Zeitschrift fur Hautkrankheiten最新文献

Patients suffering from atopic dermatitis show increased phosphodiesterase activity in leucocytes. As a result, the level of intracellular c-AMP is reduced, which can produce a number of metabolic dysfunctions: We found strong evidence that an enhanced release of several inflammation mediators can favor itching, which in turn promotes the development of eczema, since it induces reflectory scratching. In order to solve the question whether papaverine as a phosphodiesterase inhibitor might offer a new approach in the systemic therapy of itching, we performed a placebo-controlled study on 51 patients with atopic dermatitis, who were orally treated with papaverin-HCl over 8 weeks. However, we did not observe any improvement of itching or eczema during treatment. Some other recently developed phosphodiesterase inhibitors are discussed.

We discuss the latest findings regarding the therapy of acute herpes zoster and postherpetic neuralgia. Aside from the conventional modes of treatment. We especially refer to the therapy with aciclovir. In addition, we present the techniques of transcutaneous electrostimulation and neurosurgery.

In May, 1985, the Red Cross Blood Donation Center of Vienna, Lower Austria, and Burgenland started routine screening for HIV 1 antibodies; by summer 1989, about 750,000 blood donors and donations had been examined. During this period, 59 donors have been proved positive for HIV 1; they have been interviewed and the origin of the infection was explored. Since there were donors within this group, who had repeatedly given blood for many years, we carried out a follow-up study in order to find out whether the recipients had been infected by these donors before May, 1985. In addition, we give the test results of about 200,000 donors screened for HIV 1 antigen and discuss the value of such tests. Recently, 80,000 donors were screened for anti-HIV 1 and 2 antibodies; there has been no donor positive for HIV 2, so far. A much higher number of donors than those marked for confirmed western blot had to be regarded as questionable positive. In such cases, details of western blot results are listed; we discuss the problem of the evaluation of such results as well as the question of informing these donors.

The pathogenesis of the HIV associated Kaposi's sarcoma is still unclear, but it appears to be a multifactorial process. Different investigations have shown, that cytokines and growth factors influence the development of KS. Several cases with tumor manifestation after irritation of the skin are demonstrated. Therefore a mechanism of development comparable with the Koebner Phenomenon can be postulated.

Cutaneous manifestations are common in patients with HIV infection and mainly due to the immunodeficiency. In the initial stage of HIV infection, we frequently observe a rash of macular lesions. During the asymptomatic phase, the patients may typically show the following skin diseases: seborrhoic dermatitis, acneiform folliculitis, persistent herpes simplex, and infections with the human papilloma virus. In ARC and AIDS patients, 3 groups of skin disorders are found: cutaneous infections, skin tumors, and other mixed skin diseases. Herpes simplex and herpes zoster may develop into ulcerating and necrotising forms especially in patients with advanced immunodeficiency. The most frequent skin tumors in AIDS patients are the disseminated Kaposi's sarcoma and non-Hodgkin's lymphoma. More than 50% of the AIDS patients treated with trimethoprim/sulfamethoxazole developed a severe drug eruption. African and Caribbean patients with AIDS frequently suffer from pruritic skin lesions, the pathogenesis of which is not known. Aside from these cutaneous manifestations, a variety of other skin disorders have been reported in patients with HIV infection, ARC, or AIDS; future research will furnish definite proof whether they are correlated with HIV infection.

Therapy of AIDS comprises two aspects: (1) causative therapy, directed against HIV, and (2) symptomatic therapy of opportunistic infections and malignancies. The best results regarding antiretroviral therapy - both in vitro and in vivo - have been obtained, so far, with inhibitors of reverse transcriptase. We discuss the mechanism of action, the efficacy, and the side effects of AZT, a nucleoside analogue, and comment on combined therapies with acyclovir and immunomodulators. We report on the therapy of the most frequent opportunistic infection - i.e. Pneumocystis carinii pneumonia - with sulfamethoxazole/trimethoprim and pentamidine as well as the chemoprophylaxis of this disease. During the last few years, important progress has been made in the field of antiviral chemotherapy (HSV, CMV, VZV) and the therapy of gastrointestinal infections. Moreover, the therapy of Kaposi's sarcoma associated with AIDS and that of non-Hodgkin's lymphoma has been established by now.

In the course of the infection with the human immunodeficiency virus (HIV), we frequently observe disorders of the mucous membranes and, occasionally, they present the first manifestation of HIV-induced immunodeficiency. Like in other organs, opportunistic infections and malignant tumors prevail as a result of the impaired immune system. Opportunistic infections are characterized by frequency (candidiasis), aggressive expansion, persistence, frequent recurrences, and resistance to therapy (gingivitis, parodontitis, herpes simplex, warts). Oral hairy leucoplakia is considered a specific lesion of HIV infection. Malignant tumors, such as Kaposi's sarcoma, non-Hodgkin's lymphoma, and squamous cell carcinoma, may cause marked morbidity in AIDS patients; occasionally, the clinical picture of Kaposi's sarcoma and non-Hodgkin's lymphoma is rather uncharacteristic. Other manifestations on the mucous membranes may arise in association with systemic reactions, such as drug eruptions, thrombocytopenic purpura, or acute HIV infection. The etiology of still other lesions of the mucous membranes (e.g. chronic recurrent ulcers, xerostomia, disorders of pigmentation) is incompletely understood. The awareness of these disorders of the mucous membranes in HIV infection is of diagnostic, therapeutic and epidemiological importance.

The dermatopathologist must be aware of the wide spectrum of non-specific cutaneous manifestations, cutaneous infections and skin tumors associated with AIDS. We present the histological criteria essential for the diagnosis of early Kaposi's sarcoma, its differential diagnosis including epithelioid angiomatosis, as well as the diagnosis of oral hairy leucoplakia.

We briefly describe the principal techniques of antigen detection and discuss the pros and cons of routine screening and conformation assays. Regarding the differentiation of HIV 1 and HIV 2 infection, synthetic peptides corresponding to the antigenic epitopes of gp36 (HIV 2) and gp41 (HIV 1) yielded the best results. Commercially available antigen tests are relatively insensitive. New techniques, such as the polymerase chain reaction, allow the dedection of viral DNA in one infected cell out of 100,000 non-infected cells. However, since these methods are based on nucleic acid probes, they are rather laborious and cannot replace antibody tests; but they may be of use for early identification of HIV-infected infants or for the confirmation of the acute phase of the infection (CDCI). With regard to early prognosis--i.e. up to 2 years before the development of clinical symptoms__the following markers have been found useful: neopterine, beta-2-microglobulin, the lymphocyte subsets CD4, CD8, Leu2+7+, activated T-cells, as well as the decrease of antibodies against p31, p24 and p17.