Biomedical subjects
Publications and source records attributed to H Pullmann.
In two patients with exanthematical lichen planus large bullae occurred in preexisting papules during a severe rush of disease. The bullae were formed subepidermally but Ig G deposits were not found. So both patients suffered from lichen planus pemphigoides as primarily described, and not from bullous pemphigoid with lichen planus.
Six patients with mycosis fungoides, psoriasis or generalized granuloma anulare developed acral bullae showing the clinical and histological picture of bullous pemphigoid during systemically applied PUVA-therapy. Immunohistological investigations (Protein A-Per-oxidase, Immunofluorescence) produced no proof of bullous pemphigoid.
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A net of yellow reticular ledges with red pseudoatrophic areas in between developes on both cheeks of a 16 years old boy, increasing since about 4 years. Additionally there are some milia and comedones. Histologically large amounts of elastic material are to be seen in the interfollicular spaces. This material does not perforate the epidermis. The boy's mother has similar but less pronounced skin changes.
This study deals with the influence of acetylosalicyclic acid (Colfarit Bayer) on the cutaneous effect of UV-A. Each of 24 volunteers received UV-A doses from 5 J/cm2 to 50 J/cm2. The immediate and the delayed UV-A erythema were reduced by prophylactic application of acetylosalicylic acid, 3 g daily three days before exposure and three days afterwards. 72 h after exposure to UV-A the reduction of delayed erythema formation was most obvious. Acetylosalicyclic acid had no influence, however, on the pigmentation caused by UV-A radiation.
An increase of size from in average 4.7 to 5.3 mm2 was observed in 28 of 36 nevocellular nevi after selective ultraviolet phototherapy and photochemotherapy for psoriasis within 4 weeks. In 15 of 36 nevocellular nevi the moles revealed a significant darkening. Autoradiography showed an increased proliferation of melanocytes, keratinocytes and dermal cells in moles exposed to UV-light in comparison with unexposed.
We report about three cases of epithelioma cuniculatum. In two patients the tumour occurred at the auricle, in one patient at the forepart of the foot. One tumour at the ear was removed by local surgical excision, the other was treated by x-rays but without lasting success. In one patient amputation of the foot had been necessary because of intensive local invasion. The differentialdiagnosis especially at the sole of the foot must include viral warts and pseudocarcinomatous tumours as papillomatosis cutis carcinoides. The tumours on the ear could be misinterpreted as keratoacanthomas. Clinically the cauliflowerlike tumours empty on pressure foul smelling keratin. Histologically they show traits of a squamous carcinoma of low grade malignancy and an extreme keratinization beside the typical numerous anastomosing crypts similar to rabbit burrows.
16 patients with polymorphous light eruption were prophylactically treated with selective ultraviolet phototherapy (SUP). Ten patients showed no or only minimal signs of their disease in a following holiday with high sun exposition; 4 patients had the same skin manifestations as in the years before. Indirect evaluation of the therapeutic success had to be performed in two patients, who did not have holidays in this year. Thus SUP may represent a new prophylactic treatment of polymorphous light eruption.
It is sometimes difficult to recognize precursors and early forms of malignant melanoma, even in histologic sections. Atypic melanocyte hyperplasia (AMH) occurs in the epidermal part of several benign pigment cell tumours and often evoke the suspicion of beginning malignancy. Probably there are some potentials for malignant transformation in AMH. Severe atypical melanocytic hyperplasia (SMH) corresponds to the concept of "early malignancy" in the meaning of McGovern. Severe melanocytic dysplasia (SMD) in the meaning of Clark et al. stands for an intraepidermal malignant melanoma (melanoma in situ). SMD occurs in SSM and in lentigo maligna. Sometimes it is impossible to assign it to a special type of melanoma. The importance to recognize histologically the differing behaviour of proliferating melanocytes within the epidermis for diagnosis of early malignant melanoma is accentuated.
To obtain information about the role of local proliferation in the pathogenesis of dermal infiltrate in malignant cutaneous lymphomas, we determined the percentage of 3H-thymidine-labeled infiltrating cells (3H-index). A linear correlation was found between proliferative activity and clinical stage in mycosis fungoides, i.e., the 3H-index is moderately elevated in stage I and high in stage III. The 3H-index is within normal range in dermal infiltrate of Sézary syndrome, diffuse lymphocytic lymphoma, as well as in lymphocytoma benign cutis. In parapsoriasis en plaques two groups can be distinguished: in the small-plaque variant (chronic superficial dermatitis) the 3H-index is low, whereas the large-plaque variant (prereticulotic poikiloderma) shows strong proliferative activity. Thus, determination of proliferative activity seems to give new insights into the pathogenesis of dermal infiltrate in cutaneous lymphomas.
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A 74 year old woman showed typical symptoms of eruptive keratoacanthomas since three years: exanthematic sudden appearance of numberless papules, few millimeters in diameter with central keratinization, masked facies, ectropion of the eyelids and pruritus. Histology revealed the characteristic architecture of keratoacanthoma. Proliferation kinetics were characterized by increase of cell division within the basal cell layer, prolongation of time for DNA-synthesis (15,7 h) and moderate decrease of generation time. The reactive inflammatory dermal infiltrate mainly consists of lymphocytes. Ultrastructural features comprise occurrence of intracellular desmosomes and elastic and collagen fibers between the tumor cells. Therapeutically a good response was observed to aromatic retinoid Ro 10-9359.
Verrucous Leiomyoma of the Scrotum Imitating Condyloma Acuminata. Solitary leiomyomas of the scrotum have an uncharacteristical clinical appearance therefore they are usually not recognized by clinicians. A 55 year old man was found to have multiple asymptomatic verrucous lesions on the scrotal wall which resembled condylomata acuminata. As a large disk-like induration (6 x 8 cm in diameter) could be palpated in the dermis of the anterior scrotal wall, the whole area was excised. Histologically a large multicentered leiomyoma of the tunica dartos was found.
Protein A from Staphylococcus aureus, a cell wall protein with high affinity binding properties for IgG-type antibodies, has been labeled with peroxidase to form a stable immunohistological tracer molecule of relatively low molecular weight. It has been used for demonstration and titration of antinuclear antibodies in SLE sera on mouse liver sections in an indirect technique. The findings were consistent with those obtained by immunofluorescence and by staining with peroxidase-coupled anti-IgG. In contrast to immunofluorescence, the stained sections could be mounted and stored for documentation. In comparison, unspecific tissue adsorption and staining could be minimized by addition of glucose, galactose, and mannose as well as bovine serum albumine to the buffer containing Protein A-peroxidase.
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The prolongation of the S-phase, characteristic of psoriatic keratinocytes, can be observed in cells of the eccrine sweat glands as well as in those of the infundibular part of hair follicles. In healthy individuals the average duration of DNA-synthesis time (ts) in the cells of the hair follicle is 6.8 h, in unaffected psoriatic skin 11.6 h, and in affected psoriatic skin 8.4 h. Ts in the proliferating cells of the eccrine sweat glands reveals no difference between normal skin and unaffected psoriatic skin, but is markedly prolonged in affected psoriatic skin.
The treatment with UV-light with wavelengths between 292.5--335 nm (known as selective UV-phototherapy, or SUP) and 320--390 nm (plus local treatment with 8-methoxypsoralen, known as PUVAex) gave rise to a biphasic reaction of epidermal cell proliferation in guinea pig skin. A decrease of proliferative activity was followed by a synchronized stimulation of DNA synthesizing cells after 2--4 h. These quantitative displacements were accompanied by qualitative changes in the proliferative behaviour of epidermal cells in the S-compartment.