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PubMed2000

[High-mountain climate therapy for skin diseases and allergies-- mode of action, therapeutic results, and immunologic effects].

Dermatological-allergologic climatotherapy is interpreted as a therapy within a specific climate with proven therapeutic benefits, immediate and longterm. Intensive classical dermatological in-patient therapy is combined with specific climatic effects. Primarily, the climate of the high mountains (1560 m) and of the North Sea islands is of proven efficacy for dermatoses and allergic diseases such as atopic dermatitis (neurodermatitis), eczema, psoriasis, T-cell lymphoma, bronchial asthma. Specialized therapeutic utilities exist. Directly influencing climatic factors such as insolation, thermic-hygric and aerosol conditions without or with diminished allergic potency and nonspecific stimulating climate factors change immune functions and effect stabilization. The therapeutic immediate and longterm efficacy of the high mountain climate is proven by excellent follow-up results. Its superiority to the dermatological therapy applied at home is evident. Measurement and analysis of climate efficacy has however proven difficult because of its complexity. The findings of several recent clinical and biochemical studies are presented.

Adaptation, Physiological↗
PubMed1997

[Live epikeratophakia and deep lamellar keratoplasty for I-III stage-specific surgical treatment of keratoconus].

BACKGROUND: Perforating keratoplasty (PKP) for the treatment of keratoconus is a temporary procedure that sacrifices the healthy recipient endothelium. As an alternative to PKP we perform live-epikeratophakia (L-EPI) in keratoconus I-II and deep lamellar keratoplasty (DLKP) in keratoconus II-III. PATIENTS AND METHODS: 20 patients with keratoconus were operated on either with L-EPI for keratoconus I-II (n = 10) or DLKP for keratoconus II-III (n = 10) respectively. In all cases, corneal tissue eligible for corneal transplantation was used. L-EPI: The corneal lenticule was prepared by means of the Barraquer-Krumeich-Swinger (BKS) set. The recipient cornea was trephined to a depth of 0.3 mm with the Guided-Trephine-System (GTS). The incision was extended manually (inner diameter 7.0 mm, outer diameter 9.0 mm). No keratectomy was performed. The lenticule was fixed with a 10 x 0 nylon double-running anti-torque suture (DRA). DLKP: The recipient cornea was trephined with the 8.0 mm GTS to a depth of 0.68 mm. A lamellar removal of the upper layers was performed by hand. After mechanical removal of the graft endothelium, the remaining full thickness donor cornea was sutured into the bed with a 10 x 0 nylon DRA suture. RESULTS: L-EPI: Within this series, there was no disturbance of the healing process. Spherical equivalent and corneal astigmatism remained stable from the first month on. Visual acuity of 20/40 or better was obtained in 40% of the cases at 1 month, 53% at 6 months, and 100% at 1 year and 2 years. We did not observe any late decline of VA. Two patients with kerato-conus borderline stage II did not reach useful VA due to insufficiently reduced pre-existing irregular corneal astigmatism. These patients successfully underwent DLKP at 8 and 10 months respectively. DLKP: Except for 1 case (neurodermatitis), all lenticules remained stable with respect to refraction and radii up to the longest follow-up of 2 years. Starting from the first month on, refraction was stable. Visual acuity of 20/40 or better was reached in 33% of the cases at 1 month, in 56% at 6 months, and in 89% at 1 and 2 years. We did not administer systemic cyclosporine-A in either group. In the lamellar techniques presented, we did not observe any graft rejection. According to corneal topography, corneal astigmatism, spherical equivalent, and keratometry we did not observe any late re-onset of a progression of the cone. CONCLUSION: In patients with keratoconus stage I to III, L-EPI or DLKP appeared to be very useful therapies. Both procedures seem to end progression of the disease and allow to preserve the healthy recipient endothelium. If unsuccessful, either procedure may be repeated. Neither procedure precludes possibly later needed PKP.

Astigmatism↗
PubMed1980

Globular deposits of immunoglobulins and complement in the papillary dermis. Clinical significance.

Globular deposits of immunoglobulins in the papillary dermis have been reported to occur in certain dermatoses, particularly in lichen planus. The clinical correlation of these deposits in 52 skin biopsy specimens reviewed by light and fluorescent microscopy was studied. These cases included five of lichen planus, 24 of lupus erythematosus or related diseases, four of dermatitis herpetiformis, three of drug eruption; two each of bullous pemphigoid, erythema nodosum, porphyria cutanea tarda; one each of vitiligo, pyoderma gangrenosum, neurodermatitis, erythema multiforme, granuloma annulare, vasculitis, epidermolysis bullosa simplex, Rothmund-Thompson syndrome, and four of unspecified dermatoses. Using an arbitrary scale of 1-4 based on the frequency of deposits, 3+ and 4+ deposits were identified in all five cases of lichen planus, as well as in six cases of lupus erythematosus, one of drug eruption, one of bullous pemphigoid, one of erythema nodosum, the vitiligo, vasculitis, and Rothmund-Thompson syndrome cases, and two cases of unspecified dermatoses; other cases showed only 1+ and 2+ deposits. In all five cases of lichen planus, the deposits contained IgM and C3, and in addition, IgA was present in four, IgG and fibrinogen in three. Among non-lichen planus cases, C3 was detected in 11 of 49, and fibrinogen in only four of 49. These findings indicate that globular deposits of Ig in the dermis, though suggestive, are not pathognomonic of lichen planus.

Biopsy↗
PubMed2006

Factors contributing to conductance and outcome of specific immunotherapy: data from the German National Health Interview and Examination Survey 1998.

BACKGROUND: Allergies are an increasingly relevant public health problem. Specific immunotherapy (sIT) is presently the only causal treatment option. This study aimed to assess the frequency and determinants of sIT use and factors associated with treatment outcome. METHODS: A cross-sectional analysis based on data from the German National Health Interview and Examination Survey 1998. RESULTS: 2727 (39.2%) of study participants reported physician-diagnosed allergic disease. Among these, 16.5% (n = 296) stated to have undergone sIT. In this subset 43.4% (n = 129) reported improvement of symptoms, 21.9% (n = 65) had not changed, and 34.6% (n = 102) had discontinued treatment. The majority of patients treated with sIT showed multiple allergic symptoms and sensitisations. Factors significantly correlated with sIT treatment in multivariable analyses included rhinitis, asthma, several sensitisations, higher social status and residence in larger cities. Rhinitis and neurodermatitis were positively, and food allergy was negatively associated with the completion of sIT. No factors predicting improvement due to sIT could retrospectively be identified. CONCLUSION: Treatment with sIT under 'real life' conditions does not exactly follow current clinical guideline recommendations. In addition, patients may be selected for IT by socio-demographic factors. Whether this contributes to considerable discontinuation rates and limited effectiveness as observed here, needs further investigation.

Adult↗
PubMed1999

A case of pre-Sézary syndrome preceded by hand lesions.

Pre-Sézary syndrome is an erythroderma with a chronic course, clinical findings of Sézary syndrome, lymphocytic subepidermal band infiltration at times, and repeated cycles of circulating Sézary cells of less than 1,000 cells/mm3. Duration of the pre-existing skin diseases preceding pre-Sézary erythroderma varies from a few weeks to 20 years. Before the erythroderma develops, these patients are diagnosed with contact dermatitis, neurodermatitis, chronic dermatitis, atopic dermatitis, or asteatotic eczema. Hand lesion also precedes the pre-Sézary erythroderma. This condition has been controlled by three cycles of chemotherapy consisting of vincristine, cytoxan, doxorubicin, and prednisolone. We describe a case of pre-Sézary syndrome preceded by hand lesion and treated with chemotherapy.

Adult↗
PubMed1996

Cutaneous lymphangiectases associated with severe photoaging and topical corticosteroid application.

We report an elderly patient with lymphangiectases arising within skin affected by photoaging, steroid atrophy, and inflammation. Bullous lesions appeared in several sites following a year of topical corticosteroid applications for neurodermatitis. Light and electron microscopy showed that the bullae consisted of dilated lymphatic vessels within the dermis. There was also marked nodular elastosis and attenuation of dermal collagen. We suggest that this patient's lymphangiectases resulted from abnormal structure and function of the dermis due to photoaging and steroid atrophy.

Administration, Topical↗
PubMed1982

International comparison of the prevalence of psychosomatic disorders in schizophrenic patients.

An epidemiological survey was carried out in Montreal (Canada). Plattsburgh (USA) and Lodz (Poland) to test the hypothesis that certain psychosomatic disorders show a low lifetime prevalence in schizophrenic patients (total n = 665). The same method for collection and evaluation of demographic and clinical data was used in order to establish the lifetime prevalence of peptic ulcer (PU), bronchial asthma (BA), neurodermatitis (ND) and rheumatoid arthritis (RA) in the patients as well as in their nuclear families. Low values of lifetime prevalence were found in schizophrenic patients in chronic hospitals as compared with those in general-university hospitals. Similarities were found in age- and sex-related patterns of these psychosomatic disorders in both samples. However, PU showed higher prevalence, and BA, ND and RA showed lower prevalence in the Polish sample.

Adult↗
PubMed1987

Some unexplored regions of psychosomatic medicine.

The history of psychosomatic medicine in the 20th century is predominantly marked by a concern with studies of major diseases (e.g., angina pectoris, bronchial asthma, diabetes mellitus, essential hypertension, neurodermatitis, rheumatoid arthritis, etc.). Traditional physicians also narrowly focus on disease--a trend that began with Morgagni in the 18th century. But disease (defined by structural alterations) is not the only cause of illness and disability. In fact, most persons seeking health care are ill without having a disease. It is only recently that this distinction has been fully made. The various manifestations of ill-health go by a variety of descriptive names--the functional or irritable bowel and hyperventilation syndromes, fibromyositis, psychophysiological, functional and somatoform or somatization disorders. They lead to loss of productivity, cost the health care system excessively, produce negative reactions in physicians, and are fertile ground for iatrogenic disease. They do not constitute discrete syndromes but overlap, each also being closely associated with anxiety and depression, sleep disturbances or marital disruption. They are the manifestations of sick persons not only of disturbances of bodily systems. They may be precipitated by unemployment, marital discord, bereavement, and job dissatisfaction. Curiously, ill-health has not been the major area of investigative interest of psychosomatic medicine. This presentation will emphasize why it should be, and why proper interventions may radically reduce the cost of medical care, prevent iatrogenic disease, and reduce the use of ill-advised procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1976

A comparative clinical evaluation of a new topical steroid 'halcinonide' and hydrocortisone in steroid-responsive dermatoses.

Fifty patients with symmetrical, bilateral lesions of psoriasis, eczematous dermatitis, atopic dermatitis, or neurodermatitis participated in a double-blind paired comparison study in which 0-1% halcinonide (in a cream formulation containing also neomycin and nystatin) was applied to the lesions on one side of the body and 1% hydrocortisone cream to those on the opposite side for two to three weeks. The number of excellent responses to therapy showed the halcinonide combination to be significantly superior (p less than 0-01) to the control cream in all diagnostic categories if considered collectively, and in psoriasis if the responses were grouped according to diagnosis. No adverse reactions occurred during the trial.

Administration, Topical↗
PubMedDate not supplied

Comparison of 0.1% halcinonide with 0.05% betamethasone dipropionate in the treatment of acute and chronic dermatoses.

A 4-week, bilateral, controlled study was carried out in 53 patients with various acute and chronic dermatoses to compare the effectiveness of 0.1% halcinonide in a water-miscible base, applied once daily, with 0.05% betamethasone dipropionate cream applied twice daily. Patients' response to treatment was assessed at the end of each week. Halcinonide proved to be equally as effective as betamethasone dipropionate in most and superior in some patients with psoriasis, lichen chronicus simplex, and atopic and neurodermatitis. There was also a prompt response to once daily treatment with halcinonide in patients with contact dermatitis, eczema of the hands, and more serious cases of eczema nummulare and allergic skin reactions, many of whom had failed to respond to previous topical steroid therapy. Both preparations were well tolerated and side-effects were noted in only 1 patient with psoriasis whose condition was aggravated by halcinonide. Only 3 patients had a relapse during the 1-month follow-up period after treatment was stopped.

Acute Disease↗
PubMed1979

Evaluation of a topical steroid antibiotic combination (halcinonide-neomycin-amphotericin) in the treatment of cutaneous candidiasis and inflammatory dermatoses.

Halcinonide-neomycin-amphotericin (HNA) cream was evaluated in the treatment of cutaneous candidiasis and inflammatory dermatoses. The anti-candidal properties of HNA were assessed in a parallel comparison with iodochlorhydroxyquin-hydrocortisone (I-HC) as the control drug. The overall therapeutic response with HNA was excellent in 38 (95%) of 40 patients as compared to 17 (43%) of 40 treated with I-HC. In 50 patients treated for psoriasis, eczematous dermatitis, or neurodermatitis, HNA was evaluated in a paired comparison with hydrocortisone (HC). The overall therapeutic response with HNA was excellent in 36 (72%) patients as compared to 18 (36%) with HC. There were no adverse reactions with HNA or the control drugs.

Administration, Topical↗
PubMed2000

[FOITS (fast optical in vivo topometry of human skin): new approaches to 3-D surface structures of human skin].

FOITS (Fast Optical In-vivo Topometry of human Skin) is a new technique for the three-dimensional analysis of the microstructures of the skin. Based on the surface roughness standards used in the metal-working industry, it uses computer-assisted strip analysis to process information gathered from high-speed, non-contact scanning. It is possible to visualise the mathematical data in 3D form. So far, surface relief parameters have had to be acquired indirectly by first making silicone casts of the skin and then digitalising them with image analysis, mechanical scanners or, more recent, laser profilometry and confocal microscopy. We selected the roughness parameters Ra, Rz and Rmax (DIN defined) and "positive" and "negative" volume to describe the skin surface. In 40 healthy volunteers we were able to define significant intra-individual differences in these roughness parameters, which were correlated with the location of the area of skin being scanned (p < 0.05). When healthy areas of skin were compared with areas of chronic eczema in 10 patients with neurodermatitis the differences in the above-mentioned roughness parameters were just as striking (p < 0.05). In patients with chronic atopic eczema there was a statistically significant correlation between changes in the parameters "positive" and "negative" volume, and the smoothing of the skin seen after 14 days of treatment with standard ointments (p < 0.02). Apart from its industrial uses, we see potential applications for FOITS in the investigation of quantitative and qualitative aspects of aging processes, physiological and pathological processes in the skin, and the effect of topical preparations applied to the skin.

Adolescent↗
PubMed1992

Successful treatment of chronic skin diseases with clobetasol propionate and a hydrocolloid occlusive dressing.

The lesions of 141 patients with chronic skin diseases unresponsive to therapy were treated once a week with clobetasol propionate lotion left under the completely occlusive patch Duoderm. In 131 patients the lesions resolved completely, while partial remission was observed in the remaining 10. The mean interval to complete remission was: for chronic plaque psoriasis, 12 days; psoriasis on palms and soles, 2.5 weeks; palmoplantar pustulosis, 2.2 weeks; skin lesions of Reiter's syndrome, 3 weeks; chronic lichenified eczema, 2.0 weeks; neurodermatitis, 3.1 weeks; breast eczema, 9 days; discoid lupus erythematosus, 3.7 weeks; lichen planus, 2.8 weeks; sarcoidosis, 4 weeks; and lichen sclerosus et atrophicus, 2 weeks. Other conditions benefitting from the treatment were pompholyx, necrobiosis lipoidica, granuloma annulare and pretibial myxedema. The amount of topical corticosteroids needed was reduced to at most 1/20 and to as little as 1/100, compared with common topical steroid preparations.

Adult↗
PubMed1976

[Halcinonide-neomycin-nystatin in the treatment of dermatosis and cutaneous candidiasis].

Sixty-four patients were treated for inflammatory dermatoses or cutaneous candidiasis with a new corticosteroid combination drug, halcinonide-neomycin-nystatin (HNN). In 50 patients treated for psoriasis, atopic dermatitis, eczematous dermatitis, or neurodermatitis, HNN was evaluated in a double-blind, paired comparison study with hydrocortisone (HC) as the control drug. HNN was superior in 24 patients, HC was superior in 6, and the responses were equal in 18. The overall therapeutic response was Excellent with HNN in 29 patients as compared to 14 with HC. The anticandidal properties of HNN were assessed in a parallel study with iodochlorhydroxyquin-hydrocortisone (I-HC) as the control drug. The most frequently treated conditions were "erosio interdigitalis blastomycotica" and candidal lesions of the neck region. The response with HNN was Excellent in 7 of 14 patients as compared to 4 out of 14 treated with I-HC.

Administration, Topical↗
PubMed1975

The probable role of interferon in allergy.

Sera from 35 patients suffering from autoimmune or allergic diseases such as bronchial asthma, lupus erythematosus, rheumatoid arthritis, Werlhoff disease (autoimmune form), hemorrhagic vasculitis and neurodermatitis and sera from 70 donors were examined for the presence of interferon. Interferon was found in the sera of 17 of the patients but not in any one of the donors' sera. It is suggested that anit-interferon immunoglobulins against human leucocyte interferon should be employed in the treatment of autoimmune or allergic diseases because of the positive clinical results that were obtained. The different hypotheses describing the role of interferon in immunity and allergy are discussed.

Antibody Formation↗
PubMed1962

Atopic dermatitis (eczema): an appraisal.

Atopic (spontaneous) allergies and nonatopic (induced) allergies are often confused. The meaning of these terms is definite, but the occurrence of either (in a given individual) may depend upon his autonomic nervous system control. The evidence that allergens produce the cutaneous changes in atopic dermatitis is flimsy, and neurodermatitis would be a more appropriate term since the entity falls into that pattern of skin changes. Treatment carried out, from infancy sometimes to old age, consists of careful management of the patient in the physical and emotional spheres, avoidance of external irritation and the use of a multiplicity of anti-pruritic, anti-inflammatory and sedative agents.

Administration, Cutaneous↗
PubMed1964

MANAGEMENT OF ATOPIC DERMATITIS: A PRELIMINARY REPORT.

A treatment regimen for atopic dermatitis (disseminated neurodermatitis) which attempts to cope with the factors of dry skin and retention of sweat was successful in a series of 22 consecutive patients, all of whom remain under observation. Objectives of the treatment are: Preservation of the natural lipid surface film, avoidance of controllable stimuli to sweating, avoidance of greases and oils topically applied, control of bacterial infection in the skin, resolution of active dermatitis with topical corticosteroids in vehicles low in lipids or free of them, and correction of existing keratoderma. This program does not purport to alter atopic constitutional factors. Among the 22 patients were seven with severe dermatitis requiring prolonged, continuous or intermittent, systemic corticosteroid therapy who were treated and had no exacerbation for periods up to ten months at the time of last report. The total daily dose of topical corticosteroid is small. Systemic corticosteroid therapy was withdrawn at the initiation of this treatment and has not been reinstituted. No untoward reactions have been observed. Results to date warrant treatment and long term observation of additional patients to determine the ultimate value of this method.

Adrenal Cortex Hormones↗