Reflectance confocal microscopy for noninvasive examination of nonmelanocytic tumors and virus-associated skin lesions in organ transplant recipients.

BACKGROUND: Drug-induced immunosuppression is necessary to prevent rejection of the foreign organ in transplanted patients, but neoplastic and virus-associated skin diseases are frequent complications. Reflectance confocal microscopy (RCM) recently emerged as a promising tool for the early diagnosis of skin lesions. MATERIALS AND METHODS: A total of 61 skin lesions, among them 20 basal cell carcinomas, six Bowen's diseases, 23 actinic keratoses, and 12 verrucae, were analyzed. All lesions were clinically evaluated followed by RCM evaluation by two independent dermatologists and histological examination. RESULTS: For the diagnosis of basal cell carcinoma, a sensitivity of 100% by both investigators (INV I + II) and a specificity of 100% by INV I and 80% by INV II were achieved. The sensitivity average rate for RCM features reached by both investigators ranged between 60% and 100%, and the specificity between 55% and 90%. For the diagnosis of actinic keratosis, a concordant sensitivity of 94.4% and a specificity of 80% (INV I) and 60% (INV II) were detected. The sensitivity average rate of specific RCM criteria ranged between 72.3% and 97.2%, whereas specificity ranged between 20% and 90%. Regarding verrucae, RCM confirmed the histological diagnosis with a sensitivity of 85.7% (INV I) and 100% (INV II), while specificity was 100% and 80%, respectively. CONCLUSION: Reflectance confocal microscopy resulted to be a reliable tool for the noninvasive diagnosis of neoplastic and virus-associated skin changes in organ transplant recipients. Nevertheless, given the frequency and diagnostic complexity of the hyperkeratotic lesions occurring post-transplantation, larger cohorts of patients are required to confirm and consolidate these findings.

[Nonsurgical breast enlargement using a vacuum brassiere for tissue expansion]. / Nichtoperative Brustvergrösserung durch ein Vakuum-büstenhalter- System als Gewebeexpander.

We present a method for nonsurgical breast enlargement using a vacuum tissue expander and describe the first so-treated patient in Germany. The patient wore a brassiere-like system that applied a mild (average 20.4 mm Hg) vacuum distraction force to each breast for 10.6 hours/ day over a 10-week period. An increase of 5 cm chest circumference at the nipple level from 85 cm to 90 cm was measured at the end of the therapy. At 3 months follow-up visit, after resorption of the therapy-induced edema, there was still a gain of 4 cm resulting in a 89 cm chest circumference as well as natural attractive breast shape. Side effects included the brief occurrence of irritant contact dermatitis and folliculitis during therapy. The supposed mechanism is analogous to other tissue expansion methods, where tissue growth is a response to continuous controlled mechanical forces. This nonsurgical and non-invasive alternative for breast enlargement appears effective and well-tolerated. Because the only relevant side effects involve the skin, dermatologists are well-suited to perform the treatment.

[Successful reduction of the SCORAD score by a short-time teaching method using a simplified skin model in children with atopic eczema in a 6-week comparison]. / Erfolgreiche Reduktion des SCORAD-scores bei Kindern mit atopischem Ekzem im 6-Wochen-Vergleich durch Kurzschulung mit einem vereinfachten Hautmodell.

BACKGROUND: In order to achieve a long-term stabilizing effect on the clinical condition of the skin of patients with atopic eczema, it is imperative to perform consistent topical skincare. Because of time pressures during normal office visits, it is impossible to thoroughly counsel patients who suffer from atopic eczema. We performed a randomized and prospective comparative study to evaluate the outpatient effectiveness of a short-time but impressive teaching and counselling method using the skin model developed by Kardorff and Schnelle-Parker. PATIENTS AND METHODS: Thirty outpatients between 3 and 6 years old with moderate or severe atopic eczema were evaluated. Half of the patients were trained by an active, 10-min demonstration with the skin model on day 0 and day 14. Patients in the control group received verbal instructions of the same duration, as in routine dermatological practice. The SCORAD score was measured blindly on days 0, 14 and 42. RESULTS: After 42 days, the SCORAD score of the patients taught by the use of the Kardorff-Schnelle-Parker skin model was significantly reduced compared to the control group (P < 0.006). CONCLUSIONS: By counselling atopic children, even of preschool age, with the easily understandable skin model incorporating the sense of touch, better compliance concerning regular skincare can be achieved. We expect positive effects in the long-term management of atopic eczema.