It is a pleasure to review the second, thoroughly revised edition of Dr Morison's popular book on the use of light in the treatment of skin disease. Compared with the first edition published in 1983, the current version has been... more
It is a pleasure to review the second, thoroughly revised edition of Dr Morison's popular book on the use of light in the treatment of skin disease. Compared with the first edition published in 1983, the current version has been updated with new recommendations for the phototherapy of psoriasis and expanded with detailed information on photochemotherapy protocols using retinoids and other systemic drugs. There are also chapters on photopheresis and laser therapy. The first five chapters of this book provide a concise and quite readable review of the basic principles of photobiology and the history of phototherapy and therapy with psoralen and UVA (PUVA). One who is interested in an in-depth discussion of the fundamentals of photobiology, however, should seek additional information in other texts. The next section, consisting of four chapters, covers the management of psoriasis. This section addresses the essential elements of the patient workup with clarity and
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Known in part since antiquity, the salutary effects of sunlight again garnered increasing attention in the second half of the 19(th) century. The development of a device for ultraviolet irradiation of cutaneous tuberculosis by Finnsen at... more
Known in part since antiquity, the salutary effects of sunlight again garnered increasing attention in the second half of the 19(th) century. The development of a device for ultraviolet irradiation of cutaneous tuberculosis by Finnsen at the onset of the twentieth century truly marked the beginning of modern phototherapy. In dermatology, treatment methods almost exclusively use wavelengths below the visible light range (ultraviolet light). Since the early 1970s, increasingly powerful artificial light sources have become available for UVB and UVA therapy as well as the combination of UVA and photosensitizers (photochemotherapy). High structural and procedural quality standards are an essential prerequisite for the implementation of effective as well as safe phototherapy. The following guidelines outline the current consensus of leading experts in the field of phototherapy with respect to indications, contraindications, and side effects of various treatment options available. Particul...
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Die heilsame Wirkung des Sonnenlichts war teilweise schon im Altertum bekannt und fand in der zweiten Hälfte des 19. Jahrhunderts wieder zunehmend Beachtung. Den Beginn der modernen Phototherapien markiert die Entwicklung einer Apparatur... more
Die heilsame Wirkung des Sonnenlichts war teilweise schon im Altertum bekannt und fand in der zweiten Hälfte des 19. Jahrhunderts wieder zunehmend Beachtung. Den Beginn der modernen Phototherapien markiert die Entwicklung einer Apparatur zur ultravioletten Bestrahlung der Hauttuberkulose durch Finnsen zu Beginn des zwanzigsten Jahrhunderts. Zur Therapie von Hauterkrankungen finden beinahe ausschließlich die spektralen Bereiche unterhalb des sichtbaren Lichtes (ultraviolett) Anwendung. Seit den 1970er Jahren stehen zunehmend leistungsfähige künstliche Strahlenquellen bereit für die Therapie mit UVB, UVA und die Kombination von UVA mit Photosensibilisatoren (Photochemotherapie). Hohe strukturelle und prozedurale Qualitätsstandards sind unabdingbare Voraussetzung für die Durchführung einer gleichermaßen wirkungsvollen wie auch sicheren Phototherapie. Die Leitlinie formuliert den aktuellen Konsens führender Experten auf dem Gebiet der Phototherapie in Bezug auf die Indikationen für die ...
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Ungefahr 3 % der Globalstrahlung des Sonnenlichtes besteht aus ultravioletter UV-Strahlung. Trotz dieses geringen Anteils ist diese Strahlung fur die meisten durch Sonnenlicht hervorgerufenen Hautschaden verantwortlich. Abgesehen von der... more
Ungefahr 3 % der Globalstrahlung des Sonnenlichtes besteht aus ultravioletter UV-Strahlung. Trotz dieses geringen Anteils ist diese Strahlung fur die meisten durch Sonnenlicht hervorgerufenen Hautschaden verantwortlich. Abgesehen von der therapeutischen Wirkung bei einzelnen Dermatosen ist der einzige bekannte gunstige Effekt der UV-Strahlung die Photokonversion von Pro-Vitamin D3 in der Epidermis durch UVB. Alle anderen Reaktionen fuhren zu akuten und chronischen Schaden. Die akuten Schaden bestehen aus Sonnenbrand und Pigmentveranderungen. Die chronischen Schaden, die durch kumulative Wirkung der UV-Strahlung verursacht werden, sind Hautatrophie, Elastose, Ausbildung von Pigmentflecken und Teleangiektasien — Veranderungen, die als Lichtalterung der Haut bezeichnet werden und nichts mit dem physiologischen Alterungsprozes zu tun haben — und als ubelste Folge die Ausbildung von Hauttumoren.
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Vitiligo is a relatively common condition characterized by the progressive loss of normal skin coloration in certain skin areas. It is not a life-threatening disease and therefore does not require treatment unless serious disfigurement... more
Vitiligo is a relatively common condition characterized by the progressive loss of normal skin coloration in certain skin areas. It is not a life-threatening disease and therefore does not require treatment unless serious disfigurement leads to social segregation and emotional distress. Treatment is directed to reverse the progressive loss of epidermal melanocytes and to reconstitute normal skin color. Although a minority of patients with vitiligo may develop transient repigmentation when exposed to sunlight or artificial UV radiation, only photochemotherapy is effective in inducing a permanent cosmetically acceptable treatment result1–3.
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This review covers the current practice of phototherapy with ultraviolet (UV) radiation, of psoralen photochemotherapy (PUVA) and of photodynamic therapy (PDT) in the treatment of skin diseases and superficial skin tumors.
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Die Phototherapie der Psoriasis hat in der modernen Dermatologie eine Tradition von uber 60 Jahren und, wenn man die Heliotherapie miteinbezieht, von vielen Jahrhunderten. Dennoch wurde erst in den letzten acht Jahren, beeinflust durch... more
Die Phototherapie der Psoriasis hat in der modernen Dermatologie eine Tradition von uber 60 Jahren und, wenn man die Heliotherapie miteinbezieht, von vielen Jahrhunderten. Dennoch wurde erst in den letzten acht Jahren, beeinflust durch die Einfuhrung und die ausgezeichneten Erfolge der Photochemotherapie (PUVA) [13, 23, 24] das wissenschaftliche Interesse an den Mechanismen von UV-Strahlen in der dermatologischen Therapie erweckt. Kontrollierte Therapiestudien mit verschiedenen UV-Spektren, Kombinationen mit anderen Therapeutika und Untersuchungen mit verfeinerten Techniken laufen derzeit um einen optimalen Therapieerfolg bei moglichst geringem Nebenwirkungsrisiko zu erzielen. Die moderne Lichttechnologie hat die Entwicklung neuer hochenergetischer UV-Strahler ermoglicht, die sich zur Behandlung groser Hautflachen eignen und in ausgewahlten Wellenlangenbereichen ihr Emissionsmaximum aufweisen. Der folgende Beitrag beschaftigt sich mit der UV- Phototherapie ohne Photosensibilisator.
Research Interests: Medicine and Gynecology
Photochemotherapy is the combined use of a photosensitizing chemical compound with non-ionizing electromagnetic radiation to bring about a therapeutically beneficial result not produced by the drug or radiation alone. The drug may be... more
Photochemotherapy is the combined use of a photosensitizing chemical compound with non-ionizing electromagnetic radiation to bring about a therapeutically beneficial result not produced by the drug or radiation alone. The drug may be applied topically or administered systemically to reach the skin via the circulation and is subsequently activated by irradiation with appropriate wavelengths.
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This chapter reviews the current practice of phototherapy with ultraviolet (UV) radiation and of psoralen photochemotherapy (PUVA) in the treatment of psoriasis. Both treatment modalities are well-established in today’s armamentarium of... more
This chapter reviews the current practice of phototherapy with ultraviolet (UV) radiation and of psoralen photochemotherapy (PUVA) in the treatment of psoriasis. Both treatment modalities are well-established in today’s armamentarium of dermatological therapy. Continued clinical research has helped to improve treatment protocols. Simultaneously, the understanding of mechanisms underlying the biological responses to UV exposure and psoralen photosensitization has much increased. Therefore, we are well prepared to minimize the potential long-term side effects such as skin carcinogenesis by optimizing therapeutic strategies. Phototherapeutic regimens use repeated, controlled UV exposures to alter cutaneous biology, which in this context aims at inducing remission of skin disease. In this chapter we will discuss the use of UVB radiation without sensitizer as well as psoralen photosensitization (PUVA). Although UVB has been used for a longer time than PUVA, the latter has been evaluated and validated in a more detailed and coordinated fashion.
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In a 14-year-old boy with hydroa vacciniforme by UV-testing was found to be the provoking wave band region. Tolerance to artificial UV-and sunlight was achieved by inducing pigmentation with oral methoxsalen photochemotherapy (PUVA).
Research Interests: Dermatology, Adolescent, Medicine, Humans, Male, and 3 moreClinical Sciences, Photochemotherapy, and Sunlight
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Necrobiotic xanthogranuloma is a rare generalized dermatosis occurring exclusively in association with paraproteinemia. Clinically it is characterized by large, ulcerating, nodular and plaque-like tumors of the dermis and subcutis.... more
Necrobiotic xanthogranuloma is a rare generalized dermatosis occurring exclusively in association with paraproteinemia. Clinically it is characterized by large, ulcerating, nodular and plaque-like tumors of the dermis and subcutis. Histologically the lesions are composed of a nonspecific, lymphocytic and plasmacellular infiltrate and highly characteristic granulomas with giant cells of the Touton and foreign body type. Ultrastructurally, tubular cystic organelles with a central lamella and a few ribosomes at their outer membranes are found. By means of histochemical studies we excluded the skin infiltrates as the site of the paraprotein release. The pathogenesis of the disease remains unclear; it is suggested that the paraprotein has functional features of a lipoprotein, which may bind to lipoprotein receptors of the histiocytes, thereby inducing xanthoma formation.
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This is the first report on the occurrence of giant melanosomes in normal human epidermis and in moles. Due to their characteristic ultrastructural features these large pigment organelles are of special interest for the research in... more
This is the first report on the occurrence of giant melanosomes in normal human epidermis and in moles. Due to their characteristic ultrastructural features these large pigment organelles are of special interest for the research in melanin pigmentation. The diferentiation of giant malanosomes from other types of large melanin granules is discussed.
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Oral aromatic retinoid (Ro 10-9359) in the treatment of a patient with hyperkeratotic Darier's disease yielded excellent results, which could be maintained over a period of 14 months by continuous administration of the drug. No... more
Oral aromatic retinoid (Ro 10-9359) in the treatment of a patient with hyperkeratotic Darier's disease yielded excellent results, which could be maintained over a period of 14 months by continuous administration of the drug. No serious side effects occurred which would have necessitated discontinuation of the therapy.
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Electron microscopy (EM) and electron microscopic cytochemistry have shown that diffuse melanosis in advanced metastatic melanoma is the result of an unlimited spread of single melanoma cells throughout the dermis; these cells retain... more
Electron microscopy (EM) and electron microscopic cytochemistry have shown that diffuse melanosis in advanced metastatic melanoma is the result of an unlimited spread of single melanoma cells throughout the dermis; these cells retain their melanogenic capacity and continue to produce melanized melanosomes which eventually are deposited within dermal macrophages and thus impart to the skin a diffuse slate-blue color. These findings are in accordance with previous observations in a similar patient and thus support the concept that single cell metastasis represents a common pathogenic event in these patients.
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A cooperative photopatch test study was conducted by 45 dermatologic centers in Austria, Germany, and Switzerland. Results obtained from 1985 to 1990 are presented. A standard photopatch test tray of 32 substances was applied to the back... more
A cooperative photopatch test study was conducted by 45 dermatologic centers in Austria, Germany, and Switzerland. Results obtained from 1985 to 1990 are presented. A standard photopatch test tray of 32 substances was applied to the back of patients with suspected photosensivity. After applications for 24 hours, test sites were irradiated with 10 joules/cm2UVA. Unirradiated controls were included. Readings were performed immediately and 24, 48, and 72 hours after irradiation; responses were qualitatively graded on a 4-point scale. All data were stored and processed by a computer. With computer-assisted analysis of reaction patterns photoallergic reactions were identified and distinguished from phototoxic reactions. Data of 1129 patients were evaluated. Among a total of 2859 positive test reactions in 870 patients, 2041 in 778 patients were found to be photoinduced and 818 in 413 patients were contact reactions; 108 reactions in 83 patients were classified as photoallergic. Nonsteroidal anti-inflammatory drugs, disinfectants, sunscreens, phenothiazines, and fragrances caused most often photoallergic reactions. Many unspecific phototoxic reactions were induced by tiaprofenic acid, promethazine, carprofen, chlorpromazine, fenticolar, wood balsam of Peru, and perfumes. Despite the distinction between photoallergic and phototoxic responses, many test reactions lacked relevance for the patients' dermatoses.
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Melanomas are rare in albinos, although the incidence of solar radiation-induced skin tumors is extremely high because of the absence of photoprotective melanin. This report describes a 40-year-old white woman with tyrosinase-negative... more
Melanomas are rare in albinos, although the incidence of solar radiation-induced skin tumors is extremely high because of the absence of photoprotective melanin. This report describes a 40-year-old white woman with tyrosinase-negative oculocutaneous albinism who developed four primary amelanotic melanomas--three of the superficial spreading and one of the nodular type-and, in addition, displayed nevi that exhibited histologically the characteristic features of dysplastic nevi. The concomitant occurrence of multiple primary melanomas and several dysplastic nevi classifies the patient's condition as "dysplastic nevus syndrome," which to our knowledge has not been described in albinism so far.
Research Interests: Melanin, Dermatology, Medicine, Humans, Melanoma, and 7 moreMale, Albinism, Clinical Sciences, Adult, Syndrome, The American, and Skin Neoplasms
A 44-year-old female British travel guide suddenly had fever, nausea, vomiting, and diarrhea develop during her stay in South India. Four days later she was transported to our hospital. At admission she had a high temperature, impaired... more
A 44-year-old female British travel guide suddenly had fever, nausea, vomiting, and diarrhea develop during her stay in South India. Four days later she was transported to our hospital. At admission she had a high temperature, impaired respiration, and abdominal pain. Clinical examination revealed bilateral pleural effusion, hepatomegaly, and ascites. Two days later the patient showed a generalized macular rash with a conspicuous sparing of small islands of normal skin. Hemorrhagic erythema on the palms and soles as well as focal petechiae on the hard palate and scleral and conjunctival bleeding were also observed. Hypotension and renal insufficiency developed 1 week after the illness started. Laboratory investigations revealed highly elevated levels of hepatic enzymes, severe hemolytic anemia, decreased platelet counts, and abnormal coagulation values. The presumptive clinical diagnosis of dengue hemorrhagic fever was supported by serologic testing that disclosed sustained high titers of hemagglutination inhibition antibodies. Symptomatic therapy with substitution of volume and albumin, blood transfusions, and administration of antipyretics resulted in complete recovery within 6 weeks.
Research Interests: Medicine, India, Humans, Dengue fever, Female, and 15 moreDifferential Diagnosis, Small islands, High Temperature, Nausea, Enzyme, Clinical Sciences, Great Britain, Adult, Blood Transfusion, Pleural Effusion, Abdominal Pain, Dengue Hemorrhagic Fever, Clinical Diagnosis, Hemolytic Anemia, and renal insufficiency
This paper details investigations on the permeability of the intercellular spaces of guinea pig epidermis and the phagocytic capacity of keratinocytes as studied with a long-term tracer (Thorotrast) at the ultrastructural level.... more
This paper details investigations on the permeability of the intercellular spaces of guinea pig epidermis and the phagocytic capacity of keratinocytes as studied with a long-term tracer (Thorotrast) at the ultrastructural level. Immediately after injection into the skin, the tracer penetrates the basal lamina and permeates the intercellular compartment of the epidermis. A barrier to further spread is located in the upper stratum granulosum. Thorotrast fails to penetrate the desmosomes, and this contrasts the findings obtained with low molecular weight proteins. Five minutes after the injection the tracer is found in large vacuoles within keratinocytes which probably represent the “paranuclear cisternae” described previously and are believed to be continuous with the intercellular space. Osmotic pressure leads to a rupture of some of these vacuoles in the stratum granulosum and to cytolysis of some cells. Active uptake of Thorotrast by keratinocytes commences approximately 1 hour after the injection and continues as long as a tracer depot is present within the dermis. The internalization of the marker is accomplished by means of single membrane-limited phagosomes which transfer Thorotrast into the interior of the cells. Since Thorotrast is indigestible, it is stored in the vacuolar system of keratinocytes and is eliminated from the epidermis during the keratinization process. The results of the present study underscore the excellent permeability of the intercellular spaces for small particles; the readiness of keratinocytes to phagocytose even indigestible material, and the fact that substances released in the dermis diffuse into the epidermis by a continuous flow as long as a sufficient supply is maintained by the dermal depot.
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Today, October 16, 1990, Professor Antonio Milella (Rettore Magniflco of the University of Sassari), Professor Herbert Hiinigsmann (President of the European Society for Photobiology) and Professor Francesco Dall’Acqua (President of the... more
Today, October 16, 1990, Professor Antonio Milella (Rettore Magniflco of the University of Sassari), Professor Herbert Hiinigsmann (President of the European Society for Photobiology) and Professor Francesco Dall’Acqua (President of the Italian Society for Photobiology) met in the office of the Rector of the University of Sassari in order to formalize the foundation of a Center for Advanced Research in Photobiology (acronym, CARP). The centre is scientifically and technically supported by the University of Sassari, where it is hosted, as well as by the European and Italian Societies for Photobiology. The initiative is developed within a European framework of multidisciplinary cooperation, involving both basic and applied research in the field of photobiology, and also the training of investigators with expertise in photobiology. The three partners will undertake all possible actions to ensure that the CARP can begin operation as soon as possible. With this aim in mind, the University of Sassari will support the initiative by hosting the CARP on its existing site and sponsoring the incorporation of CARP into CO.RI.SA. (Consorzio Ricerche Sardegna), which is located at Tramariglio-Alghero and has established a specific agreement with the University of Sassari.