Peter Altmeyer

Antipsoriatic effect of fumaric acid derivatives: Results of a multicenter double-blind study in 100 patients

BACKGROUND Psoriasis vulgaris may benefit from treatment with fumaric acid and/or its derivatives; however, because different preparations have been used, results have been contradictory and difficult to interpret. OBJECTIVE The purpose of this clinical trial was to evaluate the therapeutic value of fumaric acid derivatives. METHODS A randomized double-blind study was carried out in patients with psoriasis, comparing a well-characterized formulation of fumaric acid derivatives with placebo. RESULTS The results indicated statistically significant superiority of the fumaric acid derivatives over placebo. Adverse events (flush, gastrointestinal disturbances) were initially relatively frequent, but decreased thereafter. CONCLUSION Fumaric acid derivatives were found to be effective and safe in the treatment of psoriasis.

Low-dose UVA1 phototherapy for treatment of localized scleroderma

BACKGROUND For treatment of localized scleroderma numerous treatments, including ones with potentially hazardous side effects, are currently used with only limited success. OBJECTIVE We attempted to determine the efficacy of low-dose UVA1 irradiation in patients with severe localized scleroderma. METHODS Patients were irradiated with 20 J/cm2 UVA1 for 12 weeks (total number of treatments: 30; cumulative UVA1 dose: 600 J/cm2). RESULTS Low-dose UVA1 irradiation induced significant clinical improvement (clearance of > 80% of lesions) in 18 of 20 patients. Clearance was documented by clinical score as well as by 20 MHz ultrasound and histopathologic analysis. CONCLUSION Low-dose UVA1 phototherapy can be highly effective for sclerotic plaques, even in patients with advanced localized scleroderma and with lesions rapidly evolving despite conventional therapy.

What causes hidradenitis suppurativa

Abstract:  Hidradenitis suppurativa (HS) – a rather common, very chronic and debilitating inflammatory skin appendage disorder with a notoriously underestimated burden of disease – has long been a playground for the high priests of nomenclature: Ask a bunch of eminent dermatologists and skin pathologists to publicly share their thoughts on what causes HS, and they will soon get entrenched in a heated debate on whether this historical term is a despicable misnomer. Fortunately, the recently founded Hidradenitis Suppurativa Foundation (HSF; http://www.hs‐foundation.org), to which EXP DERMATOL serves as home journal, has broken with this unproductive tradition and has encouraged publication of the current CONTROVERSIES feature. This is exclusively devoted to discussing the pathobiology of this chronic neutrophilic folliculitis of unknown origin. Although traces of terminological bickering remain visible, it does the HS experts in our virtual debate room credit that they engage in a constructive and comprehensive dissection of potential pathogenesis pathways that may culminate in the clinical picture we know under the competing terms HS or acne inversa. These experts sketch more often complementary than mutually exclusive pathogenesis scenarios, and the outlines of a conceivable consensus on the many open pathobiology questions begin to emerge in these CONTROVERSIES. Hopefully, this heralds a welcome new tradition: to get to the molecular heart of HS pathogenesis, which can only be achieved by a renaissance of solid basic HS research, as the key to developing more effective HS therapy.

Histomorphologic correlation with routine histology and optical coherence tomography

Background: Optical coherence tomography (OCT) is a new and promising diagnostic technique for investigation of skin tumours. We describe a method that makes evaluation and definition of specific morphologic structures of skin tumours via OCT more accurate.

The cutaneous uptake of atmospheric oxygen contributes significantly to the oxygen supply of human dermis and epidermis

It has been known since 1851 that atmospheric oxygen is taken up by the human epidermis. The contribution to total respiration is negligible. Until now the significance for the local oxygen supply of the skin has remained unknown. With a newly developed sensor, the oxygen fluxoptode, it has become possible to make local measurements of the transcutaneous oxygen flux (tcJO2). In this study the sensor was calibrated so that absolute values of tcJO2 could be reported. At rest, tcJO2 was determined on normal, humidified skin on the volar forearm of 20 volunteers of different age groups. In order to evaluate the contribution of the blood flow to the oxygen supply of the skin, tcJO2 was recorded at the end of a 5 min suprasystolic occlusion of the forearm. At normal skin surface partial oxygen pressure (163 ± 9 Torr), tcJO2 was 0.53 ± 0.27 ml O2 min−1 m−2. A 5 min interruption of blood flow resulted in an increase of 9.5 ± 6.3 % in tcJO2. The value of tcJO2 was unaffected by the age of the subject. Published data on the oxygen diffusion properties of skin and simulations of intracutaneous profiles of oxygen partial pressure indicated that under these conditions, the upper skin layers to a depth of of 0.25–0.40 mm are almost exclusively supplied by external oxygen, whereas the oxygen transport of the blood has a minor influence. As a consequence, a malfunction in capillary oxygen transport cannot be the initiator of the development of superficial skin defects such as those observed in chronic venous incompetence and peripheral arterial occlusive disease.

Expression of microRNAs in basal cell carcinoma

Background  Perturbations in the expression profiles of microRNAs (miRNAs) have been reported for a variety of different cancers. Differentially expressed miRNAs have not been systematically evaluated in basal cell carcinoma (BCC) of the skin.

MicroRNAs and the skin: Tiny players in the body's largest organ

MicroRNAs (miRNAs) are very small endogenous RNA molecules about 22-25 nucleotides in length, capable of post-transcriptional gene regulation. miRNAs bind to their target messenger RNAs (mRNAs), leading to cleavage or suppression of target mRNA translation based on the degree of complementarity. miRNAs have recently been shown to play pivotal roles in diverse developmental and cellular processes and linked to a variety of skin diseases and cancers. Disruption of miRNA metabolism is also involved in wound healing and inflammatory skin conditions. Here, we review the role of miRNAs in cutaneous biology.

Diagnostic and neural analysis of skin cancer (DANAOS). A multicentre study for collection and computer-aided analysis of data from pigmented skin lesions using digital dermoscopy

Background  Early detection of melanomas by means of diverse screening campaigns is an important step towards a reduction in mortality. Computer‐aided analysis of digital images obtained by dermoscopy has been reported to be an accurate, practical and time‐saving tool for the evaluation of pigmented skin lesions (PSLs). A prototype for the computer‐aided diagnosis of PSLs using artificial neural networks (NNs) has recently been developed: diagnostic and neural analysis of skin cancer (DANAOS).

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.

Acne inversa (alias hidradenitis suppurativa).

Acne inversa is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring. Once considered to be a disease of the apocrine glands, it is actually a defect of follicular epithelium. Thus, the term hidradenitis suppurativa is a misnomer and should be abandoned. In cases of familial acne inversa, the pattern of transmission and number of affected individuals are consistent with autosomal dominant inheritance. Aetiological factors such as hyperandrogenism, obesity, smoking and chemical irritants are not consistently associated with the affection. Bacterial involvement is not a primary event in acne inversa, but is secondary to the disease process. Potential complications include dermal contraction, local or systemic infection due to the spread of microorganisms, systemic amyloidosis, arthropathy, and squamous cell carcinoma. As spontaneous resolution is rare and progressive disability is the rule, early definitive surgical intervention is advisable. The surgical procedure of choice in most cases is wide local excision and healing by secondary intention. Pharmacotherapeutic drugs, including synthetic retinoids and antiandrogens, do not prevent progression of the disease.