C. Appelhans

Epikutantestung bei Patienten mit Ulcus cruris unter besonderer Berücksichtigung moderner Wundprodukte

BACKGROUND Patients with leg ulcers often have contact sensitizations. Modern wound care products claim low allergic potential. OBJECT To analyze the patch test results in leg ulcer patients with focus on modern care wound products. MATERIAL AND METHODS 95 leg ulcer patients were tested with the standard German patch test series as well as frequently used wound care products. RESULTS 61% of the patients had at least one positive reaction. Most frequent reactions were seen with tert-butylhydroquinone, povidone iodine, balsam of Peru, a hydrogel, fragrance mix I and II, Amerchol L101 and gentamicin. There were 14 reactions to modern wound care products with highest sensitization rates for hydrocolloids and hydrogels. Patients sensitized to wound care products had significantly more positive patch test reactions. CONCLUSION There are sensitisations against modern wound care products, especially hydrogels. That should be considered in patch test of leg ulcer patients.

Patch testing in patients with leg ulcers with special regard to modern wound products

BACKGROUND Patients with leg ulcers often have contact sensitizations. Modern wound care products claim low allergic potential. OBJECT To analyze the patch test results in leg ulcer patients with focus on modern care wound products. MATERIAL AND METHODS 95 leg ulcer patients were tested with the standard German patch test series as well as frequently used wound care products. RESULTS 61% of the patients had at least one positive reaction. Most frequent reactions were seen with tert-butylhydroquinone, povidone iodine, balsam of Peru, a hydrogel, fragrance mix I and II, Amerchol L101 and gentamicin. There were 14 reactions to modern wound care products with highest sensitization rates for hydrocolloids and hydrogels. Patients sensitized to wound care products had significantly more positive patch test reactions. CONCLUSION There are sensitisations against modern wound care products, especially hydrogels. That should be considered in patch test of leg ulcer patients.

UVA1-induced decrease in dermal neuron-specific enolase (NSE) in acrosclerosis.

Besides its role in small-cell carcinoma of the lung, elevated serum levels of neuron-specific enolase (NSE) have recently been reported to be associated with autoimmune rheumatic disorders such as systemic sclerosis. Serum NSE seems to correlate with disease activity as well as Rodnan skin score. The aim of the study was to assess the neuromodulatory effects of conventional UVA1 phototherapy on acrosclerosis as an additional mechanism besides an assumed T cell apoptosis, collagenase induction and angiogenesis. Punch skin biopsies of acrosclerotic skin lesions taken before and after treatment from four patients were evaluated immunohistochemically for the presence of NSE, S100 and neurofilament. Immunolabeling revealed a UVA-induced decrease in dermal NSE expression. In contrast, no alteration in neurofilament+ cells could be detected. In line with the findings of a previous investigation, a high number of S100+ cells were detected in most specimens. We demonstrated a UVA1-induced reduction in dermal NSE levels correlating with a softening of former sclerotic lesions. Even though the origin and the functional mechanisms remain obscure, NSE might be relevant directly within sclerotic skin lesions and may possibly be used as a diagnostic marker at least in SSc-associated acrosclerotic skin.

Epikutantestung bei Patienten mit Ulcus cruris unter besonderer Berücksichtigung moderner Wundprodukte@@@Patch testing in patients with leg ulcers with special regard to modern wound products

BACKGROUND Patients with leg ulcers often have contact sensitizations. Modern wound care products claim low allergic potential. OBJECT To analyze the patch test results in leg ulcer patients with focus on modern care wound products. MATERIAL AND METHODS 95 leg ulcer patients were tested with the standard German patch test series as well as frequently used wound care products. RESULTS 61% of the patients had at least one positive reaction. Most frequent reactions were seen with tert-butylhydroquinone, povidone iodine, balsam of Peru, a hydrogel, fragrance mix I and II, Amerchol L101 and gentamicin. There were 14 reactions to modern wound care products with highest sensitization rates for hydrocolloids and hydrogels. Patients sensitized to wound care products had significantly more positive patch test reactions. CONCLUSION There are sensitisations against modern wound care products, especially hydrogels. That should be considered in patch test of leg ulcer patients.

Fibromatosis of the hand associated with EMO syndrome: A Case report

BackgroundEMO syndrome, defined as a triad including exophthalmus, pretibial myxedema and osteoarthropathia, is a rare condition in patients suffering from hyperthyreosis.Case presentationWe here describe an interesting case of EMO syndrome associated with unilateral fibromatosis of the hand and an initial stage of generalized myxedema of the skin. To our knowledge a similar case has not yet been described in literature though reports about associated fibromatosis, e.g. located retroperitoneally, already exist. Familiar explanations include its initiation by autoimmune processes or aberrant T-cell cytokine stimulation leading to an overwhelming production of glycosaminoglycans.ConclusionInterpreting our case in context with previous reports we conclude that associated fibromatosis induced by autoimmune processes may affect a variety of different localizations and therefore requires careful monitoring. A therapeutical attempt by using UVA1 irridation for pretibial myxedema remained without a satisfying regression.