T. Reuther

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.

Effects of low dose ultraviolet A‐1 phototherapy on morphea

The effects of low dose ultraviolet A‐1 (UVA‐1) phototherapy on different clinical stages of morphea (localized scleroderma) were analyzed in this case study. Based on these data, the different types of phototherapy described in the literature and currently used for treatment of morphea are compared.

PUVA-bath photochemotherapy (PUVA-soak therapy) of recalcitrant dermatoses of the palms and soles

PUVA‐bath therapy has proven to avoid many side effects associated with oral 8‐methoxypsoralen (8‐MOP) treatment. In order to investigate the effectiveness of topical PUVA‐bath therapy (PUVA‐soak therapy) on chronic palmoplantar dermatoses, 30 patients with plaque‐type psoriasis, pustular psoriasis, endogenous eczema, dyshidrotic eczema and hyperkeratotic dermatitis of the palms and soles were treated over 8 weeks with PUVA‐soak using 8‐MOP. No additional treatment except skin moisturising cream such as unguentum emulsificans aquosum was used during the study period. The single UVA‐doses applied ranged from 0.3 to 3.0 J/cm2 (mean single dose of 1.8 J/cm2), with a mean cumulative dose of 48.6 J/cm2 per patient. Altogether 26 of 30 patients responded well within 8 weeks of treatment with 63% of all patients showing a complete remission and 23% showing considerable improvement, as shown by flattening of plaques, decreased scaling and erythema, as well as decreased vesicle and pustule formation. The condition responding best to our therapy was palmoplantar psoriasis followed by atopic eczema. Hyperkeratotic dermatitis displayed the poorest responding rates in this study. Unwanted side effects such as erythema, pain, blistering or patchy hyperpigmentation were not observed in any of the patients. We conclude that PUVA‐soak therapy can be highly efficient in the treatment of palmoplantar dermatoses, especially in the management of palmoplantar psoriasis.

Rejuvenating influence of a stabilized hyaluronic acid-based gel of nonanimal origin on facial skin aging.

BACKGROUND Skin changes associated with aging, such as loss of elasticity and turgor, can have a negative psychosocial impact. Current treatment options aimed at restoring elasticity are often ineffective or hampered by a poor risk/benefit ratio. OBJECTIVE Clinical observations and biophysical measurements were used to assess the effect of middermal placement of stabilized hyaluronic acid–based gel of nonanimal origin (NASHA, Restylane, Vital, Q-Med) on the appearance and elasticity of facial skin. METHODS AND MATERIALS In this pilot study, 19 female patients underwent a series of three treatment sessions, spaced 4 weeks apart, with NASHA injected into the lower cheeks. Elasticity, skin surface roughness, dermal thickness, and density were evaluated at each treatment session and at 4 and 12 weeks after the last treatment session. Patient satisfaction was assessed, and photographs were taken at each visit. RESULTS During the course of the study, skin elasticity and surface roughness improved significantly. Patient feedback was extremely positive. CONCLUSION Micropuncture placement of NASHA can exert a rejuvenating effect on facial skin.

Efficacy, Safety, and Patient Satisfaction of a Monophasic Cohesive Polydensified Matrix Versus a Biphasic Nonanimal Stabilized Hyaluronic Acid Filler After Single Injection in Nasolabial Folds

BACKGROUND Intradermal injection of hyaluronic acid (HA) is currently the criterion standard to reduce the appearance of nasolabial folds (NLF). OBJECTIVE Effects of a monophasic HA filler using cohesive polydensified matrix (CPM) technology were compared with those of nonanimal stabilized HA (NASHA). MATERIALS AND METHODS In a double‐blind, half‐side comparison, 20 subjects (ages 35–65, mean 52 ± 5.6) with symmetric NLF grade 3 to 4 were randomized to contralateral treatment with a monophasic polydensified filler (CPM) and a biphasic HA filler (NASHA). Efficacy was assessed at baseline and after 2, 24, and 48 weeks using a wrinkle severity rating scale (WSRS) for NLF, subject questionnaire, and biophysical in vivo methods. RESULTS All subjects showed significant improvements with both fillers up to day 365. Subject questionnaires confirmed significantly less injection pain for the CPMHA, significantly greater patient satisfaction after 2 weeks with both fillers, and after 24 and 48 weeks significantly greater improvement with the CPMHA compared to baseline. WSRS and skin surface topography parameters improved significantly up to 48 weeks with both fillers. CONCLUSION A single intradermal injection of a monophasic CPMHA and a biphasic NASHA filler showed significant improvements in WSRS and measured wrinkle depth up to 48 weeks for both fillers and significant differences in injection comfort and patient satisfaction in favor of CPMHA.

Gender Difference of in vivo Skin Surface pH in the Axilla and the Effect of a Standardized Washing Procedure with Tap Water

The purpose of our study was to evaluate the axillary skin surface pH and explore potential gender-related differences together with the influence of a washing procedure in healthy subjects. After a run-in period, the skin surface pH was measured in vivo in 10 men and 10 women under standardized conditions in three distinct locations of each axilla (at baseline and up to 6 h after washing). Potential interfering influences were thoroughly excluded. Our study revealed a statistically significant difference in axillary skin surface pH between men and women with more acidic values in females (p ≤ 0.001). The baseline axillary pH before washing was 6.58 ± 0.63 (right) and 6.67 ± 0.65 (left) in men compared to 5.8 ± 0.53 (right) and 5.94 ± 0.62 (left) in women. The difference between the right and left armpit was not statistically significant (p > 0.05) in any group. After standardized washing procedures with pure tap water, the mean axillary pH decreased significantly in women at all measurement times [lowest value 60 min after washing: 5.51 ± 0.7 (right) and 5.64 ± 0.7 (left)], while it slightly increased in men [highest value 240 min after washing: 6.7 ± 0.59 (right) and 6.78 ± 0.69 (left)]. In summary, there is a gender difference in axillary skin surface pH. Washing with water further increased the difference between male and female pH values.

Effects of water temperature on photosensitization in bath-PUVA therapy with 8-methoxypsoralen.

The pharmacokinetic aspects of bath‐PUVA are not completely clarified. Therefore, we determined the phototoxic response of human skin following psoralen baths at temperatures ranging from 32°C to 42°C (71.6–107.6°F) and UVA doses ranging from 0.5 to 5.5 J/cm2. The highest therapeutical photosensitization (i.e., lowest minimal phototoxic dose) was assessed at temperatures of 37°C (98.6°F) and above. Photosensitization was significantly decreased at lower temperatures. These data indicate that a bath temperature of 37°C (98.6°F) should be used to gain optimal therapeutic efficiency in a clinical setting. Furthermore, in order to minimize the risk of adverse phototoxic effects in bath‐PUVA, it is important to use a constant temperature during the psoralen bath.

Time course of 8-methoxypsoralen-induced skin photosensitization in PUVA-bath photochemotherapy

In recent years PUVA‐bath photochemotherapy has been shown to be an effective treatment modality for several dermatoses. A limitation of PUVA‐bath photochemotherapy has been the lack of guidelines for optimal performance, including the time course of photosensitization of the skin exposed to the 8‐methoxypsoralen (8‐MOP) bath water solution. In the present study 12 healthy volunteers were exposed to a 20 min bath in 150 1 of an 8‐MOP water solution (0.5 mg/1, 37°C). Immediately, as well as 1, 2, 3 and 5 h after the 8‐MOP bath, irradiation was performed with increasing doses of UVA (0.5, 1, 2, 3, 5 J/cm2) on 2 cm2 test areas. The minimal phototoxic dose (MPD) was determined 72 h after the UVA exposure. In all volunteers, photosensitization was highest immediately after the bath, with a MPD significantly below 5 J/cm2 (0.5‐2 J/cm2). One hour after the bath, erythema could be induced by 2 to 5 J/cm2 UVA. Two hours after the bath, erythema could be induced using irradiation of 5 J/cm2 only in two volunteers. Three and five hours after the 8‐MOP bath, no erythema could be induced in any volunteer by UVA doses up to 5 J/cm2. Our results indicate that optimal bath‐PUVA requires UVA irradiation immediately after the 8‐MOP bath. Further, these results imply that no restrictions on further sun exposure are mandatory 3 h after the 8‐MOP bath, thus allowing the patient to pursue normal life activities.

Effects of an oral contraceptive containing chlormadinone and ethinylestradiol on acne-prone skin of women of different age groups: an open-label single-centre phase IV study.

AbstractBackground and objective: Acne-prone skin, a common skin condition not only in adolescents but also in adults, can significantly influence the affected individual’s quality of life. The aim of this open-label, prospective, single-centre, phase IV study was to investigate the effects of an oral contraceptive containing chlormadinone 2 mg and ethinylestradiol 0.03 mg (Belara®) on the physiology of acneprone facial skin in healthy women aged 18–37 years. Methods: Forty-four Caucasian women requesting hormonal contraception divided into two age groups (group A: 18–27 years; group B: 28–37 years) were treated with chlormadinone/ethinylestradiol for six menstrual cycles. During each treatment phase, each subject took one tablet per day for 21 consecutive days, followed by a 7-day pill-free interval. Medication was commenced on the first day of menses. Changes in skin parameters were evaluated in terms of the clinical sum score (the primary outcome variable, calculated from the number of comedones, the number of papules/papulopustules, and the sebum secretion state), the evaluation of the pore size using standardized photography, and a range of biophysical in vivo measurements, assessed at baseline, after 12 weeks and after 24 weeks. Results: In both age groups, facial skin condition as quantified by the clinical sum score improved significantly after three and six treatment cycles, with reduced numbers of acne lesions (comedones and papules/papulopustules) and a reduction in seborrhoea. Moreover, there was a statistically significant decrease in pore size. Biophysical evaluations confirmed favourable effects of the medication on diverse skin parameters. Skin surface pH remained within the normal physiological range and there was an improvement in epidermal barrier function (as manifested by decreased transepidermal water loss from the skin of the forehead). Stratum corneum hydration increased in both age groups and the lipid content of the skin surface on the forehead decreased significantly after three treatment cycles in subjects aged 28–37 years. Ultrasound measurements verified that there was no retention of water within the dermis. There was no difference between the two age groups. Conclusion: For the first time, improvements in several facial skin parameters during treatment with a combined oral contraceptive (chlormadinone/ethinylestradiol) were quantified by biophysical methods and a clinical sum score. The highly statistically significant improvements in clinical findings and various biophysical skin parameters observed in this study suggest that the antiandrogenic oral contraceptive chlormadinone/ethinylestradiol may be a major therapy option in women with acne-prone skin who request hormonal contraception.

Hyperhidrosis plantaris – a randomized, half-side trial for efficacy and safety of an antiperspirant containing different concentrations of aluminium chloride

Background: Primary focal hyperhidrosis plantaris can cause impairment in social, physical, leisure and occupational activities. Topical treatment with aluminium chloride is the first‐line treatment. The aim of this trial was to evaluate efficacy and safety of two different concentrations of aluminium chloride hexa‐hydrate (12.5%, 30%) for 6 weeks.