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PubMed2005

[Inpatient rehabilitation of chronic dermatoses illustrated by atopic dermatitis].

Atopic dermatitis is defined as a chronically relapsing skin disease resulting from complex interactions between genetic and environmental factors. It usually occurs during early childhood and shows typical clinical manifestations, depending on the patient's age. In cases of chronic atopic dermatitis, negative effects on professional and social activities and participation have to be expected. To counteract or overcome these threatening impairments in the different facets of life, prescribing inpatient rehabilitative measures should be considered early. Dermatological rehabilitation according to guidelines guarantees an interdisciplinary and multimodal treatment of atopic dermatitis.

Chronic Disease↗
PubMed1994

[HIV-associated dermatoses and their prevalence in 456 HIV-infected patients. Relation to immune status and its importance as a diagnostic marker].

Some 456 patients with HIV-associated skin disorders were documented in the HIV follow-up clinics at the Department of Dermatology, University Medical Center Steglitz, Berlin, during the years 1982-1992. Males comprised 91% of the patients. The most important risk groups for HIV infection were homosexual and bisexual men (77.9%) and individuals with intravenous drug abuse (12.7%). The most frequent dermatological diagnoses were oral candidosis (44.5%), seborrhoeic dermatitis (38.6%), folliculitis (32.9%) and Kaposi's sarcoma (23.5%). Altogether, 138 of the patients died during the time of observation. The most frequent cause of death was disseminated Kaposi's sarcoma (26.8%). A significant proportion of the patients developed skin diseases before significant reduction of the circulating CD4+ lymphocytes. In a still satisfactory immune situation, predominantly infections of the skin with dermatophytes (tinea), human papilloma viruses (warts) and bacteria (pyodermas) were observed. A considerable number of the HIV patients who developed zoster were also still in a favourable immune status; another 50% of these cases, however, developed the disease with reduced CD4+ lymphocyte count (< 300/microliters). Skin manifestations that tended to occur later in the course of HIV infection were oral candidosis, oral hairy leukoplakia, herpes genitoanalis, mollusca contagiosa and Kaposi's sarcoma, in spite of their early appearance in some cases. In the large majority of these patients the immunological parameters were already clearly reduced. Fungal, bacterial and viral infections of the skin, especially with extended skin involvement, may manifest themselves during the early phases of HIV infection. The number and severity of the skin manifestations increase with progressing immunosuppression, and treatment is often a difficult challenge for the dermatologist.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Dermatoses in leg amputees].

Dermatologic disorders of the stump in patients with a leg amputation may have characteristic pathophysiologic and clinical features. A knowledge of these factors may lead to earlier diagnosis and avoid immobilization. There ist no German language review of this aspect of dermatology. After providing an overview of the problem, including a discussion of prostheses, we review the following problems: mechanically induced blisters, follicular keratoses, epidermoid cysts, stump edema syndrome, acroangiodermatitis (pseudo-kaposi sarcoma) and verrucous hyperplasia.

Amputation Stumps↗
PubMed1996

[Detection of Helicobacter pylori in dermatoses. Clinical incidental finding or pathogenetic association?].

Recently, several reports have been describing a possible relation between Helicobacter pylori infection of the gastric mucosa and dermatological diseases. Associations have been reported for urticaria, roascea, Sjögren's syndrome and Schönlein-Henoch purpura. In this paper we review the current knowledge on Helicobacter pylori infection and its relevance for skin diseases, especially its clinical and pathophysiological aspects.

Gastritis↗
PubMed1998

[Tissue eosinophilia and local deposition of eosinophil-specific granule proteins. Regulation and significance for inflammatory response in atopic dermatitis and other inflammatory dermatoses].

Recent in vitro-studies have substantially increased our knowledge of eosinophil activation, the regulation of eosinophilia in the peripheral blood and the role of cytokines in that process. Accordingly, chemoattraction and activation of eosinophils by cytokines results in the local release of reactive oxygen species and toxic cationic granule proteins followed by local propagation of the inflammatory reaction and tissue damage. This extracellular tissue deposition of toxic granule proteins as an expression of complete activation of eosinophils, rather than only the presence of intact eosinophil granulocytes, is crucial for their functional effect in situ. Semi-quantitative studies of local eosinophil granula deposition so far have been done only in atopic dermatitis and a limited number of other inflammatory skin diseases as summarized in this review. Evaluation of the pathogenetic role of eosinophils may be of potential therapeutic importance.

Blood Proteins↗
PubMed1999

[Hepatitis C virus-associated dermatoses: a review].

Acute infection with hepatitis C virus (HCV) is often clinically inapparent, but may affect several organ systems in its chronic course. In dermatology, common diseases such as lichen planus, cryoglobulinemic vasculitis and porphyria cutanea tarda have been described in association with HCV infection. A number of other dermatologic disorders, e.g., psoriasis, chronic urticaria, chronic pruritus, pseudo-kaposi sarcoma, necrolytic migratory erythema and Behçet disease, have been associated in case reports with HCV-induced liver disease. In this study we summarize the recent literature reports, present three patients observed by our group and update the topic.

Diagnosis, Differential↗
PubMed2001

[Autoantigens of subepidermal bullous autoimmune dermatoses].

The dermal-epidermal junction contains a network of structural proteins that link epidermis and dermis. A central component of this complex is the cell membrane-associated hemidesmosomal plaque. Formation of autoantibodies against different components of this hemidesmosomal anchoring complex can lead to subepidermal blisters. Such autoantibodies have been frequently used to characterize the target antigens at the molecular level. Autoimmune subepidermal blistering diseases include bullous pemphigoid, pemphigoid gestationis, lichen planus pemphigoides, linear IgA disease, cicatricial pemphigoid, anti-p450-, anti-p200- and anti-p105-pemphigoid, epidermolysis bullosa acquisita, bullous systemic lupus erythematosus and dermatitis herpetiformis Duhring. Differences in the clinical picture of these diseases can be attributed, at least in part, to the different specificity of the autoantibodies involved. The autoimmune response is further modulated by inflammatory cells and other inflammatory mediators. Native and recombinant forms of the autoantigens are increasingly used for the diagnosis of these diseases.

Autoantigens↗
PubMed2003

Use of infliximab, an anti-tumor necrosis alpha antibody, for inflammatory dermatoses.

BACKGROUND: Infliximab is a monoclonal antibody against tumor necrosis factor alpha currently approved by the U.S. FDA for the treatment of Crohn's disease and rheumatoid arthritis. Recently, a controlled trial reported its effectiveness for psoriasis. OBJECTIVE: The object of our study was to evaluate the efficacy and safety of infliximab for inflammatory or autoimmune cutaneous disorders. METHODS: A retrospective chart review was performed for patients who received infliximab at the University of Miami, Cedars Medical Center. RESULTS: Patients with various disease, including panniculitis, pityriasis rubra pilaris, eosinophilic fasciitis, discoid lupus erythematosus, and necrobiosis lipoidica diabeticorum, received infliximab infusion at a dose of 5 mg/kg. All patients had refractory disease or adverse effects to previous therapy, which included cyclosporine, systemic steroids, azathioprin, clofazimine, mycophenolate mofetil, acitretin, UVB, and thalidomide. Six out of the seven patients improved after treatment. CONCLUSIONS: Infliximab was well tolerated in most patients and the majority benefited from the use of infliximab.

Adult↗
PubMed2004

A review of the use of infliximab to manage cutaneous dermatoses.

BACKGROUND: Infliximab is a chimeric monoclonal antibody that binds specifically to human tumor necrosis factor-alpha (TNF-alpha), decreasing the effect of the cytokine in inflammatory diseases. OBJECTIVE: The aim of this study was to review the efficacy and safety of infliximab in the treatment of dermatological diseases. METHODS: A MEDLINE search (1966-January 2003), using the keyword "infliximab" was performed to find relevant articles pertaining to the use of infliximab in dermatology. RESULTS: Infliximab has been used in the following dermatological diseases: psoriasis, Behcet's disease, graft versus host disease, hidradenitis suppurativa, panniculitis, pyoderma gangrenosum, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome, sarcoidosis, subcorneal pustular dermatosis, Sweet's syndrome, toxic epidermal necrolysis, and Wegener's granulomatosis. There is a generally good safety profile for infliximab, which is similar to that when it is used to treat Crohn's disease and rheumatoid arthritis. CONCLUSION: Although not approved for use in dermatological diseases, there have been numerous reports of the efficacy of infliximab in cutaneous inflammatory diseases. The most promise lies in those diseases that have increased amounts of TNF-alpha in the cutaneous lesions, such as psoriasis.

Antibodies, Monoclonal↗
PubMed1995

Common dermatoses.

Skin diseases are an essential part of primary care medicine. Most dermatologic care is delivered in an outpatient setting. The initial evaluation is usually performed by the primary care physician. Women account for nearly 60% of all visits for dermatologic complaints.

Acne Vulgaris↗