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Diagnostic uses of tape and replica techniques in clinical dermatology
Syn~posiun~ SS. Atopic
procedure (e.g. resection margin). Because other tumors also appear as echo-poor areas like melanomas differential diagnosis is very difficult - often impossible. Tumor parenchyma, tumor stroma, inflammatory infiltrates and skin appendices exhibits low echogenicity resulting in discrepancies between histological and sonographic measurements. 3D-images might better visualize topography, besides tumor volume and surface area can be quantified: these parameters may prove as prognostic indicators, Preoperative sonography of basal cell carcinomas echo-poor lesions, sometimes with a dorsal signal enhancement - facilitates the decision if cryosurgery can be applied or where the resection margins have to be placed. Sonography is an accurate and more objective technique for evaluating tumor regression or progression under therapy (e.g. Metastasis of Malignant Melanoma or Kaposi sarcoma treated with local or systemic chemotherapy). Although today differential diagnosis is not possible only by means of sonongraphy high resolution ultrasound should be applied preoperatively to visualize and quantify vertical and lateral tumor invasion. Since 1996 ultrasound is a MUST in the training for dematologists (board approval).
IS4-7
to the descriptive diagnosis afforded by CSSS, quantitative and/or dynamic aspects of skin biology can be explored by such approach. I S4-9 Routine measurement of sensitivity to light
as a basis for UV dosimetry and improved therapy
H.C. Wulf. Deparrtnettt Copenhagen,
Bispebjerg
of Dertttatology, Hospital,
University
of
Denmark
The sensitivity to ultraviolet radiation is normally determined by the minimal UV dose to elicit erythema. We have developed a reflectance measurement system that can predict the MED by measuring the pigmentation independent of redness. In this way, a direct measure of the expected dose to provoke erytbema can be estimated in a few seconds. We have shown that this measurement is an efficient guidance of the optimal dose for phototherapy and photochemotberapy. The number of PWA exposures for clearing psoriasis is significantly lowered by increasing initial UV doses in UVB photothempy. The cumulative dose for clearance of psoriasis and atopic dermatitis may be lowered by up to 65 per cent.
Diagnostic uses of tape and replica techniques in clinical dermatology
Gregor B.E. Jemec. Roskilde
Hospital,
Roskilde,
Detttttark
Tape and replica techniques have been used for many years in experimental and descriptive studies of skin, they are however also potentially useful in clinical dermatology. Tape techniques, including the D-Squame tapes@ and Sebutapeso are technically simple and can be used in the collection of warious microbes, in the assessment of scaling or to study sebum excretion. The use of replicas is more restricted. They are potentially most useful in the documentation of 3-dimensional changes of tissue, e.g. tumour remission following laser therapy. Replicas may however to some extent be replaced by 3-dimensional computer modelling as is being done in e.g. plastic surgery. Both techniques offer a higher level of objective record than classical clinical assessment. Throughout the world there is increased demand for quality assurance in clinical medicine, and both techniques may be of great use in this context.
IS4-8
Sll
dertttatitis
Cyanoacrylate skin surface stripping in clinical dermatology
G.E. Pierard, C. Pi&ard-Fmnchimont.
Lige,
Eelgiutn
Cyanoacrylate skin surface stripping (CSSS) is a time-honoured method to harvest a sheet of the superficial stratum comeum and follicular casts as well. Such minimally invasive sampling is currently used to assess various physiopathological alterations of the stratum corneum. It is a cheap and rapid method of diagnosis. The main indications are the differential diagnosis of erytbemato-squamous lesions. Spongiotic dermatoses, psoriasis, dermatophytoses. yeast and bacterial infections are conveniently distinguished. The distinction between malignant melanoma, benign melanocytic neoplasms and pigmented nonmelanocytic lesions can also be helped using CSSS. Further
S5.
Atopic dermatitis
S5-1 The role of keratinocytes in atopic dermatitis
=
(ADI
G. Girolomoni, Ittututt~ology, Rome, Italy
M.L. Giustizieri, S. Pastore. Laboratory Istituto
Dertnopatico
dell’lnuttacolata,
of IRCCS,
AD is the result of specific immune responses to allergens and of skin hyperreactivity to a variety of inflammatory stimuli. Keratinocytes (KC) can potently regulate both skin inflammmatory and immune responses. Our labomtory has shown that KC cultured from AD patients sythesize and release exaggemted amounts of GM-CSF, TNFIY, IL-la and IL-lra both spontaneously and in response to phorbol esters, IL-lo or IFN-)I. The enhanced production of GM-CSF and TNFa! by KC can be important for the recruitment and prolifemtion of dendritic cell (DC) precursors as well as in the functional activation and prolonged survival of DC in the skin, thus providing a powerful mechanism of persistent immune inflammation in AD skin. In addition, the programmed hyperproduction of proinflammatory cytokines by KC may favor initiation and persistence of nonspecific inflammation, and it can be relevant for targeting to the skin rather than to the respimtory mucosa clinical expression of the atopic state. Work is in progress to verify whether increased cytokine production by AD KC is secondary to a dysregulated activity of known transcription factors.
procedure (e.g. resection margin). Because other tumors also appear as echo-poor areas like melanomas differential diagnosis is very difficult - often impossible. Tumor parenchyma, tumor stroma, inflammatory infiltrates and skin appendices exhibits low echogenicity resulting in discrepancies between histological and sonographic measurements. 3D-images might better visualize topography, besides tumor volume and surface area can be quantified: these parameters may prove as prognostic indicators, Preoperative sonography of basal cell carcinomas echo-poor lesions, sometimes with a dorsal signal enhancement - facilitates the decision if cryosurgery can be applied or where the resection margins have to be placed. Sonography is an accurate and more objective technique for evaluating tumor regression or progression under therapy (e.g. Metastasis of Malignant Melanoma or Kaposi sarcoma treated with local or systemic chemotherapy). Although today differential diagnosis is not possible only by means of sonongraphy high resolution ultrasound should be applied preoperatively to visualize and quantify vertical and lateral tumor invasion. Since 1996 ultrasound is a MUST in the training for dematologists (board approval).
IS4-7
to the descriptive diagnosis afforded by CSSS, quantitative and/or dynamic aspects of skin biology can be explored by such approach. I S4-9 Routine measurement of sensitivity to light
as a basis for UV dosimetry and improved therapy
H.C. Wulf. Deparrtnettt Copenhagen,
Bispebjerg
of Dertttatology, Hospital,
University
of
Denmark
The sensitivity to ultraviolet radiation is normally determined by the minimal UV dose to elicit erythema. We have developed a reflectance measurement system that can predict the MED by measuring the pigmentation independent of redness. In this way, a direct measure of the expected dose to provoke erytbema can be estimated in a few seconds. We have shown that this measurement is an efficient guidance of the optimal dose for phototherapy and photochemotberapy. The number of PWA exposures for clearing psoriasis is significantly lowered by increasing initial UV doses in UVB photothempy. The cumulative dose for clearance of psoriasis and atopic dermatitis may be lowered by up to 65 per cent.
Diagnostic uses of tape and replica techniques in clinical dermatology
Gregor B.E. Jemec. Roskilde
Hospital,
Roskilde,
Detttttark
Tape and replica techniques have been used for many years in experimental and descriptive studies of skin, they are however also potentially useful in clinical dermatology. Tape techniques, including the D-Squame tapes@ and Sebutapeso are technically simple and can be used in the collection of warious microbes, in the assessment of scaling or to study sebum excretion. The use of replicas is more restricted. They are potentially most useful in the documentation of 3-dimensional changes of tissue, e.g. tumour remission following laser therapy. Replicas may however to some extent be replaced by 3-dimensional computer modelling as is being done in e.g. plastic surgery. Both techniques offer a higher level of objective record than classical clinical assessment. Throughout the world there is increased demand for quality assurance in clinical medicine, and both techniques may be of great use in this context.
IS4-8
Sll
dertttatitis
Cyanoacrylate skin surface stripping in clinical dermatology
G.E. Pierard, C. Pi&ard-Fmnchimont.
Lige,
Eelgiutn
Cyanoacrylate skin surface stripping (CSSS) is a time-honoured method to harvest a sheet of the superficial stratum comeum and follicular casts as well. Such minimally invasive sampling is currently used to assess various physiopathological alterations of the stratum corneum. It is a cheap and rapid method of diagnosis. The main indications are the differential diagnosis of erytbemato-squamous lesions. Spongiotic dermatoses, psoriasis, dermatophytoses. yeast and bacterial infections are conveniently distinguished. The distinction between malignant melanoma, benign melanocytic neoplasms and pigmented nonmelanocytic lesions can also be helped using CSSS. Further
S5.
Atopic dermatitis
S5-1 The role of keratinocytes in atopic dermatitis
=
(ADI
G. Girolomoni, Ittututt~ology, Rome, Italy
M.L. Giustizieri, S. Pastore. Laboratory Istituto
Dertnopatico
dell’lnuttacolata,
of IRCCS,
AD is the result of specific immune responses to allergens and of skin hyperreactivity to a variety of inflammatory stimuli. Keratinocytes (KC) can potently regulate both skin inflammmatory and immune responses. Our labomtory has shown that KC cultured from AD patients sythesize and release exaggemted amounts of GM-CSF, TNFIY, IL-la and IL-lra both spontaneously and in response to phorbol esters, IL-lo or IFN-)I. The enhanced production of GM-CSF and TNFa! by KC can be important for the recruitment and prolifemtion of dendritic cell (DC) precursors as well as in the functional activation and prolonged survival of DC in the skin, thus providing a powerful mechanism of persistent immune inflammation in AD skin. In addition, the programmed hyperproduction of proinflammatory cytokines by KC may favor initiation and persistence of nonspecific inflammation, and it can be relevant for targeting to the skin rather than to the respimtory mucosa clinical expression of the atopic state. Work is in progress to verify whether increased cytokine production by AD KC is secondary to a dysregulated activity of known transcription factors.