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PubMed1999

[Local corticosteroid therapy in dermatology].

UNLABELLED: FOUR LEVELS OF ACTION: The introduction of dermocorticosteroids (corticosteroids for topical application) has revolutionized management of many skin diseases. Depending on their antiinflammatory action, these products can be classed into four levels of action. Dermocorticosteroids have antiinflammatory, vasoconstrictor, antiproliferative, antisynthetic and immunosuppressive actions. SKIN PENETRATION: Penetration depends on the intrinsic characteristics of the drug, but also on many other factors including the nature of the excipient, additives, occlusion, localization, nature of the treated skin disease, and patient age. There is a reservoir effect, explaining why a single application is effective for dermatoses with a normal keratin layer. INDICATIONS AND CONTRAINDICATIONS: Dermocorticosteroids can be indicated in numerous inflammatory skin diseases (psoriasis, eczema ...). They are formally contraindicated in case of skin infections, diaper rash, acne and rosacea. Contact allergies have been reported. IN PRACTICE: The choice of a dermatocorticosteroid depends on the suspected sensitivity of the disease to treat, its degree of extension, and its localization as well as the patient's age and the planned duration of treatment. Cremes provide good cosmetic satisfaction. The number of tubes to be used must be strictly controlled. Occlusion is indicated in case of palmo-plantar or the scalp involvement.

Administration, Topical↗
PubMed1999

Helicobacter pylori infection and skin diseases.

There is increasing evidence for systemic effects of gastric H. pylori infection which may result in extragastrointestinal disorders. This review summarizes the available medical literature up to September 1999, identified through a MEDLINE research including own studies, regarding H. pylori and skin diseases. Due to current knowledge best evidence for a potential link of H. pylori infection exists for chronic urticaria although the data are still conflicting. Thus, the search for H. pylori should be included in the diagnostic management of chronic urticaria. With regard to other skin diseases such as rosacea, hereditary or acquired angioedema due to C1-esterase inhibitor deficiency, systemic sclerosis, Schönlein-Henoch purpura, Sjögren's syndrome, sweet's syndrome, and atopic dermatitis only single of few cases have been reported so far. Thus, we clearly need further randomized, double-blind and placebo-controlled studies including adequate diagnostic schedules, sufficient eradication treatment protocols, confirmation of eradication, and adequate control groups to establish a role of H. pylori in skin diseases. Caution must be taken not to accuse H. pylori as the infectious agent responsible for every disease, particularly since H. pylori infection is very common. Although from an epidemiological and morphological view the skin diseases to which H. pylori has been linked seem to be completely different it is striking that in most of them an autoimmune pathogenesis is suspected or considerable vascular impairment can be found.

Helicobacter Infections↗
PubMed2000

Analysis of airborne pollen fall in Balikesir, Turkey, 1996-1997.

In this study, pollen grains were identified by use of Durham sampler in the atmosphere of Balikesir in 1996 and 1997. During these two years, a total of 17,256 pollen grains per cm(2) were recorded. A total of 8,576 pollen grains per cm(2) were identified in 1996 and a total of 8,680 pollen grains per cm(2) in 1997. Pollen fall in the years 1996-1997 comprised grains belonging to 50 taxa and unidentified pollen grains. Of these 50 taxa, 30 belonged to arboreal and 20 to non-arboreal plants. Total pollen grains consisted of 70.92% grains from arboreal plants, 24.87% grains from non-arboreal plants and 4.21% unidentified pollen grains. In the region investigated, Pinus spp., Cupressaceae/Taxaceae, Gramineae, Platanus spp., Quercus spp., Olea spp., Salix spp., Urticaceae, Moraceae, Plantago spp., Chenopodiaceae/Amaranthaceae, Ailanthus spp., Juglans spp., Carpinus spp. and Rosaceae released the greatest amounts of pollens. During the study period, the pollen fall reached its highest level in May.

Air Pollutants↗
PubMed2000

[Incidence of sensitization to profilin in a population allergic to pollen: responsibility of profilin in pollen polysensitizations in patients with a normal level of total IgE].

UNLABELLED: The study had the aim of establishing the incidence of sensitization to profilin (a panallergen found in pollens and foods of vegetal origin) in pollen-allergic patients. We evaluated the consequences of such sensitizations on the results of specific IgE, the positivity of skin tests and clinical signs. METHODS: 94 consenting patients, allergic to pollens (trees and/or grasses and/or weeds) replied to a questionnaire and had skin tests to purified profilin and measurement of serum anti-profilin IgE. RESULTS: Two groups were defined: one group was sensitized to profilin (GSP), with positive skin test and anti profilin IgE of 31 patients, and a group non-sensitive to profilin (GNSP) (negative skin test and anti-profilin IgE) of 41 patients. Discordant results were found in 22 patients. Taking in account the two groups, sensitization to profilin was 43%. The two groups were homogenous for age, sex, ethnics and clinical signs. Food allergy was more frequent but not statistically different (p = 0.09) in the group GSP (51.6%) than the GNSP (31.7%), in particular allergy to fruits of the Rosaceae family. Pollen polysensitization (to three species, trees, weeds and grasses) was more frequent in the GSP group (64.5%) than the GNSP (12.5). Polysensitization to pollens and foods was also more frequent in the sensitized group (65.5%) than in the non-sensitized group (12.5%). In a sub-group with normal levels of total IgE pollen polysensitization was more frequent in patients who were sensitive to profilin. On biological investigation, sensitization to profilin influenced the result of anti-latex IgE and also the IgE to many vegetal allergens. These results show the value of seeking a sensitization to profilin in patients with pollinoses.

Adult↗
PubMed2000

A phylogenetic analysis of Rhamnaceae using rbcL and trnL-F plastid DNA sequences.

Previous tribal classifications of Rhamnaceae have been based on fruit characters, resulting in the delimitation of large and otherwise heterogeneous groups. We evaluated the most recent classification with DNA sequences of two regions of the plastid genome, rbcL and trnL-F, from 42 genera of Rhamnaceae and representatives of the related families Elaeagnaceae, Barbeyaceae, Dirachmaceae, Urticaceae, Ulmaceae, Moraceae, and Rosaceae. The trnL-F trees have higher consistency and retention indices than the rbcL trees, and patterns of change in rbcL and trnL-F are compared. The closest relatives of Rhamnaceae are Dirachmaceae and Barbeyaceae, followed by the urticalean families. The plastid trees support the monophyly of the family and provide the basis for a new tribal classification. Three strongly supported clades are identified, but morphological characters could not be found to underpin a formal taxonomic description of these three clades as subfamilies. We therefore only recognize groups that are also defined by morphological characters. The biogeography of Rhamnaceae is discussed with reference to the molecular trees.

Journal Article↗
PubMed2000

Biochemical and haematological changes in rats administered an aqueous extract of Prunus africana stem-bark at various dosage levels.

An aqueous extract of Prunus africana (Hook. f.) Kalkm. (syn. Pygeum africanum) (Hook. f.) (Rosaceae) was administered daily at dosage rates of 10, 100 and 1,000 mg/kg body mass to randomized groups of Sprague Dawley rats. The extract caused a moderate rise in plasma alanine aminotransferase and creatine kinase mainly at rates of 1,000 mg/kg body mass, but it did not cause any significant variations in haematological parameters or in plasma levels of total proteins, albumin, aspartate aminotransferase, alkaline phosphatase and blood urea nitrogen at the dosage levels used. There were no overt clinical signs in any of the rats. It was concluded that the extract may contain components that are mildly toxic to the liver and heart of rats after repeated daily oral administrations of 1,000 mg/kg body mass.

Administration, Oral↗
PubMed1997

[Continuity and changes of breeds of fupenzi].

Based on textual researches, it has been confirmed that Fupenzi first appeared in Han Dynasty. Both Fupenzi and Penglei had the same origin, but split up during Jin Dynasty into two different breeds. Through ages Fupenzi has been taken as the fruits of the plant Rubus of Rosaceae species. Among them, R. idaeus, R. corchorifolius and R. coreanus have long been in use. R. chingii is the new breed of modern Fupenzi.

Conservation of Natural Resources↗
PubMedDate not supplied

Angiosarcoma arising on rhinophyma.

We report an 82-year-old man who presented with a tumor which had developed over the previous year on the right nasal ala of a rhinophyma. Histopathological, immunohistochemical, and electron microscopic study confirmed the diagnosis of angiosarcoma on the head and neck. He was treated with radiotherapy of the tumor and cervical adenopathy, which developed later. The possible etiological and pathogenetic role of lymphedema due to inflammatory flares of rosacea on the nose is discussed, together with the histological and immunohistochemical data leading to the diagnosis of this tumor.

Aged↗
PubMedDate not supplied

Evidence based medicine and extradigestive manifestations of Helicobacter pylori.

A putative pathogenetic role has been ascribed to Helicobacter pylori in several extradigestive diseases, including vascular (atherosclerosis and ischaemic heart disease, primary Raynaud phenomenon, primary headache), autoimmune (Sjögren's syndrome, Henoch-Schönlein purpura, autoimmune thyroiditis, idiopathic arrythmias, Parkinson's disease, nonarterial anterior optic ischemic neuropathy), and skin diseases (chronic idiopathic urticaria, rosacea, alopecia areata), sideropenic anemia, growth retardation, late menarche, extragastric MALT lymphoma, diabetes mellitus, hepatic encephalopathy, sudden infant death syndrome, and anorexia of aging. We examine critically the strength of the evidence linking these diseases to Helicobacter pylori, using ischaemic heart disease as an example of epidemiological techniques, and skin diseases as an example of treatment studies. By the standards of evidence-based medicine, studies have been often of low quality. The best evidence usually is not indicative of a role for Helicobacter pylori in these diseases.

Evidence-Based Medicine↗
PubMed2001

[The lipid layer of the lacrimal tear film: physiology and pathology].

The preocular tear film (POTF) is composed of a deep aqueous-mucin phase that supports a thin superficial lipid phase. The tear lipid layer (TLL), although thin, stabilizes the POTF providing a 25% surface-tension decrease and a 90-95% aqueous evaporation reduction. TLL is formed from lipids secreted by tarsal meibomian glands and spread onto the ocular surface by blinking. The TLL itself is composed of two phases. A thin and deep polar phase, adjacent to the aqueous-mucin layer, has a surfactant role. A thicker and superficial nonpolar phase has antievaporative properties. At the same time, tear lipocalins help the TLL spread and stabilize the lipid-aqueous interface. For clinical examination, TLL is directly observed with the Tearscope. POTF stability and the evaporation rate depend on the lipid layer pattern. When chronic, POTF qualitative trouble (evaporative syndrome) due to a TLL anomaly, leads to secondary ocular surface impairment with increased tear instability and self-propagation of ocular dryness. Meibomian gland dysfunction (MGD) results from local pathology, dermatologic disease (ocular rosacea) or iatrogenic etiology. Cosmetic use is the other principal cause of TLL destabilization. Lid hygiene is the mainstay of MGD treatment. Systemic antibiotics (cyclins) can be associated in cases of severe symptoms. Topical treatment is useful if there is marginal lid inflammation or infection.

Humans↗
PubMed2001

Pro- and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry-eye disease.

PURPOSE: To compare the expression of the pro- and anti-inflammatory forms of interleukin (IL)-1 in the tear fluid and conjunctival epithelium of normal eyes and those with dry-eye disease. METHODS: The concentrations of IL-1 alpha, IL-1 beta (precursor and mature forms), and IL-1 receptor antagonist (IL-1Ra) were measured by ELISA in tear fluid samples obtained from normal individuals and patients with dry eye who had rosacea-associated meibomian gland disease (MGD) or Sjögren's syndrome (SS) aqueous tear deficiency (ATD). These cytokines were also measured in normal tear fluid before and after nasal stimulation to induce reflex tearing. The relative expression of these cytokines was evaluated in conjunctival impression cytology specimens and conjunctival biopsy tissue obtained from normal subjects and SS ATD-affected patients using immunofluorescent staining. Matrix metalloproteinase (MMP)-9 concentration and activity in the tear fluid were evaluated with gelatin zymography and with an MMP-9 activity assay kit, respectively. RESULTS: Compared with normal subjects, the concentration of IL-1 alpha and mature IL-1 beta in the tear fluid was increased, and the concentration of precursor IL-1 beta was decreased in patients with MGD (P < 0.05, P = 0.02, and P < 0.01, respectively) and SS ATD (P < 0.001, P = 0.02, and P < 0.001, respectively). There was no significant change in the concentration of IL-1 alpha, precursor IL-1 beta, and IL-1Ra in reflex tear fluid, indicating that the lacrimal glands may secrete these cytokines. The activity of MMP-9, a physiological activator of IL-1 beta, was significantly elevated in the tear fluid of both dry-eye groups compared with normal subjects. A strong positive correlation was observed between the intensity of corneal fluorescein staining and the tear fluid IL-1 alpha concentration (r(2) = 0.17, P < 0.02) and the mature-to-precursor IL-1 beta ratio (r(2) = 0.46, P < 0.001). Positive immunofluorescent staining for IL-1 alpha, mature IL-1 beta, and IL-1Ra was observed in a significantly greater percentage of conjunctival cytology specimens from eyes with SS ATD than in those from normal eyes (P < 0.01 for IL-1 alpha, P < 0.009 for mature IL-1 beta, and P < 0.05 for IL-1Ra). CONCLUSIONS: Dry-eye disease is accompanied by an increase in the proinflammatory forms of IL-1 (IL-1 alpha and mature IL-1 beta) and a decrease in the biologically inactive precursor IL-1 beta in tear fluid. Increased protease activity on the ocular surface may be one mechanism by which precursor IL-1 beta is cleaved to the mature, biologically active form. The conjunctival epithelium appears to be one source of the increased concentration of IL-1 in the tear fluid of patients with dry-eye disease. These results suggest that IL-1 may play a key role in the pathogenesis of keratoconjunctivitis sicca.

Adult↗
PubMed2001

[Metronidazole].

Metronidazole was first introduced for the treatment of trichomoniasis. Now, its therapeutics use has subsequently been expanded to include protozoal and anaerobic infections. Oral administration is recommended: rosacea, perioral dermatitis, Helicobacter pylori, Trichomonas vaginalis and Giardia lamblia infections and bacterial vaginosis. Metronidazole given orally is absorbed almost completely. Metronidazole has limited plasma protein binding but can reach very favourable tissue distribution, including central nervous system and placenta. This drug is extensively metabolised by the liver to form 5 oxydative metabolites. The majority of this drug and metabolites are excreted in urine and feces. The half-life is 6 to 10 hours. The recommended dose is 500 mg three time per day and an adaptation is necessary in renal insufficiency. Metronidazole is well tolerated when administered in dosages of less than 2 g per day. Some adverse reactions appear to be related to the high dosages and treatment duration. Drug interactions with alcohol, warfarin and phenytoin have been reported. Mutagenesis and cancerogenesis is only described in mouse. Resistance, both clinical and microbiological, has been described only rarely.

Anti-Infective Agents↗
PubMed2001

The use of cleansers as therapeutic concomitants in various dermatologic disorders.

The choice of a mild cleansing agent is important in the adjunctive management of various skin conditions, such as atopic dermatitis, acne vulgaris, rosacea, photoaging, retinoid-induced irritant dermatitis, and sensitive skin. There are 3 major categories of cleansing agents: soaps, synthetic detergents, and lipid-free cleansing agents. The irritancy potential of cleansing agents is a function of a number of factors, including the pH, type of surfactants, and amount of skin residue. Furthermore, the presence of humectants and emollients also can influence the overall mildness of a cleansing agent. Agents with slightly acidic or neutral pH, nonionic surfactants, and minimal skin residue may be preferable for people who are at increased risk for irritancy reactions.

Detergents↗
PubMed2001

The use of therapeutic moisturizers in various dermatologic disorders.

Moisturizers can serve as important adjunctive therapeutic modalities for patients with various dermatologic disorders, including acne vulgaris, rosacea, retinoid-induced irritant dermatitis, atopic dermatitis, psoriasis, and the skin dryness that appears to occur with intrinsic and extrinsic aging. Therapeutic moisturizers, defined as those proven in clinical trials to be both compatible with topical therapies and biocompatible with the skin, not only improve the signs and symptoms of dry skin but also, as research has demonstrated, help maintain hydration and overall integrity of the stratum corneum. The type of humectants and emollients contained in a therapeutic moisturizer can affect the overall tolerability of the formulation. Dermatologists should recommend therapeutic moisturizers that are noncomedogenic, devoid of irritant ingredients, and compatible with many therapeutic regimens.

Biomechanical Phenomena↗
PubMed2002

[Indications for medical lasers in dermatology].

FOUR CATEGORIES OF LASERS ARE USED IN DERMATOLOGY: These are vascular, depigmentation, depilatory or resurfacing or vaporization lasers. Today, there are more potential or suggested indications than good methodological studies that confirm these indications. Nevertheless, there are indisputable indications for these lasers. VASCULAR LASERS: They are indicated in the treatment of capillary nevus in adults and children and, with pulsed dye lasers, infants can be treated within the first weeks of life. Another indication for vascular lasers is treatment of Stage II rosacea, i.e., at the stage of telangiectasic erythrosis or couperose. Other indications include radiodermatitis, ulcerated hemangioma and erythrosis of the neck. DEPILATORY LASERS: Treatment of patients with pale phototype and dark hairs appears possible. However, around 4 to 6 sessions are required to obtain significant lasting hair removal. DEPIGMENTATION LASERS: The best indications are the removal of tattoos, Ota's nevus and, to a lesser degree, liver spots and Becker's nevus. Melasma and chloasma are not indications or exeresis of nevo-cellular nevi using this technique, since no histological control is possible. PULSED VAPORIZATION LASERS (CO2 OR ERBIUM LASER): They permit dermabrasion in the treatment of verrucous harmatoma, extensive benign superficial dermo-epidermal lesions and the esthetic treatment of non-muscular wrinkles, i.e., excepting wrinkles of the forehead and nasal sulcus. Continuous CO2 lasers destroy small dermo-epidermal lesions. They are particularly indicated for profuse lesions, in which there is a risk of hemorrhage or when direct contact should be avoided because of potential HIV infection. CONCLUSION: There are many potential indications, but a consensus has only been reached on those mentioned. The others remain to be confirmed.

Adult↗
PubMed2001

[Lamellar keratoplasty with air or viscoelastic substance injection].

PURPOSE: To analyze the results of very deep lamellar keratoplasty using dissection with air and a viscoelastic substance. METHODS: This was a prospective monocentric noncomparative study. Candidates for lamellar keratoplasty were enrolled between November 1998 and July 2000. Deep lamellar dissection was performed following air injection into the cornea to create a white emphysema of the stroma. The dissection was performed to the Descemet membrane. Whenever a large bulla was present in the recipient bed, the dissection of the deepest stromal lamellae was performed by injecting a viscoelastic substance into the bulla. A full-thickness allogenic corneal button was sutured to the recipient bed. RESULTS: Fifteen eyes of 14 patients (mean age, 39.3 years) underwent deep lamellar keratoplasty: keratoconus (11 eyes), atopic keratoconjunctivitis (1 eye), herpes zoster keratitis (1 eye), corneal scar after pterygium surgery (1 eye), and rosacea keratitis (1 eye). Excluded from the analysis of the refractive outcome were patients who underwent intraoperative perforation (n = 3) and the patients with postoperative complications affecting the central visual axis: (n = 2 [hemorrhage in the interface and herpetic simplex keratitis]). The mean preoperative visual acuity was 0.10 (range, 0.05 to 0.3). After a 3.8-month-follow-up, the mean best corrected visual acuity was 0.21 (range, 0.1 to 0.6). The visual results were better in patients with keratoconus (mean best corrected visual acuity: 0.22; range, 0.1 to 0.6). The mean postoperative astigmatism was 4.15 diopters (range, 0 to 8). CONCLUSION: Intrastromal air and viscoelastic substance injection appeared to be very useful for performing a very deep lamellar keratoplasty. The results of the refractive outcome were encouraging. Deep lamellar keratoplasty is an interesting alternative to penetrating keratoplasty, because it cannot induce progressive primary graft failure and allogenic endothelial graft rejection and it obviates the need to perform a lamellar dissection of the donor button.

Adult↗
PubMed2002

Excision of rhinophyma with a laser scanner handpiece--a modified technique.

Rhinophyma is a slowly progressive, benign dermatological disorder of the tip of the nose. The most widely accepted theory is that rhinophyma is the end stage result of chronic acne rosacea. The primary reason for excision of rhinophyma is cosmetic deformity. However, nasal obstruction may present, as rhinophyma may obstruct nasal vestibules. Surgery is the treatment of choice for rhinophyma. Medical therapy has not given satisfactory results. The surgical treatment modalities are divided into two main groups. The first is complete excision, with primary closure for small lesions, or skin grafting for large lesions. The second group includes incomplete excision followed by re-epithelialization from the remaining glandular epithelium. The carbon dioxide (CO2) laser has been advocated for excision of rhinophyma. Newer instrumentation, such as Swiftlase and SurgiTouch (ESC Sharplan) or Ultrapulse (Coherent) is more effective in vaporization and carbonization resulting in better hemostasis (Ries and Speyer, 1996). In this report, 7 patients with rhinophyma treated with the Swiftlase are reviewed. The surgical technique, the complications and the follow-up are discussed.

Aged↗
PubMed2001

Internet advice in dermatology and allergy: 1 year analysis of telerequests and answers.

The purpose of this study was to analyze the content and objectives of questions asked by internet users who accessed the homepage of the Department of Dermatology and Allergy Biederstein at the Technical University of Munich. Users were offered the opportunity to ask free questions on the Web site. The results of lay and medical individuals seeking advice were collected over a 12 month period and the answers given were reviewed. We received inquiries from 279 laypersons and 31 physicians. The majority of questions (53.8%) asked by non-medical users dealt with dermatology-related problems. Inquiries related to hair (13.3%) and acne or rosacea (11.3%) were most common. 46.2% of e-mail requests were allergy-related. Most of the interest focused on food allergy and adverse food reactions (22.5%) or hay fever and perennial rhinoconjunctivitis (19.4%). Previous consultation of a physician was reported in 40.9%. 13.6% had consulted an allergist or dermatologist. The majority of questions asked by physicians concerned allergy-related topics (64.6%). Most questions were answered by a short letter giving advice and encouraging the non-medical user to visit a dermatologist and/or allergist (72.4%). In 27.6% we felt that the inquiries were answered completely.

Adult↗