Pruritic papules and nodules as sign of persistent scabies infestation despite treatment according to current guidelines evidence for treatment resistance to ivermectin, benzylbenzoat and permethrin proven by videomicroscopy.

Scabies infestation is a growing public health issue due to its world wide increase of incidence. The objective of this study was to proof treatment resistance towards treatment, which was applied according to international guidelines. This is a controversial issue since treatment failures were believed to be due to false application oft he treatment. Here, we proof fort he first time this treatment resistance by videomicroscopic evaluation. Additionally an escalation therapy is described, which led to an effective treatment.

[Self-administration of a "mole removal pen"]. / Eigenanwendung eines "Muttermal-Entfernungs-Stifts".

A 31-year-old woman used a "mole removal pen" purchased from the internet for cosmetic reasons to remove numerous pigmentary moles. After self-application there was multiple scarring. Sequential videodermatoscopic documentation was performed. The purchase of medical-cosmetic products, their use, and the possible risks are discussed.

[Dermoscopic changes in melanocytic nevi during use of melanotan II]. / Dermatoskopische Veränderungen von melanozytären Nävi unter Verwendung von Melanotan II.

For cosmetic reasons, a 24-year-old man performed subcutaneous autoinjections with a preparation having alpha-MSH-like effects (melanotan II) purchased via the internet. The changes of patient's nevi were documented by sequential videodermoscopy before and during treatment. The observed dermoscopic changes made it difficult to differentiate a nevus from a melanoma.

[Light protection: principles of UV protection]. / Lichtschutz: Grundlagen der UV-Protektion.

UV radiation is responsible for the induction of epithelial and melanocytic skin cancer, photoaging, and photodermatoses. UV protection is necessary to prevent damage caused by non-physiologic exposure. UV protection includes not only reduction of sun exposure but also use of sun protective filters, UV protective clothes, DNA repair enzymes, and antioxidant supplementation. Consumers are uncertain about the possibilities and limitations of commercial sun protection measures. Dermatologists must explain protective measures to the general public which continues to believe that UV-tanned skin is healthy. The sunscreen market is a highly competitive but lucrative market. The range of products with different designations and promises makes difficult for both consumers and dermatologists to determine what is sensible UV protection.

[Neurocutaneous melanosis and malignant melanoma]. / Neurokutane Melanose und malignes Melanom.

A 36-year-old man presented with a giant congenital melanocytic nevus and multiple disseminated melanocytic nevi. After he had developed neurological symptoms (grand mal seizures), a cerebral metastasis of a malignant melanoma without a primary melanoma was found. The patient was diagnosed as having a neurocutaneous melanosis with a cerebral metastasis. In spite of a variety of therapeutic attempts (surgery, radiation therapy and chemotherapy) he followed a rapidly progressive, lethal course with increased intracranial pressure, hydrocephalus and spinal metastases.

[Vacuum therapy in a pre- and postsurgical ulcera crurum]. / Vakuumtherapie in der prä- und postoperativen Versorgung von Ulcera crurum.

Chronic wounds are often a diagnostic as well as a therapeutic problem. Three case reports depi important differential diagnoses. The importance and efficacy of vacuum assisted closure in a presurgical treatment as well as after mesh graft transplanation will be described.

[Wound debridement and treatment of ulcus cruris. Conservative and operative therapeutic procedures]. / Wundreinigung und -behandlung des Ulcus cruris. Konservative und operative Therapieverfahren.

Effective debridement of necrotic tissue and wet wound conditions are essential for wound healing. This can be achieved surgically or with conservative measures. Non-surgical options are the use of enzymatic preparations and the application of maggots. This biosurgical approach is enjoying a renaissance. The underlying pathophysiology of chronic venous leg ulcers can only be addressed by compression therapy and vein surgery.

[Sun protection during holidays]. / Sonnenschutz im Urlaub.

Ultraviolet radiation is causally involved in induction of skin cancer, premature skin aging and photodermatoses. The longing of our western society for a "healthy tanning" as well as the unbroken trend to spend the holidays in sunny regions lead to the fact that human skin is increasingly exposed to ultraviolet radiation and its detrimental effects. Because of the socio-political importance of the vacation period as the "most beautiful and most important time of the year", effective prevention of these unwanted UV effects has an enormous importance to the general population. In this article the most important methods for effective sun protection are critically discussed.

[Unusual clinical presentation of melanocytic nevi]. / Ungewöhnliche klinische Präsentationen melanozytärer Nävi.

Two patients with congenital pigmented lesions with a speckled clinical appearance are described. The lesions were nevus spilus (synonym: speckled lentiginous nevus) and agminate congenital nevi. The clinical aspects of nevus spilus and agminate nevi are reviewed.

Successful treatment of solar urticaria by extracorporeal photochemotherapy (photopheresis)--a case report.

UNLABELLED: Solar urticaria is characterized by erythema and whealing immediately after exposure to ultraviolet radiation and/or visible light. We report about a patient with severe solar urticaria, who was highly sensitive to both UVA radiation and visible light with a Minimal Urticaria Dose (MUD) of 7 J/cm2 UVA. Management of this patient was extremely difficult because standard treatment with oral antihistamines, hardening with UVA, UVB, visible light or oral PUVA and even oral cyclosporin A were completely ineffective. We therefore decided to perform extracorporeal photochemotherapy (photopheresis, ECP). After nine treatment cycles with photopheresis the MUD increased from 7 J/cm2 UVA before treatment to 22 J/cm2 UVA. This hardening effect was associated with a significant decrease of the frequency and severity of whealing and the accompanying symptoms (pain, fatigue, pruritus). CONCLUSION: Photopheresis might be of some benefit in selected patients with otherwise intractable solar urticaria.

Papio cynocephalus endogenous retrovirus among old world monkeys: evidence for coevolution and ancient cross-species transmissions.

To study the evolutionary history of Papio cynocephalus endogenous retrovirus (PcEV), we analyzed the distribution and genetic characteristics of PcEV among 17 different species of primates. The viral pol-env and long terminal repeat and untranslated region (LTR-UTR) sequences could be recovered from all Old World species of the papionin tribe, which includes baboons, macaques, geladas, and mangabeys, but not from the New World monkeys and hominoids we tested. The Old World genera Cercopithecus and Miopithecus hosted either a PcEV variant with an incomplete genome or a virus with substantial mismatches in the LTR-UTR. A complete PcEV was found in the genome of Colobus guereza-but not in Colobus badius-with a copy number of 44 to 61 per diploid genome, comparable to that seen in papionins, and with a sequence most closely related to a virus of the papionin tribe. Analysis of evolutionary distances among PcEV sequences for synonymous and nonsynonymous sites indicated that purifying selection was operational during PcEV evolution. Phylogenetic analysis suggested that possibly two subtypes of PcEV entered the germ line of a common ancestor of the papionins and subsequently coevolved with their hosts. One strain of PcEV was apparently transmitted from a papionin ancestor to an ancestor of the central African lowland C. guereza.

Novel endogenous type C retrovirus in baboons: complete sequence, providing evidence for baboon endogenous virus gag-pol ancestry.

A complete endogenous type C viral genome has been isolated from a baboon genomic library. The provirus, Papio cynocephalus endogenous retrovirus (PcEV), is 8,572 nucleotides long, and 38 to 59 proviral copies per baboon genome are found. The PcEV provirus possesses the typical simple retroviral gene organization, including two long terminal repeats and genes encoding gag, pol, and env proteins. The open reading frames for gag-pol and env are complete but have premature stop codons or frameshift mutations. The primer binding site of PcEV is complementary to tRNAGly. The gag and pol genes of PcEV are closely related to those of the baboon endogenous virus (BaEV). The env coding region of PcEV is related to the env genes of type C retroviruses. This suggests that PcEV is one of the ancestors of BaEV contributing the type C gag-pol genome fragment to the type C/D recombinant virus BaEV. Earlier it was shown that another endogenous type D virus (simian endogenous retrovirus) provided the env gene for BaEV (A. C. van der Kuyl et al., J. Virol. 71:3666-3676, 1997).

Complete nucleotide sequence of simian endogenous type D retrovirus with intact genome organization: evidence for ancestry to simian retrovirus and baboon endogenous virus.

A complete endogenous type D viral genome has been isolated from a baboon genomic library. The provirus, simian endogenous retrovirus (SERV), is 8,393 nucleotides long and contains two long terminal repeats and complete genes for gag, pro, pol, and env. The primer binding site is complementary to tRNA(Lys)3, like in lentiviruses. The env GP70 protein is highly homologous to that of baboon endogenous virus (BaEV). PCR analysis of primate DNA showed that related proviral sequences are present in Old World monkeys of the subfamily Cercopithecinae but not in apes and humans. Analysis of virus and host sequences indicated that the proviral genomes were inherited from a common ancestor. Comparison of the evolution of BaEV, exogenous simian retrovirus types 1 to 3 (SRV1 to SRV3), and SERV suggests that SERV is ancestral to both BaEV and the SRVs.