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Notes: Reactions of the cutaneous microcirculation to local stimuli have been quantitated in terms of area of erythema (planimetry), change in colour (colorimetry) and time-dependent changes in perfusion (one-dimensional laser Doppler fluxmetry (LDF)). Using the new technique of laser Doppler scanning (LDS) it is now possible to quantify and demonstrate two-dimensional patterns of microvascular perfusion in terms of intensity and extent. The precision of this new technique was compared with the previously established techniques by examining the reactions of 15 healthy volunteers to the intracutaneous injection of carbacholin and isotonic NaCl solutions. Both stimuli were applied paravertebrally, on the left and right side. Reactions were examined alter 10 min. As a control for temporal reproducibility the examination was repeated on another dayAll methods allowed the differentiation of reactions to carbacholin from those to NaCl (P〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:les" location="les.gif"/〉 0·0001). Only colorimetry and I.DS provided data that were unequivocally reproducible when comparing both sides (r 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:ges" location="ges.gif"/〉 0·78). Using LDF or planimetry, reproducibility of values was lower (r 〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:les" location="les.gif"/〉 0·58). When looking; at measurements performed on different days, only values of LDS were reproducible (r 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:ges" location="ges.gif"/〉·). Hyperaemic areas seen with LDS were significantly larger than those determined by planimetry.Results of LDS are reproducible spatially and temporally: the technique will allow time-course observations of skin reactions that are accompanied by medium-term changes in perfusion.

Notes: Background/aims: Noninvasive methods are introduced for the monitoring of healing of psoriasis. Fumaris acid derivatives (FAD) were used in the treatment of psoriasis vulgaris for more than 30 years, but the effectiveness of these drugs has remained controversial. The object was to study the efficacy of FAD in a prospective study including noninvasive techniques, which may allow more accurate assessment in a smaller patient group.Methods: High-frequency ultrasound including image analysis, and colorimetry was employed. 14 patients were treated for 20 weeks.Results: In the ultrasound image, acanthosis and inflammatory infiltrate of active psoriasis cause an echopoor area under the entry echo. Under theray, this echo area diminishes while its density increases. During healing, the decrease in redness could be quantified.Conclusions: Monitoring of the healing of psoriasis is possible with ultrasonography and colorimetry. Fumaric acid was found efficient and safe in the treatment of psoriasis.

Notes: Background: The supply of oxygen to the viable skin tissue within the upper layers is not only secured by the cutaneous blood vascular system, but to a significant part also by oxygen diffusion from the atmosphere through the horny layer. The aim of this study was to examine whether changes in haemoglobin oxygenation can be observed within the isolated perfused bovine udder skin used as a skin model by removing the upper horny layer by adhesive tape stripping.Methods: Diffuse reflectance spectroscopy in the visible spectral range was used for non-invasive characterisation of haemoglobin oxygenation in skin under in vitro conditions. Mid-infrared attenuated total reflectance spectroscopy was employed for analysing the surface layer of the stratum corneum with respect to keratin, water and lipid components. Skin barrier disruption was achieved by repeated stripping of superficial corneocyte layers by adhesive tape.Results and conclusion: Significant changes in skin haemoglobin oxygenation were observed for skin areas with reduced lipid concentration and a reduced stratum corneum layer, as determined from the quantitative evaluation of the diffuse reflectance skin spectra. The result can be interpreted as an increase of oxygen diffusion after the removal of the upper horny layer.

Notes: 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.Methods Twelve patients with histological diagnosis of BCC referred to our department for tumor excision were investigated on the lesion(s) and on clinically uninvolved sites preoperatively by in vivo CLSM using the Vivascope 1000 (Lucid Inc., Rochester, USA). The images were compared to histological examinations of the excised tissue.Results Typical changes in vasculature such as increase in number and diameter of the blood vessels, loss of the vascular architecture, parallelly and horizontally orientated vessels, and accumulation and rolling phenomena of bright reflecting cells of 11.88 ± 1.75 µm in diameter along the vessel wall were observed in all BCCs. The tumor stroma of the BCCs showed a strong reflectance mainly due to numerous bundles of collagen fibers encoating dark, cell-rich areas of tumor parenchym. In five patients, slim basaloid cells with relatively large, elongated dark nuclei were observed in the periphery of the tumor parenchym. In the fibrosing type of BCC, curled bundles of collagen with large cells represented the tumor stroma.Conclusions BCC can be investigated by CLSM and provide typical features. Besides the tumor parenchym and stroma, typical changes in vasculature seem to be a sensitive criteria for BCC and may in future help in diagnosing BCC by CLSM as well as in assessing the margins of large tumors. We suggest that CLSM is a promising non-invasive tool for the diagnostics of BCC and the assessment of tumor margins prior to surgery.

Notes: Background/purpose Retinoids like tazarotene are approved for the treatment of chronic plaque psoriasis. In the beginning of topical retinoid therapy, 15–20% of the patients suffer from mild to moderate adverse reactions with burning and erythema. The aim of the study was to find predicative parameters of the individual irritative potential and to suggest options to reduce these initial irritations.Methods Twenty in-patients with different skin types (1 + 2: 11, 3 + 4: 9), with chronic plaque psoriasis were included in this open study. In each patient, 7 randomized plaques on the forearm were treated for 14 days on different ways: test area 1: morning (m) and evening (e) placebo, test area 2: placebo (m) and tazarotene 0.05% (e), test area 3: placebo (m) and tazarotene 0.1% (e), test area 4: calcipotriol (m) and calcípotriol (e), test area 5: mometasone furoate (m) and tazarotene 0.05% (e), test area 6: mometasone furoate (m) and tazarotene 0,1% (e), test area 7: placebo (m) and tazarotene in increasing concentrations (e), test area 8: healthy skin for control. Before and after therapy, skin barrier function, blood flow and plaque thickness in 20-MHz sonography were assessed in different test areas intraindividually by non- invasive biophysical measurements.Results After 14 days of therapy, tazarotene 0.05% and 0.1% produced a stronger increase of laser Doppler flow in patients with skin type 1 and 2 than in patients with skin type 3 and 4. When using the combination therapy of tazarotene and mometasone, the laser Doppler flow was significantly lower than in tazarotene as monotherapy. 20-MHz-ultrasound showed a significant decrease in the thickness of the echopoor band in all topical therapy regimens compared to placebo. Patients of skin type 1 and 2 reached a higher density of the dermis than patients of skin type 3 and 4, meaning a stronger decrease of inflammatory infiltration and acanthosis.Conclusion Adapting retinoid therapy to the patient's skin type can reduce the initial irritative side-effects. During the first days, patients with skin type 1 or 2 should add a medium potency corticosteroid. Stronger skin irritation caused by tazarotene therapy increases therapy effects.

Notes: 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.Materials and method: We investigated three patients with basal cell carcinoma and three patients with melanocytic nevi. Three-dimensional (3D) images were obtained from these skin tumours via OCT according to previously applied marks, which were tattooed with special histological marking dye after excision of the tumours. Corresponding to these marks, we investigated serial histological sections (haematoxylin&eosin staining).Results: We could prove similar morphological structures both in OCT and histology. Due to tissue deformation, the compared measurements of structures like cell nests or epidermal thickness were slightly deviated. However, by this method we could prove similar tissue formations in OCT and histology.Conclusions: Due to the deformation by histological processing and slightly different sectioning levels, the comparison of histological pictures and OCT images seems difficult. Nevertheless, in two cases it was possible to demonstrate the same morphological structures with OCT imaging and histological investigation. Our method could play an important role for further evaluation of OCT images. We estimate better evaluation of OCT imaging using a 3D reconstruction method.

Notes: This report reviews how to set up a laser Doppler perfusion imaging system intended for visualization of skin blood perfusion, capture images and evaluate the results obtained. A brief summary of related papers published in the literature within the areas of skin irritant and allergy patch testing, microdialysis and skin tumour circulation is presented, as well as early applications within other fields such as diabetology, wound healing and microvascular research.