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Background: Dyshidrotic palmoplantar eczema is a frequent disease often running a chronic relapsing course. Topical glucocorticosteroids form the mainstay of therapy, and alternatives are urgently warranted. Objective: This study was performed to compare the efficacy of tacrolimus (FK506) 0.1% ointment and mometasone furoate 0.1% ointment in the treatment of dyshidrotic palmoplantar eczema. Methods: Sixteen patients were included in the study after a randomized, observer-blind, intrapersonal comparison protocol. After a 2-week washout period, the active treatment phase amounted to 4 weeks with twice-daily topical application of test substances and additional use of emollients at will. Thereafter, patients were monitored at weekly intervals up to 8 weeks. Results: The dyshidrotic area and severity index showed a more than 50% reduction of baseline values after 2 weeks of active treatment both for FK506 ( P = .003) and mometasone furoate ( P = .022) in palmar areas. After active treatment, a nonsignificant increase in the dyshidrotic area and severity index was seen with FK506 treated areas. Fourteen of 16 patients had recurring symptoms requiring further therapy within 3 weeks after the active treatment phase. Conclusion: Treatment with FK506 offers the possibility for rotational therapy with mometasone furoate in long-standing cases of chronic dyshidrotic palmar eczema. (J Am Acad Dermatol 2002;46:73-7.)

In 1887 Kaposi 1 first reported vesiculobullous skin lesions in a patient with mycosis fungoides. Since then only few additional reports of this rare clinical variant have been published. 2-9 In most patients blisters occurred in areas of preexisting mycosis fungoides. Garb and Wise 2 coined the term mycosis fungoides bullosa for this clinical entity. We describe a patient with a dyshidrosis-like eruption on the palms and soles as the first clinical manifestation of a cutaneous T-cell lymphoma (CTCL).

UVA1 (340-400 nm) therapy proved to be highly effective in patients with severe atopic dermatitis. The optimal dose regarding therapeutic efficacy and possible side effects is still to be evaluated. In vitro cell culture as well as in vivo animal studies recently indicated that a correlation between UVA irradiation and photoaging, skin carcinogenesis, or melanoma induction may exist. Therefore it seems appropriate to focus research activities on reducing the UVA1 dose applied during phototherapeutic regimens minimizing nonbeneficial side effects.The present study was performed to evaluate the therapeutic effectiveness and long-term efficacy of medium-dose UVA1 irradiation in patients treated for acute exacerbated atopic dermatitis.Thirty-two patients underwent a medium-dose UVA1 therapy consisting of 15 treatments applied from Monday to Friday for a period of 3 weeks. The applied dose per treatment was 50 J/cm(2) resulting in a cumulative dose of 750 J/cm(2). Clinical severity was assessed according to the SCORAD index before and after irradiation as well as in monthly intervals up to 3 months after cessation of phototherapy.Medium-dose UVA1 phototherapy is effective for alleviating acute exacerbated atopic dermatitis as shown by a significant reduction of SCORAD ratings (P.001) at the end of the active UV treatment period. A significant skin improvement was still present 1 month later (P.001). However, at the end of the 3-month posttreatment observation period the skin condition had reached the pretreatment level.According to our data, medium-dose UVA1 phototherapy is a highly effective, nonsteroidal, therapeutic alternative for treatment of acute exacerbated atopic dermatitis. However, effectiveness is merely short term, limited, and is followed by recurrence of symptoms within a 3-month observation interval.

Cutaneous or subcutaneous metastases occur in 2% to 9% of visceral malignancies.lm4 Their occurrence is associated with advanced disease and poor prognosis. Skin metastases are seen most commonly from carcinomas of the breast, lungs, kidneys, stomach, uterus, and colon.5a6 Carcinomas of the prostate are common7 but account for less than 1% of all skin metastases.6 We describe a patient with carcinoma of the prostate and skin metastases.

(Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol 2000;42:1-20). The author reports an increase in the number of pediatric tinea capitis infections in the United States and elsewhere in the world. Furthermore, according to the author, current cases of anthropophilic tinea capitis in Western Europe are predominantly due to Trichophyton tonsurans. According to our data, we cannot support the author’s estimation, at least for the metropolitan areas of Munich, Germany, and Graz, Austria. From 1995 through 1999, the number of culturepositive childhood causes of tinea capitis per year at our outpatient clinics were 139, 132, 121, 87, and 152, respectively. Only in 1995 were two cases of tinea capitis caused by T tonsurans identified (unpublished data). Although it is not clear whether this number of detected tinea capitis cases presenting to our dermatological departments reflects the situation within the entire community, we do not believe there is a significant increase of tinea capitis infections or any substantial role for T tonsurans in eliciting current cases of anthropophilic tinea capitis in Central Europe. To elicit the true number of new tinea capitis infections as well as the causative fungi, more epidemiologic studies in different parts of the world, including Europe, are warranted.