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From the Middle Ages to the 20th century, talented artists have created illustrations of signs of human diseases. Since the birth of photography in 1840, artists and physicians have used photographic techniques to illustrate the diseases of the skin; dermatology especially relies on these visual signs. In dermatology today, photography is still very important because of the need for adequate illustrations in medical textbooks and journals. From the early days of daguerreotypes to modern times, medical photography was developed in different stages and many physicians have taken part in the development of photographic techniques and chemistry. This historical survey describes the milestones in the development of medical photographic illustration from its beginning to the 20th century.

REPORT OF A CASE A 42-year-old woman who suffered for more than 2 years from disseminated localized scleroderma (LS) (Figure 1) markedly improved during treatment with psoralen with UV-A (PUVA) bath photochemotherapy with 8-methoxy-psoralen (8-MOP).1The 8-MOP was applied to the skin during a warm water bath, which was immediately followed by UV-A exposure. Clinical, histological, and ultrasound indications of LS (Figure 2) regressed almost completely during PUVA bath photochemotherapy in this and 2 other patients, 1 with disseminated LS and 1 with contractures caused by linear LS of the dorsal aspects of the left thigh and entire left leg.1 THERAPEUTIC CHALLENGE No single therapy produces uniform disease remission in LS.2-6A safe and effective therapy associated with the least potential complications is required. SOLUTION Since clinical regression of sclerosis was confirmed by ultrasound and histological evaluations, we considered PUVA bath photochemotherapy a promising novel therapeutic approach

PUVA bath therapy has distinct advantages compared with systemic PUVA therapy, eg, lack of systemic side effects and better bioavailability of psoralen.1-6However, one astonishing drawback of the PUVA bath procedure is the lack of study-generated guidelines for the realization of the procedure. Therefore, we conducted 2 studies to determine the optimal time for irradiation and for how long photosensitivity persists after the bath. The biological activity of 8-methoxypsoralen (8-MOP) was evaluated by determination of the minimal phototoxicity dose (MPD). In a previous study7on PUVA bath phototoxicity, we demonstrate that irradiation immediately and 20 minutes after the bath induces a relatively uniform ).ototoxic response with low UV-A doses (0.5-1.0 J/cm2). Thereafter, a rapid increase of the MPD occurred, thus indicating a decrease of drug activity.7The aim of the present study was to evaluate the photosensitivity up to 4 hours after PUVA bath. Materials and Methods. Six

Lichen planus (LP) is a common inflammatory skin disease, accounting for approximately 1% of all diagnoses seen in patients seeking dermatologic care. In some patients, therapy remains difficult, and systemic application of glucocorticosteroids, cyclosporine, systemic photochemotherapy with psoralen plus UV-A (PUVA), and acitretin have been used with limited success.1To circumvent the problems of oral PUVA therapy, methoxsalen (8-methoxypsoralen) in a dilute bathwater solution may be applied to the skin before UV-A.2A PUVA-bath photochemotherapy regimen has been shown to be an elegant alternative in the treatment of psoria- sis.2,3We describe our first four patients with LP who received PUVA-bath photochemotherapy. Patients and Methods. Four patients (age range, 42 to 76 years) with histopathologically proven LP received PUVA-bath photochemotherapy (Table). All had a history of LP for 14 to 24 months and had received topical or systemic glucocorticosteroids, oral PUVA (one patient), and acitretin (one patient)

Polymorphous light eruption (PLE) is a common photo-dermatosis of unknown etiology. It afflicts mainly fair-skinned patients, with a preponderance of young females. There is, however, no absolute restriction as to age, sex, or race. Clinical variants include the papular, vesiculo-bullous, and hemorrhagic variety, as well as plaque, erythema multiforme—like, and insect bite (strophulus)-like types. Skin lesions appear only in certain exposed areas hours or a few days after intense sunshine, and are nearly always mono-morphous in the same patient. The rash subsides spontaneously within several days without leaving scars. The histopathologic picture is characteristic and shows a perivascular lymphocytic infiltrate in the upper and middle corium with subepidermal edema, vacuolization of basal cells, and spongiosis in the lower epidermis. The most important differential diagnoses are solar urticaria, photosensitive erythema multiforme, and lupus erythematosus. The action spectrum of PLE is under debate. Reproduction of skin lesions has been reported with UVB, UVA, and, rarely, visible light, with UVA probably being the most effective part of the spectrum. More important than treatment of PLE is prophylaxis. UVA- and UVB-effective sunscreens are of some help. Phototherapy and especially photochemotherapy (psoralen + UVA; PUVA) offer effective ways to decrease light sensitivity. Systemic treatment with chloroquine or β -car-otene has been disappointing. J Invest Dermatol 88:32s—38s, 1987

Steroid atrophy was induced in 3 volunteers by the continuous, occlusive application of clobetasol propionate to the forearms for 6 weeks. The changes were followed sequentially by light, scanning, and transmission electron microscopy. A 59% decrease in viable epidermal thickness was noted after the sixth week of treatment, as well as a flattening of the dermal-epidermal junction. The 3-dimensional architecture of the dermis was strikingly reorganized. This was largely brought about by resorption of the ground substance as revealed by a progressive dimunition of Hale's stain for acid mucopolysaccharides. Loss of ground substance resulted in decreased spaces between collagen and elastic fibers as shown by scanning and transmission electron microscopy. The fibrous network consequently collapsed, yielding a more compact papillary and reticular dermis. This compression caused the reorientation of both collagen and elastic fibers. However, no differences in collagen and elastin fine structure were noted. Fibroblasts were shrunken but not reduced in density. A marked decrease in number of mast cells was noted in 3-week specimens and virtually no mast cells were observed after 6 weeks. We found that the primary effect of short-term steroid use was a rearrangement of the geometry of the denial fibrous network. This was not due to alterations in the fibers themselves but a secondary consequence of the loss of ground substance.

Ultraviolet (UV) irradiation is a major factor in the pathogenesis of certain variants of cutaneous lupus erythematosus. Photosensitivity constitutes one of the criteria of the American Rheumatism Association for the diagnosis of systemic lupus erythematosus, which further emphasizes its importance. The pathomechanism of UV-induced lupus erythematosus remains unknown. The characterization of photosensitive subacute cutaneous lupus erythematosus (SCLE) by Gilliam and Sontheimer has Ied to a new approach. Through the development of standardized test methods it has became possible to reproduce cutaneous lesions in the UV-A and UV-B spectrum. These standardized test methods allow a better definition of photosensitivity than clinical history does. Recent clinical data show that besides SCLE another variant, lupus erythematosus tumidus, also reveals pronounced photosensitivity. In this review article phototest procedures, phototest results, and clinical correlations in different subgroups are discussed.

Tissue-specific T cell localization is crucial for immune surveillance of normal tissues and the pathogenesis of inflammatory disorders. In psoriatic skin, CD8+ lymphocytes predominantly reside within the epidermis, whereas CD4+ T cells are most abundant within the dermis. Molecular mechanisms guiding this spatial compartmentalization are not completely understood, however. Here, we demonstrate that 55% (+/-9.7%, n = 14) of the epidermal T cells, predominantly of the CD8+ phenotype, expressed the integrin alphaE(CD103)beta7. In contrast, only 5% (+/-2.0%) of the dermal T cells were alphaE(CD103)beta7+. Integrin alphaE(CD103)beta7 was not detected in normal skin (n = 10), and less than 1% of peripheral blood lymphocytes derived from normal (n = 11) or psoriatic (n = 10) donors expressed alphaE(CD103). When cultured T lymphoblasts (n = 12 donors) were stimulated with transforming growth factor beta1, expression of integrin alphaE(CD103)beta7 was induced on 52.8% (+/-16.2%) of CD8+ cells, but only on 6.1% (+/-2.3%) of CD4+ cells, suggesting selective inducibility on CD8+ lymphocytes. Whereas similar overall expression of transforming-growth-factor-beta1-specific mRNA was detected in normal and psoriatic skin by real-time quantitative polymerase chain reaction, immunohistochemistry revealed focal overexpression of transforming growth factor beta1 underneath psoriatic, but not normal, epidermis. This heterogenous transforming growth factor beta1 expression may contribute to induction of alphaE(CD103) in vivo. Adhesion of transforming-growth-factor-beta1-stimulated CD8+, but not CD4+, T cells to cultured keratinocytes and psoriatic epidermis in frozen sections could be significantly inhibited by antibodies that blocked the alphaE(CD103)/E-cadherin interaction. Co-culture of lymphoblasts and keratinocytes resulted in marginal enhancement of alphaE(CD103)beta7 expression in some cases. Overall, integrin alphaE(CD103)beta7 appears to contribute to tissue-specific epidermal localization of CD8+ T lymphocytes.

Derzeit gibt es keine einheitliche, allgemein akzeptierte Empfehlung fur Lichttestungen zur Diagnostik bei Patienten mit Verdacht auf Lichtdermatosen. Vorliegend werden Testverfahren beschrieben, die es ermoglichen, die normalen Lichtreaktionen des Patienten zu prufen und pathologische Reaktionen festzustellen. Die Durchfuhrung von Lichttreppen zur Bestimmung von minimalen Erythemdosen (MED-UV-B, MED- UV-A) und Pigmentierungsfahigkeit werden erlautert und Methoden fur UV-Provokation, Photopatchtest und systemische Photoprovokation werden beschrieben. Die Aussagekraft der Testmethoden wird diskutiert.

Untersuchungen uber den Einflus der UV-Strahlung auf die Hautreaktivitat gegen toxische Substanzen liegen bisher nicht vor. Anhand dreier unterschiedlicher Irritationsmodelle wurde der Einflus von UV-A und UV-B auf die Hautreaktivitat untersucht. Zwei seitengetrennte Testfelder am Rucken 26 freiwilliger Probanden wurden drei Wochen lang dreimal wochentlich mit UV-A und UV-B bestrahlt. Insgesamt wurden 9mal 100 J/cm2 UV-A und 9mal die 1,5fache MED-UV-B appliziert. Danach erfolgten auf den bestrahlten Feldern sowie auf normaler Haut folgende Testungen: 1. Alkaliresistenz-Test, 2. Dimethylsulfoxid-Test, 3. Natriumlaurylsulfat-Test.