[Functional study of the regeneration of nerve fibers after keratinocyte transplantation]. / Idegrostok regenerációjának funkcionális vizsgálata keratinocyta transzplantáció után.

The functional regeneration of sensory nerves was investigated in 5 patients with skin defects (caused by leg ulcers, a burn or fasciitis necrotisans) after transplantation with a keratinocyte suspension. In this area, first the pain sense and soon after wards the cold and heat sense returned, followed finally by the flare reaction caused by the mustard oil test. No sweat production could be observed during the study, because sweat glands were not found after the keratinocyte transplantation. The reinnervation course is roughly the same for skin defects covered with split skin graft or with a keratinocyte suspension.

Treatment of cold urticaria.

BACKGROUND: The etiology of cold contact urticaria is unknown and the therapy is therefore usually rather disappointing. METHODS: This study reports therapeutic data on 42 patients with cold urticaria treated with a combination of terbutaline (3 x 5 mg a week, later 3 x 2.5 mg) and aminophylline-containing drugs (3 x 150 mg). RESULTS: Complete remission of the urticarial response was achieved in 37 of the 42 patients. CONCLUSIONS: The therapy was tolerated relatively well and the results are promising.

A possible pathomechanism of the idiopathic cold contact urticaria.

Urtica is characterized by an erythematous wheal surrounded by a flare and is frequently caused by physical agents (e.g. cold). The exact mechanism and mediators involved in the mechanism of physical urticaria are not known. This study of the role of the neurogenic factors in cold urticaria showed, that local capsaicin treatment (desensitization) of the skin in patients with cold urticaria resulted in the abolition of whealing in response to cold. This result suggests that C-fibers might play an important role in the pathomechanism of idiopathic contact cold urticaria.

[Combined pizotiphen and cinnarizine treatment in urticaria factitia]. / Kombinierte Pizotiphen- und Cinnarizinbehandlung (PCB) bei der Urticaria factitia.

30 patients suffering from urticaria factitia were treated with pizotiphen and cinnarizin for 6 weeks. In 13 patients, the effect of treatment was controlled by means of the dermographism test. Placebo administration failed to affect the subjective and objective symptoms. During treatment with pizotiphen and cinnarizin, the flare significantly decreased within the first week and finally did not differ from that observed in healthy persons after 6 weeks of therapy. 19 out of 30 patients were totally free of symptoms. In 11 cases, treatment resulted in significant reduction of the urticaria, but only 7 patients still complained of itching. After repetition of the therapy, 5 patients were free of symptoms; 2 patients still reported on slight itching one year after treatment.

Capsaicin prevents histamine-induced itching.

The effects of topical treatment with capsaicin or mustard oil on histamine-induced pruritus, wheal formation and flare response were studied in the human skin. Capsaicin pretreatment resulted in a reversible marked reduction or abolition of the axon reflex flare, but did not influence whealing. Itching was also strongly diminished or even abolished, provided that the flare response was completely blocked. The onset of itching was significantly promoted by pretreatment of the skin with mustard oil, inducing axon reflex vasodilatation. It is concluded that, in addition to the axon reflex flare, capsaicin-sensitive peptide-containing primary afferent neurones are also intimately involved in the mediation of the sensation of itching.

Drug fever caused by PUVA treatment.

Here we report the case of a patient who developed drug fever during PUVA treatment. This was the only manifestation of hypersensitivity. Neither UV-A irradiation nor 8-methoxypsoralene caused a febrile reaction.

The modulation of cutaneous inflammatory reactions by peptide-containing sensory nerves.

In the present experiments the role of unmyelinated sensory fibres in the mechanism of cutaneous inflammatory reactions under normal and pathological conditions has been studied in man and animals. Dye leakage responses to histamine, serotonin, compound 48/80, bradykinin and substance P were significantly reduced, while neurogenic inflammation was completely abolished in rats treated neonatally with capsaicin, as studied quantitatively by the Evans blue technique. Neurogenic inflammation could also be elicited by mustard oil in normally innervated human skin, but not in skin areas affected by herpes zoster or in a patient suffering from congenital analgesia. Repeated topical treatment of the skin with capsaicin (local desensitization) abolished the neurogenic inflammatory response for several days. Chemical pain sensitivity was strongly reduced, and thresholds for warmth and heat pain sensations were significantly elevated. Local capsaicin desensitization of the skin prevented whealing, flare and itch in patients with acquired cold and heat urticaria. The findings indicate that peptide-containing sensory nerves are involved in the mediation of chemogenic and heat pain, and possibly itch, and are responsible for initiation of the neurogenic inflammatory response. The results also provide direct evidence of the involvement of these particular sensory nerves in the modulation of the permeability-increasing effects of putative mediators of acute inflammatory reactions. It is concluded that, through modulation of cutaneous vascular reactions, peptidergic sensory nerves may play a hitherto unrecognized role in the pathomechanism of certain diseases of human skin.

[Transient acantholytic dermatosis (Grover)]. / Transitorische akantholytische Dermatose (Grover).

Case report about a 79 year old man with transient acantholytic dermatosis (TAD). Review of the literature of Grover's disease.

Involvement of sensory nerve endings in cold and heat urticaria.

The involvement of sensory nerve endings in acquired cold and heat urticaria was studied in 8 patients. After repeated topical application of capsaicin, the skin was tested for whealing with cold and heat stimuli. Capsaicin pretreatment prevented the urticarial responses for 4-7 days. Since capsaicin is known to induce selective impairment of the chemosensitive nerve endings, the results suggest that these nerve fibers may play an important role in acquired cold and heat urticaria. The possible mechanisms are discussed.