Martina Bacharach-Buhles

Combined Treatment with Calcipotriol Ointment and Low-Dose Ultraviolet A1 Phototherapy in Childhood Morphea

Abstract: Various therapies for morphea have been used with limited success, including ones with potentially hazardous side effects. When morphea occurs in childhood it may lead to progressive and long‐lasting induration of the skin and subcutaneous tissue, growth retardation, and muscle atrophy. We report an open prospective study in which the efficacy of a combined treatment with calcipotriol ointment and low‐dose ultraviolet A1 (UVA1) phototherapy in childhood morphea was investigated. Nineteen children (mean age 8.5 years, range 3–13 years) with morphea were exposed to UVA1 (340–400 nm) phototherapy at a dose of 20 J/cm2 four times a week for 10 weeks. Forty phototherapy sessions resulted in a cumulative dose of 800 J/cm2 UVA1. In addition, calcipotriol ointment (0.005%) was applied twice a day. After 10 weeks, palpation and inspection showed a remarkable softening and repigmentation of formerly affected skin resulting in a highly significant (p < 0.001) decrease of the mean clinical score from 7.3 ± 0.9 at the beginning to 2.4 ± 0.9 (relative reduction 67.1%) at the end of combined therapy. Our results indicate that a combined therapy with calcipotriol ointment and low‐dose UVA1 phototherapy is highly effective in childhood morphea. Further controlled studies are necessary to investigate whether this combined therapy is superior to UVA1 phototherapy alone.

Opposing effects of UVA1 phototherapy on the expression of bcl-2 and p53 in atopic dermatitis

Abstract Recently, medium-dose UVA1 phototherapy (50 J/cm 2 ) has been introduced as an effective treatment for severe atopic dermatitis (AD). In order to further elucidate the mechanisms by which medium-dose UVA1 irradiation leads to an improvement in skin status in patients with AD, biopsy specimens from ten patients before and after treatment were analysed immunohistochemically for features of apoptosis. We sought to determine the extent to which UVA1 irradiation was able to modulate the balance between p53 and bcl-2 expression in vivo using monoclonal antibodies labelling these proteins. As compared with lesional skin of patients with AD before UVA1 irradiation, the number of dermal cells, apparently lymphocytes, that were positive for p53 had significantly increased after treatment and, in addition, some basal keratinocytes showed slight positive staining for p53. An increased expression of the bcl-2 gene before treatment in predominately dermal lymphocytes was significantly downregulated by UVA1 therapy. The increase in p53 + cells and the decrease in bcl-2 + cells were closely linked to a significant reduction in dermal T cells (CD3 + ) and a substantial clinical improvement in skin condition. In summary, medium-dose UVA1 irradiation led to a marked modulation of the expression of p53 and bcl-2, and this plays a key role in regulating UVA1-induced apoptosis.

[Depression and suicidal intentions as a side effect of high dosage interferon-alpha therapy--two cases].

ZusammenfassungFür die adjuvante Therapie mit Interferon bei Melanompatienten sind u.a. neurotoxische Nebenwirkungen wie Depressionen bekannt. Die kausalen biochemischen Wirkmechanismen sind noch nicht bekannt. In diesem Artikel werden 2 Fälle beschrieben, in denen Depressionen als Nebenwirkungen aufgetreten sind. In beiden Fällen traten zusätzlich amnestische Symptome auf. In einem Fall wurde ein Suizidversuch unternommen, für dessen Ablauf eine Amnesie über 7 h besteht. Beide Fälle werden hinsichtlich der diagnostischen Klassifikation und möglicher Erklärungen der amnestischen Symptome unter hochdosierter Interferon-Therapie diskutiert.SummaryAdjuvant therapy with interferon for malignant melanoma causes neurotoxic side effects such as depression. The biochemical mechanisms are unknown. We report two cases with both depression and amnesia. In one case, attempted suicide was a companied by 7 h of amnesia. The diagnostic classification and possible explanations for the amnesia secondary to interferon therapy are reviewed.

Skin Changes and Tumours after Renal Transplantation

Skin involvement in chronic renal failure is characterised by a multitude of different aspects. Apart from the typical yellow-brown discolouration of the skin, most often patients complain of pruritus and xerosis cutis. A marked actinic elastosis is noticed. Dialysis treatment alters and partly aggravates these pre-existing skin conditions. When chronic renal failure leads to a kidney transplantation, some of the reversible skin pathology, e.g. pruritus, xeroderma, tends to ameliorate, but a high tendency to develop malignancies becomes prominent.

Was bleibt von der Haut nach 2000 Jahren Moor

ZusammenfassungHintergrund und Fragestellung. Mumien haben aufgrund ihrer Konservierung einen wichtigen Stellenwert in der Archäologie und Paläopathologie. Zum ersten Mal konnten Hautproben von sechs 2300–1600 Jahre alten Moorleichen aus Norddeutschland histologisch, elektronenmikroskopisch und immunhistologisch untersucht werden. Methodik. Für die Histologie wurden die Proben mit HE und Elastica-van-Gieson gefärbt. Eine Fixierung und Eponeinbettung erfolgte für die Elektronenmikroskopie. Markiert wurde mit Anti-S-100 und Anti-Kollagen-Typ-IV. Ergebnisse. Histologisch konnten bei allen Hautproben die Kollagenbündel des Koriums nachgewiesen werden, die in einer ähnlichen Dichte wie in histologischen Präparaten aktuell entnommener Hautproben angeordnet waren. Epidermis war nicht erhalten. Elektronenoptisch waren bei allen Moorleichen Kollagenfasern mit einem Durchmesser von 45–110 nm und der typischen Periodizität der einzelnen Fasern zu erkennen. Bakteriensporen mit einem Durchmesser von 0,83±0,051 μm und einem elektronendichten Zentrum waren sichtbar. Keine der Hautproben zeigte eine Reaktivität mit den verwendeten Antikörpern. Schlussfolgerungen. Histologie und Elektronenmikroskopie demonstrieren die guten Konservierungseigenschaften des Moores für den Kollagenanteil der Haut. Im Gegensatz zu Eisleichen wie “Ötzi” oder ägyptischen Mumien sind zelluläre Elemente in der Haut von Moorleichen jedoch nicht nachweisbar.AbstractBackground and Objective. Mummies have an important place in the study of archaeology and paleopathology because they are so well preserved. For the first time skin samples of six 2300–1600 year old bog bodies from North Germany were examined by histology, transmission electron microscopy and immunohistology. Methods. For histology the samples were stained with H&E and van Gieson elastic stain. Fixation and embedding in epoxy followed for the transmission electron microscopy. Specific antibodies directed to type IV collagen and S-100 were used. Results. Histologically it was possible to observe collagen bundles in the dermis, with a density similar to recently stained samples. Epidermis was not preserved. The electron microscopy showed collagen fibrils with a diameter of 45–110 nm and the characteristic axial periodicity. Throughout the dermis, a number of spores of bacteria with a diameter of 0,83±0,051 μm and an electron dense core were found. No activity against the used antibodies could be detected. Conclusions. Histology and electron microscopy demonstrate the excellent conservation of the dermal collagen in the bog. In contrast to ice mummies like “Ötzi” and mummies from Egypt, no cellular elements could be found in the skin of bog bodies.

Dose-Dependent Shift of Apoptotic and Unaltered Melanocytes into the Dermis after Irradiation with UVA 1

Background: Intense UVA irradiation induces an increase in number, size and activity of intraepidermal melanocytes. The number of melanocytes and the activity of melanogenesis return to normal after cessation of irradiation. Objective: In this study, we aimed to clarify the mechanism of reduction of melanocytes by apoptosis to prevent an uncontrolled increase in melanocytes within the epidermis. Methods: The position of the melanocytes before and after UVA 1 irradiation was controlled by electronmicroscopy and histochemistry using Fontana-Masson staining. The status of apoptosis was demonstrated immunohistologically by the use of p53 and bcl2. Results: A dose-dependent shift of melanocytes into the corium could be demonstrated. At low irradiation doses (20 J/cm2) pendulous melanocytes protrude into the dermis without losing contact to the dermoepidermal basement membrane. Higher irradiation doses (60 J/cm2) lead to a total elimination of fibrillary degenerated, apoptotic or even morphologically intact melanocytes into the corium. Once transported into the corium, the melanocytes can be detected there for more than 4 years. Conclusion: This shift mechanism seems to regulate and control UV-induced proliferation of epidermal melanocytes.

Dreidimensionale Rekonstruktion in der Dermatologie : Ein Ausblick auf neue Möglichkeiten der histologischen Routinediagnostik

ZusammenfassungHintergrund und Fragestellung. Die Kombination von computergestützter Bildanalyse und dreidimensionaler Rekonstruktion ermöglicht die wirklichkeitsgetreue Darstellung und Analyse der dreidimensionalen Architektur der menschlichen Haut bei akzeptablem Zeitaufwand. Patienten/Methodik. Verwendet wurden exemplarisch die im Rahmen der Routinediagnostik entnommenen Probebiopsien von 3 Patienten mit unterschiedlichen dermatologischen Krankheitsbildern (malignes Melanom, Lichen ruber, Psoriasis vulgaris) und Biopsien gesunder Haut. Die immunmarkierten, digitalisierten Serienschnitte wurden mithilfe des Bildanalysesystems Lucia (Nikon GmbH, Düsseldorf) im sog. Interlaced-Verfahren digitalisiert. Die dreidimensionalen Datensätze wurden segmentiert und an einer UNIX-Workstation visualisiert. Ergebnisse. Die dreidimensionale Rekonstruktion gibt Einblick in die Architektur der pathologischen und physiologischen Histologie, wie beispielsweise der charakteristischen Windung der Schweißdrüsenausführungsgänge unterhalb der Epidermis. In der Dermatoonkologie kann der punktuelle Durchbruch eines malignen Melanoms durch das unterliegende Infiltrat nachgewiesen werden. Schlussfolgerungen. Die Automatisierung zeigt neue Anwendungsmöglichkeiten der dreidimensionalen Rekonstruktion mittels digitalisierter Bilder mit einem hohen Maß an Objektivität bei standardisierten Bearbeitungs- und Färbeverfahren. Diese Darstellung ist ein hilfreicher Beitrag zur Diagnostik in der Dermatohistopathologie und Dermatohistologie.AbstractBackground and Objective. The combination of digital image-analysis and computer-reconstruction of the three-dimensional architecture of the human skin can make this method usable on an acceptable time scale. Patients/Methods. We used biopsies of different diseases (malignant melanoma, lichen planus, psoriasis) and of normal skin. Immunhistologically stained sections were digitized and adjusted with respect to features of interest using the interlaced mode of an commercial image analysis system (Lucia G, Nikon GmbH, Düsseldorf). The sections have been segmented and the resulting three dimensional data sets were visualized on a UNIX based work station. Results. Three dimensional reconstruction provides a different view into the architecture of normal and diseased skin: for example, the course of the duct of sweat glands or the perforation of a malignant melanoma through the underlying infiltrate. Conclusions. A new rapid reconstruction method is presented producing multidimensional histological images of the skin within a few hours. This automation is of interest in basic research and should find its way into routine histological diagnosis.

The Pustule in Palmoplantar Psoriasis: Transformed Vesicle or Mature Microabscess?

Psoriasis on the palms and soles is characterized by pustules, vesicles and hyperkeratotic plaques. Several studies have postulated that the pustules and vesicles are round or egg-shaped. This three-dimensional study reveals that neither pustules nor vesicles have a regular spherical morphology. The vesicles are located in the upper and middle layers of the epidermis and may exhibit dumb-bell- or banana-shaped lumina. The pustules consist of different compartments combining characteristics of a dyshidrotic vesicle with those of a microabscess of Munro.

Ein Fall einer „Umweltneurose” skurrilen Ausmaßes

ZusammenfassungFrau T., eine 64jährige Patientin, ist seit nunmehr 25 Jahren unter der Diagnose „Sklerodermie” bettlägerig. Wegen einer „Textilunverträglichkeit” trägt sie keine Kleidung und liegt seit 8 Jahren ohne Unterbrechung nackt in einer Konstruktion aus Küchenpapier und Gummifrottee. Ein somatisches Grundleiden kann ausgeschlossen werden, es wird die Diagnose einer zönästhetischen Schizophrenie gestellt. Differentialdiagnostisch werden auch eine Somatisierung, somatoforme Störungen und eine Hypochondrie diskutiert. Die Patientin lehnt jede psychiatrische Behandlung ab.SummaryA 64 year old female patient was diagnosed with scleroderma and has been bed-ridden for 25 years. She wears no clothing whatsoever on the grounds of an intolerance to textiles, and has spent the last eight years uninterruptedly in bed in a construction of kitchen paper towels and rubber bed sheets. A somatic disease has been be ruled out and cenesthesic schizophrenia diagnosed. As differential diagnoses, somatization, somatiform disorders and hypochondria were considered. The patient refused any psychiatric treatment.

Keratosis palmoplantaris maculosa seu papulosa (Davies-Colley) unter dem Bild multipler Cornua cutanea

ZusammenfassungEs wird über einen Patienten mit ausgeprägter Keratosis palmoplantaris maculosa seu papulosa (Davies-Colley) berichtet, die sich unter dem klinischen Bild multipler Cornua cutanea manifestiert. Das klinische Bild, die Histologie, die Elektronenmikroskopie, die negative Tumorsuche, die Virusdifferenzierung im Gewebe erlauben die Abgrenzung gegenüber anderen Palmoplantarkeratosen. Eine kombinierte Lokal- und Systemtherapie mit Kürettage, keratolytischen Externa und Acitretin erwies sich als sehr effektiv.SummaryPatient with extensive keratosis palmoplantaris maculosa seu papulosa (Davies-Colley) presented with multiple cutaneous horns. The clinical picture, the histology, the electro microscopic examination, the negative tumor screening and the viral classification in the tissue allowed the differentiation from other palmoplantar keratoses. The patient was treated successfully using a combination of acitretin with physical and chemical measures.