In a prospective randomized multicenter trial for the therapy of erythema migrans, 40 patients received ceftriaxone 1 g daily for 5 days and 33 patients obtained phenoxymethylpenicillin, 1 million units 3 times daily, for 12 days. Follow-up was for a mean of 10 +/- 5 months. Eight oral penicillin recipients (24%) and six ceftriaxone recipients (15%) developed minor consecutive manifestations. Two ceftriaxone and one penicillin recipient(s) still had elevated IgG antibody titers 10 to 20 months after therapy. Borrelia burgdorferi could be isolated from the erythema migrans in 29 out of 56 patients (52%) before therapy and in one oral penicillin recipient but none of 24 other patients after therapy. Ceftriaxone was superior to oral penicillin in a subgroup of patients with more than one symptom prior to therapy (p less than 0.01), but not in the overall evaluation of clinical, serological and bacteriological outcome data. Ceftriaxone ought to be preferred to oral penicillin in patients with more severe early Lyme borreliosis.

Human skin biopsies were taken from patients with candidosis of the groin, axillary and submammary areas. The majority of the fungal cells were situated inside epithelial cells. The fungi invaded the entire stratum corneum. They were often found in parakeratotic epithelial cells. They could not be detected in noncornified cells of the malpighian layer. Mycelial forms predominated by far. They apparently invade the epidermis actively. Blastospores were found less often and they mostly were situated between or in superficial cells of the horny layer. Pseudomycelia and germ tubes were rarely observed. Remarkable was the frequent finding of lomasomas in Candida albicans cells in vivo, whereas these structures were rarely demonstrable in vitro. They probably represent structures that occur in damaged fungal cells as a result of defense mechanisms of the host. The fungal elements inside the epithelial cells were often surrounded by electron-transparent areas. These areas possibly resulted from keratolytic activities of the fungus. Characteristic manifestations of candidosis of the human skin were parakeratosis, spongiosis, and intracorneal and subcorneal micro-abscesses. However, fungal elements failed to occur in the center of these abscesses, possibly because the process of phagocytosis, killing, and lysis of the fungi had been completed.

So‐called cellulite is not a disease in a strict sense. An appropriate term to describe it would be adiposis edematosa. Clinically the condition is characterized by “orange‐peel” skin (enlarged and hyperkeratotic follicular orifices) and the “mattress” phenomenon (flattish protrusions and linear depressions of the skin surface). It is not possible to make an exact distinction between so‐called cellulite and simple obesity. The buttocks and the thighs are the most common sites of the condition. Women of all ages may be affected. When so affected, they complain of a feeling of tightness, heaviness, and tenderness or diffuse spontaneous pain in involved skin. The cause of cellulite, in addition to simple obesity, seems to be the typical inner structure of the subcutis in the female, which is probably dependent on the nature of their hormones. The connection between cutis and subcutis in skin of women displaying the “mattress” phenomenon reveals radial arch‐like structures of the connective tissue, whereas the corresponding structures in males run tangentially. Histologically there are no signs of inflammation. The only pathological changes are slight edema, enlarged lymph vessels in the dermis, and slight degenerative changes in the musculi arrectores pilorum. In the subcutis there is a conspicuous increase in the volume of fat cells. There is no convincing experimental proof of changes in the ground substance of the connective tissue. An increase in the degree of polymerization of the acid glycosaminoglycans has not been shown. For this reason treatment with so‐called “spreading” enzymes does not seem to be rational nor is it indeed effective. Therapy should be restricted to a low‐calorie diet and physiotherapy in the form of exercises, massage, and sports.

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