Arnd Jacobi

Tear film osmolarity measurements in dry eye disease using electrical impedance technology.

Purpose: Tear film hyperosmolarity is recognized as an important pathogenetic factor in dry eye syndrome, but difficulties in its measurement have limited its utility in the recent past. This prospective, nonrandomized, clinical single-center study investigates the osmolarity in tear samples of patients with keratoconjunctivitis sicca compared with healthy controls. Methods: One hundred thirty-three patients [aged 58 years (51–64 years), 86 women and 47 men] with moderate to severe keratoconjunctivitis sicca and 95 controls [aged 52 years (48–61 years), 55 women and 40 men] were enrolled in the trial. Tear samples were collected directly from the inferior lateral tear meniscus. Inclusion criteria were a tear breakup time of less than 5 seconds, a Schirmer test with anesthesia less than 5 mm, and positive symptoms (Ocular Surface Disease Index score > 83). Tear film osmolarity was analyzed by the TearLab osmometer. Results: In our study, patients with moderate to severe keratoconjunctivitis sicca showed a tear film osmolarity of 320 mOsmol/L (301–324 mOsmol/L). The results of the control group were 301 mOsmol/L (298–304 mOsmol/L). Our results revealed a significantly higher tear film osmolarity in patients with moderate to severe keratoconjunctivitis sicca compared with the control group. The sensitivity was 87%, and the specificity was 81%. Conclusions: Our results approved the referent value in moderate to severe dry eye of approximately 316 mOsmol/L, as described in the literature. The results showed a significantly higher tear film osmolarity in patients with severe keratoconjunctivitis sicca compared with the healthy controls. Testing tear film osmolarity can be a very effective objective diagnostic tool in the diagnosis of dry eye disease.

Pimecrolimus 1% Cream in the Treatment of Facial Psoriasis : A 16-Week Open-Label Study

Background: Facial psoriasis requires a treatment approach other than topical corticosteroids which bear the risk of skin atrophy. Topical pimecrolimus has been shown to be effective in atopic eczema and recently in psoriasis. Objective: The aim of this open-label single-center investigator-initiated study was to evaluate the efficacy and safety of pimecrolimus 1% cream in patients with facial psoriasis. Methods: 20 adults with facial psoriasis were enrolled. Pimecrolimus 1% cream was applied twice daily to psoriatic lesions of the face over an 8-week period. An 8-week follow-up was added. Results: All clinical parameters showed a significant improvement after 8 and 16 weeks compared to baseline. Pimecrolimus 1% cream was effective and well tolerated. Conclusions: This is the first clinical study with a larger patient cohort reporting a relevant therapeutic effect and favorable safety profile of pimecrolimus 1% cream in facial psoriasis.

Determination of eicosanoid and cytokine production in salvaged blood, stored red blood cell concentrates, and whole blood

STUDY OBJECTIVE To determine the production of the eicosanoids prostaglandin 2 (PGE2) and thromboxane 2 (TxB2) and the cytokines interleukin 1 beta (IL-1-beta) and interleukin 6 (IL-6) in whole blood (WB), unfiltered red blood cell (RBC), and filtered RBC concentrates, and salvaged blood. DESIGN Prospective study. SETTING University hospital of Erlangen. PATIENTS 32 healthy volunteers and 14 ASA physical status I, II, and III radical prostatectomy patients (mean age 65 yrs). INTERVENTIONS Sixteen WB units and 16 RBC units (divided into 16 filtered and unfiltered units each) were taken from 32 volunteers. Fourteen salvaged RBC units were obtained from the 14 radical prostatectomy patients. Sixteen WB units were stored for 35 days. From the 16 WB donations, RBC concentrates (PAGGS-M) were prepared. The RBC concentrates were halved, one half had its leukocytes removed at day 0; both halves were stored for 49 days. Salvaged blood (n = 14) was stored up to 2 hours during surgery and then retransfused. MEASUREMENTS AND MAIN RESULTS Immediately at the start of the study, in all blood units (WB, RBC filtered, and RBC unfiltered units) at days 0 and 21, and at the end of the storage period (WB: 35 days, RBC concentrates: 49 days) and in the salvaged RBC units, the following parameters were measured: PGE2, TxB2, IL-1-beta, IL-6, hematocrit, platelet number, leukocytes, blood volume, and hemoglobin. During storage, different levels of PGE2, TxB2, IL-1-beta, IL-6 for WB, filtered RBC concentrates, and unfiltered RBCs were found. The higher levels of PGE2, TxB2, IL-1-beta, and IL-6 were found in the WB and RBC salvaged units than the filtered RBCs or unfiltered RBC units. There was no statistically significant difference between WB and salvaged RBCs. Higher levels of leukocytes and platelets were found in WB units and salvaged RBCs as compared to filtered or unfiltered RBCs. CONCLUSIONS The eicosanoid and cytokine levels in the salvaged, filtered RBC, unfiltered RBC, and WB units stayed within physiological limits, suggesting that these levels do not contribute to the risk of nonhemolytic, immunomodulated transfusion reactions, even in massive transfusions.

Therapeutischer Einsatz der Tumor-Nekrose-Faktor-α-Hemmer Infliximab und Etanercept bei entzündlichen Hauterkrankungen

Hintergrund: Die Behandlung entzündlicher Hauterkrankungen ist häufig empirisch, da kausale Therapiemaßnahmen aufgrund unvollständiger Kenntnisse der Immunpathogenese meist nicht vorliegen. Die derzeit durchgeführten Therapien können zwar zur Remission der Erkrankung führen, allerdings müssen unter Umständen unerwünschte Nebenwirkungen in Kauf genommen werden. Aufbauend auf den Erfahrungen einer zytokinmodulierenden Therapie bei chronisch entzündlichen Erkrankungen wie der rheumatoiden Arthritis, könnte der Einsatz von TNF‐α‐Inhibitoren eine weitere, spezifischere und effektivere Behandlungsmöglichkeit einzelner entzündlicher Hauterkrankungen darstellen.

Treatment of inflammatory dermatoses by tumour necrosis factor antagonists

Background  The treatment of inflammatory skin diseases is at present often empirical as causal therapeutic approaches, based on an incomplete knowledge of the immune pathogenesis, are mostly unavailable. The currently applied treatments can in fact lead to remission of the disease; however, under certain circumstances undesirable side‐effects must be expected. On the basis of experience gained in cytokine modulation therapy of chronic inflammatory diseases such as rheumatoid arthritis and psoriasis, the application of TNF‐α inhibitors represents a novel, more specific, and effective therapeutic option for distinct chronic inflammatory diseases.

Comorbidities, metabolic risk profile and health-related quality of life in German patients with plaque-type psoriasis: a cross-sectional prospective study

Background  Patients with psoriasis experience a higher risk of cardiovascular and metabolic comorbidities and have a high burden of treatment. There is still a gap between treatment options and quality of care. The purpose of this study was to determine the demographic data, comorbidities, and the limitations of quality of life in patients with plaque‐type psoriasis.

Infliximab in a patient with refractory mucosal aphthosis

© 2007 The Authors 109 JEADV 2008, 22, 101–136 Journal compilation

Prevalence of Obesity in Patients with Psoriasis: Results of the National Study PsoHealth3.

Background: Psoriasis is frequently associated with obesity which possibly contributes to reduced treatment response. Objectives: Assessment of the prevalence of obesity in patients with psoriasis in Germany 2013/2014. Patients and Methods: The frequency of overweight and obesity was assessed by the body mass index (BMI) and evaluated according to the severity of psoriasis [Psoriasis Area and Severity Index (PASI)]. Results: This national, cross-sectional survey involved 83 dermatological practices and outpatient clinics, including 1,265 patients (mean age 52 years; 43.4% female). The BMI of patients with psoriasis in 2013/2014 was found to be 28.0 and therefore was significantly higher compared to that of patients with psoriasis in 2007 with a BMI of 26.9 as well as compared to the normal population in 2013 with an overall BMI of 25.9. Conclusions: The prevalence of obesity in patients with psoriasis is higher than in the normal population. The trend towards a higher BMI in patients with psoriasis continues over time.

Ustekinumab in the treatment of palmoplantar pustular psoriasis - a case series of nine patients: Ustekinumab in the treatment of palmoplantar pustular psoriasis

Palmoplantar pustular psoriasis is a chronic inflammatory skin disease that is associated with considerable impairment in quality of life and resilience. Given the lack of approved pharmacological agents for this indication and the frequently recalcitrant disease course, therapeutic options are limited.

Efficacy and tolerability of liposomal polyvinylpyrrolidone-iodine hydrogel for the localized treatment of chronic infective, inflammatory, dermatoses: an uncontrolled pilot study

Infection is common in many chronic, inflammatory skin conditions but is often difficult to treat, in part due to growing bacterial resistance to antibiotics. Liposomal polyvinyl-pyrrolidone (PVP)-iodine hydrogel has a unique mode of action, combining the antiseptic and anti-inflammatory actions of PVP-iodine with the drug delivery and moisturizing properties of liposomes. We investigated the utility of liposomal PVP-iodine to treat infective dermatoses. In this prospective, single-arm (uncontrolled), open-label Phase II pilot study, patients with acne vulgaris (n=30), atopic dermatitis (n=20), impetigo contagiosa (n=10), and rosacea (n=10) received PVP-iodine (3%) hydrogel for ≤4 weeks. Global Clinical Severity score improved for all dermatoses (range: 0.5 for acne vulgaris [p<0.001] to 1.0 for impetigo contagiosa [p=0.011]). Improvements in pain, quality of life, (Freiburg Life Quality Assessment), and Eczema Area and Severity Index scores were also seen. Treatment was well tolerated; most frequent adverse events were burning (14%) or itching (9%) sensations. Thus, liposomal PVP-iodine hydrogel has potential utility as an effective treatment for inflammatory skin conditions associated with bacterial colonization.