Nephrogenic fibrosing dermopathy.

Nephrogenic fibrosing dermopathy (NFD) is an uncommon, recently described fibrotic skin disorder that has been observed in patients with end-stage renal disease. We describe a 81-year-old man with end-stage renal disease who developed NFD in the seventh year of haemodialysis. Laboratory investigations revealed considerably increased circulating immune complexes and anti double stranded DNA antibodies. Because the pathogenesis of NFD may not entirely be attributable to haemodialysis, the role of circulating factors in the development of cutaneous manifestations requires further investigation.

Angiokeratoma Fordyce of the glans penis: combined treatment with erbium: YAG and 532 nm KTP (frequency doubled neodynium: YAG) laser.

A rare case of angiokeratoma Fordyce localized on the margin of the glans penis in a 52-year-old Caucasian patient is reported. Combined treatment with Erbium: YAG and 532 nm KTP (frequency doubled Neodynium: YAG) laser led to excellent cosmetic results.

Investigation of basal cell carcinoma [correction of carcionoma] by confocal laser scanning microscopy in vivo.

BACKGROUND/PURPOSE: In vivo confocal laser scanning microscopy (CLSM) allows to study human skin up to 200 micro m deep non-invasively. Aim of this study was to investigate basal cell carcinoma (BCC) using in vivo CLSM, and to compare the micromorphologic features of BCC with uninvolved skin. METHODS: Twelve patients with histological diagnosis of BCC referred to our department for tumor excision were investigated on the lesion(s) and on clinically uninvolved sites preoperatively by in vivo CLSM using the Vivascope 1000 (Lucid Inc., Rochester, USA). The images were compared to histological examinations of the excised tissue. RESULTS: Typical changes in vasculature such as increase in number and diameter of the blood vessels, loss of the vascular architecture, parallelly and horizontally orientated vessels, and accumulation and rolling phenomena of bright reflecting cells of 11.88 +/- 1.75 micro m in diameter along the vessel wall were observed in all BCCs. The tumor stroma of the BCCs showed a strong reflectance mainly due to numerous bundles of collagen fibers encoating dark, cell-rich areas of tumor parenchym. In five patients, slim basaloid cells with relatively large, elongated dark nuclei were observed in the periphery of the tumor parenchym. In the fibrosing type of BCC, curled bundles of collagen with large cells represented the tumor stroma. CONCLUSIONS: BCC can be investigated by CLSM and provide typical features. Besides the tumor parenchym and stroma, typical changes in vasculature seem to be a sensitive criteria for BCC and may in future help in diagnosing BCC by CLSM as well as in assessing the margins of large tumors. We suggest that CLSM is a promising non-invasive tool for the diagnostics of BCC and the assessment of tumor margins prior to surgery.

Generalized essential telangiectasia successfully treated with high-energy, long-pulse, frequency-doubled Nd:YAG laser.

BACKGROUND: Generalized essential telangiectasia is a rare cutaneous disorder with limited therapeutic options. OBJECTIVE: To evaluate the treatment with high-energy, high-frequency, long-pulse Nd:YAG laser in a patient with generalized essential telangiectasia. METHODS: A 62-year-old woman presented with a 20-year history of generalized essential telangiectasia. She had extensive telangiectasias primarily on the forearms and lower legs. The patient was treated with an Nd:YAG laser using a fluence of 20 J/cm2 and a pulse width of 20 msec. A sapphire water-cooled chill tip was used to cool the skin during laser therapy. The treatment was performed every 4 weeks over a period of 6 months. RESULTS: After six treatment sessions an almost complete clearance of telangiectatic lesions was observed. Side effects such as purpura, scarring, and pain did not occur. After a follow-up of 6 months, small telangiectatic lesions relapsed. CONCLUSION: Our results suggest that the Nd:YAG laser appears to be an effective and safe treatment option for generalized essential telangiectasia.

[Objectivity, reproducibility and validity of 3D ultrasound in dermatology]. / Objektivität, Reproduzierbarkeit und Validität der 3D-Sonographie in der Dermatologie.

Recently it has become possible to visualize the three-dimensional (3D) architecture of sonographic structures using high-resolution ultrasound above 20 MHz (Dermascan C, Denmark; DUB 20, Germany). We studied the objectivity, reproducibility, and validity of these two 3D analysis systems on 22 skin tumors. To validate both systems, we compared the sonometric and histometric volume in 4 tumors. The objectivity was calculated by repeated evaluation of the volume on the same serial B-scan sections at 3-month intervals. The two-dimensional B-scans and 3D images exhibited similar characteristics. Volumetric evaluations were reproducible with both systems (variation coefficient < or = 9.9%), when the applicator was oriented longitudinal to the body axis. By changing the orientation, the coefficient increased up to 58.1% (DUB 20). Sonometric and histometric volumes of a phantom model and of the tumors exhibited small deviations in the Dermascan C (< or = 8.1%) and in some tumors large deviations in the DUB 20 (< or = 93.1%). We can conclude that the 3D sonography is a reproducible method, which can be used to evaluate the volume of skin tumors and metastases under chemotherapy or radiotherapy. We suggest in particular to use the in-vivo tumor volume as a prognostic parameter for the malignant melanoma.

[History of high frequency sonography]. / Geschichte der hochfrequenten Sonographie.

The development of high frequency sonography (< 20MHz) has gained increasing importance since the last decade. In this field A-mode-scanner were used firstly in the measurement of skin thickness. 1987 the first commercial available 20 MHz B-scanning system was introduced. These systems provided the possibility of correlating the ultrasound images with the micromorphological findings in histology. With these correlations we were able to interpret ultrasound phenomena and in conclusion we were able to measure tumour thicknesses with direct impact on the therapeutic regimen. In inflammatory skin diseases the role of high frequency ultrasound in follow up investigations of morphea and systemic sclerosis must be underlined. We believe that in this field the technique is the "golden standard". In other inflammatory diseases (e.g. psoriasis) or wound healing ultrasound is mainly used for scientific purposes. The investigation of intraepidermal structures and differential diagnosis is only possible with higher frequencies than 20 MHz. Therefore we developed 50 and 100 MHz in vivo scanning systems. With resolution up to 11 microns (100 MHz) we hope to answer open questions in the future. Ultrasound microscopy is widely used for scientific evaluation of tissue morphology in vitro (resolution < 1 micron). Computer-based three-dimensional reconstructions provide additional information (e.g. tumour volume or tumour surface). These parameters are well suited to follow up the effect of systemic or local therapies on skin metastases of different cancers. However, also the tumour volume of the primary tumour (in vivo) might be of great interest as a prognostic parameter in future.(ABSTRACT TRUNCATED AT 250 WORDS)