Notes: No tree anti-basement membrane antibodies were found in the sera of four patients with bullous pemphigoid, and no free anti-DNA antibodies in the sera of two patients with systemic lupus erythematosus. The sera were treated with 3 mol/l urea and by gel chromatography to separate these antibodies from any circulating complexes, and antibodies to basement membrane were detected by immunofluorescence and to DNA by the Farr technique. The appropriate antibodies were found in all the sera, indicating that failure to detect antibodies by routine procedures may be due to binding of the antibodies to soluble antigens, forming complexes in the sera.

Notes: We report on one patient suffering from amyopathic dermatomyositis, and two patients with transient or mild muscle involvement, respectively. The rare subset of amyopathic dermatomyositis is characterized by benign clinical course and prognosis. Leading cutaneous symptoms are heliotropic rash, periorbital violaceous-red erythema and edema, erythematous lichenoid plaques at the dorsum of the hands and fingers, hyperkeratotic, hyperesthetic eponychium, nailfold capillary abnormalities and the skin histology, while itching and photosensitivity are optional features. On the other hand, clinical or laboratory evidence of muscle involvement is absent for at least 2 years. The two patients with transient or mild muscle involvement point to transitional forms between amyopathic and classical dermatomyositis. As differential diagnosis lupus erythematosus, (photo)contact eczema, lichen planus, psoriasis, seborrhoic dermatitis and atopic dermatitis, as well as polymorphic light eruption and erythroderma, should be considered. Association with internal malignancy is rare, but is to be excluded. Waiting, hydroxychlorochine and systemic glucocorticoids are the steps of treatment, depending on the clinical course.

Notes: Background In addition to the infestation with scabies mites also allergic IgE mediated mechanisms play a role in the pathogenesis of scabies.Aim The aim of this study was to answer the question whether specific IgE mediated reactions to house dust and storage mites can be found and whether eosinophils are involved in the pathogenesis of scabies.Material 44 scabies patients (12 children. 32 adults) were classified according to the extent of skin involvement as mild, moderate and severe. Age- and sex-matched healthy controls and patients with atopic dermatitis were studied for comparative purposes.Methods Total and specific IgE to Dermatophagoides pteronyssinus, D. farinae, Acartis siro and Pityrosporon ovale were tested by CAP-FEIA (Pharmacia. Sweden) before and 6 weeks after treatment and prick tests were performed with the same allergens. The number of eosinophils in the peripheral blood and tissue specimens was counted and the eosinophil cationic protein (ECP) was determined by CAP-FEIA in serum before and 6 weeks after therapy.Results The total IgE was increased in 86% of patients. It was correlated with the extent of skin involvement (p 〈 0.05) and was significantly less increased 6 weeks after treatment (p 〈 0.115). Specific IgE to house dust and storage mites was increased up to 48% in the CAP-EEIA and up to 61% in the prick test, all together significantly higher than in controls and in comparable frequencies with atopic dermatitis. Pityrosporon ovate IgE was within normal ranges. Die ECP levels were increased in 89% of patients and correlated only in mild versus moderate or severe extent of the disease. 6 weeks after treatment, however, they were significantly less increased (p 〈 1.01). In addition. ECP levels were correlated with the IgE levels in scabies (C = 0.88). The number of eosinophils in the peripheral blood was increased in 64% of cases and in tissue specimens in 84% of cases studied. In principle, the extent of skin lesions was milder and the frequencies of specific IgE in the CAP- and prick test as well as the levels of total IgE (p 〈 0.01) and ECP (only in the tendency) were lower in children than in adults.Discussion The frequencies in the total and specific IgE to house dust and storage mites are comparable with those in atopic dermatitis. The question remains open, whether this is due to cross reactivity with scabies mites or whether this suggests an enhanced susceptibility to generalized scabies eruption. The increase in the ECP and its correlation to IgE, its decline after treatment (p 〈 0.05) and the occurrence of eosinophils in the peripheral blood and in inflammatory infiltrates of the skin suggest the involvement of eosinophils in the pathogenesis of scabies as an ectoparasitic IgE mediated disease.

Notes: Objective To evaluate the efficacy, safety and side-effects of methotrexate (MTX) in psoriasis. Design A 26-year retrospective study. Setting Department of Dermatology, Leipzig University, Leipzig, Germany. Patients One hundred and fifty-seven patients with extensive plaque psoriasis, erythrodermic, pustular and arthropathic forms, were treated with low-dose methotrexate (15–20 mg maximum weekly dosage [Weinstein schedule]), the majority for long-term periods. The mean cumulative dose was 3394 mg, the mean duration 237 weeks. Results The effect of MTX treatment was good in 76%, moderate in 18% and poor in 6% of subjects; 61% experienced side-effects, most frequently due to liver function abnormalities, bone marrow suppression, nausea, gastric complaints and hair loss. In 20% of cases the subjects were forced to discontinue therapy; 9% refused therapy due to physical and psychological discomfort, 2% wanted to become pregnant, 16% were lost to follow-up, 6% died from multimorbidity and old age. Three subjects (2%) developed cancer of the lung, breast or cervix uteri, possibly in relation to long-term MTX treatment. Altogether there were no deaths or life-threatening side-effects attributable to MTX treatment, and no cases of progressive liver cirrhosis apart from two extensive skin necroses due to overdosage (misunderstanding, suicidal attempt) that were treated successfully with citrovorum factor. Conclusion Low-dose MTX (〈15–20 mg/week) is an effective therapy for extensive and severe forms of psoriasis if patients are selected carefully and monitored regularly, particularly with respect to liver and bone marrow toxicity. This helps to reduce severe side-effects even during long-term treatment. Drug interactions must be avoided. MTX therapy according to the guidelines is relatively safe and still has a place in the systemic treatment of psoriasis with 40 years of experience and an acceptable safety record.

Notes: Objectives To review the pathophysiological background of systemic sclerosis in relation to the main, components involved: microvascular system, immunological system and fibroblasts of the connective tissue.Background Although many particular aspects of the pathophysiology of systemic sclerosis have been investigated in recent years, the complexity of the pathogenesis and the important links between the components involved remain unclear.Methods Literature review.Results and conclusion Scleroderma is a connective tissue disorder resulting in a progressive fibrosis of skin and internal organs. The genetic background is not clear. The microvascular system is one of the first targets involved (damage of capillaries, enhanced expression of adhesion molecules interacting with lymphocytes, perivascular infiltrates as starting points for tissue fibrosis). The immune system is unbalanced (selection of T-cell subpopulations, elevated serum levels of several cytokines, occurrence of autoantigens to topoisomerase I, centromeric proteins and RNA polymerases). As far as autoimmunity is concerned the triggering autoantigen is still unknown. Development of connective tissue fibrosis is prominent (sub-populations of fibroblasts with disturbed regulation of collagen turnover by TGF-β, CTGF and collagen receptors (α1β1, α2β2)). Investigation of pathophysiology of scleroderma is effected by monitoring the serum levels for soluble mediators, by cell culture studies of affected and non-affected fibroblasts and EC, by studying environmentally induced forms of scleroderma and by studies using animal models.

Notes: Background Owing to the rising incidence of tumours, the question of reliable risk classification is becoming increasingly significant.Objective Participation in the multicentre carcinoma registry maintained by the Association of Operative and Oncological Dermatology of the German Dermatological Society requires, in addition to the parameters of clinical staging and grading already established by the International Union against Cancer, description of other histopathological criteria related to prognosis, with special attention to microstaging.Methods One hundred and eighty-four patients with squamous cell carcinoma of the skin were examined. The histological parameters, carcinoma type, Breslow index, invasion level, growth form, grading and mitotic index were recorded and classified, and clinical staging was performed.Results It was found that the clinical criterion of tumour diameter (T-category) determines the further course of the disease. The other parameters taken into account, namely pathohistological microstaging and grading, can increase the accuracy of prognosis evaluation, and in particular enable carcinomas of the T1-category to be classified as either high malignant or low malignant tumours. The desmoplastic squamous cell carcinoma subtype is a potential risk tumour. Endophytic tumours are more malignant in their development than exophytically-growing carcinomas, and the probability of recurrence and metastatic tumour spread further increases when ulceration can be detected by microscope. In order to distinguish metastatic and recurring carcinomas, in addition to determining the invasion levels after Clark, measuring the Breslow index proved to be an important criterion. Quoting the mitotic index augmented the grading system, which further improved the reliability of malignancy assessment.Conclusions The TNM categories currently applied to squamous cell carcinomas of the skin must be supplemented by additional histological parameters which, according to our findings, permit more accurate classification of high and low malignant tumours.