[Reflexphotometric determinations of vasoconstriction after topical application of steroids. Method, reliability, errors (author's transl)].
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Administration, Topical↗
Biomedical subjects
P Altmeyer
Publications and source records attributed to P Altmeyer.
Accessory tragus: report of two cases and review of the literature.
Accessory tragus is a fairly common congenital malformation of the external ear. In the vast majority of cases it is an isolated developmental defect not associated with other abnormalities. However, the remote possibility exists that it could be associated with other abnormalities of the first and second branchial arch. Accessory tragus is a consistent feature of the oculoauriculovertebral syndrome (Goldenhar syndrome). When correctly identified, surgical excision of accessory tragus is quite simple and rarely results in any complications.
Child, Preschool↗
Disfiguring draining sinus tracts in a female acne patient.
A 17-year-old girl with a 9-month history of papulopustular acne developed disfiguring, highly inflammatory, fluctuant nodules in both nasolabial folds within 2 months. Periodically she experienced discharge of pus and blood from these lesions. A diagnosis of disfiguring draining sinus tracts associated with acne vulgaris was made. The therapeutic regimen included intralesional corticosteroid injection, systemic corticosteroids along with a macrolide antibiotic, and systemic isotretinoin to reduce the inflammatory process. Outcome was favorable, with no recurrences during the following 10 months. Draining sinus is a malevolent lesion usually seen in severe forms of acne such as acne conglobata, acne fulminans, and acne inversa. Treatment is difficult and often unsatisfactory. In many cases, excision of the lesion is necessary to provide a permanent cure.
Acne Vulgaris↗
Combined treatment with calcipotriol ointment and low-dose ultraviolet A1 phototherapy in childhood morphea.
Various therapies for morphea have been used with limited success, including ones with potentially hazardous side effects. When morphea occurs in childhood it may lead to progressive and long-lasting induration of the skin and subcutaneous tissue, growth retardation, and muscle atrophy. We report an open prospective study in which the efficacy of a combined treatment with calcipotriol ointment and low-dose ultraviolet A1 (UVA1) phototherapy in childhood morphea was investigated. Nineteen children (mean age 8.5 years, range 3-13 years) with morphea were exposed to UVA1 (340-400 nm) phototherapy at a dose of 20 J/cm(2) four times a week for 10 weeks. Forty phototherapy sessions resulted in a cumulative dose of 800 J/cm(2) UVA1. In addition, calcipotriol ointment (0.005%) was applied twice a day. After 10 weeks, palpation and inspection showed a remarkable softening and repigmentation of formerly affected skin resulting in a highly significant (p < 0.001) decrease of the mean clinical score from 7.3 +/- 0.9 at the beginning to 2.4 +/- 0.9 (relative reduction 67.1%) at the end of combined therapy. Our results indicate that a combined therapy with calcipotriol ointment and low-dose UVA1 phototherapy is highly effective in childhood morphea. Further controlled studies are necessary to investigate whether this combined therapy is superior to UVA1 phototherapy alone.
Adolescent↗
Psoriasiform pustular eruptions from pegylated-liposomal doxorubicin in AIDS-related Kaposi's sarcoma.
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Acquired Immunodeficiency Syndrome↗
Time course of 8-methoxypsoralen-induced skin photosensitization in PUVA-bath photochemotherapy.
In recent years PUVA-bath photochemotherapy has been shown to be an effective treatment modality for several dermatoses. A limitation of PUVA-bath photochemotherapy has been the lack of guidelines for optimal performance, including the time course of photosensitization of the skin exposed to the 8-methoxypsoralen (8-MOP) bath water solution. In the present study 12 healthy volunteers were exposed to a 20 min bath in 150 l of an 8-MOP water solution (0.5 mg/l, 37 degrees C). Immediately, as well as 1, 2, 3 and 5 h after the 8-MOP bath, irradiation was performed with increasing doses of UVA (0.5, 1, 2, 3, 5 J/cm2) on 2 cm2 test areas. The minimal phototoxic dose (MPD) was determined 72 h after the UVA exposure. In all volunteers, photosensitization was highest immediately after the bath, with a MPD significantly below 5 J/cm2 (0.5-2 J/cm2). One hour after the bath, erythema could be induced by 2 to 5 J/cm2 UVA. Two hours after the bath, erythema could be induced using irradiation of 5 J/cm2 only in two volunteers. Three and five hours after the 8-MOP bath, no erythema could be induced in any volunteer by UVA doses up to 5 J/cm2. Our results indicate that optimal bath-PUVA requires UVA irradiation immediately after the 8-MOP bath. Further, these results imply that no restrictions on further sun exposure are mandatory 3 h after the 8-MOP bath, thus allowing the patient to pursue normal life activities.
Erythema↗
Plasma levels of 8-methoxypsoralen following PUVA-bath photochemotherapy.
Administration of 8-methoxypsoralen (8-MOP) in a dilute bath water solution is an effective therapeutic alternative to oral PUVA therapy, avoiding systemic side effects, offering better bioavailability of the psoralen and requiring much smaller amounts of UVA for induction of therapeutic effects. To obtain exact data about the percutaneous absorption of 8-MOP during a psoralen bath, the plasma levels of the drug were determined in 26 patients with different skin diseases by a reverse high-performance liquid chromatographic method. Fifteen patients receiving oral PUVA therapy (0.8 mg 8-MOP/kg body weight) served as a positive control group. Bath solutions were prepared by diluting 15 ml of 0.5% stock solution of 8-MOP in 150 l of bath water (0.5 mg/l, 37 degrees C). Blood samples were drawn from patients 5, 30, 60, 120 and 180 min after the bath. In the oral PUVA group, blood samples were obtained 1 1/2 h after administration of the drug. In 23 of 26 patients, 8-MOP levels were undetectable in every blood sample. After 30 min, two patients showed detectable levels of 8-MOP (5 ng/ml, 7 ng/ml), while 60 min after the PUVA bath 8-MOP was detectable in only one volunteer (5 ng/ml). In patients receiving oral 8-MOP therapy, serum levels varied between 45 and 360 ng/ml 1 1/2 h after drug administration. Our data confirm extremely low 8-MOP levels resulting from 8-MOP bath water treatments and provide confirmation of the absence of systemic side effects in patients who are undergoing PUVA-bath therapy.
Administration, Oral↗
Effects of water temperature on photosensitization in bath-PUVA therapy with 8-methoxypsoralen.
The pharmacokinetic aspects of bath-PUVA are not completely clarified. Therefore, we determined the phototoxic response of human skin following psoralen baths at temperatures ranging from 32 degrees C to 42 degrees C (71.6-107.6 degrees F) and UVA doses ranging from 0.5 to 5.5 J/cm2. The highest therapeutical photosensitization (i.e., lowest minimal phototoxic dose) was assessed at temperatures of 37 degrees C (98.6 degrees F) and above. Photosensitization was significantly decreased at lower temperatures. These data indicate that a bath temperature of 37 degrees C (98.6 degrees F) should be used to gain optimal therapeutic efficiency in a clinical setting. Furthermore, in order to minimize the risk of adverse phototoxic effects in bath-PUVA, it is important to use a constant temperature during the psoralen bath.
Adult↗
UV transmission and UV protection factor (UPF) measured on split skin following exposure to UVB radiation--correlation with the minimal erythema dose (MED).
In this study the ultraviolet (UV) transmission of split skin exposed to UVB radiation and of non-exposed skin was compared in the 280-390 nm wavelength range and quantified. In addition, the correlation between the increase in the minimal erythema dose (MED) associated with a defined exposure to UVB and the ultraviolet protection factor (UPF) calculated from the transmission data was investigated. The study population consisted of 12 patients. Two pieces of split skin of the same thickness (0.3 mm) were taken from the right thigh of each patient. One specimen was removed from an area of non-exposed healthy skin and the other from an area which had been exposed to UVB radiation for a period of 12 days in which the initial dose of 1/3 MED was raised by 1/3 MED every 4 days. The split skin specimens were stretched over a special frame; subsequently, the UV transmission was determined with a spectrophotometer. The mean values obtained for UV transmission were all significantly below the initial data for non-exposed split skin. In the UV range of 280--390 nm, the transmission measured in the exposed specimens was 49.1% of the value measured in the non-exposed split skin (P<0.05). The corresponding values for the UVA range (315--390 nm) and the UVB range (280--315 nm) were 50.1% and 29.5%, respectively (P<0.05), based on the initial transmission data obtained from non-exposed skin. The clinical determination of MED after 12 days of exposure to UVB yielded mean values that were 3.2 times the initial values. Moreover, the mean UPFs calculated from the transmission data measured at the end of the 12-day exposure period were also about three times the initial values. The present study has thus established a significant correlation between the clinical MED values and the UPFs calculated from the transmission data measured following exposure to UVB.
Adult↗
Differences in the two-dimensionally measured laser Doppler flow at different skin localisations.
The cutaneous microcirculation shows a significant heterogeneity. With high-resolution two-dimensional laser Doppler perfusion imaging (LDPI), spatial and temporal reproducible perfusion measurements can be reached. The objective of this study was the quantification of skin perfusion in 20 defined skin areas with LDPI, in 60 healthy young and old volunteers. The perfusion of the face was significantly higher than that of the trunk and extremities. The highest perfusion values were seen at the lips, 1.47 arbitrary units (AU), followed by the chin (0.99 AU), the nose (0.95 AU), the forehead (0.73 AU) and the cheek (0.72 AU). Mean perfusion, between 0.40 and 0.49 AU, was seen at the extremities and at the trunk. The lowest perfusion was found at the bottom (0.37 AU), on the back of the foot (0.36 AU) and on the soles (0.31 AU). There was a tendency to show higher perfusion values in men than in women (0.60 +/- 0.31 vs. 0.53 +/- 0.26 AU). Age-related differences in perfusion could not be demonstrated. In the evaluation of the perfusion of pathological skin, regional perfusion differences must be considered, whereas moderate age or gender differences between different investigation groups can be tolerated.
Adult↗
The effect of the base on the kinetics of action of the capsaicinoid nonivamide: evaluation with a hyperemic test.
Because of their selective receptor-mediated action on cutaneous nociceptive C-fibers, the interest in capsaicinoids as topical analgetic drugs has been constantly growing over the past years. Knowledge of the pharmacokinetics seems particularly important for potential future clinical applications. Therefore, the aim of the present study was to investigate the influence of the type of preparation on the time course of action of the capsaicinoid nonivamide monitored by the axon-reflex-induced hyperemic action and area of erythema. Sixteen healthy subjects were included in the study. The hyperemic responses after application of nonivamide in an oil-in-water (O/W) emulsion and in a water-free ointment were assessed both by laser Doppler perfusion imaging and planimetry after 0, 15, 30, 45, 60, 120 and 240 min. They were compared with the reaction after application of the nicotinic ester nicoboxil and a combination of nonivamide and nicoboxil in the same preparations. Applied as a water-free ointment, nonivamide showed a slow onset of hyperemic action, reaching its maximum 45 min after application. When applied as an O/W emulsion, however, the increase in effect was high, reaching its maximum already after 30 min. Application of the nicoboxil preparations revealed a clearly lesser influence of the base regarding the onset of maximum effect. The combination of both substances showed an additive effect for both bases, and a maximum effect was found already after 15 min with both the water-free ointment and the O/W emulsion base. In conclusion, the results of the present study show that there appears to be a strong influence of the vehicle on the kinetics of action of capsaicinoids, and that the hyperemic test used in this paper is very useful for the quantitative determination of the pharmacokinetic properties of capsaicinoids. Moreover, the C-fiber-stimulating effect of capsaicinoids can, at least in part, be enhanced by combination with a nicotinic ester, even though these substances have no direct effect on the C-fibers.
Adolescent↗
Effect of fenticonazole spray in cutaneous mycosis: a double-blind clinical trial versus cyclopyroxolamine spray.
A double-blind clinical trial was performed to evaluate efficacy and tolerance of once-daily 2% fenticonazole compared with 1% cyclopyroxolamine spray applied for 2-4 weeks in 100 patients with cutaneous mycotic lesions. After treatment lasting 21.9 +/- 6.7 or 22.5 +/- 6.2 days, respectively, patients receiving fenticonazole or cyclopyroxolamine had negative microscopic findings and cultures were sterile. Comparable clinical improvement was observed in both treatment groups, with 91.8% and 89.8% of patients, respectively, receiving fenticonazole or cyclopyroxolamine being evaluated as cured or greatly improved. Following a drug-free period, the clinical evaluation of nine (20.9%) patients treated with fenticonazole and 14 (30.4%) treated with cyclopyroxolamine worsened. The incidence of side-effects was low; only one patient withdrew from treatment because of a slight itch. It is suggested that fenticonazole and cyclopyroxolamine are equally effective in eradicating cutaneous mycoses and that their efficacy and tolerance are comparable.
Administration, Topical↗
Reference limits for erythema-effective UV doses.
Diagnostic phototesting, including the determination of the minimal erythema dose (MED), is a useful procedure to detect abnormal sensitivity to UV radiation. We aimed to estimate the reference limits (RLs) of the MED in a reasonably large reference sample of white individuals. Skin phototypes and MED values for broadband UVB and for UVA were determined in 461 white subjects. When appropriate, the 95% reference intervals, including the 0.025 fractile and 0.975 fractile, were computed for the MED-UVB reference values (by means of parametric methods) and the MED-UVA reference values (by means of nonparametric methods). MED data were also converted to standard erythema doses (SEDs). As described elsewhere we observed a considerable overlap of MED values for all skin phototypes and confirmed that age and sex do not substantially influence the MED. The lower RLs observed for MED-UVB were 33 mJ cm(-2) (0.5 SEDs) and for MED-UVA 12.6 mJ cm(-2) (1.2 SEDs). The MED and SED findings from this investigation may serve as reference data for white individuals and give support to the clinician in differentiating between normal and pathologically abnormal photosensitivity. Although the MED data given here are limited to the phototest device used in the present study, the SED results establish comparability between our data and phototest results obtained from laboratories using different UV sources.
Adolescent↗
Long-term treatment of psoriasis with calcipotriol scalp solution and cream.
The efficacy and safety of long-term concurrent twice-daily treatment of scalp and body psoriasis with calcipotriol scalp solution (50 mcg/ml) and calcipotriol cream (50 mcg/g) were evaluated in a prospective, multi-centre, open-label, non-controlled evaluation over 52 weeks in 202 patients. Safety and efficacy as measured by total sign score (scalp psoriasis), modified PASI (body psoriasis) and patient self-assessment were assessed at week 2, 6 and 10 and thereafter every six weeks. By week 28, mean total sign score for scalp psoriasis had reduced from 5.9 to 2.5 (p<0.001). No further reduction was seen. By week 34, mean PASI for body psoriasis had reduced from 6.8 to 2.6 (p<0.001). No further reduction was seen. At week 52, the percentage of patients assessing their psoriasis as moderate or severe had decreased from 72 to 21% for scalp psoriasis and from 62 to 19% for body psoriasis. Facial irritation was the most frequent adverse event (91/276 events) with the highest incidence occurring at week 2 and few new reports at subsequent visits. There were no significant changes in mean serum calcium, parathormone or urinary calcium/creatinine ratio. Combined treatment with calcipotriol scalp solution and cream was effective and safe for long-term treatment of scalp and body psoriasis.
Administration, Topical↗
UVA1 cold-light phototherapy of small plaque parapsoriasis.
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Humans↗