Interferon gamma in survivors of the Chernobyl power plant accident: new therapeutic option for radiation-induced fibrosis.

BACKGROUND: One of the remarkable clinical consequences of the Chernobyl accident was skin involvement, leading to extensive cutaneous fibrosis. Apart from surgery, no established treatment is available. METHODS: A group of survivors, working in or present at the accident site on April 26, 1986, and a few days thereafter, were examined, treated, and followed-up in 6-month intervals from September 1991 to November 1995. Eight individuals were identified as suffering from excessive cutaneous fibrosis. Skin thickness was measured with high-frequency (20 MHz) ultrasound in a clinically well-defined target skin lesion, in addition to histologic confirmation of radiation fibrosis. Interferon gamma was scheduled for all patients on a low-dose regimen (3 x 50 microg/week s.c.). In 2 patients, interferon was discontinued after the first injection, due to withdrawal of consent. In 6 patients, interferon was continued for 30 months, with 1 injection weekly for a further 6 months. Treatment was discontinued in November 1994. Four patients in the treated group and 1 of the 2 patients treated only once ("untreated patients") were reexamined 1 year later. RESULTS: In all individuals treated for 36 months, a significant (p < 0.005) reduction of radiation fibrosis could be determined, in contrast to a significant (p < 0.005) increase in the 2 untreated patients. Follow-up 1 year after discontinuation of the interferon treatment demonstrated significant (p < 0.005) recurrence of fibrosis. CONCLUSION: Low-dose interferon appears to be a safe and effective treatment of cutaneous radiation fibrosis following accidental exposure to high doses of ionizing radiation. Long-term supportive therapy may be required.

Palpable migratory arciform erythema. Clinical morphology, histopathology, immunohistochemistry, and response to treatment.

BACKGROUND: Palpable migratory arciform erythema is clinically characterized by sharply circumscribed, infiltrated erythematous patches that tend to spread irregularly, resulting in arciform morphologic features. The histopathologic features are characterized by a patchy inflammatory perivascular and periadnexal T-lymphocytic infiltrate throughout the dermis. The disease runs a chronic course and is rarely described in the literature. OBSERVATION: Three middle-aged patients of both sexes had palpable migratory arciform erythema with 1, several, or multiple lesions on the trunk. There was a dense perivascular and periadnexal, predominantly lymphocytic infiltrate of the reticular dermis without any interstitial distribution of inflammatory cells. Absence of mucin deposits and plasma cells was a striking feature. The immunohistochemical profile showed an infiltrate dominated by T cells of polyclonal origin. In addition, polyclonal B cells and histiocytes were present in small numbers. In all 3 cases, oral antibacterial treatment resulted in a complete (2 patients) or temporary (1 patient) resolution of skin lesions. CONCLUSIONS: Palpable migratory arciform erythema shows distinctive differences in clinical and pathological features and treatment in contrast to other diseases with cutaneous lymphocytic infiltrates, including lymphocytic infiltration of Jessner and Kanof. Therefore, it is likely a distinct disease entity.

[The value of oil baths for adjuvant basic therapy of inflammatory dermatoses with dry, barrier-disrupted skin]. / Bedeutung aer Olbäder für die adjuvante Basistherapie entzündlicher Dermatosen mit trockener, barrieregestörter Haut.

The therapeutic value of oil baths for the treatment of dry skin with disturbed barrier function in atopic eczema, atopic xerosis, dry aged skin, exsiccation eczematid and psoriasis vulgaris is presented with special regard to modern concepts of epidermal barrier function. The use of oil baths with emollients as an integral and indispensable constitutent of maintenance therapy in dry skin conditions, atopic eczema and inflammatory dermatoses is reviewed.

The influence of the pH-value on the growth of Brevibacterium epidermidis in continuous culture.

Brevibacterium epidermidis is a major component of the bacterial flora of certain skin surface biotopes, characterized by a comparatively high pH-value. The presence of Brevibacterium epidermidis seems to be linked to the production of malodour. Skin surface pH has been found to be a major factor of bacterial growth on the skin. In order to find out if this might also apply to Brevibacterium epidermidis, this microorganism was grown in vitro in continuous culture using a chemostat. Specific growth rate and density of colony forming units were well correlated. While the organism grew readily from pH 5.5 to 8.5, this was not the case with a pH of 5.0. Thus pH-shifts induced by cosmetic procedures can only prevent unpleasant body odour due to abundant growth of bacteria if the pH-value is decreased to 5.0 or less.

[The tuberculid concept from the current viewpoint]. / Zum Tuberkulid-Begriff aus heutiger Sicht.

The concept of tuberculid was introduced by Darier in 1896. In contrast to "true" cutaneous tuberculosis, properties of the tuberculids were explained by an hyperergic response to myobacteria or their fragments released from a different site of manifest or passed tuberculous infection. Key features include a strongly positive tuberculin skin test, evidence of concomitant manifest or past tuberculosis, and prompt response to antituberculous therapy. The inability to culture M. tuberculosis or to demonstrate it microscopically from lesional biopsies, together with reports on tuberculid-like eruptions after BCG vaccination, supports this concept. Clinical manifestations are lichen scrophulosorum, papulo-necrotic tuberculids and erythema induratum of Bazin. The existence of tuberculids has been questioned, however, because the clinical and histological appearances are not always specific. An increasing number of case reports on tuberculids, new immunological tests and molecular biology-based techniques for the detection of mycobacteria have shed new light on the tuberculid concept.

The influence of the regular use of a soap or an acidic syndet bar on pre-acne.

The role of regular skin cleansing with soap or syndet in pre-acne is ill-defined. The intention of this study was to assess the relative value of an acidic syndet bar and a conventional soap bar in the prevention of acne lesions in acne-prone patients. In a randomized, open, comparative trial the three months' application of either an acidic syndet bar or a conventional soap to facial skin for 1 min each in the morning and in the evening was compared in 120 adolescents and young adults with inflammatory acne grade I or II according to the Plewig and Kligman classification. It was a confirmatory trial with the number of inflammatory lesions being the prime parameter of concern. In addition, non-inflammatory acne lesions were analyzed as were parameters of safety such as itching, redness and scaling. While the number of inflammatory acne lesions, i.e., papulopustules, did not differ in the two trial groups composed of 57 evaluable cases each, this was the case from 4 weeks of application onward: in the group using soap the mean number of inflammatory lesions increased from 14.6 (+/- 5.3) to 15.3 (+/- 6.0), while it decreased in the other group from 13.4 (+/- 5.2) to 10.4 (+/- 5.8) (p < 0.0001). Symptoms or signs of irritation were seen in 40.4% of individuals belonging to the former and 1.8% belonging to the latter group. The number of papulopustules characteristic of inflammatory acne thus is clearly lower when a syndet bar of the acidic type is regularly used for cleansing the face as compared to a (necessarily alkaline) soap.(ABSTRACT TRUNCATED AT 250 WORDS)

Late irradiation damage to the skin caused by soft X-ray radiation therapy of cutaneous tumors.

BACKGROUND: Although radiotherapy of skin tumors has lost its former preeminence, there is still need for this modality. The aim of this study was, therefore, to determine the frequency of radiogenic ulcers and tumors following soft x-ray therapy of skin lesions. STUDY DESIGN: A total of 612 radiation sites in 522 patients were retrospectively analyzed by means of medical records. All patients received at least a total dose of more than 12 Gy and had a minimum follow-up time of 10 years. The average radiation dose was about 80 Gy, ranging from 56 to 184 Gy. Determined was occurrence of radiogenic tumors after more than 10 years and of ulcers during the entire follow-up period. The frequency of radiogenic tumors and ulcers was related to the total dose applied and the patient's age at the time of irradiation. RESULTS: In the 612 radiation fields used, 58 ulcers (9.4%), 12 basal cell carcinomas (2%), and nine squamous cell carcinomas (1.5%) were observed. There was no relationship between the total dose of radiation and the frequency of tumors; in contrast, radiogenic ulcers increased with a higher total dose. Radiogenic ulcers occurred more often in patients who were of a younger age at the time of irradiation. CONCLUSIONS: The risk of developing radiogenic ulcers and tumors after soft x-ray therapy is not very high. Since most of the ulcers can be prevented by modern dose recommendation (time dose fractionation factor), soft x-ray therapy can be considered as a safe and effective means of therapy, especially in older patients.