Background. Assessment methods for atopic dermatitis (AD) are not standardized, and therapeutic studies are difficult to interpret. Aims. To obtain a consensus on assessment methods in AD and to use a statistical method to develop a composite severity index.Methods. Consensus definitions were given for items used in the scoring system (extent, intensity, subjective) and illustrated for intensity items. Slides were reviewed to address within and between-observer variability by a group of 10 trained clinicians, and data were statistically evaluated with a two way analysis of variance. Two variants of an assessment system were compared in 88 patients at 5 different institutions. Data were analyzed using principal-component analysis. Results. For 5 intensity items studied (erythema, edema/papulation, oozing/crusts, excoriations, lichenification), within- and between-observer variability was good overall, except for edema/papulation which was difficult to assess with slides. In the series of 88 patients, principal-component analysis allowed to extract two unrelated components: the first one accounting for 33% of total variance was interpreted as a ‘severity’ component; the second one, accounting for 18% of variance, was interpreted as a ‘profile’ component distinguishing patients with mostly erythema and subjective symptoms and those with mostly lichenification and dryness and lower subjective symptoms. Of the two evaluation systems used, the one using the rule of nine to assess extent was found more workable than the one using a distribution × intensity product. A scoring index (SCORAD) combining extent, severity and subjective symptoms was mathematically derived from the first system and showed a normal distribution of the population studied. Conclusion. The final choice for the evaluation system was mostly made based on simplicity and easy routine use in outpatient clinics. Based on mathematical appreciation of weights of the items used in the assessment of AD, extent and subjective symptoms account for around 20% each of the total score, intensity items representing 60%. The so-designed composite index SCORAD needs to be further tested in clinical trials.

Thirty-three patients with the depigmentation disorder vitiligo were successfully treated with a new topical application of pseudocatalase, calcium and short-term UVB light exposure. First repigmentation occurred in the majority of cases after 2–4 months. Complete repigmentation on the face and dorsum of the hands appeared in 90% of the group. In all patients, active depigmentation was arrested. None of them developed new lesions during treatment. No recurrence of the disease was observed during a 2-year follow-up. The rationale for this pilot study originated from a recent understanding of vitiligo at the molecular level. The involved epidermis produces hydrogen peroxide due to defective tetrahydrobiopterin recycling and increased monoamine oxidase A activity, whereupon catalase is inactivated. In addition, calcium homeostasis is perturbed in the affected skin. The substitution for insufficient catalase by a pseudocatalase together with calcium and UVB exposure lead to effective repigmentation.

One-hundred and two patients from the area of Hamburg, Germany, with vitiligo (photo-skin types II and III, Fitzpatrick classification, 1979), were examined for a possible association of the human lymphocyte antigen (HLA) complex with this disease. Antisera panels for the detection of 75 HLA antigens were utilized for this HLA typing (WHO Bulletin, 1988). The results were compared with 400 unrelated age- and sex-matched controls with photo-skin types II and III from the same geographical area. Nine of 76 vitiligo patients showed a significantly increased expression of the rare antigen HLA DRW 12 (p_c = 0.000708), and 65/102 patients showed a marginally significant increased frequency of HLA A2 (p_c = 0.04850) compared with controls. For HLA BW60 (40), a significant increase in frequency was shown only in the adult vitiligo group (p_c = 0.0126). A ‘preventive’ antigen for the manifestation of vitiligo has not been identified in this study. A comparative analysis of all published data on the possible association of HLA with vitiligo does not support a definitive linkage to the MHC so far.

The examination of 623 melanoma patients in North Germany yielded the depigmentation disorder vitiligo in 23 cases (i.e. 3.7%). In 11 patients, the disease preceded their tumor, whereas in 11 patients, vitiligo developed after diagnosis of primary and/or metastatic melanoma into the regional lymph nodes. In 1 case the onset of melanoma in relation to the tumor remained undefined. The prevalence of vitiligo increased with tumor risk factors based on tumor thickness and anatomical site of tumor location (i.e. for low risk 1.75% intermediate risk 5.2% and high risk 5.8%). A comparison of the prevalence of vitiligo to the normal population of Northwestern Europe (i. e. 0.38–0.57%) showed a 7- to 10-fold increase for the patients with melanoma. A reverse analysis of the data yielded a 180-fold higher prevalence of melanoma in the group of patients with vitiligo. These results strongly support a more thorough examination of patients with vitiligo for primary melanoma.

In the past, several authors described an association of cutaneous malignant melanoma (MM) with other neoplasms. As their results were not conclusive, we designed this study with the aim to determine whether the frequency and spectrum of coexisting neoplasms in patients with cutaneous MM are either a significant or a random event. Therefore, the histories of 623 patients with primary MM from our clinic have been evaluated by a direct questionnaire. Diagnosis of MM has been established by histologic examination after excisional biopsy. The male/female (M/F) ratio was 240/383, the mean age 52.5 years (range 14–93). The distribution of risk groups yielded 277 patients (M/F = 90/187) for low risk (Breslow < 0.75 mm trunk, < 1.50 mm extremities), 245 patients (M/F =105/140) for intermediate risk (Breslow 0.76–3.00 and 1.51–5.00 mm, respectively), 101 patients (M/F = 45/56) for high risk (Breslow > 3.00 and > 5.00 mm, respectively). 64 patients (10.3%) had associated primary carcinomas including 7 patients with 2 primary carcinomas compared to a control group (n = 313) with 12 carcinomas (3.8%). 50% of the carcinomas were diagnosed before the diagnosis of melanoma. The M/F ratio of this group was 25/39, the mean age at diagnosis of MM 62.7 years (range 28–91), the mean age at diagnosis of carcinoma 55.6 years (range 29–90). In the female group, breast cancer predominated (18/39), followed by uterus (7/39) and basal cell carcinoma (7/39); in the male group, basal cell carcinoma (10/25) was followed by prostate cancer (6/25). The frequency of breast cancer in the female group (n = 383) was 4.7% compared to a female control group (n = 171) with 1.2%.