Henning Hamm

Effect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial.

Summary Background  Botulinum toxin type A (BTX‐A) has been shown to be a safe and effective treatment for primary focal hyperhidrosis. However, the effect of BTX‐A therapy on quality of life (QOL) in patients with this condition has only recently begun to be studied in controlled clinical trials.

Botulinum toxin type A in the treatment of focal, axillary and palmar hyperhidrosis and other hyperhidrotic conditions

Focal essential hyperhidrosis is a common and often disabling disorder mainly involving the palms, axillae, face, and soles of the feet. Focal hyperhidrosis may also arise from several neurological or internal diseases. Current therapeutic options include topical aluminium chloride salts, systemic anticholinergic drugs, tap‐water iontophoresis, and a number of surgical approaches. However, none of these are entirely satisfactory. In recent studies, injection of botulinum toxin type A (BTX‐A) into the hyperhidrotic area has proved very effective in reducing or abolishing focal sweating of different aetiologies without major side effects. BTX‐A therefore has the potential to replace more invasive therapies.

Effective treatment of frontal hyperhidrosis with botulinum toxin A

Background Focal hyperhidrosis is a common condition mostly confined to the axillae, palms and soles. In some individuals, predominantly men, increased sweating of the forehead may be the major complaint and may interfere with the person’s quality of life. Botulinum toxin A has been shown to be a very effective treatment for focal hyperhidrosis of the axillae and palms.

Primary Focal Hyperhidrosis: Disease Characteristics and Functional Impairment

Background: There are few published data on the clinical characteristics of hyperhidrosis. Objective: To describe the functional impairment caused by primary focal hyperhidrosis. Methods: Patients with hyperhidrosis (n = 345) were enrolled at the Department of Dermatology, University of Würzburg. Controls (n = 154) were a convenience sample of subjects without hyperhidrosis. Hyperhidrosis characteristics, health-related quality of life and functional impairment were assessed. Results: Patients with axillary hyperhidrosis reported a later age at onset and a higher prevalence of a family history of hyperhidrosis than patients with palmar hyperhidrosis. Sixty-three percent of patients reported occupational impairment related to hyperhidrosis. Hyperhidrosis patients reported emotional and physical impairment, with a greater proportion of the axillary group reporting impairment. More than 50% of patients reported moderate to extreme impairment in personal relationships and in social situations. Conclusion: Primary focal hyperhidrosis is a serious medical condition, affecting work productivity, daily activities, emotional well-being and personal relationships.

Narrow-band UVB311 nm vs. broad-band UVB therapy in combination with topical calcipotriol vs. placebo in vitiligo

Background  Recently, it has been shown that UVB phototherapy may be more effective than UVA in the treatment of vitiligo. Currently, however, no studies have compared the efficacy of UVB311 nm and broad‐band UVB therapy. Calcipotriol has recently been reported to be effective adjunctive treatment for vitiligo, enhancing the efficacy of 8‐methoxypsoralen plus UVA (PUVA) therapy.

Loose anagen hair of childhood: The phenomenon of easily pluckable hair

We report two unrelated boys aged 4 and 9 years who had the recently delineated phenomenon of easily pluckable hair. Hair tufts could be pulled out without effort and without pain. Alopecia without any sign of scalp inflammation or scarring was noted. In the older child spontaneous remission occurred within 3 months, whereas the condition remained active in the younger boy for a follow-up period of 1 year. Trichograms from clinically involved and uninvolved areas disclosed a striking predominance of anagen hairs (98% to 100%) and complete absence of telogen hairs. A loss of the normal round or oval configuration of many hair shafts could be well visualized by the shrinking tube technique. Horizontal and transverse sections of scalp obtained for biopsy revealed marked cleft formations between hair shafts and regressively altered inner root sheaths. We suggest the name loose anagen hair of childhood for this newly described disease.

Cutaneous mosaicism of lethal mutations

The concept of autosomal lethal genes surviving only in a mosaic state was proposed by Happle to explain the genetic basis of several syndromes characterized by (almost always) sporadic occurrence, distribution of lesions in a scattered or asymmetrical pattern, variable extent of involvement, lack of diffuse involvement of entire organs, and equal sex ratio. The mosaic may either arise from a gametic half-chromatid mutation or from an early postzygotic mutation. The purpose of this article is to review current knowledge of the genetics and cutaneous manifestations of some of the birth defects to which the lethal gene concept is thought to apply: the Schimmelpenning (Feuerstein-Mims) syndrome, Proteus syndrome, encephalocraniocutaneous lipomatosis, Sturge-Weber and Klippel-Trenaunay syndrome, cutis marmorata teleangiectatica congenita (van Lohuizen syndrome), and neurocutaneous melanosis.

Topical immunotherapy in alopecia areata: anamnestic and clinical criteria of prognostic significance.

BACKGROUND Topical immunotherapy of alopecia areata (AA) is an effective but time-consuming treatment with unknown long-term risks. OBJECTIVE The purpose of this study was to identify criteria which allow a selection of patients with a good prognosis for topical immunotherapy with diphencyprone. METHODS The anamnestic and clinical data of 50 successfully and 55 unsuccessfully treated patients were compared by the Mann-Whitney test. RESULTS Five factors were found to be of prognostic significance: type of AA (p < or = 0.001), presence of nail changes (p < or = 0.001), duration of AA before treatment (p < or = 0.005), age at onset (p < or = 0.01) and association with atopic eczema (p < or = 0.02). CONCLUSION A selection of AA patients who are likely to respond to topical immunotherapy is possible on the basis of anamnestic and clinical data.

Short duration treatment with terbinafine for tinea capitis caused by Trichophyton or Microsporum species

Thirty‐five patients with mycologically proven scalp infections were enrolled in a randomized, double‐blind clinical trial with oral terbinafine (dose adjusted according to patient weight) for either 1 or 2 weeks. Patients were observed for 12 weeks; after 4 weeks, non‐responders were offered an additional 4 weeks of treatment followed by a second observation period. The causative organisms were Microsporum canis (n = 12), Trichophyton tonsurans (n = 12) and other Trichophyton spp. (n = 11). The Trichophyton infections were treated effectively in five of nine (56%) patients treated for 1 week and 12 of 14 (86%) patients treated for 2 weeks. Three of the non‐responders were treated for an additional 4 weeks, and one responded. In the Microsporum group only one of seven patients treated for 1 week and none of five treated for 2 weeks responded. However, treatment was effective in four of six (66%) patients treated for an additional 4 weeks. Mild to moderate adverse events believed to be drug related occurred in four patients in each of the two groups. Terbinafine is well tolerated, and requires 2 weeks of treatment in most patients with Trichophyton scalp infections and 4 weeks or more in Microsporum scalp infections, to achieve a successful clinical and mycological response.

Involvement of the adherens junction-actin filament system in acantholytic dyskeratosis of Hailey-Hailey disease. A histological, ultrastructural, and histochemical study of lesional and non-lesional skin

Hailey‐Hailey disease is a blistering genodermatosis that shows acantholytic dyskeratosis throughout the epidermis. The aim of our study was to investigate the involvement of adherens structures and cytofilaments in this particular type of acantholysis. Both lesional and non‐lesional skin from 18 patients was studied histologically and ultrastructurally. Additionally, the samples were stained for desmosomes, adherens junctions, keratin filaments, actin filaments, and actin‐associated proteins, and finally investigated with an electron and a confocal laser scanning microscope (CLSM), respectively. Acantholytic dyskeratosis was not only confined to lesions, but was also focally detectable in clinically unaffected skin. Despite disruption and internalization of the desmosomes, keratinocytes remained linked together by well‐preserved adherens junctions. Staining for actin filaments with fluorochrome‐labeled phalloidin showed a remarkable formation of actin stress fibers in these keratinocytes. Thus, incomplete acantholysis, as demonstrable in both lesional and non‐lesional skin of Hailey‐Hailey patients, may be due to a cohesive function of the adherens junction‐actin system succeeding the dissolution of desmosomes. Most remarkably, none of the adnexal epithelia expressed the intrinsic defect of cell adhesion. This finding offers an explanation for the successful treatment of Hailey‐Hailey disease by dermabrasion, which after complete removal of the involved epidermis results in reepithelialization from skin appendages.