Harald Maier

639 Anti-TNF Antibody-Induced Psoriasiform Skin Lesions in Patients With Inflammatory Bowel Disease Are Characterized by Interferon-y-Expressing TH1 Cells and IL-17A/IL-22-Expressing TH17 Cells and Respond to Anti-IL-12/IL-23 Antibody Treatment

Background We analysed incidence, predictors, histological features and specific treatment options of anti-tumour necrosis factor α (TNF-α) antibody-induced psoriasiform skin lesions in patients with inflammatory bowel diseases (IBD). Design Patients with IBD were prospectively screened for anti-TNF-induced psoriasiform skin lesions. Patients were genotyped for IL23R and IL12B variants. Skin lesions were examined for infiltrating Th1 and Th17 cells. Patients with severe lesions were treated with the anti-interleukin (IL)-12/IL-23 p40 antibody ustekinumab. Results Among 434 anti-TNF-treated patients with IBD, 21 (4.8%) developed psoriasiform skin lesions. Multiple logistic regression revealed smoking (p=0.007; OR 4.24, 95% CI 1.55 to 13.60) and an increased body mass index (p=0.029; OR 1.12, 95% CI 1.01 to 1.24) as main predictors for these lesions. Nine patients with Crohns disease and with severe psoriasiform lesions and/or anti-TNF antibody-induced alopecia were successfully treated with the anti-p40-IL-12/IL-23 antibody ustekinumab (response rate 100%). Skin lesions were histologically characterised by infiltrates of IL-17A/IL-22-secreting T helper 17 (Th17) cells and interferon (IFN)-γ-secreting Th1 cells and IFN-α-expressing cells. IL-17A expression was significantly stronger in patients requiring ustekinumab than in patients responding to topical therapy (p=0.001). IL23R genotyping suggests disease-modifying effects of rs11209026 (p.Arg381Gln) and rs7530511 (p.Leu310Pro) in patients requiring ustekinumab. Conclusions New onset psoriasiform skin lesions develop in nearly 5% of anti-TNF-treated patients with IBD. We identified smoking as a main risk factor for developing these lesions. Anti-TNF-induced psoriasiform skin lesions are characterised by Th17 and Th1 cell infiltrates. The number of IL-17A-expressing T cells correlates with the severity of skin lesions. Anti-IL-12/IL-23 antibody therapy is a highly effective therapy for these lesions.

Furuncular myiasis caused by Dermatobia hominis, the human botfly

Myiasis is a common travel-associated dermatosis. Travelers to many parts of Central and South America are susceptible to infestation by Dermatobia hominis. Despite the common name of human botfly, D hominis infests a broad range of mammals and is a severe pest to economically important farm animals in endemic regions. The adult female does not lay the eggs on the host. Instead, the adult female infests hosts indirectly by using blood-feeding arthropods to serve as phoretic vectors to transport the eggs. We present a patient who acquired Dermatobia when bitten by a day-active mosquito during a visit to Guatemala. He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates. The patient applied an occlusive ointment and recovered the larva after it emerged. In this report we discuss the life cycle of D hominis, the differential diagnosis, and therapeutic approaches.

Skin Tumors in Photochemotherapy for Psoriasis: A Single-Center Follow-Up of 496 Patients

BACKGROUND The significance of oral psoralen photochemotherapy (PUVA) for the development of nonmelanoma skin cancers (NMSC) is still controversial. OBJECTIVE We evaluated 496 psoriatics, who received PUVA treatment according to the European PUVA protocol in order to reassess the influence of the cumulative UVA dose on the development of NMSC and to answer the question if there is a UVA threshold dose above which the carcinogenic risk is increased. METHODS The study was conducted as a retrospective investigation. All patients were seen personally. Age, sex, skin type, cumulative UVA dose and carcinogenic risk factors (arsenic, X-rays, tar, UVB, methotrexate) were recorded and investigated by marginal (MA) and partial effects analyses (PA) according to the Cox regression model. RESULTS In 14 patients (2.8%), one or multiple histologically confirmed NMSC were diagnosed. Nine patients (1.8%) had squamous cell carcinoma (SCC), 5 patients (1.0%) had basal cell carcinoma (BCC). No patient had both types of NMSC. None of the SCC had metastasized. By taking the appearance of BCC and SCC as the endpoint, arsenic [MA: relative risk (RR) = 7.62; PA:RR = 5.36], tar (MA:RR = 4.51; PA:RR = 3.83) and methotrexate (MTX; MA:RR = 4.97; PA:RR = 4.07) appear to produce strong and significant effects (p < 0.05), both in MA and PA. Using the endpoint SCC only, the effect of the natural logarithm of UVA (ln UVA; RR = 2.47), arsenic (RR = 11.2), tar (RR = 9.92) and MTX (RR = 7.1) is significant (p < 0.05) in MA. In PA, only the effect of arsenic (RR = 5.19) is strong and significant (p < 0.05) while the effects of tar (RR = 7.85), MTX (RR = 3.22) and ln UVA (RR = 2.77) are strong but of borderline significance (p = 0.05-0.11). Nonlinear effects of ln UVA on the risk of SCC were far from significant (p > 0.2). CONCLUSION PUVA with the European treatment protocol appears to be only a weak carcinogen by itself for SCC with a linear increase in tumor risk but not for BCC development.

The oak processionary caterpillar as the cause of an epidemic airborne disease: survey and analysis

Background  Thaumetopoea processionea L. (order Lepidoptera), the oak processionary moth, is found in oak forests in most European countries. Its third to sixth larval instars are armed with poisonous hairs (setae) containing an urticating toxin (thaumetopoein) potentially harmful to humans. Because T. processionea infests trees at the edges of forests or standing alone people frequently come into contact with its setae. In the woodland bordering on the western suburbs of Vienna conditions favouring its increase have led to frequent outbreaks of lepidopterism.

Caterpillar Dermatitis in Two Siblings due to the Larvae of Thaumetopoea processionea L., the Oak Processionary Caterpillar

Two siblings, 16 months and 5 years of age, came into contact with the urticating hairs (setae) of oak processionary caterpillars, the larvae of Thaumetopoea processionea L., when the family moved to a suburb of Vienna, where mass gradation of T. processionea had started the year before. The setae were being spread by the wind from an infested oak tree in the neighbourhood. Both children repeatedly suffered bouts of dermatitis during the 10 weeks of the larval development. Owing to the fact that T. processionea often infests oak trees, whether isolated or at the edges of forests, there is a high likelihood of people being affected. Children frequently explore their surroundings and are at an even greater risk of developing lepidopterism. Caterpillar dermatitis should therefore be taken into consideration in the differential diagnosis of a pruritic rash in infants from regions with caterpillar-infested trees, especially during the larval development of T. processionea.

Pyoderma gangraenosum als Vorläufer einer myeloischen Leukämie

ZusammenfassungBei einer 34jährigen Patientin traten in der 20. Schwangerschaftswoche eine Infarktpneumonie und ein Pyoderma gangraenosum auf. Aufgrund des septischen Zustandsbildes wurde eine Interruptio durchgeführt. Zur Behandlung des Pyoderma gangraenosum erhielt die Patientin eine parenterale Prednisolon-Pulstherapie, gefolgt von Methylprednisolon und Dapson per os über 6 Wochen. Ein schweres Rezidiv nach Dosisreduktion machte eine neuerliche Erhöhung der Steroiddosis erforderlich. Dapson wurde durch Cyclosporin A ersetzt. Nach Abheilung kleinerer Ulzera erfolgte die plastische Deckung des größten Defekts. Cyclosporin A wurde nach Absetzen des Steroids noch 10 Wochen als Monotherapie fortgesetzt. Danach war die Patientin 7 Monate erscheinungsfrei. 12 Monate nach dem erstmaligen Auftreten des Pyoderma gangraenosum entwickelte sie eine akute myeloische Leukämie bei gleichzeitigem Rezidiv des Pyoderma gangraenosum.SummaryA 34-year-old woman who was 20 weeks pregnant developed pyoderma gangrenosum while receiving treatment for infarct pneumonia. Because of her septic condition an abortion was performed. The patient received intravenous prednisolone as a pulse treatment for her pyoderma gangrenosum, which was followed by oral methylprednisolone and oral dapsone for 6 weeks. After dose reduction the patient had a severe relapse. The steroid dose was increased and dapsone was replaced by cyclosporin A. The smaller ulcers healed spontaneously, but skin grafting had to be performed for the large ulcer. The steroid therapy was tapered and discontinued. Cyclosporin A was continued for 10 weeks as monotherapy. Subsequently, the patient was free of symptoms for 7 months. Twelve months after the diagnosis of pyoderma gangrenosum the patient developed acute myeloid leukaemia accompanied by a recurrence of the skin disease.

Effect of Work-Related Ultraviolet Exposure and Ophthalmic Changes in Austrian Farmers: The SVB-UV Study

Background: Epidemiological screening to examine possible ultraviolet-induced ocular changes and pathologies in Austrian farmers. Methods: The study was performed on behalf of the Austrian farmer insurance (Sozialversicherungsanstalt der Bauern). Randomly selected farmers and office workers as controls, both at the age of 35–55 years, underwent ophthalmic screening examinations. All subjects underwent complete ophthalmic examinations by slit lamp examination and Schirmer’s test 1. A survey, regarding per- sonal habits in the sun, was also conducted. Results: Three hundred and ninety-two subjects underwent ophthalmic examinations of whom 297 were farmers and 95 were controls. Due to the survey, 89.7% of the farmers claimed to protect themselves from the sun during work. From these subjects, 83.7% wear a head protection, 71.0% wear sunglasses, and 54.4% usually work in the shade. There were significant differences in lid (p = 0.021) and conjunctival pathologies (p < 0.0001) between farmers and controls. Conclusion: Austrian farmers are at a higher risk for developing lid and conjunctival tumours which require treatment at some point. We believe that the study group was too young to show significant differences within the lens and the posterior pole. A 5-year follow-up is planned.

Sun behaviour and personal UVR exposure among Europeans on short term holidays

Solar ultraviolet radiation (UVR) is known to be the main cause of skin cancer, the incidence of which is rising with national differences across Europe. With this observation study we aimed to determine the impact of nationality on sun behaviour and personal UVR exposure on sun and ski holidays. 25 Danish and 20 Spanish sun-seekers were observed during a sun holiday in Spain, and 26 Danish and 27 Austrian skiers were observed during a ski holiday in Austria. The participants recorded their location and clothing in diaries. Personal time-logged UVR data were recorded as standard erythema doses (SEDs) by an electronic UVR dosimeter worn on the wrist. Danish sun-seekers were outdoors for significantly longer, received significant higher percentages of ambient UVR, and received greater accumulated UVR doses than Spanish sun-seekers. Danish skiers were also outdoors for significantly longer than Austrian skiers, but the behaviour of the Danish skiers did not result in significantly greater accumulated UVR doses. Both Danish and Spanish sun-seekers and Danish and Austrian skiers received substantial UVR doses. The behaviours influence on the UVR doses received by the Danish participants may indicate an explanation of the higher skin cancer incidence among Scandinavians compared with other European populations.

Evaluation of the goodness of fit of solar simulated radiation to a reference solar spectrum for photobiological experiments.

There is a great need for photochemical and photobiological experiments to mimic the spectral distribution of solar ultraviolet radiation by artificial ultraviolet sources. The spectral distribution of various ultraviolet sources were compared with a reference solar spectrum which represents a realistic maximum solar spectrum under cloudless sky. Various methods to compare the artificial sources with the COLIPA solar reference spectrum were presented. Beside a graphical method which is based on the Lorenz curve also integral indices were used to characterize the deviations from the solar spectrum. Following parameters should be used to characterize an artificial source: (1) total output of the biologically effective irradiance, (2) maximum deviation of the cumulative relative spectral irradiance of the biologically effective solar simulated radiation, (3) spectral distribution of the difference of the cumulative relative spectral irradiance of the biologically effective solar simulated radiation, and (4) the index of the goodness of the spectral fit. Further on upper and lower limit values are suggested to improve the quality of the spectral fit of solar simulated radiation and the irradiance maximum should be limited to the range in which dose reciprocity is known to be conserved.

Assessment of thickness of photoprotective lipsticks and frequency of reapplication: results from a laboratory test and a field experiment

Summary Background The thickness of the sunscreen layer that is actually applied by consumers under usual conditions has been determined for photoprotective lotions and creams; however, this question is still unanswered for photoprotective lipsticks.