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Biomedical subjects

Uwe Gieler

Publications and source records attributed to Uwe Gieler.

At least 19 recordsLinked to original sources
PubMed2006

Intermedin: a skin peptide that is downregulated in atopic dermatitis.

Intermedin (IMD), also called adrenomedullin-2, is a peptide that belongs to the calcitonin/calcitonin gene-related peptide/amylin peptide family. IMD exerts many effects on the cardiovascular system, gastrointestinal tract, and central nervous system. Here, we analyzed the expression of the IMD peptide in human skin of healthy controls, in biopsies from lesional and non-lesional areas of atopic dermatitis (AD) skin, in cultured human keratinocytes, and in the HaCaT keratinocyte cell line at the transcriptional (quantitative reverse transcription-PCR) and translational (immunohistochemistry) level. IMD messenger RNA (mRNA) and protein could be detected in keratinocytes and human skin. Keratinocytes, nerve fibers, periglandular cells, arterial/arteriolar smooth muscle cells, and pericytes of dermal microvessels were intensely IMD-immunoreactive. The IMD mRNA was, compared to healthy skin, significantly reduced in lesional and non-lesional areas of AD skin. This was accompanied by a reduction of IMD immunoreactivity in pericytes of the upper dermis indicating that skin from AD patients is generally affected, and downregulation of IMD in AD skin is not a secondary phenomenon caused by acute inflammation but is a general characteristic of AD skin. These data further point to a role of IMD expressed by pericytes in conferring higher susceptibility of the skin of AD patients to inflammatory stimuli.

Adult↗
PubMed2006

Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial.

OBJECTIVE: To determine the effects of age related, structured educational programmes on the management of moderate to severe atopic dermatitis in childhood and adolescence. DESIGN: Multicentre, randomised controlled trial. SETTING: Seven hospitals in Germany. PARTICIPANTS: Parents of children with atopic dermatitis aged 3 months to 7 years (n = 274) and 8-12 years (n = 102), adolescents with atopic dermatitis aged 13-18 years (n = 70), and controls (n = 244, n = 83, and n = 50, respectively). INTERVENTIONS: Group sessions of standardised intervention programmes for atopic dermatitis once weekly for six weeks or no education (control group). MAIN OUTCOME MEASURES: Severity of eczema (scoring of atopic dermatitis scale), subjective severity (standardised questionnaires), and quality of life for parents of affected children aged less than 13 years, over 12 months. RESULTS: Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups (total score for severity: age 3 months to 7 years - 17.5, 95% confidence intervals - 19.6 to - 15.3 v - 12.2, - 14.3 to - 10.1; age 8-12 years - 16.0, - 20.0 to - 12.0 v - 7.8, - 11.4; - 4.3; and age 13-18 years - 19.7, - 23.7 to - 15.7 v - 5.2, - 10.5 to 0.1). Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales, whereas parents of affected children aged 8-12 years experienced significantly better improvement in three of five quality of life subscales. CONCLUSION: Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease.

Adolescent↗
PubMed2006

Treatment of head and neck dermatitis with ciclopiroxolamine cream--results of a double-blind, placebo-controlled study.

In atopic dermatitis, microbial allergens may be pathogenetically significant. Apart from Staphylococcus aureus, these are primarily lipophilic Malassezia yeasts. They are particularly involved in the pathogenesis of head and neck dermatitis (HND), a special form of atopic dermatitis, which is often difficult to treat. Fifty patients (21 men, 29 women) with moderate to severe HND of at least 6 months' duration were included in a prospective double-blind study. All of them showed at least 10% involvement of the head-neck region. The severity of disease was evaluated by Investigator Global Assessment (IGA), Eczema Area and Severity Index (EASI) for the head-neck region and a pruritus score. IgE antibodies to Malassezia sympodialis and/or Malassezia furfur (at least CAP class 1) were a prerequisite for study enrollment. Either 1% ciclopiroxolamine cream (Batrafen; Aventis Pharma, Bad Soden, Germany) or the corresponding base cream were thinly applied to the affected areas twice daily for 28 days. Sixteen patients in the ciclopiroxolamine group and 13 patients in the placebo group completed the study. To assess the change in severity of atopic eczema, IGA differences between the individual measuring points were determined for all patients. There were significant differences in the IGA score change between the ciclopiroxolamine group and the placebo group, from t3 to t4, and over the total period. Similar, but not significant, changes were observed with the EASI score, in terms of affected skin area and itching. The present study is the first to examine the effect of antifungal single-drug therapy with a cream containing ciclopiroxolamine on the course of HND. The study medication was found to be significantly effective. To optimize this effect, suitable patients selected in terms of fungal load, specific IgE, prick test and particularly atopy patch test for Malassezia antigens could receive combined treatment with antimycotic-containing shampoos and/or short-term systemic antimycotic therapy in severe cases.

Adolescent↗
PubMed2006

[Psychological side effects during interferon-alpha therapy -- a case study].

OBJECTIVE: Psychological side effects of the therapy with interferon-alpha (IFN-alpha) have frequently been reported. The symptomatology varies, although there seems to be a predominance of depressive complaints. Mediating somatopsychological vs. psychosomatic pathways remain unknown so far. PATIENT: We describe the case of a 26-year old female inpatient suffering from hepatitis C infection. During medical treatment with interferon-alpha, a transfer to a psychosomatic unit became necessary due to increasing agitation, somatization and a lacking response to psychopharmacological medication. RESULTS: After the discontinuation of IFN-alpha-treatment, the patient's gradual emotional stabilization could be attained. In psychotherapy, inner conflicts as well as fears about possible side effects of the medication were worked through. After discharge, parallel to an ambulatory psychotherapy, the IFN-alpha medication was readministered and completed successfully. CONCLUSIONS: As long as aetiology and mechanisms of psychic side effects of IFN-alpha-treatment remain unclear, ward-based integrative psychosomatic psychotherapy can be supportive and enlightening with regard to psychosocial factors of influence on the IFN-alpha-induced side effects.

Adult↗
PubMed2006

Acne vulgaris--psychosomatic aspects.

More than a cosmetic nuisance, acne can produce anxiety, depression, and other psychological problems that affect patients' lives in ways comparable to life-threatening or disabling diseases. Emotional problems due to the disease should be taken seriously and included in the treatment plan. A purely dermatological therapy by itself may not achieve its purpose. Even mild to moderate disease can be associated with significant depression and suicidal ideation, and psychologic change does not necessarily correlate with disease severity. Acne patients suffer particularly under social limitations and reduced quality of life. Psychological comorbidities in acne are probably greater than generally assumed. Attention should be paid to psychosomatic aspects especially if depressive-anxious disorders are suspected, particularly with evidence of suicidal tendencies, body dysmorphic disorders, or also in disrupted compliance.Therefore, patients who report particularly high emotional distress or dysmorphic tendencies due to the disease should be treated, if possible, by interdisciplinary therapy. The dermatologist should have some knowledge of the basics of psychotherapy and psychopharmacology, which sometimes must be combined with systemic and topical treatment of acne in conjunction with basic psychosomatic treatment.

Acne Vulgaris↗
PubMed2005

Brittle nail syndrome: a pathogenesis-based approach with a proposed grading system.

Brittle nail syndrome is a heterogeneous abnormality, characterized by increased fragility of the nail plate. Brittle nails affect about 20% of the population and women are affected twice as frequently as men. The vast majority of patients experience brittle nails as a significant cosmetic problem and a substantial number indicate that these nail abnormalities are painful, impair daily activities, and may have a negative impact on occupational abilities. Pathogenic factors leading to brittle nails are factors that impair intercellular adhesion of the corneocytes of the nail plate or factors that cause a pathologic nail formation by involving the matrix. Clinical features of brittle nail syndrome are onychoschizia and onychorrhexis: the impairment of intercellular adhesive factors of the nail plate is expressed as onychoschizia, whereas the involvement of the nail matrix is expressed as onychorrhexis. Although impairment of life quality has not been evaluated for patients with brittle nail syndrome, the reduction of life quality in other nail problems has been studied and is evident. A proposed scoring system of key features of brittle nails is presented, and therapeutic approaches focussed on the pathogenic factors are discussed.

Diagnosis, Differential↗
PubMed2005

[Stress and psoriasis -- a psychoneuroimmunological study].

UNLABELLED: Psoriasis is a polygenetic hereditary multifactorial disease which may be influenced by a number of environmental factors. To date only a few studies experimentally investigated the influence of stress on psoriasis. One problem of these studies is that it remains unclear whether the experimental findings are relevant for the entire group of patients, or whether there are subgroups who are particularly susceptible to stress. Therefore our main objective is to examine whether experimental stressors can identify subgroups of patients who are particularly susceptible to stress and if these differ in immunological parameters. METHOD: The Trier Social Stress Test (TSST) was used as stressor. The severity was recorded both objectively using the PASI (Psoriasis Area and Severity Index) as well as subjectively by the patient. Somatic parameters for which stress reactivity is known but no direct relationship to psoriasis is assumed were selected and exploratively examined within the present study (salivary cortisol). The second set of parameters for which the stress reactivity was unclear included variables which are linked to the pathophysiology and/or the severity of psoriasis. In addition to salivary cortisol, eosinophils, ICAM-3, and sIL-2R were determined in serum. 38 psoriasis patients and 38 control subjects were examined (21 male and 17 female participants within each group). RESULTS: The PASI correlated very inconsistently with the subjective severity parameters. The relationships between severity and blood parameters tested showed a systematic relationship for eosinophils only. The TSST is suitable for eliciting stress in psoriasis patients. In one subgroup, there was an increase in skin affliction, while skin affliction in the second group remained constant or decreased. A classification into stress-reactive or non-reactive patients cannot, however, be supported by the immunological parameters tested.

Adult↗
PubMed2005

[Short-term and long-term inpatient psychotherapy -- indications, results, predictors].

OBJECTIVES: This study investigated differences between patients in both short-term and long-term inpatient psychotherapy. Results for both settings as well as predictors of treatment outcomes were determined. METHODS: Consecutive patients of the Giessen University Clinic for Psychosomatics and Psychotherapy, who were treated during a two-year period in both short- and long-term treatment settings, were studied prospectively (N = 166; return-rate 70 %). Standardized questionnaires were applied for distress (SCL-90 R), physical complaints (GBB 24) and interpersonal problems (IIP-D) as well as for object relationships (IPO). RESULTS: In concordance with treatment concepts, patients in short-term psychotherapy had a more acute onset of symptoms, were more highly distressed and better occupationally integrated; patients in long-term treatment suffered more frequently from chronic psychosomatic disorders, personality disorders and comorbid somatic conditions. In both treatment settings distress and physical complaints decreased considerably and remained quite stable during follow-up. Concurring predictors of outcome were more adaptive patterns of object and interpersonal relationships as well as social resources. No differences were seen between the short-term and long-term treatment for utilization of ambulatory psychotherapy after discharge. DISCUSSION: The study shows that a differentiation between short- and long-term treatments, even within one psychosomatic hospital unit, allows for differential indication and treatment concepts.

Adult↗
PubMed2004

Interdisciplinary diagnostics in environmental medicine--findings and follow-up in patients with chronic medically unexplained health complaints.

PROBLEM: In patients attributing their chronic, medically unexplained complaints to environmental factors the greatest challenge is to overcome their disabling belief in toxicogenic explanations. METHOD: Patients presenting with health complaints that they attributed to environmental causes in an environmental outpatient department (EOPD) within a university medical center in Germany were studied. An interdisciplinary review of previously diagnosed medical conditions, current clinical consultations, personal risk communication and therapeutic advice is presented. Additionally, patient contentedness, complaint development, and belief in environmental attribution in a follow-up interview are given. RESULTS: The open, prospective study comprises 51 patients reporting more than one complaint. Symptoms had lasted for more than 3 years in 63% of the cases. Seventy percent attributed their complaints to more than one environmental cause. The clinical diagnostic procedure reduced the number of prediagnosed clinical conditions by 50%. Numerous foregoing environmental laboratory analyses had overestimated toxicologically relevant findings. These were not confirmed in 80% (8/10) of the cases. In 8% (n = 4) of the patients a relevant environmental or occupational medical condition was found. A mental or behavioral condition was not considered to have first priority in explaining all complaints in 43% (22/51) of the patients. Among these, mostly respiratory or skin-related diseases were found. All patients contacted participated in a follow-up study after a minimum of 21 months. Sixty-seven percent reported having felt that they were taken seriously, 38% felt better after the beginning of the study, and 45% were no longer certain about the importance of the environmental attribution. Since 83% of the patients with a preceding residential diagnosis of MCS or SBS still believed in environmental causes of their complaints in the follow-up study, we conclude that these prediagnoses appear to be a risk for persisting attribution of the environmental factor. About one third (37%) of these patients with complaints that had not been medically explained by an organic condition during interdisciplinary diagnostics had meanwhile consulted a psychotherapist. CONCLUSIONS: Interdisciplinary diagnostics and scientifically based risk assessment in a specialized clinical center were effective and mostly well accepted by the patients and resulted in reduced attribution of complaints to environmental conditions. No indication was found that patients with complaints not medically explained by organic conditions were managed less successfully by this approach. Considering the high costs that these patients have previously caused, it appears valuable to apply an interdisciplinary diagnostic strategy.

Adult↗
PubMed2004

German adaptation of the Skindex-29 questionnaire on quality of life in dermatology: validation and clinical results.

BACKGROUND: Health-related quality of life (HRQOL) has increasingly been recognized as an important aspect of a comprehensive clinical assessment in dermatology. OBJECTIVE: The aim of the present study was to translate and validate one of the most frequently used and established skin disease-specific HRQOL questionnaires originally developed in English for the German language area: the Skindex-29. METHODS: 295 in-patients with psoriasis and atopic dermatitis completed the German translation of the Skindex as well as a number of additional skin disease-specific questionnaires. Data from 2 subsamples were analysed separately to test for the robustness of results. RESULTS: Results from principal component analyses supported the scale structure of the original Skindex. Internal consistency coefficients were high for all scales. Further analyses supported the convergent validity of the German adaptation of the Skindex-29 as well as its sensitivity to change. CONCLUSION: The study provides evidence for the validity and reliability of the Skindex-29.

Adult↗
PubMed2003

Health effects associated with indoor storage of organic waste.

OBJECTIVES: The storing of organic waste indoors for several days can be considered a risk factor for microbial contamination of homes. This has become relevant in the scope of modern waste management programmes. This study specifically addresses possible health aspects in this context. METHODS: In a cross-sectional study, doctors collected 384 questionnaires in three neighbourhoods without industrial sources for microbial contamination in 1997 in Hesse, Germany. Self-reported prevalence of airway, skin and general health complaints during the past year, lifetime diagnoses by a doctor, and home hygiene (storage of garbage, private composting, pet contact, indoor mould growth), were assessed. With logistic regression analysis, odds ratios (ORs) adjusted for age, gender, level of school education, and frequent contact with dog or cat were determined for indoor storage of waste for more than 2 days for the whole study group and also for a subgroup reporting atopic disposition. RESULTS: Longer indoor storage of organic waste was associated with "skin rash" (OR=2.05 [95% confidence interval (CI) 1.09, 3.83]), "itching skin rash (>2 months) in the past 12 months" (OR=3.58 [95% CI 1.61, 7.96]) and "itching skin rash (>2 months) ever" (OR=2.77 [95% CI 1.33, 5.75]), as well as lifetime diagnoses of skin disease by a doctor (OR=3.16 [95% CI 1.40, 7.10]) and allergy other than hay fever (OR=2.74 [95% CI 1.28, 5.85]). Associations remained when adjustment was made for atopic disposition. Atopic subjects were at higher risk for these skin-related complaints and diseases. CONCLUSIONS: These results point to a possible health relevance of the storing of organic waste in the home for several days, especially as far as skin irritation is concerned. These associations possibly result from indoor microbial contamination, e.g., endotoxins due to waste. Atopic disposition is a possible risk factor for this health impairment. Personal waste management should also be considered in studies on health and indoor environments.

Cross-Sectional Studies↗
PubMed2003

Measuring adjustment to chronic skin disorders: validation of a self-report measure.

This article describes the development of a questionnaire that assesses problems in adapting to chronic skin disorders, the Adjustment to Chronic Skin Diseases Questionnaire. Patients (N = 442) with different skin disorders completed the original item pool. Principal-components analysis suggested a 6-factor solution that was largely replicated with 2 additional samples of 192 patients with psoriasis or atopic dermatitis and 165 patients with atopic dermatitis. Four of the subscales showed very good internal consistencies, retest reliabilities, and sufficient correlations with expert ratings: Social Anxiety/Avoidance, Itch-Scratch Cycle, Helplessness, and Anxious-Depressive Mood. Two short additional subscales, Impact on Quality of Life and Deficit in Active Coping, showed moderate internal consistencies, but good retest reliabilities. Correlations of the subscales with measures of depression, anxiety, and coping, and meaningful differences between dermatological subgroups support their construct validity. A treatment study showed that changes in some of the subscales correlated with changes in the severity of the skin condition.

Adaptation, Psychological↗
PubMed2003

Influences on human internal exposure to environmental platinum.

Different influences on internal exposure to platinum are investigated and for the first time weighted in environmentally exposed subjects as far as individual internal platinum concentrations are concerned. Detailed medical and environmental histories as well as oral cavity status were assessed in 84 dermatological patients, and internal platinum exposure was determined by analyzing platinum in urine using adsorptive voltammetry (AV). Platinum concentrations ranged from <0.9 (detection limit) to 65.5 ng Pt/l urine. Influence of different types and age of alloy restorations and therefore relevance of the exposure pathway due to solubilization of platinum in saliva could be demonstrated. No platinum-related health effects (contact stomatitis, asthma or kidney conditions) were observed. Analysis of covariance showed the number of noble dental alloy restorations (P<0.0001) and to a lesser extent age (P=0.0017) to independently influence internal platinum exposure. Even though spread of environmental platinum has increased, internal platinum exposure is low in subjects without assessable medical or dental devices (usually <4.5 ng/l urine) and not related to adverse health effects. For the first time, detailed individual information on possible exposure pathways to platinum were considered in an analysis of relevant influential factors: Car traffic exposure and dermatological condition showed no association with internal platinum exposure. Uptake from platinum containing noble metal dental alloy restorations (NMDAR) is of greatest relevance, surmounting the influence of each year of lifetime on platinum body load by more than 10-fold.

Adolescent↗