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Notes: Background  Vitamin B12 is an effective scavenger of nitric oxide (NO). As the experimental application of a NO synthase inhibitor, Nω-nitro-l-arginine, led to a clear decrease in pruritus and erythema in atopic dermatitis, it would be reasonable to assume a comparable effect of vitamin B12.Objectives  The efficacy and tolerability of a new vitamin B12 cream as a possible alternative to current therapies was examined.Methods  A prospective, randomized and placebo-controlled phase III multicentre trial, involving 49 patients was conducted. For the treatment duration of 8 weeks, each patient applied twice daily (in the morning and evening) the vitamin B12-containing active preparation to the affected skin areas of one side of the body and the placebo preparation to the contralateral side according to the randomization scheme.Results  On the body side treated with the vitamin B12 cream, the modified Six Area Six Sign Atopic Dermatitis score dropped to a significantly greater extent than on the placebo-treated body side (for the investigational drug 55·34 ± 5·74 SEM, for placebo 28·87 ± 4·86 SEM, P 〈 0·001). At the conclusion of the study, the investigator and patients awarded mostly a ‘good’ or ‘very good’ rating to the active drug (58% and 59%, respectively) and a ‘moderate’ or ‘poor’ rating to the placebo (89% and 87%, respectively).Conclusions  Topical vitamin B12 is a new therapeutic approach in atopic dermatitis. These results document a significant superiority of vitamin B12 cream in comparison with placebo with regard to the reduction of the extent and severity of atopic dermatitis. Furthermore, the treatment was very well tolerated and involved only very low safety risks for the patients.

Notes: Background/aims: Cutaneous malignant melanoma is a disease of increasing clinical and economical importance. The prognosis is good with early diagnosis. The chief differential diagnosis is benign melanocytic naevus, a common lesion in Caucasians. Attempts have been made to use bioengineering techniques to aid in the initial diagnosis. The present study proposes a method of extracting possibly discriminative blood perfusion properties in pigmented skin lesions by combining information on the lesions' blood perfusion with optical or visual information of their spatial extent.Methods: A total of 46 blood perfusion measurements were performed on 22 pigmented skin lesions, the ultimate diagnosis of which was three histologically proven malignant melanomas, four histologically proven benign naevi and fifteen naevi assessed by two specialist dermatologists as being benign. Laser Doppler perfusion imaging gave two different types of two-dimensional data sets (64×64 pixels), one representing the total backscattered light intensity at each measurement point (TLI image) and the second corresponding to perfusion values. The boundaries of each examined lesion were derived from the TLI image employing greyscale thresholding, thus resulting in an estimated region of interest (ROI) approximating the optical extent of the lesion. The ROI was superimposed on the perfusion image and extraction of perfusion features was then performed.Results: The processing of the TLI images was successful in delineating the lesions' boundaries. The first hypothesis that the mean perfusion quotients in MM and benign naevi are equal could not be rejected at the chosen 5% level of significance. The second hypothesis that the mean percent-age of elevated perfusion values (image pixels) within the ROI shows no difference between MM and benign naevi could be rejected at a 5% level of significance.Conclusions: This study has presented a method of extracting blood perfusion parameters of pigmented skin lesions by combining blood perfusion information with information on the lesion's optical extent. The proposed method of presenting data could prove to be a useful discriminative adjunct in the assessment of pigmented skin lesions.

Notes: Topical glucocorticoids with improved benefit/risk ratio are of great interest in dermatology, but there are very few trials directly comparing the efficacy and side-effects of these new preparations. In our study the vasoconstrictor effect and side-effects of two of these new glucocorticoids were evaluated and blanching effect was determined by two-dimensional laser scanning.〈section xml:id="abs1-3"〉〈title type="main"〉MethodsIn a randomised, double blind intra-individual comparative trial, 10 subjects were treated with various glucocorticoids or drug-free vehicle. The test drugs were mometasone furoate (MF), methylprednisolone aceponate (MP) and hydrocortisone (OH-C). The preparations were tested for a period of 3 weeks with occlusion on the flexor side of the forearm. Skin thickness and vasoconstriction were determined using 20 MHz ultrasound scanning, laser Doppler scanning (LDS) and chromometry.〈section xml:id="abs1-4"〉〈title type="main"〉ResultsNo adverse effects were observed during the observation period. Only partial vasoconstriction occurred in most cases during the observation period. MP and MF produced maximal blanching between days 3 and 5 of treatment, while with OH-C clinically visible blanching did not occur. Ultrasound evaluation of skin thickness showed similar behaviour for all three steroids tested: there were no signs of skin atrophy in any of the cases. LDS evidenced hypoperfusion of a test area on the perfusion image in only a few patients and there were no significant differences between the steroids tested. On evaluation of vasoconstriction caused by the steroids tested using chromometry there was a significant difference between MF and OH-C on the L*a*b* scale (P 〈 0.005). Only at day 3 was a blanching effect caused by MP and MF demonstrable (a-value, P 〈 0.05).〈section xml:id="abs1-5"〉〈title type="main"〉ConclusionIn summary, the synthetic steroids MF and MP presented side-effects similar to those of OH-C but much greater vasoconstrictor effect; after an application period of over 5 days under occlusion a blanching effect in our model was not demonstrable by means of chromometry. Two-dimensional laser scanning offers no advantage in the evaluation of the blanching effect in comparison to one-dimensional laser fluxmetry (LDF). © 1998 Elsevier Science B.V.

Notes: Nephrogenic fibrosing dermopathy (NFD) is an uncommon, recently described fibrotic skin disorder that has been observed in patients with end-stage renal disease. We describe a 81-year-old man with end-stage renal disease who developed NFD in the seventh year of haemodialysis. Laboratory investigations revealed considerably increased circulating immune complexes and anti double stranded DNA antibodies. Because the pathogenesis of NFD may not entirely be attributable to haemodialysis, the role of circulating factors in the development of cutaneous manifestations requires further investigation.

Notes: 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 Gieson's 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.

Notes: The superior vena cava syndrome occurs when extrinsic compression or intraluminal occlusion impedes blood flow through this vessel. Detecting the characteristic cutaneous features can lead to an early diagnosis of this condition. We report a 73-year-old patient with a 4-year-history of erythematous oedema of the face. The underlying cause was a large restrosternal goitre obstructing the superior vena cava. Subtotal thyroidectomy led to dramatic improvement of all dermatologic symptoms.

Notes: Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory skin disease characterized by white porcelain-like sclerotic skin lesions. It is most commonly seen in adult females and usually affects the genitoanal area. Extragenital LSA appears in 15–20% of cases. We report a 9-year-old Caucasian girl suffering from extragenital LSA that was resistant to conventional treatment. After 40 treatment sessions with low-dose UVA1 phototherapy, all skin lesions were resolved completely. Moreover, the improvement of skin status has been sustained during 6-months of follow-up. Long-wave UVA irradiation has been shown to induce intensively collagenase activity in human dermal fibroblasts. We suggest that UVA1 irradiation could be an effective treatment in patients suffering from extragenital LSA.

Notes: 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.Objectives  We sought to investigate the efficacy of FAE in a larger number of patients with NL.Methods  Eighteen patients with histopathologically proven NL were consecutively recruited into a prospective noncontrolled study. Dosage of FAE was given according to the standard therapy regimen for psoriasis. FAE were administered for at least 6 months. The treatment outcome was evaluated by means of clinical and histological scoring and 20-MHz ultrasound assessments.Results  Three patients discontinued therapy with FAE, while the remaining 15 patients finished the study. After a mean ± SD treatment period of 7·7 ± 2·9 months, a significant (P 〈 0·001) decrease in the mean ± SD clinical score, from 7·4 ± 1·8 at the beginning to 2·5 ± 1·3 at the end of therapy, was observed. Significant clinical improvement of NL was accompanied by significant (P = 0·019) increase of dermal density as assessed by means of 20-MHz ultrasound, and significant (P = 0·011) reduction of the histological score. Adverse effects were moderate and consisted mainly of gastrointestinal complaints and flushing. During follow-up of at least 6 months, clinical outcome remained stable in all patients.Conclusions  The results of this study demonstrate that FAE are beneficial and safe in the treatment of patients with NL.