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Biomedical subjects

Herbert Hönigsmann

Publications and source records attributed to Herbert Hönigsmann.

12 recordsLinked to original sources
PubMed2006

Randomized, double-blind comparison of 1 mg/L versus 5 mg/L methoxsalen bath-PUVA therapy for chronic plaque-type psoriasis.

BACKGROUND: Bath-psoralen plus ultraviolet A (PUVA) radiation therapy is increasingly replacing oral PUVA because of its superior short- and long-term safety profile. Several investigations in recent years have led to a refinement of the bath-PUVA protocol; however, the optimal therapeutic concentration of methoxsalen in the bath water has as yet not been delineated. OBJECTIVES: The therapeutic efficacy and tolerability of bath-PUVA by using two different dilutions of methoxsalen (1 mg/L vs 5 mg/L or 0.0001% vs 0.0005%) were compared in 46 patients with chronic plaque-type psoriasis in a prospective, randomized, double-blind study. METHODS: Scores of the Psoriasis Area and Severity Index excluding psoriasis of the head (PASI(TUL)) and the Plaque Severity Index (PSI) were assessed at baseline and at biweekly intervals thereafter until (near)complete clearance or maximal improvement. In addition, methoxsalen plasma levels were determined immediately after the psoralen bath during the first week of treatment and treatment-related side effects were recorded throughout the entire study period. RESULTS: The median baseline PASI(TUL) score decreased from 11.7 (7.5-32.8) to 3.3 (0.6-1.2) (-72%) in the 1 mg/L methoxsalen group and from 10.8 (6.6-20.7) to 1.4 (03.2) (-87%) in the 5 mg/L methoxsalen group (P < .01). The median baseline PSI score decreased from 9 (6-12) to 3.1 (0.6-10) (-66%) in the 1 mg/L methoxsalen group and from 9.3 (7.3-12) to 1.6 (0-3.6) (-83%) in the 5 mg/L methoxsalen group (P < .01). The median cumulative UVA exposure dose was 25.4 (5.3-81.5) J/cm2 for 5 mg/L methoxsalen and 71.9 (20.7-587.3) J/cm2 for 1 mg/L methoxsalen (P = .001). The number of exposures (22 [11-29] vs 23 [11-34]) and treatment duration (43 [19-68] vs 44 [23-66] days) was comparable for both methoxsalen dilutions (P = .97). Median psoralen plasma levels were 0 (0-26) ng/mL after the 1 mg/L and 30 (0-64) ng/mL after the 5 mg/L methoxsalen immersion (P = .001). Mild to moderate adverse events were more common in the 5 mg/L methoxsalen group. LIMITATIONS: The conclusions of this randomized controlled study are limited by the relatively small sample size. CONCLUSIONS: Our data indicate that in bath-PUVA treatment the use of a high (5 mg/L) methoxsalen concentration is substantially more effective in clearing chronic plaque-type psoriasis than a low (1 mg/L) concentration.

Adult↗
PubMed2005

UVA-induced oxidative damage and cytotoxicity depend on the mode of exposure.

The reciprocity rule (Bunsen-Roscoe law) states that a photochemical reaction is directly proportional to the total energy dose, irrespective of the dose distribution. In photomedicine the validity of this law is usually taken for granted, although the influence of radiation intensity and dose distribution are largely unknown. We have examined in a tissue culture model the effects of fractionated versus single dose exposure to UV from a metal halide source on survival, DNA synthesis, glutathione, and oxidative membrane damage. Exposure to fractionated UVA was followed by an increased rate of cell death compared to single dose exposure, when intervals between fractions where short (10-120 min). Longer intervals had the opposite effect. Corresponding results were obtained for DNA synthesis (BrdU incorporation). The increased cytotoxicity of dose fractionation with short intervals could not be abrogated by non-enzymatic antioxidants (astaxanthin, ascorbic acid, alpha-tocopherol). Fractionated irradiation with short intervals led to higher degree of depletion of glutathione (GSH) and to enhanced formation of thiobarbituric acid reactive substances (TBARS) in comparison to an identical single dose. Long intervals between fractions induced opposite effects. Taken together, these data indicate that immediately after UVA exposure cells are more sensitive to a further oxidative attack making repeated exposure with short intervals more cytotoxic than continuous single dose UVA. This might have implications also for responses to UVA in vivo and further studies will have to extend these findings to the situation in healthy and diseased human skin.

Antioxidants↗
PubMed2005

Efficacy of 3 different light doses in the treatment of actinic keratosis with 5-aminolevulinic acid photodynamic therapy: a randomized, observer-blinded, intrapatient, comparison study.

BACKGROUND: Topical 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) has been established in recent years as an effective treatment for disseminated actinic keratosis (AK). As yet, however, data are lacking to define the optimal light dose for activation of ALA-induced protoporphyrin IX in AK. OBJECTIVE: In the present study our purpose was to compare the efficacy and tolerability of 3 different doses of red light for ALA-PDT of AK. METHODS: Twenty-seven patients with at least 3 clearly definable, mild or moderate AKs on the scalp or face entered the study. After occlusion for 4 hours with 20% ALA, one AK each was irradiated at random with a single dose of 70, 100, or 140 J/cm2. PDT-induced pain was assessed by the patients by means of a visual analog scale that graded pain intensity between 0 and 10. Follow-up examinations were performed 1 and 3 months after PDT. RESULTS: One month after PDT, the rate of complete remission (CR) was 89% for 70 J/cm2, 92% for 100 J/cm2, and 81% for 140 J/cm2. The CR rates at 3 months were 81% for 70 J/cm2, 77% for 100 J/cm2, and 69% for 140 J/cm2. No significant difference in therapeutic efficacy was found among the 3 light doses at either 1 month (P = .36) or 3 months (P = .96) after PDT. The degree of PDT-induced pain during irradiation was substantial and not statistically different (P = .06) for all 3 light doses. LIMITATIONS: The conclusions from this study are limited by the small sample size and only apply to topical ALA-PDT. CONCLUSION: Our results indicate that a red light dose of 70 J/cm2 may be sufficient for effective topical ALA-PDT of disseminated, mild to moderate AK on the face and scalp.

Aminolevulinic Acid↗
PubMed2005

[UV-radiation--sources, wavelength, environment].

The UV-radiation in our environment is part of the electromagnetic radiation, which emanates from the sun. It is designated as optical radiation and reaches from 290-4,000 nm on the earth's surface. According to international definitions UV irradiation is divided into short-wave UVC (200-280 nm), medium-wave UVB (280-320 nm), and long-wave UVA (320-400 nm). Solar radiation which reaches the surface of the globe at a defined geographical site and a defined time point is called global radiation. It is modified quantitatively and qualitatively while penetrating the atmosphere. Besides atmospheric conditions, like ozone layer and air pollution, geographic latitude, elevation, time of the season, time of the day, cloudiness and the influence of indirect radiation resulting from stray effects in the atmosphere and reflection from the underground play a role in modifying global radiation, which finally represents the biologically effective radiation. The radiation's distribution on the body surface varies according to sun angle and body posture. The cumulative UV exposure is mainly influenced by outdoor profession and recreational activities. The use of sun beds and phototherapeutic measures additionally may contribute to the cumulative UV dose.

Air Pollution↗
PubMed2005

[UV-induced skin cancers].

In this review the epidemiology and pathogenetic aspects of UV-induced malignant skin tumours (basal cell carcinoma, squamous cell carcinoma and melanoma) are discussed with regard to current literature. Whereas present knowledge, in particular, gained from experimental data, permits substantial conclusions about the development of squamous cell carcinoma, the situation for basal cell carcinoma and melanoma does not appear to be unequivocally clear. One reason for this can be explained by the fact that there exist no adequate animal models for these tumours that could exactly reflect the biological behaviour in man. Although there is no doubt about a causal role of sun exposure, this relationship is based on mere epidemiological facts.

Adolescent↗
PubMed2004

Furuncular myiasis caused by Dermatobia hominis, the human botfly.

Myiasis is a common travel-associated dermatosis. Travelers to many parts of Central and South America are susceptible to infestation by Dermatobia hominis. Despite the common name of human botfly, D hominis infests a broad range of mammals and is a severe pest to economically important farm animals in endemic regions. The adult female does not lay the eggs on the host. Instead, the adult female infests hosts indirectly by using blood-feeding arthropods to serve as phoretic vectors to transport the eggs. We present a patient who acquired Dermatobia when bitten by a day-active mosquito during a visit to Guatemala. He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates. The patient applied an occlusive ointment and recovered the larva after it emerged. In this report we discuss the life cycle of D hominis, the differential diagnosis, and therapeutic approaches.

Animals↗
PubMed2004

Caterpillar dermatitis in two siblings due to the larvae of Thaumetopoea processionea L, the oak processionary caterpillar.

Two siblings, 16 months and 5 years of age, came into contact with the urticating hairs (setae) of oak processionary caterpillars, the larvae of Thaumetopoea processionea L., when the family moved to a suburb of Vienna, where mass gradation of T. processionea had started the year before. The setae were being spread by the wind from an infested oak tree in the neighbourhood. Both children repeatedly suffered bouts of dermatitis during the 10 weeks of the larval development. Owing to the fact that T. processionea often infests oak trees, whether isolated or at the edges of forests, there is a high likelihood of people being affected. Children frequently explore their surroundings and are at an even greater risk of developing lepidopterism. Caterpillar dermatitis should therefore be taken into consideration in the differential diagnosis of a pruritic rash in infants from regions with caterpillar-infested trees, especially during the larval development of T. processionea .

Air Pollutants↗
PubMed2003

Mechanisms of phototherapy and photochemotherapy for photodermatoses.

Most photodermatoses represent indications for preventive ultraviolet (UV) phototherapy and/or psoralen plus ultraviolet A (PUVA) photochemotherapy. The aim of treatment is to prevent the outbreak of disease by increasing the patient's tolerance to sunlight. The mechanisms by which ultraviolet B (UVB) and PUVA induce such tolerance are not completely understood. Pigmentation and skin thickening may be important factors in the protective effect, but they cannot sufficiently explain the degree of protection induced. Other mechanisms that may be of critical importance for the therapeutic efficacy encompass a variety of immunomodulatory effects on human skin known to be induced by UVA, UVB, and PUVA. Obviously the mechanisms of prophylactic phototherapy are strongly intertwined with the pathogenesis of the photodermatoses. The possible mechanisms of photoprevention are discussed for polymorphic light eruption (PMLE), actinic prurigo, chronic actinic dermatitis, and solar urticaria.

Chronic Disease↗
PubMed2003

Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis.

BACKGROUND: The water content of the stratum corneum and skin surface lipids are important factors in the appearance and function of the skin. A disruption of the balance between the two may lead to the clinical manifestation of dryness of skin in patients with atopic dermatitis. OBJECTIVE: The aim of our study was to examine the so-called dry skin of patients with atopic dermatitis using objective parameters. We compared the epidermal hydration and the skin surface lipids, the so-called hydro-lipid film, of the clinically unaffected skin of patients suffering from atopic dermatitis with that of healthy subjects. METHODS: A total of 48 patients of either gender were included in this retrospective case-control study. We used the Corneometer CM 820 (Courage+Khazaka Electronic GmbH, Cologne, Germany) and the Sebumeter SM 810 (Courage+Khazaka Electronic GmbH) as noninvasive measuring methods. RESULTS: The results showed marked decreases in the atopic dermatitis group for both the Corneometer and Sebumeter measuring methods. CONCLUSION: Our results show that the dry skin of patients with atopic dermatitis, as previously shown, is due not only to a decrease in skin moisture but also to a reduction of skin lipids. This finding gives rise to a new understanding of the condition, and therefore one should always speak of a hydro-lipid film.

Adult↗
PubMed2002

Dengue hemorrhagic fever in a British travel guide.

A 44-year-old female British travel guide suddenly had fever, nausea, vomiting, and diarrhea develop during her stay in South India. Four days later she was transported to our hospital. At admission she had a high temperature, impaired respiration, and abdominal pain. Clinical examination revealed bilateral pleural effusion, hepatomegaly, and ascites. Two days later the patient showed a generalized macular rash with a conspicuous sparing of small islands of normal skin. Hemorrhagic erythema on the palms and soles as well as focal petechiae on the hard palate and scleral and conjunctival bleeding were also observed. Hypotension and renal insufficiency developed 1 week after the illness started. Laboratory investigations revealed highly elevated levels of hepatic enzymes, severe hemolytic anemia, decreased platelet counts, and abnormal coagulation values. The presumptive clinical diagnosis of dengue hemorrhagic fever was supported by serologic testing that disclosed sustained high titers of hemagglutination inhibition antibodies. Symptomatic therapy with substitution of volume and albumin, blood transfusions, and administration of antipyretics resulted in complete recovery within 6 weeks.

Adult↗