Biomedical subjects

R M Szeimies

Publications and source records attributed to R M Szeimies.

At least 19 recordsLinked to original sources

PubMed2006

Towards a more specific therapy: targeting nonmelanoma skin cancer cells.

Epithelial cancers of the skin, e.g. basal cell carcinoma and squamous cell carcinoma, are the most common tumours in humans with increasing incidence. Hence the development of new therapeutic strategies is of utmost interest. For many years the most often used conventional therapies for these diseases were surgical procedures such as curettage and electrodesiccation, excision or, with so far the best outcome in terms of remission rates, micrographic surgery. Other ablative treatment modalities are cryotherapy, radiation therapy or the use of lasers (Er:YAG, CO(2)). All those above-mentioned treatments have in common that they are quite unspecific and do not target the tumour itself or its environment, thus leading to unwanted effects in the surrounding tissue such as scar formation or other cosmetically disfiguring events. Therefore, the development of novel, more pathogenesis-based therapies such as the use of retinoids, cyclooxygenase inhibitors, topical immunomodulators, inhibitors of the sonic-hedgehog signalling pathway or photodynamic therapy are challenging new approaches.

Basal Cell Carcinoma↗

PubMed2006

Disappointing results and low tolerability of photodynamic therapy with topical 5-aminolaevulinic acid in psoriasis. A randomized, double-blind phase I/II study.

BACKGROUND: Based on good results in the treatment of superficial skin tumours, since the early 1990s topical photodynamic therapy with aminolaevulinic acid (ALA PDT) has been used for disseminated, inflammatory dermatoses including psoriasis. However, there is still a lack of well-documented trials. OBJECTIVE: A prospective randomized, double-blind phase I/II intrapatient comparison study was conducted in 12 patients to investigate whether topical ALA PDT is an effective treatment for chronic plaque-type psoriasis. METHODS: In each patient three psoriatic plaques were randomly treated with a light dose of 20 J/cm(2) and 0.1%, 1% and 5% ALA, respectively. Treatment was conducted twice a week until complete clearance or for a maximum of 12 irradiations. Therapeutic efficacy was assessed by weekly determination of the psoriasis severity index (PSI). RESULTS: The mean percentage improvement was 37.5%, 45.6% and 51.2% in the 0.1%, 1% and 5% ALA-treated groups, respectively. Irradiation had to be interrupted several times because of severe burning and pain sensation. CONCLUSION: Topical ALA PDT did not prove to be an appropriate treatment option for plaque-type psoriasis due to disappointing clinical efficacy, the time-consuming treatment procedure and its unfavourable adverse event profile.

Administration, Topical↗

PubMed2005

[Tattoos].

Explore the source record for details and available documents.

Adult↗

PubMed2005

Topical aminolaevulinic acid-based photodynamic therapy as a treatment option for psoriasis? Results of a randomized, observer-blinded study.

BACKGROUND: Topical aminolaevulinic acid-based photodynamic therapy (ALA-PDT) has recently been tried in small open studies for several inflammatory dermatoses including psoriasis. OBJECTIVES: The purpose of this randomized, within patient comparison study was to investigate whether topical ALA-based PDT using a range of light doses can induce a satisfactory response in localized psoriasis. PATIENTS AND METHODS: Twenty-nine patients with chronic plaque type psoriasis were enrolled in the study. After keratolytic pretreatment three psoriatic plaques in each patient were randomly allocated to PDT with 1% ALA and a light dose of 5 J cm(-2), 10 J cm(-2) or 20 J cm(-2), respectively. Treatment was performed twice weekly until complete clearance or for a maximum of 12 irradiations. As a measure of clinical response the psoriasis severity index (PSI) of the three target plaques was assessed separately by an observer blinded to the treatment at baseline, before each PDT treatment and 3-4 days after the last irradiation. RESULTS: Eight patients withdrew prematurely from the study. Keratolytic pretreatment alone reduced the baseline PSI in all three dose groups by about 25%. Subsequent PDT with 20 J cm(-2) resulted in a final reduction of PSI by 59%, PDT with the lower doses of 10 J cm(-2) and 5 J cm(-2) decreased the baseline PSI by 46% and 49%, respectively. The difference in clinical efficacy between 20 J cm(-2) and 10 J cm(-2) or 5 J cm(-2) was statistically significant (P = 0.003; P = 0.02), whereas no difference was found between 10 J cm(-2) and 5 J cm(-2) (P = 0.4). All patients reported some degree of PDT-induced stinging or burning during irradiation. CONCLUSIONS: The unsatisfactory clinical response and frequent occurrence of pain during and after irradiation renders topical ALA-based PDT an inadequate treatment option for psoriasis.

Adult↗

PubMed2005

Management of erosive lichen planus with topical tacrolimus and recurrence secondary to metoprolol.

Metoprolol, a widely prescribed beta-adrenergic receptor blocker, has occasionally been associated with a diversity of cutaneous reactions. We present a 79-year-old male patient with erosive lichen planus (LP) on the feet and hands who was successfully treated with topical tacrolimus. Six months after the lesions had been cured the patient received the beta-receptor blocker metoprolol for the treatment of hypertonus. Within only 2 weeks of metoprolol intake the erosive lesions on the palms and feet recurred. After discontinuation of the drug and repetitive topical treatment with tacrolimus a complete remission of the lesions could be achieved. The recurrence of erosive LP probably secondary to metoprolol and the therapeutic success of topical tacrolimus in the treatment of LP are discussed.

Administration, Topical↗

PubMed2004

Early detection of skin cancer (EDISCIM) through the use of non-invasive confocal imaging.

In the past 15 years the number of malignant melanomas and non-melanoma skin cancer, (i.e. squamous cell carcinoma, basal cell carcinoma), have increased dramatically throughout the whole world, in particular among people with white skin. For example, in Germany the number of new cases of melanoma is about 10 to 12 per 100,000 people, (for basal cell carcinoma as a non-melanoma skin cancer 140 per 100,000), the absolute number of annual new cases of melanoma is an estimated 9,000 to 10,000, and the increasing rate is 5 to 10%. However, there are more than 40 differential diagnoses for skin cancer which makes it difficult even for expert dermatologists to give correct diagnosis, (estimated 75% correct diagnoses). This figure is even worse for doctors from other specialities. There is only a chance of high cure rates when skin tumours are detected at an early stage. The prognosis of skin cancer is dependent very much on the thickness, (as a sign of invasiveness), of the tumour and the number of mitotic figures in the tumour, (as a sign of proliferation activity). However, the final diagnosis of skin cancer is usually done by biopsy, the sample being investigated by a specialist. This is an invasive method, which is painful for the patient and might require several cuts and samples taken before being absolutely certain. Due to the potential risk of dissemination of tumour cells, taking an incisional biopsy is obsolete in malignant melanoma. Therefore the correct diagnosis of malignant melanoma can be made only after a total removal of the lesion and consecutive histopathological examination. The EDISCIM project intends to develop a system for the early diagnosis of skin cancer which uses confocal imaging for the non-invasive diagnosis of the upper layers of the skin that aids the physician in the analysis of the images and therefore with the diagnosis, allows for potential remote diagnosis by specialist dermatologists via tele-diagnosis if need be. The objectives of the system are Captures microscopic images of the skin by confocal imaging, Processes and records these images in real time, Compares these images against a knowledge base of known skin symptoms, Displays the results in a suitable interface to the physician performing the diagnosis, And supports the online telematic support by specialists.

Animals↗

PubMed2002

[Cutaneous microdialysis. Use in dermatology].

The determination of concentrations of exogenous or endogenous substances in the dermis, e.g. for pharmacokinetic studies, is technically difficult. Performing skin biopsies or inducing suction blisters results in the disintegration of the tissue and allows only single measurements. Recently, cutaneous microdialysis, a new simple and minimally invasive technique for continuously measuring of substances in the dermis in vivo, has been introduced in dermatological research. According to the principle of dialysis, a semipermeable membrane is inserted in the dermis and due to a concentration gradient between the interstitial space and a perfusate, substances diffuse through the pores of the membrane and can be analyzed in the dialysate. Cutaneous microdialysis represents a useful technique for pharmacokinetic or pharmacodynamic studies as well as for investigations regarding cutaneous physiology and pathophysiology.

Biological Availability↗

PubMed2002

Photodynamic therapy using topical methyl 5-aminolevulinate compared with cryotherapy for actinic keratosis: A prospective, randomized study.

BACKGROUND: Actinic keratoses (AKs) are the most common premalignant tumors. Without treatment, a significant number of patients with AK will experience squamous cell carcinoma. Photodynamic therapy (PDT) using the new highly selective photosensitizer methyl 5-aminolevulinate is a promising new treatment modality for AK. OBJECTIVE: We investigated the complete response rates, cosmetic outcome, and patient satisfaction after photodynamic therapy (PDT) using methyl 5-aminolevulinate (Metvix) versus cryotherapy in the treatment of AKs. METHODS: Patients were randomized to receive either cryotherapy with liquid nitrogen spray or PDT using methyl 5-aminolevulinate cream 160 mg/g, 3 hours application time, and red light (75 J/cm(2)). RESULTS: Efficacy results from 193 patients with 699 lesions (92% face/scalp and 93% thin/moderately thick) were analyzed. Overall complete response rates after 3 months were 69% for PDT and 75% for cryotherapy. Both treatments gave higher response rates in thin lesions (PDT 75%, cryotherapy 80%). PDT gave better cosmetic results and higher patient satisfaction than cryotherapy. CONCLUSION: PDT using methyl 5-aminolevulinate is an attractive treatment option for patients with AK, with a response rate similar to that of cryotherapy, but with superior cosmetic results and high patient satisfaction.

Administration, Topical↗

PubMed2001

[Cutaneous manifestations of graft-versus-host disease].

Graft-versus-host disease (GvHD) is a severe complication of allogeneic stem cell transplantation. GvHD can arise at various time points: acute GvHD occurs during the first 100 days after transplantation in up to 50% of graft recipients. Chronic GvHD develops less frequently in about 30% after the 3rd month following transplantation involving the skin, the liver, the gastrointestinal tract, the eyes, and the neuromuscular apparatus. Early diagnosis of GvHD can be difficult, as drug reactions, viral infections and cutaneous reactions to radiation therapy may have clinical and histological similarities. In this review, the various cutaneous manifestations of GvHD, the histopathologic features, prophylaxis, and therapies of acute and chronic GvHD are discussed according to the recent literature.

Diagnosis, Differential↗

PubMed2001

[Paraneoplastic Bazex acrokeratosis in adenocarcinoma of the stomach].

HISTORY AND EXAMINATION: A 58-year-old man presented with a sudden eruption of hyperkeratoses on hands and feet. Alcohol abuse had been present 10 years ago, together with a gastric ulcer. Physical examination was unremarkable, except for plantar bizarre hyperkeratoses especially at the sides of the feet as well as some rhagades with spread to the dorsum of the toes. Similar but less severe hyperkeratoses were found on the palms. INVESTIGATIONS: Laboratory investigation was essentially normal. X-rays of the thorax and sinuses as well as a sonography of the stomach revealed, except for a fatty liver, no pathological findings. Gastroscopy revealed a chronic active gastritis on the small curvature of the stomach. Only a second gastroscopy and biopsy revealed an adenocarcinoma of the stomach. DIAGNOSIS, THERAPY AND COURSE: According to the clinical presentation a paraneoplastic acrokeratosis (Bazex syndrome) was diagnosed. The patient was given high-dose chemotherapy with subsequent stem-cell transplantation and gastrectomy. The skin problems resolved after the first cycles of chemotherapy. CONCLUSION: If clinically a paraneoplastic acrokeratosis is suspected extensive search for a malignancy has to be initiated, including a gastroscopy, because rarely, but as in the present case, a carcinoma of the stomach can be the underlying cause.

Adenocarcinoma↗

PubMed2001

[Photochemotherapy of cutaneous AIDS-associated Kaposi sarcoma with indocyanine green and laser light].

BACKGROUND AND OBJECTIVE: Indocyanine green (ICG) is a clinically approved dye for diagnostic purposes, which has an absorption peak in the near infrared and remains intravascular due to a high plasma protein binding. Its therapeutic potential in combination with a diode laser was studied for well vascularized cutaneous tumors. PATIENTS/METHODS: Six male patients (mean age 49.2 years) with AIDS-related Kaposi sarcomas (n = 30) received ICG (2 x 2 mg/kg i.v.) followed directly by irradiation with a diode laser (lambda = 805 nm, 100 J/cm2, 3 W/cm2). RESULTS: All macular and plaque-type lesions (n = 27) showed primarily blister- and crust formation and healed within 14 days. Only one out of the 3 nodular lesions treated showed complete remission. The only side effect recognized was a mild burning sensation during irradiation. Nineteen lesions resolved completely leaving a slight atrophic scar, in three lesions a transient postinflammatory hyperpigmentation occurred. Within the follow-up period of 2 years no recurrence was detected. CONCLUSIONS: The ICG-mediated photochemotherapy is an effective palliative therapeutic modality with a low rate of side effects in the treatment of macular or plaque-type cutaneous Kaposi sarcomas.

Acquired Immunodeficiency Syndrome↗

PubMed2001

[Treatment of therapy refractory verrucae vulgares with a ciclopirox-containing lacquer].

BACKGROUND AND OBJECTIVE: Anti-inflammatory actions of ciclopirox, an antifungal agent, have been described previously. We assessed the effectiveness of ciclopirox in the treatment of viral warts. PATIENTS/METHODS: Twenty-three immunocompetent patients (age 9-61 years) with common warts at the hands, feet and in the face resistant to conventional therapy were treated. Following keratolysis with a salicylic acid-containing patch, an 8% ciclopirox lacquer was applied 1-2 times daily. At the beginning and the end of the treatment lesions were photographed and the time span (minimum 4 weeks) until complete resolution was documented. RESULTS: In 7 patients complete remission, and in 12 patients partial remission was achieved. Only 4 patients did not show any effect under topical ciclopirox treatment (mean duration of therapy 3.2 +/- 2.1 months). The overall response rate was 82.6%. Local side effects like erythema or pruritus were not reported. CONCLUSION: Our data suggest that a ciclopirox lacquer may be helpful in the treatment of common warts. However, the data have to be confirmed in a randomized controlled trial in the future.

Administration, Topical↗

PubMed2001

Endoscopic fluorescence detection of low and high grade dysplasia in Barrett's oesophagus using systemic or local 5-aminolaevulinic acid sensitisation.

BACKGROUND AND AIMS: Barrett's oesophagus is associated with an increased risk of cancer. As dysplasia is not visible during routine endoscopy, random biopsies in the four quadrants every 1-2 cm are recommended. Endoscopic fluorescence detection (EFD) after sensitisation with 5-aminolaevulinic acid (5-ALA) with different modes and concentrations was assessed to optimise the technique for detection of dysplasia or early cancers. 5-ALA is converted intracellularly to protoporphyrin IX which accumulates in malignant tissue and can be detected by typical red fluorescence after illumination with blue light. METHODS: In 47 patients with Barrett's oesophagus, 10 with known dysplasia, 58 fluorescence endoscopies were performed after sensitisation with different concentrations of 5-ALA given orally (5, 10, 20, 30 mg/kg) or locally (500-1000 mg) by spraying the mucosa via a catheter. EFD was performed 4-6 hours after systemic and 1-2 hours after local sensitisation using a special light source delivering white or blue light. A total of 243 biopsies of red fluorescent (n=113) and non-fluorescent areas (n=130) were taken. RESULTS: In three patients, two early cancers and dysplasia, not visible during routine endoscopy, were detected by EFD. Thirty three biopsies revealed either low or high grade dysplasia. Sensitivity for detection of dysplastic lesions ranged from 60% after local sensitisation with 500 mg to 80%, 100%, and 100% after systemic application of 5-ALA 10, 20, and 30 mg/kg, respectively. However, specificity was best for local sensitisation (70%) while systemic administration revealed values between 27% and 56%. Using 5 mg/kg, no red fluorescence in dysplastic lesions was found. No severe side effects were noted. CONCLUSION: EFD is a promising tool to detect non-visible dysplastic lesions in Barrett's oesophagus using 5-ALA sensitisation. A randomised controlled study is now indicated to compare the efficacy of EFD with the standard technique of four quadrant random biopsies.

Administration, Oral↗

PubMed2001

Phototherapy of psoriasis: comparative experience of different phototherapeutic approaches.

BACKGROUND: Broad-band UVB alone or in combination with different topical drugs (anthralin, calcipotriol), systemic PUVA and bath-PUVA therapy are very effective and well-established treatment modalities for psoriasis. OBJECTIVE: The aim of this retrospective study was to assess which of these routinely applied phototherapeutic modalities might be most effective and safe for the treatment of plaque-type psoriasis. METHODS: Patients (n = 203) with moderate to severe (pretreatment Psoriasis Area and Severity Index score between 12 and 35) chronic plaque-type psoriasis treated between 1992 and 1998 at our department with either UVB (with/without anthralin or calcipotriol; n = 97), systemic PUVA (n = 19) or bath-PUVA therapy (n = 87) were evaluated for efficacy, duration of treatment, number of treatments necessary for complete remission (CR), cumulative light dose, side effects of therapy and duration of remission after therapy. RESULTS: No statistically significant difference comparing the efficacy of bath-PUVA (CR in 72.4%), PUVA (CR in 89.5%) and UVB phototherapy (CR in 69.1%) was found. Although the duration of therapy was significantly longer for bath-PUVA (66 +/- 42 days) as compared to UVB treatment (50 +/- 27 days), the mean number of treatments did not differ significantly between bath-PUVA (28 +/- 12), UVB therapy (30 +/- 12) and PUVA (26 +/- 13). Significantly fewer side effects of phototherapy were observed with bath-PUVA (14.9%) therapy compared to UVB treatment (30.9%). Also, the duration of remission after successful therapy was significantly longer for bath-PUVA (8.4 +/- 3.5 months) as compared to UVB phototherapy (5.1 +/- 4.2 months). CONCLUSION: Bath-PUVA therapy has some advantages over UVB phototherapy in the treatment of psoriasis: fewer UV-related acute side effects and a longer period of remission after therapy. However, the choice of treatment with either UVB, bath-PUVA or systemic PUVA should also be based on a history of previous response to treatment and patient considerations, including compliance and responsibility for following the precautions to avoid potential side effects.

Administration, Topical↗

PubMed2001

Role of lasers and photodynamic therapy in the treatment of cutaneous malignancy.

Tumor therapy is not a common indication for the use of lasers, as it is in the treatment of benign vascular skin lesions, since many alternative treatment modalities exist. However, certain patients may benefit from laser therapy of premalignant and malignant skin tumors. Skin tumors can be treated by laser excision, laser coagulation, laser vaporization, or photodynamic therapy (PDT). For these purposes, the carbon dioxide laser, the neodymium:yttrium aluminum garnet laser and the argon laser are particularly suitable. PDT is a therapeutic approach based on the photosensitization of the target tissue by topical or systemic photosensitizers and subsequent irradiation with light from a laser or a lamp inducing cell death via generation of reactive oxygen species. Laser therapy and PDT have shown good results in the curative treatment of actinic keratoses, superficial basal cell carcinoma, Bowen's disease and cheilitis actinica. However, they are not recommended for primary malignant melanoma and invasive squamous cell carcinoma. In some patients, lasers and PDT might also be used effectively for the palliative treatment of cutaneous metastases. In selected patients, lasers and PDT may offer some advantages over routine procedures, e.g. reduction of scarring and better cosmetic results. However, when treating invasive tumors with curative intention, one has to bear in mind the lack of histologic control and the limited depth of tissue penetration of most laser and PDT therapies.

Aged↗

PubMed2001

[Truss-induced macular amyloidosis].

A 80-year-old male presented with a long time history of a localized red-brown macule with superficial lichenification and slight scaling in the right groin. An earlier skin biopsy revealed the presence of amyloid deposits. The patient therefore had a complete internal checkup including a rectal biopsy for exclusion of systemic amyloidosis. However, the laboratory data did not reveal any specific abnormalities including immunoglobulins and Bence-Jones protein. The rectal biopsy was also nonspecific. After skin examination, a rebiopsy was performed at our department showing acanthosis and spongiosis of the epidermis with parakeratosis. A homogenous eosinophilic deposit was present in the upper dermis and stained positive with thioflavine. At the second visit the patient wore a truss for a right inguinal hernia, perfectly matching the area of the skin lesion. Thus, the diagnosis of a localized macular amyloidosis was confirmed very likely due to permanent local friction. The classification of localized cutaneous amyloidoses should include local trauma as a cause to avoid unnecessary and exhausting internal checkups to exclude systemic involvement.

Aged↗

PubMed2000

[Therapy of onychomycosis].

BACKGROUND: Considering the increased rate of mycotic infections of the nail, various concepts in the treatment of onychomycosis have been developed looking for a successful therapeutic approach. AIMS: An overview of the actual standards of topic and systemic treatment of onychomycosis depending on clinical findings, classification of onychomycosis and type of fungus will be presented. RESULTS: Topical urea and bifonazole therapy was available in the past as well as systemic antimycotic therapy with just griseofulvin or ketoconazole. Nowadays a different spectrum of easily applicable, safe and effective therapeutic measures is on the physician's hands. Besides topical therapy with ciclopirox and amorolfine oral treatment with itraconazole, terbinafine and fluconazole is available. Combination therapy of terbinafine orally in addition with topical application of ciclopirox may possibly optimize the therapeutic approach considering the respective response rates however, no clinical study evaluating this hypothesis has been performed so far.

Administration, Oral↗

PubMed2000

[Ectopic parotid tissue. An usual differential cervical cystic tumor diagnosis].

Cystic tumors of the neck are usually cysts, inflammatory masses, lymph nodes, benign and malignant tumors or metastases. Malformations are less common. Ectopic salivary tissue is a rather rare but clinically important malformation. Accessory and aberrant tissue can be identified histologically. There may be an association with lymphatic tissue. Possible complications include inflammation as well as the development of benign and in rare cases malignant salivary gland tumors. We report on two patients who underwent surgical treatment under the tentative diagnosis of epidermal cysts which histologically turned out to be ectopic parotid tissue.

Adult↗