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Lichtempfindlichkeitsreaktionen umfassen eine Reihe differenter dermatologischer Krankheitsbilder. Lichtallergien im engeren Sinne sind Hautkrankheiten, bei denen es unter Einwirkung von nicht-ionisierender elektromagnetischer Strahlung (meist Ultraviolett (UV)-A/-B-Strahlung, gelegentlich auch sichtbares Licht) zu allergischen Reaktionen an der Haut kommt. Dazu zahlen Lichturtikaria, eine Immunglobulin-E-ver-mittelte allergische Sofortreaktion, photoallergisches Kontaktekzem und photoallergisches (Arznei-) Exanthem, zellvermittelte allergische Spattypreaktionen auf dem Boden einer Photosensibilisierung, chronische aktinische Dermatitis und die Polymorphe Lichtdermatose. Weiterhin gibt es nichtallergische Unvertraglichkeitsreaktionen der Haut auf Licht, wie vor allem exogene und endogene phototoxische Reaktionen, aber auch das auf einem Gendefekt beruhende Xeroderma pigmentosum oder die mit UV-Licht-Unvertraglichkeit einhergehende Autoimmunkrankheit Lupus Erythematodes.

Reproducibility of skin prick testing (SPT) and its modulation by ultraviolet B (UVB) radiation is of clinical interest. Sensitized atopic volunteers (groups A and B, n=21) were prick tested with common commercial allergen solutions (undiluted, diluted 1:10 and diluted 1:100) before, 24 h after one and 24 h after three suberythematous UVB irradiations. Volunteers in group A (n=8) received local UVB irradiation of prick test areas, whereas volunteers in group B (n=13) received whole body UVB irradiation, with prick test areas covered. In group A, the wheal intensities, expressed as the ratio allergen wheal size to histamine wheal size, were decreased by 28% (1:10 dilution) (P=0.01) and 45% (1:100 dilution) (P=0.02) after one UVB irradiation. Flare intensities were decreased by 48% (1:10 dilution) (P=0.03) after three UVB irradiations. In group B, the wheal and flare responses tended to decrease. Possible mechanisms of this short-term suppressive effect of UVB irradiation on SPT reactions include a direct effect on mast cells. It is concluded that UV irradiation, even a single exposure, prior to skin testing may compromise the validity of SPT testing.

Background: Dyshidrotic eczema of the palms and soles is a common condition, which can be rather resistant to treatment. Therapy studies and their comparability are of clinical importance. Objective: As standardized assessment methods for the severity of this particular form of eczema are lacking, we developed a severity index for dyshidrotic eczema. Methods: The Dyshidrotic Eczema Area and Severity Index (DASI) is based on the severity grade of single items – number of vesicles per square centimetre (V), erythema (E), desquamation (S) and itch (I) – and the extension of the affected area (A) and is calculated with defined score points (p) as: DASI = (pv + pE = pS + pI) × pA. Results: In two treatment studies on dyshidrotic hand eczema, the DASI was found to be a simple and useful tool to assess the severity of dyshidrotic eczema and the effect of therapy. Conclusion: The DASI needs to be further validated in larger cohorts.

Bei einer 61jahrigen depressiven Patientin kam es nach 3jahriger Einnahme eines Johanniskrautextraktes rezidivierend zu elevierten juckenden Erythemen in lichtexponierten Hautarealen. Im Epikutantest fanden sich positive Reaktionen gegen Benzocain, 4,4-Diaminodiphenylmethan und (Chlor)-Methylisothiazolinon ohne aktuelle klinische Relevanz, der Photopatchtest war negativ. In der systemischen Photoprovokation mit oraler Gabe eines Johanniskrautextrakt-Praparates konnte eine Erniedrigung der MED-UV B festgestellt werden, die nach Absetzen der Medikation reversibel war.

A case of erythema annulare centrifugum-type psoriasis in a 58-year-old white woman with a history of chronic plaque psoriasis is described. Initial failure of antipsoriatic treatments and an untypical histology complicated the diagnosis. After several trials acitretin at a low maintenance dose combined with oral fish oil and topical calcitriol led to sustained long-term remission. The spectrum of clinical differentiation of this rare disease, the histological characteristics and its nosological classification are discussed. It is suggested that this dermatosis represents a variant of acute psoriasis, rather than a variant of pustular psoriasis.

Allergy to kiwi, poppy seeds, and/or sesame seeds often occurs in patients with a simultaneous sensitization to nuts and flour. Previously cross reactions have been verified by RAST inhibition. In this study the nature of this cross-reactivity is further characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), followed by immunoblotting to nitrocellulose. The degree of cross-reactivity among kiwi, sesame seeds, poppy seeds, hazelnuts, and rye grain was found to be very high in the patients studied. The existence of both cross-reacting and unique components was observed; however, the cross-reacting and unique components could be different for different patients.

A case of digital gangrene in a patient with systemic lupus erythematosus without secondary anti-phospholipid syndrome is reported. The acute onset of the necrotizing acrovasculitis occurred without a history of Raynaud's phenomenon. Preceding symptoms of the systemic lupus erythematosus were arthritis, photosensitivity, alopecia and anorexia. Despite the seriousness of the acute episode the patient achieved an excellent outcome.

Atopic dermatitis is a pruritic inflammatory skin disorder, involving immunological and non-immunological factors. Substance P seems to be involved in the pathogenesis of atopic dermatitis. Substance P-containing nerve fibers are increased in the lesional skin of patients with atopic dermatitis and a reduced weal and flare reaction to intradermal injection of substance P has been observed. We investigated the distribution of substance P receptors in the involved skin of patients before and after single or repetitive UVA irradiations. Our results indicate that substance P receptors of the NK-1 subtype are expressed on blood vessels and on epidermal keratinocytes of involved skin of patients with atopic dermatitis. UVA irradiations did not modify the epidermal distribution of substance P receptors but decreased their expression intensity on blood vessels. UVA irradiations seem to decrease skin inflammation through the modulation of NK-1 receptor expression on endothelial cells.

Immediate-type allergy to natural rubber latex (NRL) proteins has become widespread within well-defined highly exposed populations,especially health care workers [1]. The potential economic impact on workers’ compensation and disability is considerable. Since NRL represents a “new” allergen, only little is known about the longterm course of NRL sensitization and allergy [2,3].

The frequent clinical observation that the course of atopic eczema, a skin disease involving a disturbed cutaneous barrier function, is influenced by climate and weather motivated us to analyse these relationships biometrically. In the Swiss high-mountain area of Davos the intensity of itching experienced by patients with atopic eczema was evaluated and compared to 15 single meteorological variables recorded daily during an entire 7-year observation period. By means of univariate analyses and multiple regressions, itch intensity was found to be correlated with some meteorological variables. A clear-cut inverse correlation exists with air temperature (coefficient of correlation: -0.235, P < 0.001), but the effects of water vapour pressure, air pressure and hours of sunshine are less pronounced. The results show that itching in atopic eczema is significantly dependent on meteorological conditions. The data suggest that, in patients with atopic eczema, a certain range of thermo-hygric atmospheric conditions with a balance of heat and water loss on the skin surface is essential for the skin to feel comfortable.

Dermatological-allergologic climatotherapy is interpreted as a therapy within a specific climate with proven therapeutic benefits, immediate and longterm. Intensive classical dermatological in-patient therapy is combined with specific climatic effects. Primarily, the climate of the high mountains (1560 m) and of the North Sea islands is of proven efficacy for dermatoses and allergic diseases such as atopic dermatitis (neurodermatitis), eczema, psoriasis, T-cell lymphoma, bronchial asthma. Specialized therapeutic utilities exist. Directly influencing climatic factors such as insolation, thermic-hygric and aerosol conditions without or with diminished allergic potency and nonspecific stimulating climate factors change immune functions and effect stabilization. The therapeutic immediate and longterm efficacy of the high mountain climate is proven by excellent follow-up results. Its superiority to the dermatological therapy applied at home is evident. Measurement and analysis of climate efficacy has however proven difficult because of its complexity. The findings of several recent clinical and biochemical studies are presented.

Actinic prurigo (AP) is a hereditary photodermatoses with typical symptoms and is quite common in North- and South-America. The key genetic factor appears to be a Native American background. In Europeans this type of AP is extremely rare; some dispute if this disease exists in Caucasians. Some newer publications postulate that these patients share HLA markers with the Native Americans. The most important differential diagnosis for AP is polymorphic light eruption which can be excluded relatively accurately by the clinical picture, typical histology and HLA pattern.The case of a female patient of Mayan ancestry living in Germany is presented.Since in literature sometimes cases from Europe are diagnosed as AP this is a problem of naming the disease. It would be helpful to integrate the terms hereditary or hereditaria into the name of the disease in indians.

We report an unusual case of a cutaneous T cell lymphoma with the clinical picture of leonine facies as the only skin symptom appearing during the first years of the disease. Small atypical lymphocytes with partly pleomorphic, partly indented cerebriform nuclei are present in the facial skin as well as in the peripheral blood and in the bone marrow. The lymphoma shows an indolent clinical behaviour without rapid progression of the disease. It shares features with both pleomorphic small/medium-sized T cell lymphoma and mycosis fungoides, but cannot be classified according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC) Classification for Primary Cutaneous Lymphomas. At present the lymphoma has to be ranged among the group of so-called unspecified peripheral T cell lymphomas according to the proposal of the International Lymphoma Study Group.

Training, Schadenseliminierung und Entspannung sind die Grundlagen der konservativen Therapie chronischer Herz-, Gefas- und Kreislaufkrankheiten (Buchwalsky u. Blumchen 1994). Die Kur enthalt diese zur Kuration, Rehabilitation und Pravention notwendigen Faktoren in konzentrierter Form (Luhr 1977; Jordan 1980; Agishi u. Ohtsuha 1995). Heilbad und Heilklima mit ihren kodifizierten Normen garantieren spezifische therapeutische Stimuli, eine die Rekreation fordernde Umweltqualitat sowie die zum „life style changing“ notwendigen Verfahren und entsprechende Spezialkliniken (Deutscher Baderverband 1995). Psychotherapie — als Psychosomatik durch Georg Groddeck (1866–1934) im Kurort im Kontext mit der Massage inauguriert —, Di„t, Entspannung und Gesundheitsbildung sind schon immer integrale Bestandteile der ambulanten und klinischen Kuren (Will 1984).

A 61-year-old woman with depression developed recurring elevated itching erythematous lesions in light-exposed areas after taking St. John's Wort-extract for three years. Routine patchtesting did not reveal any relevant reactions and photopatch testing was negative. Using a systemic oral photoprovocation test with St. John's Wort, we were able to demonstrate a decrease of the MED-UVB which was reversible after withdrawal of the medication.

Patients with atopic eczema remark improvement or aggravation of the disease in dependence on variation of climate or weather: after move, during vacation, but also in different seasons of the year the clinical course of atopic eczema is changing, which is subjectively referred to climatic influence.

The efficacy of tap water iontophoresis in treating palmoplantar hyperhidrosis has been sufficiently documented and has led to its extensive use in clinical practice. In order to test the efficacy of this treatment modality in cases of dyshidrotic hand eczema, 20 patients were treated with tap water iontophoresis in addition to two-sided steroid-free topical therapy in a randomized half-side-study. A special score for dyshidrotic eczema including objective and subjective criteria was developed to document the success of the therapy. Only those sides treated with tap water iontophoresis showed significant improvement. This significant effect of iontophoresis indicates the efficacy of this treatment in cases of dyshidrotic hand eczema.

The present study was designed to evaluate the effects of single irradiation either with UVA (dosage: 50 J/ cm2) or UVB (dosage: 1 MED) on surface structure and viscoelastic properties of human skin. Biophysical measurements by means of profilometry and cutometry were carried out on normally sunprotected skin areas directly before and 24 hours after irradiation. UVA induced neither measurable changes in skin surface structure (expressed by the profilometrically calculated parameters of roughness Ra and RzDIN and the parameter Wt reflecting depths of furrows) nor in its viscoelastic properties (expressed by the cutometrically calculated ratio Uv/Ue reflecting viscosity and the ratio Ur/Uf reflecting biological elasticity). However, a single erythemogenic dose of UVB radiation was followed by significant increase in the depths of furrows, increase in viscosity and decrease in biological elasticity.

Dermatological climatotherapy is used in the treatment of chronic and chronically relapsing long-term dermatoses, such as, especially, atopic dermatitis and psoriasis, complementing the dermatological therapies applied at the patient's place of living. It is a classical dermatological in-clinic therapy carried through in specific rough and stimulating climate areas of proven therapeutic benefit, primarily the North Sea climate and certain alpine locations over 1 500 m above sea-level, like especially in the high mountain valley of Davos, Switzerland. Dermatological climatotherapy is a well-tried therapeutic agent which, in comparison to the dermatological therapies applied at home, as a rule has fewer side effects as well as, above all, an additional long-lasting time effect. The latter is of particular importance regarding chronical diseases and cannot be achieved by other therapies. Dermatological climatotherapy, hence, represents an all-entailing therapy form and moreover is the most comprehensive therapy anyway. Dermatological climatotherapy can only be performed in rough and stimulating climate zones with additional special insolation, thermichygric and defined aerosol conditions. On the one hand, the organism is stabilized general by those climatic conditions, and, on the other, the constitutionally damaged skin is affected positively by the direct influence of climate factors. As every climate has its specific overall effect, the therapeutical immediate and long-term effects of a climate have to be proven scientifically by follow-up studies.

A 69-year-old white woman with muscle invasive T2N0M0 bladder cancer underwent surgical transurethral resection in January 1996 followed by 6 cycles of intravesical instillation of bacillus Calmette-Guerin in the 2 postoperative months. In June 1998 she had thickened velvety palms with pronounced dermatoglyphics, classified as tripe palms (fig. 1). In addition, a gray-brown velvety verrucous and papillomatous thickening of the skin (malignant acanthosis nigricans) became symptomatic, involving the intertriginous areas (fig. 2). A metastasis in the lymph nodes (G2) of the left supraclavicular plexus found 4 months later on ultrasound was extirpated. Several weeks later metastatic masses in the lymph nodes of the lumbar para-aortic and iliac regions of both sides were detected on computerized tomography. The patient died in April 1999 despite the initiation of chemotherapy with

Erythema migrans (EM), Borrelia lymphocytoma (BL) and acrodermatitis chronica atrophicans (ACA) are the established dermatological manifestations of borrelia infection, a complex multiorganic disease. Analogous to syphilis Borrelia infection can be classified by three stages, at which stage I (localized infection) and II (disseminated infection) are manifestations of early infection and stage III (persistent infection) a symptom of late infection. At all stages skin manifestations can be present, the above mentioned as stage-marker as well as other non-specific polymorphous skin lesions which sometimes appear at stage II. Because of its frequent (60-80%) occurrence in all borrelia infections EM has a pathognomonic importance for borrelia infection. In diagnosis serology is currently the only practical laboratory aid. False negative and false positive results must be considered. Treatment of choice is ceftriaxone, penicillin G (or amoxycillin) or tetracycline. Prophylactic antibiotic therapy for tick bites is not recommended. Congenital borrelia infections seem to be unusual, but it is likely that they can occur and cause different adverse fetal outcome or abortion.

The aim of this investigation was to obtain eczematous reactions in patch tests with immediate type allergens in atopic dermatitis patients. In the modified patch test (abraded skin) 65% of 100 adult patients had a positive patch test reaction with an early onset dermatitis in the test area in response to house dust mite and/or grass pollen. The correlation with the corresponding intracutaneous test was high with house dust mite and moderate with grass pollen. In the modified patch test with molds and basic foods we also obtained positive reactions, but they were fewer and weaker than those in response to mite and grass pollen.

Specific hyposensitization is a well-established therapy for IgE-mediated allergic rhinitis, asthma bronchiale, and insect venom allergies. In 0.1%-1% of therapies, serious side effects have to be treated. Fatalities following hyposensitization are known from the literature. We analyzed these data to find out the most important risk factors.

During a period of a few months we observed 3 female patients suffering from contact urticaria by use of rubber gloves. In one case the local urticarial reaction at the fore arms was followed by asthma. In all 3 cases we could prove type I allergy against latex by radio allergo sorbent test (RAST).

At the Davos Clinic for Dermatology and Allergy (Alexanderhausklinik), patients suffering from psoriasis were treated with natural UV irradiation over 6 weeks in 1987: the average doses applied amounted to 1.042 J/cm2 UVB (= 41.7 sunburn units (SU] and 41.511 J/cm2 UVA. These doses were far below those of artificial UV sources usually required in the treatment of psoriasis. The doses were also far below those which statistically increase the incidence of non-melanotic skin cancer.

Skin protection has a particular importance in occupational dermatology. The skin has to be protected from different occupational noxae for example physical like heat, cold, UV-radiation or friction or chemical like toxic or allergenic contactants. The protection measures are specified, in detail new formation of workrooms to prevent irritation of the skin, protective clothes and gloves, different noxa-adapted, skin protective preparations including different detergents and care of the skin. Their valence concerning prophylaxis and present occupational eccema is discussed.

A 38-year-old male homosexual patient, who had suffered from hepatopathy for many years and from rosacea since 15 years, showed pronounced exacerbation of the rosacea following HIV infection.

In den vergangenen 5 Jahren behandelten wir 58 Patienten mit Pilon-Tibialfrakturen im eigenen Krankengut, 54 operativ, 4 konservativ. 8 Patienten hatten einfache Spaltfrakturen, 26 Spalt- bzw. Stuckfrakturen mit Impression, 24 Trummerdefektfrakturen (37 Manner, 21 Frauen). Es uberwog das 40.- 60. Lebensjahr. 83 % der operativ versorgten Falle heilten komplikationslos ab, bei den ubrigen kam es zu Wundheilungsstorungen. In 7,4 % beobachteten wir Osteomyelitiden, wobei 29 % der 54 operierten Patienten offene Frakturen aufgewiesen hatten. Pseudarthrosen beobachteten wir bei 3 Patienten.