MADAM, Chronic hand eczema (CHE) is a distressing disease of the palms with variable aetiology, severity and morphology. Clinical phenotypes essentially distinguish hyperkeratotic and dyshidrotic or mixed disease patterns. The underlying disease mechanisms include allergic contact dermatitis, irritative damage and atopy. 1 Alitretinoin (9-cis retinoic acid) is a novel antagonist vitamin A derivative, which binds both retinoic acid receptors (RAR) and retinoid X receptors (RXR). It has recently been licensed for oral treatment of CHE in several European countries. 2 The clinical efficacy of alitretinoin for CHE has been confirmed in two large, randomized, double-blinded, placebo-controlled, clinical trials. 3,4 We wondered if oral alitretinoin would also be effective in extrapalmar atopic eczema (AE) lesions of patients with ato-

Background: The role of angiogenesis in the pathogenesis of renal cell carcinoma is well recognized, however, the influence of tumor cells in this activity has not yet been fully clarified. The aim of this study was to analyze the expression of hypoxia inducible factor-1α (HIF-1α), a regulatory factor of angiogenic switch, in comparison to vascular endothelial growth factor A and C (VEGF-A and VEGF-C), recognized to be involved in blood and lymph vessel neoangiogenesis, with potential association in the prognosis of patients with renal cell carcinoma.

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A controlled trial of photodynamic therapy of actinic keratosis comparing different red light sourcesBackground: Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA) with red light is well established for actinic keratosis (AK). Differences have been observed concerning pain and efficacy rates with different red light sources. Objectives: To compare pain scores, shortand long-term efficacy rates of PDT of multiple AKs when employing different red light sources. Material and methods: In a controlled trial, 88 patients (310 AK lesions) received ALA-PDT in combination with either visible light (VIS) + water-filtered infrared A (wIRA) light (PhotoDyn ® 750 (PD750), 580-1400 nm) for 30 min or incoherent light (Waldmann ® 1200L (Wa1200L), 600-720 nm) for 10-11 min. Followup visits were performed after 1, 3, 6, and 12 months. If there was no complete cure after 1, 3 or 6 months, a second cycle of PDT was performed. Results: Pain scores were significantly lower in patients illuminated with PD750 rather than Wa1200L. Patient complete clearance rates were 85% and 91% after 1 month, 79% and 92% after 3 months, 97% and 92% after 6 months, and 69% and 85% after 12 months in the PD750 and Wa1200L groups, respectively. Lesion complete clearance rates were 94% and 92% after 1 month, 88% and 97% after 3 months, 96% and 95% after 6 months, and 81% and 89% after 12 months in the PD750 and Wa1200L group, respectively. The efficacy rates were not significantly different. Conclusion: A VIS + wIRA light source produced considerably less pain, while efficacy was not much affected in contrast to previously published studies, probably because the illumination time was longer in this study.