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Biomedical subjects

G Plewig

Publications and source records attributed to G Plewig.

At least 145 records · Page 8Linked to original sources
PubMed1994

Treatment of severe atopic dermatitis with extracorporeal photopheresis.

Extracorporeal photopheresis using UVA irradiation of enriched lymphocytes in the presence of 8-methoxypsoralen (8-MOP) as a photoactivatable substrate has been employed for the treatment of several immunologically mediated disorders. We report on the first three patients subjected to extracorporeal photopheresis for severe atopic dermatitis. All patients had a lifelong history of atopic skin inflammation, and their disease had finally become resistant to well-established therapeutic regimes. Extracorporeal photopheresis resulted in a marked clinical improvement in the skin lesions of all patients. The decrease in cutaneous inflammatory activity became evident by the end of the second photopheresis cycle. In two patients skin lesions had virtually disappeared after the fifth treatment cycle, while in the third patient a lasting and substantial improvement in pruritus and erythema was achieved. Clinical remission was stable under maintenance therapy with prolonged intervals between photopheresis sessions. Therapeutic efficacy was reflected by a marked reduction in IgE serum levels in all three patients, while serum concentration of IgG, IgM and IgA as well as the profile of circulating lymphocytes remained essentially unchanged. No clinical signs of immunosuppression or other severe adverse events became evident. Collectively, our preliminary results indicate that extracorporeal photopheresis may interfere with the pathomechanisms leading to atopic dermatitis and therefore should be considered as a treatment modality for severe forms of this recalcitrant disorder.

Adult↗
PubMed1994

[Atrophodermia linearis Moulin. A new disease picture, following the Blaschko lines].

Many different congenital and acquired skin diseases are seen along Blaschko's lines. In 1992, Moulin et al. [40] described five patients affected with a new clinical entity characterized by acquired atrophic band-like skin lesions showing hyperpigmentation. We report on a further patient with this skin disease. Characteristic features are hyperpigmented atrophoderma arranged in a pattern following the lines of Blaschko, with no preceding inflammation and no subsequent induration or scleroderma. The lesions usually appear during childhood or adolescence, but sometimes in young adults. For this skin disease we propose the term 'linear atrophoderma of Moulin'.

Adult↗
PubMed1994

[PUVA bath therapy. Indications and practical implementation].

Systemic PUVA photochemotherapy is widely used for a variety of skin diseases. Administration of 8-methoxypsoralen in a dilute bathwater solution may be an effective alternative therapy with no systemic side-effects and requiring smaller amounts of UVA to induce the required phototoxic response. PUVA baths of the palms and soles are an interesting alternative for dermatoses confined to these sites. This article reviews the authors' experience with PUVA bath therapy. Indications for and applications of this technique are discussed.

Baths↗
PubMed1994

[Extracorporeal photopheresis].

Extracorporeal photopheresis is a new therapeutic approach developed by Edelson et al.; it is conceptually designed for the management of diseases mediated by malignant lymphocyte pathology, such as cutaneous T-cell-lymphoma (CTCL), and other disorders mediated by aberrant lymphocyte function, e.g. autoimmune diseases. The treatment is described in this paper, and theories on the mechanisms of action are discussed. In addition, the indications for treatment with extracorporeal photopheresis are discussed.

Animals↗
PubMed1994

Chronic cutaneous damage after accidental exposure to ionizing radiation: the Chernobyl experience.

BACKGROUND: The hazards of acute radiation exposure are well known. Bone marrow failure from total body gamma or neutron irradiation is the most clinically relevant aspect of acute radiation disease. With nonhomogeneous exposure, as is characteristic in accidents, other organ systems, such as the skin, may be more important in determining clinical prognosis. This became obvious in the two worst radiation accidents since 1945, the Chernobyl accident in April 1986 and the Goiania accident in September 1987. OBJECTIVE: Our purpose was to describe the characteristic chronic sequelae of accidental cutaneous radiation in a group of patients who survived the Chernobyl nuclear power plant accident. METHODS: Fifteen patients with the delayed type of the cutaneous radiation syndrome were examined between September 1991 and January 1992. All patients had a history of acute radiation disease. The exposure pattern was characterized by partial body exposure with high doses of beta and gamma irradiation from radioactive water, steam, or dust. RESULTS: Radiation-induced lesions were confined primarily to the legs and distal arms, but sometimes involved up to 50% of the total body surface. In addition to telangiectases, radiation keratoses, and radiation ulcers, hemangiomas, hematolymphangiomas, splinter hemorrhages in the distal nail bed, lentiginous hyperpigmentation, and severe subcutaneous fibrosis were noted. No malignant transformation could be detected. Associated diseases included cataracts, chronic hepatitis, and recalcitrant bacterial and herpesvirus infections. CONCLUSION: After accidental partial body exposure to high doses of beta and gamma irradiation, the predominant involvement of the skin, described as the cutaneous radiation syndrome, can become the characteristic feature. This causes longlasting, serious diagnostic and therapeutic problems.

Accidents↗
PubMed1994

The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions.

BACKGROUND: The difficulties in accurately assessing pigmented skin lesions are ever present in practice. The recently described ABCD rule of dermatoscopy (skin surface microscopy at x10 magnification), based on the criteria asymmetry (A), border (B), color (C), and differential structure (D), improved diagnostic accuracy when applied retrospectively to clinical slides. OBJECTIVE: A study was designed to evaluate the prospective value of the ABCD rule of dermatoscopy in melanocytic lesions. METHODS: In 172 melanocytic pigmented skin lesions, the criteria of the ABCD rule of dermatoscopy were analyzed with a semiquantitative scoring system before excision. RESULTS: According to the retrospectively determined threshold, tumors with a score higher than 5.45 (64/69 melanomas [92.8%]) were classified as malignant, whereas lesions with a lower score were considered as benign (93/103 melanocytic nevi [90.3%]). Negative predictive value for melanoma (True-Negative divided by [True-Negative+False-Negative]) was 95.8%, whereas positive predictive value (True-Positive divided by [True-Positive+False-Positive]) was 85.3%. Diagnostic accuracy for melanoma (True-Positive divided by [True-Positive+False-Positive+False-Negative]) was 80.0%, compared with 64.4% by the naked eye. Melanoma showed a mean final dermatoscopy score of 6.79 (SD, +/- 0.92), significantly differing from melanocytic nevi (mean score, 4.27 +/- 0.99; p < 0.01, U test). CONCLUSION: The ABCD rule can be easily learned and rapidly calculated, and has proven to be reliable. It should be routinely applied to all equivocal pigmented skin lesions to reach a more objective and reproducible diagnosis and to obtain this assessment preoperatively.

Dermatology↗
PubMed1994

Ultraviolet-A radiation induces adhesion molecule expression on human dermal microvascular endothelial cells.

Ultraviolet radiation is capable of inducing numerous skin reactions. Considerable amounts of UVA radiation penetrate the epidermis and reach the microvascular endothelium of the papillary dermis. In order to investigate putative direct effects of UV radiation on endothelial cells, we studied adhesion molecule expression by immunostaining procedures and FACS analysis, following irradiation of normal human skin and cultured human dermal endothelial cells. Enhanced immunostaining for ICAM-1 and E-selectin was detected in biopsies taken after in vivo UVA and UVB irradiation, compared with non-irradiated control skin. On cultured human dermal endothelial cells, however, ICAM-1 and E-selectin were inducible by UVA but not UVB. The induction was dose-dependent, peaking at 20 J/cm2 for both adhesion molecules, and time-dependent, peaking after 6 and 24 h for E-selectin and ICAM-1, respectively. Expression of VCAM-1 and PECAM/EndoCAM/CD31 was unaffected by any UV-radiation modality. The functional integrity of irradiated cells was monitored by an exclusion assay of the fluorescent dye 7-AAD, and by staining for the cytoskeletal proteins actin and vimentin. Our results demonstrate that dermal microvascular endothelial cells are a critical and direct target of UVA, and suggest they may play a pivotal role in UV-induced inflammatory skin conditions.

Cell Adhesion↗
PubMed1994

Papular elastorrhexis: a variant of dermatofibrosis lenticularis disseminata (Buschke-Ollendorff syndrome)?

BACKGROUND: Buschke-Ollendorff syndrome is an autosomal dominant disorder clinically characterized by the appearance of disseminated white papules and osteopoikilosis. Histologically most cases show normal collagen and increased elastic tissue. Abortive forms of Buschke-Ollendorff syndrome are described, which show characteristic skin involvement, absence of skeletal changes and decreased elastic tissue. Papular elastorrhexis is characterized by nonfollicular, white papules, decreased elastic tissue, no genetic inheritance and no osteopoikilosis. OBJECTIVE: Is papular elastorrhexis a new entity or an abortive form of Buschke-Ollendorff syndrome? METHODS: We examined three members of one family (brother, sister and mother) presenting with nonfollicular, distributed, white papules on the trunk and extremities. Skin biopsies were examined by histological and electron-microscopic methods. RESULTS: The histological and electron-microscopic examinations of skin biopsies showed decreased, fragmented elastic fibers and normal collagen. By X-ray examination, no osteopoikilosis was found. The family presented here supports a genetic background of the disease. CONCLUSION: The clinical appearance with the absence of osteopoikilosis and the histological findings of our cases suggest the diagnosis of papular elastorrhexis. Papular elastorrhexis however was reported to be nonfamilial. Because of the genetic background found here we believe that papular elastorrhexis is an abortive form of Buschke-Ollendorff syndrome. Summarizing our data and reviewing the literature, we suggest that connective tissue nevi with the most prominent alterations in the elastic tissue should be classified under the term elastic tissue nevi.

Adolescent↗
PubMed1994

Diagnosis and treatment of rosacea fulminans.

Rosacea fulminans is a rare disease of unknown cause which occurs exclusively in women well past adolescence. It was previously called pyoderma faciale because of its confinement to the face covering most of the surface with innumerable fluctuant inflammatory nodules and papules which frequently fuse and form monstrosities. Seborrhea prior to onset is typical. It is not a pyoderma; neither it is infectious or a variant of acne conglobata. The patients respond well to a therapeutic regimen including isotretinoin in combination with topical and systemic corticosteroids. The response is superior and much more rapid than in patients treated with oral antibiotics. Rosacea fulminans is the only indication for topical or systemic corticosteroids in the treatment of rosacea. Scarring is often minimal when the lesions clear. No recurrence is seen.

Acne Vulgaris↗
PubMed1994

Pattern analysis of photopatch test reactions.

In a multicenter study, photopatch test results from more than 1500 patients were evaluated between 1985 and 1990 and from 614 patients between 1990 and 1992. Photopatch testing was conducted according to a standardized procedure. Nearly half of the photoreactions were unclassifiable according to the classic definitions of photoallergic or phototoxic reactions. To facilitate the interpretation of these remaining photopatch test reactions, we developed a computerized substance specific reaction pattern analysis. By sequential readings from immediately after irradiation up to 72 h later and by morphological qualification of the reactions, the time course and morphological changes of each individual reaction were monitored. The summation of each individual photoreaction resulted in an overall reaction pattern of a specific substance. Four main categories could be distinguished. The first category was characterized by a peak immediately after irradiation followed by a descrescendo reaction. The second category comprized reactions combining an immediate with a delayed reaction. The third category exhibited a plateau-like delayed reaction. The fourth category showed delayed reactions in a crescendo pattern. Whereas category 1 represents classic phototoxic and category 4 classic photoallergic reaction patterns, the underlying mechanisms of categories 2 and 3 remain to be investigated. Typical substances of category 1 were many of the tested systemic drugs, such as furosemide, most of which are well-known phototoxic agents. Disinfectants, nonsteroidal anti-inflammatory agents and phenothiazines showed the reaction patterns of categories 2 and 3. A delayed type reaction (category 4) could be demonstrated for well-known photoallergens such as fenticlor, musk ambrette, and ultraviolet adsorbents in sunscreens.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗
PubMed1993

Narrow-band UVB (311 nm) versus conventional broad-band UVB with and without dithranol in phototherapy for psoriasis.

BACKGROUND: A narrow-band UVB lamp (Philips TL 01) emitting a peak of approximately 311 nm was developed to improve the phototherapy for psoriasis. Only a few studies have been performed with promising results. OBJECTIVE: The therapeutic efficacy of the Philips TL 01 lamp in a new 100 W version was compared with conventional broad-band lamps (Sylvania UV 6) in a controlled trial. METHODS: Twenty-three patients with psoriasis were treated with half-body exposures from the different UVB sources. The rate of clearing was monitored by estimation of the Psoriasis Area and Severity Index. All patients used emollients; excessive scaling was removed with salicylic acid in yellow petrolatum. In 13 patients dithranol in a modified Ingram regimen was added. In most cases the study was discontinued once a difference between the two sides was evident. RESULTS: In 20 of 23 cases the TL 01 lamp proved to be significantly more effective than the conventional source. Application of dithranol provided a substantial additional therapeutic effect. With the high-intensity TL 01/100W bulbs, exposure times were comparable to broad-band UVB phototherapy. CONCLUSION: The therapeutic efficacy of Philips TL 01/100W and its practicability for psoriasis phototherapy have been demonstrated.

Adolescent↗
PubMed1993

Phototesting in lupus erythematosus.

Ultraviolet (UV) irradiation is a major factor in the pathogenesis of certain variants of cutaneous lupus erythematosus. Photosensitivity constitutes one of the criteria of the American Rheumatism Association for the diagnosis of systemic lupus erythematosus, which further emphasizes its importance. The pathomechanism of UV-induced lupus erythematosus remains unknown. The characterization of photosensitive subacute cutaneous lupus erythematosus (SCLE) by Gilliam and Sontheimer has led to a new approach. Through the development of standardized test methods it has became possible to reproduce cutaneous lesions in the UV-A and UV-B spectrum. These standardized test methods allow a better definition of photosensitivity than clinical history does. Recent clinical data show that besides SCLE another variant, lupus erythematosus tumidus, also reveals pronounced photosensitivity. In this review article phototest procedures, phototest results, and clinical correlations in different subgroups are discussed.

Fluorescent Antibody Technique↗
PubMed1993

An historical note on pyoderma faciale.

Pyoderma faciale is a rare disorder, recently interpreted as a maximal variant of rosacea in women, with a sudden onset. A survey of the history of pyoderma faciale is presented.

Facial Dermatoses↗
PubMed1993

Solid persistent facial edema of acne: successful treatment with isotretinoin and ketotifen.

A 20-year-old man suffering from acne vulgaris since the age of 12 developed a solid persistent inflammatory edema of the face through the last 2 years. The edema was resistant to conventional treatment of acne including various systemic and topical antibiotics, isotretinoin and interferon-gamma. Histopathologic examination revealed an extensive fibrosis of the middle and deeper corium with a dense lymphohistiocytic perivascular infiltrate, notably with many mast cells. The therapeutic combination of oral isotretinoin (0.5 mg/kg body weight daily) and ketotifen (2 mg daily) led to complete resolution of all facial lesions. The pathogenesis of persistent edema remains mysterious but may be related to chronic inflammation resulting in obstruction of lymph vessels or fibrosis induced by mast cells.

Acne Vulgaris↗