Palmoplantar reactions.

The palmoplantar skin reacts monotonously to acute causes with vesicles or pustules and to chronic or chronically recurrent noxae with hyperkeratosis. Vesicular reactions are mostly triggered by eczematogens and fungi. Among the primary pustuloses, pustular psoriasis of the palms and soles is the dominating one, while the secondary pustuloses stem from infections of vesicular reactions with pyogens. Hyperkeratotic reactions may be caused directly by mechanical irritations or dehydration of the skin but also secondarily by chronic or chronically recurrent vesicular and pustular reactions.

Localization of fibronectin in the initial lymphatics and blood vessels of normal human skin: an immunoelectron microscopic investigation.

The initial lymphatics of the human skin do not possess a basal lamina, but a subendothelial fibrous network, of which we do not know the biochemical and immunohistological composition. We investigated the wall of blood vessels and initial lymphatics in normal human skin for the presence of fibronectin by immunoelectron microscopy. We found discontinuous linear subendothelial diaminobenzidine (DAB) reaction products in both blood vessels and lymphatics. In addition fibronectin could be found at the anchoring fibrils of the initial lymphatics.

Teicoplanin in the treatment of skin and soft tissue infections: results of a multicentre study.

The clinical efficacy and safety of teicoplanin was studied in hospitalized patients with skin and soft tissue infections. In an open multicentre study 64 patients were treated with teicoplanin i.v. and/or i.m. Predisposing or complicating factors for infection were present in almost 80% of the patients. Teicoplanin was usually given as an initial loading dose of 400 mg (87.1%), or 800 mg (6.5%) or various doses (6.5%). During the course of the study, the mean daily dose of teicoplanin was 261.3 mg. Sixty of the 62 evaluable patients responded to treatment. 58 gram-positive pathogens were isolated, consisting of Staphylococcus aureus (n = 41), coagulase-negative staphylococci (n = 6) and streptococci (n = 11). Elimination of pathogens was seen in 37/47 of all microbiologically evaluable cases. Persistence, recurrence or reinfection occurred in 7/47, 2/47 and 1/47, respectively. Adverse reactions were reported in only three patients with allergic reaction, local reaction and rise in transaminases in one case each. Therapy failed only in two patients.

[Skin metastases of internal cancers. A critical review of the literature]. / Hautmetastasen interner Karzinome. Eine kritische Literaturstudie.

The value of global statistical data on skin metastases of internal carcinomas is a relative one, since skin metastases are frequently seen in carcinomas of the breast, but rarely found in other internal cancer. Nevertheless, the study of skin metastases is important, because they may help to identify and locate an occult carcinoma; moreover they can serve as a parameter to appreciate the efficiency of polychemotherapy.

[Congenital poikiloderma]. / Kongenitale Poikilodermien.

Poikiloderma is characterized by the syntopy of diffuse atrophy, leukomelanodermia and teleangiectasia. We differentiate between symptomatic, idiopathic and congenital forms. Congenital poikiloderma shows 3 decisive features: early appearance, familial occurrence, and various associated congenital malfomations. On account of distinctive features - such as the consanguinity of the parents, cataracts, leukoplakia, bullas, and verrucous keratoses - we can distinguish between 5 biotypes of congenital poikiloderma, which are named after their first observers: Rothmund's, Thomson's, Zinsser's, Brain's and Dowling's syndrome.

[Lupoid form of rosacea-like dermatitis]. / Lupoide Form der Rosazea-artigen Dermatitis.

In a 9-year-old girl, a lupoid variant of rosacea-like dermatitis was observed following the topical application of potent glucocorticosteroids. In addition to the micro- and macro-papulopustular forms, this is a third clinical variant of the disease, which has to date only been described in children.

Disseminated bilateral hyperkeratotic variant of porokeratosis Mibelli.

Clinical, histopathological, and ultrastructural features of a new clinical variant of porokeratosis Mibelli (PM) are presented. We report a solitary case of a patient, male aged 62, who developed disseminated verrucous nodules on the buttocks and the lower extremities 3 years before diagnosis. Histopathologically, all specific signs of the keratinization disorder of PM were demonstrable; in addition, however, multiple cornoid lamellae were found at the margin as well as in the center of the lesions, which only in part showed relationships to the epidermal appendages. In the papillary dermis, numerous ectatic capillaries were conspicuous. Using electron microscopy the same specific abnormalities of the keratinization process as known from classical cases of PM could be demonstrated: autophagocytic cells that revealed perinuclear edematization and vacuolization, accumulation of autophagic vacuoles and heterolysosomes, and dyskeratotic corps ronds-like cells that become transformed to fibrillar or Civatte bodies. Problems of the classification, differential diagnosis, and pathomorphogenesis are discussed.

[Eczematids]. / Uber die Ekzematide.

Eczematids are itching dermatoses showing indistinct redness, pityriasiform scales, and superficial fissures of the horny layer. The seborrheic and sebostatic variants differ with regard to localization of the dermatosis and condition of the skin surface. Their relationship to the imbalance of production and consumption of skin surface lipids is discussed.

[Uranitis circinata in Reiter's disease. Therapy with etretinate (Tigason)]. / Uranitis circinata bei M. Reiter. Therapie mit Etretinat (Tigason).

Lesions analogous to the balanitis circinata on the mucous membrane of the palate are reported in two males. Tigason quickly improved the skin lesions, mucous membrane lesions and nail lesions.

[Local treatment of psoriasis with glucocorticosteroids]. / Die örtliche Behandlung der Psoriasis mit Glukokortikosteroiden.

With regard to indications for topical treatment of psoriasis with glucocorticosteroids, the resorptive toxicity and topical side effects of the drug are decisive. Equivalent therapeutical agents, such as dithranol, UV light and retinoids, limit their supplementary use in the management of this disease.

[Congenital reticular ichthyosiform erythroderma]. / Kongenitale retikuläre ichthyosiforme Erythrodermie.

A 57-year-old female patient has had generalized cutaneous lesions since birth. Clinically there are patch- and band-like areas of erythrokeratotic and pigmented skin in reticular arrangement. The most important histological findings are band-like parakeratosis, psoriasiform acanthosis, vacuolization of the keratinocytes in the upper layers of the epidermis with a high frequency of binuclear cells, and deposits of amyloid in the dermis. Ultrastructurally, the formation of perinuclear shells built from a three-dimensional network of fine filaments is the most peculiar finding. Binuclear cells are frequently found from the first suprabasal layers. Oedematization of the perinuclear cytoplasm within the shells finally leads to vacuolization of the uppermost granular cells. The horny layer is parakeratotic and contains debris of nuclei and lipid vacuoles. In the clinically normal appearing skin within the reticular network, keratinization occurs in a completely normal fashion. In spite of a good response to retinoid treatment, perinuclear shells and binuclear cells remain demonstrable in involved regions. The clinical, histological and ultrastructural peculiarities of this case suggest the diagnosis of a special type of congenital disturbances of keratinization, which can be clearly distinguished from the well-known ichthyosiform dermatoses and other inborn errors of keratinization.