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Thilo Gambichler

Publications and source records attributed to Thilo Gambichler.

49 records · Page 3Linked to original sources
PubMed2002

Histometric data obtained by in vivo confocal laser scanning microscopy in patients with systemic sclerosis.

BACKGROUND: It would be a benefit if time-saving, non-invasive methods could give hints for diagnosing systemic sclerosis. To investigate the skin of patients with systemic sclerosis using confocal laser scanning microscopy in vivo and to develop histometric parameters to describe characteristic cutaneous changes of systemic sclerosis observed by this new technique, we conducted an exploratory study. MATERIALS AND METHODS: Fifteen patients with systemic sclerosis treated with extracorporal photopheresis were compared with 15 healthy volunteers and 10 patients with other disorders also treated with extracorporal photopheresis. All subjects were investigated using confocal laser scanning microscopy in vivo. RESULTS: Micromorphologic characteristics of skin of patients with systemic sclerosis and measuring parameters for melanisation, epidermal hypotrophy, and fibrosis for dislocation of capillaries by collagen deposits in the papillary dermis were evaluated. An interesting finding was an increased thickness of the tissue in the dermal papillae superior to the first dermal papilla vessel. It was also possible to reproduce characteristic histologic features by confocal laser scanning microscopy in vivo. Histometric parameters for fibrosis and vascular features developed in this study showed significant differences in patients with systemic sclerosis compared to controls. CONCLUSIONS: Although the predominant histopathological features in systemic sclerosis are findings of the reticular dermis and the subcutis, and in histopathological investigation the epidermis seems to remain unaffected by the disease, we have demonstrate some characteristic differences in the epidermis and papillary dermis by confocal laser scanning microscopy in vivo. Some of them have not been described so far. However, to use this technique as a tool for diagnosis and/or staging of systemic sclerosis, further studies are needed investigating the sensitivity and specificity of the histometric parameters developed in this study.

Adult↗
PubMed2002

Impact of UVA exposure on psychological parameters and circulating serotonin and melatonin.

BACKGROUND: People tend to feel better after exposure to ultraviolet (UV) radiation. This study was performed to investigate the impact of UVA exposure on psychological and neuroendocrine parameters. METHODS: Fifty-three volunteers were separated into 42 individuals who had UVA exposure and 11 individuals who had no UVA exposure. The UVA-exposed volunteers had irradiation sessions six times in a three-week period. All volunteers completed two questionnaires at baseline (T1) and at the end of the study (T3). For the determination of serotonin and melatonin serum levels of all volunteers blood samples were collected at baseline (T1), after the first UVA exposure (T2), and at the end of the study after the sixth exposure (T3). RESULTS: UVA-exposed volunteers felt significantly more balanced, less nervous, more strengthened, and more satisfied with their appearance at T3. By contrast, the controls did not show significant changes of psychological parameters. In comparison to T1 and T3, serum serotonin was significantly higher and the serum melatonin was significantly lower for the volunteers exposed to UVA at T2. Both, for exposed and non-exposed volunteers serotonin and melatonin levels did not significantly differ at T1 and T3. CONCLUSIONS: It remains obscure, whether the exposure to UVA or other components of the treatment were responsible for the psychological benefits observed. The changes of circulating neuroendocrine mediators found after UVA exposure at T2 may be due to an UVA-induced effect via a cutaneous pathway. Nevertheless, the positive psychological effects observed in our study cannot be attributed to circulating serotonin or melatonin.

Humans↗
PubMed2002

Treatment of disseminated granuloma annulare with fumaric acid esters.

BACKGROUND: Granuloma annulare is a granulomatous disease of unknown etiology. Various therapies have been tried in disseminated granuloma annulare (DGA), including corticosteroids, several variants of psoralen plus ultraviolet-A radiation, ultraviolet- A1 radiation, systemic retinoids, and dapsone, with variable success. We report a patient with recalcitrant DGA who was treated with fumaric acid esters (FAE). CASE PRESENTATION: A 40-year old Caucasian woman presented with a 25-year history of recalcitrant DGA. On both legs and the abdomen there were erythematous annular plaques. She was treated with FAE in tablet form using two formulations differing in strength (low strength tablets: 30 mg dimethylfumarate, 67 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt; high strength tablets: 120 mg dimethylfumarate, 87 mg monoethylfumarate Ca salt, 5 mg monoethylfumarate Mg salt, 3 mg monoethylfumarate Zn salt). After three-month therapy, an almost complete clearance of skin lesions was achieved. With the exception of temporary lymphopenia, no adverse effects were observed. The patient remained in remission during a six-month follow up period. CONCLUSIONS: Our observation has demonstrated that FAE is a potentially beneficial therapeutic option for patients with recalcitrant DGA. However controlled trials are necessary to fully explore the efficacy, optimal dosage, and safety of FAE in the management of DGA.

Adult↗
PubMed2002

Role of clothes in sun protection.

Ultraviolet (UV) radiation is the carcinogenic factor in sunlight. Damage to skin cells from repeated UV exposure can lead to the development of skin cancer. Apart from avoidance of the sun, the most frequently used form of UV protection has been the application of sunscreens. The use of textiles as a means of sun protection has been underrated in previous educational campaigns, even though suitable clothing offers usually simple and effective broadband protection against the sun. Apart from skin cancer formation, exacerbation of photosensitive disorders and premature skin aging could be prevented by suitable UV-protective clothing. Nevertheless, several studies have recently shown that, contrary to popular opinion, some textiles provide only limited UV protection. It has been found that one-third of commercial summer clothing items provide a UV protection factor (UPF) less than 15. Given the increasing interest in sun protection, recreationally and occupationally, test methods and a rating scheme for clothing were needed that would ensure sufficient UV protection. Various textile parameters have an influence on the UPF of a finished garment. Important parameters are the fabric porosity, type, color, weight and thickness. The application of UV absorbers into the yarns significantly improves the UPF of a garment. Under the conditions of wear and use several factors can alter the UV-protective properties of a textile, e.g., stretch, wetness and laundering. The use of UV-blocking cloths can provide excellent protection against the hazards of sunlight; this is especially true for garments manufactured as UV-protective clothing. However, further educational efforts are necessary to change people's sun behavior and raise awareness for the use of adequate sun-protective clothing.

Humans↗
PubMed2002

Comparison of methods: determination of UV protection of clothing.

Based on spectrophotometric measurements and mathematical calculations, the ultraviolet (UV) protection factor of a textile is determined in vitro. This technique is the most established test method for the determination of UV protection of a garment. However, the validity and practicality of the in vitro UV protection factor (UPF) determined in the laboratory has been a controversial issue with regard to its significance in the field. Several studies have verified the in vitro UPF by comparing it with various in vivo test protocols using solar-simulated radiation for the determination of the minimal erythema dose. The data inconsistency between these studies is certainly due to different methodology. Furthermore, UV dosimetry is a suitable method for quantifying UV transmission through a garment. Chemical dosimeters (e.g. polysulfone films) and biological UV detector films have been used in in vivo-simulated studies in the form of small portable badges monitoring solar UV transmittance through garments on manikins and mobile subjects. As sunlight consists to a considerable extent of diffuse radiation, which is more scattered and absorbed by the fabric than direct radiation, UPF values obtained by measurements in real exposure situations are usually higher than those obtained by conventional in vitro and in vivo testing with collimated radiation beams. Thus the discrepancy between laboratory-based testing and field-based measurements may be due to different radiation geometry of UV sources. Taken together, the in vitro method is the most practicable and inexpensive method for routine measurements of UPF, but dosimetry seems to be a highly useful method for determining the UPF in real exposure situations.

Materials Testing↗
PubMed2002

Ultraviolet protection factor of fabrics: comparison of laboratory and field-based measurements.

BACKGROUND/PURPOSE: Spectrophotometry has become an accepted laboratory-based method for the determination of the ultraviolet protection factor (UPF) of fabrics. However, the validity of the UPF determined in the laboratory has been a controversial issue with regard to its significance in the field. To compare UPF values obtained by spectrophotometry, determination of the minimal erythema dose (MED), and biological dosimetry, we conducted laboratory and field-based measurements on various fabric materials. METHODS: One cotton, two viscose, and two polyester fabrics were enrolled into the study. Spectrophotometric (SP) testing was performed in accordance with the European standard. In vivo "on skin" (IV) testing on human subjects was performed with and without fabric protection. For determination of MED, a solar-simulator was used. In another part of the study, biological dosimetry (BD) testing was employed for laboratory testing with solar-simulated radiation (laboratory BD testing) as well as field-based measurements with natural sunlight in stationary (stationary BD testing) and "real life" exposure situations (mobile subject BD testing). For field-based measurements one light-weight polyester fabric was selected. RESULTS: The differences of the mean UPF values obtained by the laboratory-based methods were significant (MANOVA; P = 0.05), except for fabric no. 2 (MANOVA; P = 0.097). In 4 of the 5 fabrics tested, UPF values obtained by IV testing were significantly lower than those obtained by SP testing (t-test; P = 0.05). In 3 fabrics, SP testing revealed significantly higher UPF values in comparison to laboratory BD testing (t-test; P = 0.05). The differences of UPF values obtained by the laboratory and field-based measurements employed for the light-weight polyester fabric were significant (ANOVA; P = 0.05). In comparison to SP testing (UPF 3.8), stationary BD testing resulted in significantly lower (UPF 3.5) and mobile subject BD testing in a significantly higher UPF of 4.4 (t-test; P = 0.05). The UPF obtained by mobile subject BD testing differed significantly from the UPF obtained by stationary BD testing (t-test; P = 0.05). CONCLUSIONS: Comparison of the presented methods indicates that IV testing generally results in lower UPF values. By contrast BD testing in "real life" exposure situations reveals relatively high UPF values. Although an overestimation of the spectrophotometrically measured UPF has been observed in comparative laboratory testing, UPF values obtained by field-based measurements are in relatively good agreement, or even surpass UPF values obtained by spectrophotometry. It is, therefore, suggested that SP testing provides "safe" UPF values which may be also valid in extreme real exposure situations. Biological UV dosimetry is, however, a promising alternative method for UPF testing: the test is easily performed in realistic exposure situations, the test is relatively inexpensive, and the measurements are valid.

Analysis of Variance↗
PubMed2002

Influence of wetness on the ultraviolet protection factor (UPF) of textiles: in vitro and in vivo measurements.

BACKGROUND/PURPOSE: Clothing is an important product for sunburn protection and skin cancer prevention. The moisture content of a fabric, which can increase during its wearing, may decrease the fabric's capability of protecting the skin from solar UV radiation, that is, lower its UPF (ultraviolet protection factor). Due to limited data about the effect of fabric wetness on UPF, this study was undertaken to investigate the following: (a) the effect of saturating a variety of fabrics with tap water and with salt water on fabric UPF and (b) whether wetted-fabric UPF values reflect only the fact that the fabric is wet during testing or the fact that the skin is hydrated and the fabric is wet. METHODS: For objective a, 69 summer fabrics were spectrophotometrically (in vitro) assessed when "dry" and when saturated with tap and salt water. In vitro UPFs, percent UVA transmission and percent UVB transmission values were calculated from the transmission data. For objective b, 100% cotton and 100% polyester fabrics were tested in vivo to determine in vivo UPF values. The minimal erythema dose (MED) was determined for each of the 12 subjects on unprotected "dry" skin and on "hydrated" unprotected skin. MEDprotected was determined when the subject's skin was covered with "dry" and with saturated fabric. In vivo UPFs were calculated using this data. Student's paired t-tests were used to determine the effect of wetting. RESULTS: With one exception, in vitro UPF values were the same when the fabrics were saturated with tap water and when they were saturated with salt water. However, saturating the fabrics with water had different effects on the UPF, UVA transmission, and UVB transmission values. For linen, viscose and polyester fabrics, UPF significantly increased. For the cotton fabrics and the polyester + TiO2 fabrics, UPF significantly decreased. For the modal + TiO2 fabrics and the polyester crepe + TiO2 fabrics, UPF significantly increased. From the in vivo testing, the MED of the "hydrated unprotected" skin was not different than the MED of "dry unprotected skin." Values obtained from subtracting dry-fabric in vivo UPF values from dry-fabric in vitro values and subtracting wet-fabric in vivo UPF values from wet-fabric in vitro values are not different. CONCLUSION: Fabrics do not need to be tested when saturated with tap and with salt water. Testing fabrics wet and dry should be done, as the effect of saturating fabric on UPF value varies. Fortunately, UPF values for wetted fabrics reveal only the effect of increased moisture content in the fabric and have nothing to do with wetting of the skin by the fabric.

Adult↗
PubMed2002

Age related changes of human skin investigated with histometric measurements by confocal laser scanning microscopy in vivo.

BACKGROUND/AIMS: The confocal laser scanning microscope Vivascope (Lucid, Henrietta) allows skin to be studied in real-time with a resolution of 0.5 microm horizontal and 1.3 microm vertical in vivo. In this study, we present the results of a comparison between the skin of an older and a younger group of volunteers by in vivo histometric measurements. METHODS: To investigate changes caused by age, 13 young (18-25years) and 13 older (>65years) volunteers were examined. The following parameters were measured using the Vivascope at the volar forearm: minimal thickness of the epidermis (E(min)), size of cells in the granular layer (A(gran)), thickness of the horny layer (DSC), thickness of the basal layer (DSB) and number of dermal papillae per area (Papl). The image analysis program image tool was used to measure the size of the cells and the thickness of the basal layer. RESULTS: The older group of volunteers showed a significant increase in E(min), no significant change in DSC, a significant decrease in dermal papillae and in the thickness of the basal layer, and an increase in A(gran) compared to the younger group. CONCLUSIONS: Histometric measurements by in vivo confocal laser scanning microscopy are a sensitive and non-invasive tool for characterizing and quantifying histological changes of the epidermis and papillary dermis due to ageing.

Adolescent↗
PubMed2002

Low-dose ultraviolet A1 phototherapy for extragenital lichen sclerosus: results of a preliminary study.

BACKGROUND: Lichen sclerosus (LS) is a chronic inflammatory skin disease in which numerous therapies have been used, with only limited success. Because low-dose UVA1 phototherapy has been shown to be an effective treatment option for localized scleroderma, which shares several similar clinical and histologic features with LS, we initiated a clinical trial with this phototherapeutic modality in patients with LS. METHODS: Ten patients suffering from extragenital LS were treated with low-dose UVA1 phototherapy 4 times weekly with single UVA1 doses of 20 J/cm(2). Forty treatment sessions were performed within 10 weeks, resulting in a cumulative UVA1 dose of 800 J/cm(2). RESULTS: Low-dose UVA1 phototherapy resulted in a marked reduction of the clinical score and a significant (P <.05) decrease of ultrasonographically measured skin thickness as well as a highly significant (P <.001) increase of dermal density. The patients reported a remarkable softening and repigmentation of the affected skin. CONCLUSION: Analogous to the treatment results in localized scleroderma, low-dose UVA1 phototherapy seems to be an effective and well-tolerated treatment option for extragenital LS.

Adult↗
PubMedDate not supplied

Comparison of histometric data obtained by optical coherence tomography and routine histology.

There is a lack of systematic investigations comparing optical coherence tomography (OCT) with histology. OCT assessments were performed on the upper back of 16 healthy subjects. Epidermis thickness (ET) was assessed using three methods: first, peak-to-valley analysis of the A-scan (ET-OCT-V); second, manual measurements in the OCT images (ET-OCT-M); third, light microscopic determination using routine histology (ET-Histo). The relationship between the different methods was assessed by means of the Pearson correlation procedure and Bland and Altman plots. We observed a strong correlation between ET-Histo (79.4+/-21.9 microm) and ET-OCT-V (79.2+/-15.5 microm, r=0.77) and ET-OCT-M (82.9+/-15.8 microm, r=0.75), respectively. Bland and Altman plots revealed a bias of -0.19 microm (95% limits of agreement: -27.94 microm to 27.56 microm) for ET-OCT-V versus ET-Histo and a bias of 3.44 microm (95% limits of agreement: -24.9 microm to 31.78 microm) for ET-OCT-M versus ET-Histo. Despite the strong correlation and low bias observed, the 95% limits of agreement demonstrated an unsatisfactory numerical agreement between the two OCT methods and routine histology indicating that these methods cannot be employed interchangeably. Regarding practicability, precision, and indication spectrum, ET-OCT-V and ET-OCT-M are of different clinical value.

Biopsy↗
PubMedDate not supplied

Correlation between clinical scoring of allergic patch test reactions and optical coherence tomography.

Noninvasive imaging techniques might be of particular diagnostic value for studying and monitoring cutaneous inflammatory conditions such as contact dermatitis. We evaluate acute allergic contact dermatitis (AACD) by means of optical coherence tomography (OCT) and correlate the clinical grading of patch test reactions with the findings obtained from OCT. Twenty positive patch test reactions (+, n = 6; ++, n = 7; +++, n = 7) are investigated using a conventional OCT scanner. In comparison to the control sites, OCT of AACD showed pronounced skin folds, thickened and/or disrupted entrance signals, and a significant increase in epidermal thickness. Moreover, clearly demarcated signal-free cavities within the epidermis and considerable reduction of dermal reflectivity are demonstrated by OCT. Notably, the latter findings strongly correlate with the clinical patch test grading. OCT may be a useful tool for visualization of micromorphological features of AACD. However, before OCT can be employed as an objective parameter in grading severity of patch test reactions, larger studies are required that correlate clinical patch test readings and OCT findings with histopathology.

Adult↗
PubMedDate not supplied

A comparative pilot study on ultraviolet-induced skin changes assessed by noninvasive imaging techniques in vivo.

The effects of acute and chronic ultraviolet (UV) on the morphology of human skin have been extensively studied ex vivo by means of histological investigations. However, innovative skin imaging techniques enable visualization of micromorphological structures in vivo. We aimed to perform a correlation study evaluating in vivo dose and time dependent skin changes following solar-simulated irradiation using noninvasive techniques such as optical coherence tomography (OCT) and confocal laser scanning microscopy (CLSM). The forearms of 10 healthy subjects were exposed to 1 minimal erythema dose (MED) and 3 MED of solar-simulated radiation. Noninvasive measurements were performed before and 24 h and 72 h after UV exposures. We demonstrate definite OCT and CLSM findings obtained from UV-exposed skin, including an increase in epidermal thickness (hyperproliferation, acanthosis), a reduction in dermal reflectivity (dermal edema), an increase in brightness of the basal layer (pigmentation), and an increase in vessel diameter within the dermal papillae (vasodilatation). A moderate to strong linear association between the methods employed was observed. In conclusion, noninvasive high-resolution imaging techniques such as OCT and CLSM may be promising tools for photobiological studies aimed at assessing photoadaptive and/or phototoxic processes in vivo. However, larger studies are needed to demonstrate the applicability of the findings presented in this pilot study.

Adult↗