Anna Sommer

Ultraviolet A1-induced downregulation of human β-defensins and interleukin-6 and interleukin-8 correlates with clinical improvement in localized scleroderma

Background  In previous studies, distinct immunological abnormalities have been reported in localized scleroderma (LS). Several pro‐inflammatory cytokines have been demonstrated at increased levels in sera of patients with LS in parallel with disease activity. Human β‐defensins (hBDs) are peptides with antimicrobial activity, but have been also shown to be implicated in tissue injury, scarring and wound healing. hBD expression in LS, a condition resembling pathological scarring due to excessive stimulation of matrix synthesis and fibroblast activation, has so far not been investigated. Ultraviolet (UV) A1 phototherapy, the most recent advance in the treatment of LS, targets T‐cell dermal inflammatory infiltrates via induction of various cytokines and soluble factors besides well‐known effects on collagen metabolism.

A Comparative Pilot Study on Ultraviolet-induced Skin Changes Assessed by Noninvasive Imaging Techniques in Vivo

Abstract The effects of acute and chronic ultraviolet (UV) on the morphology of human skin have been extensively studied ex vivo by means of histological investigations. However, innovative skin imaging techniques enable visualization of micromorphological structures in vivo. We aimed to perform a correlation study evaluating in vivo dose and time dependent skin changes following solar-simulated irradiation using noninvasive techniques such as optical coherence tomography (OCT) and confocal laser scanning microscopy (CLSM). The forearms of 10 healthy subjects were exposed to 1 minimal erythema dose (MED) and 3 MED of solar-simulated radiation. Noninvasive measurements were performed before and 24 h and 72 h after UV exposures. We demonstrate definite OCT and CLSM findings obtained from UV-exposed skin, including an increase in epidermal thickness (hyperproliferation, acanthosis), a reduction in dermal reflectivity (dermal edema), an increase in brightness of the basal layer (pigmentation), and an increase in vessel diameter within the dermal papillae (vasodilatation). A moderate to strong linear association between the methods employed was observed. In conclusion, noninvasive high-resolution imaging techniques such as OCT and CLSM may be promising tools for photobiological studies aimed at assessing photoadaptive and/or phototoxic processes in vivo. However, larger studies are needed to demonstrate the applicability of the findings presented in this pilot study.

A randomised controlled trial on photo(chemo)therapy of subacute purigo

Background.  Psoralen ultraviolet A (PUVA) is the standard photo(chemo)therapeutic regimen for patients suffering from subacute prurigo (SP).

A case of cutis verticis gyrata, induced by misuse of anabolic substances?

microscopy from one of the pustules showed no evidence of herpetic infection. The clinical picture was now consistent with acute generalized pustular psoriasis (GPP). Skin biopsy showed epidermal hyperplasia, some trafficking of neutrophils across the epidermis, and mounds of parakeratosis containing neutrophils with loss of the granular layer in keeping with early psoriasis (Fig. 2). Methotrexate was commenced at a dose of 10 mg weekly. Six weeks after the onset of treatment, the patient’s skin was clear. The methotrexate was gradually reduced, and 5 months after the onset of her eruption it was discontinued altogether. There has been no subsequent relapse over the following 3 years. When oral and potent topical steroids were being used for treatment of psoriasis in the 1960s and 1970s, it became well recognized that abrupt withdrawal could provoke an episode of GPP. In 1969, Ryan and Baker compared the treatment of GPP with either systemic corticosteroids or folic-acid antagonists. There were more deaths and fewer lasting remissions in the steroid-treated patients, who were also at risk of generalized pustular relapses precipitated by attempted withdrawal of the steroid. Our patient is unusual in that her GPP developed de novo within a week of starting prednisolone. The only other new drug she had received preceding the rash was mesalazine, which we do not think is likely to have caused the rash because it was stopped 5 weeks prior to the rash onset. Drugs that have been reported to induce or exacerbate psoriasis include b-blockers, lithium, and antimalarials. Other exacerbating factors that have been proposed for GPP include pregnancy, hypocalcaemia, topical crude coal tar application, and infection. More recently, the onset of pustular psoriasis has been reported in a patient given the antitumour necrosis factor-a antibody, infliximab, for treatment of chronic ulcerative colitis. Precipitation of GPP by steroid withdrawal is well recognized. This paradoxical case illustrates that the introduction of steroid treatment can also be a precipitating factor for GPP.

Painful unusual ulcers of the ankle

A 55-year-old white woman presented to our clinic with painful ulcerations of the lower leg, which had been recurrently present for several years. Clinical examination revealed two very unusual, oozing ulcerations, 20 · 25 mm and 5 · 8 mm at the right dorsal foot and ankle, which were surrounded by an erythematous border (Fig. 1a). A third ulcer (20 · 15 mm) was found at the dorsum of the left foot. Additionally, erythematous to livid, reticulate vascular patterns were present on the patient’s thighs and sides (Fig. 1b). The patient’s medical history included current arterial hypertension and a history of previous myocardial infarction and deep-vein thrombosis. Complete laboratory investigation including auto-antibody and thrombophilia screens were unremarkable. However, greatly raised levels of circulating immune complexes were detected (43.8 lg ⁄ mL) (normal range: 0.0–1.5 lg ⁄ mL). Magnetic resonance imaging of the central nervous system showed bilateral periventricular and parietal subcortical located hyperintense lesions suspicious for previous ischaemic damage (Fig. 2).