Psoriasis: Altmeyer P

Mrowietz U, Altmeyer P, Bieber T, Röcken M, Schopf RE, Sterry W. · Psoriasis Center, Department of Dermatology, Venereology and Allergy, University Clinic of Schleswig-Holstein, Campus Kiel, Kiel, Germany. · J Dtsch Dermatol Ges. · Pubmed #17659047 No free full text.

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Sand M, Gambichler T, Sand D, Skrygan M, Altmeyer P, Bechara FG. · Department of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany. · J Dermatol Sci. · Pubmed #19058951 No free full text.

Abstract: MicroRNAs (miRNAs) are very small endogenous RNA molecules about 22-25 nucleotides in length, capable of post-transcriptional gene regulation. miRNAs bind to their target messenger RNAs (mRNAs), leading to cleavage or suppression of target mRNA translation based on the degree of complementarity. miRNAs have recently been shown to play pivotal roles in diverse developmental and cellular processes and linked to a variety of skin diseases and cancers. Disruption of miRNA metabolism is also involved in wound healing and inflammatory skin conditions. Here, we review the role of miRNAs in cutaneous biology.

Gambichler T, Breuckmann F, Boms S, Altmeyer P, Kreuter A. · Department of Dermatology, Oldchurch Hospital, London, United Kingdom. · J Am Acad Dermatol. · Pubmed #15793518 No free full text.

Abstract: BACKGROUND: Narrowband (NB) UVB phototherapy has been proven to be clearly more effective than broadband UVB and safer and/or more practicable than psoralen-UVA in the management of psoriasis. However, the role of NB UVB seems to be less clear in the management of skin conditions beyond psoriasis. OBJECTIVES: We sought to give an update on clinical experiences in NB UVB of nonpsoriatic skin conditions, and to establish its current position within the spectrum of competing photo(chemo)therapeutic options. METHODS: The computerized bibliographic database PubMed, without time limits, and other sources were screened for clinical trials on NB UVB. Included were research articles of randomized controlled trials, open prospective studies, and retrospective observations on NB UVB in skin disorders other than psoriasis. RESULTS: A total of 28 articles met our eligibility criteria including 6 randomized controlled studies, 16 open prospective studies, and 6 retrospective observations. NB UVB is effective in patients with chronic atopic dermatitis (AD) (n = 719) and generalized vitiligo (n = 305) and appears to have some advantages over competing photo(chemo)therapeutic regimens. NB UVB also seems to be effective in patients with polymorphic light eruption (n = 25), early stages of cutaneous T-cell lymphoma (n = 108), chronic urticaria (n = 88), lichen planus (n = 15), pruritus associated with polycythemia vera (n = 10), seborrheic dermatitis (n = 18), actinic prurigo (n = 6), and acquired perforating dermatosis (n = 5). The quality of evidence determined for the aforementioned diagnoses ranged from high to moderate to very low. CONCLUSIONS: The best currently available data on NB UVB in nonpsoriatic conditions exist for AD and generalized vitiligo. In view of its efficacy, benefit/risk profile, and costs, NB UVB may be considered the first-line photo(chemo)therapeutic option for moderately severe AD and widespread vitiligo. In the treatment of most other nonpsoriatic conditions, NB UVB appears to be effective, but current data allow no definitive conclusions as to whether NB UVB should be preferred to competing photo(chemo)therapeutic options such as UVA1 and psoralen-UVA regimens. Because NB UVB may have a wider indication spectrum, including AD, vitiligo, and early-stage T-cell lymphoma, and appears to be equally effective or even more effective than broadband UVB, a switch from broadband UVB to NB UVB seems to be justified.

Gambichler T, Küster W, Kreuter A, Altmeyer P, Hoffmann K. · No affiliation provided · J Eur Acad Dermatol Venereol. · Pubmed #11305394 No free full text.

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Kreuter A, Knierim C, Stücker M, Pawlak F, Rotterdam S, Altmeyer P, Gambichler T. · Department of Dermatology and Allergology, Ruhr-University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany. · Br J Dermatol. · Pubmed #16181464 No free full text.

Abstract: BACKGROUND: Necrobiosis lipoidica (NL) is an uncommon granulomatous skin disease with association to diabetes mellitus. To date, no proven effective therapy for NL has been implemented. The standard treatment is topical application of corticosteroids, but numerous agents have been reported for NL, with varying degrees of success. In recent case reports, fumaric acid esters (FAE) have been reported to be effective in granulomatous skin diseases such as granuloma annulare, cutaneous sarcoidosis and NL. OBJECTIVES: We sought to investigate the efficacy of FAE in a larger number of patients with NL. METHODS: Eighteen patients with histopathologically proven NL were consecutively recruited into a prospective noncontrolled study. Dosage of FAE was given according to the standard therapy regimen for psoriasis. FAE were administered for at least 6 months. The treatment outcome was evaluated by means of clinical and histological scoring and 20-MHz ultrasound assessments. RESULTS: Three patients discontinued therapy with FAE, while the remaining 15 patients finished the study. After a mean +/- SD treatment period of 7.7 +/- 2.9 months, a significant (P < 0.001) decrease in the mean +/- SD clinical score, from 7.4 +/- 1.8 at the beginning to 2.5 +/- 1.3 at the end of therapy, was observed. Significant clinical improvement of NL was accompanied by significant (P = 0.019) increase of dermal density as assessed by means of 20-MHz ultrasound, and significant (P = 0.011) reduction of the histological score. Adverse effects were moderate and consisted mainly of gastrointestinal complaints and flushing. During follow-up of at least 6 months, clinical outcome remained stable in all patients. CONCLUSIONS: The results of this study demonstrate that FAE are beneficial and safe in the treatment of patients with NL.

Gollnick H, Altmeyer P, Kaufmann R, Ring J, Christophers E, Pavel S, Ziegler J. · Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany. · Dermatology. · Pubmed #12145434 No free full text.

Abstract: BACKGROUND: Calcipotriol is an established topical therapy for psoriasis vulgaris. OBJECTIVE: This study aimed to investigate whether the addition of calcipotriol to fumaric acid ester (FAE) monotherapy had an additive efficacy and an FAE-sparing effect in patients with severe plaque psoriasis. METHODS: This multicentre, randomised, double-blind, vehicle-controlled study included 143 patients for up to 13 weeks treatment. Group A received FAE tablets (Fumaderm) with an increasing daily dosage from 105 to 1,075 mg + ointment vehicle. Group B received FAE tablets + calcipotriol ointment (50 microg/g). Ointments were applied twice daily. Clinical response was assessed using percentage changes in the Psoriasis Area and Severity Index (PASI), from baseline to treatment end. RESULTS: The mean percentage change in the PASI was -76.1% in group B and -51.9% in group A, the difference between treatments was -24.2% (95% CI from -34.2 to -14.2%; p < 0.001). Group B responded more rapidly to treatment. Investigators' and patients' overall efficacy assessments were significantly more favourable for group B (p < or = 0.001). Group B was prescribed less FAE than group A. This difference was greatest at the last visit (mean daily dose 529 and 685 mg, respectively; p = 0.006). Overall adverse events in the two groups were similar. CONCLUSION: This study shows that the combination of calcipotriol and FAEs is significantly more effective and faster acting than FAE monotherapy in the treatment of severe plaque psoriasis. The combination has a slight FEA-sparing effect and therefore a superior benefit/risk ratio.

Stücker M, Hoffmann M, Altmeyer P. · Department of Dermatology and Allergology, Ruhr-University Bochum, Germany. · Skin Res Technol. · Pubmed #12060479 No free full text.

Abstract: BACKGROUND/PURPOSE: Retinoids like tazarotene are approved for the treatment of chronic plaque psoriasis. In the beginning of topical retinoid therapy, 15-20% of the patients suffer from mild to moderate adverse reactions with burning and erythema. The aim of the study was to find predicative parameters of the individual irritative potential and to suggest options to reduce these initial irritations. METHODS: Twenty in-patients with different skin types (1 + 2: 11, 3 + 4: 9), with chronic plaque psoriasis were included in this open study. In each patient, 7 randomized plaques on the forearm were treated for 14 days on different ways: test area 1: morning (m) and evening (e) placebo, test area 2: placebo (m) and tazarotene 0.05% (e), test area 3: placebo (m) and tazarotene 0.1% (e), test area 4: calcipotriol (m) and calcípotriol (e), test area 5: mometasone furoate (m) and tazarotene 0.05% (e), test area 6: mometasone furoate (m) and tazarotene 0,1% (e), test area 7: placebo (m) and tazarotene in increasing concentrations (e), test area 8: healthy skin for control. Before and after therapy, skin barrier function, blood flow and plaque thickness in 20-MHz sonography were assessed in different test areas intraindividually by non- invasive biophysical measurements. RESULTS: After 14 days of therapy, tazarotene 0.05% and 0.1% produced a stronger increase of laser Doppler flow in patients with skin type 1 and 2 than in patients with skin type 3 and 4. When using the combination therapy of tazarotene and mometasone, the laser Doppler flow was significantly lower than in tazarotene as monotherapy. 20-MHz-ultrasound showed a significant decrease in the thickness of the echo-poor band in all topical therapy regimens compared to placebo. Patients of skin type 1 and 2 reached a higher density of the dermis than patients of skin type 3 and 4, meaning a stronger decrease of inflammatory infiltration and acanthosis. CONCLUSION: Adapting retinoid therapy to the patient's skin type can reduce the initial irritative side-effects. During the first days, patients with skin type 1 or 2 should add a medium potency corticosteroid. Stronger skin irritation caused by tazarotene therapy increases therapy effects.

Stücker M, Memmel U, Hoffmann M, Hartung J, Altmeyer P. · Department of Dermatology and Allergology, Ruhr University, Bochum, Germany. · Dermatology. · Pubmed #11586013 No free full text.

Abstract: BACKGROUND: There are already many effective topical therapies available for use in the treatment of chronic plaque psoriasis. Unfortunately, these treatments are often associated with a rather significant risk of undesirable effects. OBJECTIVE AND METHODS: In this randomized, prospective clinical trial, the effects of the vitamin D(3) analog calcipotriol were evaluated against those of a recently developed vitamin B(12) cream containing avocado oil in an intraindividual right/left-side comparison. The trial population consisted of 13 patients, 10 men and 3 women, with chronic plaque psoriasis. The observation period was 12 weeks; the effects of therapy were assessed on the basis of a PASI score adapted to the right/left-side comparison technique, the subjective evaluations of the investigator and patients and the results of 20-MHz sonography. RESULTS: There was a more rapid development of beneficial effects with the use of calcipotriol in the initial 8 weeks, although differences in effects were significant only at the time point of therapy week 8 (p < 0.05). After 12 weeks, neither the PASI score nor 20-MHz sonography showed significant differences between the two treatments. While the efficacy of the calcipotriol preparation reached a maximum in the first 4 weeks and then began to subside, the effects of the vitamin B(12) cream containing avocado oil remained at a constant level over the whole observation period. This would indicate that the vitamin B(12) preparation containing avocado oil may be suitable for use in long-term therapy, a hypothesis further supported by the fact that the investigator and the patients assessed the tolerability of the vitamin B(12) cream containing avocado oil as significantly better in comparison with that of calcipotriol. CONCLUSION: The results of this clinical trial provide evidence that the recently developed vitamin B(12) cream containing avocado oil has considerable potential as a well-tolerated, long-term topical therapy of psoriasis.

Ring J, Kowalzick L, Christophers E, Schill WB, Schöpf E, Ständer M, Wolff HH, Altmeyer P. · University Hospital of Dermatology, Hamburg, Germany. JohannesRing@lrz/tu.muenchen.de · Br J Dermatol. · Pubmed #11260005 No free full text.

Abstract: BACKGROUND: Combinations of topical treatments and ultraviolet (UV) B phototherapy for plaque psoriasis may be more beneficial than either type of treatment used alone. OBJECTIVES: To determine the efficacy of calcitriol 3 microg g-1 ointment in combination with UVB phototherapy in treating plaque psoriasis. METHODS: Calcitriol ointment with UVB was compared with vehicle plus UVB in a randomized, double-blind study in 104 patients. RESULTS: Mean global improvement scores for both groups increased over the 8-week study period; there was a statistically significant difference (P < 0.05) in favour of the calcitriol/UVB combination from week 1. At end-point, 45% of the calcitriol/UVB group showed considerable improvement or clearing of psoriasis, compared with 21% of the control group. The superiority of calcitriol plus UVB was also reflected in the global severity and Psoriasis Area and Severity Index (PASI) scores; at end-point the mean percentage decrease in PASI score was 65% for the calcitriol/UVB group and 43% for vehicle/UVB (P = 0.0014). The incidence of skin-related adverse events was low (< 12%) and similar in the two treatment groups. No clinically significant changes in blood chemistry, in particular calcium levels, occurred. The greater efficacy of combined calcitriol and phototherapy allowed a 34% decrease in total UVB exposure. CONCLUSIONS: Calcitriol 3 microg g-1 ointment and UVB phototherapy in combination provides a promising therapy for managing chronic plaque psoriasis.

Gambichler T, Rapp S, Senger E, Altmeyer P, Hoffmann K. · Department of Dermatology, Ruhr-University Bochum, Rödermark, Germany. · Photodermatol Photoimmunol Photomed. · Pubmed #11169172 No free full text.

Abstract: BACKGROUND/PURPOSE: Apart from climatotherapy and spa therapy, combined treatment with salt water baths and artificial UV radiation (balneophototherapy) has been advocated for the treatment of psoriasis. As there is a lack of controlled studies on balneophototherapy (BPT), we conducted a randomized, one-blind, right/left comparison with salt water versus tap water in order to investigate the significance of the salt concentration in the efficacy of BPT. METHODS: Ten psoriasis patients with chronic plaques on the elbows were included in the study. One elbow was soaked in 24% NaCl solution and the other in tap water. Subsequently, broadband UVB irradiation was administered. BPT was performed 4 times weekly with a total of 30 treatments. RESULTS: A highly significant (P<0.001) decrease of the clinical baseline score was observed after 30 treatments; however, there was no significant (P>0.5) difference in clearance of the psoriatic lesions between the sites soaked in salt water and tap water. CONCLUSION: Our results suggest that any additional benefit of soaking in salt water and tap water in BPT are unlikely to be due to the salinity of the liquids.

Barnes L, Altmeyer P, Fôrstrôm L, Stenström MH. · Dermatologische Klinik der, Ruhr-Universitat, St Josef-Hospital, Gudrunstr 56, D-44791 Bochum, Germany. · Eur J Dermatol. · Pubmed #10725818 links to  free full text

Abstract: The efficacy and safety of long-term concurrent twice-daily treatment of scalp and body psoriasis with calcipotriol scalp solution (50 mcg/ml) and calcipotriol cream (50 mcg/g) were evaluated in a prospective, multi-centre, open-label, non-controlled evaluation over 52 weeks in 202 patients. Safety and efficacy as measured by total sign score (scalp psoriasis), modified PASI (body psoriasis) and patient self-assessment were assessed at week 2, 6 and 10 and thereafter every six weeks. By week 28, mean total sign score for scalp psoriasis had reduced from 5.9 to 2.5 (p<0.001). No further reduction was seen. By week 34, mean PASI for body psoriasis had reduced from 6.8 to 2.6 (p<0.001). No further reduction was seen. At week 52, the percentage of patients assessing their psoriasis as moderate or severe had decreased from 72 to 21% for scalp psoriasis and from 62 to 19% for body psoriasis. Facial irritation was the most frequent adverse event (91/276 events) with the highest incidence occurring at week 2 and few new reports at subsequent visits. There were no significant changes in mean serum calcium, parathormone or urinary calcium/creatinine ratio. Combined treatment with calcipotriol scalp solution and cream was effective and safe for long-term treatment of scalp and body psoriasis.

Sander P, Happe M, Stücker M, Hermes N, Hoffmann K, Altmeyer P. · Dermatologische Klinik der Ruhr-Universität, Bochum im St.Josef-Hospital, Bochum. · Hautarzt. · Pubmed #10550358 No free full text.

Abstract: We examined whether it is possible to increase the antipsoriatic action by combining dithranol with a retinoid (tazarotene). In a randomized, open, prospective study with 50 psoriatic patients (22 females, 28 males, PASI>10) the antipsoriatic effectiveness of dithranol monotherapy to was compared combined therapy with dithranol and retinoid. The combination dithranol/retinoid (collective 2, reduction of the PASI from 17,2 to 2,8) revealed a significantly faster healing than the dithranol monotherapy (collective 1, reduction of the PASI from 18,5 to 4,8). The irritation of the combination therapy as evaluated with clinical score and laser doppler imaging was increased. Anti-psoriatic effectiveness of dithranol can be increased by combining it with tazarotene.

Behrens S, von Kobyletzki G, Gruss C, Reuther T, Altmeyer P, Kerscher M. · Department of Dermatology, University of Ulm, Germany. · Photodermatol Photoimmunol Photomed. · Pubmed #10321515 No free full text.

Abstract: PUVA-bath therapy has proven to avoid many side effects associated with oral 8-methoxypsoralen (8-MOP) treatment. In order to investigate the effectiveness of topical PUVA-bath therapy (PUVA-soak therapy) on chronic palmoplantar dermatoses, 30 patients with plaque-type psoriasis, pustular psoriasis, endogenous eczema, dyshidrotic eczema and hyperkeratotic dermatitis of the palms and soles were treated over 8 weeks with PUVA-soak using 8-MOP. No additional treatment except skin moisturising cream such as unguentum emulsificans aquosum was used during the study period. The single UVA-doses applied ranged from 0.3 to 3.0 J/cm2 (mean single dose of 1.8 J/cm2), with a mean cumulative dose of 48.6 J/cm2 per patient. Altogether 26 of 30 patients responded well within 8 weeks of treatment with 63% of all patients showing a complete remission and 23% showing considerable improvement, as shown by flattening of plaques, decreased scaling and erythema, as well as decreased vesicle and pustule formation. The condition responding best to our therapy was palmoplantar psoriasis followed by atopic eczema. Hyperkeratotic dermatitis displayed the poorest responding rates in this study. Unwanted side effects such as erythema, pain, blistering or patchy hyperpigmentation were not observed in any of the patients. We conclude that PUVA-soak therapy can be highly efficient in the treatment of palmoplantar dermatoses, especially in the management of palmoplantar psoriasis.

Gambichler T, Skrygan M, Tomi NS, Othlinghaus N, Brockmeyer NH, Altmeyer P, Kreuter A. · Department of Dermatology, Ruhr-University Bochum, Bochum, Germany. · Int Arch Allergy Immunol. · Pubmed #18446049 No free full text.

Abstract: BACKGROUND: Patients with atopic dermatitis (AD) are prone to have skin infections. We aimed to investigate mRNA expression levels of various antimicrobial peptides and proteins (AMPs) in AD patients, and compare it with psoriasis vulgaris (PV) patients and healthy subjects. METHODS: Skin biopsies were obtained from healthy subjects and patients with AD and PV. Quantitative real-time RT-PCR was used to determine the mRNA levels of human beta-defensin (hBD)-1, hBD-2, hBD-3, LL-37, psoriasin, RNase 7, interferon-gamma, and interleukin-10 (IL-10). RESULTS: Except for LL-37, mRNA of hBDs, psoriasin, and RNase 7 was significantly higher expressed in AD (n = 42) and/or PV (n = 35) patients when compared to controls (n = 18). While PV lesions showed significantly higher mRNA hBD-2 levels than lesions of AD, the latter was associated with significantly higher mRNA levels of RNase 7 when compared to PV. A significant positive correlation of hBD expression was observed both in AD patients and PV patients. hBD mRNA levels of AD skin correlated with psoriasin and RNase 7 levels. hBD-1 mRNA expression correlated with AD activity and IL-10 mRNA expression. CONCLUSIONS: Most AMPs investigated in this study proved to be overexpressed in AD as well as PV when compared to controls. However, a statistically significant difference in AMP mRNA expression between AD and PV was only found for hBD-2 and RNase 7. A moderate-to-strong linear relationship between the mRNA expression of particular AMPs appears to exist in AD, and to a lesser extent in PV as well.

Gambichler T, Boms S, Hochdorfer B, Altmeyer P, Kreuter A. · Department of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, D-44791 Bochum, Germany. · Clin Exp Dermatol. · Pubmed #17244342 No free full text.

Abstract: Amicrobial pustulosis of the folds (APF), is a rare pustular eruption, predominantly involving the cutaneous folds, the external auditory canals and the scalp, occurring in patients who exhibit a wide spectrum of autoimmune abnormalities. There is a lack of data on the immunohistology of APF. We report a new case of APF associated with features of systemic lupus erythematosus (LE). Extensive immunohistological examinations of lesional and nonlesional skin were performed. The results of our immunohistological studies indicate that immunostaining with p53, Bcl-2, and CD8 antigens could be useful in differentiating APF from closely related inflammatory conditions such as psoriasis and cutaneous LE. However, studies on a larger sample size including controls are needed to substantiate our findings.

Gambichler T, Skrygan M, Tomi NS, Altmeyer P, Kreuter A. · Department of Dermatology, Ruhr-University of Bochum, Gudrunstr 56, Bochum, Germany. · Br J Dermatol. · Pubmed #17107401 No free full text.

Abstract: BACKGROUND: The epidermal expression of antimicrobial peptides (AMPs) such as human beta-defensin (hBD)-2 and cathelicidin LL-37 is downregulated in atopic eczema (AE) as compared with psoriasis. Hence, AMPs may represent important cofactors in the pathogenesis of AE. OBJECTIVES: In the present pilot study we aimed to investigate whether the cutaneous mRNA expression of AMPs is altered in patients with AE following narrowband ultraviolet B (NB-UVB) phototherapy. METHODS: We studied 12 patients diagnosed with extrinsic AE who underwent a 6-week course of NB-UVB. Skin biopsies were taken from healthy controls (n = 12) and patients with AE at baseline and after the last NB-UVB irradiation. Quantitative real-time reverse transcription-polymerase chain reaction was performed for hBD-1, hBD-2, hBD-3 and LL-37. RESULTS: A significant (P < 0.05) reduction in the clinical score was observed after treatment with NB-UVB. As compared with controls, patients with AE showed a significantly lower hBD-1 mRNA expression and significantly higher hBD-2 levels (P < 0.05). Following NB-UVB treatment of patients with AE we observed a significant increase of hBD-1 expression as well a significant decrease of hBD-2 (P < 0.05). Levels of hBD-3 and LL-37 did not significantly differ between the groups (P > 0.05). CONCLUSIONS: The pattern of mRNA expression of constitutive (hBD-1) as well as inducible (hBD-2) AMPs seems to be altered in AE as compared with healthy controls. The resolution of AE lesions following phototherapy is accompanied by significant changes in mRNA expression of hBDs, indicating that AMPs may play a role in the pathogenesis of AE.

Kreuter A, Sommer A, Hyun J, Bräutigam M, Brockmeyer NH, Altmeyer P, Gambichler T. · Department of Dermatology and Allergology, Ruhr University of Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany. · Arch Dermatol. · Pubmed #16983001 links to  free full text

Abstract: OBJECTIVE: During the last decades, management of intertriginous psoriasis (IP) has been unsatisfactory because of the adverse effects associated with long-term corticosteroid application and the lack of alternatives. Recently, both pimecrolimus and tacrolimus have been investigated for this indication and shown to be safe and effective. So far, to our knowledge, a comparison of one of these drugs with standard regimens for IP has not been performed. DESIGN: A single-center, 4-week, double-blind, randomized, vehicle-controlled comparison study to assess the safety and efficacy of 1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone valerate in the treatment of IP. SETTING: Dermatologic hospital at Ruhr University of Bochum. PATIENTS: Eighty adults with IP. INTERVENTIONS: Treatment of IP with 1% pimecrolimus, 0.005% calcipotriol, 0.1% betamethasone, or the vehicle once daily for 28 days. MAIN OUTCOME MEASURES: Mean reduction of the Modified Psoriasis Area and Severity Index (M-PASI) score after 28 days of treatment was considered the primary outcome measure, which was analyzed on an intention-to-treat basis. The secondary outcome was a visual analog scale score for itching. RESULTS: After 4 weeks of treatment, the 3 active compounds and the vehicle resulted in a significant decrease in mean M-PASI score (86.4% for 0.1% betamethasone, 62.4% for 0.005% calcipotriol, 39.7% for 1% pimecrolimus, and 21.1% for vehicle). The 0.1% betamethasone was significantly more effective than 1% pimecrolimus during the study period (P<.05). No significant difference was found between 0.005% calcipotriol and 0.1% betamethasone and between 0.005% calcipotriol and 1% pimecrolimus. The visual analog scale score for pruritus decreased by 78% for 0.1% betamethasone, 57% for 0.005% calcipotriol, 35% for 1% pimecrolimus, and 43% for the vehicle, again demonstrating a clear advantage for the corticosteroid (P<.05). CONCLUSIONS: The 1% pimecrolimus was shown to be less potent than 0.1% betamethasone in the treatment of IP. Considering the adverse-effect profile of long-term application of corticosteroids, occasional or intermittent rescue therapy with short-term topical corticosteroids and maintenance with a less potent agent, such as 1% pimecrolimus or 0.005% calcipotriol, might be appropriate for patients with IP in general practice.

Stücker M, Moll C, Altmeyer P. · Klinik für Dermatologie und Allergologie, Ruhr-Universität Bochum, St. Josef Hospital, Bochum. · Hautarzt. · Pubmed #15029434 No free full text.

Abstract: Oxygen reaches the skin from the blood as well as from the atmosphere. The diffusion gradient is a key factor in oxygen delivery. Measurements with puncture electrodes show a maximum oxygen partial pressure on the skin surface and a minimum in the deeper dermis. Non-invasive measures show that oxygen uptake depends on location. Assuming the oxygen consumption is 0.276+/-0.029 ml O(2).100 g(-1).min(-1) (37 degrees) and no oxygen is removed by capillaries, then the skin can be supplied by atmospheric oxygen to a depth of 0.25 to 0.40 mm, well into the dermis. Only the deeper dermis receives oxygen from the blood. The stratum corneum is a significant barrier to diffusion from the atmosphere. When this barrier is damaged, the oxygen diffusion increases Keratinocytes in culture proliferate in response to increased oxygen pressure; the same mechanism may explain epidermal hyperplasia following stratum corneum damage in vivo.

Stücker M, von Rothenburg TH, Moll C, Bechara FG, Hoffmann K, Altmeyer P. · Department of Dermatology and Allergology, Ruhr-University Bochum, Germany. · Clin Hemorheol Microcirc. · Pubmed #14967881 No free full text.

Abstract: BACKGROUND: Cutaneous microcirculation shows a distinctive spatiotemporal inhomogeneity. Therefore provocation tests are necessary to receive significant and reproducible data. The present study investigated the effect of localized cutaneous vascular alteration, like in psoriasis vulgaris, on different parameters of reactive hyperemia (peak capillary blood cell velocity [pCBV], postocclusive reactive hyperemia [PRH%], and time to peak capillary blood cell velocity [tpCBV]). MATERIAL AND METHODS: Psoriatic plaques and normal skin on the contralateral side of 20 patients with psoriasis vulgaris were examined by Laser Doppler Anemometry. Capillary blood cell velocity was measured before suprasystolic occlusion and during postocclusive hyperemia. RESULTS: Compared to normal skin psoriatic plaques showed a significant increase of peak capillary blood cell velocity (pCBV, normal skin: 0.89+/-0.23 mm/s, psoriatic plaque: 2.03+/-0.94 mm/s), resting capillary blood cell velocity (rCBV, normal skin: 0.43+/-0.12 mm/s psoriatic plaque: 0.72+/-0.20 mm/s) and postocclusive reactive hyperemia (PRH%, normal skin: 107%, psoriatic plaque: 180%). The time to peak capillary blood cell velocity (tpCBV) during reactive hyperemia did not change significantly. CONCLUSION: In reactive hyperemia, changing of pCBV and PRH% combined with unaltered tCBV indicate a dysfunction of cutaneous microcirculation. In contrast acute closure of upper and lower arterial extremity show a changed tCBV with stable pCBV and PRH%.

Nowack U, Gambichler T, Hanefeld C, Kastner U, Altmeyer P. · Department of Dermatology, Ruhr-University Bochum, Bochum, Germany. · BMC Dermatol. · Pubmed #12498617 links to  free full text

Abstract: BACKGROUND: Sarcoidosis is a multisystem disease of unknown origin characterized by the formation of noncaseating granulomas, in particular in the lungs, lymph nodes, eyes, and skin. Systemic treatment for cutaneous sarcoidosis can be used for large disfiguring lesions, generalized involvement, or recalcitrant lesions that did not respond to topical therapy. CASE PRESENTATIONS: We report three patients with recalcitrant cutaneous sarcoidosis who were treated with oral fumaric acid esters (FAE). Three female patients presented with cutaneous sarcoidosis that have proved to be refractory to various therapies, including corticosteroids and chloroquine. We treated the patients with FAE in tablet form using two formulations differing in strength (Fumaderm initial, Fumaderm). Dosage of FAE was performed according to the standard therapy regimen for psoriasis patients. After treatment with FAE (4-12 months), a complete clearance of skin lesions was achieved in the three patients. The side effects observed in this trial correspond to the well-known spectrum of adverse effects of FAE (flush, minor gastrointestinal complaints, lymphopenia). CONCLUSIONS: On the basis of our findings FAE therapy seems to be a safe and effective regimen for patients with recalcitrant cutaneous sarcoidosis. Nevertheless further investigations are necessary to confirm our preliminary results.

Canbay A, Rünzi M, Gieseler R, Alamouti D, von Kobyletzki G, Stücker M, Goebell H, Altmeyer P. · Medizinische Klinik, Abteilung für Gastroenterologie und Hepatologie. · Z Gastroenterol. · Pubmed #11558073 No free full text.

Abstract: A 66-year-old female patient suffering for 10 years from Crohn's disease firstly presented with a parallel outbreak of generalized pustulous psoriasis and Crohn's disease. A second synchronous exacerbation of both disorders occurred after discontinuation of treatment with prednisolone, methotrexate, and mesalazine. As to their pathogenetic concepts, both disease entities reveal similar immunologic alterations, i. e. comparable patterns of cytokines, chemokines, and inflammatory cells (T cells and neutrophils). Generalized pustulous psoriasis, therefore, might develop as hitherto undescribed, more rare extraintestinal manifestation of Crohn's disease.

Stern-Kiefer M, Porwol T, Acker H, Altmeyer P, Bacharach-Buhles M. · Dermatologische Klinik der Ruhr-Universität Bochum im St. Josef-Hospital, Bochum. · Hautarzt. · Pubmed #11153360 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: The combination of digital image-analysis and computer-reconstruction of the three-dimensional architecture of the human skin can make this method usable on an acceptable time scale. PATIENTS/METHODS: We used biopsies of different diseases (malignant melanoma, lichen planus, psoriasis) and of normal skin. Immunohistologically stained sections were digitized and adjusted with respect to features of interest using the interlaced mode of an commercial image analysis system (Lucia G, Nikon GmbH, Düsseldorf). The sections have been segmented and the resulting three dimensional data sets were visualized on a UNIX based work station. RESULTS: Three dimensional reconstruction provides a different view into the architecture of normal and diseased skin: for example, the course of the duct of sweat glands or the perforation of a malignant melanoma through the underlying infiltrate. CONCLUSIONS: A new rapid reconstruction method is presented producing multidimensional histological images of the skin within a few hours. This automation is of interest in basic research and should find its way into routine histological diagnosis.

Windemuth D, Stücker M, Altmeyer P. · Dermatologische Klinik der Ruhr-Universität Bochum im St. Josef-Hospital. · Hautarzt. · Pubmed #10789079 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Studies about the personality of dermatological patients are numerous. The results are inconsistent and peculiarities of the personality are rarely confirmed. Contrary to the usual procedure, this study asks for the impressions physicians have about their patients. PATIENTS/METHODS: To elicit associations dependent on a dermatological diagnosis, 27 physicians filled in a three-dimensional differential asking for their impressions about patients with atopic dermatitis, leg ulcer, malignant melanoma, or psoriasis vulgaris in order to quantify these impressions. RESULTS: The dimension valence (good-bad) did not differ between the groups. The dimensions of excitation (active-passive) and potency (strong-weak) showed the biggest differences between patients with atopic dermatitis and ulcus cruris. The latter get significantly lower values on both dimensions. The correlations between the impression and the duration of employment in dermatology were low. CONCLUSIONS: In our opinion it is necessary to raise the impression of medical personal about their patients because these impressions affect the interaction of the personal with the patient.

Mrowietz U, Christophers E, Altmeyer P. · Department of Dermatology, University of Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany. · Br J Dermatol. · Pubmed #10584060 No free full text.

Abstract: Fumaric acid ester (FAE) therapy has proved to be safe and effective in patients with severe psoriasis vulgaris. This treatment was introduced nearly 30 years ago, but is only now gaining renewed interest among dermatologists. FAE therapy is licensed in Germany and registration is pending in many European countries. Multicentre trials have confirmed the beneficial effect of FAE in psoriasis and have defined the spectrum of its adverse effects. Although the mode of action of FAEs in the treatment of psoriasis is not fully understood, recent experimental data point towards a skewing of the Th1-dominated T-cell response in psoriasis to a Th2-like pattern, and inhibition of proliferation of keratinocytes. This article reviews the experimental and clinical information on FAEs in psoriasis and provides guidelines for the clinical use of FAEs derived from a consensus meeting of leading experts.

El Gammal S, El Gammal C, Kaspar K, Pieck C, Altmeyer P, Vogt M, Ermert H. · Dermatological Clinic of the Ruhr-University Bochum, Germany. · J Invest Dermatol. · Pubmed #10571740 links to  free full text

Abstract: A main drawback of 20-25 MHz ultrasound units for skin imaging is their limited resolution. We used a transducer with a center frequency of 95 MHz and a resolution of 8.5 microm axially and 27 microm laterally - an almost 10-fold increase compared with 20 MHz. By means of a new scanning technology we reached a depth of field of 3.2 mm. We examined normal palmar skin, normal glabrous skin on the abdomen, the upper back, the calf and the dorsal forearm, and 35 lesions of psoriasis vulgaris. From 11 psoriatic plaques biopsies were taken for correlation with the sonograms. In normal palmar skin, the horny layer is represented as an echopoor band below the skin entry echo, traversed by echorich coils, which correspond to eccrine sweat gland ducts. The thickness of this band significantly increases after occlusive application of petrolatum. Its lower border is defined by an echorich line, representing the stratum corneum/stratum Malpighii-interface. Underneath, a second echopoor band is visible, which corresponds to the viable epidermis plus the papillary dermis, bordered by the scattered echo reflexes of the reticular dermis. This band is also visible in glabrous skin; however, the stratum corneum cannot be detected. In psoriatic lesions, the thickened horny layer appears echorich; after application of petrolatum, its echodensity decreases. Below, the acanthotic epidermis plus the dermis with the inflammatory infiltrate are represented as an echopoor band. There is an excellent correlation between the sonometric thickness of this band and the histometric thickness of the acanthosis plus the infiltrated dermis. Our results show that 100 MHz sonography is a valuable tool for in vivo examination of the upper skin layers.