Biomedical subjects
Publications and source records attributed to P Elsner.
The treatment of granuloma annulare is still unsatisfactory. A number of topical and systemic therapies have been tried, some of which can improve the condition, but serious side effects are possible with those reported so far. We treated a patient with disseminated granuloma annulare by local application of a vitamin E emulsion and achieved a marked improvement within as little as 12 days.
A case of vulvar giant lichenification of Pautrier showed uncommon ulcerations in the center of hyperplastic verrucoid plaques. The diagnosis was made from the history, clinical findings and characteristic features on the skin biopsy. Other causes of vulvar ulcers, such as venereal disease, chronic bullous and autoimmune diseases, and neoplastic conditions were excluded. We treated the patient with systemic antihistamines, topical antiseptics and corticosteroids, and sublesional injections of triamcinolone. The itch-scratch cycle was interrupted by the patient's wearing cotton gloves at night. Complete healing of the ulcers and an improvement in the pruritus was achieved within 14 weeks.
Reactivity of the skin of the forearm and labia majora to three concentrations (2%, 3%, 5%) of sodium lauryl sulfate was studied in 20 healthy women, 10 premenopausal and 10 postmenopausal. Patches with the irritant were applied on day 0 for 24 hours. Skin changes were monitored by visual scoring and by the measurement of transepidermal water loss and capacitance as indicators of stratum corneum hydration on days 2, 3, 7, and 10. In forearm skin, irritant dermatitis developed in the majority of subjects as indicated by visual scoring and increase of transepidermal water loss. These changes were not significantly dependent on the concentration of sodium lauryl sulfate. In labia majora skin, irritant dermatitis developed in 50% of the women as determined by visual scoring; however, because of the pigmentation, visual scoring readings were less reliable in labia majora skin. Transepidermal water loss did not increase, but a significant and immediate decrease in capacitance was noted in labia majora skin. In forearm skin, postmenopausal women reacted less frequently and more slowly to sodium lauryl sulfate than premenopausal women whereas no age-related differences were observed in reaction of the vulvar skin. It is concluded that labia majora skin is not more reactive to sodium lauryl sulfate than forearm skin and that capacitance is more sensitive than transepidermal water loss in monitoring vulvar irritant dermatitis. Age-related differences in irritant reaction are apparent in the forearm, but not the vulva.
Using a newly developed suction device, the mechanical properties of forearm and vulvar skin were studied in 22 healthy women, 12 before and 10 after the menopause. The ratio between viscous deformation (Uv) and elastic deformation (Ue) and the biological elasticity, i.e. the ratio between immediate recovery (Ur) and total deformation (Uf), were both significantly lower in vulvar than in forearm skin. Ur/Uf decreased significantly with load in vulvar, but not in forearm skin, whereas Uv/Ue was not load-dependent in either site. Uv/Ue remained constant with age in both test sites, whereas Ur/Uf was significantly lower in post-menopausal women in both forearm and vulvar skin. In vulvar, but not in forearm skin, Uv/Ue was significantly correlated with body height which may be an indicator of mechanical connective tissue properties. Viscous deformation plays a lesser role and biological elasticity is decreased in vulvar compared to forearm skin. Despite differences in mechanical parameters at both sites, age-related changes seem to be similar.
Transepidermal water loss (TEWL), capacitance, pH, blood flow and color reflectance were evaluated for quantifying the irritant response of vulvar and forearm skin to 3% sodium lauryl sulfate in 9 healthy premenopausal women. TEWL, capacitance, pH, blood flow, and all parameters of color reflectance changed significantly in forearm irritant dermatitis. In vulvar irritant dermatitis, however, significant changes were observed only for blood flow and the color reflectance parameters a* and b*. Using the combination of TEWL, capacitance and blood flow, forearm irritant dermatitis was detected with a sensitivity of 84% and a specificity of 100%. In this study, the best combination of parameters to detect vulvar irritant dermatitis was pH, blood flow, a* and b*, which had a sensitivity of 78% and a specificity of 75%. It is concluded that available bioengineering techniques are less suitable to quantify irritant dermatitis in the vulva than in the forearm.
The dynamic friction coefficient between skin and a Teflon probe and its correlation with age, body weight, height, transepidermal water loss and skin capacitance was studied in vulvar and forearm skin of 44 healthy female volunteers. The friction coefficient of vulvar skin was 0.66 +/- 0.03 (mean +/- SEM) compared to that of forearm skin of 0.48 +/- 0.01. The difference was highly significant (p less than 0.001). Multiple-regression analysis showed that the vulvar skin friction coefficient was significantly correlated with capacitance as an indicator of stratum corneum hydration (p less than 0.01) but not with age, weight, height or transepidermal water loss. It is concluded that the high friction coefficient of vulvar skin may be due to the increased hydration of vulvar skin. Age-related differences seem to exist for transepidermal water loss and friction coefficient in forearm but not in vulvar skin.
Ureaplasma urealyticum is one of the microorganisms possibly causing nongonococcal urethritis. In a prospective study, 606 men without urethritis presented to an STD clinic in a rural West German region were investigated for the prevalence of U. urealyticum in the urethra. The overall isolation rate of the organism was 21.3%. Analyzing patients grouped by clinical diagnoses, the isolation rate of U. urealyticum was significantly higher in the genital warts group (25%) and in the partner's control group (35%) than in the group of patients suffering from fertility disorder (15.2%) or balanitis (14%). These findings stress the importance and the difficulty to select the appropriate controls in clinical studies concerning the role of U. urealyticum in the male urethra.
In order to estimate the influence of occlusion and sweating on forearm and vulvar skin surface water loss (SSWL), both were measured simultaneously and continuously for 30 min in 8 healthy women. Vulvar SSWL decreased significantly during the measuring period from 24.9 +/- 5.2 gm-2 h-1 (mean +/- standard error of the mean) in the first 5 min, to 13.4 +/- 1.7 gm-2 h-1 in the last 5 min (p less than 0.05), whereas no significant changes were observed in forearm SSWL. The vulvar SSWL decay curve followed a logarithmic equation of the form y = a*tb. Irregular SSWL increases ('bursts') were observed in vulvar (but not in forearm) skin of 7 out of 8 women. These SSWL bursts were considered to be caused by sweating. The study shows possible causes of systematic errors in vulvar irritation studies. Methods for error reduction are discussed.
The effect of prolonged drying on transepidermal water loss (TEWL), capacitance and pH of vulvar and forearm skin was studied in 15 healthy female volunteers. A desiccation chamber that absorbed water evaporating from the skin surface was applied to the forearm and labia majora skin daily for 4 days. Skin TEWL, capacitance and pH were measured daily and 4 days after removal of the desiccation chamber at the site of drying and at a symmetrical control site. Under desiccation, TEWL both of forearm and of vulvar skin showed an increase during the first days of drying, followed by a gradual decrease. After 4 days of drying, forearm TEWL was reduced to 91% of the control value, without reaching significance. Vulvar TEWL was significantly reduced to 80% of the control value. Although relative reduction of vulvar TEWL was higher than that of forearm TEWL, the absolute of value of vulvar TEWL after drying remained significantly higher than that of forearm TEWL. Skin capacitance significantly decreased under drying both in forearm and vulvar skin. Skin pH was significantly reduced by drying at the vulva, but not at the forearm. It is concluded that although changes in physiological parameters during drying seem to be more pronounced in vulvar than in forearm skin, differences suggest that the specific properties of vulvar skin are not explained by anatomically related occlusion alone.
The reactivity of forearm and vulvar skin to sodium lauryl sulfate (SLS) was studied in two groups of 20 healthy women each, 10 before and 10 after menopause. Vulvar skin was less reactive to SLS in both low and high concentrations than was forearm skin. Transepidermal water loss measurement did not seem to be an indicator of irritant dermatitis in vulvar skin. Capacitance measurements, reflecting changes in skin hydration, seemed to be more suitable for monitoring vulvar irritant dermatitis. Age-related differences in irritant reaction were more apparent in low-grade irritant dermatitis induced by low concentrations of SLS than in intense reactions to higher SLS concentrations.
Human vulvar skin is an example of specialized skin. This is not only true for its gross and microscopic anatomy and physiology, but also for its microbiology. To the microbiologist, the vulva consists of several distinct ecotopes. These are defined by the physical factors, especially occlusion, nutrient factors, and by the close proximity to the vagina, the urethra, and the anus, which may result in contamination with the flora typical for those sites. Of the vulva ecotopes, only the labia majora have been seriously studied. The microbial flora of the labia majora is characterized by a high density of microorganisms, as is typical for occluded areas of the body, by the presence of organisms common for intertriginous skin such as gram-negative rods, and by the carriage of organisms unique for the vulva and probably related to urethral and vaginal flora such as the nonpathogenic neisseria, lactobacilli, and Gardnerella vaginalis. Finally, the labia majora skin is a preferred site of Staphylococcus aureus carriage that can be of clinical and epidemiological relevance.
In a retrospective study, the efficacy of tetracycline therapy was assessed in 48 men with non-gonococcal urethritis who only harbored Ureaplasma urealyticum in their urethras. After 2 weeks of therapy with 2.0 g oxytetracycline per day, U. urealyticum was still found in the urethra of 8 patients (17%). Urethritis was still present in 8 patients (17%) according to clinical criteria and in 11 patients (23%) according to microscopic findings. The persistence of U. urealyticum in the urethra did not correlate with the persistence of urethritis to a statistically significant degree. Therapy compliance, antibiotic resistance in a few cases, reinfections in 2 cases and a special host-parasite relationship are discussed with respect to the treatment failures.
Using noninvasive bioengineering skin technology, the vulvar skin has been partially characterized as having unique properties. The reduction in stratum corneum barrier function and the increase in basal blood flow in the vulvar skin may explain the high rate of percutaneous absorption and the increased reactivity to irritants. The vulvar microbial flora represents a unique combination of contaminants from the vagina and the perianal area and a resident flora that is typical for intertriginous skin, together with a high carrier rate of Staphylococcus aureus. The long-term goal of vulvar physiology is to understand better how this more specialized skin differs from less specialized areas in the hope of using this information clinically.
Explore the source record for details and available documents.
In a prospective study, urethral swabs were taken from 544 men presented to an STD clinic, 118 with and 426 without urethritis, and examined by microscope and/or culture for G. vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum, Mycoplasma hominis, Candida species and Trichomonas vaginalis. G. vaginalis was isolated from 4.2% of the males with urethritis and from 6.3% of those without urethritis. Using loglinear analysis, the following associations were significant (p less than 0.05): three-way: G. vaginalis, U. urealyticum, C. trachomatis; two-way: G. vaginalis, U. urealyticum and G. vaginalis, M. hominis and U. urealyticum, M. hominis. It is concluded that G. vaginalis is associated with genital mycoplasmas not only in the female, but also in the male urogenital tract.
Tetracyclines and erythromycin are the chemotherapeutic agents most often used in the Federal Republic of Germany for eradication of U. urealyticum from the male urogenital tract. Few data on current susceptibility in the FRG are available. Therefore, we investigated the minimal inhibitory concentration (MIC) values of 10 chemotherapeutic agents against 27 isolates from the male urethra and 4 ATCC strains of U. urealyticum by a micro broth dilution method using a modified U-9 medium. The MIC90 values (microgram/ml) of the chemotherapeutic agents tested were as follows: minocycline-0.25, doxycycline-1.0, tetracycline and chlortetracycline-2.0, erythromycin and streptomycin-4.0, chloramphenicol, gentamicin, rosoxacin-8.0, spectinomycin-32.0. According to the blood levels attained in treatment, the chemotherapeutic agents can be divided into three groups based on the MIC90-values, i.e. sensitive: chloramphenicol, doxycycline, minocycline and streptomycin; weakly effective: chlortetracycline, tetracycline, spectinomycin and erythromycin; and resistant: gentamicin and rosoxacin.
The aim of the study was to investigate the antimicrobial longterm efficacy of the combined application of an anionic detergent (Dermofug) either with 50 v/v% isopropanol or FABRY's tincture (3 w/v% salicylic acid, 1 v/v% liquefied phenol containing 50 v/v% isopropanol) on the resident flora of the human forehead skin after repeated applications using the forehead skin test. The test results show that both combinations tested are able to penetrate the infrainfundibulum of the sebaceous glands. The combined application of 10 v/v% Dermofug solution (D) and FABRY's tincture (F) showed better antibacterial efficacy than the combination of D and 50 v/v% isopropanol (I) against the coagulase-negative-staphylococci in the stratum corneum/acroinfundibulum as well as in the infrainfundibulum of the sebaceous glands. Against Propionibacterium spp., D and F showed better efficacy than D and I in the stratum corneum/acroinfundibulum, and equal efficacy in the infrainfundibulum of the sebaceous glands. It remains to be clarified in further investigations, which of the components of FABRY's tincture leads to the better antibacterial efficacy of the combined application of D and F in comparison to D and I, the salicylic acid or the phenol acid component.
Using the forehead skin test, we investigated the combined application of 10 v/v% Dermofug solution and 3 w/v% salicylic acid tincture or 1 v/v% phenol acid tincture. The former combination showed better antibacterial efficacy against the coagulase-negative staphylococci and Propionibacterium spp. in the stratum corneum/acroinfundibulum as well as in the infrainfundibulum of the sebaceous glands. No antibacterial efficacy could be determined against Propionibacterium spp. in the infrainfundibulum of the sebaceous glands after the combined application of Dermofug solution and 1 v/v% phenol acid tincture. In contrast, the combined application of Dermofug solution and 3 w/v% salicylic acid tincture led to a long-term reduction of the cfu-counts of Propionibacterium spp. in the infrainfundibulum of the sebaceous glands. The following conclusions can be drawn from our study and applied to external therapy: a detergent like Dermofug should be used instead of an alcohol to enhance the penetration of a drug into the infrainfundibulum of the sebaceous glands, since the former can block the growth of Propionibacterium spp. in the infrainfundibulum. Secondly, it should be kept in mind that the addition of salicylic acid to a topical antibiotic ointment does not only enhance the penetration of the antibiotic into the infrainfundibulum of the sebacous glands, but that the antibacterial effect of the salicylic acid itself may be the reason for the better clinical antibacterial efficacy of such combinations.