Standard therapies for skin diseases
It almost looks as if Karl Schosser is getting a tan in the solarium. But his stay in the light cabin at the University Hospital in Ulm has nothing to do with cosmetics. The 78-year-old is exposed to high-energy UV radiation, which fights uncontrollably proliferating white blood cells in his skin. He suffers from a tumor disease in which cells of the body’s immune system multiply in the skin. The symptoms, scaly redness, are reminiscent of a fungal attack.
Because the disease progresses very slowly, Thorsten Peters , senior physician at the University Dermatology Clinic in Ulm, can treat it well. Light is one of the standard therapies in dermatology. The doctors use the high-energy UV radiation as well as against eczema or psoriasis ( psoriasis ). If classic methods such as light therapy do not sufficiently relieve the symptoms or if the course is more severe, for example if the joints are affected by psoriasis, medication is used.
“We are now treating many skin diseases with targeted molecular therapies, ” says Peters. This means that the drugs intervene directly in the mechanism by which the disease develops. Dermatologists and scientists are deciphering more and more what exactly happens in the cells during various diseases. They explain how individual molecules communicate with one another and ultimately cause inflammation or increased growth of skin cells. “So that we can help in the clinic, we first have to work in the research laboratory,” says Karin Scharffetter-Kochanek , Medical Director of the Clinic for Dermatology and Allergology in Ulm.
New research findings in skin diseases
Through their research, experts discovered messenger substances, the interleukins, which trigger inflammation in the skin. New drugs inhibit these substances and thus slow down relapses. Experts were able to develop other active substances because they discovered surface proteins on certain tumor cells that are only found there. Medicines attach to the proteins and smuggle toxic substances into the tumor cells in order to destroy them. In interdisciplinary teams with rheumatologists, cardiologists, psychologists and others, the dermatologists decide which form of therapy is optimal for the patient.
The doctors at the Dermatology Clinic in Ulm meet at lunchtime to discuss particularly difficult cases in large groups. Karl Schosser is one of them – and forewarned. A dozen doctors and students will soon take a closer look at his reddened, flaky skin and weeping eczema. Experts from a wide variety of disciplines, from skin surgeons to specialists in psoriasis and neurodermatitis to doctors in tumor diseases of the skin, combine their knowledge in order to make the correct diagnosis and give your patient the best possible therapy. The large competence team is an advantage that the clinics have to offer.
Wrong diagnosis – psoriasis or mycosis fungoides?
The skin changes occurred in Schosser as early as 1986. At the time, doctors suspected it was psoriasis. Only in 2011 did doctors at the University Skin Clinic in Ulm diagnose a tumor called mycosis fungoides. “ The suffering is difficult to determine . Sometimes doctors only recognize them after ten years or more and confuse them with eczema or psoriasis, ”explains Anca Sindrilaru, senior physician at the skin tumor center at the University Dermatology Clinic in Ulm.
Mycosis fungoides is the most common tumor disease affecting the white blood cells in the skin. The exact causes are unknown. Early therapy can help extend the symptom-free period. Medical professionals treat mycosis fungoides using many different approaches. “The tumor cells develop resistance to the therapies, so that they become ineffective,” says skin doctor in delhi. For example, a cream therapy with vitamin A acid helps for a quarter of a year, with the next attack the doctors use a cortisone treatment, then a light therapy.
As a breakthrough skin expert called the discovery of a surface molecule on the sprawling white blood cells called CD30. A drug that fits the surface protein like a key to a lock binds to the tumor cells. CD30 then reacts like a door opener – the active ingredient is absorbed into the cell. He’s carrying a poison that prevents the cell from doubling. A tumor cell that does not divide dies.
New treatment methods for neurodermatitis and psoriasis
In recent years, scientists have also found target molecules for new drugs for other skin diseases. In neurodermatitis and psoriasis , messenger substances, the cytokines , are the focus of research interests. These substances regulate the growth and differentiation of cells and trigger an overreaction of the immune system that leads to inflammation.
Specific active ingredients that inhibit cytokines can prevent relapses in skin diseases. To do this, the researchers have to understand exactly how the messenger substances work together. It is not a single signal substance that drives the inflammatory process, but they play together in a complex concert.
Trigger skin inflammation
The reddened, flaky skin in psoriasis develops as follows – as far as scientists have deciphered the communication between the individual molecules in the cell: Through a genetic change and certain triggering factors such as stress , medication or smoking, cells in the epidermis produce the cytokines TNF-alpha, Interleukin-1 and Interleukin-6.
However, these do not directly trigger the inflammation. As if in a kind of whispered mail , the messengers activate cells of the immune system to produce further cytokines: interleukin-23, which in turn stimulates the production of interleukin-17. TNF-alpha can also directly effect the synthesis of interleukin-17. Only this cytokine with the number 17 leads to inflammation in the skin. “Early, targeted drugs blocked TNF-alpha,” says Johannes Weiss , Senior Consultant in charge at the Clinic for Dermatology and Allergology in Ulm.
“Understanding the entire signal chain made it possible to develop more effective antibodies that are directed against the late triggering of inflammation.” Researchers have also discovered cytokines that are involved in the development of the disease in neurodermatitis. Interleukin-4 and -13 bind to the same docking point on skin cells and start inflammatory processes there. New active ingredients block these binding sites and reduce redness and itching of the skin.
“Atopic dermatitis does not go away as completely with the interleukin inhibitors as does psoriasis,” says skin expert Weiss. Because many other cytokines play a role in neurodermatitis. The researchers do not yet know exactly what the central messenger substances are.
Another open question: not every drug works equally well for every person affected. This also applies to psoriasis. “Perhaps at some point we will be able to use genetic analyzes to predict which active ingredient is optimal for a patient,” says Weiss. At the moment, criteria such as the severity of the disease, the age of the patient and accompanying diseases play a role in the selection of therapy.
If the red areas of the skin do not completely disappear, doctors also treat them with ointments or light therapy. “Therapy with UV light is a very old treatment principle. It was already used in Egypt during the times of the pharaohs, ”explains Thorsten Peters, head of the light therapy department at the University Clinic for Dermatology and Allergology in Ulm.