[Tattoos and permanent make-up: background and complications]. / Das sollten lhre Patienten vor der Tätowierung wissen. Cave: Tabus bei Tattoos.

Tattoos and permanent make-up have enjoyed great popularity during recent years. However, a careful consideration of the risks is made only rarely before each procedure. Above all the undefined pigment compositions create unforeseeable health and appearance problems. The family physician should be familiar with the techniques, materials, as well as the possible risks of tattoos and permanent make-up when advising patients. Medical complications include, among other things, infections, allergies, keloid and granuloma formation.

Effectiveness of LPG treatment in morphea.

BACKGROUND: The LPG technique, also known as Endermology treatment, is a noninvasive technique consisting of a tissue mobilization process in which a skin fold is created between two rollers, stretching the underlying tissue and mobilizing the fold. The LPG technique is very effective in treating scars. Because the lesions of morphea or circumscribed scleroderma are similar to atrophic scars, it seemed reasonable to treat them with a method proven helpful for scars. MATERIALS AND METHODS: We treated 17 lesions of 10 patients (four males and six females) with the diagnosis of morphea ranging in age from 17 to 78 years (mean age 55 years) and investigated and documented the evolution of their lesions and changes in their quality of life. RESULTS: In all patients there was a large improvement in the clinical appearance of the lesions, the induration and the pain. Elasticity was particularly increased, not only based on clinical findings but also as documented with objective assessment. The acceptability of the treatment was good and the patients reported an improved quality of life. CONCLUSION: The LPG technique (Endermology) is an adjunctive treatment for morphea. It cannot eliminate the disease but can relieve the pain, soften the skin and improve the quality of life for these patients.

Erythema annulare centrifugum-type psoriasis: a particular variant of acute-eruptive psoriasis.

A case of erythema annulare centrifugum-type psoriasis in a 58-year-old white woman with a history of chronic plaque psoriasis is described. Initial failure of antipsoriatic treatments and an untypical histology complicated the diagnosis. After several trials acitretin at a low maintenance dose combined with oral fish oil and topical calcitriol led to sustained long-term remission. The spectrum of clinical differentiation of this rare disease, the histological characteristics and its nosological classification are discussed. It is suggested that this dermatosis represents a variant of acute psoriasis, rather than a variant of pustular psoriasis.

[Actinic prurigo. An assessment of current status]. / Aktinische Prurigo. Eine Standortbestimmung.

BACKGROUND AND OBJECTIVE: Actinic prurigo (AP) is a hereditary photodermatoses with typical symptoms and is quite common in North- and South-America. The key genetic factor appears to be a Native American background. In Europeans this type of AP is extremely rare; some dispute if this disease exists in Caucasians. Some newer publications postulate that these patients share HLA markers with the Native Americans. The most important differential diagnosis for AP is polymorphic light eruption which can be excluded relatively accurately by the clinical picture, typical histology and HLA pattern. PATIENTS/METHODS: The case of a female patient of Mayan ancestry living in Germany is presented. CONCLUSIONS: Since in literature sometimes cases from Europe are diagnosed as AP this is a problem of naming the disease. It would be helpful to integrate the terms hereditary or hereditaria into the name of the disease in indians.

An unusual cutaneous T cell lymphoma presenting as leonine facies.

We report an unusual case of a cutaneous T cell lymphoma with the clinical picture of leonine facies as the only skin symptom appearing during the first years of the disease. Small atypical lymphocytes with partly pleomorphic, partly indented cerebriform nuclei are present in the facial skin as well as in the peripheral blood and in the bone marrow. The lymphoma shows an indolent clinical behaviour without rapid progression of the disease. It shares features with both pleomorphic small/medium-sized T cell lymphoma and mycosis fungoides, but cannot be classified according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC) Classification for Primary Cutaneous Lymphomas. At present the lymphoma has to be ranged among the group of so-called unspecified peripheral T cell lymphomas according to the proposal of the International Lymphoma Study Group.

Myxoid liposarcoma in a 12-year-old girl.

A 12-year-old girl developed a myxoid liposarcoma on the inner side of her right thigh. Liposarcomas are extremely rare at this age compared to benign lipoblastomas, which are the most frequent tumors of fatty tissue in childhood. The prognosis of myxoid liposarcoma is good, especially when, as in this patient, the tumor is located in the subcutis where a large and deep excision is possible and often curative.

Subcutaneous oleomas induced by self-injection of sesame seed oil for muscle augmentation.

This case presentation describes a 48-year-old man who experienced subcutaneous nodules 9 months after self-injection of sesame seed oil into the pectoral area for muscle augmentation. This procedure was reported by our patient to be frequently performed in the body-building and fitness scene. Ultrasound imaging showed multiple, low reflecting round nodular areas of up to 1 cm diameter in both breasts. Excision of a representative nodule revealed a cyst filled with oily material, surrounded by granulomatous tissue. This case report demonstrates an unusual side effect of augmentation measures in body-builders.

The wide spectrum of clinical expression in Adams-Oliver syndrome: a report of two cases.

Two children are described with the combination of aplasia cutis congenita (ACC) and transverse limb defects known as Adams-Oliver syndrome. Whereas in the first child the typical features of ACC, syndactyly and transverse nail dystrophy were only mildly expressed and associated defects of the central nervous system and cardiac malformations were absent, the second child suffered from a very severe expression of the syndrome, with a combination of ACC, syndactyly, cutis marmorata telangiectatica congenita and multiple cardiac and central nervous system malformations which resulted in fatal central respiratory insufficiency.

Stromelysin-3 (ST-3): immunohistochemical characterization of the matrix metalloproteinase (MMP)-11 in benign and malignant skin tumours and other skin disorders.

Matrix metalloproteinases (MMP) are involved in remodelling of the extracellular matrix (ECM) proteins suggesting that they play an important role in inflammatory process, in tumour invasion and metastasis. We examined immunohistochemically 330 cases of different skin disorders with the monoclonal antibody against MMP 11, stromelysin-3 (ST-3) protein. We found a positive immunoreactivity in fibroblasts surrounding malignant epithelial tumour cells in 63 of 125 cases (50.4%) of basal cell carcinomas, in four of 25 (16%) squamous cell carcinomas, whereas the tumour cells themselves were negative. Furthermore, the ST-3 protein could be detected in 23 of 40 cases (57.5%) of dermatofibroma, in two of five cases (40%) of atypical fibroxanthoma, in one of eight cases (12.5%) of dermatofibrosarcoma protuberans and, locally, in one of 10 cases (10%) of malignant fibrous histiocytoma. It was not present in the following skin lesions: keratoakanthomas (n = 12), Bowen's disease (n = 10), malignant melanoma (n = 12), melanocytic nevi (n = 28) and Kaposi's sarcomas (n = 25). In eczema (n = 10), psoriasis (n = 10) and virus-induced tissues (i.e. condylomata acuminata, n = 10) we did not observe an expression of ST-3 protein. We conclude first that ST-3 protein is a fibroblastic factor expressed in stromal cells adjacent to carcinoma cells; second, that ST-3 protein seems to be associated with benign fibroblastic tumours; and third, that it does not play a role in eczema, psoriasis or virus-induced skin lesions.

Which direction do nevus cells move? Abtropfung reexamined.

In 1893, Unna published his theory of Abtropfung in which he suggested that melanocytic nevus cells originate in the epidermis and drop off into the dermis. We studied 3,534 nevi from patients of all ages to reassess this almost sacred concept. If Unna was correct, one would expect that in childhood most nevi would be junctional, while in late adult life almost all nevi would be intradermal. In our series, no child under age 10 had a purely junctional nevus, 52% had compound nevi, and 48% had dermal nevi. In patients older than age 60, 12% had junctional nevi, 23% had compound nevi, and 65% had dermal nevi. Our data fail to support the concept of Abtropfung; they fit better with the contradictory theory of upward migration of nevus cells.

Stromelysin-3: a potent marker for histopathologic differentiation between desmoplastic trichoepithelioma and morphealike basal cell carcinoma.

Histopathological differentiation between desmoplastic trichoepithelioma (DTE) and morphealike basal cell carcinoma (BCC) is a difficult problem because of their similar morphological features. The matrix metalloproteinase stromelysin-3 (ST-3), which is expressed as a specific fibroblastic factor especially surrounding carcinoma cells, was studied in these both conditions of wholly different clinical outcome. Using formalin-fixed paraffin-embedded tissues, we found positive immunoreactivity for ST-3 in fibroblastic cells surrounding morphealike BCC cells in 34 (68%) of 50 cases, whereas the epithelial tumor cells themselves were negative. In none of the 12 cases of DTE did we observe expression of ST-3 in fibroblasts. We conclude that the antibody against ST-3 protein is an immunohistochemical marker to distinguish morphealike BCC from DTE.