Schönlein-Henoch purpura associated with gastric Helicobacter pylori infection.

Schönlein-Henoch purpura is characterized by palpable purpura, colicky abdominal pain, gastrointestinal hemorrhage, arthralgias, and renal involvement. Bacterial and viral infections, as well as drugs and diseases associated with immune complexes, are thought to be responsible. We describe the case of a 21-year-old woman with Schönlein-Henoch purpura and chronic active gastritis with erosions. Helicobacter pylori was found in gastric mucosa using the newly introduced, nontoxic, noninvasive 13C-urea breath test; infection was confirmed by gastric mucosal biopsy. After eradication of H. pylori with omeprazole and amoxicillin, the skin changes, gastric complaints, and proteinuria disappeared. Ten months later, Schönlein-Henoch purpura recurred. H. pylori was again detected. After therapy, H. pylori was eradicated and the clinical manifestations faded. To our knowledge, H. pylori has not previously been described as a cause of Schönlein-Henoch purpura.

[Abdominal variant of benign symmetrical Launois-Bensaude lipomatosis]. / Abdominelle Variante einer benignen symmetrischen Lipomatose Launois-Bensaude.

We report on a patient with an abdominal type of benign symmetrical Launois-Bensaude lipomatosis. New aspects of the pathogenesis of abnormal distribution of the fatty tissue are also discussed.

[Pulsed direct current iontophoresis as a possible new treatment for hyperhidrosis]. / Die gepulste Gleichstrom-Iontophorese als neue Behandlungsmöglichkeit der Hyperhidrosis.

Tap water iontophoresis with direct current represents the therapy of choice in palmoplantar hyperhidrosis. Side effects are minor discomfort and skin irritations. Improper use may induce iontophoretic burns at sites of minor skin injuries. The aim of this study was to find ways of minimizing side effects, increasing safety standards and reducing the technical complications of tap water iontophoresis without loss of efficacy. In a blind study, 30 patients with palmar hyperhidrosis were treated with tap water iontophoresis using pulsed direct current of 4.3 kHz or 10.0 kHz. Efficacy and side effects were compared with those of the conventional direct current method as a control. Normal sweat secretion rates of palms were found after an average of ten treatment sessions with the conventional direct current method and after twelve with pulsed direct current of 4.3 or 10 kHz. Treatment with pulsed direct current of 4.3 kHz failed to inhibit palmar hyperhidrosis in two of ten patients. Occasionally, such side effects as discomfort, skin irritation, and mild electric shock occurred when direct current was applied. Using pulsed direct current subjective sensations of discomfort and skin irritation were rare (4.3 kHz) or very rare (10 kHz). Electric shock was completely prevented. Because of the minimal side effects, despite minor loss of efficacy tap water iontophoresis with pulsed direct current can be a valuable alternative treatment for palmar hyperhidrosis.

Effects of human recombinant interferon-alpha 2b on P450-dependent isozymes in rat liver and skin.

Adult female Wistar rats divided into two groups (6 animals each) were subcutaneously treated with 10(5) units/day recombinant human interferon-alpha 2b (hrIFN-alpha 2b) and corresponding quantities of the vehicle, respectively, over a period of 7 days. Microsomal protein, P450 content, and the activities of aminopyrine-N-demethylase (ADM), 7-ethoxyresofurin-O-deethylase (7-ERO-D) and of erythromycin-N-demethylase (EMDM) were determined in the liver microsomes. Moreover, 7-ERO-D and EMDM activities were determined in the skin microsomes of the treated animals. In the liver microsomes hrIFN-alpha 2b caused a statistically significant increase in ADM activity and a statistically significant decrease in 7-ERO-D and EMDM activities, as compared to the controls. However, in the pooled skin microsomes 7-ERO-D activity showed a trend to increase under the administration of hrIFN-alpha 2b, whereas EMDM activity could not be detected in the treated or the control animals. The results of the present study indicate that hrIFN-alpha 2b is capable of affecting the activities of P450-dependent isozymes in the rat liver and skin in a different manner. Our findings support the hypothesis that clinically relevant interactions may occur during the concomitant administration of hrIFN-alpha 2b and other compounds that are metabolized by hepatic and cutaneous P450 monooxygenases.

[Modification and optimization of tap water iontophoresis]. / Modifikation und Optimierung der Leitungswasser-Iontophorese.

Tap water iontophoresis is the therapy of choice in hyperhidrosis palmoplantaris. Therapeutic regimens, however, vary greatly. The aim of the present study was to develop an optimized therapeutic scheme. The main methodologic parameters subjected to systematic experimental study included the effects of current polarity, the duration of a single treatment session, the addition of electrolytes to the tap water and the treatment interval during maintenance therapy. The following procedure is proposed. During the initial phase, treatments are carried out three times weekly for 10 min each time. The anode is kept on one extremity until normhidrosis is reached on this extremity. Then, polarity is changed until sweating is reduced to normal on the other extremity (constant polarity). In the subsequent maintenance phase, patients are treated at intervals of 6-8 days for 10 min each time. Polarity is switched from treatment to treatment (alternating polarity). Plain tap water is used without additives.

Acquired relapsing self-healing Blaschko dermatitis.

We describe a 44-year-old woman who had a unilateral relapsing linear dermatosis for 12 years. The lesions consisted of erythematous, discrete and grouped papules and papulovesicles that were localized to the left side of the upper and lower limbs, chest, abdomen, and back. They were distributed along Blaschko's lines. There was also a diffuse erythematous scaly hyperkeratosis of both palms. The lesions healed spontaneously. Examination of biopsy specimens from the back and the left palm revealed acute and subacute spongiotic dermatitis, respectively. This dermatosis was first described by Grosshans and Marot in 1990 and termed "Blaschkite de l'adulte." Because the disease is acquired, relapsing, heals spontaneously, follows Blaschko's lines, and is characterized histopathologically by a spongiotic dermatitis, we propose the term "acquired relapsing self-healing Blaschko dermatitis."

[Distal edema and hyperhidrosis of the arm. Symptoms of reflex sympathetic dystrophy (Sudeck's disease)]. / Distales Odem und Hyperhidrosis des Armes. Symptome der sympathischen Reflexdystrophie (M. Sudeck).

Reflex sympathetic dystrophy is characterized clinically by the triad of autonomic sympathetic dysfunction, and motor and sensory disturbances of the affected extremity. Typical symptoms are distal generalized edema with cyanotic skin, pathologic function of eccrine sweat glands and diffuse dull pain. If reflex sympathetic dystrophy is not recognized an irreversible stage may be reached, with atrophic pale, cool, and anhidrotic skin, contractures and diffuse osteoporosis. The syndrome can be idiopathic but can also be precipitated by a variety of factors, including banal trauma, bone fracture, and traumatic nerve lesions. Pathophysiologically, a functional disturbance of sympathetic nerve fibres may result in a vicious circle of blood flow dysfunction, excitation of afferent nociceptors and maintenance of sympathetic dysfunction at the level of the spinal or central nervous system. In the patient presented in this paper, sympathetic dysregulation of reflex sympathetic dystrophy was cured by means of blockades of the stellate ganglion.

Helicobacter pylori in patients with systemic sclerosis: detection with the 13C-urea breath test and eradication.

In patients with systemic sclerosis peristaltic abnormalities may delay gastric emptying, giving rise to bacterial overgrowth, including possibly Helicobacter pylori (HP). Infection with Helicobacter is an important risk factor for esophageal and gastric diseases, including esophagitis, gastritis and gastric cancer. The purpose of this prospective study was to assess gastric HP infection in patients with systemic sclerosis. In 12 patients with systemic sclerosis the newly introduced breath test with 13C-labelled urea was used for indirect detection of gastric urease activity due to HP infection. Five out of 12 patients gave Helicobacter-positive results (42%); 7 patients were negative for Helicobacter colonization (58%). Thus, the risk for gastric diseases caused by HP infection is enhanced in patients with systemic sclerosis compared with white healthy, asymptomatic persons examined in other studies. Helicobacter-positive patients were treated with 2 x 20 mg omeprazole and 4 x 500 mg amoxicillin over 14 days. Afterwards the 13C-urea breath test was repeated and showed negative results for Helicobacter in all systemic sclerosis patients treated. Dual therapy with omeprazole and amoxicillin therapy effectively eradicated HP. The 13C-urea breath test did not cause any side-effects and is therefore considered to be a non-invasive, non-toxic and safe method for the diagnosis and therapeutic control of Helicobacter-status.

[Photochemotherapy (PUVA) of acute graft-versus-host disease]. / Photochemotherapie (PUVA) der akuten Graft-versus-Host-Erkrankung.

For several years, psoralen and UV-A light (PUVA) therapy has been used in the treatment of chronic graft-versus-host disease (GvHD) following allogeneic bone marrow transplantation (BMT). There is little experience with PUVA treatment of acute GvHD. Allogeneic BMT was performed in 25 patients, 10 of whom developed acute GvHD despite immunosuppressive therapy. Six patients with acute cutaneous GvHD grade II-III (n = 2 grade II, n = 4 grade III) were treated with PUVA. We present the results. All the PUVA-treated patients improved markedly after 5-12 sessions of irradiation. In 5 patients the skin cleared completely with 8-18 treatments. In 4 patients chronic GvHD was prevented by maintenance treatment for up to 10 months. Following clearing of acute cutaneous GvHD, 2 patients developed chronic GvHD after therapy-free intervals of 3 and 12 months, respectively. These results indicate a beneficial effect of PUVA in acute cutaneous GvHD and suggest a protective effect against chronic GvHD.

Fixed solar urticaria.

BACKGROUND: Three unusual cases of solar urticaria limited to fixed skin sites are described. OBJECTIVE: Our objective was to study the clinical course and several therapeutic regimens for fixed solar urticaria. METHODS: Phototesting and in vitro activation of a plasma factor were performed. RESULTS: Wheals in a patchy pattern were strictly localized to the same circumscribed skin areas; they were reproducible in their pattern and location by irradiation. The action spectra ranged from 320 to 700 nm, 320 to 585 nm, and 400 to 560 nm. In one patient inhibition was found by wavelengths between 280 and 320 nm. Intradermal injection of the patients' plasma activated by in vitro irradiation induced wheals only in the affected skin sites. The patients showed a good therapeutic response to H1-antihistamines or repeated exposures to natural sunlight. CONCLUSION: The term fixed solar urticaria is proposed for this peculiar type of solar urticaria.

Iontophoresis with alternating current and direct current offset (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis.

Tap-water iontophoresis (TWI) using direct current (DC) is the most effective therapy in palmoplantar hyperhidrosis. Side-effects of this method are discomfort, with burning and tingling, and skin irritation, including erythema and vesicles. Incorrect use may induce iontophoretic burns at sites of minor skin injury. Elaborate safety measures are required to prevent electric shock. The aim of this study was to minimize side-effects and to increase technical and safety standards of TWI, without loss of efficacy. In a controlled blind study, treatment of palmar hyperhidrosis by alternating current (AC) or by AC with DC-offset (AC/DC) was compared with the conventional DC method. Palmar hyperhidrosis was completely controlled after an average of 11 treatments by either AC/DC iontophoresis or the conventional DC method. Virtually no effect was seen when AC without DC-offset was used for TWI. There were no signs of cutaneous irritation, or subjective sensations of discomfort when AC with or without DC-offset was employed. AC/DC iontophoresis should become the treatment of choice for palmoplantar hyperhidrosis. The mechanism of action is unknown. It is hypothesized that an interrupted stimulus-secretion-coupling leads to a functional disturbance of sweat secretion.

Ross syndrome: treatment of segmental compensatory hyperhidrosis by a modified iontophoretic device.

In 1958 the triad of tonic pupils, areflexia (Holmes-Adie syndrome), and hypohidrosis was first described by Ross. Since then more than 15 patients with a similar condition have been described. Two cases with the typical triad in combination with associated autonomic dysfunctions are presented. Subjectively, the most disturbing symptom is segmental compensatory hyperhidrosis, which results from widespread hypohidrosis or anhidrosis. For treatment of hyperhidrosis, tap water iontophoresis was applied using a modified technique with special electrodes. In both patients the hyperhidrosis was relieved after 20 treatments.

[Eosinophilia-myalgia syndrome]. / Das Eosinophilie-Myalgie-Syndrom.

The eosinophilia-myalgia syndrome was first reported from New Mexico, USA, in 1989. Since then, there have been further reports from the USA, Canada and Europe. Patients with the eosinophilia-myalgia syndrome present with myalgias, morbilliform and urticarial rash, oedema, sclerodermiform lesions, fever, pneumonia, fatigue and peripheral eosinophilia (greater than 1,000/mm3). The ultimate cause is postulated to be a contamination produced by Bacterium amyloliquefaciens during the production of L-tryptophan by genetic engineering techniques. HPLC analysis revealed that the causative agent was a condensation product of 1 mole acetaldehyde and 2 moles tryptophan. Clinical and laboratory findings of the eosinophilia-myalgia syndrome, Shulman syndrome and toxic-oil syndrome are discussed.