Dermatology

Möhrle, M.; Häfner, H.M.

doi: 10.1159/000063354pmid: 12077517

Subungual melanomas represent approximately 20% in dark-skinned and oriental populations compared to about 2% of cutaneous melanomas in white populations. UV exposure seems to be an important risk factor for cutaneous melanoma. However, UV radiation is unlikely to penetrate the nail plate. Another pathogenetic factor of subungual melanoma will be discussed. 406 subungual melanomas of the hands (n = 240) and feet (n = 166) of 74 patients from the melanoma registry of the Department of Dermatology, University of Tübingen, and of 332 patients from the literature were evaluated. The hypothesis of a uniform distribution of the occurrence of subungual melanoma on the fingers and toes had to be rejected (p < 0.001 using the χ²;_4,0.95 test).There was a considerable predominance of subungual melanoma localized on the thumb (58% of all fingers) and the hallux (86% of all toes). Many patients report direct trauma related to the onset of subungual melanoma. This might be explained by coincidence, increased attention to a dark area under the nail, traumatic bleeding of a subclinical subungual melanoma or mutation of melanocytes during trauma-induced proliferation. Squamous cell carcinoma is known to occur in sites of chronic trauma. Trauma could be an etiologic factor in subungual melanoma as well.

Vašků, V.; Vašků, A.; Tschöplová, S.; Izakovičová Hollá, L.; Semrádová, V.; Vácha, J.

doi: 10.1159/000063355pmid: 12077518

Background: Excessive angiogenesis is one of the characteristic features of psoriasis. Objective: To determine the possible genetic background of neo-angiogenesis in plaque psoriasis, frequent polymorphisms in matrix metalloproteinase 2 (MMP-2) and endothelin 1 (ET-1) genes were studied. Methods: The case group (n = 119) included patients with plaque psoriasis, aged 44 ± 15 years. The age of onset of psoriasis was 27 ± 11 years. The control group (n = 184) consisted of healthy subjects without any individual history of psoriasis, aged 37 ± 15 years. C(-735)T MMP-2 and G(8002)A ET-1 polymorphisms were determined by PCR reaction with subsequent restriction analyses. Results: A significant difference in genotype distribution of C(-735)T MMP-2 between psoriatic and control patients was found (p_corr = 0.008). Two associated genotypes (CCGG and CTGG) of the two polymorphisms were significantly less frequent in psoriatic patients (p_corr = 0.03 and p_corr = 0.008, respectively). Conclusion: The results seem to reflect a different susceptibility of MMP-2 as well as of some associated MMP-2 and ET-1 genotypes to psoriasis.

Uter, Wolfgang; Geier, Johannes; Pfahlberg, Annette; Effendy, Isaak

doi: 10.1159/000063356pmid: 12077519

Background: There is a strong influence of lower leg dermatitis on the spectrum of allergic contact sensitivity in elderly patients. Objective: To quantitatively assess the impact of this factor which confounds the age-related pattern of allergic contact sensitivity. Methods: Stratified analysis of allergic contact sensitivity data collected between 1996 and 1999 in the 32 centres of the Information Network of Departments of Dermatology (three age groups: ≤60, 61–75, ≧76 years), both as crude and as directly standardised (for sex and leg dermatitis) proportions. Results: Among the 36,070 patients tested with the German standard series, allergic contact sensitivity to neomycin, lanolin, cetostearylic alcohols, colophony, fragrance mix and balsam of Peru, among others, was (much) more common in the elderly, with proportions more or less affected by standardisation. Conclusion: The comparison of crude and standardised proportions provides evidence that allergic contact sensitivity to several allergens strongly depends not only on age itself, but on age-related and thus confounding co-morbidity.

Soriano-Hernández, Yaara L.; Orozco-Covarrubias, Luz; Tamayo-Sánchez, Lourdes; Durán-McKinster, Carola; Sosa-de-Martínez, Cristina; Ruiz-Maldonado, Ramón

doi: 10.1159/000063357pmid: 12077520

Background: Exanthems in children often represent a diagnostic challenge. Purpose: To determine the concordance between pediatric and dermatological diagnoses of exanthems. Design: Prospective study. Procedure: Exanthems that appeared in hospitalized pediatric patients were diagnosed by pediatricians. Pediatric dermatologists, by consensus, either confirmed or modified the diagnoses. Whenever possible, laboratory tests were used to confirm the final clinical diagnoses. Age and evolution were compared with the Kruskal-Wallis test; the ĸ coefficient was used to determine concordance. Setting: Institutional tertiary referral pediatric care center. Results: Concordance between pediatric and dermatological diagnoses was found in only 44 patients. When pediatric and dermatological diagnoses of exanthems were classified, the concordance between both diagnoses was very low (ĸ = 0.165). Conclusions: Pediatric specialists, other than dermatologists, failed to diagnose common skin diseases. This may be a consequence of insufficient training in dermatology by medical schools and pediatric residency.

Akamatsu, H.; Tomita, T.; Horio, T.

doi: 10.1159/000063358pmid: 12077521

Background: The macrolide antibiotic roxithromycin is effective against acne associated with inflammation, but the mechanism by which this is achieved has not been clarified. Objective: We studied the effects of roxithromycin on the production of lipase and neutrophil chemotactic factor by Propionibacterium acnes in vitro. Results: Roxithromycin significantly inhibited the production of lipase and neutrophil chemotactic factor by P. acnes at a concentration one eighth of the MIC, at which the growth curve of P. acnes is not affected. Conclusion: One mechanism of the effectiveness of roxithromycin in acne therapy is thought to be the inhibition of bacterial lipase and neutrophil chemotactic factor production by P. acnes.

Hermanns, J.F.; Petit, L.; Piérard-Franchimont, C.; Paquet, P.; Piérard, G.E.

doi: 10.1159/000063359pmid: 12077522

Background: So-called darkened age spots encompass distinct pathological processes. The efficacy of topical depigmenting agents is difficult to objectivate. Objective: To assess the hypopigmenting effect of three cosmetic formulations using objective biometrological methods. Methods: 50 women of South-East Asian ancestry were enrolled in this pilot study. They had solar lentigines according to dermoscopic criteria. The lesions were treated by topical hypopigmenting formulations. Products were applied twice daily for 2 or 3 months. Assessments at 1-month intervals were made using narrow-band reflectance spectrophotometry, image analysis of video-recorded ultraviolet light reflection and photodensitometry- and image-analysis-assisted corneomelametry. Results: A 20% azelaic acid formulation and another one containing 5% ascorbyl glucosamine, 1% kojic acid and α-hydroxyacid esters appeared inefficacious on solar lentigines. A stabilized soy extract showed a better although modest lightening effect when assessed by corneomelametry. The subclinical or faint mottled skin revealed by ultraviolet light examination better responded (p < 0.05) to treatments. Conclusion: Focal epidermal hyperpigmentation is better controlled by topical whitening agents when the increase in melanin content reflects a modest functional hyperactivity of melanocytes.

Meineke, Viktor; Reichrath, Jörg; Reinhold, Uwe; Tilgen, Wolfgang

doi: 10.1159/000063360pmid: 12077523

Background: Treatment of verrucae vulgares is sometimes difficult. Invasive methods should not be used for young children. Objective: Evaluation of a special suggestion therapy for treatment of verrucae vulgares in children. Methods: Nine children with warts on the hands and/or feet and in the face were treated with a simulated X-ray treatment. Results: Five children showed a complete remission of warts, 3 children a partial remission. For 1 child, there was no response. On average, 3 treatment sessions were needed for children showing a complete remission. Conclusion: This therapy offers an easy-to-perform, alternative treatment option. It is noninvasive and does not depend on special psychological techniques for which training is required.

Simonart, T.; Boelaert, J.R.; van Vooren, J.P.

doi: 10.1159/000063361pmid: 12077524

We have previously shown that iron may be involved in the pathogenesis of Kaposi’s sarcoma (KS) and that the iron chelator desferrioxamine (DFO) inhibits the growth and induces the apoptosis of KS cells in vitro. We treated an 85-year-old man with classic KS with 5 weekly intralesional injections of DFO and observed the opposite effect in vivo. The DFO-treated lesion was characterised by the development of numerous KS papules within the drug diffusion area, whereas no change was noted in untreated or control saline-treated lesions. This suggests that intralesional iron chelators are not indicated in patients with KS.

Virgili, Annarosa; Tosti, Giulio; Bettoli, Vincenzo; Corazza, Monica

doi: 10.1159/000063362pmid: 12077525

Skin dimples are seldom observed in sites other than the face. We report on a male premature child who was seen at the age of 2 months for the evaluation of cutaneous depressions symmetrically located on the shoulders, elbows and in the sacral region. Skin dimples have sometimes been considered a benign autosomal dominant trait. However, several authors have reported these cutaneous defects in a variety of conditions like congenital syndromes, infections, inborn errors of metabolism and mechanical trauma. In our case, the aetiology is unknown, even though maternal drug or infective exposure can reasonably be excluded as well as traumatic events. At a 3-year follow-up, the patient shows a normal psychophysical development. This appears to be the first case of a child presenting congenital, symmetric dimples in three different areas.

Schultz, Erwin S.; Kaufmann, Dieter; Tinschert, Sigrid; Schell, Hermann; von den Driesch, Peter; Schuler, Gerold

doi: 10.1159/000063363pmid: 12077526

Segmental neurofibromatosis is characterised by a limited, segmental distribution of cutaneous neurofibromatosis type 1 (NF1) lesions. It has been suggested that segmental NF results from a postzygotic NF1 gene mutation, and, recently, this hypothesis has been proven in a patient with regionally distributed café-au-lait (CAL) spots and freckles by demonstrating an NF1 microdeletion restricted to fibroblasts cultured from CAL spots. We describe here a patient with segmental NF in which we could not demonstrate any NF1 gene mutation in fibroblasts cultured from neurofibromas by use of the protein truncation test, enzymatic mutation detection and fluorescence in situ hybridisation. These data are in line with the concept that NF1 mutations in Schwann cells, but not in fibroblasts, correlate with neurofibroma formation.