Sebastian Rotterdam

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.

Investigation of basal cell carcionoma by confocal laser scanning microscopy in vivo

Background/purpose In vivo confocal laser scanning microscopy (CLSM) allows to study human skin up to 200 µm deep non‐invasively. Aim of this study was to investigate basal cell carcinoma (BCC) using in vivo CLSM, and to compare the micromorphologic features of BCC with uninvolved skin.

Autonomic neurocardiac function in patients with major depression and effects of antidepressive treatment with nefazodone

BACKGROUND Major depression (MD) is associated with an augmented risk of cardiovascular mortality. One possible explanation for this association is that MD influences autonomic neurocardiac regulation (ANR). However, previous studies on this subject revealed conflicting results. METHODS Using an autonomic test battery, which consisted of standardised measurements of heart rate variability (HRV) and blood pressure, we (1) compared ANR between 25 patients with DSM-III-R diagnosed MD and 60 healthy controls, and (2) investigated the autonomic effects of antidepressive treatment with nefazodone. RESULTS Following multivariate analysis of all tests a significant reduction in HRV could only be shown for the Valsalva ratio amongst the depressives compared to controls. There was a significant inverse correlation between the HRV during deep respiration and both the severity of depression and the duration of the depressive episode. Serial HRV recordings revealed that both the mean resting heart rate and systolic blood pressure significantly decreased after 21 days of nefazodone treatment (average dosage 413 mg/day), whereas after 10 days (average dosage 270.8 mg/day) there were no striking changes compared to the pre-treatment values. During nefazodone treatment no significant changes in parasympathetic tone occurred. LIMITATIONS ANR was not assessed in a randomised, placebo-controlled fashion. CONCLUSIONS (1) Patients with MD may suffer from functional disturbances in the interaction between the sympathetic and parasympathetic autonomic tree. (2) The pattern of autonomic changes during treatment suggests that nefazodone induced a dose dependent, serotonergically-mediated down-regulation of the sympathetic tone. This mechanism might be responsible for nefazodones properties of reducing anxiety.

Fumaric acid esters in necrobiosis lipoidica: results of a prospective noncontrolled study

Background  Necrobiosis lipoidica (NL) is an uncommon granulomatous skin disease with association to diabetes mellitus. To date, no proven effective therapy for NL has been implemented. The standard treatment is topical application of corticosteroids, but numerous agents have been reported for NL, with varying degrees of success. In recent case reports, fumaric acid esters (FAE) have been reported to be effective in granulomatous skin diseases such as granuloma annulare, cutaneous sarcoidosis and NL.

Indoor tanning in North Rhine-Westphalia Germany: a self-reported survey.

Background/aims: We examined the prevalence of indoor tanning in North Rhine‐Westphalia and identified correlates of sunbed use.

Combination of adalimumab with traditional systemic antipsoriatic drugs – a report of 39 cases

Background: Monotherapy with TNF‐α inhibitors does not always produce a sufficient response in psoriasis patients. Combinations of TNF‐α antagonists such as adalimumab with systemic antipsoriatic therapies such as methotrexate are not approved for use in psoriasis, and the published data are scarce.

Protein Expression of Carcinoembryonic Antigen Cell Adhesion Molecules in Benign and Malignant Melanocytic Skin Lesions

Dysregulation of cell adhesion molecules is associated with progression of malignant melanoma. Immunohistologic study of benign nevi (BN), dysplastic nevi (DN), and primary superficial spreading melanoma (SSM) was performed for carcinoembryonic antigen (CEA) and CEA cell adhesion molecule-1 (CEACAM1) using monoclonal antibodies. We investigated BN (n = 42), DN (n = 22), thin SSM (n = 21), and thick SSM (n = 21). CEA expression in melanomas and DN was significantly increased compared with BN. CEA expression in thick SSM was significantly higher than in DN. Compared with BN, expression of CEACAM1 in melanomas was significantly increased. CEACAM1 expression in thick SSM was significantly increased compared with DN and thin SSM. Our data support the findings of previous studies indicating that cell adhesion molecules of the CEA family may have a role in the development and progression of cutaneous melanoma and potentially serve as prognostic markers.

Linear scleroderma ‘en coup de sabre’ treated with topical calcipotriol and cream psoralen plus ultraviolet A

To the Editor Linear scleroderma ‘en coup de sabre’ usually affects one side of the face and head in the frontoparietal area with band-like indurated and hyperpigmented skin lesions. The disease may be associated with ophthalmological and neurological abnormalities and facial hemiatrophy of the subcutis and underlying tissues. Linear scleroderma ‘en coup de sabre’, a subtype of localized scleroderma, is not rare in children. The patients are usually treated either by dermatologists or paediatricians. Numerous treatment modalities have been used but have not been found to be effective or safe. 1,2 We report our experience in two children with linear scleroderma ‘en coup de sabre’ treated successfully with calcipotriol ointment and cream psoralen plus ultraviolet A (PUVA). A 10-year-old girl presented with band-like scleroderma and hyperpigmentation on the neck and left upper side of the face. There was also moderate facial hemiatrophy, discrete loss of the left eyebrow, and cicatricial alopecia in the left parietal area. She also had focal psychomotoric seizures ipsilateral to the skin involvement. Cranial computed tomography revealed calcification in the ipsilateral parietal lobe, and cranial magnetic resonance imaging showed thinning of the skullcap in the left frontal region. A 10-year-old boy presented with band-like scleroderma and hyperpigmentation on the entire right side of the face. There was corresponding remarkable facial hemiatrophy and asymmetry. No evidence for neurological manifestations was found. Cranial computed tomography, however, demonstrated extensive hypoplasia of cranial bones on the left side. Because of rapidly progressive disease at the age of 7, he was treated with 0.6 mg/body weight methotrexate as a single weekly dose for 3 months. Both children were classified as skin type II (Fitzpatrick’s classification) and were treated with cream PUVA [0.0006% 8methoxypsoralen containing ambiphil cream (30% H 2 O) ]. One hour before UVA irradiation, performed with a classic PUVA device (PUVA 200, Waldmann, Villingen-Schwenningen, Germany), a thin layer of the cream was applied to the sclerotic lesions. The initial UVA dose was 0.3 J/cm 2 . The treatment was performed three times weekly and the UVA dose was increased at the earliest after 3 days with 0.2 J/cm 2 . In addition, calcipotriol ointment was applied daily in the morning and evening. The amount of calcipotriol was restricted to a thin layer in the affected areas. Ninety days after beginning therapy, a considerable softening of sclerotic lesions was observed by the physician as well as the patients. Forty treatments of cream PUVA resulted in a cumulative UVA dose of 71 J/cm 2 . In both patients, the pre-existing indurated skin lesions were easy to fold after therapy. Skin softening was also confirmed by 20-MHz ultrasound (figs 1 and 2). No adverse effects were observed. Various therapeutic modalities (e.g. topical and pharmacological agents, immunosuppression, physiotherapy and phototherapy) have been suggested; however, a consistently effective therapy has not been found for patients with localized scleroderma. 2 In general, a combination of the above-mentioned therapies and attention to psychosocial issues are reasonable for the overall management of the child with any form of fig. 1 20 MHz ultrasound (DUB 20, Taberna pro medicum, Lüneburg, Germany) image of a representative sclerotic plaque on the forehead of the girl before treatment.

Minichromosome maintenance proteins are useful adjuncts to differentiate between benign and malignant melanocytic skin lesions

BACKGROUND Markers identifying premalignant and malignant melanocytic skin lesions are needed. OBJECTIVE We aimed to investigate the protein expression of minichromosome maintenance (MCM) proteins in melanocytic skin lesions with different malignant potential. METHODS Paraffin-embedded sections of benign melanocytic nevi (BN, n = 37), dysplastic nevi (DN, n = 25), and primary superficial spreading (SSM, n = 58) were assessed. Immunohistochemistry was performed for Ki-67, MCM3, MCM4, and MCM7 antibodies. RESULTS Ki-67 expression of SSM was significantly increased when compared to DN (P = .0001) and BN (P = .0015). Compared to BN and DN, expression of MCM3 was significantly increased in SSM (P < .0001 and P = .019, respectively). MCM3 expression of DN was significantly increased as compared to BN (P = .0067). There was a significant correlation between MCM3 expression and Breslow tumor thickness (r = 0.44, P = .019). In SSM, MCM4 expression was significantly increased when compared with DN (P < .0001) and BN (P = .0033). MCM4 immunoreactivity was significantly higher in DN than in BN (P = .016). Immunohistology of MCM7 did not reveal significant differences between the groups investigated (P = .48). However, immunoreactivity of MCM7 significantly correlated with Breslow tumor thickness and Clark level (r = 0.39, P = .023; r = 0.44, P = .010, respectively). LIMITATIONS Limitations of our study include the absence of survival data, mRNA results, and functional studies. CONCLUSIONS MCM3 as well as MCM4 are differentially expressed in BN, DN, and SSM. Hence, immunolabeling of MCM3 and MCM4 proteins appears to be a promising additive tool for distinguishing benign from malignant melanocytic skin lesions.

Efficacy and safety of fumaric acid esters in patients with psoriasis on medication for comorbid conditions – a retrospective evaluation (FACTS)

Safety and efficacy of fumaric acid esters (FAE) in patients with psoriasis requiring treated comorbidit condition were investigated.