U Jappe

Publications of U Jappe

• Nurses' perceptions of the benefits and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group.

  Authors: N Stutz, D Becker, U Jappe, S M John, A Ladwig, P Spornraft-Ragaller, W Uter, H Löffler

  The British journal of dermatology. 12/2008;

  Summary Background Nurses have a high risk of developing hand eczema due to hand disinfection procedures. Objectives To investigate the perception of nurses regarding the adverse effects of handSummary Background Nurses have a high risk of developing hand eczema due to hand disinfection procedures. Objectives To investigate the perception of nurses regarding the adverse effects of hand washing (HW) and alcoholic disinfection (ADI), and to obtain data on the prevalence of hand dermatitis and sensitization to alcohols and alcohol-based hand rubs (ABHRs). Methods A self-administered questionnaire survey, carried out as a pilot study (PS), followed by a modified multicentre study (MC) in five hospitals. Patch tests to ethanol (80%), 1-propanol (60%), 2-propanol (70%) and ABHRs were performed in a subsample. Results The majority (PS 60.1%; MC 69.5%) of nurses considered ADI to be more damaging than HW. Mostly, ADI and HW were suspected to have irritant effects (ADI 79.2%/52.1%; HW 65.5%/36.2%) compared with an allergenic potential (ADI 10.4%/5.8%; HW 7.8%/3.9%). The prevalence of hand dermatitis in the MC was 13.4% by self-diagnosis and 22.4% by symptom-based questions. In 50 tested individuals no sensitization and only two irritant reactions to alcohols and three single-positive reactions to ABHRs were observed, none of the latter related to alcohols. Conclusions Although ADI is known to cause less skin irritation than HW, nurses perceive ADI as more damaging, resulting in: (i) a low compliance with ADI and (ii) a higher prevalence of hand dermatitis because the more deleterious HW is preferred. This may result in an increase in occupational disease and nosocomial infections. Educational programmes should promote ADI as a procedure with good efficiency and skin tolerability to reduce the prevalence of hand eczema in nurses and to enhance compliance with hand hygiene standards.

• [Disseminated granulomatous type IV reaction after a tattoo.]

  Authors: J Schulz, A Lonsdorf, U Jappe, W Hartschuh

  Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete. 08/2008; 59(7):567-70.

  Localized type-IV allergies to tattoo dyes are quite common. p-Phenylendiamine, which is used as a black pigment in temporary henna tattoos, is a particularly potent allergen. Generalized type IVLocalized type-IV allergies to tattoo dyes are quite common. p-Phenylendiamine, which is used as a black pigment in temporary henna tattoos, is a particularly potent allergen. Generalized type IV reactions are very rare, however. Disseminated granulomatous reactions on tattoo dyes have so far not been reported in the literature. We describe the case of a 54-year-old female patient who had such a reaction pattern after a tattoo owing to a previously unknown sensitization to potassium dichromate.

• Contact allergy in patients with rosacea: a clinic-based, prospective epidemiological study.

  Authors: U Jappe, T Schäfer, A Schnuch, W Uter

  Journal of the European Academy of Dermatology and Venereology : JEADV. 05/2008;

  Background Rosacea is a relatively common inflammatory skin disease of unknown prevalence. The proportion of contact allergy complicating rosacea and its therapy, respectively, is largely unknown.Background Rosacea is a relatively common inflammatory skin disease of unknown prevalence. The proportion of contact allergy complicating rosacea and its therapy, respectively, is largely unknown. Objective To estimate the prevalence of specific contact allergy in rosacea patients and to compare this with the prevalence observed in the general population and in general patch test patients. Patients/methods In this prospective monocentre study, 78 patients with rosacea were investigated for contact sensitizations via patch testing the standard series, constituents of topical formulations, preservatives, fragrances, topically applied drugs and, if available, patient's own products. Results Positive reactions occurred to nickel (II) sulphate (12 of 78, 15.4%), fragrance mix I (4 of 77, 5.2%), balsam of Peru (8 of 77, 10.4%; significantly elevated prevalence compared to that observed in the population-based KORA study), potassium dichromate (4 of 78, 5.1%) and Lyral (3 of 78, 3.8%). Regarding topical antibiotics, only 1 of 78 (1.3%) patients was positive to neomycin sulphate, and none to metronidazole; however, 6 of 75 (8%) patients were positive to gentamicin sulphate, and 4 of 76 (5.3%) patients were positive to framycetin sulphate. No allergic but irritant patch test reactions, instead, were provoked by various patients' own products as well as by the irritant sodium lauryl sulphate (SLS) even in low concentrations. Conclusion Despite the limited power of the study, a strikingly high prevalence of contact allergy to gentamicin sulphate was observed, which is probably due to antibiotic treatment of rosacea-associated eye symptoms. The reactions to the irritant SLS probably mirror the extreme skin sensitivity in rosacea.

• [First manifestation of psoriasis vulgaris in tumor necrosis factor receptor-associated periodic syndrome during treatment with etanercept.]

  Authors: S Boms, T Sehr, U Jappe, A Enk

  Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 02/2008;

  Drugs antagonizing tumor necrosis factor (TNF) alpha have been increasingly and successfully used in the treatment of psoriasis vulgaris and psoriatic arthritis. We report a patient with TNF receptorDrugs antagonizing tumor necrosis factor (TNF) alpha have been increasingly and successfully used in the treatment of psoriasis vulgaris and psoriatic arthritis. We report a patient with TNF receptor 1-associated periodic syndrome (TRAPS) who received TNF-alpha antagonist etanercept. A month later, the patient developed for the first time generalized psoriasis vulgaris. This paradoxical phenomenon has been reported sporadically in patients receiving TNF-alpha antagonists for other inflammatory diseases. The cause of psoriasis induced by TNF-alpha antagonists is still obscure.

• [Furunculoid skin lesions after travel to the tropics]

  Authors: T Göksu, A Lonsdorf, U Jappe, T Junghanss

  Der Internist. 04/2007; 48(3):311-3.

  We present a case of cutaneous myiasis (Tumbu fly; Cordylobia anthropophaga) in a German traveller returning from Africa. Myiasis is caused by dipterous larvae invading human or animal tissues. TheWe present a case of cutaneous myiasis (Tumbu fly; Cordylobia anthropophaga) in a German traveller returning from Africa. Myiasis is caused by dipterous larvae invading human or animal tissues. The diagnosis is based on the travel history and specific features of the furunculoid skin lesions. Larvae are extracted with forceps or are surgically removed.

• [Occupational inhalant allergy to the common housefly (Musca domestica)]

  Authors: E Tas, U Jappe, H Beltraminelli, A Bircher

  Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete. 03/2007; 58(2):156-60.

  Isolated allergy to the common housefly (Musca domestica) has only been described in four cases. Predisposing factors include high concentrations of allergens and prolonged exposure time. TwoIsolated allergy to the common housefly (Musca domestica) has only been described in four cases. Predisposing factors include high concentrations of allergens and prolonged exposure time. Two pharmaceutical industry workers, 59 and 34 years of age, both without atopy, presented with recent onset of allergic rhinitis. Their symptoms appeared about 30 minutes after exposure to Musca domestica in the closed breeding rooms. They were symptom-free with other insects, on weekends and on vacation. Skin prick tests with common inhalant allergens were negative. Prick testing with crushed Musca domestica adults, hatched eggs, contaminated nets and sand, as well as fly feces were all positive. One patient had specific IGE antibodies against Musca domestica. Both patients lacked specific IgE antibodies against other insect species and common aeroallergens. In these two patients there was a species-specific sensitization without relevant cross reactions to other arthropods. The patients were transferred to new work sites where they had no contact with Musca domestica and became symptom-free. Thus this common insect can be a relevant occupational aeroallergen.

• In vitro hymenoptera venom allergy diagnosis: improved by screening for cross-reactive carbohydrate determinants and reciprocal inhibition.

  Authors: U Jappe, M Raulf-Heimsoth, M Hoffmann, G Burow, C Hübsch-Müller, A Enk

  Allergy. 10/2006; 61(10):1220-9.

  BACKGROUND: Immunoglobulin (Ig) E-double positivity for honeybee (HB) and yellow jacket (YJ) venom causes diagnostic difficulties concerning therapeutical strategies. The aim of this study was toBACKGROUND: Immunoglobulin (Ig) E-double positivity for honeybee (HB) and yellow jacket (YJ) venom causes diagnostic difficulties concerning therapeutical strategies. The aim of this study was to clarify the cause and relation of the cross-reactivity in patients with insect venom allergy. METHODS: For this purpose, 147 patients with suspected stinging insect allergy and CAP-FEIA-double positivity were investigated for specific sIgE to additional cross-reactive carbohydrate determinant (CCD)-containing allergens: timothy grass pollen, rape pollen, natural rubber latex (NRL), bromelain, and horseradish peroxidase (HRP). Sera with sIgE to NRL were further investigated with the commercially available recombinant latex allergens. Reciprocal inhibition assays with both venoms and HRP were performed. RESULTS: About 36 of 147 (24.5%) patients had sIgE to both venoms only. However, 111 of 147 (75.5%) additionally reacted to CCD-carrying allergens. 89 of 111 CCD-reactive sera had NRL-sIgE. In cases where inhibition experiments were performed, the NRL-sIgE binding was completely abolished in the presence of HRP. Only nine of 61 sera were positive for at least one recombinant latex allergen; all of them were negative in history and NRL-skin prick test. In 43 sera containing sIgE to CCD, HRP inhibition revealed unequivocal results: In 28 of 43 (65%) an HRP-inhibition >70% of sIgE to one venom occurred, pointing out the relevant venom. In three of 43 sIgE proved to be entirely CCD-specific. CONCLUSIONS: Our data indicate that in cases of IgE positivity to both insect venoms supplementary screening tests with at least one CCD-containing allergen should be performed; HRP being a suitable tool for this test. In addition, subsequent reciprocal inhibition is an essential diagnostic method to specify cross-reacting sIgE results.

• Late reactions to the patch-test preparations para-phenylenediamine and epoxy resin: a prospective multicentre investigation of the German Contact Dermatitis Research Group.

  Authors: U Hillen, U Jappe, P J Frosch, D Becker, J Brasch, M Lilie, T Fuchs, B Kreft, C Pirker, J Geier

  The British journal of dermatology. 05/2006; 154(4):665-70.

  BACKGROUND: Late patch-test reactions, developing at day (D) 7 or later have been described for several allergens. Late reactions may reflect patch-test sensitization. Para-phenylenediamine (PPD) andBACKGROUND: Late patch-test reactions, developing at day (D) 7 or later have been described for several allergens. Late reactions may reflect patch-test sensitization. Para-phenylenediamine (PPD) and epoxy resins (ER) are potent allergens and therefore may potentially induce patch-test sensitization. Up to now, there has been no prospective study on the frequency of late reactions in routine patch testing with these allergens. OBJECTIVES: To assess the frequency of late reactions to PPD and ER. PATIENTS/METHODS: In 1748 patients PPD (PPD-base, 1% pet.) and ER [based on diglycidylether of bisphenol A (DGEBA, 1% pet.)], and in 812 patients, nickel sulphate (5% pet.) were removed from the test panel of the standard series and applied on the medial side of the upper arm. Patch-test occlusion time was 24 h in 588 (PPD and ER) and 241 patients (nickel sulphate), respectively, and 48 h in 1160 (PPD and ER) and 571 (nickel sulphate) patients, respectively. Patch tests were read on D1-3 and D2-3, respectively; additional late readings were performed on D7, D14 and D21 after patch-test application. Patients who were not able to return for all scheduled late readings were telephoned on D7, D14 or D21, and questioned about a reaction at the test sites. Patients were instructed to perform daily self-examination from D4 onwards and to return immediately to the clinic if a reaction at the upper arm became visible. RESULTS: Data of 1428 patients (ER and PPD) and 638 patients (nickel) were evaluable. In 25 patients (1.8%), patch tests became positive not before D7, among them 21 reactions to PPD (1.5%) and four reactions to ER (0.3%). In five of seven patients, repeated patch tests with PPD disclosed patch-test sensitization as the cause of the late reaction. All late reactions, except for one, occurred in patients in whom patch tests were applied for 48 h. No late reactions were seen with nickel sulphate. CONCLUSIONS: PPD (1% pet.) elicited late reactions in 1.5% of routine patch tests, the majority of them probably being caused by patch-test sensitization. Therefore, the German Contact Dermatitis Research Group decided to remove PPD 1% pet. from the German standard series and to take efforts to optimize the patch-test conditions of PPD. One way to optimize PPD testing could be to reduce the exposure of PPD 1% to 24 h. Alternatively the patch-test concentration of PPD might be reduced.

• Contact vitiligo following a strong patch test reaction to triglycidyl-p-aminophenol in an aircraft industry worker: case report and review of the literature.

  Authors: U Jappe, J Geier, B M Hausen

  Contact dermatitis. 09/2005; 53(2):89-92.

  Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. A 50-year-old patient developed eczematous skin lesions on the back of his hands, lower arms and eye lids,Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. A 50-year-old patient developed eczematous skin lesions on the back of his hands, lower arms and eye lids, 2 months after he had started working in aircraft construction. Patch tests showed positive reactions at day 3 to nickel sulfate, epoxy resin based on diglycidyl ether of bisphenol F (DGEBF) and 1,4-butanediol diglycidyl ether (1,4-BDDGE). The chemical triglycidyl-p-aminophenol (TGPAP) applied at 1% and 0.1% induced the strongest (+++ positive) reaction. About 4 months after the patch test with TGPAP, the patient presented with 2 circular depigmented spots in the former TGPAP-patch test areas. Dermatohistopathology confirmed the diagnosis of contact vitiligo.

• [Community-based MRSA. A new challenge for dermatology]

  Authors: W Witte, M Wiese-Posselt, U Jappe

  Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete. 09/2005; 56(8):731-8.

  Treatment options for infections with MRSA are extremely limited because of resistance to all beta-lactam antibiotics and primarily because of the fast acquisition of further antibiotic resistance.Treatment options for infections with MRSA are extremely limited because of resistance to all beta-lactam antibiotics and primarily because of the fast acquisition of further antibiotic resistance. During the past six years MRSA possessing the genomic determinant of an additional virulence factor emerged. This virulence factor, Panton-Valentine-Leukocidin, seems to be responsible for deep skin infections as well as necrotizing pneumonia. In order to avoid a continuous spread of MRSA, consequent prevention measures both in dermatological practices and for colonized patients in their general environment are essential.

• Quantitative patch and repeated open application testing in methyldibromo glutaronitrile-sensitive patients.

  Authors: A Schnuch, D Kelterer, A Bauer, Ch Schuster, W Aberer, V Mahler, K Katzer, J Rakoski, U Jappe, A Krautheim, A Bircher, P Koch, M Worm, H Löffler, U Hillen, P J Frosch, W Uter

  Contact dermatitis. 05/2005; 52(4):197-206.

  Contact allergy to methyldibromo glutaronitrile (MDBGN), often combined with phenoxyethanol (PE) (e.g., Euxyl K 400), increased throughout the 1990s in Europe. Consequently, in 2003, the EuropeanContact allergy to methyldibromo glutaronitrile (MDBGN), often combined with phenoxyethanol (PE) (e.g., Euxyl K 400), increased throughout the 1990s in Europe. Consequently, in 2003, the European Commission banned its use in leave-on products, where its use concentration was considered too high and the non-sensitizing use concentration as yet unknown. The 2 objectives of the study are (a) to find a maximum non-eliciting concentration in a leave-on product in MDBGN/PE-sensitized patients, which could possibly also be considered safe regarding induction and (b) to find the best patch test concentration for MDBGN. We, therefore, performed a use-related test (ROAT) in patients sensitized to MDBGN/PE (n = 39) with 3 concentrations of MDBGN/PE (50, 100 and 250 p.p.m. MDBGN, respectively). A subset of these patients (n = 24) was later patch-tested with various concentrations (0.1, 0.2, 0.3 and 0.5% MDBGN, respectively). 15 patients (38%, 95% confidence interval (CI) = 23-55%) had a negative and 24 (62%; 95% CI = 45-77%) a positive overall repeated open application test (ROAT) result. 13 reacted to the lowest (50 p.p.m.), 8 to the middle (100 p.p.m.) and 3 to the highest concentration (250 p.p.m.) only. In those 13 reacting to the lowest ROAT concentration, dermatitis developed within a few days (1-7). The strength of the initial and the confirmatory patch test result, respectively, and the outcome of the ROAT were positively associated. Of the 24 patients with a use and confirmatory patch test, 15 reacted to 0.1% MDBGN, 16 to 0.2%, 17 to 0.3% and 22 to 0.5%. With the patch test concentration of 0.5%, the number of ROAT-negative patients but patch-test-positive patients increases considerably, particularly due to + reactions. A maximum sensitivity of 94% (95% CI = 70-100%) is reached with a patch test concentration of 0.2%, and is not further improved by increasing the concentration. However, the specificity decreases dramatically from 88 (95% CI = 47-100%) with 0.2% to a mere 12.5% (95% CI = 0-53%) with 0.5%. It can be concluded (a) that for MDBGN 0.2% is very likely the best patch test concentration and (b) that 50 p.p.m. in a leave-on product can elicit contact dermatitis in sensitized persons. We were, therefore, unable to find a safe, still microbicidal, concentration for leave-on products. By contrast, with other contact allergens, dose-response use tests may be able to identify a non-eliciting concentration, which could give valuable clues to a non-inducing (i.e., safe) concentration in products.

• Rosacea and contact allergy to cosmetics and topical medicaments--retrospective analysis of multicentre surveillance data 1995-2002.

  Authors: U Jappe, A Schnuch, W Uter

  Contact dermatitis. 03/2005; 52(2):96-101.

  The role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76,697 patients tested and documented by the Information Network of Departments ofThe role of contact allergy in rosacea has rarely been investigated. In this retrospective study, 361 out of 76,697 patients tested and documented by the Information Network of Departments of Dermatology between 1995 and 2002 had rosacea. Patch tests included standard series and constituents of cosmetics and topical medicaments. 118/361 had additionally been patch tested with their own cosmetics/medicaments. Positive reactions occurred to nickel (II) sulfate in 9.3%, fragrance mix in 8.8%, thimerosal in 6.9%, Myroxylon pereirae resin in 5.9%, potassium dichromate in 4.6% and propolis in 2.8%. Whereas rosacea patients had a significantly higher risk of contact allergy to propolis compared to the remaining patients, in an age- and sex-adjusted analysis, contact allergy to nickel was significantly less frequent in this group. For Lyral, the risk was elevated, albeit not significantly. Only 2/329 patients were positive to neomycin sulfate and 1/100 to gentamicin sulfate, among the panel of (topical) antibiotics tested. Among 118 patients tested with their own products, 3 were tested to metronidazole, 1 reacting positively. Irritant or doubtful patch test reactions were provoked by various substances (vehicles, oxidants and preservatives of various creams), which might also be clinically important, considering the heightened sensitivity of rosaceous skin.

• Emergence of methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin genes in central Europe.

  Authors: W Witte, C Braulke, C Cuny, B Strommenger, G Werner, D Heuck, U Jappe, C Wendt, H J Linde, D Harmsen

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 02/2005; 24(1):1-5.

  The aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS-lukF determinant of Panton-Valentine leukocidin and toThe aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS-lukF determinant of Panton-Valentine leukocidin and to further characterize strains found to contain the genes. During the past 2 years, MRSA containing the lukS-lukF genes for Panton-Valentine leukocidin, particularly those emerging outside of hospitals, have become of interest. MRSA strains sent to the national reference center in Germany were investigated for lukS-lukF by polymerase chain reaction (PCR). If the presence of lukS-lukF was demonstrated, strains were further characterized by molecular typing (determination of SmaI pattern, spa sequence, and multilocus sequence type), PCR demonstration of resistance genes, and characterization of the SCCmec element. Since the end of 2002, MRSA containing Panton-Valentine leukocidin genes have been demonstrated as the causative agent of 28 cases of infection (9 community-acquired cases, 19 sporadic nosocomial cases) in different areas of Germany. Twenty-seven of these 28 isolates exhibited a unique pattern of genomic typing: all exhibited multilocus sequence type 80, spa sequence type 44, and a SmaI macrorestriction pattern that corresponds to a community-acquired strain of MRSA from France and Switzerland. In addition to resistance to oxacillin, the strains exhibited resistance to ciprofloxacin, tetracycline (tetM), and fusidic acid, the last of which is encoded by the far-1 gene. The far-1 gene was shown to be located on the plasmid. One isolate corresponded to community MRSA (cMRSA) of multilocus sequence type 1 from the USA.

• Valdecoxib-induced systemic contact dermatitis confirmed by positive patch test.

  Authors: C Jaeger, U Jappe

  Contact dermatitis. 02/2005; 52(1):47-8.

• [Sunlight-induced granulomatous reaction to permanent lip liner]

  Authors: C Jäger, W Hartschuh, U Jappe

  Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete. 02/2005; 56(1):63-5.

  The demand for permanent make up and especially permanent lip liner has increased in recent years in Germany. Information about complications is not available in the medical literature, becauseThe demand for permanent make up and especially permanent lip liner has increased in recent years in Germany. Information about complications is not available in the medical literature, because tattooing is a trade whose results and problems are not monitored and documented, as is the case for medical procedures. A female patient with permanent lip liner experienced no complications for one year. Then, after intensive sun exposure she developed solid, linear papules along the outer margin of her lips. Histology revealed a granulomatous tissue reaction with a marked lymphohistiocytic infiltrate including epithelioid histiocytes. Treatment with topical steroids over three weeks led to a complete healing without relapse. To the best of our knowledge this is the first report on UV-light-induced granulomatous reaction to permanent lip liner.

• Fondaparinux: a suitable alternative in cases of delayed-type allergy to heparins and semisynthetic heparinoids? A study of 7 cases.

  Authors: U Jappe, U Juschka, N Kuner, B M Hausen, K Krohn

  Contact dermatitis. 09/2004; 51(2):67-72.

  Hypersensitivity to unfractionated and low-molecular-weight heparins and semisynthetic heparinoids is increasingly common. 7 female patients between 30 and 74 years with delayed-type allergy toHypersensitivity to unfractionated and low-molecular-weight heparins and semisynthetic heparinoids is increasingly common. 7 female patients between 30 and 74 years with delayed-type allergy to heparins and semisynthetic heparinoids were investigated for (cross)-reactivity to fondaparinux, a new pentasaccharide with selective factor Xa inhibition. All patients showed delayed-type reactions to heparins and some additional cross-reaction to a heparinoid on intracutaneous testing. 6/7 tolerated fondaparinux on intradermal testing as well as on subcutaneous challenge testing. However, the 7th patient developed a characteristic delayed-type reaction to both skin tests with fondaparinux. Fondaparinux is a new synthetic pentasaccharide with a molecular weight of 1.728 Da. In some patients with cross-reactivity between various heparins and semisynthetic heparinoids, lepirudin, a recombinant hirudin, may be a safe and effective alternative. However, combined allergy to hirudin and heparins has been reported. Sometimes, intravenous administration of heparins or heparinoids may be tolerated. However, these patients are at risk of developing a systemic reaction. The pathogenesis of heparin hypersensitivity is not fully understood. Heparins may act as haptens by binding to dermal and/or subcutaneous structural proteins. The chemical structures of heparins and fondaparinux are different concerning their alpha- and beta-configuration and the molecular weight. However, some of their functional groups are nearly identical and therefore similar chemical and pharmacological reactivity is to be expected. Fondaparinux seems to be a valuable alternative in most cases of heparin and hirudin hypersensitivity. The clearly rare cross-reaction between fondaparinux and heparins, now confirmed by us, may be due to differences in the response to haptens.

• Evidence for diversity within Propionibacterium acnes: a comparison of the T-cell stimulatory activity of isolates from inflammatory acne, endocarditis and the laboratory.

  Authors: U Jappe, R Boit, M D Farrar, E Ingham, J Sandoe, K T Holland

  Journal of the European Academy of Dermatology and Venereology : JEADV. 08/2004; 18(4):450-4.

  BACKGROUND: Propionibacterium acnes is primarily associated with the pathogenesis of acne vulgaris but reports are increasing in number implicating P. acnes in other diseases such as abscessBACKGROUND: Propionibacterium acnes is primarily associated with the pathogenesis of acne vulgaris but reports are increasing in number implicating P. acnes in other diseases such as abscess formation, meningitis and endocarditis. The pathogenicity of P. acnes is thought to be partly due to the interaction of the bacterium with the immune system. Historically, investigations have focused on humoral and cell-mediated immune responses to P. acnes antigens without attention to the possibility that different antigens may be expressed by different isolates. OBJECTIVE: Investigations were performed to determine whether there were differences between a laboratory strain of P. acnes (P-37) and fresh clinical isolates in their ability to stimulate naive and adult lymphocytes. MATERIAL AND METHODS: The fresh isolates were collected from a patient with inflammatory acne and a patient with P. acnes-induced prosthetic valve endocarditis. The lymphocyte transformation assay was used to detect responses to whole-cell suspensions of stationary phase P. acnes isolates during 7 days of incubation. RESULTS: The acne isolate was significantly more stimulatory for cord blood mononuclear cells (CBMNCs) than the laboratory isolate (P. acnes P-37) at day 4 of incubation. There were no significant differences between the three strains at any other time points. However, the isolate cultivated from inflammatory acne was significantly more stimulatory for peripheral blood mononuclear cells (PBMNCs) from acne donors than the endocarditis isolate or the laboratory strain at most time points. There were no significant differences between the endocarditis strain and the laboratory strain. CONCLUSION: It can be hypothesized that in case of P. acnes-induced endocarditis lymphocyte stimulation is a disadvantage for the microorganism and therefore a lack of lymphocyte stimulation may be relevant to the pathogenesis of endocarditis.

• Actinic superficial folliculitis.

  Authors: C Jaeger, W Hartschuh, U Jappe

  Journal of the European Academy of Dermatology and Venereology : JEADV. 10/2003; 17(5):562-5.

  Actinic superficial folliculitis was first described in 1985, and since then only three reports have been published. Clinically and histopathologically this disease is very particular and has beenActinic superficial folliculitis was first described in 1985, and since then only three reports have been published. Clinically and histopathologically this disease is very particular and has been suggested to be considered as an entity. We report on a 30-year-old man who presented with an extensive superficial follicular pustulosis on his back, shoulders and upper chest after exposure to intense heat and subsequent sweating on a sunny day. The pustules arose within 24-36 h afterwards. Histology and immunohistochemistry revealed subcorneal pustules, suppurative folliculitis and an infiltrate consisting of T cells, macrophages and neutrophils around the hair follicle, sebaceous glands and small vessels. To the best of our knowledge this is the fourth report on actinic superficial folliculitis and the first on which a characterization of the inflammatory infiltrate has been performed. Because of the impressive, unique symptoms and the characteristic histology we agree with those who have suggested that actinic superficial folliculitis is a new entity.

• Frequency of sensitization to antimicrobials in patients with atopic eczema compared with nonatopic individuals: analysis of multicentre surveillance data, 1995-1999.

  Authors: U Jappe, A Schnuch, W Uter

  The British journal of dermatology. 08/2003; 149(1):87-93.

  BACKGROUND: Atopic eczema, a multifactorial disease, is influenced by bacterial factors, particularly Staphylococcus aureus. Consequently, treatment includes therapy with antibiotics andBACKGROUND: Atopic eczema, a multifactorial disease, is influenced by bacterial factors, particularly Staphylococcus aureus. Consequently, treatment includes therapy with antibiotics and nonantibiotic antimicrobials. OBJECTIVES: In our study the sensitizing potential of some topical antimicrobials was investigated by comparing proportions sensitized to various antibiotics and antiseptics between patients with current or past atopic eczema, and patients who had never had atopic eczema. METHODS: Data of all patients patch tested in the Departments of Dermatology participating in the Information Network of Departments of Dermatology (IVDK) between 1995 and 1999 were analysed. Patients with a current leg ulcer or stasis dermatitis that might cause a confounding effect were excluded. RESULTS: Controlling for the additional confounding effect of sex and particularly age, we did not find that patients with atopic eczema had a generally higher risk compared with nonatopic individuals. CONCLUSIONS: While the risk of sensitization should always be considered when applying topical therapy, our data-within the methodological limitations of this type of study-would not support a very restrictive use of these agents in the management of atopic eczema.

• Tufted hair folliculitis associated with pemphigus vulgaris.

  Authors: U Jappe, K Schröder, D Zillikens, D Petzoldt

  Journal of the European Academy of Dermatology and Venereology : JEADV. 04/2003; 17(2):223-6.

  Tufted hair folliculitis (THF) is a rare disease which is characterized by the emergence of multiple hairs from widely dilated follicular orifices surrounded by an inflammatory infiltrate resultingTufted hair folliculitis (THF) is a rare disease which is characterized by the emergence of multiple hairs from widely dilated follicular orifices surrounded by an inflammatory infiltrate resulting in scarring alopecia. The pathogenesis is not yet fully understood. Although colonization with Staphylococcus aureus could not always be detected and systemic treatment with antibiotics alone is not sufficient, this microorganism is considered to play an important role. Around 30 patients with THF have been reported since the first publication. We present a patient with pemphigus vulgaris who developed THF. To our knowledge, this is the fourth case with an association of these two entities. Amongst other causing mechanisms, the autoimmune reaction may play an important role for the development of THF.