Stefanie Boms

Medium-dose ultraviolet (UV) A1 vs. narrowband UVB phototherapy in atopic eczema: a randomized crossover study

Background  Ultraviolet (UV) A1 and narrowband (NB)‐UVB have been reported to be effective treatments for atopic eczema (AE).

Pimecrolimus 1% cream for anogenital lichen sclerosus in childhood

BackgroundLichen sclerosus is a chronic inflammatory disease with a predilection of the anogenital region. Because of the potential side effects of repeated local application of potent glucocorticosteroids, equally-effective, safer therapeutic options are required, especially in the treatment of children.Case presentationsWe report on the efficacy of twice-daily application of pimecrolimus 1% cream in four prepubertal girls (range of age: 4 to 9 years) who suffered from anogenital lichen sclerosus. After three to four-month treatment, all patients had almost complete clinical remission including relief from itch, pain and inflammation. Only minor improvement was observed for the white sclerotic lesions. No significant side effects have been observed.ConclusionsTopical pimecrolimus appears to be an effective and safe treatment for children with anogenital lichen sclerosus. The clinical benefits observed in the four patient presented particularly include relief of pruritus, pain and inflammation. Vehicle-controlled studies on a larger number of patients are now warranted to substantiate our promising findings, and to investigate long-term efficacy and safety of topical pimecrolimus in anogenital lichen sclerosus.

Epidermal thickness assessed by optical coherence tomography and routine histology: preliminary results of method comparison.

Background  Optical coherence tomography (OCT) is a promising non‐invasive imaging technique for studying the epidermis and upper dermis in vivo. As proposed previously by Welzel et al. (J Am Acad Dermatol 1997; 37: 958–963), distance measurements between the entrance peak and the second peak of the A‐scan seem to correspond to epidermal thickness (ET). However, there is a lack of systematic studies comparing OCT with histology.

UVA1 and UVB irradiated skin investigated by optical coherence tomography in vivo: a preliminary study

In histological studies, it has frequently been demonstrated that ultraviolet (UV) exposure, in particular UVB, can induce significant thickening of the viable epidermis and/or stratum corneum. Since skin biopsy alters the original skin morphology and always requires an iatrogenic trauma, we aimed to introduce optical coherence tomography (OCT) in vivo for the investigation of changes of epidermal thickness (ET) following UVA1 and UVB irradiation. Twelve healthy subjects received daily 60 J/cm2 of UVA1 and 1.5 minimal erythema doses UVB on their upper back over 3 consecutive days. Twenty‐four hours after the last irradiation, OCT assessments were performed on UV exposed and adjacent nonirradiated control sites. Data of ET as expressed by comparison of the averaged A‐scans differed significantly between nonirradiated (94.2 ± 15.7 µm), UVA1 (105.4 ± 12.8 µm) and UVB (125.7 ± 22.1 µm) exposed sites. In comparison to the nonirradiated sites, UVA1 exposed skin showed significant (P = 0.022) increase of ET of 11% and UVB exposed sites a significant (P < 0.001) increase of 25%. ET of UVA1 and UVB exposed skin sites differed significantly (P =0.005). Our results obtained from OCT in vivo measurements confirm data of previous histological studies indicating that not only erythemogenic doses of UVB, but also suberythemogenic doses of UVA1 may have a significant impact on ET. OCT appears to be a promising bioengineering technique for photobiological studies. However, further studies are needed to establish its measurement precision and validity, and to investigate in vivo spectral dependence on UV induced skin changes such as skin thickening.

Immunologically Mediated Photodermatoses: Diagnosis and Treatment

Electromagnetic radiation may cause distinct skin conditions. The immunologically mediated photodermatoses (IMP, previous term: idiopathic photodermatoses) represent a heterogenous group of disorders presenting with pathologic skin reactions caused by optical radiation, particularly in the UVA wavelength region. The exact pathomechanism in IMP remains to be elucidated; however, it is very likely (auto)-immunologic in nature. Polymorphic light eruption, actinic prurigo, hydroa vacciniforme, chronic actinic dermatitis, and solar urticaria are the most important conditions that may be summarized under the term IMP. IMP frequently result in a significant reduction in quality of life in affected individuals, mainly because of troublesome symptoms such as intractable itch and pain.Photodiagnostic procedures are mandatory for the exact determination of action spectra and the degree of photosensitivity. Broad-spectrum photoprotection is essential in the prevention of IMP. Photo(chemo)therapeutic regimens are predominantly used to increase the cutaneous immunologic tolerance against ambient UV radiation. In severe forms of IMP, immunomodulatory and immunosuppressive therapies may need to be considered. Overall, IMP form a significant group of skin conditions that can be extremely disabling to the patient and are difficult to diagnose and treat.

Immunohistochemical investigation of mid-dermal elastolysis

We report a 31‐year‐old Caucasian woman presenting with remarkable wrinkling on her trunk and proximal extremities. Diagnosis of mid‐dermal elastolysis (MDE) was confirmed by Van Giesons staining. Immunohistochemical investigations revealed enhanced expression of CD34+ and CD68+ cells accompanied by slightly increased expression of CD3+ and CD4+ lymphocytes in lesional skin. Furthermore an elevated cellular expression of matrix metalloproteinase (MMP)‐1 and slightly increased presence of MMP‐12 positive cells combined with a decrease of tissue inhibitor of metalloproteinases 1 (TIMP‐1) positive cells was observed in lesional skin as compared with a control specimen obtained from nonlesional skin. Our data may indicate inflammatory processes and an altered balance between MMPs and TIMPs in MDE. Furthermore CD34+ dendritic fibroblasts and/or histiocytes are possibly involved in the pathogenesis of MDE.

Comparison of histometric data obtained by optical coherence tomography and routine histology

There is a lack of systematic investigations comparing optical coherence tomography (OCT) with histology. OCT assessments were performed on the upper back of 16 healthy subjects. Epidermis thickness (ET) was assessed using three methods: first, peak-to-valley analysis of the A-scan (ET-OCT-V); second, manual measurements in the OCT images (ET-OCT-M); third, light microscopic determination using routine histology (ET-Histo). The relationship between the different methods was assessed by means of the Pearson correlation procedure and Bland and Altman plots. We observed a strong correlation between ET-Histo (79.4+/-21.9 microm) and ET-OCT-V (79.2+/-15.5 microm, r=0.77) and ET-OCT-M (82.9+/-15.8 microm, r=0.75), respectively. Bland and Altman plots revealed a bias of -0.19 microm (95% limits of agreement: -27.94 microm to 27.56 microm) for ET-OCT-V versus ET-Histo and a bias of 3.44 microm (95% limits of agreement: -24.9 microm to 31.78 microm) for ET-OCT-M versus ET-Histo. Despite the strong correlation and low bias observed, the 95% limits of agreement demonstrated an unsatisfactory numerical agreement between the two OCT methods and routine histology indicating that these methods cannot be employed interchangeably. Regarding practicability, precision, and indication spectrum, ET-OCT-V and ET-OCT-M are of different clinical value.

Immunohistology of amicrobial pustulosis of the folds

Amicrobial pustulosis of the folds (APF), is a rare pustular eruption, predominantly involving the cutaneous folds, the external auditory canals and the scalp, occurring in patients who exhibit a wide spectrum of autoimmune abnormalities. There is a lack of data on the immunohistology of APF. We report a new case of APF associated with features of systemic lupus erythematosus (LE). Extensive immunohistological examinations of lesional and nonlesional skin were performed. The results of our immunohistological studies indicate that immunostaining with p53, Bcl‐2, and CD8 antigens could be useful in differentiating APF from closely related inflammatory conditions such as psoriasis and cutaneous LE. However, studies on a larger sample size including controls are needed to substantiate our findings.

Umschriebene feine Fältelung entlang der Hautspannungslinien

Eine 30-jährige Patientin stellte sich mit auffälliger Hautfältelung am Abdomen vor. Die Hautveränderungen bestanden seit 2 Jahren und riefen keinerlei subjektive Symptomatik hervor. Nur zu Beginn der Erkrankung wurden von der Patientin auch Rötungen am Abdomen bemerkt. Weitere Erkrankungen waren bei der Patientin nicht bekannt.Medikamente wurden nicht eingenommen.Eine übermäßige Sonnenexposition war der Patientin nicht erinnerlich.Die Familienanamnese war unauffällig.