H. A. Martino Neumann

Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid 0.5% liposomal spray and intense pulsed light in combination with topical keratolytic agents

Background  Increasing antibiotic resistance of Propionibacterium acnes and growing awareness on the side effects of topical and systemic drugs in the treatment of acne vulgaris by physicians and patients have paved the way for a search into new efficacious and safe treatment modalities such as photodynamic therapy (PDT). Although the efficacy of PDT using 20% 5‐aminolevulinic acid (ALA) cream has been established, phototoxic side effects limit its use. The 5‐ALA concentration can be lowered by a factor of 40 by changing the vehicle of 5‐ALA from a moisturizing cream to liposome encapsulation.

Fluorescence Detection and Diagnosis of Non-Melanoma Skin Cancer at an Early Stage

The occurrence of non‐melanoma skin cancer (NMSC), including actinic keratosis (AK) is increasing all over the world. The detection and diagnosis of NMSC is not optimal in clinical practice. Complementary methods for detection and accurate demarcation of NMSC at an early stage are needed in order to limit the damage caused by tumours.

Pressure Differences of Elastic Compression Stockings at the Ankle Region

BACKGROUND. Ekstic Compression stockings are widely used medical devices for the prevention of edema and treatment of venous diseases. Many beneficial effects have been described in the past. The exact amount of pressure underneath elastic com‐pression stockings at different areas of the leg remains contro‐versial. OBJECTIVE. To examine the pressure at the skin underneath class 11 elastic compression stockings at different places around the ankle at the B level. METHODS. Patients with known venous insufficiency and reg‐ularly using class U elastic therapeutic compression stockings (25–35 mm Hg) for venous diseases were included. AU subjects iverc wearing completely new stockings at the time ofthe study. Measurements were performed with an electropneumatic inter‐face pressure measuring device (Oxford Pressure Monitor MK ID ivith inflatable small sensoring cells. Six sensors were placed around the smallest circumference at the ankle (B‐area). The highest and lowest recordings as well as the means were evaluated. RESULTS. The mean pressure of class 11 elastic stockings mea‐sured around the ankle was 24.7 mm Hg (SD, 8.4). The lowest pressures were found at the medial site (28.3 mm Hg: 74% ofthe mean), and the highest at the pretihial zone (5i.9 mm Hg, 137%). CONCLUSIONS. The pressure exerted by pressure class II elastic compression stockings a the medial site just above the ankle (B area) is too low to have influence and improve the venous in‐sufficiency. For phlebology this is the target area. It might be a reason for the high recurrence rate of venous ulcers even if patients wear stockings. Also, the mean pressure of class II stockings was found to be below the normal levels of its pressure class (25–35 mm Hg according to the European CEN classifi‐cation). The results advocate the use of pressure class III elastic compression stocking more often and the use ofpelottes or foam pads.

Bax expression and growth behavior of basal cell carcinomas.

Background:  To understand the typical growth behavior of basal cell carcinoma (BCC) we searched for the correlation between proliferation and apoptosis and progression of BCC.

Treatment of vitiligo with khellin liposomes, ultraviolet light and blister roof transplantation

Background  Various surgical and non‐surgical methods are available to treat vitiligo. Surgical techniques such as epidermal blister graft transplantation may be effective for the re‐pigmentation of stable, but refractory vitiligo areas. Khellin has phototherapeutic properties that are similar to those of the psoralens, but with substantially lower phototoxic effects and DNA mutation effects. Its penetration into the hair follicles is enhanced by encapsulating it into liposomes. Subsequent activation of the khellin with UV light stimulates the melanocytes in the hair follicles.

Compression therapy with medical elastic stockings for venous diseases

background. Compression therapy is the cornerstone in the treatment of venous disease. In many cases, but especially for the maintenance of compression, medical elastic compression stockings (MECS) are being used. Preprescription investigation includes determining the severity of venous insufficiency and the arterial system. An ankle/arm index < 0.6 will be the contraindication for compression therapy. MECS can be divided in flat‐knitted and round‐knitted MECS. Flat‐knitted MECS can be made tailor sized, with a tolerance up to 0.5 cm. Several classes of MECS are characterized by the elasticity coefficient (EC) of the used elastic threads. The stiffer the stocking (high EC), the better a MECS will prevent edema formation during the day, but the more difficult it is to put them on. MECS with a high EC are always flat knitted. Most round‐knitted MECS will last 4–6 months, and flat‐knitted MECS, 6–9 months. results. The physician can prescribe MECS for a wide variety of venous and some other diseases. He can determine the amount of compression as well as the stiffness of the MECS. conclusion. Only a well‐motivated patient and an experienced physician together are able to ensure ongoing successful compression therapy with MECS.© 1998 by the American Society for Dermatologic Surgery, Inc.

Light fractionation does not enhance the efficacy of methyl 5-aminolevulinate mediated photodynamic therapy in normal mouse skin

Previous work demonstrated that fractionated illumination using two fractions separated by a dark interval of 2 h, significantly enhanced the clinical efficacy of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA). Considering the increasing clinical use of methyl 5-aminolevulinate (MAL) and the expected gain in efficacy by light fractionation we have investigated the response to MAL-PDT using a single and a two-fold illumination scheme and compared that with ALA-PDT. Our results show that fractionated illumination does not enhance the efficacy of PDT using MAL as it does using ALA despite the comparable fluorescence intensities at the end of the first light fraction and at the start of the second light fraction. Only the initial rate of photobleaching was slightly greater during ALA-PDT although the difference was small. Previously we hypothesized that cells surviving the first fraction are more susceptible to the second fraction. Since this is not true for MAL-PDT our data suggest that the distribution of MAL and ALA in tissues, and therefore the site of PDT induced damage, is an important parameter in the mechanism underlying the 2-fold illumination scheme.

Fractionated illumination at low fluence rate photodynamic therapy in mice.

Photodynamic therapy (PDT) for actinic field cancerization is effective but painful. Pain mechanisms remain unclear but fluence rate has been shown to be a critical factor. Lower fluence rates also utilize available oxygen more efficiently. We investigated PDT effect in normal SKH1‐HR mice using low and high fluence rate aminolevulinic acid (ALA) PDT and a fractionated illumination scheme. Six groups of six mice with different light treatment parameters were studied. Visual skin damage was assessed up to 7 days post‐PDT. Fluorescence and reflectance spectroscopy during illuminations provided us with real‐time information about protoporphyrin IX (PpIX) photobleaching. A novel dosing approach was introduced in that we used a photobleaching percentage instead of a preset fluence. Data show similar total and maximum damage scores in high and low fluence rate groups. Photobleaching of PpIX in the low fluence rate groups shows a trend toward more efficient photobleaching. Results indicate that low fluence rate PDT is as effective as and more efficient than high fluence rate PDT in normal mouse skin. Low fluence rate PDT light protocols need to be explored in human studies in search for an effective and well‐tolerated treatment for actinic field cancerization.

Assessing the public's preference for surgical treatment of primary basal cell carcinoma: a discrete-choice experiment in the south of the Netherlands.

BACKGROUND Basal cell carcinoma (BCC) is a slowly growing nonmelanoma type of skin cancer that often is located on the face. Different therapies are available to treat BCC, of which surgical excision (SE) and Mohs micrographic surgery (MMS) are the most frequently used surgical procedures. OBJECTIVES To examine which attributes of a surgical treatment the general public values as important and to determine the incremental willingness to pay for MMS versus SE. METHODS A discrete‐choice experiment (DCE) was conducted among members of the general public to examine which attributes of a surgical treatment for primary BCC are valued as important. In addition, based on the attributes included in the experiment, the willingness to pay for MMS versus SE was determined. RESULTS Respondents (N=312) preferred a treatment with a lower recurrence rate, shorter surgery time, shorter travelling time, shorter waiting time, no risk for re‐excision, and lower cost. The incremental willingness to pay for MMS was 847 euro (

A Comparative Study on the Efficacy of Treatment with 585 nm Pulsed Dye Laser and Ultraviolet B-TL01 in Plaque Type Psoriasis

1,203). CONCLUSIONS Results from this DCE indicate that, when outcome and process attributes are considered from a societal perspective, MMS is preferred over SE for primary BCC. &NA; The authors have indicated no significant interest with commercial supporters.