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Notizen: Background Seborrhoeic dermatitis is a common papulosquamous dermatosis affecting 2–10% of the adult population. Current treatment options are limited and not always satisfactory. Objectives We aimed to investigate the efficacy of narrow-band ultraviolet (UV) B (TL-01) phototherapy as an alternative treatment for seborrhoeic dermatitis. Methods Eighteen patients with severe disease were enrolled in an open prospective study. Treatment was given three times weekly until complete clearing or to a maximum of 8 weeks. A clinical score assessing erythema, scaling, infiltration and pruritus was performed at baseline and every 2 weeks thereafter. Additionally, the patients were asked to rate the intensity of pruritus on a visual analogue scale. After completion of the study the patients were followed up to determine the median time interval until recurrence. Results All patients responded favourably to treatment, with six showing complete clearance and 12 marked improvement. The median clinical score decreased from 7·5 (range 4–8) at baseline to 0·5 (range 0–3) after 8 weeks of treatment (P = 0·005). The median pruritus score decreased from 4·5 (range 0–8) at baseline to 0 (range 0–3) at week 8 (P = 0·008). Relapses occurred in all patients after a median of 21 days (range 12–40). No side-effects of treatment were observed except occasional episodes of a moderate erythemal response. Conclusions Narrow-band UVB phototherapy appears to be a very effective and safe treatment option for patients with severe seborrhoeic dermatitis.

Notizen: In patients with severe chronic atopic dermatitis (AD), both photochemotherapy [psoralen ultraviolet A (PUVA)] and narrow-band (TL-01) UV B phototherapy have been reported to be very effective. As no data exist on the relative therapeutic efficacy of these two regimens, we performed a randomized investigator-blinded half-side comparison study on 12 patients with severe chronic AD. Half-side irradiation with threshold erythemogenic doses of 8-methoxypsoralen bath-PUVA and narrow-band UVB was performed three times weekly over a period of 6 weeks. The severity of the disease was assessed separately for the paired halves of the patients’ bodies by a modified SCORAD score at baseline and after 2, 4 and 6 weeks of treatment. Ten of the 12 patients completed the trial. All but one showed marked improvement or complete remission with both treatments. The mean baseline SCORAD score decreased by 65·7% by the bath-PUVA treatment and by 64·1% by the narrow-band UVB treatment (P = 0·48). No serious adverse reactions to either of the two regimens were observed. Our data confirm the high efficacy of bath-PUVA and narrow-band UVB phototherapy in the treatment of patients with chronic severe AD. Both regimens appear to be equally effective when administered in equi-erythemogenic doses.

Notizen: This study describes a family of 30 people in which 14 members have hereditary epidermolytic palmoplantar keratoderma. Four patients were treated with an oral aromatic retinoid for up to 5 months. They responded in a uniform and dramatic way: 10-14 days after the onset of therapy, the hyperkeratotic horny layer was sequestered in large sheets resulting in normal appearing skin and restoration of normal surface sensitivity. Biopsies revealed that the underlying disorder of keratinization had remained unchanged. Treatment with the retinoid had to be discontinued as the sensitivity and vulnerability restricted normal function of hands and feet.Epidermolytic hyperkeratosis (Frost & Van Scott, 1966) is a disorder of keratinization with distinctive histopathological (Ackermann, 1970; Frost & Van Scott, 1966; Lapière, 1932; Lapière, 1957) and ultrastructural (Anton-Lamprecht & Schnyder, 1974; Lapière, 1932; Lapière, 1957) characteristics which may be found in genetically transmitted diseases, certain types of naevi and hamartomas (Ackermann, 1970; Gebhart & Kidd, 1973; Plewig & Christophers, 1975; Schnyder, 1970) or, as an accidental feature, in a variety of acquired hyperkeratotic skin conditions (Ackermann, 1970; Plewig & Christophers, 1975). As a genodermatosis, epidermolytic hyperkeratosis in generalized expression presents as bullous ichthyosiform erythroderma (Frost & van Scott, 1966; Lapière, 1932; Lapière, 1957), but localized manifestations may assume the clinical appearance of hereditary linear naevus or hereditary palmoplantar keratoderma. In these localized lesions, the propensity to form bullae is minimal or absent. The epidermolytic variants of linear naevi and palmoplantar keratoderma thus do not differ appreciably from the common orthohyperkeratotic types, and the diagnosis is often made on an incidental basis.Although estimates of its incidence are a matter of speculation, epidermolytic hereditary palmoplantar keratoderma (EHPPK) appears to be exceedingly rare. Hitherto, only four affected families (Klaus, Weinstein & Frost, 1970; Voerner, 1901) and one single case (Brunsting et al., 1962) have

Notizen: Cell culture experiments using haematoporphyrin photosensitized bovine hoof fibroblasts and longwave uv-irradiation revealed two distinct and separable patterns of lethal photosensitization according to two different sensitization procedures:〈list xml:id="l1" style="custom"〉1Photosensitization of cell membranes by short exposure (5 min) of cells to haematoporphyrin.2Cytoplasmic photosensitization elicited by a 2 h exposure of cells to hacmatoporphyrin. Cellmembrane photosensitization was reversible by incubation of cells in serum which removed surface bound haematoporphyrin; cytoplasmic photosensitization was irreversible.Beta-carotene was tested in these two systems and the following results were obtained: (i) Preincubation of bovine hoof fibroblasts in β-carotene protects from lethal haematoporphyrin photosensitization. (2) Protection with β-carotene is achieved against both types of photosensitization. (3) The protective effect of β-carotene depends upon the duration of pretreatment, reaching a maximum after 7 days. (4) β-carotene protection is maintained even after trypsinization of bovine hoof fibroblasts and withdrawal of β-carotene from the medium for 24 h or more. (5) Haematoporphyrin sensitized bovine hoof fibroblasts show a distinct pattern of red fluorescence for each type of photosensitization. Incubation of bovine hoof fibroblasts in β-carotene prior to haematoporphyrin photosensitization results in a pronounced reduction of red fluorescence. Some of these data indicate that β-carotene acts, at least in cell membrane photosensitization, at the level of the cell membrane into which it appears to be incorporated.

Notizen: A tan induced by 8-methoxypsoralen-long wave ultraviolet light has proved an effective photo- protective sunscreen in 5 patients with long wave ultraviolet light-induced polymorphic light eruption.

Notizen: Summary Background Skin ageing can be differentiated into intrinsic (chronological) ageing, and photoageing due to chronic sun exposure. Photoageing is the superimposition of photodamage on the ageing process. Objectives The aim of the study was to investigate possible differences between the skin of photochemotherapy (PUVA)-treated psoriasis patients and of untreated normal subjects using a high-frequency ultrasound system. Methods A total of 124 volunteers (aged 21–88 years, median 52 years, 62 female, 62 male), 62 psoriasis patients who had received PUVA therapy and 62 healthy controls, were investigated. Skin thickness and a subepidermal low-echogenic band (SLEB), a parameter for photodamage, were measured in 12 different areas. Results Female skin is thinner than male skin. The skin thickness values of PUVA patients were more markedly decreased than those of the controls for the older patients. There was a clear dependence of the occurrence of SLEB on PUVA therapy in psoriasis patients. Conclusions Long-term PUVA treatment in psoriasis patients accelerates thinning of the skin in comparison to age-matched controls. The results show that ultrasonography is a sensitive method to investigate the effects of PUVA-induced skin ageing.

Notizen: Summary  Background In a recent pilot study a novel, patented fatty acid-based 1% coal tar preparation (Exorex) has been found to be similar in efficacy to calcipotriol in the treatment of psoriasis. Objectives Our aim was to investigate the therapeutic efficacy, safety and cosmetic acceptability of the new 1% coal tar preparation in comparison with calcipotriol cream in a larger patient cohort. Patients and methods Forty patients with chronic plaque type psoriasis were included in this randomized, observer-blind, intrapatient comparison trial. In each patient two comparable target plaques were treated twice daily with 1% coal tar preparation or calcipotriol cream. At the onset of therapy and at weeks 2, 4, 6 and 8, the response to treatment was determined by the psoriasis severity index (PSI) that assesses the degree of erythema, infiltration and scaling of the psoriatic lesions on a five-point scale. In addition, all treatment-related side-effects were recorded and cosmetic acceptability of both treatments was rated every second week by the patients. After complete or near complete clearing the patients were followed up until relapse or for a maximum period of 18 months. Results Thirty-eight patients completed the study. At termination of the trial the mean ± SD baseline PSI score of 9·2 ± 1·5 was reduced to 3·0 ± 2·9 by 1% coal tar preparation and to 2·8 ± 2·7 by calcipotriol. The mean PSI reduction between baseline and final assessment did not differ significantly between 1% coal tar preparation and calcipotriol (P = 0·77). The mean intraindividual difference in reduction of PSI score between 1% coal tar preparation and calcipotriol was 0·1 score points (95% confidence interval − 0·84 to + 0·63). No difference between either preparation was observed with regard to time until relapse. Itching was caused by 1% coal tar preparation in four patients and by calcipotriol in one patient. Unpleasant odour or staining of the 1% coal tar preparation was reported by six patients, whereas one patient complained about the smell of the calcipotriol cream. Conclusions The novel 1% coal tar preparation was found to be comparably as effective as calcipotriol in treating psoriasis. Tolerability and cosmetic acceptability was better for calcipotriol. Taking into consideration that the coal tar preparation is considerably less expensive than calcipotriol this new product appears as a very useful topical medication for chronic plaque type psoriasis.

Notizen: Summary Background The thickness of the sunscreen layer that is actually applied by consumers under usual conditions has been determined for photoprotective lotions and creams; however, this question is still unanswered for photoprotective lipsticks. Objectives To assess lipstick thickness (area density) and frequency of application per day for two commercially available photoprotective lipsticks with different consistency. Methods The study consisted of a laboratory test and a field experiment. In the laboratory test the applied lipstick thickness was determined as area density in mg cm−2 for a group of 28 panellists under standardized conditions. In a separate group of 18 subjects we assessed the area density and the frequency of application per day for two photoprotective lipsticks during a 6-day skiing course. Results In the laboratory test the median and 95% confidence interval of the area density was 0·98 mg cm−2 (0·66–1·65) and 0·86 mg cm−2 (0·63–1·40) for products A and B, respectively. The respective values of the field experiment were 1·58 mg cm−2 (0·79–2·23) (product A) and 1·76 mg cm−2 (1·16–3·50) (product B). Only 11% of all applications of lipstick A and 6% of all applications of lipstick B reached the reference area density of 2·0 mg cm−2. The difference between the median of the area density for lipstick A (firm consistency) and lipstick B (soft consistency) was not statistically significant. No statistically significant influence on the area density was found for age, sex, photobiological skin type or regular lipstick use. The median daily frequency of application was 2·2 times for lipstick A and 3·0 times for lipstick B. Conclusions Our investigation shows that photoprotective lipsticks are applied in a much thinner layer than recommended by international standards (2 mg cm−2). This results in a significant reduction of the photoprotective capacity. Furthermore, the frequency of application is too low for adequate protection. Therefore, we propose that the sun protection factor (SPF) should be assessed for an area density that reflects the actual usage patterns. As long as the test protocol is not adapted to the reduced area density, photoprotective lipsticks with high and ultrahigh SPF should be recommended, especially for individuals with increased risk for the development of lip malignancies.

Notizen: Summary Background Numerous studies have shown that the additional administration of topical or systemic antipsoriatic agents might serve as an effective means to increase the efficacy of photochemotherapy [psoralen plus ultraviolet (UV) A (PUVA)] for psoriasis. Objectives To compare the therapeutic response to tacalcitol plus PUVA, tazarotene plus PUVA and PUVA monotherapy in patients with chronic plaque-type psoriasis. In addition, we also assessed the duration of remission induced by each regimen and the tolerability of the two combination treatments. Methods Thirty-one patients with chronic plaque-type psoriasis were included in this observer-blinded, intrapatient comparison trial. PUVA treatment was given four times weekly. Additionally, tacalcitol ointment and 0·1% tazarotene gel were applied separately on two target areas once daily in the evening. At the onset of therapy and every 2 weeks thereafter the response to treatment was determined by the Psoriasis Severity Index score, which assesses the degree of erythema, infiltration and scaling of the psoriatic lesions. After complete or near complete clearing patients were followed-up until relapse. Results Twenty-four patients completed the study. The treatment requirements to induce complete or near complete clearing were significantly lower for both combination treatments than for PUVA monotherapy (P 〈 0·01). The median cumulative UVA dose and number of exposures were 30·6 J cm−2 (95% confidence interval, CI 22·5–71·2) and 14 (95% CI 11–16) for tacalcitol plus PUVA, 32·3 J cm−2 (95% CI 22·5–73·8) and 14 (95% CI 11–19) for tazarotene plus PUVA, and 37·0 J cm−2 (95% CI 29·5–83·9) and 16 (95% CI 14–22) for PUVA monotherapy. No difference between the three regimens was observed with regard to duration of remission. Adverse reactions occurred more often with 0·1% tazarotene than with tacalcitol but were in general mild and completely reversible upon using a lower concentration of 0·05% tazarotene. Conclusions Tacalcitol ointment and tazarotene gel are both comparably effective in improving the therapeutic result of PUVA therapy in patients with chronic plaque-type psoriasis. Besides accelerating the treatment response, both agents, by virtue of their UVA dose-sparing effect, might also help to reduce possible long-term hazards of PUVA treatment.