Franklin Kiesewetter

Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men

Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Initial signs of androgenetic alopecia usually develop during teenage years leading to progressive hair loss with a pattern distribution. Moreover, its frequency increases with age and affects up to 80 % Caucasian men and 42 % of women.

Successful treatment of calciphylaxis with pamidronate

Calciphylaxis is a rare syndrome characterized by calcification of blood vessels and panniculitis in association with ecchymosis and/or skin necrosis. Most commonly, calciphylaxis is seen in patients with chronic renal failure. In this context, bisphosphonates have been successfully applied in some patients. Here we report on a patient with calciphylaxis of unknown origin treated with pamidronate.

Endocrinological Markers for Assessment of Hyperandrogenemia in Hirsute Women

Background: Measured endocrinological parameters (total testosterone [TT], free testosterone [FT], dihydrotestosterone [DHT], dehydroepiandrosterone sulfate [DHEAS], and sex hormone binding globulin [SHBG]) and calculated parameters (calculated FT (cFT), calculated bioavailable testosterone (cBT), and the free androgen index [FAI]) in women with hirsutism were compared to the values of a control group. The question remains if cFT or cBT are more appropriate markers for assessment of hyperandrogenemia in clinical situations such as hirsutism in women. Methods: Sixty-six women showed an modified Ferriman-Gallwey (mF-G) score of ≧6 and were classified as hirsutism group and 58 women showed mF-G scores of ≤5 and were classified as control group. TT, FT, DHT, DHEAS, and SHBG were measured with enzyme immunoassays in one serum sample. Albumin was measured in the same sample. Afterwards, cFT, cBT, and the FAI were calculated. Results: The hirsutism group revealed significantly increased cFT, cBT, and FAI, while SHBG was significantly decreased compared to the controls. All values of the hirsutism group showed significant, but poor correlation with the mF-G score. SHBG correlated negatively with the mF-G score and BMI. Conclusion: Despite the limited correlation of all endocrinological parameters to severity of hirsutism described by the mF-G score, cFT, cBT, and FAI may be more appropriate markers for assessment of hyperandrogenemia in women with hirsutism in comparison with measured values of simple enzyme immunoassays.

Sex hormones and antiandrogens influence in vitro growth of dermal papilla cells and outer root sheath keratinocytes of human hair follicles

Anagen hair bulb papillae, interfollicular dermal fibroblasts, and interfollicular keratinocytes isolated from fronto-parietal scalp biopsies as well as outer root sheath keratinocytes from plucked anagen hairs were separately grown in subculture for 14 d. The effect of different concentrations (2.4 nM-17.3 microM) of testosterone, dihydrotestosterone, and the antiandrogens cyproterone acetate or 17 alpha-propylmesterolone on growth behavior of the mesenchymal and epithelial cell types of the hair follicle were comparatively studied by means of growth curves, cell doubling times, and 3H-thymidine incorporation. For control, all cell lines were subcultured in hormone-free medium. Testosterone and dihydrotestosterone (345 nM) significantly reduced proliferation of papilla cells compared with dermal fibroblasts (p < 0.01) and outer root sheath keratinocytes compared with interfollicular keratinocytes (p < 0.01), as well as compared with cells cultured in control medium. Low concentrations of 17 beta-estradiol were ineffective, whereas doses of 180 nM 17 beta-estradiol increased the growth velocities of all cell types, especially of papilla cells, compared with dermal fibroblasts. Low doses of either cyproterone acetate (24 nM) or 17 alpha-propylmesterolone (29 nM) induced a growth enhancement, especially of papilla cells and outer root sheath keratinocytes, whereas high doses of cyproterone (1.20 microM) and 17 alpha-propylmesterolone (1.45 microM) had opposite effects. These changes were significant between papilla cells and dermal fibroblasts as well as between outer root sheath keratinocytes and interfollicular keratinocytes. Applying increasing doses of androgens to cyproterone acetate (24 nM)- or 17 alpha-propylmesterolone (29 nM)-containing media neutralized the growth-stimulating effect of antiandrogens, particularly in papilla cells and outer root sheath keratinocytes. However, minor differences between testosterone and dihydrotestosterone effects on cell growth were found. The data clearly demonstrate that the changes of in vitro growth of hair follicle cells depend on the concentrations of androgens and antiandrogens, as higher doses of both antiandrogens tested retarded the cell proliferation similar to testosterone or dihydrotestosterone. The papilla cells and outer root sheath keratinocytes reacted more sensitively to the hormones tested, thereby confirming the concept of a distinct androgen sensitivity of these specialized hair follicle cells.

Cell Cycle Kinetics of Human Anagen Scalp Hair Bulbs in Thyroid Disorders Determined by DNA Flow Cytometry

In both, 6 hyperthyroid and 6 hypothyroid patients as well as 10 healthy volunteers, cell cycle kinetics of dissected anagen scalp hair bulbs were determined by means of DNA flow cytometry (DNA-FCM). Compared with the healthy control group in patients with thyroid disorders striking differences of cell kinetic data were evaluated. In hyperthyroidism a significant increase (30%) and in hypothyroidism a significant decrease (15%) of S and G2+M phase cell percentages was found. The proliferation index (S+G2+M %) calculated revealed similar results. A correlation between the height of S phase percentages and plasma T3 levels was recognizable but could not be proven statistically. By means of DNA-FCM the study demonstrates for the first time the influence of thyroid hormones on in vivo cell cycle kinetics of human scalp hair bulbs.

Plasma cell gingivitis: Treatment with 2% fusidic acid

Plasma cell gingivitis is analogous to balanitis plasmacellularis, which Zoon’ fast described in 1950. It is usually confined to the anterior maxillary gingiva and represents a manifestation of plasmocytosis circumorificialis,’ which appears as slightly raised, bright red, velvety plaques. Histologic examination shows a characteristic dense plasma cell accumulation. We describe a patient with plasma cell gingivitis for 15 years, which was markedly reduced after treatment with 2% fusidic acid in tetracainecontaining Dynexan adhesive ointment.

Erosive pustular dermatosis of the leg in a patient with ankylosing spondylitis: neutrophilic dysfunction as a common etiological factor?

A 73-year-old Caucasian man presented with a 6-week history of erosive lesions of both lower legs, which showed no improvement upon topical Betametason treatment. Additionally, he suffered from a chronic venous insufficiency, ankylosing spondylitis for over 12 years, hypothyroidism, and anemia. Medication consisted of prednisolone 5 mg, levothyroxine 75 μ g daily, and iron substitution. Examination showed superficial erosions with crusting on both shins measuring approximately 7 × 12 cm. Removal of the crusting revealed multiple pinhead-sized, nonfollicular pustules coalescing into pustular lakes strictly limited to circumscribed painless, erythematous, moist erosions on both lower legs (Fig. 1, left). Light microscopy revealed parakeratosis and subcorneal pustules. The papillary dermis showed a diffuse lymphocytic infiltrate and numerous granulocytes migrating into the epidermis (Fig. 2). Direct immunofluorescence demonstrated discontinuous granular C3 deposits at the basal membrane and minor dermal vessel associated IgM deposits. Indirect immunofluorescence was negative. Microbiology revealed sterile pustules. Laboratory examinations disclosed an elevated C-reactive protein 112 mg/l (< 5 mg/l), borderline serum IgG and IgA levels, and an inflammatory-associated anemia: hemoglobin 9.5 g/dl (> 13 g/dl); 3.76 × 10 6 erythrocytes per μ l (> 4.2 × 10 6 / μ l); ferritin 22 μ g/ml (> 160 μ g/ml).

Lupus-erythematodes-/Lichen-ruber-planus-Overlap-Syndrom : 5 Fälle im Patientengut der Dermatologischen Universitätsklinik Erlangen (1984-1995)

ZusammenfassungDas simultane Vorkommen von Lupus-erythematodes-(LE-) und Lichen-ruber-planus-(LP-) artigen Symptomen wird als LE/LP-Overlap-Syndrom (LE/LP-OS) bezeichnet. Es wird definiert durch das gleichzeitige Vorkommen klinischer, histologischer und immunhistologischer Charakteristika beider Krankheitsbilder. In der Literatur sind bisher 47 Patienten mit dieser seltenen Erkrankung beschrieben, wobei die klinischen Erscheinungsbilder heterogen sind: Die einzelnen Hauterscheinungen zeigen ein zwischen LE und LP intermediäres Erscheinungsbild (Typ I=intermediärer Typ) oder aber ein Nebeneinander von LE- und LP-typischen Effloreszenzen (Typ II=polarer Typ). Zur Bestimmung der Häufigkeit und Charakteristika des LE/LP-OS untersuchten wir retrospektiv unser LE-Patientengut von 1984–1995: In 5 Fällen wurde die Diagnose eines LE/LP-OS gestellt. Das LE/LP-OS ist demnach im untersuchten Kollektiv häufiger als bisher angenommen. Aufgrund der großen Variationsbreite der klinischen, histologischen und immunhistologischen Befunde und Fehlen pathognomonischer Merkmale des LE/LP-OS, wird die Diagnose möglicherweise zu selten gestellt. Da sich jedoch aus der Diagnose therapeutische Konsequenzen ergeben, werden Kriterien vorgestellt, die Erkennen und Abgrenzung des LE/LP-OS erleichtern.SummaryThe simultaneous occurrence of lupus erythematosus (LE)- and lichen ruber (LP)-like symptoms is called LE/LP-overlap syndrome (LE/LP-OS). It is defined by concomitant clinical, histologic and immunhistologic features of both diseases. To date, 47 cases of this rare dermatosis have been reported with marked differences in the skin lesions: They are either of intermediate appearance between LE and LP (type I=intermediate type), or show a co-existence of LE- and LP-specific lesions (type II=polar type). To determine the frequency and characteristics of the LE/LP-OS we reviewed our LE-patients from 1984–1995. 5 cases were diagnosed. The frequency of LE/LP-OS in our patients is higher than generally assumed. Due to its variable clinical, histological and immunhistological appearance and the lack of unequivocal pathognomonic signs, this overlap-dermatosis may be underdiagnosed. Since therapeutic consequences result from the diagnosis, criteria are suggested to faciliate the recognition of the LE/LP-OS.

[Multiple keratoacanthomas (Witten-Zak type) in prurigo simplex subacuta].

Zusammenfassung. Bei einer 51jährigen Patientin traten seit 3 Jahren langsam zunehmende stark juckende Hautveränderungen auf. Neben einzelnen klinisch und histologisch typischen großen Keratoakanthomen (KA) zeigten sich multiple kleinere exkoriierte Knötchen, die sich histologisch teils als beginnende Keratoakanthome, teils als ausgeprägte Papeln von Prurigo simplex subacuta herausstellten. In zwei KA war HPV Subtyp 2 durch In-situ-Hybridisation nachweisbar. Im weiteren Verlauf entwickelten sich zahlreiche KA aus Läsionen der Prurigo simplex subacuta. Systemische Therapie mit Etretinat (Tigason) führte zur Abheilung der großen KA und reduzierte deren Neuentstehung, beeinflußte jedoch nur wenig das Auftreten neuer pruriginöser Herde während bisher 28monatiger Nachbeobachtungszeit. Das simultane und sukzessive Auftreten multipler Keratoakanthome bei dieser Patientin entspricht am ehesten der seltenen von Witten und Zak beschriebenen Variante. Die Entstehung aus Prurigo-Herden wurde noch nicht beschrieben.Abstract. We report on the case of a 51-year-old female patient who had been suffering from multiple itching nodules for 3 years. Some of these lesions were classified clinically and histologically as keratoacanthomas (KA), whereas the multiple smaller nodules were found on histological examination to be either early stage KA or lesions of prurigo simplex subacuta. In two KA, HPV subtype 2 was identified by in situ hybridization. Treatment with etretinate resulted in remission of the fully developed KA and reduced the occurrence of new ones. The outbreak of multiple KA in our patient resembled a rare subtype described by Witten and Zak. Postclinical follow-up for 28 months to date has revealed that the KA arise from the subacute prurigo lesions. This mode of prurigo-dependent KA development has not previously been reported.

Progressive partially symmetric erythrokeratodermia with deafness : histological and ultrastructural evidence for a subtype distinct from Schnyder's syndrome

An atypical case of the rare genodermatosis erythrokeratodermia progressiva partim symmetrica (EPPS) with deafness and myopathy is described. Our findings suggest that this case of EPPS with deafness and myopathy represents a distinct entity of atypical erythrokeratodermias with characteristic epidermal and dermal skin changes.