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Editor—In their note, “Piloting patient attitudinal surveys on the web” Suchard et al rightly point out that the web is a powerful resource to use in developing surveys quickly and effectively.1 But the power of the web goes far beyond that. Psychologists and sociologists are already using the web for surveys,2 and there has also been a recent experiment to collect health status information for medical outcomes research with a web based questionnaire.3 The web …

Background: The digital image has become an important tool in dermatology because of the rapid development of computer hardware, networks, and the World Wide Web. Objective: Our purpose was to examine the resolution requirements for digital images. Methods: Slides of eight selected images showing characteristic lesions were produced in five different resolutions each, ranging from 192 × 128 × 24 (192 pixels x, 128 pixels y, and 24-bit color depth) up to 3072 × 2048 × 24. They were compared side by side by a group of six experienced dermatologists using a standardized questionnaire. Results: Images at the resolution of 768 × 512 × 24 were perceived as equivalent to higher resolutions, whereas a clear difference was visible between 768 × 512 × 24 and 384 × 256 × 24. The slide projector had a significant influence on the rating of the images. Conclusion: For digital images in dermatology a resolution of 768 × 512 × 24 is suitable to recognize the relevant details of the source image. (J Am Acad Dermatol 1997;37:195-8.)

Background: Fibrotic skin lesions in patients with localized scleroderma can cause muscle atrophy, disfigurement, and flexion contractures. There is no effective therapy for this disease. Skin fibrosis is thought to be caused by decreased collagenase activity. Collagenase activity can be induced in dermal fibroblasts by UVA 1 irradiation. Objective: Our purpose was to assess whether UVA 1 radiation therapy is effective for patients with localized scleroderma. Methods: Patients with localized scleroderma ( n = 17) were exposed 30 times to 130 J/cm 2 UVA 1 (high-dose UVA 1 therapy; n = 10) or 20 J/cm2 UVA 1 (low-dose UVA 1 therapy; n = 7). Therapeutic effectiveness was assessed by evaluation of (1) clinical features, (2) thickness of sclerotic plaques, and (3) cutaneous elastometry. Sequential biopsy specimens from treated lesions were analyzed for collagenase I messenger RNA (mRNA) expression by semiquantitative reverse transcriptase-polymerase chain reaction. Results: In all patients, high-dose UVA 1 therapy softened sclerotic plaques, and complete clearance was observed in four of 10 patients. High-dose UVA 1 therapy significantly reduced thickness and increased elasticity of plaques. These changes could not be detected in unirradiated control plaques and were still present in 9 of 10 patients 3 months after cessation of therapy. For all factors assessed, high-dose UVA 1 was superior to low-dose UVA 1 therapy ( p = 0.001). High-dose UVA 1 therapy increased collagenase I mRNA expression about 20-fold in treated plaques. Conclusion: High-dose UVA 1 therapy is effective in the treatment of localized scleroderma. Effectiveness is UVA 1 dose dependent and is associated with induction of collagenase I expression.

Eczema (p = 0.015) and hay fever (p = 0.020) within the past four weeks were significantly associated with decreased HRQoL after adjusting for all other variables when no mental health abnormalities were present. No significant associations between these two atopic condition and HRQoL were observed in the groups with borderline or abnormal mental health, respectively. No impact of asthma in any of the groups was observed. Conclusions While the results suggest mental health to have a modifying effect on the relationship between some atopic conditions and HRQoL caution needs to be exercised in interpreting the results as the groups with borderline or abnormal mental health were comparably smaller than the group with normal mental health. In the group with normal mental health small effects were more likely to become significant than in the other two groups.

Rivaling textbooks and journals, the Internet is about to become the most important source of information in virtually any academic profession. Dermatology has a growing presence in many areas of the Internet. A number of sites offer dermatologic data in the form of text and images. Discussion groups and continuing education programs invite regular participation. A dermatologic image data base has been created, which is aiming to provide clinical and histopathological images for most dermatological diseases. However, there is a deplorable lack of dermatologic basic research data and discussion on the Internet. In this mini-review we shall give an overview of the available information sites.

No objective classification criteria for atopic dermatitis (AD) exist. Therefore the diagnosis is usually based on many variables including anamnestic, clinical, and laboratory findings. The aim of this study was to develop and validate a diagnostic score to standardize the diagnosis of atopic skin diathesis for clinical and epidemiological studies. In two separate studies, each consisting of cases and controls, 19 atopic binary features were examined by two independent experienced physicians and these features were classified as "objective," respectively, "subjective." On the basis of these criteria and two additional laboratory measures, we developed a score with high discriminative ability, using the logistic regression model and backward elimination. Ignoring "subjective" variables and the two laboratory measures, two additional models were built that had a worse fit in the original data, but still yielded high estimates of sensitivity (approximately 90%) and specificity (approximately 96%). Using the same data as for the model building, it is well known that these estimates are too optimistic. The validation study allows us to obtain unbiased estimates of sensitivity and specificity for the different scores and to investigate the influence of data quality-here given by the assessment of the reproducibility of the features (objective and subjective)-on the usefulness of diagnostic scores. The results of the validation study show that we developed simple and easy-to-use scores offering a base for a broad practical use in epidemiological and clinical research. In addition, we demonstrate that the criteria classified as "subjective" have no influence on the case-control status in the validation study.

Die elektronische Datenverarbeitung (EDV) spielt auch in der Medizin eine immer wichtigere Rolle und ist aus dem heutigen Alltag nicht mehr wegzu denken. Sinkende Hardware- und Softwarepreise bei hoherer Leistung, wachsende Benutzerfreund lichkeit, bessere Vorbildung der Benutzer sowie zu nehmend EDV-orientierte Rahmenbedingungen der Krankenkassen und Verwaltung beschleunigen diesen Trend seit einigen Jahren in fruher kaum vorstellbarem Ausmas. Wie in der gesamten Medi zin, so ermoglicht auch in der Dermatologie der Einsatz moderner Computertechnologie die effi zientere Bewaltigung klinischer und wissenschaftli cher Aufgaben. Daher wurde vor wenigen Jahren die Arbeitsgemeinschaft »Epidemiologie, Biostati stik und Informatik« der DDG (gleichzeitig Arbeits kreis »Dermatologie« der Deutschen Gesellschaft fur Medizinische Informatik, Biometrie und Epide miologie GMDS) gegrundet. Bis 1994 fanden 8 in terdisziplinare Tagungen der Arbeitsgemeinschaft statt.

Besides glucocorticosteroids, there is currently no known effective therapy for patients with acute atopic dermatitis.The therapeutic effectiveness of high-dose UVA1 irradiation in the management of patients with acute exacerbation of atopic dermatitis was examined.Patients in the high-dose UVA1 group (n = 15) were irradiated with 130 joules/cm2 UVA1; the control group (n = 10) was treated with UVA-UVB therapy in a minimal erythema dose-dependent manner (total number of treatments 15).High-dose UVA1 irradiation was found to induce a significant clinical improvement of atopic dermatitis (p less than 0.001). In comparison with UVA-UVB therapy, significant differences in favor of high-dose UVA1 were observed (p less than 0.01). High-dose UVA1, but not UVA-UVB treatment, significantly reduced the elevated serum level of eosinophil cationic protein in patients with atopic dermatitis (p less than 0.003).These studies indicate that high-dose UVA1 irradiation may represent a novel phototherapeutic modality for the treatment of patients with an acute exacerbation of atopic dermatitis.

A characteristic feature of non-eczematous atopic dry skin (DS) appears to be an impaired water permeability barrier (WPB) function. The WPB is constituted by intercellular lipid lamellae, located between the horny cells of the stratum corneum (SC), which are provided by exocytosis of lamellar bodies (LB). The aim of this study was to elucidate whether alterations in the dynamics of LB-extrusion could be responsible for this WPB disturbance. In an ultrastructural morphometric comparison the relative volume of LB in the two uppermost subcorneal layers in DS of atopics (n = 9) and healthy skin of controls (n = 7) was determined. The LBs were differentiated into extracytoplasmic LB, i.e. with the cell membrane already fused, and intracytoplasmic LB, i.e. entirely located within the cell. The total volume in the two cell layers of the stratum granulosum did not differ between atopics and controls. However, separate evaluation of the two LB-compartments revealed statistically significant differences between atopics and healthy controls. In the second uppermost cell layer of the stratum granulosum only 13% of the total LB volume of this layer had already fused with the cell membrane in the atopics as opposed to 42% in the controls. On the other hand more LB remained undelivered within the cells of the uppermost SG cell layer of the atopics (26% in atopics versus 8% in controls, P < 0.01). These findings suggest that a pathological extruding mechanism of LB in DS may be at least partly responsible for the recently detected biochemical alterations of epidermal lipids, and for the deficient WPB. Br J Dermatol

Different types of inflammatory cells in healthy major and minor salivary glands (SG), including those in labial and palatal non-autoimmune sialadenitis, were quantified immunohistochemically. Plasma cells, mainly IgA type predominated in all SG types, with the smallest number seen in the palatal glands. The numbers of common leukocyte antigen (CLA) reactive lymphocytes were greater in major SGs than in minor ones and were predominantly UCHL1 positive T cell type. Macrophages and neutrophils were absent in palatal glands, rarely present in labial ones and usually present in major SGs. Increases in the number of IgG and IgM plasma cells and lymphocytes (CLA+) which include both UCHL1+ T and L26+ B cell types, were found in non-autoimmune labial and palatal sialadenitis. There was no significant correlation between the number of the inflammatory cells and the degree of glandular atrophy in both labial and palatal non-autoimmune sialadenitis. Increase in their number represents a protective response of these glands in contrast to the inflammatory cells in major autoimmune sialadenitis playing there a pathogenetic role.

Macroscopic discrimination between amelanotic malignant melanoma (aMM) and the so-called granuloma pyogenicum (GP) is often uncertain since reliable criteria for a clear differentiation of either growth are lacking. In a search of such criteria we analysed the data of 57 consecutive in-patients with cutaneous aMM and of 83 with GP presenting at our Department during the years 1970–1988. The following items were compared with each other: duration from growth onset to definite diagnosis, siteof growth, age and sex of the patients. Significant differences (p < 0.01) between either growth were found for all items evaluated. Our results substantiate the hitherto gained impression of a remarkably shorter median history of GP as compared to aMM (5 vs. 26 weeks). Furthermore aMM prevailed in elder (age > 50 years) particularly female (70%) patients, whereas GP developed about equally in both sexes and at all ages. Site distribution was also found to differ for either growth (GP predominantly in the head and neck region, rarely on lower limbs; aMM in all areas, rarely on the trunk). These data yield additional measures for clinical distinction between aMM and GP.

Objectives: In the prevention of occupational contact dermatitis the usage of personal skin protection measures have a high priority, however there is a lack of intervention field studies to demonstrate its efficacy. Therefore we conducted a field study in a plant of the metal-working industry and investigated the efficacy of an established skin protection programme. Methods: First, a professional dermatological appraisal of the current status and a skin-protection analysis were carried out for 180 company employees, and a dermatological evaluation of each workplace from the aspect of prevention was conducted. Using the information obtained a skin protection programme for the whole company was devised and subsequently set up. The follow-up examination was performed eight months later. Results: At the beginning of the study 26% of the employees were found to have skin problems related to the work they were doing. In 50% of the cases skin protection was never or only rarely used, with the right kind of skin protection almost never being applied. There was no skin protection programme in place meeting today’s professional dermatological requirements, or at the most there were just the first signs of one. After the programme had been set up and suitable instruction and information given there was a follow-up observation period of eight months, during which several professional dermatological examinations of the employees were carried out and further instruction (individual prevention) was given. In the final examination only 8.7% of the employees were found to have work related skin problems. Conclusions: We could demonstrated that the occurrence of occupationally-related hand eczema can be significantly reduced by setting up and providing instruction in a skin protection concept matched to the hazards the skin is exposed to at work. Additionally, valuable knowledge and experience were gained on implementing industrial skin protection programmes and performing intervention studies.

Occupational contact dermatitis (OCD) take the first rank of all occupational diseases in many countries. The incidence rate is believed to be around 0.5 to 1.9 cases per 1000 full-time workers per year. However, the true incidence of work-related hand eczema (mostly irritant hand eczema) is highly underreported. The development of OCD is determined by a combination of individual susceptibility (endogenous factors) and exposure characteristics (exogenous factors). Skin contact with irritants and/or allergens is a necessary condition of contact dermatitis and the probability and severity of a reaction depend on the type and intensity of exposure. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. Occupational Contact Dermatitis (OCD) has become an issue of increasing importance world-wide, not only due to cost- intensification for employers but also due to impairment of employees’ quality of life. This lecture summarizes some important causes of occupational contact dermatitis in Europe, demonstrates possibilities of prevention based on recently conducted epidemiological studies, and ends by highlighting important future health service and population research issues. The following questions will be discussed: • How common are OCD in different industries and what is the extent of underestimation • What kind of regulations are needed to prevent OCD • How to deal with high risk individuals (atopics) Research into the causes and prevention of occupational contact dermatitis using an epidemiological approach is still in its infancy, yet already there are some pointers that OCD can be prevented effectively.

Cell surface carbohydrates in healthy oral mucosa (n = 15), leukoplakias without (n = 48) and with (n = 62) dysplasia, oral papillomas (n = 6) and squamous cell carcinomas (SCCs) (n = 40) were examined using the lectins peanut agglutinin (PNA), Ulex europaeus agglutinin I (UEA I), soybean agglutinin (SBA), Helix pomatia agglutinin (HPA), and Griffonia simplicifolia agglutinin I (GS I-B4). Binding of these lectins in formalin-fixed, paraffin-embedded tissues was demonstrated using either the peroxidase-anti-peroxidase (PAP) method or the avidin-biotin method. Healthy oral epithelia revealed binding sites for these lectins mostly in the suprabasal keratinocytes with occasional PNA binding also in their basal cells. Unlike healthy mucosa, a number of leukoplakias without and with dysplasia revealed receptor sites for UEA I also in their basal layer. Only those keratinocytes undergoing squamoidal differentiation exhibited SBA binding. Staining patterns of UEA I and SBA did not vary significantly between either leukoplakias without and with dysplasia or papillomas and SCCs. Conversely, a reduction or lack of binding sites for PNA (Gal beta 1-3GalNAc), HPA (D-GalNAc alpha) and GS I-B4 (alpha D-Gal) was observed more frequently in leukoplakias with dysplasia and SCCs contrasting their counterparts lacking epithelial dysplasia. Cell surface glycosyl residues play an important role in the regulation of cell proliferation and epithelial growth. Aberrant glycosylation in oral dysplastic leukoplakias and carcinomas leading to the lack of the relevant terminal sugar residues from their cell surface carbohydrates is probably a major reason for the hyper-/disordered proliferation.

Human serum contains EDTA‐sensitive (Ca++‐dependent) and EDTA‐stable (albumin) paraoxonases which hydrolyse paraoxon, 0,0‐diethyl,0–4‐nitrophenyl phosphate. In Caucasians the EDTA‐sensitive enzyme shows a genetically determined polymorphism which is governed by two alleles. In typical Mongoloid or Negro populations this polymorphism is expressed to a lesser degree, and in a few samples (e.g. Aborigines) it cannot be observed at all. The distribution of the activity of the EDTA‐stable (albumin) paraoxonase is unimodal. Many authors supposed that paraoxonase is an arylesterase (EC 3.1.1.2) which means that it is also able to hydrolyse phenylacetate or β‐naphthylacetate. New investigations have shown that the human serum fractions splitting paraoxon can be separated from those hydrolysing phenylacetate and related substrates. The polymorphism of the EDTA‐sensitive human serum paraoxonase can be applied to investigations concerning specificity. From this it becomes evident that this enzyme is rather specific....

Some 30–50% of cases of atopic dermatitis (AD) are believed to be associated with autosomal dominant ichthyosis vulgaris (ADI). The diagnosis of ADI can be proved by the ultrastructural demonstration of fewer and abnormal keratohyalin (KH) granules in all ADI patients, even in clinically unaffected skin. To prove the suggested frequent association of ADI with AD, an ultrastructural investigation of dry skin of 49 AD patients was performed. Only in 2 (4%) patients ADI could be confirmed by electron microscopy. In 17 patients, including the 2 patients with abnormal KH, hyperlinear palms were clinically seen. The present study yields evidence that hyperlinear palms, if present, and dry skin are in most cases a phenotypic marker of AD and not a sign of concomitant ADI. A histologically absent stratum granulosum in AD does not signify by itself a manifestation of concomitant ADI.

Present evidence convincingly indicates that workers with occupational skin disease are more frequently affected by atopic skin diathesis than the general working population. Population-based studies estimating the impact of atopic skin diathesis on occupational skin disease in various occupations have not been reported to date. We analyzed data of all initial reports of occupational skin diseases recorded in the register of occupational skin diseases in northern Bavaria, Germany, from 1990 to 1999. The main outcome measure was the attributable risk of atopic skin diathesis on occupational skin disease within 24 occupational groups that are most hazardous to the skin. Of the 5285 registered cases, 3730 had a confirmed occupational causation. Among these, 1366 workers (37%) presented an atopic skin diathesis. Assuming a prevalence of atopic skin diathesis of 20% in the total population, we found that 21.6% (95% confidence interval 19.4; 23.7) of occupational skin disease cases within 24 occupational groups may be ascribed to this endogenous risk factor. The attributable risk of atopic skin diathesis helped to explain a large proportion of occupational skin diseases. Empirical evidence supports the importance of surveying atopic skin diathesis as part of an occupational skin disease prevention strategy.

Summary Atopic dermatitis (AD) represents a pruritic, non-contagious, chronic or chronically relapsing, inflammatory skin disease. The course of the disease may be complicated by bacterial or viral superinfections. The first manifestation of the disease and further flare-ups are due to genetic predisposition and also to a variety of further trigger factors. The therapy regimen should be adapted to disease symptoms that are actually present and consider individual features of the disease as reported by the patients or their parents. This short version of the German guideline on AD provides an overview of evidence-based diagnostic and treatment options. All recommendations made here are the result of a consensus of the scientific medical societies, working groups and support groups based on scientific data published to date. Abstracts and details of the studies cited are provided in the long version of this guideline (see: www.awmf.org).