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Biomedical subjects

Dieter Metze

Publications and source records attributed to Dieter Metze.

36 records · Page 2Linked to original sources
PubMed2004

[Papuloerythroderma of Ofuji with urticarial lesions].

Papuloerythroderma of Ofuji is a rare disease that mainly affects older men of Asiatic origin. Clinically, it is marked by highly pruritic papules which form larger plaques or may give rise to erythroderma. Larger body folds of the abdomen are typically spared (deckchair sign). There is a dispute whether papuloerythroderma of Ofuji represents an own entity or should be regarded as a variant of other inflammatory, neoplastic, or paraneoplastic dermatoses. We present a case of papuloerythroderma of Ofuji in a European patient in which the clinical course as well as the laboratory and histology suggested a relation to mycosis fungoides. Our patient developed pruritic urticarial plaques when systemic corticosteroids were tapered, but cleared complete with cyclosporin A.

Adrenal Cortex Hormones↗
PubMed2004

[Miliaria and follicular atrophodermia as an early sign of Bazex-Dupré-Christol syndrome].

The Bazex-Dupré-Christol syndrome (BDC syndrome) is a rare X-chromosomal dominantly inherited genodermatosis. Major symptoms are (1) follicular atrophoderma, (2) congenital hypotrichosis, and (3) multiple basal cell carcinomas, the latter appearing in the second or third decade. More variably associated findings are milia, hypohidrosis, disorders of cornification, hyperflexibility of joints, and skeletal abnormalities. A 2.5-year-old Turkish girl presented with early signs of BDC syndrome in the form of milia, follicular atrophoderma on the face and hands, and hypotrichosis. Accurate diagnosis of this genodermatosis is necessary to prevent the development of basal cell carcinomas by sun protection and regular dermatological inspection.

Atrophy↗
PubMed2003

Neurophysiology of pruritus: cutaneous elicitation of itch.

Itching is defined as an unpleasant cutaneous sensation leading to the desire to scratch. It serves as a physiological self-protective mechanism as do other cutaneous sensations like pain, touch, vibration, cold, and heat to help defend the skin against harmful external agents. Pruritus can be evoked in the skin directly by mechanical and thermal stimuli or indirectly through chemical mediators. It may also be generated in the central nervous system independently of peripheral stimulation. Single-nerve-fiber recordings have shown that histamine-evoked itch is transmitted by selective slow-conducting subpopulations of unmyelinated C-polymodal neurons. Recent experimental studies using improved methods have demonstrated which of the suspected chemical itch mediators such as histamine, neuropeptides, prostaglandins, serotonin, acetylcholine, or bradykinin act pruritogenically on C-fibers. Moreover, investigations have revealed new receptor systems such as vanilloid, opioid, and cannabinoid receptors on cutaneous sensory nerve fibers that may modulate itch and thereby represent targets for antipruritic therapy. This review focuses on the peripheral generation of itch, including neurotransmitters, neuropeptides, and inflammatory mediators.

Humans↗
PubMed2003

Fibroblastic/myofibroblastic sarcoma of the skin: a report of five cases.

BACKGROUND: A number of malignant soft tissue tumors, particularly those of fibroblastic and fibrohistiocytic derivation, have been found to display myofibroblastic differentiation focally. The term myofibroblastic sarcoma, a controversial presumably distinctive entity, defines a malignant soft tissue tumor in which myofibroblasts are quantitatively the predominant cell type. METHODS: Five cases of cutaneous spindle-cell sarcomas showing fibroblastic-myofibroblastic differentiation with predominance of fibroblasts were retrieved from the files of three large centers of dermatopathology. Tumors were analyzed histopathologically, immunophenotypically, and, in two cases, ultrastructurally. Results were compared with those previously reported in fibrosarcoma, malignant fibrous histiocytoma, and myofibroblastic sarcoma. RESULTS: Immunophenotypic and ultrastructural profiles of the cases analyzed in this series were closer to fibrosarcoma and to malignant fibrous histiocytoma than to myofibroblastic sarcoma by virtue of quantitative predominance of fibroblasts over myofibroblasts. On the other hand, histopathologic findings were in keeping with those reported in myofibroblastic sarcoma. CONCLUSIONS: Our series highlights the intrinsic problems in attaching certain cutaneous sarcomas with fibroblastic-myofibroblastic differentiation to one of the recognized entities and gives support to the hypothesis that fibrosarcoma, malignant fibrous histiocytoma, and myofibroblastic sarcoma are related histogenetically.

Aged↗
PubMed2003

[Pruritus--pathophysiology, clinical features and therapy--an overview].

Pruritus is an unpleasant sensory perception of the skin associated with the desire to scratch. As a physiological nociception, pruritus leads to the removal of harmful agents such as parasites and plants from the skin surface. More often, pruritus occurs as a severe and therapy-refractory symptom of various underlying dermatological and systemic diseases. Comparable to chronic pain, chronic pruritus worsens the general condition and may lead to physical and psychological exhaustion. Until the 1990s, pruritus had been regarded as an incomplete pain sensation. Only recently, itch was defined as a separate, pain-independent sensation with its own mediators, spinal neurons and cortical areas. These observations led to the development of new therapeutic modalities. This paper gives an overview of itch pathophysiology, clinical types and therapies.

Humans↗
PubMed2003

Proinflammatory role of proteinase-activated receptor-2 in humans and mice during cutaneous inflammation in vivo.

Proteinase-activated receptor-2 belongs to a new subfamily of G-protein-coupled receptors. Its precise role during inflammation and the underlying mechanisms is still unclear. Our study establishes that PAR-2 plays a direct proinflammatory role during cutaneous inflammation in mice and humans in vivo. In a model of experimentally induced allergic (ACD) and toxic (ICD) contact dermatitis (CD) we show that ear swelling responses, plasma extravasation, and leucocyte adherence were significantly attenuated in PAR-2 null mutant (PAR-2-/-) mice compared with wild-type (PAR-2+/+) mice, especially at early stages. The proinflammatory effects by PAR-2 activation were significantly diminished using nitric oxide-synthase inhibitors, while NF-kappaB and neuropeptides appear to play a minor role in these mechanisms. PAR-2-mediated up-regulation of E-selectin and cell adhesion molecule ICAM-1; enhanced plasma extravasation was observed in humans and mice and of interleukin-6 in mice in vivo. Thus, PAR-2 may be a beneficial therapeutic target for the treatment of inflammatory skin diseases.

Adolescent↗
PubMed2003

Topical tacrolimus as a therapeutic adjunct in patients with cutaneous lupus erythematosus. A report of three cases.

The topical therapy of cutaneous lupus erythematosus (LE) consists mainly of corticosteroids which may lead to significant side effects when overused. We report the efficacy of topical tacrolimus as a therapeutic adjunct in 3 patients with cutaneous LE of the face. All patients, 1 with systemic LE and a malar rash, 1 with annular subacute cutaneous LE, the other with a papular variant of subacute cutaneous LE, experienced significant improvement following application of tacrolimus ointment. Treatment with topical tacrolimus was tolerated well without major side effects in all patients. The presented cases are in line with recent reports that topical tacrolimus may be effective in facial LE.

Administration, Cutaneous↗
PubMed2003

[Interstitial granulomatous dermatitis without arthritis: successful therapy with hydroxychloroquine].

Interstitial granulomatous dermatitis is a rare entity characterized by cutaneous linear strands (the "rope sign") and rheumatoid arthritis. In the past years, 12 other cases have been described with variable cutaneous symptoms. All showed similar histological features, resembling those of granuloma annulare or 'palisaded neutrophilic and granulomatous dermatitis', suggesting a wide spectrum for a single entity. A 60-year-old patient presented with erythematous patches with an indurated, violaceous border resembling the "rope sign" on both flanks. The histological investigation revealed dense diffuse interstitial inflammatory infiltrates composed of eosinophils, neutrophils, lymphocytes, macrophages and multinucleated giant cells in the superficial and deep dermis. In the deep dermis, prominent eosinophilic degenerated collagen fibres with surrounding macrophages ('floating sign') occurred. In contrast to most previously described patients, our patient did not have arthralgias. The skin findings cleared following therapy with hydroxychloroquine.

Arthritis↗
PubMed2003

[Graft-versus-host-like flexural eruption after autologous stem cell transplantation].

A 29-year-old man received an autologous stem cell transplantation after myeloablation with busulfan and cyclophosphamide to treat his acute myeloid leukemia, a. Five days after retransfusion of stem cells, hyperpigmented, scaly lesions with occasional perpheral lichenoid papules developed in groins, axillae, genitalia, and elbows. Histology revealed a graft-versus-host-like reaction. Although the graft-versus-host reaction, by definition, requires allogeneic cells, similar lesions have been reported after autologous stem cell transplantation. The clinical course is usually mild and self-limited. Flexural graft-versus-host-like reactions after autologous stem cell transplantation have been reported in four patients.

Adult↗
PubMed2002

Localization of mu-opioid receptor 1A on sensory nerve fibers in human skin.

Opioid peptides are endogenous neuromodulators that play a major role in the nociceptive pathway by interacting with opioid receptors. So far, four opioid receptors (micro-, delta-, kappa-, orphan-receptor) have been cloned with a wide distribution in the central and peripheral nervous system. In the present study, we give first evidence for the presence of the micro-opioid receptor (MOR) isoform 1A in nerve fibers of human skin. Immunohistochemical analysis revealed MOR immunoreactivity to be present in dermal and epidermal nerve fibers. Double-immunofluorescence staining revealed that MOR is present on calcitonin gene-related protein (CGRP)-positive sensory nerve fibers, while autonomic nerves of blood vessels, hair follicles, or skin glands were negative. In diseased skin such as psoriasis vulgaris, atopic dermatitis, and prurigo nodularis, distribution of MOR 1A immunoreactivity was similar to that of normal skin. These findings expand our knowledge about a direct regulatory role of cutaneous opioid receptors in the skin. Thus, peripheral cutaneous opioid receptors may be involved in the transmission of pain and pruritus, respectively. This is supported by previous observation that opioid receptor antagonists may significantly diminish experimentally evoked histamine-induced itch of the skin. Together, our findings contribute to the understanding of the high antipruritic potency of opioid receptor antagonists in various skin and systemic diseases.

Adolescent↗
PubMed2002

Expression of melanocortin-1 receptor in normal, malformed and neoplastic skin glands and hair follicles.

Melanocortin receptors (MC-Rs) are G-protein coupled receptors that mediate pleiotropic actions of melanocyte-stimulating hormones and adrenocorticotropin. There is increasing evidence that one of the five so far identified melanocortin receptors, i.e. melanocortin-1 receptor (MC-1R), has a more ubiquitous distribution in the skin than originally expected. In the present study, the expression of MC-1R in normal skin glands and hair follicles, various malformations and neoplasms with adnexal differentiation is described. Using an anti-MC-1R antibody directed against the amino acids 2-18 of the human MC-1R, specimens of normal healthy skin (n = 10) as well as hamartomas, cysts, hyperplasias, and benign or malignant neoplasms with eccrine, apocrine, sebaceous gland, and hair follicle differentiation (n = 98) were immunostained. MC-1R expression was widely preserved in various adnexal malformations and neoplasms as compared with normal skin and did not show major differences with regard to maturation of the neoplasms. The majority of adnexal epithelia showed an intracytoplasmically granular staining and, to a lesser extent, an intercellular staining pattern. Immunoelectron microscopical investigations revealed expression of MC-1R both along the cell surface and intracytoplasmically within tubular endosomes, the latter suggesting internalisation of the receptor. In conclusion, preserved MC-1R expression in adnexal epithelia suggests a functional role of proopiomelanocortin (POMC) in various malformations and neoplasms of the skin.

Apocrine Glands↗
PubMed2002

Evidence for expression of melanocortin-1 receptor in human sebocytes in vitro and in situ.

Many lines of evidence indicate that the activity of sebaceous glands can be modulated by neuropeptides. Direct evidence in man, however, is still missing. We show that SZ95 sebocytes, an immortalized human sebaceous gland cell line, express receptors for alpha-melanocyte-stimulating hormone. Reverse transcription polymerase chain reaction with primers against the five melanocortin receptors and immunofluorescence studies using an antibody directed against a peptide corresponding to the amino acids 2-18 of the human melanocortin-1 receptor disclosed specific transcripts and immunoreactivity for melanocortin-1 receptor in these cells. Melanocortin-1 receptor expression was confirmed in sebocytes of normal human skin by immunohistochemistry. In contrast, no immunostaining for the melanocortin-5 receptor could be detected in sebocytes in situ, in accordance with the lack of specific transcripts for this melanocortin receptor in SZ95 sebocytes. As cytokines play an important role in the recruitment of inflammatory cells in acne and related disorders and alpha-melanocyte-stimulating hormone exerts immunomodulatory effects in many other cell types, we investigated the effect of alpha-melanocyte-stimulating hormone on interleukin-8 secretion by SZ95 sebocytes. Treatment with interleukin-1beta resulted in a marked increase in interleukin-8 release that was partially blocked by coincubation with alpha-melanocyte-stimulating hormone in a dose-dependent manner. Taken together, we show here that the melanocortin-1 receptor is expressed in vitro and in situ in human sebocytes. By modulating interleukin-8 secretion, alpha-melanocyte-stimulating hormone may act as a modulator of inflammatory responses in the pilosebaceous unit.

Cell Membrane↗
PubMed2002

Expression of endomucin, a novel endothelial sialomucin, in normal and diseased human skin.

Endomucin is an endothelial sialomucin that was recently identified with the help of monoclonal antibodies raised against mouse endothelial cells. Cloning of human endomucin allowed us to generate monoclonal antibodies against soluble recombinant forms of human endomucin. In this study, we investigated the expression of this novel molecule in human skin under different conditions, using the monoclonal antibodies. In normal human skin, endomucin was detected for the monoclonal antibody L6H10 by immunoblotting, and immunohistologic analysis of wax-embedded sections revealed that this glycoprotein is expressed on capillaries, venules, and lymphatic vessels. Interestingly, staining of arterial endothelium was either weak or focal using the monoclonal antibodies against endomucin. In situ hybridization of normal human skin confirmed the expression pattern on the messenger RNA level obtained above. We further analyzed the expression of endomucin in skin biopsy specimens from patients with inflammatory skin diseases, such as atopic dermatitis, psoriasis, lichen planus, cutaneous lupus erythematosus, and T cell lymphoma as well as with vascular skin tumors, such as hemangioma, pyogenic granuloma, angiolipoma, Kaposi's sarcoma, and angiosarcoma. We found endomucin expressed on the endothelium of each tissue, concluding that this novel molecule is a new endothelial-specific marker in the study of normal and diseased human skin.

Antibodies, Monoclonal↗
PubMed2002

Cutaneous hyperpigmentation induced by doxycycline: histochemical and ultrastructural examination, laser microprobe mass analysis, and cathodoluminescence.

Skin hyperpigmentation induced by minocycline is a well-recognized side effect of minocycline but has rarely been reported for other tetracyclines. Based on a previously reported unusual case of chronic doxycycline abuse in a psychotic patient, we have investigated the nature of the observed pigment changes in the same patient. Histopathologic investigation of lesional skin by light microscopy disclosed hyperpigmentation of the basal keratinocytes and pigment-laden histiocytes in the dermis and subcutaneous fat. Only the pigment in the histiocytes of the upper dermis was reactive for Fontana Masson stain and could be bleached by hydrogen peroxide. The other histiocytes contained iron and calcium deposits as shown by von Kossa and Perls staining as well as by laser microprobe mass analysis. Ultrastructurally, these histiocytes contained amorphous material within the cytoplasm and stored in lysosomal structures. Comparative cathodoluminescence disclosed the presence of doxycycline in affected skin by means of overlapping emission spectra between the patient's skin and pure doxycycline. Taken together, the histomorphologic and ultrastructural changes induced by doxycycline shared several features with cutaneous hyperpigmentation caused by minocycline. Our biophysical findings further suggest a direct deposition of doxycycline, probably chelated with iron and/or calcium, within the lesional skin. Based on the presented unique case and the reviewed literature, only suprapharmacologic doses of doxycycline may be sufficient to cause such pigment changes.

Adult↗
PubMedDate not supplied

Dystrophic epidermolysis bullosa inversa with COL7A1 mutations and absence of GDA-J/F3 protein.

Epidermolysis bullosa dystrophica inversa (DEB-I) is a very rare disease characterized by autosomal recessive inheritance that causes blistering and erosions on the trunk and extremities occurring in early infancy with a predilection for flexural and mucosal areas thereafter. Ultrastructural findings show dermolytic blistering and absent or rudimentary anchoring fibrils as in generalized forms of dystrophic epidermolysis bullosa. Immunoreactivity for type VII collagen, however, is preserved. We present two patients with DEB-I with compound heterozygosity for the two different COL7A1 mutations, one of them (Arg2069Cys in exon 74) carried by the heterozygous mother, the other one (Lys142Arg in exon 3) carried by the heterozygous father, accompanied by absence of the associated anchoring fibrils protein GDA-J/F3.

Adolescent↗
PubMedDate not supplied

Disseminated hyperkeratotic and granulomatous nodules in a child with fatal Epstein-Barr-virus-associated hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis is a rare and potentially fatal syndrome associated with a variety of genetic, malignant, autoimmune, or infectious conditions. The importance of cutaneous presentations of this syndrome has only recently been brought forward. We report the first case of Epstein-Barr-virus-associated hemophagocytic lymphohistiocytosis presenting with papulonodular and granulomatous skin lesions. A girl of African origin developed several umbilicated papules on her extremities and face at the age of 18 months. She was born in Germany, had never visited Africa, and was otherwise healthy. Over the next 5 months the lesions progressed in size and number and became hyperkeratotic. Histopathologic analysis of early lesions revealed a superficial lympho- and plasmacellular dermatitis with some features of panniculitis. Later biopsy specimens from nodular lesions showed the formation of tuberculoid granulomas in the deep dermis. At the age of 23 months she became severely ill, rapidly developing high fever, hepatosplenomegaly, icterus, pancytopenia, and ascites. On the basis of bone marrow and lymph node biopsies, the diagnosis of hemophagocytic lymphohistiocytosis was established. However, this phenomenon could not be detected in any of the skin specimens. An active Epstein-Barr virus infection was diagnosed by polymerase chain reaction in blood, lymphoid tissue, and skin. Despite chemotherapy with etoposide and cortisone, the girl expired 14 days after clinical onset of her systemic disease.

Biopsy, Needle↗