Biomedical subjects
Publications and source records attributed to G Plewig.
27 patients with lichen planus mucosae or erosive lichen planus mucosae were treated with two vitamin A acid derivatives, 13-cis-retinoic acid or an aroumatic retinoid. 20 patients were definitively improved or healed. The treatment was especially effective in erosive lesions of the oral mucous membrane. Side-effects of this treatment are pointed out.
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The mode of action of "classical peeling agents" such as resorcinol, crystalline sulfur, and salicylic acid on the epidermis is almost unknown. There are only a few experimental data available. Therefore the effects of resorcinol, crystalline sulfur, and salicylic acid were studied. A 1% and 3% concentration of these chemicals in vaselinum flavum or Unguentum Cordes was applied to the ears and flanks of adult male guinea pigs up to 14 days. Prior to biopsies at various time intervals, 3H-thymidine was injected intradermally. Specimens were paraffin embedded and routinely processed for autoradiographical analysis. The following parameters were assessed: Labelling index (L.I. in %); number of labelled basal cells per unit length of basement membrane; papillomatosis-index; and acanthosis-factor (projection histoplanimetry). The data were statistically analysed. The peeling agents induced a concentration-dependent increase of the L.I., acanthosis, and papillomatosis. Crystalline sulfur caused the most pronounced effect, followed by resorcinol. In contrast salicylic acid caused only a minute acanthosis factor and a slight increase in labelling. The correlation coefficient r of epidermal thickness to the L.I. for all concentrations and peeling agents used reaches the high figure of 0.978 for the ear. The 1% and 3% salicylic acid has a lower acanthosis factor than vaselinum flavum by itself. Preliminary autoradiographical studies in humans with 1% and 10% salicylic acid confirm these data. Salicylic acid counteracts acanthosis. These experiments show that crystalline sulfur and resorcinol have a potent effect on cell proliferation and acanthosis. They peel via proliferation hyperkeratosis. The mode of peeling by salicylic acid must be different, as cell proliferation and acanthosis are barely enhanced. The clinically known "keratolytic" effect of salicylic acid may be due to a direct action on the intercellular cement substance of the horny cells.
8-Methoxypsoralen (8-MOP) and long-wave ultra-violet light (UVA) were administered to 16 patients with mycosis fungoides and to three with other cutaneous lymphomas. Total body clearing was achieved in eleven patients, while temporary recurrences were observed in three, maintenance treatment arresting the recurrences. In the others all treatment failed. Histological and enzyme-cytochemical studies indicate that the histological features under 8-MOP-UVA treatment correspond to those induced by other forms of treatment: a lose enzyme-cytochemically negative lymphocytoid infiltrate remaining around blood vessels, after regression of the skin disease. Oral 8-MOV-UVA treatment (12 patients) proved superior to topical treatment (seven patients), because cutaneous lymphoma is a systemic disease. In mycosis fungoides the mean number of exposures causing clearance of skin lesions and the mean UVA dose (single treatment) were generally less than those for psoriasis vulgaris.
The Syrian hamster ear model was used to study effects of the anti-androgen cyproterone acetate and of the anti-lipogenic compound 17beta-carboxylic acid methyl ester and its ethyl ester. The steroid derivatives were applied topically in a 1-2% concentration or given systemically. Response of sebaceous gland was measured by means of cell proliferation (3H-TdR autoradiography) and by gland size (histoplanimetry). Cyproterone acetate significantly reduced the labelling and the planimetric value, both topically and systemically. The carboxylic acid derivatives, which block the 5alpha-reductase were ineffective. The new animal model is a sensitive and suitable means to study inhibition of sebum production.
Fifty-two biopsies from involved and clinically normal looking skin of patients with psoriasis vulgaris and from normal control subjects, all being treated with 8-MOP-UVA (PUVA) were obtained between days 2 and 300. The following parameters were investigated: 1. initial PUVA effects; 2. initial regression of psoriasis under PUVA-therapy; 3. late effects of PUVA-therapy on regression of psoriatic lesions; 4. EFFects on melanocytes and pigmentation; and 5. long-term effects of PUVA-therapy. Paraffin embedded and cryostat sections were prepared with routine stains for light microscopy and enzyme histochemical special stains. The regression of psoriatic lesions following PUVA-therapy was separately assessed for epidermal and dermal components. The sequence of events was as follows: re-establishment of a continous stratum granulosum, re-establishment of a continuous normal appearing stratum corneum, regression of acanthosis and papillomatosis, and regression of inflammatory infiltration. During the initial phase of PUVA-therapy there is a sharp increase of melanocytes which leads to a foamy appearance of the basal cell area. Long term studies did not reveal actinic damage of the skin, neither in the epidermis (absence of actinic keratoses or squamous cell carcinomas) nor in the dermis (absence of actinic "solar" elastosis).
The ventral side of the earlobes of Syrian hamsters richly endowed with sebaceous glands. These glands are large and are similar to human sebaceous follicles since they have an infundibulum, a sebaceous duct, multiple lobules, and a pilary unit which enters from below into the gland. In this study we have measured gland size by planimetry,and cellular activity by autoradiography using tritiated thymidine and tritated histidine. Males have much larger glands in sagittal sections than do females(0.1750 mm2 vs 0.0727 mm2, p less than 0.001) and a higher labeling index (19.85% vs 14.3%, p less than 0.01). Injection of testosterone propionate increases the gland size in female hamsters to 0.2362 mm2 (p less than 0.001). The labeling index also increases. The turnover of the total gland population is 12 to 14 days. Androgen sensitivity, gland size, and turnover time make the sebaceous glands on the ventral surface of the hamster earlobe a suitable model for study.
This study was designed to investigate the effects of increased or decreased epidermal turnover on the morphology of human corneocytes. The desquamating portion of the stratum corneum was sampled with the detergent scrub technique using Triton X-100. The following parameters were measured: size (surface micron2), shape (regular, irregular), nuclear inclusions, trabeculae, and numerical counts. Specimens were obtained from adult males with allergic contact dermatitis (N=18); with tretinoin-induced dermatitis (N=11); after cellophane stripping (N=11); and after treatment of these conditions with topical steroids (N=40). Data from 250,000 cells were analyzed statistically. The reproducibility of the method is good (r=0.934). Corneocytes from skin of patients with allergic contact dermatitis differed from those of normal skin: they were 15% smaller and of irregular shape with asymmetrical trabeculae; 50% were nucleated and about 3 times as many cells were collected per cm2 skin surface. Tretinoin and stripping produced similar but more pronounced effects. Topical steroids significantly improved all parameters (p less 0.01). Betamethasone-17-dipropionate was more effective than the valerate. This bioassay permits sensitive measurements of corneocyte morphology in conditions with altered epidermal cellular kinetics. It provides a method to evaluate steroid effectiveness.
In nine of 121 patients unusual side effects of PUVA-therapy were observed: hypertrichosis, subungual hemorrhage of fingernails, nevus spilus-like hyperpigmentation, acneiform eruptions, and a photoallergic dermatitis to 8-methoxypsoralen.
The case is reported of a man with uniformly silver-blue discolouration of all fingernails, with deeper colouring over the lunulae. The nail bed changes resulted from the uncontrolled ingestion of a silver-containing granular powder. The total silver intake was over 15 g. The only other sign of argyrosis was a barely perceptible greyish discolouration over the cheeks and in the sclerae. Biopsies were taken from the nail bed and the cheek. Electron microscopy revealed metallic deposits in elastic fibres and basement membranes. The silver deposition was much heavier in the nail bed than in facial skin. Long-wave ultraviolet light (UVA) and lack of melanin protection seem to be responsible for this phenomenon. Argyrosis and the differential diagnosis of nail discolourations are reviewed.
Sebaceous filaments are cylindrical tubes of whitish-yellowish color, which can be expressed from areas of the face rich in sebaceous follicles by pinching the skin or by the cyanoacrylat-technique. Sebaceous filaments are most commonly found in the centrofacial areas and the alae nasae in postpuberal individuals with large facial pores and seborrhea. Sebaceous filaments are composed of a skeleton of 10-30 horny cell layers which enclose a mixture of bacteria, sebaceous lipid, corneocyte fragments and one hair. Following the expression of the filament the follicle refills within 30 days. The various portions of sebaceous follicles (acro- and infrainfundibulum) and the follicular contents are presented at the light microscopial and ultrastructural level. Follicles containing sebaceous filaments have a conspicuous granular layer and no acanthosis. Sebaceous filaments should be differentiated from a microcomedo and trichostasis spinolosa. They are a common morphological variant of sebaceous follicles.
Seventy patients with various forms of psoriasis were treated topically and orally with 8-MOP and UVA in high or low intensity treatment units. Most of the patients were treated with the oral route. Treatment modalities, age distribution, and medical history of psoriasis are compiled. The present investigations are based upon experiences with three treatment units, a horizontal box, a stand-up box, and a hand-foot-box. The mean exposure time and the mean duration of treatment are compared. Advantage and disadvantage of oral vz. topical 8-MOP-UVA-therapy are discussed. The typical treatment-schedule with determination of minimal phototoxic dose, initial treatment and maintenance irradiation are described. Side-effects are reported. A careful selection of patients for PUVA-therapy is stressed. Possible long-term side-effects are considered.
Three young male patients with chewing pads are reported. Their tic-like habit of chewing on the dorsal aspects over the middle joints of fingers I-IV caused a pad-like thickening of soft tissue. These chewing pads are a variant of "false" knuckle pads. The importance of a medical history and dermatological inspection is stressed to avoid unnecessary diagnostic procedures. This harmless augmentation of soft tissue is commonly confused with rheumatoid disease of the fingers, sarcoidosis or pachydermoperiostosis. Patients should be informed of the true nature of their pads, as discontinuation of their chewing habit will resolve their problems.
The resident flora of skin surface, sebaceous follicles, and acne comedones: Pityrosporum, micrococci, and corynebacterium (propionibacterium) acnes is described. The nomenclature, topography, incidence, pathogenic role, and especially the ultrastructural morphology of these organisms are presented.
Photochemotherapy with 8-MOP und UV-A is a modality to treat psoriasis vulgaris successfully. Technical experiences with three types of machines, a horizontal box with Sylvania fluorescent lamps, a stand-up box, and a hand-foot-box with Osram fluorescent lamps are reported. Oral and topical 8-MOP applications are compared for these three types of boxes. Disadvantages of the oral or topical 8-MOP applications are compiled. Oral 8-MOP is superior to the topical treatment in both the stand-up and the horizontal box. The following technical features are discussed: Minimal phototoxic dose, photopigmentation index, radiation-dose, time increments during treatment, maintenance therapy, and UV-A meters.
The clinical and histopathological picture of the pigmented epidermal cyst and the pigmented trichilemmcyst is illustrated by three case-reports. The pigment is melanin, which is located in the epithelium of the cyst-wall, the corneocytes of the lumen and in macrophages in the dermis. The clinical appearance of melanin pigmented cysts is blue due to the Tyndall-phenomenon.
Econazole-nitrate is a new potent antifungal drug with a broad spectrum against dermatophytes, yeasts and moulds; in addition it is effective against gram-positive bacteria. Econazole nitrate was tested in-vitro for antifungal and anti-microbial properties. In an open trial 75 patients were treated with a 1 percent econazole cream. Cure was achieved in tinea pedis in 91 percent; in tinea genitocruralis in 100 percent and in tinea corporis in 92 percent. The remainder were greatly improved. 22 patients with erythrasma were cured within 3 weeks.