[Thomas Mann mystifies dermatology]. / Thomas Mann verzaubert die Dermatologie.

The central theme in the chapter 'Humanoria' of the novel 'Der Zauberberg' by Thomas Mann is a discussion focusing on the skin, where the dialogue takes place on a number of different levels. The physiological facts are construed as double meanings for the erotic sensitivity of man and highlight the artful linguistic skills of the author, Thomas Mann. An intensive portrayal of different diseases and the notion of disease itself as a part of mankind are main elements of Mann's novel. In this essay, Thomas Mann's genius as a novelist is honoured against the background of poor modern literacy of the internet age.

A comparison of acrivastine versus clemastine and placebo in the treatment of patients with chronic idiopathic urticaria.

Twenty patients of mean age 41.3 years, with a diagnosis of chronic idiopathic urticaria were assessed in a fully randomized, double-blind, crossover study to investigate the efficacy of acrivastine at two doses (8 mg and 4 mg) versus 1 mg clemastine and placebo, given three times per day. All active preparations were found to be effective, and significantly better than placebo, in controlling the signs and symptoms of urticaria. There was a higher incidence of sedation with clemastine than with either acrivastine or placebo, although this difference did not achieve statistical significance in this small study.

[Zinc--a new therapeutic principle in dermatology?]. / Zink--ein neues Therapieprinzip in der Dermatologie?

Zinc, a metal enzyme, is essential for the metabolism, it is mainly found in moulting tissue. Success or failure of systemic treatment with zinc of acne vulgaris, alopecia areata, or leg ulcer may be explained by understanding the metabolism of zinc in the organism interpreted as a feedback mechanism: treatment with zinc is only successful if zinc is not available in a sufficient amount for the organism, i.e. in case of primary zinc deficiency. This concept of therapy is illustrated by the case of a female patient suffering from leg ulcer, who developed an epithelization rate of 2.31 cm2 per day during treatment with zinc.

[Systemic lupus erythematosus and hyper-IgE syndrome in a 13-year-old child]. / Systemischer Lupus erythematodes und Hyper-IgE-Syndrom bei einem 13jährigen Kind.

In 1979, suspicion of convulsive disorder was diagnosed in a 9-year-old girl, who consequently underwent treatment with carbamazepine. In 1983, she developed hyperimmunoglobulinemia E syndrome. IgE values reached up to 5,400 u/ml. During the following weeks, we detected systemic lupus erythematosus with epimembranous glomerulonephritis histologically proved. The patient's immunological status does not allow the decision whether the lupus erythematosus may be classified as idiopathic or as a drug-induced disease having started with the convulsive disorder. Discontinuation of the carbamazepine therapy will not give a further hint on the etiology of the lupus erythematosus since long-lasting anticonvulsive therapy using this drug leads to an irreversible course of the disease.

Congenital nevi less than or equal to 10 cm as precursors to melanoma. 52 cases, a review, and a new conception.

Fifty-two congenital melanocytic nevi (CMN) as precursors to melanoma or severe melanocytic dysplasia were reviewed macroscopically and microscopically. Forty-eight "small" CMN measured less than 10 cm in diameter. Histologically, only five reached to the lower third of the dermis or subcutis ("deep type"); the remaining 47 were limited to the upper two thirds of the corium ("superficial type"). There were 47 invasive melanomas, two in situ melanomas, and three severe focal melanocytic dysplasias. All melanomas were of "epidermal" origin and primarily of the superficial spreading type. The age at diagnosis ranged from 18 to 79 years. Prepubertal melanomas were not observed. Melanoma may also arise on small CMN. The most frequent origin of the melanomas in small CMN and the preferred age at manifestation seem to be different from that for giant nevi.

[Budd-Chiari syndrome following dacarbazine therapy of malignant melanoma--an avoidable complication?]. / Budd-Chiari-Syndrom nach Dacarbacin-(DTIC-)Therapie bei malignem Melanom--Ein vermeidbarer Zwischenfall?

A 51-year-old female patient died of Budd-Chiari syndrome during treatment with adjuvant DTIC mono-chemotherapy for malignant melanoma. We report on clinical course and laboratory findings in detail. Differentiating BCS from VOD, we describe the liver damages referring to the latest findings about the effect of DTIC in fibrinolysis. In order to prevent further lethal complications, we suggest to regard pre-existing liver damage as a contra-indication for DTIC therapy; to prefer intraspinal anesthesia for malignant melanoma of the lower extremities; to avoid hepatotoxic drugs and alcohol during chemotherapy; to protect DTIC from light; to extend the interval between first and second cycle. Laboratory data, the "finger-prints" of DTIC, are unreliable. Great attention should be paid to clinical findings which may justify immediate and high dose corticosteroid therapy as well as intensive care monitoring.

[Multiple bowenoid arsenic keratoses]. / Multiple bowenoide Arsen-Keratosen.

Case report of multiple keratoses and chronic lymphatic leukemia after arsenic poisoning 30 years ago during a one-year exposure to copper acetoarsenate in a pesticide factory. Absorption through the skin with local arsenic skin damage is discussed. Etretinate therapy (1 mg/kg b. w.) was ineffective.

[Pathogenesis of pyoderma gangraenosum]. / Uberlegungen zur Pathogenese des Pyoderma gangraenosum.

Pyoderma gangraenosum (Pg) is regarded as an indicator of internal primary diseases of mainly auto-immunological character. Gammopathies as basic diseases are very often of the IgA-type. In contrast to the characteristic clinical picture we have observed unspecific, cellular traits. New investigations have reported immunological findings such as deposition of IgG and IgM as well as C3-complexes at the vascular walls. A decreased function of T-cells is described. Pg often develops in consequence of minor traumata. In these cases the disproportion between the primary lesion and the ulcerous process becomes obvious. By presentation of a typical case in addition to a literature survey, it is discussed whether the primary disease is responsible for this development. Because of the close relationship between Pg and the underlying immunopathology it is proposed that Pg - in analogy to the neoplastic cutaneous syndrome - be classified dipolar-like as a paraimmunological syndrome.

[Enzymatic debridement in venous ulcus cruris. Report of a multicenter clinical comparative study with various enzyme preparations]. / Enzymatische Wundreinigung beim venösen Ulcus cruris. Bericht über eine multizentrische klinische Vergleichsstudie mit verschiedenen Enzympräparaten.

In a multicenter trial (comprising 258 patients in eight centers) three topical preparations for enzymatic debridement, which are widely used in our country, have been compared in the treatment of leg ulcers. Preparation A is a combination of bovine fibrinolysin and desoxyribonuclease (but without antibiotic); preparation B is a combination of clostridiopeptidase and chloramphenicol and preparation C of trypsin and framycetin sulphate. The results showed no significant difference in the effects of treatment between the preparation. Preparation A however was much better tolerated; preparation B and C induced a lot of side effects. This means that antibiotics in preparations for enzymatic debridement are not of real advantage.

[New protective skin cream from hydrocarbon gel]. / Bericht über eine neue Hautschutzsalbe aus Kohlenwasserstoffgel.

In a one-year study we tested the skin care and protective action of a new hydrocarbon gel. This gel is made of a two-component gel of petrolatum fractions in which the easily volatile and irritant white oils have been diminished. The gel contains no additives or perfumes and is therefore free of these allergens. The tests on different groups of "wet workers" ( gardeners and fish- sellers as well as workers in the fish preparation and canned-food industries) showed both objectively and subjectively good results.

[Syphilis therapy--results of an inquiry]. / Die Behandlung der Syphilis--Ergebnis einer Umfrage

In order to get some more information about the kind of treatment of syphilis in the F.R.G. a study among the 1578 practising dermatologists (without members of hospital staff) by means of questionaires was made. 1164 (79%) answered the inquiry. The study shows that nearly 50% of the answering dermatologists treat syphilis by several series of penicillin applications. On the other side, only one third of the respective dermatologists performs treatment by one series, giving penicillin from 15 to 21 Mega units. The study shows that the kind of therapy is rather age-dependend insofar as the older dermatologists prefer the multiple therapy series scheme, whereas the younger dermatologists are inclined to use the single series scheme. Furthermore geographical differences could be shown, e.g. most of the Bavarian dermatologists use the single series scheme. The kind of penicillin, way of application and the time intervals were rather uniform related to regions and schemes of therapy. Tetracycline and Erythromycin are used in case of penicillin allergy. In the opinion of less than 50% of dermatologists additional redications are necessary, whereby the younger ones prefere corticosteroides, the older ones potassium iodide. The benefits of uniformly performed therapy of syphilis by the single series scheme are discussed.