[Extragenital, disseminated infection with human papillomaviruses : Therapeutic response through vaccination with HPV]. / Extragenitale, disseminierte Infektion mit humanen Papillomaviren : Therapeutisches Ansprechen auf HPV-Vakzinierung.

A 50-year-old man with widespread manifestation of warts and distinct pruritus for the last 5 years was diagnosed with a reactivated human papillomavirus (HPV) infection by three, genetically verified types (6, 16, 18), which are included in the vaccine Gardasil®. Conventional treatment was not successful, but a rapid and significant reduction of the skin manifestation was observed after vaccination with Gardasil®. To what extent therapy-resistant infections with HPV can be influenced through an active HPV vaccination should be investigated in future trials.

Chemoimmunotherapy for cutaneous melanoma with dacarbazine and epifocal contact sensitizers: results of a nationwide survey of the German Dermatologic Co-operative Oncology Group.

PURPOSE: To scrutinize published data from small mono-centric studies and case reports which implicated high response rates and promising survival times for a combination therapy consisting of epifocal dinitrochlorobenzene (DNCB) and dacarbazine (DTIC) for metastasized melanoma. This therapy merges the effects of an allergic contact dermatitis elicited at the site of a cutaneous metastasis, and systemic chemotherapy. METHODS: We performed a retrospective survey with nine German centers and evaluated 72 patients treated from 1993 to 2005. RESULTS: The objective response rate in stage III melanoma (n = 39) was 62%. In contrast, only 9% objective responses were observed in 33 stage IV patients. Interestingly, more than half of patients with objective remissions remained progression-free for more than 1 year irrespective of the stage of disease. CONCLUSIONS: Epifocal DNCB combined with DTIC is effective in patients with regionally metastasized melanoma not amenable to surgery or isolated limb perfusion, whereas in stage IV disease in spite of few durable remissions the addition of DNCB does not improve the therapeutic efficacy of DTIC.

Bizarre annular lesion emerging as tinea incognito.

Tinea incognito has first been described in 1968. The term describes a tinea infection whose clinical morphology has been modified by the application of topical corticosteroids. The clinical manifestation can masquerade a number of other dermatoses and leads to misdiagnosis of annular eruptions. We describe a patient who showed a bizarre appearance of annular, inflammatory skin lesions at the umbilical region. Mycological culture yielded Microsporum canis.

[Merkel cell carcinoma. Clinical and histological differential diagnosis, diagnostic approach and therapy]. / Merkel-Zell-Karzinom. Klinische und histologische Differenzialdiagnose, Diagnostik und Therapie.

Merkel cell carcinomas are rare tumors of the skin with an aggressive behavior and frequent regional and distant metastases. Typically, the primary is a fast-growing, painless, reddish nodule with an iceberg-like effect, broadening in the depth. On the trunk and the buttocks, deep clinically rather inconspicuous nodules can occur. The clinical differential diagnosis of the Merkel cell carcinoma includes skin metastases, malignant lymphomas, malignant adnexal tumors and cysts when the tumor is located deep in the soft tissue (e.g. on the buttocks). Histological and immunohistochemical analysis is necessary for the diagnosis. The demonstration of cytokeratin 20 in the typical globular distribution pattern is of main importance in the diagnosis of Merkel cell carcinoma. Because they are very rare, Merkel cell carcinomas are infrequently diagnosed clinically, in spite of the rather characteristic picture. Diagnostic excision with a safety margin of 3 cm is recommended followed by an adjuvant radiotherapy. The radiation field should include the area of the draining vessels and the first regional lymph nodes. There are some reports concerning the advantage of sentinel lymph node biopsy. In distant metastases, the therapy is multimodal and palliative including surgery, radiation and chemotherapy. Because of the high incidence of regional and distant metastases, regular follow-up is important.

Somatostatin analogue scintigraphy in Merkel cell tumours.

BACKGROUND: Merkel cell tumours are rare neoplasms of the skin with frequent regional and distant metastases. Scintigraphy with the radiolabelled somatostatin analogue octreotide is a possible method for in vivo localization of the primary tumour and its metastases. OBJECTIVES: To estimate the diagnostic value of indium (111) -octreotide scintigraphy (Octreoscan in detecting metastases. METHODS: Scans of 11 patients with Merkel cell carcinoma were evaluated, in whom scintigraphy was performed in addition to the conventional investigations, chest X-ray, ultrasonography and computed tomography (CT). RESULTS: In four cases metastases were found both by scintigraphy and by conventional methods; two investigations showed a suspicious accumulation of radioactivity on scintigraphy that could not be confirmed by CT and clinical progression. In three cases CT-verified metastases were not found by scintigraphy. Two patients were found to be tumour free, i.e. free of metastases by scintigraphy and conventional methods, indicating true-negative results. CONCLUSION: These data confirm that scintigraphy with the radiolabelled somatostatin analogue octreotide is not clinically helpful in detecting metastases from Merkel cell carcinoma. In this relatively small sample the method generated false-positive or false-negative results in five of 11 cases.

[Heinrich Köbner and the "isomorphic phenomenon". History and review of the literature]. / Heinrich Köbner und der "isomorphe Reizeffekt". Geschichte und Uberblick.

The isomorphic phenomenon belongs to the probably most well-known entities of dermatology and is closely connected to the man who was the first to describe it. Today the Koebner phenomenon is well documented in a number of skin diseases and still of considerable interest. Heinrich Koebner first reported his observation in 1872 and caused considerable diverse discussion about the origin of psoriasis in the following years. Heinrich Koebner is not only well known as "father" of the Koebner phenomenon, but also as a founder of the university dermatology clinic and pioneer of dermatology in Breslau. We not only describe the life of Heinrich Koebner, but also discuss the evolution of the term "Koebner phenomenon" and its current status.

Drug-induced Sweet's syndrome in acne caused by different tetracyclines: case report and review of the literature.

Sweet's syndrome was first described in 1964. It is characterized by an acute onset of non-pruritic, painful reddish nodules on the head and neck, chest and/or the upper limbs, mostly accompanied by fever, general malaise and leucocytosis. Histopathological examination shows a diffuse dermal neutrophilic infiltrate. The pathogenesis is still not fully understood, and different diseases have been shown to be associated with this syndrome. However, although still very rare, there is an increase of reports on Sweet's syndrome induced by drugs. We describe a 30-year-old man who experienced acute neutrophilic dermatosis after systemic treatment with minocycline. Additionally, there is a strong possibility that the same patient developed a drug-induced Sweet's syndrome after oral administration of tetracycline and doxycycline.

Malignant transformation of multiple dermal cylindromas.

Cylindromas are benign tumours arising as small, solitary, slow-growing nodules on the head and neck. Multiple cylindromas may form a 'turban tumour' in the autosomal dominant Brooke-Spiegler syndrome. We report two unusual cases of multiple cylindromas with transformation into cylindrocarcinomas. The first patient, a 63-year-old white woman, developed a cylindrocarcinoma on pre-existing multiple cylindromas on her right shoulder. Eight months after resection she developed a lymph node metastasis in the right axilla. The second patient, a 68-year-old white woman, presented with multiple cylindromas of the scalp. One of these transformed into a cylindrocarcinoma, infiltrating the dura mater, with local recurrence 2 years after incomplete resection and postoperative radiation.

[Extracorporeal photopheresis--treatment option in scleromyxedema?]. / Extrakorporale Photopherese--Therapieoption beim Skleromyxödem?

Scleromyxedema is an uncommon disease of unclear etiology. Therapy is difficult. Two patients with scleromyxedema were treated with extracorporeal photopheresis (ECP). The first patient has been treated unsuccessfully for 3 months with PUVA-bath-therapy and for one year with cyclophosphamide and prednisolone. Thus supplementary treatment with ECP was initiated, as the cyclophosphamide and prednisolone were gradually reduced. After 29 cycles of ECP, the skin lesions had almost disappeared and the associated myopathy also resolved. In the second patient initial monotherapy with ECP was started after PUVA-bath-therapy for 3 months did not show any effect. After temporary improvement with ECP every four weeks, the skin lesions relapsed, so oral cyclophosphamide was added. These two cases confirm the effect of ECP in scleromyxedema, but probably combination therapy is at least initially more successful.

Koebner phenomenon due to scratch test in scleromyxoedema.

The Koebner phenomenon or isomorphic response was originally described in psoriasis and has subsequently been observed in various other diseases. We report a patient with isomorphic response in scleromyxoedema, a variant of papular mucinosis with diffuse infiltration of the skin. The Koebner phenomenon was due to a scratch test performed 4 weeks before the appearance of streaky, lichenoid infiltrations on the forearms.

Effect of acarbose and simultaneous antacid therapy on blood glucose.

In a single-centre, placebo-controlled, clinical study, the influence of an antacid containing magnesium hydroxide and aluminium hydroxide (Maalox 70; 10 ml) on the pharmacodynamics of the oral antidiabetic drug acarbose (Glucobay 100, Bay g 5421, CAS 56180; 100 mg) was tested in 24 healthy male volunteers. The drugs were given alone or in combination and were compared with placebo. Volunteers were randomized into four different treatment groups. The daily medication over 4 days was 1 x 1 placebo tablet, or 1 x 1 tablet containing 100 mg acarbose, or 1 x 1 tablet containing 100 mg acarbose plus 10 ml antacid suspension, or 1 x 1 placebo tablet plus 10 ml antacid suspension, interrupted by wash-out phases of 6-10 days between successive treatments. Efficacy was assessed on the basis of postprandial blood glucose and serum insulin levels after administration of 75 g sucrose, and was measured as maximal concentrations and 'area under the curve' (0-4 h). No influence of the antacid on the blood glucose and insulin-lowering effect of acarbose could be detected. Hence, there does not appear to be a significant interaction between acarbose and the antacid tested. Antacids similar to that tested do not need to be classified as a contraindication when used in combination with acarbose.