Markus Stuecker

Histological and clinical findings in different surgical strategies for focal axillary hyperhidrosis.

INTRODUCTION Although a variety of different surgical strategies for focal axillary hyperhidrosis (FAH) have proven effective, little is known of intraoperative and postoperative histologies of different surgical methods. OBJECTIVE The objective was to use pre-, intra-, and postoperative histologic findings to evaluate different surgical procedures for FAH in establishing a possible correlation between the interventions and clinical outcome. MATERIAL AND METHODS A total of 40 patients underwent surgery with 15 undergoing liposuction-curettage (LC), 14 radical skin excision (RSE) with Y-plasty closure, and 11 a skin-sparing technique (SST). Before surgery, density and ratio of eccrine and apocrine sweat glands were evaluated with routine histology. Further biopsies were taken directly after surgery in the RSE and SST groups and 1 year postoperatively in all patients. Additionally, gravimetry was performed, side effects were documented, and patients were asked to evaluate the aesthetic outcome of the surgical method by using an analogue scale. RESULTS Preoperatively, the mean density of eccrine glands was 11.1/cm2 compared to 16.9/cm2 apocrine glands (apocrine/eccrine ratio, 1.6). Biopsy specimen directly after surgery showed remaining sweat glands in 7/15 (46.7%) LC patients and in 4/11 (36.4%) of the SST patients. One year after surgery, sweat gland density was significantly reduced in the LC (79.1%) and the SST (74.9%) groups. In the RSE group, only scar formation was present. Gravimetry showed significantly reduced sweat rates 12 months after surgery in all groups (LC, 66.4%; SST, 62.9%; RSE, 65.3% [p<.05]). Most frequent side effects were hematoma (LC, n=3; SST, n=2; RSE, n=3), subcutaneous fibrotic bridles (LC, n=8; SST, n=3; RSE, n=0), skin erosion (LC, n=3; SST, n=4; RSE, n=0), focal hair loss (LC, n=9; SST, n=11; RSE, n=14), and paresthesia (LC, n=4; SST, n=3; RSE, n=5). CONCLUSION Histologic distribution and density of sweat glands were comparable to previous studies. All three surgical procedures evaluated are effective in the treatment of FAH. RSE and SST techniques are associated with a higher risk of side effects and cause more extensive scarring. However, one LC patient (n=1; 6.7%) did not respond to treatment.

Upregulation of cathepsin S in psoriatic keratinocytes

Please cite this paper as: Upregulation of cathepsin S in psoriatic keratinocytes. Experimental Dermatology 2010; 19: e80–e88.

Modulation of endothelial dysfunction and apoptosis: UVA1-mediated skin improvement in systemic sclerosis

UVA1-mediated effects regarding vascular dysregulation as a primary pathogenetic factor of systemic sclerosis skin lesions have so far not been investigated. Pre- and posttherapy skin biopsies of four patients were evaluated immunohistochemically for angiostatic, angiogenic and angioapoptotic features. Immunohistochemistry revealed a partial pretherapy loss of endothelial CD31 and CD34 expression accompanied by a posttherapy increase of CD34+ cells. Simultaneously, VEGF and M30 CytoDEATH immunolabeling demonstrated UVA1-induced neovascularization and decreased endothelial apoptosis. Our results suggest that UVA1 irradiation exerts its positive effects by a modulation of endothelial regulation/transformation beside the proposed induction of T cell apoptosis and collagenases.

Femtosecond two-photon-excited fluorescence of melanin

Spectral and time-resolved fluorescence studies of different eumelanins (natural, synthetic, enzymatic) in solution have been carried out by two-photon excitation at 800 nm, using 80 fs pulses with photon flux densities ≤ 1027 cm-2.s-1. Whereas all samples show monotonously decreasing absorption between near UV and near IR, their fluorescence behavior indicates strong heterogeneity. With respect to the also measured one-photon excited fluorescence (OPF) of melanin at 400 nm, the overall spectral shape of the two-photon excited fluorescence (TPF) is red-shifted. Both OPF and TPF exhibit three-exponential decay with a shortest component £ 200 ps. As is also shown, the fluorescence properties of melanin are dependent on the micro-environment. This allows the hypothesis, that the process of malignant transformation in skin tissue could be reflected in the fluorescence, provided the melanin in skin is selectively excited. The latter is realized by the described stepwise absorption of two 800 nm photons. In this way, indeed characteristic differences between the TPF spectra of healthy tissue, nevus cell nevi and malignant melanoma have been found.

UVA1-induced decrease in dermal neuron-specific enolase (NSE) in acrosclerosis.

Besides its role in small-cell carcinoma of the lung, elevated serum levels of neuron-specific enolase (NSE) have recently been reported to be associated with autoimmune rheumatic disorders such as systemic sclerosis. Serum NSE seems to correlate with disease activity as well as Rodnan skin score. The aim of the study was to assess the neuromodulatory effects of conventional UVA1 phototherapy on acrosclerosis as an additional mechanism besides an assumed T cell apoptosis, collagenase induction and angiogenesis. Punch skin biopsies of acrosclerotic skin lesions taken before and after treatment from four patients were evaluated immunohistochemically for the presence of NSE, S100 and neurofilament. Immunolabeling revealed a UVA-induced decrease in dermal NSE expression. In contrast, no alteration in neurofilament+ cells could be detected. In line with the findings of a previous investigation, a high number of S100+ cells were detected in most specimens. We demonstrated a UVA1-induced reduction in dermal NSE levels correlating with a softening of former sclerotic lesions. Even though the origin and the functional mechanisms remain obscure, NSE might be relevant directly within sclerotic skin lesions and may possibly be used as a diagnostic marker at least in SSc-associated acrosclerotic skin.

Decorin Expression with Stump Recurrence and Neovascularization after Varicose Vein Surgery—a Pilot Study

BACKGROUND An evaluation of the reason for saphenofemoral recurrence (SFR, technical error vs neovascularization) after surgery is necessary to improve the method or find purchase for new therapies. Currently, differentiation by the surgeon or ultrasound are unsatisfying; histology depends mainly on the physicians experience. Decorin, an extracellular matrix component, is up‐regulated in angiogenesis with antiangiogenetic effects on neovascularization. OBJECTIVE To determine whether decorin is a reliable marker to distinguish neovascularization and stump recurrence. METHODS Twenty specimens obtained in re‐operation of patients with duplex‐detected SFR were stained with hematoxylin and eosin, Elastica van Gieson, and decorin antibody. An experienced pathologist reviewed specimens for stump recurrence or neovascularization. An independent physician analyzed the specimens semiquantitatively for expression of decorin (0=none to 3=strong). RESULTS Only low expression of decorin was found around residual stumps (1.4±0.5), but extensive expression was detectable around neovascularization (2.4±0.3, p=.001). In one specimen with neovascularization and a residual stump, decorin was a capable marker to divide the two zones. Correlation of histological and decorin‐based diagnosis was 100%, but differentiation was much easier with decorin. CONCLUSION Decorin is a marker for any easy differentiation of stump recurrence and neovascularization and can support further investigation in SFR and improvement of the primary therapy. The authors have indicated no significant interest with commercial supporters.

Capillary blood flow and cutaneous uptake of oxygen from the atmosphere

In 1 987 Baurngartl, using needle electrodes to measure P02 in skin, demonstrated that a minimum P02 value could be observed between the surface and the capillary bed. This indicated that there is an 02 flux through the epidermis supplying the upper layers of the skin. The recent development of a fluorescence-based 02-fluxoptode for measuring oxygen flux has meant that the phenomenon could be studied directly. More recently Stucker et. al. showed, using simultaneous measurement of oxygen flux, transcutaneous P02 and laser Doppler perfusion, that the epidermal oxygen uptake from the atmosphere is in balance with the blood-borne (haematogenic) oxygen supply. These measurements of oxygen flux and previous measurements of P02 profiles indicated that capillary blood flow in skin at normal skin temperature may not contribute to the oxygen supply of the superficial layers. In order to investigate this further, in the present study the transcutaneous hydrogen clearance technique was applied at various skin temperatures between 33°C and 40°C. Laser Doppler flowmetry (LDF), transcutaneous oxygen flux, and tsanscutaneous oxygen measurements were also carried at the same site. The inability to detect hydrogen at the skin surface at 33°C confirms the minimal contribution of capillary blood flow to the oxygen supply to superficial layers

Immunohistochemical investigations and introduction of new therapeutic strategies in scleromyxoedema: case report.

BackgroundScleromyxoedema is a rare chronic skin disease of obscure origin, which may often be associated with severe internal co-morbidity. Even though different casuistic treatment modalities have been described, to date, curing still seems to be impossible.Case presentationWe report a 44-year-old Caucasian female presenting with remarkable circumscribed, erythematous to skin-coloured, indurated skin eruptions at the forehead, arms, shoulders, legs and the gluteal region. Routine histology and Alcian blue labelling confirmed a massive deposition of acid mucopolysaccharides. Immunohistochemical investigations revealed proliferating fibroblasts and a discrete lymphocytic infiltration as well as increased dermal expression of MIB-1+ and anti-mastcell-tryptase+ cells. Bone marrow biopsies confirmed a monoclonal gammopathy of undetermined significance without morphological characteristics of plasmocytoma; immunofixation unveiled the presence of IgG-kappa paraproteins.ConclusionsTaking all data into account, our patient exhibited a complex form of lichen mxyoedematosus, which could most likely be linked a variant of scleromyxoedema. Experimental treatment with methotrexate resulted in a stabilisation of clinical symptoms but no improvement after five months of therapy. A subsequent therapeutic attempt by the use of medium-dose ultraviolet A1 cold-light photomonotherapy led to a further stabilisation of clinical symptoms, but could not induce a sustained amelioration of skin condition.