Thalidomide treatment of recurrent erythema multiforme.
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Biomedical subjects
Publications and source records attributed to H Zaun.
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A monoclonal gammopathy was observed in three patients with long-term and widespread scleredema (Buschke's disease). There was no evidence of multiple myeloma in any patient. Deposition of monoclonal immunoglobulins in the skin was not detected by direct immunofluorescence microscopy. In contrast to scleromyxedema (lichen myxedematosus), from which scleredema can be distinguished clinically and histologically, the monoclonal immunoglobulins in two cases were of IgG2-kappa and IgG3-kappa type. Only one of the three patients had IgG1-lambda paraproteinemia, which is frequently seen in scleromyxedema. Our findings suggest that diffuse scleredema may be characterized by paraproteinemia but that the possible role of monoclonal immunoglobulins in the pathogenesis of this disease has yet to be resolved.
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In a 40-year-old patient with a basal cell nevus syndrome an eruption of multiple basal cell epitheliomas had been induced by the manifestation of a seminoma. Combined incidence of basal cell nevus syndrome and seminoma hitherto has not been reported. Most of the eruptive epitheliomas occurred in the marginal areas of burn scars.
Concerning differential diagnosis of mucosal lesions of the mouth the frequent occurrence of eruptions of skin diseases in the oral cavity has to be taken into consideration. The accompanying mucosa symptoms of dermatological diseases are observed under the clinical picture of aphthae, leucoplacia or stomatitis like phenomenon.
In spite of remarkable therapeutic results obtained by gestagens with antiandrogenic activity, usually combined with estrogen, in oily seborrhea, acne, Fox-Fordyce disease, androgenetic alopecia and hirsutism many dermatologist still hesitate to treat the named disorders by hormones. The reason for their hesitation appears to be the erroneous belief, that the named disturbances represent hormonal disorders the treatment of which does not belong to dermatology. After a survey on the mechanism of action of antiandrogens the basic difference between androgen dependent skin disorders and endocrinopathies with manifestation on the skin and its appendages is explained. Androgen dependent skin disorders, like oily seborrhea and most cases of acne are not the result of endocrine disturbances in the sense of an pathologically increased or decreased production of sexual hormons. Administering sexual hormons the physician takes advantage of the sebosuppressive effect of female sexual hormons as he does of the antiallergic activity of the hormon cortisol (and related compounds) in the treatment of eczemas. The antiandrogenic treatment of androgenetic alopecia, hirsutism and androgenetic acne--with their underlying hormonal disturbance, consisting in an increased production of androgens, represents an quasi etiological therapy. As in these cases the hormonal disturbances finds its expression mainly or exclusively in disorders of the skin or hair growth, the dermatologist, preferentially in cooperation with endocrinogists and/or gynacologists remains entitled to take over the treatment. The available drugs are discussed and suggestions are made for their appropriate use.
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In this study a reflex photometrical technique has been used to examine local steroid induced vasoreactions. When applied but once, steroids cause a maximum vasoconstriction between 8 and 16 h after beginning the test. Followed by a 32 h period, the phase of vasoconstriction is succeeded by a dilatation of dermis blood vessels. It appears, that the stronger the vasocontriction, the smaller the degree of vasodilatation.
On the basis of reflexphotometrical vasoconstriction tests it is demonstrated, that the intensity of vasoreactions caused by a first topical application of steroids, diminishes rapidly after repeated applications, until there is no response of vessels to a new application. This phaenomenon is know as tachyphylaxis and has been found in all tested glucocorticoids.
Some uncommon forms of dystrophic hair roots, stimulating club hairs, "dysplastic anagen hairs" or catagen hairs, are demonstrated.
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