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The human sebaceous gland undergoes both extrinsic and intrinsic ageing. The latter is associated with morphological changes and alteration in the sebaceous gland activity. The high androgen-dependent sebum secretion in neonates falls during childhood, starts to rise again during puberty and reaches its maximum in young adults. While the number of sebaceous glands remains the same during life, sebum levels tend to decrease after menopause in females, whereas no major changes appear until the eighth decade of life in men. Reduced androgen levels in aged individuals lead to a slow cellular turnover in the sebaceous glands resulting in hyperplasia of the facial sebaceous glands in advanced age. Ultraviolet radiation and immune suppression (cyclosporin A with corticosteroids) represent cofactors for the development of sebaceous gland hyperplasia. Current molecular findings indicate that overexpression of the ageing-associated gene Smad7 and parathormone-related protein correlate with sebaceous gland hyperplasia, whereas c-myc overexpression is associated with enhanced sebum production. On the other hand, down-regulation of the mismatch repair genes hMLH-1 and hMSH-2 may promote the development of sebaceous gland carcinoma. In addition to spontaneous single tumours, sebaceous gland carcinomas have been reported in immune-suppressed transplant recipients (azathiorpine, cisplatin, cyclosporin A) and in association with the Muir-Torre syndrome. Microsatellite instability with a loss of the mismatch repair gene hMSH-2 has been detected in immune suppressed patients and under photo-induced DNA damage. Topical and systemic oestrogens offer treatment options for skin xerosis in menopausal females. A combination of isotretinoin and interferon-alpha may prevent tumour development in patients with Muir-Torre syndrome.

A woman developed widespread contact dermatitis after temporary tattooing with henna, caused by paraphenylenediamine (PPD) which had been added to the henna as an enhancer. The patient recovered after treatment; a week later an acute generalized rebound occurred after she wore dark clothing (black chador). Patch tests revealed type-IV allergy to PPD, along with multiple sensitisations to other textile dyes (disperse orange 3, para-aminoazobenzole, Bismark brown R). Temporary henna tattoos are not always harmless holiday souvenirs. The addition of color enhancers such as PPD into henna may lead to multiple contact allergies to other textile dyes.

Background: Zileuton, a 5-lipoxygenase inhibitor, reduces the number of inflammatory lesions in moderate acne and inhibits the synthesis of sebaceous lipids. Objective: To detect whether zileuton directly reduces sebum synthesis. Methods: A 40-year-old female with mild disseminated sebaceous gland hyperplasia and seborrhea was treated with zileuton 4 × 600 mg/day over 2 weeks, was followed-up for 6 weeks after discontinuation of zileuton and was re-treated with low-dose isotretinoin 10 mg/2nd day over 5 weeks. Casual skin surface lipids and sebum synthesis were determined. Results: Under treatment with zileuton increased casual skin surface lipids were normalized and synthesis of facial sebum was decreased. Six weeks after discontinuation of treatment casual skin surface lipids were increased again and synthesis of sebum returned to baseline. Subsequent low-dose isotretinoin treatment led to similar changes of casual skin surface lipids and sebum synthesis with zileuton already after 2 weeks. Conclusion: Zileuton directly inhibits sebum synthesis in a transient manner with a potency similar to low-dose isotretinoin at least in our patient.

In den letzten Jahren haben sich die Empfehlungen für eine Antibiotikaprophylaxe in der Herzchirurgie bezüglich Antibiotikawahl und Applikationsdauer verändert und gehen nicht speziell auf die Kinderherzchirurgie ein. Im Deutschen Herzzentrum Berlin wurde seit 1988 bei Operationen aufgrund angeborener Herzfehler die Kombinationsprophylaxe mit Piperacillin und Cefotaxim angewandt. Neue internationale Empfehlungen schlagen jedoch ein Cephalosporin der I. oder II. Generation vor. Fragestellung dieser prospektiven Beobachtungsstudie ist deshalb, ob eine Umstellung der im DHZB üblichen Kombinationsprophylaxe auf eine Monoprophylaxe mit Cefotiam gerechtfertigt ist. Vom 1.3. - 31.8. 1995 wurden 180 Patienten mit Operationen am offenen Herzen in die Studie eingeschlossen. 99 Patienten erhielten die bisher im DHZB etablierte Kombinationsprophylaxe mit Cefotaxim und Piperacillin (Cx/P-Gruppe). 81 Patienten bekamen eine Monoprophylaxe mit Cefotiam (Ct-Gruppe). Die postoperative Infektionsrate betrug in der Ct-Gruppe 14,8 % und in der Cx/P-Gruppe 17,2 %. Die Prophylaxe erfolgte für beide Gruppen durchschnittlich 103 Stunden bzw. 110 Stunden. Die Studie konnte aufgrund geringer Patientenanzahl aus statistischer Sicht keinen Beweis für einen Unterschied erbringen. Dafür zeigte die Metaanalyse, daß auch bei einer großen Patientenanzahl (n=4177) kein statistischer Unterschied zwischen einer Schmalspektrum- und einer Breitspektrumprophylaxe besteht. Es wurde ferner gezeigt, daß Cefotiam den Anforderungen einer effektiven Prophylaxe gerecht wird und Vorteile gegenüber der Kombinationsprophylaxe aufweist. Die Studie hat dazu beigetragen, daß seit 1996 in der Kinderherzchirurgie im DHZB eine Monoprophylaxe mit einem Cephalosporin der I. Generation - Cefazolin - durchgeführt wird und hat weiterhin eine Verkürzung der Prophylaxedauer bewirkt. Perioperative antibiotic prophylaxis for patients with congenital heart diseases Recommendations for antimicrobial prophylaxis regarding the choice of antibiotics and the application time have changed and do not include cardiac surgery for infants. A combination of piperacillin and cefotaxim has been used since 1988 in the German Heart Institute of Berlin. Updated recommendation now propose the use of a I. or II. generation cephalosporin. The purpose of this prospective study was to evaluate whether a change from the so long used combined prophylaxis towards a monoprophylaxis with cefotiam is justified. From 1st of March until 31st of August 1995 a total number of 180 patients with an open heart surgery were included into the study. 99 patients received a combination with cefotaxim and piperacillin (cx/p-group), which was the standard combination in the German Heart Institute of Berlin. 81 patients received a monoprophylaxis with cefotiam (ct-group). The postoperative rate of infections was 14,8 % in the ct-group and 17,2 % in the cx/p-group. For both groups the duration of prophylaxis was on average 103 respectively 110 hours. Due to a relatively small number of patients the study could not show a statistically significant difference between both prophylactic regimes. The performed meta-analysis comparing the postoperative infections in small spectrum and broad spectrum prophylaxis in the open heart surgery did not find a significant difference in a large group of patients (n=4177). Our study supports the fact, that cefotiam meets the criteria of an effective antibiotic prophylaxis and has additional benefits compared to the combined prophylaxis scheme. The results of this study have led to a replacement of the old perioperative prophylaxis regime by cefotiam for open heart surgery for infants in the German Heart Institute of Berlin since 1996 and have led to a reduction of the application time during the prophylaxis.

The human sebaceous gland undergoes both extrinsic and intrinsic ageing. The latter is associated with morphological changes and alteration in the sebaceous gland activity. The high androgen-dependent sebum secretion in neonates falls during childhood, starts to rise again during puberty and reaches its maximum in young adults. While the number of sebaceous glands remains the same during life, sebum levels tend to decrease after menopause in females, whereas no major changes appear until the eighth decade of life in men. Reduced androgen levels in aged individuals lead to a slow cellular turnover in the sebaceous glands resulting in hyperplasia of the facial sebaceous glands in advanced age. Ultraviolet radiation and immune suppression (cyclosporin A with corticosteroids) represent cofactors for the development of sebaceous gland hyperplasia. Current molecular findings indicate that overexpression of the ageing-associated gene Smad7 and parathormone-related protein correlate with sebaceous gland hyperplasia, whereas c-myc overexpression is associated with enhanced sebum production. On the other hand, down-regulation of the mismatch repair genes hMLH-1 and hMSH-2 may promote the development of sebaceous gland carcinoma. In addition to spontaneous single tumours, sebaceous gland carcinomas have been reported in immune-suppressed transplant recipients (azathiorpine, cisplatin, cyclosporin A) and in association with the Muir-Torre syndrome. Microsatellite instability with a loss of the mismatch repair gene hMSH-2 has been detected in immune suppressed patients and under photo-induced DNA damage. Topical and systemic oestrogens offer treatment options for skin xerosis in menopausal females. A combination of isotretinoin and interferon-alpha may prevent tumour development in patients with Muir-Torre syndrome.