Oxidative and nitrosative stress and apoptosis in oral mucosa cells after ex vivo exposure to lead and benzo[a]pyrene.

Exposure of human oral mucosa to lead (Pb) and benzo[a]pyrene (BaP) by inhalation and ingestion can lead to pathological conditions via apoptosis and oxidative and nitrosative stress. However, few studies have investigated the effects of Pb and BaP on oral mucosa cells. Furthermore, previous studies focused on chronic Pb and BaP exposure. Therefore, we evaluated important markers of apoptosis and oxidative and nitrosative stress in oral mucosa cells by incubating the cells with Pb and BaP for 5-360 min. Ex vivo samples of human oral mucosa were exposed to Pb or BaP, and immunohistochemical staining was performed to evaluate active caspase-3, 8-epi-prostaglandin F2 alpha (8-epi-PGF2a), and 3-nitrotyrosine (3-NT). Pb and BaP treatments significantly increased active caspase-3 levels in a time-dependent manner. Furthermore, the treatments induced an early increase in 3-NT level, which ceased with longer incubation times. 8-Epi-PGF2a level increased only after prolonged incubation with Pb, and this elevation was irrespective of BaP incubation duration. Smokers' samples had significantly lower levels of markers of oxidative and nitrosative stress than did nonsmokers' samples. Thus, single, short-term exposure to Pb or BaP increases the levels of apoptosis markers and markers of oxidative and nitrosative stress.

Effects of an oral contraceptive containing chlormadinone acetate and ethinylestradiol on hair and skin quality in women wishing to use hormonal contraception.

BACKGROUND: Skin and hair appearance is important to body image. Oily skin and oily, impaired hair quality, which can develop in women taking certain types of hormonal contraceptives, may cause psychosocial stress. OBJECTIVES: The aim of the current study was to investigate the effects of an oral monophasic contraceptive (0.03 mg ethinylestradiol/2 mg chlormadinone acetate) for 12 treatment cycles on the pathophysiology of oily skin and oily, impaired hair quality in healthy women. METHODS: We assessed changes in hair and skin parameters at baseline, 12, 24 and 48 weeks, in 60 women aged 18-45 years. Psychological well-being was verified by two subject self-assessments (Hair quality, Hairdex). RESULTS: Data from 31 subjects showed that treatment significantly improved sebum excretion at capillitium and forehead, and the number of terminal hairs. Visual haptic scores revealed significant decreases in capillitium seborrhoea, hair condition/density, capillitium dandruff and irritation/redness. Subject self-assessment confirmed improvements in hair quality. Treatment was well tolerated. CONCLUSION: Chlormadinone acetate in hormonal contraception provides excellent cosmetic and dermatological benefits, which can improve psychosocial well-being.

Persons with cleft lip and palate are looked at differently.

There is evidence that persons with cleft lip and palate (CLP) suffer psychosocial consequences as a result of their facial appearance. However, no data exist on how they are perceived by others. Our hypothesis was that CLP faces were looked at differently compared with faces lacking an anomaly. Eye movements of 30 healthy participants were recorded (via an eye-tracking camera) while they viewed photographs of faces with/without a CLP. Subsequently, the faces were rated for appearance, symmetry, and facial expression. When the CLP faces were viewed, there were significantly more initial fixations in the mouth and longer fixations in the mouth and nose regions, compared with reactions when control faces were viewed. Moreover, CLP faces were rated more negatively overall. When faces with CLP were viewed, attention was directed to the mouth and nose region. Together with the negative ratings, this may explain at least some of the social deprivations in persons with CLP, probably due to residual asymmetry.

[Axillary hyperhidrosis--efficacy and tolerability of an aluminium chloride antiperspirant. Prospective evaluation on 20 patients with idiopathic axillary hyperhidrosis]. / Hyperhidrosis axillaris--Effektivität und Verträglichkeit eines aluminiumchloridhaltigen Antiperspirants. Prospektive Evaluation an 20 Patienten mit idiopathischer Hyperhidrosis axillaris.

BACKGROUND: The purpose of this study was to evaluate the efficacy and tolerability of aluminium chloride gel for treatment of axillary hyperhidrosis. PATIENTS AND METHODS: A total of 20 patients aged 22-38 (mean age: 26.9+/-4.3) with idiopathic axillary hyperhidrosis were included and treated with an antiperspirant (Sweat-off, Sweat-off GmbH, Hügelsheim). Study duration was 42 days. Treatment efficacy was evaluated clinically, as well as by starch-iodine test, gravimetric analysis and evaluation of the skin surface pH. RESULTS: After treatment there was a significant clinical improvement accompanied by significant qualitative and quantitative reduction of sweat as well as a significant reduction of skin surface pH. Except for slight skin irritation in 6 patients, there were no other side effects. Patient satisfaction improved markedly during the study. CONCLUSION: Treatment of axillary hyperhidrosis with aluminium chloride is an effective, safe and inexpensive treatment modality.

Cytocompatibility of brushite and monetite cell culture scaffolds made by three-dimensional powder printing.

This study investigated the cytocompatibility of low-temperature direct 3-D printed calcium phosphate scaffolds in vitro. The fabrication of the scaffolds was performed with a commercial 3-D powder printing system. Diluted phosphoric acid was printed into tricalcium phosphate powder, leading to the formation of dicalcium phosphate dihydrate (brushite). Hydrothermal conversion of the brushite matrices led to the formation of dicalcium phosphate anhydrous (monetite). The biocompatibility was investigated using the osteoblastic cell line MC3T3-E1. Cell viability and the expression of alkaline phosphatase served as parameters. The culture medium was analyzed for pH value, concentration of free calcium and phosphate ions and osteocalcin. Both types of scaffolds showed a considerable increase of cell proliferation and viability; the monetite matrices were a little inferior compared with the brushite ones. The activity of alkaline phosphatase showed a similar pattern. Optical and electron microscopy revealed an obvious cell growth on the surface of both materials. Analysis of the culture medium showed minor alterations of pH value within the physiological range. The concentrations of free calcium and phosphate ions were obviously different among brushite and monetite cultures, due to their different solubility. The content of osteocalcin of the culture medium was reduced by the printed scaffolds due to adsorption. We conclude that the powder printed brushite and monetite matrices have a suitable biocompatibility for their use as cell culture scaffolds. Both materials enable osteoblastic cells in vitro to proliferate and differentiate due to the expression of typical osteoblastic markers.

Healing of onlay mandibular bone grafts covered with collagen membrane or bovine bone substitutes: a microscopical and immunohistochemical study in the sheep.

The objective of this study was to evaluate the role of collagen membrane and Bio-Oss coverage in healing of an onlay graft to the mandible. Twelve adult sheep each received an onlay bone graft (experiment 1), bone graft+Bio-Gide (experiment 2), and bone graft+Bio-Oss/Bio-Gide (experiment 3) on the lateral surface of the mandible. The animals were euthanized at 4, 8, 12 or 16 weeks after surgery, and findings were analysed by routine microscopy and immunohistochemistry for proliferation (Ki67) and apoptotic (Caspase-3) markers. Grafts were fully incorporated in all specimens. Pronounced resorption was observed in experiment 1. Minimal loss of graft volume was seen in experiment 2 specimens without membrane displacement. A remarkable increase in the augmented region of the mandible was observed in experiment 3. A high number of osteoclasts were expressed within the grafts during the early healing period, and thereafter declined markedly. Osteoblasts within the grafts expressed a moderate level of Ki67 at 8 weeks, which thereafter declined markedly. The strongest expression of Caspase-3 on the bone surface was observed after 16 weeks. In conclusion, the effect of collagen membrane coverage on bone graft volume maintenance was dependent on membrane stability during healing. An autogenous bone graft covered with Bio-Oss particles resulted in a remarkable increase in augmented lateral surface of the mandible. The late stage of bone graft healing was associated with a high apoptotic induction pathway of osteoblasts lining the surfaces of the new bone, demonstrated by strong positive Caspase-3 immunoreactivity.

[Use of biophysical techniques to evaluate the physiologic effects of injected hyaluronic acid]. / Einsatz biophysikalischer Messverfahren zur Untersuchung der hautphysiologischen Wirkung injizierbarer Hyaluronsäure.

BACKGROUND: To evaluate the effects of intradermal injection of native hyaluronic acid on physiology of aged skin using bioengineering methods. PATIENTS AND METHODS: 10 female patients aged 44-69 were included. Study duration was 24 weeks. Each patient received 3 treatments (at week 0, 2 and 4) with native hyaluronic acid (Hyalsystem Merz Pharmaceuticals, Frankfurt/Main, Germany) and 4 examinations (week 0, 4, 12 and 24). Biophysical properties assessed were skin elasticity and surface roughness, as well as skin thickness and density. RESULTS: Skin elasticity increased while skin surface roughness was reduced. High frequency ultrasound revealed an increase of skin thickness, whereas skin density decreased during treatment and slightly increased above baseline at week 24. CONCLUSION: The evaluation of the effects of an intradermal injection of hyaluronic acid on aged skin showed an improvement of skin elasticity and skin surface roughness.

[Effect of urea nail lacquer on nail quality. Clinical evaluation and biophysical measurements]. / Einfluss eines ureahaltigen Lackes auf die Nagelqualität: Evaluation mittels klinischer Scores und biophysikalischer Parameter.

BACKGROUND: Urea is a well-known humectant. The aim of our study was to evaluate the in vivo effect of 10% urea lacquer on nail quality. METHODS: 60 healthy probands with brittle nails were included in a randomized, controlled study. The nail lacquer was applied once (n=30) or twice daily (n=30) on one hand for 28 days, while the other hand served as untreated control. Assessments included clinical evaluations and bioengineering measurements. RESULTS: Application of the nail lacquer was well-tolerated and led to a significant clinical improvement of nail surface morphology, nail plate consistency, reflection of the nail plate surface, appearance of the cuticle and the nail fold. Sonographic nail density was slightly increased. No relevant changes were found in nail thickness and transonychial water loss. CONCLUSIONS: Nail lacquer containing urea improves the cosmetic appearance of fingernails.

[Oral squamous cell carcinoma Retrospective analysis of therapy results and prognosis by neoadjuvant, preoperative radio-chemotherapy]. / Plattenepithelkarzinom der Mundhöhle Retrospektive Analyse der Therapieergebnisse und Uberlebensraten bei neoadjuvanter, präoperativer Radiochemotherapie.

We investigated the charts of 129 patients treated for oral squamous cell carcinoma (SCC) in the Department of Oral and Maxillofacial Surgery, University of Cologne, between 1995 and 2004. Only patients treated preoperatively with combined radio-chemotherapy (carboplatin/39.6 Gy) were included. The purpose of the present study was to show the therapeutic outcome and the survival rates for this regimen. The mean age of the patients was 56.6 years. Male patients outnumbered female patients by 3:1. The floor of the mouth was the most common location (48.1%), and three out of four tumours (76.7%) had a G2 grading, while 82.9% were keratinized. Grade T4 was most the common (53.4%), and all patients were operated after preoperative treatment. In 82.2% of the cases, there were no tumour cells detectable microscopically (R0). In 34.1% there were viable tumour cells in the cervical lymph nodes, whereas in 66.7% these cells were found in the primary tumour despite preoperative treatment. A total of 38.8% of patients showed a recurrence of SCC. Mean survival was 4.8 years and 5 year survival 46.6%. The overall survival time of the disease was significantly influenced by pT (P=0.004), pN (P>0.001), R0 resections (P=0.0002), viable tumour cells in lymph node metastasis (P=0.0001), viable tumour cells in the primary (P=0.0004) and recurrence of the disease (P>0.001). In comparison to the current literature, no improvements in prognosis and survival of oral squamous cell carcinoma could be observed.

[Endosonographic imaging of tumor thickness in oral squamous cell cancer and its effect on the incidence of lymph node metastases]. / Endosonographische Darstellung der Tumordicke von oralen Plattenepithelkarzinomen und deren Einfluss auf die Inzidenz von Lymphknotenmetastasen.

BACKGROUND: The correlation between increasing tumor thickness and lymph node metastases as well as reduced survival in oral cancer has been proven by several studies. In most investigations the tumor thickness was assessed in histological sections. The aim of our prospective study was to assess tumor thickness in oral squamous cell carcinoma (OSCC) by intraoral ultrasonography and to evaluate the predictive value of tumor thickness for incidence of cervical lymph node involvement and survival. PATIENTS AND METHODS: A total of 64 patients with primary carcinomas of the oral cavity (stage I-IV) were included. Endosonographic assessment of patients was carried out using a 7.5-mHz probe (Hitachi EUP F334). The primary tumor could be visualized in all cases as a hypoechoic, sometimes irregular mass. RESULTS: The average tumor thickness in all tumors was 14+/-7 mm. The N+ patients showed a greater tumor thickness (15+/-7 mm) than N0 OSCCs with 12+/-6 mm (p =0.032, t -test). Less advanced T1/T2 carcinomas revealed a tumor thickness of 10+/-5 mm in contrast to T3/T4 carcinomas with 16+/-7 mm (p <0.001, t-test). The overall survival was reduced in patients with tumors thicker than 14 mm (48.9 versus 28.3 months, p =0,0102 log rank test). CONCLUSION: Although this technique facilitates the accurate assessment of tumor thickness in OSCC, only in less advanced tumors could endosonography provide additional information, since these tumors were not visible on CT or MRT scans. Nonetheless endosonography is a fast, cost-effective, and reliable technique for assessment of tumor extent in oral cancer.

[Quality of life of patients with squamous cell carcinoma of the oral cavity]. / Die Veränderung der Lebensqualität während und nach der Behandlung von Mundhöhlenkarzinomen.

OBJECTIVE: The aim of this study was to assess the changes in quality of life during and after treatment in patients with cancer of the oral cavity. PATIENTS AND METHODS: In the period between October 1999 and September 2000, 57 patients of the Department of Craniomaxillofacial Surgery, University of Cologne, underwent surgery, radiation therapy or the combination of both for the treatment of cancer of the oral cavity. Before, during and after the therapy their quality of life was measured with two psychometric scales. RESULTS: The average loss of quality of life in the female group was less than in the male group. Younger patients suffered more than older ones did. All patients had a loss of quality of life 3 months after the beginning of the therapy. The biggest decrease was in the group of patients treated with combined therapy, and the lowest loss in the radiated group. During the assessment period of 9 months, there were significant differences between all three groups. The size of the tumor did not show any influence on the reduction of quality of life. Patients with cancer of the tongue or maxilla showed more loss of quality of life than patients with tumors located in other regions of the oral cavity. CONCLUSION: Location of the tumor, age, gender of the patient, and type of therapy influenced the quality of life, while the size of the tumor did not.

[Ampicillin and sulbactam concentrations in the irradiated mandible after oral squamous cell cancer]. / Untersuchungen zum Ampicillin/Sulbactam-Spiegel im bestrahlten Unterkieferknochen bei Patienten mit oralen Plattenepithelkarzinomen.

INTRODUCTION: Radiation therapy of the oral and maxillo-facial region increases the risk of an infected osteoradionecrosis (IORN) which is a severe complication. Therefore, perioperative antibiotics for the prophylaxis of ORN is a standard in clinical oncology. The combination therapy of ampicillin and sulbactam (Unacid) promises a good therapeutic and prophylactic outcome. PATIENTS: We compared the concentration of Unacid in bone and blood specimens of 22 irradiated patients. All patients were irradiated with 39.6 Gy prior to surgery. The specimens were obtained during the operation 3 weeks after the end of the radiation therapy. RESULTS: The concentration of ampicillin/sulbactam in the blood was 124.9/64.5 microg/ml. The bone specimens showed a concentration of ampicillin/sulbactam of 5.54/1.21 microg/g. The concentration of the antibiotic in the bone was three to four times lower than in non-irradiated patients. Nevertheless, this concentration exceeds the minimum inhibitory concentration for bacteria in the oral cavity such as streptcoccae (MHK90<0.25 microg/ml) or staphylococcae (MHK90=0.12-2.0 microg/ml). CONCLUSIONS: The results of this study suggest, that Unacid is an effective antibiotic in the prophylaxis of ORN in irradiated patients with head and neck tumors.

[Active ingredients in dermatocosmetics]. / Dermatokosmetische Wirkstoffe.

Modern skin care- and anti-aging preparations feature both advanced formulation concepts and active ingredients against skin aging. Most of these ingredients are based on the recent findings that in aging the balance between collagen synthesis and collagen fragmentation is altered. Environmental factors inducing oxidative stress as well as decreased estrogen levels during menopause are important factors leading to these changes in connective tissue metabolism. Thus the major targets of anti-aging ingredients are oxidative stress and collagen metabolism. Evaluation of the effects of most of these ingredients has not been completed so far. In general scientifically evaluated anti-aging preparations can viewed as supplementing effective sunscreens and maximized skin care.

Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients--a report of a thirty year retrospective review.

This retrospective study aimed to demonstrate the incidence and the aetiological factors involved in osteoradionecrosis (ORN) in a group of 830 head and neck tumour patients who received radiotherapy between 1969 and 1999. The data showed an over all incidence of 8.2% and a 3-fold higher incidence for men than for women. Osteoradionecrosis was most commonly located in the body of the mandible. Concerning the risk factors, a negative influence was shown for advanced tumours, segmental resections of the mandible and pre-/post-radiation tooth extractions. Tooth extractions were found to be responsible for 50% of all cases. The osteoradionecroses were observed significantly earlier in patients who received pre-surgical radiotherapy than those who received post-surgical radiotherapy. Combined pre-surgical radio- and chemotherapy significantly hastened the appearance of osteoradionecrosis compared to pre-surgical radiotherapy alone. Only 40% of patients with osteoradionecrosis could be healed completely by means of surgery and antibiotic medication. Hyperbaric oxygenation (HBO) therapy was performed only in individual cases. The data suggest that osteoradionecrosis has a multifactorial aetiology. Therefore, a very close follow-up of tumour patients and a strict prophylactic management are required.

Morphogenesis and proliferation in mono- and organotypic co-cultures of primary human periodontal ligament fibroblasts and alveolar bone cells.

Cells of the periodontal ligament and the alveolar bone lie in close vicinity in the periodontium. The goal of this study was to create an in vitro model to facilitate the study of the morphogenesis and proliferation of these two cell types under more in-vivo-like conditions. This was accomplished by the generation of organotypic co-cultures of primary human periodontal ligament fibroblasts (PDL) and alveolar bone cells (BC) and matched mono-cultures after 1, 2 and 3 weeks. Indirect immunofluorescence (IIF) for vimentin indicated that PDL cells exhibited sustained stratification only in the presence of BC cells, suggesting an important role for BCs in maintaining the stratification of PDL cells. In mono-cultures, only BC cells showed progressing stratification. They also displayed the most pronounced contraction of the cell culture matrix. Moreover, Ki-67 antigen detection by IIF revealed that these features coincided with cell proliferation localized on the matrix surface at the onset of cell stratification. These findings suggest that, in addition to proliferation, a further prerequisite for stratification may be cell migration. Furthermore, the maintained cell stratification, proliferation, and compartmentalization noted for PDL cells in organotypic co-cultures and BCs in mono-cultures can only be observed in a three-dimensional culture system. Thus, our system represents a novel experimental tool to further elucidate the underlying mechanisms of the growth and differentiation of PDL and bone tissue.

Hohenheimer Consensus Talk. Oxidative and premature skin ageing.

To elucidate the scientific state of the art with respect to the role of nutrition in skin ageing, nine experts from different disciplines discussed the role of micronutrients on 'oxidative and premature skin ageing'. In this 25th Hohenheim Consensus Meeting, 13 questions were discussed and, based on published valid data, answered by mutual agreement. The consensus answers achieved during the meeting are justified by a scientific background text. The importance of in vitro and in vivo models regarding oxidative and premature skin ageing was critically evaluated. There was a special focus on prevention and intervention of skin ageing with nutrition. Finally, the paper summarizes the scientific background from different areas related to oxidative and premature skin ageing.

[Retrospective analysis of facial fractures related to falls in 260 Japanese patients]. / Retrospektive Analyse von Frakturen des Viszerokraniums nach Sturztraumen in einem japanischen Patientenkollektiv.

OBJECTIVE: Numerous epidemiological studies concerning fall-related injuries have been performed in the geriatric and orthopedic field to clarify the relation between the type of fall and fracture patterns. Although falls are a common cause of facial fractures, there is no study describing these relations. This study thus investigates the relationship between the type of fall and fracture pattern. MATERIALS AND METHODS: We analyzed 260 patients with fall-related facial fractures treated between 1995 and 2000 at the First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital, Japan. These patients were classified into two groups: (1) those who suffered fractures by a fall from a standing position or lower and (2) those who suffered fractures by a fall from a level higher than the standing position. RESULTS: Fractures caused by falling from a standing position or lower was more common in older patients, especially in women beyond 70 years. The localization of mandibular fractures was not significantly different between the two groups. However, a high incidence of midface fractures was observed in the patients who fell from a higher position. These patients tended to suffer from central midface or dislocated fractures. CONCLUSION: The results were consistent with recent orthopedic studies, which suggest a relation between fractures in old patients and osteoporosis. A strong force caused by falls from a high position tends to act on the high portion of the midface. Our classification based on the height of the falls was able to demonstrate clearly the relation between etiological factors and fracture patterns. Therefore, it seemed reasonable to analyze patients treated in the Department of Oral and Maxillofacial Surgery, Heidelberg University, Germany, according to the same classification in order to compare both collectives.

Do we alter ultraviolet sensitivity in vivo with stratum corneum rehydration? A pilot study and review of the literature.

BACKGROUND: Numerous therapeutic schemes recommend topical administration of emollients immediately prior to ultraviolet (UV) B therapy. The rationale behind the clinical improvement is a presumed enhancement of UV transmission through the epidermis. Originating from this clinical observation, there has been some concern as to whether a well-hydrated skin in general might be more susceptible to actinic damage. OBJECTIVES: To investigate whether rehydration of healthy skin causes an altered UVB sensitivity in vivo. METHODS: We determined minimal erythema doses (MEDs) and erythema sum scores (ESSs) after differential rehydration of the skin in 10 healthy volunteers. In each subject six UVB phototests were performed after pretreatment with five different emulsifying ointments (unguentum emulsificans and dilutions with 30, 50, 70 and 90% aqua purificans) plus a negative control. In vivo evaluation of stratum corneum hydration was performed by measurement of electrical capacitance. RESULTS: The results of this randomized, double-blind in vivo study indicated that rehydration of normal stratum corneum with the emulsifying ointments tested did not result in a significantly altered sensitivity to the erythematous effects of UVB irradiation (no significant differences in MED and ESS). Furthermore, there was no correlation between measured stratum corneum hydration and the erythema response of healthy skin. CONCLUSIONS: Although many schemes recommend the administration of emollients prior to UV therapy, there have also been calls for caution, as an uncritical application may interfere with such treatment. We showed that the emulsifying ointments tested exhibited no photoprotective potential and thus are suitable for the pretreatment of psoriasis prior to phototherapy. It has long been discussed whether the effects of emollient pretreatment on response to UV occur only in psoriatic skin or also in healthy skin. Our results indicated that stratum corneum rehydration did not result in a significantly increased erythema response of healthy skin to UVB exposure. With regard to the use of rehydrating cosmetics in everyday life, the outcome of our pilot study is reassuring, as we could not confirm with our experimental design that well-hydrated healthy skin is more prone to actinic damage.

Comparison of the in vivo efficiency of photofrin II-, mTHPC-, mTHPC-PEG- and mTHPCnPEG-mediated PDT in a human xenografted head and neck carcinoma.

BACKGROUND AND OBJECTIVE: One of the approaches to enhance the selectivity and efficiency of photodynamic therapy (PDT) was the conjugation of the photosensitizer meta-tetrahydroxyphenylchlorin (mTHPC) to the water-soluble polymer polyethylene glycol (PEG). Several studies have demonstrated that mTHPC-PEG has a higher selectivity and a longer circulating half-life than free mTHPC, whereas no in vivo effect of this benefit could be seen. STUDY DESIGN/MATERIALS AND METHODS: In a model of RAG-2-mice bearing a human oral squamous cell carcinoma xenograft (XF 354), the in vivo efficiency assessed as growth retardation or remission caused by Photofrin II and free mTHPC was compared with mTHPC coupled in two different ways to polyethylene glycol (PEG). One hundred and fourty-nine female RAG-2-mice were randomised into one control group and 13 therapy groups. Treatment parameters were adapted from those routinely applied in animal studies. RESULTS: Photofrin II-mediated PDT and mTHPC-mediated PDT were both in vivo highly effective, whereas mTHPC induced less scars. The in vivo results after mTHPC-PEG-mediated PDT were disappointing, whereas the effectiveness of mTHPCnPEG-mediated PDT, a newly coupled macromolecular photosensitizer, were promising. CONCLUSIONS: These results demonstrated the impact of the method of linkage between the photoactive agent mTHPC and polyethylene glycol (PEG) upon the in vivo effectiveness. mTHPC and mTHPCnPEG are promising photosensitizers for the future, especially for the cosmetic treatment needs of head and neck surgery.

Effects of low dose ultraviolet A-1 phototherapy on morphea.

AIM: The effects of low dose ultraviolet A-1 (UVA-1) phototherapy on different clinical stages of morphea (localized scleroderma) were analyzed in this case study. Based on these data, the different types of phototherapy described in the literature and currently used for treatment of morphea are compared. METHODS: Three patients with severe plaque type morphea in different stages were studied: one patient with late-stage lesions having stable sclerotic plaques; another patient with active inflammatory lesions; and a third patient with late-stage lesions associated with overlying lichen sclerosus et atrophicus (LSA). The treatment given was low dose UVA-1 phototherapy with single doses of 20 J/cm2 administered four times a week for 6 weeks, and once a week for another 6 weeks. RESULTS: Following UVA-1 phototherapy, the sclerotic plaques resolved, leaving smooth and soft tanned skin with normal structure, consistency and folding capability. In morphea with overlying LSA the elastic fibers did not completely return to the superficial papillary dermis despite the clinical clearance of both morphea and LSA. These data suggest that low dose UVA-1 phototherapy may improve, but not completely reverse, the histopathological changes of LSA. No side effects were observed during or after treatment. CONCLUSION: Our observations show in three patients that low-dose UVA-1 phototherapy is highly effective for treatment of all stages of morphea, including early inflammatory and late sclerotic lesions, and morphea with overlying lichen sclerosus et atrophicus. Because of its safety and efficacy, low dose UVA-1 phototherapy appears to be the treatment modality of choice.