classes such as oxygen radical controllers and immunomodulators will clarify their mechanisms and establish their therapeutic usefulness among the anti-inflammatory agents now available for dermatological use.

[Facial involvement in scabies in infancy]. / Gesichtsbefall bei der Skabies des Säuglings.

The infestation of a 3-month-old child with Sarcoptes scabiei by way of infested nipples during the breast-feeding period led initially to facial papules and later to generalized dermatitis. Scabies mites were not detected on the face; studies on ten infested babies in India supported this findings. Thus, direct antiscabies treatment to the face is not necessary in babies.