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Biomedical subjects

H Gollnick

Publications and source records attributed to H Gollnick.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Observations on the "pretherapeutic phase" of malignant melanoma of the skin 1988-1990 and 1993-1995].

In a prospective trial patients were interviewed in two periods, from 1988 to 1990 and from 1993 to 1995. Ninety out of 189 patients (47.6%) with a histologically confirmed diagnosis of malignant melanoma who noted morphological changes in a pigmented lesion reported the mole had been present at least 10 years. 20.7% stated it was present since birth. 156 out of 189 patients (82.5%) noticed changes in the lesion over the time. Growth, discolouration and elevation were the most frequent changes but no significant early sign of disease was found. Bleeding and crusting were found with tumor thickness > 1.5 mm and thus be signs of an advanced stage. Almost 6 months passed until half of the patients visited a physician, either because of changes in the mole or in the lesion was detected during other medical examinations. In the second period of the survey from 1993 to 1995 the physician was frequently consulted earlier. The main reasons for the delay between identification by the patient and seeking medical cedure were lack of symptoms and the notion that the lesion was harmless. Only 72 out of 189 patients (38.1%) visited the physician on their own initiative. The primary evaluation of the "pigmental lesion" was done by a primary care physician in 57%, by a dermatologist in 32% and by others in 11% of our cases. A diagnosis of a non-melanoma was made and no further steps were initiated by 27% of the primary care physicians and 22.7% of the surgeons, gynecologists or internists. Only 5% of the dermatologists misdiagnosed the lesions. In the second trial period from 1993 to 1995 in all physician groups the rate of misdiagnosis increased due to changes in healthcare services in the context of privatisation in our health care system in East Germany. Whereas 83.2% of the patients first evaluated by dermatologists had a surgical removal of the mole within the first 2 months after consultation, the proportion for those diagnosed by non-dermatologists was only 58.5%. The rate of primary treatment by surgeons, often with a small safety margin, also increased.

Adult↗
PubMed1998

Topical drug treatment in acne.

The main part of acne treatment uses the topical route. More than 50% of acne patients belong to the group presenting with acne comedonica and papulopustulosa. Whenever small nodes or scarring occur, systemic comedication is indicated, however. Topical treatment affects at least three of the four main pathogenetic factors responsible for the development of acne, i.e. hyperseborrhea, hyperkeratosis, microbial colonization and inflammation. The agents currently available influence at least one of these factors but often have additional properties. Those which act in a comedolytic and anticomedogenic manner are the retinoids tretinoin, isotretinoin, adapalene and tazarotene and azelaic acid as well, some of the retinoids having additional anti-inflammatory potency. Azelaic acid has strong antibacterial potency without inducing bacterial resistance similar to benzoyl peroxide. Unfortunately, bacterial resistances are beginning to emerge as a significant problem. Propionibacterium acnes resistance to the commonly used erythromycin can also be transferred to clindamycin, whereas no resistance has been reported to nadifloxacin so far. Today, more and more evidence comes up that topical antiandrogenic agents will soon be available to treat the important factor seborrhea, because patients with marked hyperseborrhea frequently relapse. Finally, liposome encapsulation of agents including phospholipids can enhance penetration and efficacy but, particularly with regard to retinoids, can lead to higher absorption and adverse drug reactions.

Acne Vulgaris↗
PubMed1998

Current experience with tacalcitol ointment in the treatment of psoriasis.

Various controlled studies have demonstrated the efficacy and safety of tacalcitol ointment (4 micrograms/g) in the treatment of psoriasis. Further data are now available from a multicentre post-marketing surveillance study involving more than 5000 outpatients. Once-daily treatment with tacalcitol resulted in a marked decrease of mean sum score (erythema, infiltration, scaling) from 6.3 to 2.7 score points in an average period of 61 days. Efficacy was assessed by dermatologists as 'very good' or 'good' in 71% of the patients. Local tolerance was stated to be 'very good' or 'good' in 94% of the patients. Only 1% of the patients experienced skin irritation. No case of hypercalcaemia was observed. Compared with conventional therapies, 52% of the patients saved up to half an hour of treatment time daily because of the once-daily application. Good local tolerance and a convenient treatment regimen may also help compliance.

Adolescent↗
PubMed1998

Topical therapy in acne.

The majority of acne patients will receive a topical treatment either as monotherapy or in combination with a systemic drug therapy depending on the severity of the disease. The currently available topical agents affect at least one of the four main pathogenetic factors responsible for the development of acne, i.e. hyperkeratosis, microbial colonization, immune response and inflammation. Retinoids, azelaic acid, benzoyl peroxide and topical antibiotics represent the spectrum of the established and proven topical agents. Presumably, antiandrogenic agents will soon be available for topical use to treat the important factor of seborrhea. In general, by combining topical agents, their potency can be enhanced and toxicity diminished. Unfortunately, bacterial resistances are beginning to emerge as a significant problem.

Acne Vulgaris↗
PubMed1997

Can a serotonin type 3 (5-HT3) receptor antagonist reduce experimentally-induced itch?

BACKGROUND: Serotonin type 3 (5-HT3) receptor antagonists have been reported to be a novel therapeutic principle for the treatment of cholestatic and uremic pruritus. OBJECTIVE: To determine the antipruritic effect of a 5-HT3 receptor antagonist (tropisetron) on histamine and serotonin-induced itch under experimental conditions in comparison to native skin and after pretreatment with an orally applied antihistamine (cetirizine). METHODS: Histamine and serotonin were iontophoretically applied in 10 healthy volunteers. Wheals and flares were planimetrically evaluated. Itching and burning sensations were entered on a scale over 24 min. The examination also comprised alloknesis, elicitation of perifocal itch sensation by usually non-itching (e.g. mechanical) stimuli. RESULTS: Tropisetron did not have any significant influence on histamine-induced reactions but could significantly reduce serotonin-induced flares. Cetirizine led to a significant reduction of all histamine-induced parameters and abolished serotonin-induced wheals. CONCLUSIONS: Serotonin has an own pruritic potency and does not only act over histamine containing mast cells. The antipruritic effect of tropisetron reported in cholestatic and uremic pruritus could not be verified in healthy persons under experimental conditions.

Adult↗
PubMed1997

Effects of retinoids on the generation of neutrophil-derived reactive oxygen species studied by EPR spin trapping techniques.

OBJECTIVE: To study the potential efficacy of retinoids on granulocytes with regard to their role in inflammatory dermatoses. METHODS: We investigated the in vitro effect of acitretin and isotretinoin on the generation of reactive oxygen species (ROS) by stimulated human neutrophils using EPR spin trapping techniques. RESULTS: The effects of the two retinoids on ROS generation by neutrophils were different. Acitretin increased the generation of hydroxyl radicals, whereas isotretinoin showed an antioxidant activity against the superoxide anion. CONCLUSIONS: Our study demonstrates retinoid type-dependent effects on ROS production by stimulated neutrophils.

Acitretin↗
PubMed1997

Protection against UVA damage and effects on neutrophil-derived reactive oxygen species by beta-carotene.

OBJECTIVE: Phagocyte-derived reactive oxygen species (ROS) are involved in microbicidal activities as well as in tissue damage at sites of inflammation. Carotenoids play an important function in protecting cells from oxidant damage. We investigated the in vitro and in vivo effect of 13-cis and 9-cis-beta-carotene on human neutrophils. METHODS: Neutrophils from healthy donors in the presence of 0.25 mumol/L-1 mumol/l beta-carotene and from subjects under beta-carotene supplementation and UVA or UVA/B exposure were stimulated by opsonized zymosan and the generation of ROS was measured by electron spin resonance spectroscopy. RESULTS: Our in vitro results show different effects of the two isomers on stimulated neutrophils. 9-cis-beta-carotene did not produce any change, whereas 13-cis-beta-carotene significantly and concentration-dependent inhibited the ROS generation by stimulated neutrophils. Further, in a controlled study, we were able to demonstrate an in vivo protective effect of beta-carotene on neutrophils against UVA damage by beta-carotene supplemented subjects.

Electron Spin Resonance Spectroscopy↗
PubMed1997

Atrial myxoma syndrome mimicking Ehrmann-Sneddon syndrome.

Livedo racemosa with cerebrovascular lesions has been described as Ehrmann-Sneddon syndrome. The etiopathogenetic factors provoking the vascular lesions, however, are of high diversity reaching from mechanical to autoimmune causes. We present a male patient with typical livedo racemosa, muscle pain and feeling of coldness of the forearms. By dermatohistopathology and magnetic resonance tomography of the brain, Ehrmann-Sneddon syndrome could be confirmed. At this time a chronic streptococcal infection could be diagnosed. Antibiotics, anticoagulants and vascularity-supplying therapy improved the clinical and subjective symptoms. Six months later, the patient developed dizziness, vision disorder, hypesthesia of the right forehead, malaise and weight loss. A further diagnostic workup including echocardiography revealed a myxoma of the left atrium. This report illustrates the association of Ehrmann-Sneddon syndrome with cardiac myxoma and points out that cardiac diagnostic examination should be included when dealing with small-vessel involvement of the brain.

Adult↗
PubMed1997

Roaccutane treatment guidelines: results of an international survey.

BACKGROUND: Oral isotretinoin (Roaccutane) revolutionized the treatment of acne when it was introduced in 1982. METHODS: Twelve dermatologists from several countries with a special interest in acne treatment met to formally review the survey of their last 100 acne patients treated with oral isotretinoin. The primary purpose of the survey was to identify the types of acne patients who were prescribed oral isotretinoin and how the patients were managed. RESULTS: Of the 1,000 patients reviewed, 55% of those who received oral isotretinoin had those indications treated historically, i.e. severe nodular cystic acne or severe inflammatory acne, not responding to conventional treatment. Forty-five percent of patients who were prescribed oral isotretinoin however had either moderate or mild acne. Most patients in this group had moderate acne (85%). However, 7.3% had mild acne on physical examination. The criteria for prescribing oral isotretinoin in this less severe group of patients included acne that improves < 50% after 6 months of conventional oral antibiotic and topical combination therapy, acne that scars, acne that induces psychological distress and acne that significantly relapses during or quickly after conventional therapy. Treatment is usually initiated at daily doses of 0.5 mg/kg (but may be higher) and is increased to 1.0 mg/kg. Most of the physicians aimed to achieve a cumulative dose of > 100-120 mg/kg. Mucocutaneous side-effects occur frequently but are manageable while severe systemic side-effects are rarely problematic (2%). The teratogenicity of oral isotretinoin demands responsible consideration by both female patients and their physicians. Significant cost savings when treating acne patients with oral isotretinoin as compared to other treatment modalities were further proven in this study. CONCLUSIONS: Our recommendation is that oral isotretinoin should be prescribed not only to patients with severe disease but also to patients with less severe acne, especially if there is scarring and significant psychological stress associated with their disease. Acne patients should, where appropriate, be prescribed isotretinoin sooner rather than later.

Acne Vulgaris↗
PubMed1997

Detection of Borrelia burgdorferi DNA (B garinii or B afzelii) in morphea and lichen sclerosus et atrophicus tissues of German and Japanese but not of US patients.

OBJECTIVE: To elucidate the geographic and genospecific association of Borrelia with morphea and lichen sclerosus et atrophicus (LSA). DESIGN: The association of Borrelia burgdorferi with morphea and LSA has been reported, but is still controversial. We conducted a retrospective survey of Borrelia DNA in skin biopsy specimens. SETTINGS: The samples were collected from the outpatient clinic of university hospitals and a dermatopathology laboratory. PATIENTS: Skin biopsy specimens (19 morphea and 34 LSA) were obtained from patients in the United States, Japan, and Germany. DNA samples were subjected to amplification with polymerase chain reaction for B burgdorferi flagellin gene, and for the genotype-specific detection of B burgdorferi sensu stricto, Borrelia garinii, and Borrelia afzelii. RESULTS: Five cases of morphea and 2 cases of LSA in Germany and Japan yielded positive signals for B garinii or B afzelii, the European species. None of the American samples were positive for Borrelia polymerase chain reaction. Borrelia burgdorferi sensu stricto was not detected in any of the specimens. CONCLUSION: Morphea and LSA in Germany and Japan can be related with European genotypes of Borrelia.

Adolescent↗
PubMed1996

[Therapeutic experiences with extracorporeal photopheresis. Technical procedure, follow-up and clinical outcome in 31 skin diseases].

Extracorporeal photophoresis (ECP), a therapeutic modality that has been under investigation for some years, is based on separation of a leucocyte/lymphocyte-enriched cell fraction from the peripheral blood, extracorporeal treatment of the cells with 8-MOP/UVA and subsequent reinfusion of the cells in the patient. Its main effects seem to consist in changes to the immunologic behaviour of the photoinactivated/modulated cells. The immune response of the host is obviously stimulated by this treatment. ECP is normally performed for 4 h per day on 2 consecutive days every 4 weeks. The treatment is well tolerated and causes few side effects. In our department, 1210 ECP treatments were administered to 41 patients between 1990 and 1994 and a preliminary evaluation was performed. These patients included 21 with cutaneous T-cell lymphoma (CTCL), 10 with progressive systemic scleroderma, 4 with chronic graft-versus-host disease and 1 each with pemphigus vulgaris, epidermolysis bullosa acquisita, lupus erythematosus and cutaneous mucinosis. Patients with erythroderma and preserved immunocompetence achieved the best responses of all patients with CTCL. A treatment combining ECP with rIFN-alpha, PUVA and/or radiation was also successful in patients with tumour-stage CTCL and lymph node involvement. Progressive systemic scleroderma responded in more than 50% of our cases. Treatment results were impressive in 4 patients with chronic graft-versus-host disease presenting with sclerodermatous and lichenoid changes of the skin and mucous membranes. A clear improvement was also observed in the patient with pemphigus vulgaris refractory to standard therapies and in another patient with scleromyxoedema (Arndt-Gottron syndrome). The effectiveness of ECP seems to be quite well established in CTCL, but remains to be examined in autoimmune dermatoses. ECP is an attractive addition to the dermatological therapies available but our experience is still preliminary.

Adult↗
PubMed1996

Improved method for studying skin lipid samples from cyanoacrylate strips by high-performance thin-layer chromatography.

A non-invasive method for sampling skin surface lipids is cyanoacrylate stripping (CAC-TS). It was the purpose of our study to improve the method for sampling of skin surface lipids and the separation of epidermal lipid fractions by a modification of the methods described by Melnik and by Imokawa et al. Briefly, lipids on the glass slide sampled by CAC-TS from the forearm of 75 volunteers and from the forehead of 60 volunteers were eluted in hexane/ethanol under ultrasonication. Identification of the diluted total superficial sebaceous and epidermal skin lipids was performed by sequential high-performance thin-layer chromatography. For quantification of the lipids we used densitometric methods. By this modified method we were able to show a clear and complete separation of all relevant lipids from a cyanoacrylate strip that represented 1-2 mg stratum corneum only.

Cell Fractionation↗
PubMed1996

Hypotrichosis, hair structure defects, hypercysteine hair and glucosuria: a new genetic syndrome?

Structural hair changes may be the expression of a genetic disorder affecting hair growth, part of a congenital syndrome with accompanying hair malformations, or a marker for an underlying metabolic disorder. We report a 22-month-old Turkish girl and her 10-month-old brother, whose scalp hair became fragile and sparse at about 6-7 months of age. Glucosuria, without diabetes or kidney disease, was detected 3-4 months later. Clinical examination revealed normal physical and mental development, and an analysis of plucked hairs showed dysplastic and broken hair shafts. Polarizing microscopy and scanning electron microscopic studies revealed torsion, and irregularities and impressions of the hair shaft, as seen in pili torti, trichorrhexis nodosa and pseudomonilethrix. Analysis of the amino-acid composition of the hair demonstrated a significant reduction of sulphonic cysteic acid and an elevated cysteine and lanthionine content in the girl, and elevated lanthionine levels in her brother. Electrophoretic analysis of the girl's hair proteins revealed a normal composition but a high extractability of hair proteins. The triad of hypotrichosis, structural hair-shaft defects and abnormal amino-acid composition, accompanied by glucosuria without diabetes, may represent a new genetic syndrome.

Amino Acids↗