[Cutaneous manifestation of late-type syphilis]. / Hautmanifestation bei Spätsyphilis.

HISTORY AND CLINICAL FINDINGS: A 49-year-old, otherwise healthy man presented at his dermatologist with tuberous skin changes that had be present for several weeks on head, arm and leg. These were asymptomatic, but disturbed him cosmetically. A skin biopsy was performed. INVESTIGATIONS: The skin biopsy showed a granulomatous inflammation with prominent plasma cells, consistent with granulomatous infiltrate. Serologic tests confirmed a Treponema pallidum-infection. In addition, the patient was tested positive for hepatitis C and HIV (CDC stage A1). The clinical neurological examination did not show any pathological findings, however, analysis of the cerebrospinal fluid revealed a mild pleocytosis, elevation of protein and the glucose quotient and a normal Treponema pallidum TPPA-antibody index. A mesaortitis was excluded. THERAPY AND COURSE: We diagnosed a tertiary syphilis (stage III). The patient refused prolonged inpatient treatment with penicillin G i.v., as recommended as first-line therapy in the national guidelines for asymptomatic neurosyphilis. Therefore, after a single oral administration of 100 mg prednisolone he received ceftriaxone intravenously for 14 days. The skin changes resolved. With regard to the HIV infection anti-retro-viral therapy was not yet indicated. CONCLUSIONS: In view of the increasing incidence of syphilis in Germany clinicians should consider this diagnosis when confronted with oligosymptomatic skin lesions.

Juvenile generalized circinate pustular psoriasis treated with oral cyclosporin A.

We report on a 17-year-old boy presenting with relapsing generalized circinate pustular psoriasis exacerbated by streptococcal angina. Because of the severe course in his case, we started systemic treatment with cyclosporin A and corticosteroids. Corticosteroids could easily be tapered down. Cyclosporin A maintenance therapy was realized with 100 mg/day (1.6 mg per kg body weight and day). Side effects were a temporary increase in blood pressure during initiation with 200 mg cyclosporin A/day. After dose reduction no side effects were seen. The pustular lesions disappeared and the PASI score decreased from 40.7 to 4.8. The treatment was found to be well tolerated and effective.

Reproducibility of patch tests. A multicenter study of synchronous left-versus right-sided patch tests by the German Contact Dermatitis Research Group.

BACKGROUND: The efficiency and reproducibility of patch tests remain controversial. OBJECTIVE: Our purpose was to determine the efficiency and reproducibility of patch tests and to identify factors influencing these features. METHODS: We double-tested 1285 patients concomitantly with 10 standard allergens by manually filled test chambers. Additional information was obtained from all patients with a standardized protocol. RESULTS: Patch test efficiency was good (> or = 0.94) with all 10 allergens. In contrast, nonreproducibility of patch tests was strongly allergen dependent, ranging from 0.2 for nickel sulfate to 0.6 for formaldehyde. The likelihood of nonreproducible allergic reactions increased when more than four positive reactions were seen at the same time, and with another positive reaction located in close proximity to an allergic reaction. Sex and age of patients, atopy, dermatitis at distant sites, sleeping habits, and the time of allergen exposure (24 or 48 hours) did not affect the rate of nonreproducible results. CONCLUSION: To increase patch test reproducibility, specific preparations of patch test allergens need to be improved. Furthermore, amplification effects by synchronous neighboring positive reactions should be excluded.

Pachyonychia congenita. Immunohistologic findings.

Pachyonychia congenita (PC) is a very rare hereditary disorder of keratinization. Immunohistological findings has so far been lacking. Reported in this paper is a case of Jadassohn-Lewandowsky type PC in a woman aged 18 years on which immunohistological investigations could be performed. Several monoclonal antibodies to filaggrin and keratin were used to stain tissue sections of lesional plantar skin, with a view to studying impairment of epidermal differentiation. While staining patterns comparable to those of normal skin were exhibited by anti-filaggrin and some antikeratins (RPN 1161, A51-B/H4), substantially altered immunostaining was recordable from other anti-keratins. Only superficial vital keratinocytes were stained by RKSE 60 against keratin 10 and K 8.12 against keratins 13 and 16. The authors, in other words, obtained information on expression of keratin 10, normally occurring in all suprabasal keratinocytes, as well as of the basal proliferation keratin 16 in the uppermost vital cell positions of PC lesion. The above results are likely to suggest impairment of keratin expression in cases of PC.

[Pachyonychia congenita. Presentation of a case and histological-histochemical findings]. / Pachyonychia congenita. Falldarstellung und histologisch-histochemische Befunde.

We report on two cases of pachyonychia congenita, Jadassohn-Lewandowsky type, in a father and daughter. Histopathological examination revealed thickened, aggregated bundles of tonofilaments and an increased number of atypical keratohyalin granula, which is suggestive of an altered keratinization. Immunohistological staining with antibodies to cytokeratins (A45-B/B3, A51-B/H4, A53-B/A2, RPN 1161) was unchanged. Filaggrin could not be detected. Basal cells immunoreactive for calmodulin were markedly reduced or even absent in the rete ridges. Staining with a monoclonal antibody against Ki67 made epidermal cell hyperproliferation seem unlikely. The epidermal lectin binding was normal. C3 was detectable in vessel walls mainly of the stratum reticulare. The findings are discussed with reference to pachyonychia pathogenesis.

[Occlusive therapy of psoriasis--comparison of clinical effectiveness of short-term and prolonged use]. / Okklusivtherapie der Psoriasis--Vergleich der klinischen Wirksamkeit von kurzzeitiger und prolongierter Anwendung.

In an open clinical trial on stationary psoriatic plaques, we compared the effects of shortime occlusive (SO) dressing (24h) and prolonged occlusion (PO: 5-28 days). IN SO, Weinstein's index decreased from 7.3 +/- 1.7 to 3.3 +/- 1.8 (n = 21), in PO from 6.5 +/- 1.1 to 3.7 +/- 1.7 (n = 15). The results were even better in cases with optimal PO dressing (decrease from 6.8 +/- 1.4 to 2.5 +/- 0.9). The most important side effects were itching and exsudation with ensuing smell. In only one of the cases did the side effects cause a drop-out after 5 days. Regarding stationary psoriatic plaques on the extensor sides of the lower legs and forearms. We recommend continuous occlusive dressing for 8-10 days--either as an alternative mode of therapy, or as an intermediate regimen.

[Chloroquine-induced isolated palatal hyperpigmentation]. / Chloroquin-induzierte isolierte palatinale Hyperpigmentierung.

We report about an isolated slate-greyish discoloration of the palatinum during chloroquine therapy of cutaneous lupus erythematosus of a 28-year-old woman. The hyperpigmentation is harmless. It is due to increased melanin synthesis and not due to deposition of the drug or its metabolites. The oculist should be consulted however, to exclude possible retinopathia.

[Simuliosis--dermatosis caused by black flies. A forgotten epizootic infection?]. / Simuliosis--Dermatose durch Kriebelmücken. Eine vergessene Epizootie.

Bites of black flies (Simuliidae) can produce strong ictus reactions in humans, associated with rubor, central hemorrhages, swellings, hemorrhagic erythema and edema. This can be accompanied by impairment of the general state of health. Suitable weather conditions may result in mass multiplication of the species. As a consequence man and animals may be seriously molested. Starting from strong ictus reactions of a patient the case report and therapy of simuliosis (simuliotoxicosis) as well as some points of the biology of black flies are described.

Alterations of epidermal lectin binding sites in acute contact dermatitis.

We investigated alterations of epidermal lectin binding sites, as well as of pemphigus and bullous pemphigoid antigens, in 28 human patch test reactions, both allergic (nickel, formaldehyde, N,N'-1,3-dimethylbutyl-N'-phenylenediamine) and irritant (sodium lauryl sulfate). The epidermal reactivity to a panel of lectins and human antisera to pemphigus vulgaris and bullous pemphigoid antigens was compared with samples obtained from normal skin and from skin under tape occlusion. We observed selective perturbations of lectin and antibody binding in acute contact dermatitis, whether allergic or irritant. The main findings were a loss of terminal sialic acids and longer bi- and triantennary mannosyl residues as well as a loss of pemphigus vulgaris antigen. The only difference between allergic and irritant patch test reactions was in topography of loss of WGA binding sites: in the former, it was most pronounced in the lower and middle epidermis, whereas in the latter it was seen in the uppermost subcorneal layers. Our findings support a common pathway of cell membrane alterations of keratinocytes in acute contact dermatitis.

[Contact allergy to dicyclohexylcarbodiimide]. / Kontaktallergie gegenüber Dicyclohexylcarbodiimid.

Allergic contact dermatitis occurring in a 25 years old female biochemist was found to be due to occupational handling of dicyclohexylcarbodiimide (DCC). This was confirmed by patch testing. Though DCC is widely used in peptide chemistry as completing reagent, only a few publications report occupational allergic contact dermatitis.