[Palmar and axillary hyperhidrosis in children: endoscopic thoracic sympathectomy using clips for an underestimated problem]. / Hyperhidrosis palmaris en axillaris bij kinderen.

BACKGROUND: Palmar and axillary hyperhidrosis are defined as perspiration exceeding the body's 'normal' physiological need for thermal regulation. This condition affects about 1% of adolescents and children and may lead to psychosocial problems and poor school performance. CASE DESCRIPTION: We carried out an endoscopic thoracic sympathectomy (ETS) with clips in a 14-year-old girl and a 16-year-old girl who suffered from debilitating palmar and axillary hyperhidrosis. They were able to quickly resume their general daily activities and both were free of symptoms during an outpatient visit after 6 weeks. CONCLUSION: ETS using clips is a safe, relatively simple and effective technique, which may provide a permanent solution. ETS can be an option in case of therapy-resistant debilitating hyperhidrosis. This surgical procedure should be carefully considered, possible causes should be excluded and ETS should not be offered as the first treatment option for children.

Oral R115866 in the treatment of moderate to severe facial acne vulgaris: an exploratory study.

BACKGROUND: R115866 (Rambazole; Barrier Therapeutics NV, Geel, Belgium), a new-generation retinoic acid metabolism-blocking agent, is a nonretinoid compound enhancing intracellularly the endogenous levels of all-trans-retinoic acid by blocking its catabolism. By virtue of this property, and the proven positive effects of retinoids in the treatment of acne, R115866 could potentially be a useful drug for acne. OBJECTIVES: To explore the efficacy, safety and tolerability of systemic R115866 in male patients with moderate to severe facial acne vulgaris (at least 15 papules and/or pustules and at least two nodulocystic lesions). METHODS: In this exploratory trial, 17 patients were treated with oral R115866 1 mg once daily for 12 weeks, followed by a 4-week treatment-free period. RESULTS: At the end of treatment (week 12, n = 16) a mean reduction in inflammatory lesion count of 77.4% (P < 0.001), in noninflammatory lesion count of 58.3% (P < 0.001) and in total lesion count of 76.0% (P < 0.001) was observed as compared with baseline. All lesion counts were significantly reduced from week 4 onwards. Mild side-effects were reported occasionally. CONCLUSIONS: The current data indicate that treatment with oral R115866 1 mg once daily for 12 weeks in patients with moderate to severe facial acne vulgaris is efficacious and well tolerated and merits further investigation.

Transcutaneous oxygen tension in patients with and without pericapillary fibrin cuffs in chronic venous insufficiency, porphyria cutanea tarda and non-venous leg ulcers.

To evaluate the influence of fibrin cuffs on the transcutaneous oxygen tension in patients with chronic venous insufficiency (CVI) we performed a prospective comparative study in an out-patient dermatological department of a district hospital in the Netherlands. 16 patients with CVI grade II or III, 6 patients with porphyria cutanea tarda (PCT) without any sign of CVI, 4 patients with clinical ecthyma type ulcers without CVI and 10 healthy volunteers were studied. Skin biopsies for fibrinogen staining, transcutaneous oxygen tension measurements (TcPO2) and light reflexion rheography (LRR) were performed. TcPO2 readings were significantly lower in patients with CVI compared to patients of the other groups. Fibrin cuffs were found in 8 out of 16 patients with CVI, all PCT patients and 3 out of 4 ecthyma-ulcer patients. On the basis of these results we conclude that the fibrin cuff alone does not act as a barrier for oxygen transport. Fibrin cuffs in CVI are not the cause of venous ulceration but only a part of the complicated mechanism of the altered microcirculation induced by reflux in the venous macrocirculation. Fibrin cuffs are not unique for CVI but an indication of a disturbed microcirculation.

[Fungal infections of the facial skin]. / Schimmelinfecties van de huid van het gelaat.

In two patients, a woman of 35 and a man of 57, tinea faciei was eventually diagnosed, after prolonged treatment with corticosteroids had taken place and a facial biopsy had been performed in the woman, without the diagnosis being made. Tinea faciei is frequently misdiagnosed, as it is fairly uncommon and many diseases must be considered in the differential diagnosis.