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Radiation-induced acne is a rare, clinically and pathogenetically ill-defined acneiform dermatosis with special features that may occur in irradiated skin areas especially after high doses of deeply penetrating radiation. We report on a patient with an oropharyngeal carcinoma who developed severe radiation-induced acne including comedones and cysts as well as few inflammatory papules and pustules in a skin area irradiated with up to 63 gray of a 6 MeV photon beam. Acnegenic drugs may precipitate the disease; our patient was on longterm therapy with carbamazepine whose acnegenic potency is less well documented than that of testosterone or glucocorticoids. Treatment of radiation-induced acne is comedolytic; topical retinoids are especially valuable.

Allergische Reaktionen induziert durch das Antimykotikum Nystatin sind trotz des jahrelangen weitverbreiteten Einsatzes eine Raritat. Wir konnten einen Fall beobachten, bei dem es nach oraler Nystatinanwendung zur Entwicklung einer akuten generalisierten exanthematischen Pustulose mit Allgemeinsymptomatik (Fieber, Arthralgien) kam. Die Kausalitat wurde durch eine positive Intrakutantestung mit Nystatin-haltigen Arzneimitteln gesichert. Immunhistologisch fanden sich in den Testreaktionen positive Ablagerungen von Komplement C3, wohingegen zirkulierende Immunkomplexe nicht nachweisbar waren. Immunologisch ist der beschriebene Fall am ehesten als Typ-II-Reaktion nach Coombs und Gell einzuordnen. Unter systemischer Prednisolongabe kam es innerhalb von 11 Tagen zu einer kompletten Remission. Bei 2 Probanden, die berichteten, zuvor niemals Nystatin eingenommen oder lokal angewandt zu haben, wurde ebenfalls eine Intrakutantestung mit Nystatin-haltigen Arzneimitteln durchgefuhrt, die zunachst unauffallig war. Allerdings entwickelten sich bei beiden Probanden an den Injektionsstellen nach 3 Wochen juckende erythematose Papeln. Offenbar besteht fur Nystatin ein bislang nicht bekanntes Sensibilisierungsrisiko durch die Intrakutantestung.

Summary Scleromyxoedema, a disseminated papular and sclerotic variant of lichen myxoedematosus, is a rare disease with a chronic progressive course, and little tendency towards spontaneous remission. The treatment of scleromyxoedema has been largely ineffective. Aggressive chemotherapeutic agents have been used, often leading to therapy-related morbidity and mortality. We report a 41-year-old woman with scleromyxoedema, associated with a monoclonal gammopathy of IgG-k type, whose condition almost completely cleared with 12 monthly sessions of extracorporeal photopheresis. The patient had previously not responded to isotretinoin, and chlorambucil with prednisolone.

Suramin has long been used in the treatment of onchocerciasis and trypanosomiasis. Recent investigations showed an antiproliferative effect of suramin on prostate carcinoma cell lines. Ongoing clinical trials have confirmed the effect of suramin on metastasizing prostate carcinoma. Five patients with metastatic prostate carcinoma resistant to classic hormonal therapy were treated with high-dose suramin. Four of the five developed a papulovesicular or maculopapular rash within 2-4 weeks of starting therapy. The rashes disappeared after discontinuation of suramin within 10 days. In tumour therapy, high dosages of suramin are used to achieve a serum level of 200-300 micrograms/ml. Therefore, a toxic reaction to suramin is suspected as the explanation for the skin rashes.

Schnitzler’s syndrome (SS) is characterized by the association of generalized chronic urticaria, osteocondensation and monoclonal IgM gammopathy. Nonsteroidal anti-inflammatory drugs and systemic steroids are the most promising treatments. In our patient, they were ineffective. By contrast, during the follow-up period of 18 months, interferon α2b therapy (IFN-α) relieved the patient from its urticarial lesions and bone pain. IFN-α was tried to be stopped twice: each time, relapse of urticaria was noticed and, each time, the cutaneous lesions disappeared after IFN-α had been reintroduced. Furthermore, our observation supports the idea of the interleukin (IL)-1-mediated pathogenesis of SS as IFN-α induces high levels of IL-1 receptor antagonists. IFN-α could be an alternative treatment in disabling SS resisting other drugs.

We report the case of drug-induced, acrolocalized Kaposi sarcoma (KS), arising multicentrically in both palms and soles of a male patient who has had widespread psoriasis since 12 years of age. This 59-year-old man, of Mediterranean origin, was HIV antibody-negative and had received oral prednisolone treatment over 5 months for chronic obstructive lung disease (initial dose: 75 mg/d). Eight months after discontinuing oral treatment the KS nodules regressed spontaneously and finally disappeared completely without additional treatment. Light and electron microscopic investigations confirmed the diagnosis of KS, whereas laboratory tests excluded HIV infection and suggested mild immune dysfunction. The existence of HLA loci predisposing to KS and to psoriasis (A1, DR5, DR7, DR11) was characteristic for the simultaneous occurrence of these two diseases. This case report demonstrates the complex interrelationships between genetic predisposition, drugs leading to immune suppression, and the evolution of an unusual neoplasm.

Background: Merkel cell carcinoma (MCC) is an uncommon primary neuroendocrine skin tumor most often seen in the elderly. The clinical course varies. Treatment is controversial and few data on drug sensitivity are available. Objective: We evaluated the clinical course and treatment of 10 MCC patients and determined MCC chemosensitivity. Methods: Clinical records as well as laboratory and histopathologic data from 10 patients with MCC treated in our department were examined. Chemosensitivity to various chemotherapeutic agents and interferons of MCC cells from four patients was determined in a soft agar clonogenic assay. Results: MCC behaved as an aggressive tumor with early and frequent local relapses (4 of 10 patients at a 2.2-month average), regional (4 of 10 patients at 2.5 months), and distant metastases (5 of 10 patients 9.6 months after excision of the primary tumor). In all but one patient, regional metastases preceded distant ones. Metastatic spread was associated with an average survival of 21 months from the initial diagnosis. Long-term survival (53+ and 65+ months) was observed in two women. Wide excision of the primary tumor, alone or combined with adjuvant chemotherapy and radiotherapy, was the most effective treatment. In advanced disease, chemotherapy and radiotherapy were not able to induce long-term remission. In vitro assays for MCC drug sensitivity revealed cisplatin, doxorubicin, and vindesine to be the most active. Conclusion: MCC has a poor prognosis in advanced stages; therefore the primary tumor should be aggressively treated. The in vitro clonogenic assay may help to identify the chemosensitivity profile of MCC and to optimize chemotherapy protocols.

Together with antihistamines, various antibiotics including penicillin, tetracycline, and others have been empirically used to treat chronic urticaria in an attempt to eliminate an underlying focal infection. On the basis of this knowledge, we posed the question as to whether Helicobacter pylori infection could be an underlying cause of chronic urticaria. H. pylori infection can easily be diagnosed with high sensitivity and specificity with the [13C]-urea breath test.l, 2 The present study was performed to investigate the possible role of H. pylori in patients with chronic urticaria. We screened an unselected series of patients for infection and investigated whether specific treatment against the pathogen could cure the urticaria.

Summary An immunohistochemical analysis of skin biopsies was performed in 18 patients with cutaneous lupus erythematosus (LE), using the alkaline phosphatase and monoclonal anti-alkaline phosphatase method (APAAP). The study group was subdivided on the basis of clinical criteria into 10 patients with chronic discoid LE (CDLE) and eight patients with subacute cutaneous LE (SCLE). Using a panel of monoclonal antibodies the following results were obtained: (i) ICAM-1 was expressed on epidermal keratinocytes, dermal inflammatory cells, and endothelial cells in most biopsies, whereas LFA-1 was confined to the dermis. Attachments between keratinocytes or endothelial cells and activated T lymphocytes via ICAM-1/LFA-1 may be a possible mechanism of target/effector recognition in cutaneous LE. (ii) HLA-DR was expressed on epidermal keratinocytes and cells of the dermal infiltrate, but not on endothelial cells. HLA-DR+ cells probably function as antigen-presenting cells, leading to major histocompatibility complex-restricted cellular cytotoxicity in cutaneous LE. (iii) Interleukin 2 receptor expression on dermal inflammatory cells was weak, indicating non-specific activation of T lymphocytes. (iv) The dermal inflammatory cells were T lymphocytes, mainly of the helper/inducer subtype. B lymphocytes were rarely found in the dermis. In general, no significant immunohistochemical differences were found between CDLE and SCLE, suggesting that these variants represent clinical subtypes rather than different pathogenetic entities.