Calculation of nail plate and nail matrix parameters by 20 MHz ultrasound in healthy volunteers and patients with skin disease.

BACKGROUND/AIMS: The objective, but noninvasive, assessment of the nail plate and nail matrix is of interest in dermatology, and cosmetics as well. These cutaneous structures were investigated with 20 MHz ultrasound. This study was performed to obtain data on normal nails in adults of different age groups, with a left-right comparison, and to investigate nail changes in selected dermatologic diseases. METHODS: Healthy controls (n = 34) and patients with dermatologic complaints and nail disease (n = 37) were included after informed consent. In the control group, 18 woman and 16 men with a mean age of 37.2 years (range 15 to 82 years) were investigated for age- and gender-related differences. Patients with one of the following disorders were investigated: systemic lupus erythematosus (SLE; n = 11), systemic sclerosis (PSS; n = 8), psoriasis (n = 9), chronic hand eczema (n = 5), and others (n = 4). Measurements of length and width of the nail plate and the lunulae were performed with a micrometer device. Sonography was performed with a 20 MHz probe in B-scan mode. RESULTS: The mean nail thickness of healthy controls varied between 0.481 mm (right thumb) and 0.397 mm (left fifth finger). The nail volume and the matrix volume disclosed a positive, but mostly nonsignificant, correlation for all controls. Age-specific differences were investigated for both genders. In men and women, the matrix volume increased significantly with age. The nail and matrix volume was higher in men than in women, independent of age. The left-right comparison disclosed a trend to higher nail and matrix volumes on the right hand. In patients with SLE there was an increase in nail thickness and in matrix volume. Patients with PSS showed a significant decrease in nail thickness and matrix volume. In other diseases the measurements disclosed no confident differences to healthy controls. CONCLUSION: The 20 MHz ultrasound offers a noninvasive method to calculate nail thickness, nail volume and matrix volume in healthy volunteers and in nail disease. Skin diseases show characteristic quantitative changes in these parameters.

Lower relapse rate of botulinum toxin A therapy for axillary hyperhidrosis by dose increase.

BACKGROUND: Primary focal hyperhidrosis is a common condition that gives rise to functional and emotional problems and may disturb professional and social life. Recently, low-dose intracutaneous injections of botulinum toxin A have been shown to induce a temporary anhidrosis, with relapses occurring usually after 4 to 6 months. OBJECTIVE: To evaluate the short- and long-term effectiveness and possible adverse effects of high-dose botulinum toxin therapy in the treatment of axillary hyperhidrosis. DESIGN: In an open study, patients with focal hyperhidrosis were treated with intracutaneous injections of botulinum toxin A (Botox; Allergan Inc, Irvine, Calif). A total dose of 200 U of botulinum toxin A was used once per axilla. Patients were observed for up to 15 months. SETTINGS: University medical center. PATIENTS: Twenty-four patients with axillary hyperhidrosis were treated. Their ages ranged from 19 to 58 years (mean +/- SD, 34.8 +/- 12.4 years). MAIN OUTCOME MEASURES: Reduction of sweating as assessed by the Minor iodine-starch test and planimetry of hyperhidrotic areas. Patients were interviewed at the end of follow-up about their satisfaction with this treatment. RESULTS: Within 6 days, all patients reported cessation of excessive sweating. The mean +/- SD area of excessive sweating identified by the Minor iodine-starch test decreased from 19.27 +/- 11.95 cm2 to 0.25 +/- 0.61 cm2 (P<.001). The mean follow-up was 10.0 +/- 2.8 months (range, 5-15 months). Four patients (17%) reported a return of axillary hyperhidrosis after 7 to 10 months. All patients who experienced relapse showed an excellent response to a second treatment. The only adverse effects reported were temporary pain and burning during the injections. No muscular weakness, insensitivity, or systemic reactions were observed. CONCLUSIONS: High-dose botulinum toxin A seems to be as safe as low-dose botulinum toxin A in the treatment of axillary hyperhidrosis. The preliminary data suggest a lower rate of relapse.

Serum protein s100beta in patients with malignant melanoma detected by an immunoluminometric assay.

S100 protein is well established as a diagnostic tool in malignant melanoma immunohistology. In this study we measured S100beta in serum with a recently developed luminometric immunoassay with a detection limit of 0.02 microg/l. By measuring S-100beta in a group of apparently healthy individuals a mean value of 0.031 +/- 0.026 microg/l was found. In the reference group, serum S100beta was below 0.12 microg/l in all cases. To assess the sensitivity of the assay we investigated serum S-100beta levels in 371 serum samples of 315 patients with histological proven malignant melanoma at different disease stages. Staging was performed according to the German Society of Dermatology classification. Significant differences were observed between the control group and stages IIb (P = 0.01) and IV (P = 0.001). In tumour-bearing patients of stages IIIb and IV, the difference was highly significant (P < 0.0001). S100beta > 0.20 microg/l helps to distinguish between tumour-free and tumour-bearing patients with a specificity of 97.0% and a sensitivity of 64.6%. Our results demonstrate the serum S100beta is of limited value as a melanoma marker. However, it has clinical significance for identifying tumour-positive patients in advanced malignant melanoma stages III and IV.

Biosurgery in wound healing--the renaissance of maggot therapy.

Chronic wounds are a challenge for modern health care. A basic principle of treatment is the removal of sloughy, necrotic, devitalized tissue to prevent wound infection and delayed healing. Biosurgery (syn. maggot or larval therapy) is a promising adjunct to the whole spectrum of topical treatment methods, in particular for debridement. The term 'biosurgery' describes the use of living maggots on wounds to remove devitalized tissue, decrease the risk of infection and improve wound healing. The present paper gives a brief review of history, entomology, biochemistry and medical indications of biosurgery and the practical handling of maggots. We also provide some clinical data from the literature and our own experience in a wound care unit. Biosurgery is an effective and safe treatment option for debridement and disinfection.

Treatment of relapsing or recalcitrant cutaneous T-cell lymphoma with pegylated liposomal doxorubicin.

BACKGROUND: Pegylated liposomes are stable, long-circulating carriers useful for delivering doxorubicin to tumor sites with a lower toxicity than the free drug. Free doxorubicin is used in several treatment protocols for non-Hodgkin's lymphoma. Although pegylated liposomal doxorubicin is currently used in the treatment of Kaposi's sarcoma, no data are available for tumors, such as primary cutaneous T-cell lymphomas (CTCLs). OBJECTIVE: Our purpose was to determine the efficacy and toxicity of pegylated liposomal doxorubicin in patients with relapsing or recalcitrant CTCL. The cumulative dose was limited to 320 mg. METHODS: A prospective pilot study was performed. Six patients (1 woman and 5 men) aged 59 to 78 years with relapsing or recalcitrant CTCL of the mycosis fungoides type, stage (Ib/IIb), were treated with pegylated liposomal doxorubicin to induce a clinical response. The drug was administered at a dosage of 20 mg m(-2) once a month. Four patients received 8 doses, and 2 patients received 6 doses. RESULTS: The best response was a complete response in 4 patients and a partial response in 2 patients. The final outcome was a complete response in 4, a partial response in 1, and progressive disease in 1 patient (overall response rate, 83%). The responders showed a decrease of lymphocytic infiltrates and activated T lymphocytes in skin biopsy specimens. Side effects were seen temporarily, ranging from grade 0 to grade 3. The most frequent side effects were mild anemia and lymphopenia. There was no need of additional therapy because of side effects. CONCLUSION: These results indicate that patients with relapsing or recalcitrant CTCL can achieve a high response rate with pegylated liposomal doxorubicin and that a monthly dose is a well-tolerated regimen.

Simultaneous measurement of circulating intercellular adhesion molecule-1 and serum copper zinc superoxide dismutase activity in patients with malignant melanoma.

Soluble intercellular adhesion molecule-1 (sICAM-1) and copper zinc superoxide dismutase (CuZnSOD) were measured in 930 serum samples of 256 patients with histologically proven malignant melanoma and 78 serum samples of 78 controls by enzyme-linked immunosorbent assay. Seventy-seven patients were stage Ia, 79 stage Ib, 59 stage IIa, 30 stage IIb, 13 stage IIIb, and 7 stage IV according to the German Society of Dermatology (DDG) classification. We calculated the normal range (mean +/- SD) for sICAM-1 (71.3-257.3 ng/ml; mean 163.3 ng/ml) and CuZnSOD (34.8-175.6 ng/ml, mean 105.2 ng/ml). The serum levels of sICAM-1 were significantly higher in all stages of melanoma than in controls (p<0.00005). Additionally, significant differences were observed between different stages of melanoma (Ia and Ib vs IIa/IIb/IIb/IV, IIa and b vs IV). The mean levels of sICAM-1 in melanoma were lowest in stage I (Ia: 257.25 ng/ ml, Ib: 252.47 ng/ml) and highest in stage IV (394.24 ng/ml). Significant differences in CuZnSOD levels were not detected between melanoma patients and controls, neither between melanoma patients of different stages. A decrease of CuZnSOD was found in only 37 samples of melanoma patients independent of the clinical stage. Our results demonstrate a relationship of increased sICAM-1 levels to melanoma and disease progression. We conclude that sICAM-1, but not CuZnSOD, is useful in monitoring of patients with malignant melanoma and might be beneficial in evaluation of therapeutic efficacy.

Remittance spectroscopy of human skin in vivo.

BACKGROUND/AIMS: The skin is an easily accessible organ on which non-invasive examination methods can be applied. Recently spectroscopic methods have been introduced in characterization of skin under physiological and pathological conditions. To examine remittance spectroscopic qualities of human skin in vivo and to clarify the influence of selected test conditions, a single-beam spectrometer MCS 410 (Carl Zeiss, Jena, Germany) has been used. METHODS: Remittance spectra readings were performed in 35 volunteers. Wavelength ranged from 362 nm to 780 nm. Individual remittance values and their standard deviations were obtained from 20 readings under standardized test conditions. The effect of pressure, rubbing, cooling, washing, greasing and degreasing on average remittance values was investigated. Statistical analysis was done with paired Student's f-test and Fisher's test. RESULTS: Pressure increased remittance values over a wide range of wavelength, peaking at 518 nm. Greasing and degreasing modified spectral remittance of shorter wavelength peaking around 362 nm. Rubbing and cooling did not induce significant variations of spectral remittance of skin. CONCLUSION: Spectral remittance provides an individual profile in human skin, which may be influenced by pressure and greasing/ degreasing. To establish standardized test conditions with a narrow range of intra-individual variation these items have to be kept constant.