Erhard Hölzle

Polymorphous light eruption. Experimental reproduction of skin lesions

The clinical features of polymorphous light eruption (PLE) are reviewed from the literature with special emphasis on the experimental reproduction of skin lesions. Our clinical experience with 180 patients is reported. In forty-three patients a newly developed UVA provocation test was performed. UVA, free of sunburn radiation (50-100 J/cm2), was administered, sometimes repeatedly up to four times, to large sites of previously involved skin. With this technic the reproduction of PLE lesions under laboratory conditions was possible in 90% of this group of forty-three patients. The diagnosis was substantiated by microscopic examination of genuine and experimentally induced lesions. Characteristic histologic features of PLE are described. Phototesting with large doses of UVA aids in confirming the diagnosis of PLE. Hitherto, this diagnosis depended often on exclusion of other dermatoses. Eusolex 8021, a UVA-effective sunscreen, blocked eruptions of PLE lesions under laboratory conditions. An effective means of treatment is offered by PUVA therapy.

Pathogenesis and classification of solar urticaria: A new concept

Although its exact mechanism remains unknown, evidence supports the immunologic nature of solar urticaria. On the basis of experimental findings in the literature and our own observations, a new concept of the pathogenesis and classification of solar urticaria is presented. We propose two types of solar urticaria: type I, IgE-mediated hypersensitivity to specific photoallergens, which are generated only in patients with solar urticaria, and type II, induction of IgE-mediated hypersensitivity to a nonspecific photoallergen, which is generated both in patients with solar urticaria and in normal persons.

PUVA-Treatment for solar urticaria and persistent light reaction

SummaryA technique is described to successfully treat patients with extreme sensitivity to UV electromagnetic wave lengths with photochemotherapy. Representative data from a patient with solar urticaria and two patients with persistent light reaction are given. Prior to treatment the threshold doses for UV-C, UV-B, and UV-A were determined. Photochemotherapy was performed with standard 8-methoxypsoralen-UV-A (PUVA) schedules. Initial treatments were very difficult because of the extreme UV-sensitivity in all patients. Once pigmentation was induced, PUVA-treatments were easy to perform.All patients became almost free of symptoms and were able, for the first time in years, to resume normal outdoor activities. Remission was long-lasting.Photochemotherapy is offered as a new effective means to alleviate the symptoms of disabling photodermatoses.ZusammenfassungEs wird ein Verfahren zur Photochemotherapie von Patienten mit extremer Empfindlichkeit auf elektomagnetische Strahlung im UV-Bereich beschrieben. Zwei Patienten mit persistierender Lichtreaktion und eine Patientin mit Lichturtikaria werden kasuistisch vorgestellt.Jeweils vor und nach der Therapie wurde die Reaktionsschwelle für UV-C, UV-B und UV-A bestimmt. Die Photochemotherapie erfolgte entsprechend dem standardisierten Schema der 8-Methoxypsoralen-UV-A-Therapie (PUVA). Wegen der extremen Lichtempfindlichkeit der Patienten, gestaltete sich die Therapie anfangs schwierig. Nach Stimmulierung einer ausreichenden Pigmentierung konnte die PUVA-Behandlung problemlos fortgesetzt werden.Bei allen Patienten kam es zu einer vollständigen und langanhaltenden Remission. Die Patienten konnten sich erstmals nach langer Zeit wieder ungehindert der direkten Sonnenbestrahlung aussetzten.

Ross syndrome: Treatment of segmental compensatory hyperhidrosis by a modified iontophoretic device*

In 1958 the triad of tonic pupils, areflexia (Holmes-Adie syndrome), and hypohidrosis was first described by Ross. Since then more than 15 patients with a similar condition have been described. Two cases with the typical triad in combination with associated autonomic dysfunctions are presented. Subjectively, the most disturbing symptom is segmental compensatory hyperhidrosis, which results from widespread hypohidrosis or anhidrosis. For treatment of hyperhidrosis, tap water iontophoresis was applied using a modified technique with special electrodes. In both patients the hyperhidrosis was relieved after 20 treatments.

Morbus Morbihan : chronisch persistierendes Erythem und Ödem des Gesichts

ZusammenfassungDer Morbus Morbihan wurde 1957 erstmals von Degos als selbständigs Krankheitsbild herausgestellt und bezeichnet ein chronisches Erythem und Ödem der oberen Gesichtshälfte unbekannter Ätiologie. Ähnliche Patienten wurden in der Literatur unter den Diagnosen chronisches Lymphödem oder solides persistierendes Gesichtsödem bei Akne oder Rosazea beschrieben. Typisch sind der chronische Verlauf, das charakteristische klinische Bild bei Fehlen spezifischer laborchemischer oder histologischer Veränderungen sowie die weitgehende Therapieresistenz.SummaryMorbihans disease was first reported as a distinct entity in 1957 by Degos, describing a chronic persistent erythema and oedema of the upper half of the face. Such conditions have been noted in the literature designated as chronic lymphoedema or solid persistent facial oedema in acne or rosacea. The characteristic features are a chronic course, a typical clinical picture, lack of specific laboratory and histological findings and refractoriness to therapeutic measures.

Fixed solar urticaria

BACKGROUNDnThree unusual cases of solar urticaria limited to fixed skin sites are described.nnnOBJECTIVEnOur objective was to study the clinical course and several therapeutic regimens for fixed solar urticaria.nnnMETHODSnPhototesting and in vitro activation of a plasma factor were performed.nnnRESULTSnWheals in a patchy pattern were strictly localized to the same circumscribed skin areas; they were reproducible in their pattern and location by irradiation. The action spectra ranged from 320 to 700 nm, 320 to 585 nm, and 400 to 560 nm. In one patient inhibition was found by wavelengths between 280 and 320 nm. Intradermal injection of the patients plasma activated by in vitro irradiation induced wheals only in the affected skin sites. The patients showed a good therapeutic response to H1-antihistamines or repeated exposures to natural sunlight.nnnCONCLUSIONnThe term fixed solar urticaria is proposed for this peculiar type of solar urticaria.

Antimicrobial effects of an antiperspirant formulation containing aqueous aluminum chloride hexahydrate.

SummaryTo document deodorant efficacy the antimicrobial activity of a gelatinous antiperspirant formulation of aqueous aluminum chloride hexahydrate was investigated. In vitro assays demonstrated highly bactericidal activity on microorganisms comprising the resident axillary skin flora, including micrococcaceae and aerobic diphtheroid bacteria. Gram-negative bacteria and yeast were partially inhibited. In vivo experiments utilizing occlusive patches on forearm skin and bacterial sampling of the axilla showed pronounced bacteriostasis and persistence of aluminum chloride on the skin. Inhibition of microbial growth lasted more than 3 days after a single treatement of the axilla. Following repeated open applications to the volar aspect of the forearm, the skin remained virtually sterile for 3 days.ZusammenfassungDie antimikrobielle Wirkung einer gelatinierten wäßrigen Antiperspirantlösung mit Aluminiumchloridhexahydrat wurde untersucht, um die desodorierende Wirkung zu dokumentieren. In vitro konnte ein hochgradig bakterizider Effekt auf Mikroorganismen der axillären Hautflora, wie Micrococcaceae und aerobe Corynebakterien gezeigt werden. Gram-negative Bakterien und Hefen wurden nur teilweise gehemmt. In-vivo-Experimente bestätigten eine ausgeprägte bakteriostatische Wirkung sowie eine Persistenz von Aluminiumchlorid an der Hautoberfläche. Dies gelang durch Untersuchung der Bakterienflora sowohl in Okklusionsversuchen am Unterarm als auch in der Axilla nach üblicher Antiperspirantanwendung. Nach einer einzigen Behandlung der Axilla dauerte die Wachstumshemmung der Hautflora mehr als 3 Tage an. Nach wiederholter offener Anwendung am volaren Unterarm blieb die Haut über 3 Tage annähernd keimfrei.

Modification and optimization of tap water iontophoresis

Zusammenfassung. Die Leitungswasser-Iontophorese ist Therapie der Wahl bei Hyperhidrosis palmoplantaris, doch sind die bisher publizierten Therapieschemata methodisch unterschiedlich. Das Ziel der vorliegenden Studie war, die wesentlichen methodischen Parameter anhand von systematischen, experimentellen Behandlungsserien zu untersuchen und ein optimales Therapieschema zu entwickeln. Gegenstand der Prüfung waren die Polung des Gleichstromes, die Dauer einer Behandlungssitzung, der Effekt von Elektrolytzugaben zum Behandlungsmedium und die Therapiefrequenz in der Erhaltungsphase. Als Ergebnis wird ein Behandlungsplan vorgeschlagen, bei dem während der Initialphase 3mal wöchentlich 10u2005min lang therapiert wird. Die Anode wird bis zum Erreichen der Normhidrosis konstant an einer Extremität gehalten. Anschließend erfolgt die Umpolung des Stromes. Die Therapie wird bis zur beidseitigen Normhidrosis weitergeführt (Dauerpolung). In der darauf folgenden Erhaltungsphase werden die Patienten alle 6u2009–u20098 Tage 10u2005min lang mit von Behandlung zu Behandlung alternierender Strompolung therapiert (Wechselpolung). Als Behandlungsmedium dient Leitungswasser ohne Zusätze.Abstract. Tap water iontophoresis is the therapy of choice in hyperhidrosis palmoplantaris. Therapeutic regimens, however, vary greatly. The aim of the present study was to develop an optimized therapeutic scheme. The main methodologic parameters subjected to systematic experimental study included the effects of current polarity, the duration of a single treatment session, the addition of electrolytes to the tap water and the treatment interval during maintenance therapy. The following procedure is proposed. During the initial phase, treatments are carried out three times weekly for 10u2005min each time. The anode is kept on one extremity until normhidrosis is reached on this extremity. Then, polarity is changed until sweating is reduced to normal on the other extremity (constant polarity). In the subsequent maintenance phase, patients are treated at intervals of 6u2009–u20098 days for 10u2005min each time. Polarity is switched from treatment to treatment (alternating polarity). Plain tap water is used without additives.

Photochemotherapie von Photodermatosen: Lichturtikaria, persistierende Lichtreaktion und polymorphe Lichtdermatose

Es werden Erfahrungen uber die Photochemotherapie von 2 Patienten mit Lichturtikaria (LU), 5 Patienten mit persistierender Lichtreaktion (PLR) und 7 Patienten mit polymorpher Lichtdermatose (PLD) mitgeteilt.