Search

Eml® cream is frequently used in surgical dermatology and in anesthesiology, for instance, during vascular surgery procedures. Because local anesthetics can have a vasoactive effect in addition to producing analgesia, we decided to document the effect of 5% Eml® cream on cutaneous circulation in a prospective, placebo-controlled study. Skin circulation was monitored continuously under standardized conditions using video capillaroscopy, laser Doppler flowmetry and skin temperature. Recordings were made at the nailfold of the fourth finger (DIV) of the left hand of 12 volunteers with healthy veins over an observation period of 60 minutes under either Eml® occlusive dressing or an occlusive dressing with placebo. Mean capillary red blood cell velocity changed only minimally under the Eml® occlusive dressing, while placebo occlusive dressing led to a reduction of mean capillary red blood cell velocity from 0.21 mm/s to 0.12 mm/s (p < 0.01). There was no statistically significant change of arterial capillary diameter under Eml® or placebo occlusive dressing. Skin temperature dropped after 60 minutes of Eml® cream occlusive dressing from an initial 26.7 to 24.0°C (-10.1%; p < 0.02). The same duration of placebo caused skin temperature to drop from 27.6 to 23.0°C (-16.7%; p < 0.001). Laser Doppler flux (543 nm) rose 13% with Eml® (p = 0.9) and dropped 41.9% under placebo occlusive dressing (p < 0.03). Eml® cream upregulated nutritive perfusion. No clinically relevant vasoconstrictive effects are expected from an application period of 60 minutes. [ABSTRACT FROM AUTHOR]

Background: Early paediatric dermatosurgery reveals excellent cosmetic results due to high skin elasticity and pronounced capacity to recover from trauma. Furthermore, the size of skin lesions increases during life proportionally to skin growth and therefore early removal is of major importance. Selected local anaesthetics like prilocaine can cause methaemoglobinemia. However, in contrast to general anaesthesia, many other local anaesthetics do not bare any major risks for infants., Objective: In this retrospective study, we analysed infants aged less than 7 months receiving tumescent local anaesthesia (TLA) followed by dermatosurgery at our department between 2005 and 2015. The analysis is mainly based on our records. Additional information for a subset of patients was gained by a postoperative survey., Methods: Ninety-two infants (39 male, 53 female) with a median age of 4.2 months (range: 1.5 months; 6.7 months) were included in this study. Additional postoperative information was available for 33 of the 92 studied patients (35%)., Results: Infants were mainly operated for removal of a melanocytic naevus (n = 54), followed by haemangioma (n = 23), naevus sebaceous (n = 6) and other lesions (n = 9). The lesions were located on the scalp or neck (n = 31), on the extremities (n = 31), on the trunk (n = 21), in the face (n = 6) or on the buttocks (n = 3). The median size of excision was 509 mm 2 (range: 16 mm 2 ; 3600 mm 2 ). Primary defect closure was performed by intracutaneous (n = 68) or extracutaneous (n = 24) suture techniques. No side-effects of local anaesthesia were observed in any patient. Postoperative complications include pain (1/33; 3%), wound-healing disorder (1/33; 3%) and visible severe scarring (2/33; 6%)., Conclusions: The combination of TLA and dermatosurgery in infants is a suitable outpatient treatment option for small lesions without any major risks or side-effects and the benefit of prolonged postoperative analgesia., (© 2017 European Academy of Dermatology and Venereology.)

Squamous cell carcinomas of the skin and their precursors, actinic keratosis as well as basal cell carcinomas are classified as non-melanocytic skin cancer and belong to the group of epithelial skin tumors. This tumor entity is one of the most common forms of malignant cancer in western countries with an incidence of approximately 100-170 per 100,000 inhabitants per year in Europe. In German-speaking countries no exact numbers are available on the early forms of squamous cell carcinoma, actinic keratosis (carcinoma in situ); however, results from Great Britain show that at ages over 70 years old the prevalence of actinic keratosis is 34 % in men and 18 % in women. Because invasive epithelial cancer is very common and most commonly occurs in the head region, a safe but skin-sparing approach to surgical treatment is desirable. The safest procedure with respect to local recurrence is surgical excision with subsequent complete 3-dimensional histological preparation (micrographic surgery). With this method it is possible to excise tissue affected by tumor tissue in small steps. This facilitates defect coverage and leads to very good results as well as good esthetic results. The local recurrence rates are extremely low compared to alternative treatment methods, such as photodynamic therapy, topical application of imiquimod or cryosurgery and for the treatment of basal cell carcinoma, for example is 0.7 %. Dermatological operations are therefore interventions with a very high guarantee of tumor-free survival and functional and esthetic results.

A 68-year-old woman with insulin-dependent diabetes mellitus presented with blue nodules on the ventral aspect of the thorax. According to the past history, these lesions had developed repeatedly. She had already had bilateral mastectomies and lymph node dissection. The histologic diagnosis was always mastitis with plasma cells and no neoplasia. Yet another biopsy was taken; the subcutis was stained blue-black. Histology revealed exogenous black pigment and mastitis. With Raman spectroscopy the pigment was identified as carbon black, which is a component of India ink. These findings together with the unusual course of the disease suggested the diagnosis of an artificial disorder. The likely conclusion is that our patient, over years, used her own (insulin) syringe to inject India ink into her skin and subcutaneous tissue; the damaging effect and tissue reaction was probably caused by preservatives such as phenol.

Background: Patients with systemic scleroderma exhibit a noticeable slowing of blood cell velocities or even stasis in the capillaries of the skin. In this study the effects of transdermally applied prostaglandin PGE1 ethyl ester on nutritive cutaneous perfusion and on Raynaud's symptoms were investigated., Patients and Methods: 24 patients with systemic scleroderma were treated transdermally over a period of 14 days with prostaglandin E1 ethyl ester patches. The response of blood cell velocity in the nailfold capillaries to cold exposure was tested in 20 patients, and all of the patients recorded the number of Raynaud's episodes in a journal over a period of two weeks., Results: After the transdermal application of prostaglandin E1 ethyl ester there was an increase in blood cell velocity in the nutritive capillaries of systemic scleroderma patients (increase from 0.35 +/- 0.14 mm/s to 0.47 +/- 0.11 mm/s, (p < 0.05)). At the same time there was a decrease in the number of Raynaud's episodes (2.9 +/- 2.4 per day to 2.6 +/- 2.0 per day (p < 0.05))., Conclusion: The transdermal application of prostaglandin E1 ethyl ester was shown to have a favourable effect on nutritive blood flow in the capillaries of the skin in systemic scleroderma patients.

Background: The most important component in the treatment of venous ulcers is compression therapy. The function of compression therapy is the pressure exterted on the extrafascial and intrafascial venous system. Therefore the interface pressure of specially designed compressions stockings for the treatment of venous ulcers are in the focus of interest., Patients and Methods: We examined 20 patients (6 men and 14 women) with chronic venous insufficiency in CEAP stages CS0-4EPAS1-3PR). Interface pressure was measured under the Venotrain Ulcertec over an observation period of six weeks with piezoresistance sensors at four different sites on the lower leg and with the patient in different body positions., Results: Resting pressure supine at the ankle corresponded to compression class III and was constant over the period of six weeks (mean difference 2.8 SD 15.3 mmHg, p = 0.49). Working pressure explained as the quotient of maximum pressure during tiptoing/resting pressure in standing position was initially at the ankle 1.70 SD 0.44 and after 6 weeks 1.44 SD 0.29 (mean difference 0.27 SD 0.42, p < 0.03)., Conclusions: The compression stocking maintained a therapeutically effective pressure profile over a period of six weeks. Working interface pressure was comparable to that of short-stretch compression bandages applied by an experienced bandager immediately after application.

Subungual melanomas represent approximately 20% in dark-skinned and oriental populations compared to about 2% of cutaneous melanomas in white populations. UV exposure seems to be an important risk factor for cutaneous melanoma. However, UV radiation is unlikely to penetrate the nail plate. Another pathogenetic factor of subungual melanoma will be discussed. 406 subungual melanomas of the hands (n = 240) and feet (n = 166) of 74 patients from the melanoma registry of the Department of Dermatology, University of Tübingen, and of 332 patients from the literature were evaluated. The hypothesis of a uniform distribution of the occurrence of subungual melanoma on the fingers and toes had to be rejected (p < 0.001 using the chi(2)(4,0.95) test). There was a considerable predominance of subungual melanoma localized on the thumb (58% of all fingers) and the hallux (86% of all toes). Many patients report direct trauma related to the onset of subungual melanoma. This might be explained by coincidence, increased attention to a dark area under the nail, traumatic bleeding of a subclinical subungual melanoma or mutation of melanocytes during trauma-induced proliferation. Squamous cell carcinoma is known to occur in sites of chronic trauma. Trauma could be an etiologic factor in subungual melanoma as well., (Copyright 2002 S. Karger AG, Basel)

Background and Objective: The aim of this study was to measure the pressure exerted by a tubular bandaging material developed for the treatment of leg ulcers in vivo in healthy volunteers and to compare the measured values with the pressure exerted by short- or long-stretch medical compression bandages., Patients/methods: This was an open, randomized, prospective study on 15 volunteers with healthy veins. Both static pressure and dynamic pressure fluctuations during exercise (10 toe stands) were measured. All volunteers wore tubular bandage on one leg and on the other leg in random order short- or long-stretch medical compression bandages., Results: The tubular bandaging material produced a more steady pressure over the 8 hours of usage than both the short- and long-stretch bandages. The test subjects found the tubular bandage more comfortable., Conclusions: The pressure exerted by the different bandaging materials varied with the experience of the bandager and the material used. The tubular bandage maintains a therapeutically beneficial pressure profile throughout the day and provide the conditions necessary for the reliable prevention of edema, thus promising to be effective in the treatment of venous ulcers.

In order to evaluate the correlation between the pressure exerted by compression stockings and a resulting improvement in venous hemodynamics, we carried out an open, randomized, prospective study on 22 patients (11 women and 11 men with an average age of 55.1 [10.3]) with chronic venous insufficiency (CVI) in the clinical stages C1-4, Ep, AS, Ap, PR. Dynamic strain gauge plethysmography was used to measure the acute effect on venous hemodynamics of 9 different compression stockings in compression class 2 (A-D). At the same time when venous function parameters were monitored, we also measured the pressure exerted by the compression stockings during rest and exercise. With all compression stockings the average resting pressure fulfilled in reclined patients the specifications for compression class 2 (25-35 mmHg at the ankle, CEN). The compression stockings lengthened venous refill time t0 in a statistically significant degree. The improvement in venous function was correlated with the ratios of maximal working pressure to resting pressure while standing (r = 0.97, p < 0.001). Compression stockings belonging to the same compression class vary in their acute effect on venous hemodynamics. The efficiency of the different therapeutic compression stockings was largely dependent on the amount of fabric stretch, which can be characterized in vivo with the ratio of maximum exerted pressure during movement to that while standing still. A knowledge of the hemodynamic effectivity of the various compression stockings allows the optimal stocking selection for each patient and his individual clinical situation.

Background and Objective: The aim of the study was to measure the pressure exerted on the skin with application of the specially designed UlcerCare compression stocking for treatment of chronic venous leg ulcers and simultaneously to objectify the improvement in venous function., Patients/methods: Twenty patients with chronic venous insufficiency according to the CEAP Classification C1-4 EP AS, A14, AP, PR were examined. Static exerted pressure was measured while standing and the dynamic equivalent was measured during 10 repetitions of tip-toe exercise. The patients were wearing the standard stocking JOBST Medical LegWear UlcerCare (Beiersdorf AG, Hamburg, Germany). As a control for the effectiveness of the therapy on venous hemodynamics, the lower leg volume, calculated using optoelectronically-measured lower leg circumference and venous reflux, determined by strain gauge plethysmographically-measured venous refill time, were used., Results: Use of the compression stocking system UlcerCare resulted in a decreased lower leg volume. This decrease was on average 5.3%, corresponding to 106 +/- 78 ml (p < 0.001). The calf and forefoot venous function parameters also improved. The venous refill time improved from 27.2 +/- 15.2 s to 45.0 +/- 27.4 s at the forefoot (p < 0.003) and from 10.5 +/- 4.5 s to 19.4 +/- 10.9 s at the calf (p < 0.002). The exerted pressure at the ankle while standing was 46.2 +/- 24.2 mmHg (resting pressure) and 48.5 +/- 27.2 mmHg during repetitive tip-toe exercises (mean exercise pressure). At the calf, the exerted pressure while standing was 40.7 +/- 26.9 mmHg (resting pressure) and during the repetitive tip-toe exercises it was 42.1 +/- 29.5 mmHg (mean exercise pressure)., Conclusions: The exerted pressure of the UlcerCare compression stocking is equivalent to that of a class 3 medical compression stocking. This newly developed stocking diminishes venous reflux and reduces leg edema. These objectified effects suggest that the UlcerCare stocking is effective as compression therapy for venous ulcers.

FOITS (Fast Optical In-vivo Topometry of human Skin) is a new technique for the three-dimensional analysis of the microstructures of the skin. Based on the surface roughness standards used in the metal-working industry, it uses computer-assisted strip analysis to process information gathered from high-speed, non-contact scanning. It is possible to visualise the mathematical data in 3D form. So far, surface relief parameters have had to be acquired indirectly by first making silicone casts of the skin and then digitalising them with image analysis, mechanical scanners or, more recent, laser profilometry and confocal microscopy. We selected the roughness parameters Ra, Rz and Rmax (DIN defined) and "positive" and "negative" volume to describe the skin surface. In 40 healthy volunteers we were able to define significant intra-individual differences in these roughness parameters, which were correlated with the location of the area of skin being scanned (p < 0.05). When healthy areas of skin were compared with areas of chronic eczema in 10 patients with neurodermatitis the differences in the above-mentioned roughness parameters were just as striking (p < 0.05). In patients with chronic atopic eczema there was a statistically significant correlation between changes in the parameters "positive" and "negative" volume, and the smoothing of the skin seen after 14 days of treatment with standard ointments (p < 0.02). Apart from its industrial uses, we see potential applications for FOITS in the investigation of quantitative and qualitative aspects of aging processes, physiological and pathological processes in the skin, and the effect of topical preparations applied to the skin.

For compression treatment to be effective in patients with chronic venous insufficiency, it is vital that leg circumference be measured accurately. If compression stockings are custom fit and appropriate for the medical indications, patient compliance will be high. Exact measurements of circumference and length are prerequisites for a good fit. The aim of the present study was to compare an opto-electronic device for the contact-free measurement of calf circumference with the conventional manual method using a tape measure. We investigated the differences between the results obtained with the two methods, and also their reproducibility. Circumferences were measured at defined heights on an anatomically shaped non-yielding leg model and on the leg of a healthy volunteer by 10 different experimenters both with the tape measure and with the opto-electronic device. The calf circumferences measured manually with the tape measure varied significantly more than those measured opto-electronically, both in the leg model and in the leg of the volunteer. A systematic error in the opto-electronic method appears unlikely, since the manual measurements on the leg model were both larger and smaller than those obtained with the opto-electronic device. Reproducibility was exceptionally high with the opto-electronic device (standard deviation 0.11-0.42 cm). The opto-electronic method yields rapid accurate measurements of circumference with excellent intra- and inter-operator reproducibility.

The elevated ambulatory pressure in the peripheral venous system of chronic venous insufficiency (CVI) patients manifests itself not only in the form of disturbed macrocirculation but also and particularly in microangiopathic changes. For this reason, it is closely correlated with trophic disorders of the skin and can ultimately lead to ulceration. Using microcirculation research techniques, we are able to provide clear evidence of a typical microangiopathy in chronic venous insufficiency. Fifty CVI in Widmer stages I, II, and III were examined with fluorescence video microscopy, intravital video capillaroscopy, transcutaneous oxygen partial pressure measurement, TcpO2 and laser Doppler flowmetry. The effects of compression therapy with individually fitted compression stockings on capillary morphology were studied over a period of 4 weeks in 20 CVI patients in Widmer stages I and II. The capillary pressure was measured during simulated muscle contraction using a servo-null micropressure system. We periodically drew blood from the dorsalis pedis vein and a brachial vein of 11 healthy test persons and 8 patients with stage III CVI during experimental venous hypertension in order to evaluate the expression pattern of leukocyte adhesion molecules involved in inflammation: LFA-1 (CD11a), Mac-1 (CD11b), p150,95 (CD11c), CD18, VLA-4 (CD49d), and L-selectin (CD62L). In the same patients, we used immunohistochemical methods to examine clinically unaffected skin and the skin near an ulcer, focusing on the adhesion molecules ICAM-1, VCAM-1, and E-selectin. The microangiopathic changes observed with worsening clinical symptoms include a decrease in the number of capillaries, glomerulus-like changes in capillary morphology, a drop in the oxygen content (tcpO2) of the skin, increased permeability of the capillaries to low-molecular-weight substances, increased laser Doppler flux reflecting elevated subcutaneous flow, and diminished vascular reserve. These microangiopathic changes worsen in linear proportion to the clinical severity of chronic venous insufficiency. In patients with venous ulcerations, the baseline expression of LFA-1 and VLA-4 on lymphocytes, Mac-1 expression on the myeloid cell line, and L-selectin expression on all three cell lines was not significantly different form that in healthy controls. During orthostatic stress, there was a significant reduction in the expression of L-selectin in blood cells collected at foot level in the controls (p=0.002), but not in the patients. Clinical improvement by compression therapy was accompanied by an increase in the number of nutritive capillaries, while the diameter of the capillaries and the dermal papillae was reduced. When ulcers healed in a short period (<6 weeks), we observed a concomitant increase in the number of capillaries (p<0.05). Microangiopathy appears before tropic disorders of the skin develop. Even trophically normal skin areas may have dilated nutritive capillaries, an early sign of disturbed skin perfusion. These changes represent a plausible explanation for the development and to recurrency tendency of venous ulcers. The reduced expression of lymphocytic L-selectin in healthy controls during the orthostatic stress test may be an indication that the cells are activated by venous stasis. Clinically effective therapeutic measures improve the impaired microcirculation of the skin in the ankle area.