Malignant melanoma of the conjunctiva – successful surgical excision of the primary tumor and reconstruction by conjunctival auto transplantation from the contralateral eye.

Malignant melanoma of the conjunctiva is a rare tumor with incidence of 0.5 cases/year per million population. It may also occur as de novo, as on the basis of preexisting melanocytic lesions (nevus or freckle) or most often from the so-called primary acquired melanosis of the conjuctiva (PAM). It metastasizes mainly lymphogenic and hematogenous. The size of the primary tumor lesion, histopathological findings and absolute tumor thickness are essential for unfavorable prognosis. Conjunctival auto transplantation from the other eye is modern and innovative, but also a seldomly feasible method of reconstruction after conjunctival excision of tumors in this area. We present a rare case of a 75-year-old patient with epithelioid cell malignant melanoma of the bulbar conjunctiva of the right eye, which de novo occurred, successfully treated by excision of the primary tumor and subsequent reconstruction by conjunctival auto transplant from the other eye. A very good therapeutic and aesthetic result was achieved.

Evaluation of the inhibitory activity of topical indomethacin, betamethasone valerate and emollients on UVL-induced inflammation by means of non-invasive measurements of the skin elasticity.

BACKGROUND/AIM: Topical indomethacin has been reported to inhibit ultraviolet light-induced erythema. The objective of this study was to verify this assertion and to compare indomethacin 10% ointment to beta-methasone valerate 0.1% ointment, water-in-oil emulsion and oil-in-water emulsion by means of non-invasive skin elasticity measurements. METHODS: Products were applied on the back skin 60 min and 5 min before and 5 min after UVL irradiation. Untreated test sites served as controls. Clinical evaluation, measurements of epidermal hydration (Corneometer) and mechanical properties of the skin (Cutometer) were made 1 h before and 24 h after exposure. RESULTS: Test areas treated with indomethacin 60 min and 5 min before irradiation showed the significantly lowest visual erythema scores and no significant changes in skin mechanical parameters. At all other test sites, a significant decrease in elasticity parameters (Ue, Ur, Ua/Uf, Ur/Uf) and an increase in viscoelasticity parameters (Uv, Uv/Ue) of the skin were observed. No significant changes of epidermal hydration were found at any of the test sites. CONCLUSION: The inhibitory action of topical indomethacin on UVL-induced inflammation is superior to beta-methasone valerate and emollients. Non-invasive measurement of skin elasticity could be used as a supplementary tool for objective evaluation and comparison of the photoprotective activity of different topical agents.

In vivo study of skin mechanical properties in psoriasis vulgaris.

The aim of this study was to investigate the mechanical properties of the skin in psoriatic plaques before and after treatment with dithranol and in clinically uninvolved psoriatic skin in comparison with the skin of healthy controls. In total, 82 psoriatic plaques in 19 in-patients and 51 age-matched control subjects were studied with a non-invasive suction device (Cutometer). The plaques were characterized by statistically significant lower skin distensibility and elasticity, and a higher viscoelastic to elastic ratio compared with adjacent apparently normal skin. Delayed distension and hysteresis measured using a 2-mm diameter probe were decreased, but were increased when measured by a 8-mm diameter probe. These differences can be explained by the increased skin thickness in psoriasis and by the different aspects of skin mechanics determined by the 2 measuring probes. After treatment, the mechanical parameters of psoriatic plaques approached the values of adjacent control skin. The uninvolved volar forearm skin in psoriatic patients (2-mm diameter probe) showed statistically significant lower values of skin distensibility and higher values of viscoelasticity parameters compared with the skin of healthy control subjects. This suggests that the normal-appearing psoriatic skin is not entirely normal. The non-invasive method applied can be used for objective and quantitative evaluation of the effect of therapy in patients with psoriasis.

Biomechanical measurement of skin distensibility in scleredema of Buschke associated with multiple myeloma.

We report a case of scleredema of Buschke associated with IgG kappa monoclonal hypergammaglobulinaemia. After myeloma polychemotherapy an improvement in skin involvement was observed and confirmed by means of noninvasive skin elasticity measurements. This suggests a relationship between the two diseases. The bioengineering method used can be useful for early detection and monitoring the skin involvement in patients with this disease association.

In vivo study of skin mechanical properties in patients with systemic sclerosis.

BACKGROUND: Measurements of skin elasticity are more sensitive than the skin severity score and appropriate for evaluation of sclerodermatous skin. OBJECTIVE: Our purpose was to investigate the mechanical properties of the skin in patients with systemic sclerosis depending on the stage of the disease. METHODS: Seventeen patients, 8 with edematous phase and 9 with indurative phase of skin involvement, and 16 healthy subjects were studied. Clinical scoring of skin thickness and measurements of skin elasticity with a noninvasive suction device (Cutometer) were performed over 11 anatomic regions. RESULTS: Edematous phase was characterized by significantly lower immediate distention (Ue) and final distention (Uf), and higher viscoelastic to elastic ratio (Uv/Ue) of the skin compared with indurative phase, except for the forehead (8 mm probe). The changes in skin mechanical parameters for fingers were identical in both phases. Low values of skin distensibility correlated with severe skin thickness or hidebound skin. Results were influenced by body site and by the diameter of measuring probe used. CONCLUSION: The noninvasive method applied is suitable for objective and quantitative monitoring of skin involvement in patients with systemic sclerosis.

In vivo study of skin mechanical properties in scleredema of Buschke.

A non-invasive, in vivo suction device was used to investigate the mechanical properties of the skin in a patient with scleredema of Buschke. Clinical scoring of skin induration and measurements of skin elasticity were performed over 9 anatomic regions on admission and after 3 (on discharge), 17 and 28 months. Immediate distension, final distension and immediate retraction were significantly decreased, while the viscoelastic to elastic ratio was significantly increased in the patient as compared to the healthy controls. Delayed distension and biological elasticity were preserved. Low values of skin distensibility correlated with a severe skin induration (p < 0.001). The changes were more expressive with the 8 mm-diameter measuring probe than the 2 mm-diameter probe. The method applied can be used for objective and quantitative assessment of skin involvement in scleredema of Buschke.

Use of Cutometer to assess dermal oedema in erysipelas of the lower legs.

BACKGROUND/AIMS: Inflammatory dermal oedema in erysipelas alters skin mechanics. The aims of this study were to determine the relationship between skin mechanical properties and changes in dermal water content in patients with erysipelas of the lower leg, and to assess the value of measuring skin elasticity in monitoring the effect of therapy. METHODS: Twenty-five in-patients were studied before treatment and after 10 and 20 days. Visual scoring of oedema, measurements of limb circumference and skin elasticity with a non-invasive suction device (Cutometer) were made on the affected and unaffected lower legs. RESULTS: Indurated skin was characterized by raised delayed distension (Uv ), final distension (Ut ), resilient distension (R), viscoelastic to elastic ratio (Uv /Ue ) and hysteresis (H) and lower immediate distension (Ue ), immediate retraction (Ur ), gross elasticity (Ua /Uf ) and biological elasticity (Ur /Uf ). The visual score of oedema and leg circumference significantly correlated with the increase in Uv Uv /Ue and H and the decrease in Ua /Uf and Ur /Uf . The large 8 mm diameter measuring probe produced more pronounced changes than the small 2 mm probe. As a result of treatment, a significant reduction in viscoelastic parameters (Uv , Uv /Ue , R, H) and an increase in elastic parameters (Ua /Uf , Ur /Ut ) were observed. CONCLUSION: The non-invasive method applied is suitable for objective assessment of dermal oedema and disease evolution in patients with erysipelas.

Effect of ketoconazole 2% shampoo on scalp sebum level in patients with seborrhoeic dermatitis.

Twenty patients with scalp seborrhoeic dermatitis were treated twice weekly with ketoconazole 2% shampoo for 4 weeks. Clinical assessment, culture for P. ovale on Dixon broth and lipid measurement at two places were made before treatment and after 2 and 4 weeks. Significant improvement of the severity of seborrhoeic dermatitis (p < 0.001) and negative mycological tests by 19 (95%) of patients were observed. The scalp lipid content remained unaltered in 11 patients with an initial lipid value over 220 micrograms/cm2 but increased in those with lower initial values. This is probably due to the improvement of sebum delivery onto skin surface as a result of the elimination of the follicular occlusion.

Proteinase inhibitors and pemphigus vulgaris. An in vitro and in vivo study.

The aim of this study was to determine the inhibitory effect of clinically usable proteinase inhibitors p-aminomethylbenzoic acid (PAMBA), and aprotinin on acantholysis in skin organ culture and in clinical trials with pemphigus patients. PAMBA added to the culture medium at a concentration of 1 mg/ml fully prevented the acantholysis, while Contrykal at 10 ATrE/ml reduced acantholysis. Subsequently, we treated 12 patients (groups 1) with PAMBA 100-200 mg daily for 7 to 26 days in combination with a moderate dose of corticosteroid (mean dose 36.1 mg prednisolone equivalent) or immunosuppressive drugs. A second group of 12 patients (group 2) were treated with a high dose of corticosteroid (mean 94.2 mg prednisolone equivalent) and immunosuppressive drugs. Evaluation was performed before treatment, after 3 weeks and on discharge using a clinical scoring system. The inclusion of PAMBA in the treatment protocol of group 1 resulted in active disease being brought under control with lower corticosteroid doses. As a result, fewer side effects were observed in group 1 than in group 2. In our opinion, protease inhibitors may be useful as adjuvant drugs in the combination therapy of pemphigus.

In vivo noninvasive study of the mechanical properties of the human skin after single application of topical corticosteroids.

A noninvasive in vivo suction device for measuring skin elasticity was used to determine the changes in skin mechanical properties 60 min. after application of 5 commercially available topical corticosteroids as ointments and creams. 25 healthy volunteers (20 females and 5 males, aged 16-55 years, mean age 36 years) were studied. The following relative parameters, independent of skin thickness, were calculated and compared: R2-gross, R5-net, R7-biologic elasticity and R6-viscoelastic/elastic ratio. Corticosteroid ointments increased the purely elastic parameters R2, R5 (P < 0.05) and R7 as well as the parameter of viscoelasticity, R6 (P < 0.001). Corticosteroid creams changed the elastic parameters slightly increasing significantly at the same time the viscoelastic parameter, R6 (P < 0.05). These effects of topical corticosteroid formulations are probably due to the stratum corneum hydration and softening of keratin which improves the epidermal mechanical properties. Moreover, as a result of the dermal oedema and a probable biochemical effect on the basic substance, the friction between the fibres is reduced and interstitial fluid movement through the fibrous network is facilitated. The noninvasive method applied can be useful for an evaluation and comparison of the effects of different topical preparations on the elastic and viscoelastic properties of human skin.

Pathogenic in vitro studies of pemphigus vulgaris. I. Experimental model of pemphigus vulgaris in cultures in diffusion chambers.

Normal human skin, cultivated in diffusion chambers with biological membranes in the presence of serum from pemphigus vulgaris patient in the culture, developed all microscopic signs of an acantholytic process. An experimental model of pemphigus was thus created for the first time in our country and proposed by the authors as suitable basis for further studies on the disease pathogenesis and treatment.

Herpes zoster in infants.

The author reported four cases of herpes zoster in infants without history of chickenpox but with positive history of maternal varicella either in the early life or during pregnancy. One of the infants had been in a close contact with his father who had varicella. Herpes zoster in infancy develops secondary to an asymptomatic foetal varicella zoster virus infection or to an unrecognized subclinical varicella in infants born to varicella zoster virus immune mothers.