Acne inversa is a chronic inflammatory disease of the hair follicles. It can lead to severe funct... more Acne inversa is a chronic inflammatory disease of the hair follicles. It can lead to severe functional and psychological impairment. It is characterized by inflamed painful nodules, abscesses, fistulas and scarring in late stages of the disease. The causes of acne inversa are still not fully understood. Conservative treatment options such as antibiotics may lead to clinical improvement; however they do not produce healing. Therapy of choice, especially in severe forms, is radical wide excision of all affected areas. Despite a variety of treatment options, acne inversa is still a therapeutic challenge.
Since met-enkephalin-like substance has been demonstrated only in Merkel cells of some rodents bu... more Since met-enkephalin-like substance has been demonstrated only in Merkel cells of some rodents but not of cat, dog, pig, and humans, Merkel cells of these species were analyzed by immunohistochemistry using a variety of different antisera for the occurrence of neuropeptides different from met-...
Reddish-blue nodules were found on the tips of some of the toes of a 62-year-old woman. These nod... more Reddish-blue nodules were found on the tips of some of the toes of a 62-year-old woman. These nodules were painful when pressure was applied The clinical appearance of the efflorescence was most similar to that of glomangiomas. In addition, a lesion was observed on her lip that was suspected of being a lymphoma. The histological and immunohistological findings for all the lesions were consistent with the diagnosis of a non-Hodgkin lymphoma of low-grade malignancy. Consequently, a detailed internal medical examination was performed: biopsy specimens of the gastrointestinal mucosa revealed the presence of an immunocytoma. The significance of the immunohistological differentiation of lymphocyte subclasses by monoclonal antibodies for the diagnosis of lymphoma is demonstrated.
Journal der Deutschen Dermatologischen Gesellschaft, Jul 1, 2009
The hallmark of Schimmelpenning-Feuerstein-Mims syndrome (SFMS) is a systematized nevus sebaceous... more The hallmark of Schimmelpenning-Feuerstein-Mims syndrome (SFMS) is a systematized nevus sebaceous that follows Blaschko lines and usually involves the face. It represents a rare congenital nevus syndrome with alterations of skin, bones, CNS, eyes and heart. Nevi sebacei can proliferate and develop into epithelial tumors like trichoblastoma, syringocystadenoma and basal cell carcinoma. The histological differentiation between basal cell carcinoma and trichoblastoma is difficult. We present an adult woman with SFMS who was followed by multiple specialties since birth without the correct diagnosis being made. She was referred to us with the diagnosis of multiple basal cell carcinomas of head and face. Our diagnosis of systematized nevus sebaceus was crucial for the correct classification of SFMS. We identified multiple trichoblastomas in the nevi sebacei and could exclude basal cell carcinomas. The essential clue was the detection of multiple Merkel cells within the epidermal layer by cytokeratin 20 staining.
The possibility of a neuroendocrine differentiation in basal cell carcinomas (BCCs) has been a ma... more The possibility of a neuroendocrine differentiation in basal cell carcinomas (BCCs) has been a matter of debate for many years. In the present immunohistochemical study, applying the cytokeratins 8, 18 and 20 as the most established markers for Merkel cells (MCs), we did not find elevated numbers of MCs in any of 205 BCCs. This speaks against a neuroendocrine line of differentiation in BCCs. In contrast, we found various amounts of MCs in 15 of 36 trichoblastomas, which are the main benign differential diagnosis of BCC. In 4 trichoblastomas abundant MCs were spread over the whole epithelial tumor area. Additionally, the trichoblastomas' overlying epidermis exhibited significantly much higher numbers of MCs than the uninvolved adjacent skin or the epidermis overlying the BCCs. These findings might be an additional aid in the distinction between trichoblastomas and BCCs. Furthermore, concerning the recent discussion about the role of MC in growth and development of follicular germ, our observations are another sign of regulative influences of the MC, also in follicular germ under pathological conditions. Trichoblastomas with high numbers of MCs could be characterized as showing advanced differentiation toward the neuroendocrine component of the hair follicle, i.e. the MCs.
Acne inversa is a chronic inflammatory disease of the hair follicles. It can lead to severe funct... more Acne inversa is a chronic inflammatory disease of the hair follicles. It can lead to severe functional and psychological impairment. It is characterized by inflamed painful nodules, abscesses, fistulas and scarring in late stages of the disease. The causes of acne inversa are still not fully understood. Conservative treatment options such as antibiotics may lead to clinical improvement; however they do not produce healing. Therapy of choice, especially in severe forms, is radical wide excision of all affected areas. Despite a variety of treatment options, acne inversa is still a therapeutic challenge.
Since met-enkephalin-like substance has been demonstrated only in Merkel cells of some rodents bu... more Since met-enkephalin-like substance has been demonstrated only in Merkel cells of some rodents but not of cat, dog, pig, and humans, Merkel cells of these species were analyzed by immunohistochemistry using a variety of different antisera for the occurrence of neuropeptides different from met-...
Reddish-blue nodules were found on the tips of some of the toes of a 62-year-old woman. These nod... more Reddish-blue nodules were found on the tips of some of the toes of a 62-year-old woman. These nodules were painful when pressure was applied The clinical appearance of the efflorescence was most similar to that of glomangiomas. In addition, a lesion was observed on her lip that was suspected of being a lymphoma. The histological and immunohistological findings for all the lesions were consistent with the diagnosis of a non-Hodgkin lymphoma of low-grade malignancy. Consequently, a detailed internal medical examination was performed: biopsy specimens of the gastrointestinal mucosa revealed the presence of an immunocytoma. The significance of the immunohistological differentiation of lymphocyte subclasses by monoclonal antibodies for the diagnosis of lymphoma is demonstrated.
Journal der Deutschen Dermatologischen Gesellschaft, Jul 1, 2009
The hallmark of Schimmelpenning-Feuerstein-Mims syndrome (SFMS) is a systematized nevus sebaceous... more The hallmark of Schimmelpenning-Feuerstein-Mims syndrome (SFMS) is a systematized nevus sebaceous that follows Blaschko lines and usually involves the face. It represents a rare congenital nevus syndrome with alterations of skin, bones, CNS, eyes and heart. Nevi sebacei can proliferate and develop into epithelial tumors like trichoblastoma, syringocystadenoma and basal cell carcinoma. The histological differentiation between basal cell carcinoma and trichoblastoma is difficult. We present an adult woman with SFMS who was followed by multiple specialties since birth without the correct diagnosis being made. She was referred to us with the diagnosis of multiple basal cell carcinomas of head and face. Our diagnosis of systematized nevus sebaceus was crucial for the correct classification of SFMS. We identified multiple trichoblastomas in the nevi sebacei and could exclude basal cell carcinomas. The essential clue was the detection of multiple Merkel cells within the epidermal layer by cytokeratin 20 staining.
The possibility of a neuroendocrine differentiation in basal cell carcinomas (BCCs) has been a ma... more The possibility of a neuroendocrine differentiation in basal cell carcinomas (BCCs) has been a matter of debate for many years. In the present immunohistochemical study, applying the cytokeratins 8, 18 and 20 as the most established markers for Merkel cells (MCs), we did not find elevated numbers of MCs in any of 205 BCCs. This speaks against a neuroendocrine line of differentiation in BCCs. In contrast, we found various amounts of MCs in 15 of 36 trichoblastomas, which are the main benign differential diagnosis of BCC. In 4 trichoblastomas abundant MCs were spread over the whole epithelial tumor area. Additionally, the trichoblastomas' overlying epidermis exhibited significantly much higher numbers of MCs than the uninvolved adjacent skin or the epidermis overlying the BCCs. These findings might be an additional aid in the distinction between trichoblastomas and BCCs. Furthermore, concerning the recent discussion about the role of MC in growth and development of follicular germ, our observations are another sign of regulative influences of the MC, also in follicular germ under pathological conditions. Trichoblastomas with high numbers of MCs could be characterized as showing advanced differentiation toward the neuroendocrine component of the hair follicle, i.e. the MCs.
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Papers by Wolfgang Hartschuh