Bibliothek

Notizen: We describe 2 patients with a dermatosis like Darier's disease and resembling it histologically. However, the eruption was characterized by adult-onset and rapid spread.

Notizen: Oral psoralen photochemotherapy (PUVA) was found to be effective in five patients with chronic hyperkeratotic dermatitis of the palms. Relapses may occur but they respond well to retreatment.

Notizen: Thirty two adult patients who presented with a sharply marginated, hyperkeratotic dermatitis of the palms (HDP), but with no skin lesions elsewhere, have been re-examined approximately 10 years later. Topical treatments had had limited effect. The morphological appearance and localization had remained unchanged, except in two individuals who were free from symptoms. One had developed psoriasis. The incidence of atopic disease and psoriasis in first degree relatives did not differ from that in control subjects, Mycological cultures and patch tests were negative. Serum IgE was normal. Skin biopsies in nine patients all revealed a chronic spongiotic dermatitis.

Notizen: Aim of the study An observational study with valaciclovir was conducted to assess clinical outcome in herpes zoster, especially pain and associated neurological signs and symptoms in relation to a series of demographic and disease characteristics discernible at presentation. The safety and acceptability of valaciclovir for treatment of zoster was assessed in a wide variety of primary care and clinic referral settings. Methods In total, 1897 immunocompetent adults with clinically diagnosed, localized acute herpes zoster were enrolled in this international, open-label study of valaciclovir. All subjects received treatment with oral valaciclovir (1000 mg three times daily) for 7 days from entry to the study and were asked to record the presence of zoster-associated pain and abnormal sensations throughout treatment and 6 months’ follow-up. They were seen frequently in clinic to verify subjective assessments and for evaluation of rash healing. Safety and tolerability were assessed by adverse event monitoring. Results Overall, 1191 subjects (63%) were aged ≥ 50 years, and 203 (11%) had ophthalmic zoster. Cessation of zoster-associated pain was significantly faster in the younger age group; median times to loss of zoster-associated pain were 23 days and 9 days in the ≥ 50 and 〈 50 years age groups, respectively. Similarly, abnormal sensations resolved significantly more rapidly in the younger subjects; the median duration of abnormal sensations was 31 days in the ≥ 50 year olds and 16 days in those aged 〈 50 years. In cases of ophthalmic zoster, the rate of pain resolution was not different from those with zoster in other dermatomes (median duration of pain 18 vs. 16 days). However, abnormal sensations persisted significantly longer in subjects with ophthalmic zoster than in those with zoster at other sites (47 vs. 22 days). In addition to advancing age, subjects suffering moderate to severe prodromal pain or acute pain during the rash phase were at significantly greater risk of zoster-associated pain and abnormal sensations persisting for longer. Subjects with concomitant neurological disorders were also more likely to develop prolonged abnormal sensations. Valaciclovir treatment was well tolerated, and adverse events were rare and generally mild. Conclusion This study confirmed the prognostic importance of advancing age and the intensity of prodromal or acute pain as risk factors for prolonged zoster-associated pain and persisting abnormal sensations in the affected dermatome. Ophthalmic zoster and pre-existing neurological disorders are also identified as highly significant risk factors for prolonged abnormal sensations in herpes zoster.

Notizen: SUMMARY.— Autoerythrocyte sensitization syndrome (painful bruising syndrome) is a chronic purpuric cutaneous disease of women, characterized by localized painful inflammatory swellings which in a few hr. develop into painful ecchymoses. Some patients also have systemic manifestations: psychiatric and neurological symptoms, abdominal pain, and genito-urinary and gastrointestinal bleeding, in that order of prevalence.Histological examination shows an intense vasculitis. Ecchymoses can occur spontaneously, particularly with emotional stress and after mild trauma. The haematological and blood clotting pictures are normal. Intradermal injection of erythrocytes or red cell stroma reproduces the spontaneous lesion.Two patients with this syndrome are presented. In both, typical ecchymotic reactions were induced by the injection of erythrocytes, in one a similar response could be provoked with phosphatidyl L-serine.The literature is reviewed in detail and the possible pathogenesis of the syndrome is discussed.

Notizen: We report three patients with psoriasis and bipolar affective illness who showed marked deterioration of their skin condition when treated with lithium.

Notizen: Contact urticaria to potato was confirmed by skin testing in a 26–year-old male with atopic dermatitis, birch-pollen rhinoconjunctivitis and a history of immediate finger itching upon handling raw potato. The potato peel was non-reactive. The urticarial reactivity to potato could be transferred by the patient's serum in a Prausnitz-Küstner test, indicating an immunological etiology. Electrophoretic and chromatographic examination of extracts from homogenized potatoes (unexposed to synthetic fertilizers and insecticides) revealed allergenic activity in a heat-labile macromolecular fraction with a mass of 20-30 kdalton migrating towards the anode during agarose gel electrophoresis at pH 8.6 with a mobility similar to that of human α1-antitrypsin. The technique used for preliminary fractionation of the allergenic activity in a potato extract, similar to crossed immunoelectrophoresis, appears to be a simple and widely applicable technique for the characterization of proteins with this biological activity. A partially purified fraction with allergenic activity, seemingly more stable than the activity in crude homogenates, was obtained by gel filtration and preparative agarose gel electrophoresis. When an antihistamine was also injected, the urticarial reaction to the protein fraction was less pronounced. Pretreatment of the skin with compound 48/80, a histamine releaser, blocked the reaction. Histamine thus seems 10 be the major vasoactive substance mediating the contact urticarial response to potato antigen in this patient.

Notizen: 67 patients with oral lichen planus of the atrophic-erosive or reticular plaque type were examined. Dental amalgam in contact with mucosal lesions was present in 64 patients, and gold fillings in 33. Patch testing with a standard procedure was performed with components of dental fillings. 11 patients (16%) reacted to at least one of the mercury compounds compared to 8% in a reference group. Most positive reactions were caused by elemental mercury and ammoniated mercury. No patient reacted to gold or capper. Readings at days 10–14 did not increase the number of responders. 13 patients were patch tested with palladium; all were negative. It is not clear whether in the mercury-positive patients allergy to dental amalgam is a causative or aggravating factor, or merely on epiphenomenon.

Notizen: A case is presented of a confectioner with a chronic hand dermatitis and positive patch test reactions to cardamom and certain terpenoid compounds present in the dried ripe seeds of cardamom. Cardamom is a popular traditional flavouring agent for baked goods and confectionery. Dermatitis from skin exposure to cardamom has to the best of our knowledge not been reported. We report one case of allergic contact dermatitis to cardamom elicited by terpenes present in the seeds.

Notizen: Twenty-five patients with chronic oral lichen planus, usually of the atrophic-erosive type, were treated for 2 months with Etretinate® 0.6 mg/kg b.w./day, followed for 4 months by Etretinate® 0.3 mg/kg/day, or 0.1% Tretinoin® in an adhesive base. Complete resolution or improvement was seen in 85% of the lesions after first treatment. The number of patients with oral soreness and pain was significantly reduced (p 〈 0.001). During the second treatment, the improvement was maintained or even increased in about 70% of the patients, irrespective of the mode of treatment. Treatment was discontinued in one patient owing to moderately increased serum transaminase levels. The number of drug-related drop-outs was significantly lower than in a previous study utilizing an etretinate dose of about 1 mg/kg/day (p 〈 0.05). Other adverse effects were minor and tolerable. Retinoids offer an effective mode of therapy for severe oral lichen planus.