Astrid Steen

Inflammatory mediators potentiate pain induced by experimental tissue acidosis.

&NA; Electrophysiological evidence from cutaneous nociceptors suggested a synergism between excitatory actions of inflammatory mediators (IM) and low pH. In human skin it is possible to induce constant ongoing pain with continuous infusion of acid buffer. This method was used to study the interaction with mediators of inflammation psychophysiologically. A skin area on the palmar forearm of 6 subjects (either gender, age 22–35 years) was continuously infiltrated with a phosphate buffered electrolyte solution (pH 5.2) using a motorized syringe pump that was adjusted so as to produce constant pain of about 20% on a visual analog scale (VAS; extending from ‘no’ to ‘unbearable pain’). Pain was assessed on the VAS at 10‐sec intervals; the rating was called up by means of an acoustic signal. An additional cannula was placed in the skin before the infusion of acidic buffer started. Injections of an acidic combination of IM (BK, 5‐HT, HIS, PGE2) 0.2 ml were then given through the cannula at intervals of 10 min in a randomized double blind order of concentrations. The other arm was used for negative control, i.e. IM in neutral solution were injected into normal skin continuously infiltrated with a buffer solution at pH 7.4. The IM induced dose‐dependent, transient burning pain on both arms — markedly more intense and prolonged, however, in the acidotic skin (P < 0.004, U‐test). The difference corresponded to a 10‐fold increase in algogenic potency with 10−7 M IM, being smaller with 10−6 and 10−5 M concentration. The interaction between low pH and IM was mutual: additional injections of plain phosphate buffer (pH 5.2) into the acidotic skin were significantly more painful (20‐fold) after application of IM than under control conditions. Thus, we tend to conclude that it is the inflammatory mediators that potentiate the algogenic effect of low pH rather than vice versa. Tissue acidosis appears as a dominant factor in inflammatory pain.

Plasma levels after peroral and topical ibuprofen and effects upon low pH-induced cutaneous and muscle pain

Cutaneous applications are gaining popularity in the treatment of cutaneous pain and of painful disorders in joints and muscle. The low pH‐pain model in human skin has previously been able to demonstrate the effects of NSAIDs in dose‐dependent manner and to establish time‐effect relationships. We examined the analgesic action of ibuprofen after cutaneous application and compared the effects with oral administration. The two studies (with n = 12 subjects each) were performed in a double‐blind, randomized fashion with a 1‐week cross‐over interval. In study 1 volunteers received intradermal infusions with phosphate buffered saline solution of pH 5.2 and received either 800 mg ibuprofen per os and topical placebo, or 4 g of a 5% commercial ibuprofen gel topically applied and oral placebo capsules, respectively. In study 2 the same protocol was applied with painful intramuscular infusion of stronger, isotonic phosphate buffer (pH 5.2). The flow rate of the pH‐infusion was individually adjusted to induce pain with a magnitude of 20% on a visual analogue scale (ranging from ‘no’ (0%) to ‘unbearable pain’ (100%)). Ibuprofen (S‐, R‐) plasma levels after oral administrations were measured with HPLC, and after topical applications, by gas chromatography combined with mass spectroscopy to determine plasma levels in the range of ng/ml. In the cutaneous model pain ratings decreased to zero after topical verum gel within 45 min of the observation period of 55 min. Pain reduction after peroral ibuprofen was of the same magnitude, but was achieved within only 30 min. In the muscle model, the commercial ibuprofen gel did not reduce the pain in the acidic muscle. The peroral ibuprofen was less effective in the muscle compared to the skin pain model, although there was a significant progressive pain reduction within 55 min. Reasons for the differential susceptibility of cutaneous vs muscular acidosis pain to ibuprofen remain to be established.

Zoster in childhood after inapparent varicella.

The history revealed that, 3 months previously, the boy’s 3 siblings Sir, had had chickenpox. At that time the baby was 3.5 months old. Zoster infection is rare in healthy children and if it occurs it Although he had permanent contact with the other children in the is usually associated with a history of chickenpox. We report family, no skin lesions were apparent. The serological investigations here a case of a 7-month-old, otherwise healthy boy who at the time of hospitalization were: displayed typical skin lesions of zoster in trigeminus I. At no Mother: VZV-IgG positive, VZV-IgM negative; time was chickenpox clinically apparent, although exposure Patient: VZV-IgG positive, VZV-IgM borderline, VZV-IgA positive, to the varicella zoster virus at the age of 3.5 months had HIV I and II negative; been noted. Varicella occurs before the age of 14 years in 95% of all The boy received acyclovir (10 mg/kg per day) perorally 3 times a day children (1). Zoster usually occurs in patients over 50 years for 5 days. Under this treatment complete resolution of the lesions old and is rare in childhood. Risk factors for zoster in infants occurred. include immunocompromised states and/or primary varicella zoster virus (VZV) infection in utero or before 12 months of age (2). Zoster can also occur when children are infected with DISCUSSION chickenpox after 1 year of age (3).

Congenital smooth muscle hamartoma of the skin: clinical classification.

Case 1 A 2-year-old girl presented with an asymptomatic congenital skin lesion on her right upper arm. Examination revealed an elevated, slightly hyperpigmented plaque, 663 cm in size. There was prominent overlying hair and a localized folliculitis that had developed 6 months earlier (Fig. 1). The pseudo Darier sign was positive, with visible piloerection and increased ®rmness produced by rubbing the lesion. Histopathology showed a prominent dilated hair follicle with a keratin plug and a perifollicular in ̄ammatory in®ltrate with some mucin. Multiple bundles of smooth muscles, running in various directions, were demonstrated in the surrounding dermis. Four months later, after use of a topical antibiotic preparation, the folliculitis had decreased in intensity. The rest of the lesion remained unchanged.

Hauttumoren im Kindesalter

Pigmentzellnavi werden hervorgerufen durch eine zu grose Anzahl und/oder Aktivitat der dermalen und/oder epidermalen Melanozyten. Bei den Cafe-au-Lait-Flecken handelt es sich um rundliche bis ovale, homogene, pigmentierte, milchkaffeefarbene Flecken. Finden sich mehr als 5 grosere dieser an sich harmlosen Flecken, so kann dies, insbesondere in Kombination mit sommersprossenartigen Hyperpigmentierungen in den Axillen, ein Hinweis auf das Vorliegen einer Neurofibromatose sein. Epheliden, sog. Sommersprossen, sind sehr kleine, gelb bis braunliche, scharf begrenzte Pigmentflecken, die haufiger bei rothaarigen Menschen zu finden sind und durch UV-Licht im Sommer besonders deutlich hervortreten. Davon abzugrenzen sind Lentigines, die den Sommersprossen ahneln, aber meist dunkler und bis linsengros sind und lichtunabhangig entstehen. Bei plotzlicher Aussaat und Auftreten zahlreicher Lentigines spricht man von einer Lentiginose, die auch auf innere Veranderungen hinweisen kann wie z. B. beim LEOPARD-Syndrom.

Autoimmune bullöse Dermatosen

Die erworbenen bullosen Krankheiten im Kindesalter sind relativ selten und klinisch in der Regel sehr schwer voneinander zu unterscheiden. Die diagnostische Klarung erfolgt in der Regel uber die direkte Immunfluoreszenz oder das sog. Immunomapping und/oder Immunoblotting.

Papulöse und nodöse Krankheiten

Definition. Das Granuloma anulare (Abb. 274.1), eine bei Kindern gehauft auftretende granulomatose Dermatose, kann gelegentlich mit einer diabetischen Stoffwechselneigung assoziiert sein.

Erkrankungen des Nagelorgans

Angeborene oder erworbene Erkrankungen des Nagelorgans sind bei Kindern relativ selten. Wie bei Erwachsenen stellen diese sehr oft diagnostische und therapeutische Herausforderungen dar. Die grundliche korperliche Untersuchung sollte stets die Untersuchung der Nagel beinhalten, da sie ggf. wichtige Hinweise fur angeborene, meist monogenetische Erkrankungen oder weitere erworbene, meist entzundliche Dermatosen liefern.

Krankheiten der Hautanhangsgebilde

Definition, Atiologie und Pathogenese. Die Alopecia areata (Abb. 279.1), eine nichtvernarbende Alopezie, kann in jedem Lebensalter auftreten, insbesondere bei Kindern im Schulalter. Es handelt sich offensichtlich um eine Autoimmunaggression zytotoxischer Lymphozyten gegen Bestandteile des Follikelapparats. Bei langer bestehender Krankheit kann es zur irreversiblen Zerstorung des Follikels kommen.

Benigne Dermatosen bei Neugeborenen und Säuglingen

Besonderheiten der Haut bei Neugeborenen und Sauglingen. Die Haut erfullt mehrere Funktionen. Sie dient als physikalische und chemische Barriere, produziert Talg und reguliert uber die Abdunstung durch Schweisbildung den Warmehaushalt. Wahrend bei der Geburt die Talgproduktion gut entwickelt ist (auser bei Fruhgeborenen), haben die anderen Funktionen noch nicht ihre Reife erreicht. Diese Unreife der kutanen Physiologie hat tief greifende Konsequenzen.