Invasive squamous cell carcinoma (SCC) as a “quasi occupational disease” according to §9 Section 2 of the German Social Code Book (SGB) VII typically develops on chronically UV-damaged skin from actinic keratoses. After the Medical Scientific Committee of the Federal Ministry of Labor and Social Affairs has confirmed the legal criteria for acknowledging UV-induced SCC as an occupational disease, it is expected that the condition will be added to the official list of occupational diseases issued by the Federal Government in the near future. The Social Accident Insurance is required by law (§3 Occupational Disease Regulation) to prevent these tumors by “all appropriate means“. There are excellent therapeutic and preventive measures for the management of actinic keratoses to avoid the development of SCC. The “Dermatologist's Procedure“according to §§ 41–43 of the agreement between the Social Accident Insurance and the Federal Medical Association was established in Germany in 1972 to take preventive measures in insured persons with skin lesions possibly developing into an occupational disease, or worsening it, or leading to a recurrence of it This procedure proved to be very successful in the prevention of severe and/or recurring skin diseases forcing a worker to leave his job. On the basis of this agreement, the Social Accident Insurance has the instruments to independently provide preventive measures for the new occupational skin disease SCC induced by natural UV light according to §9 Section 2 of the German Social Code Book (SGB) VII.
In addition to providing effective treatment for non-melanoma skin cancers or their precursors, photodynamic therapy (PDT) has also attracted considerable attention for its use on aesthetic dermatology. In a first consensus publication the mechanisms of action of its photorejuvenation effects and recent studies were presented; in this paper treatment protocols for the different anatomical regions exposed to chronic sun damage like face, neck, décolleté and the back of the hands are given and suitable procedures for pre- and after-care are discussed.
Acquired hyperpigmentation of the skin is sometimes interpreted as an adverse effect of drugs. Systematic studies are rare in the literature; predominantly case reports have been published. The present review provides evaluates the evidence for a causal relation.
The reports on a relationship between hyperpigmentation and drugs from 1970 until June 2012 found in MEDLINE and EMBASE were rated according to the SIGN grading system for clinical studies. In this system, the grade of evidence of each report is rated. The highest grade of evidence for each drug is cited.
306 publications were included. They were predominantly case reports; only a small number of case series was available. Only very few case-control-studies and randomized controlled trials (RCT) were found. For the majority of drugs, there was a low level of evidence for a causal relationship in drug-induced hyperpigmentation. A causal relationship is likely only for prostaglandins, minocycline, phenothiazine, nicotine, and antimalarial drugs.
There is little evidence for drug-induced hyperpigmentation. A causal relationship appears liklely only for a limited number of drugs.
In Europe, grass pollen and house dust mites are the most common allergens responsible for IgE-mediated allergies. The aim of our study was to examine the data provided by various medical practices specialized in allergic diseases in Germany regarding patients with rhinoconjunctivitis in terms of demographic data and the prescribed treatment by different medical specialists.
Data from patients who were diagnosed with allergic rhinoconjunctivitis were taken from the “disease-analyzer” database (IMS Health GmbH) and analyzed. The data assessment was anonymous in accordance with the guidelines for data protection. The information collected included specific data about diagnosis and treatment in private practices in Germany.
The majority of patients with grass pollen allergy were treated by their general practitioners, while those with house dust mite allergy were treated by a specialist with a background in allergic diseases (pulmonologists, otorhinolaryngologists, and dermatologists). Treatment was primarily symptomatic, usually consisting of antihistamines. Allergen-specific immunotherapy, the only causal treatment for IgE-mediated allergies at present, was performed rarely.
The data suggest the need for interaction and knowledge transfer between various specialists in order to improve patient-centered care in regard to allergic diseases.
To compare the efficacy and safety of fluconazole and griseofulvin in the treatment of tinea capitis.
Patients with tinea capitis (n = 113) with positive fungal cultures entered the study. The patients were divided into four groups with different treatment regimes. Two groups received griseofulvin 15 or 25 mg/kg/day and two groups received fluconazole 4 or 6 mg/kg/day, all for up to 12 weeks.
Griseofulvin was found to be slightly better than fluconazole. The lower doses for both griseofulvin and fluconazole required significantly longer treatment duration until mycological cure than the higher doses, independent of the fungus type.
Since no significant difference was found between the drugs, it is suggested that the choice should be based on tolerability, availability and cost of the drugs.
Optical coherence tomography (OCT) is a non-invasive, tomographic imaging technique which generates high-resolution in-vivo images up to mid-dermal layers. Due to continuous technological improvements, OCT is moving from research projects into daily dermatological practice. It can complement other imaging methods like high-frequency ultrasound or confocal microscopy. There is a wide variety of indications for OCT. In addition to aiding in the diagnosis and clinical monitoring of inflammatory dermatoses, OCT is a very useful and feasible technique in dermato-oncology.
Acne inversa (AI) is a common chronic inflammatory disease that has a profound impact on the patientsí quality of life. We hypothesized a higher level of depression in AI patients compared to controls.
We studied depression in patients with AI and control subjects. Additionally, we evaluated whether the severity of the disease, anxiety, sexual distress and acute inflammation may have an influence on depression.
The Hospital Anxiety and Depression Scale (HADS) was given to 90 voluntary study participants to assess depression in AI patients and in age-, gender-, and BMI-matched controls. Moreover, the correlation between depression and conjectural influencing factors was evaluated.
This study demonstrated that AI patients have a higher depression score than matched controls. Importantly, 38.6 % of AI patients are affected by depression compared to 2.4 % of the control subjects. In contrast to the duration of the disease and the AI patientsí age, anxiety and sexual distress showed a strong correlation with the degree of depression.
Patients with AI have a higher risk of developing depression. Physicians should be alert to the possible development of depression when treating patients with this disorder.
The incidence of skin tumors is increasing among elderly patients, and the multi-morbidities which occur in the elderly are a great challenge for dermatologic surgeons. The currently required safety margins for different types of melanomas and non-melanoma skin cancers lead to extensive and profound wounds.
To investigate the usefulness of a dermal substitute (Integra®) for routine use in surgery for dermatologic tumors.
In this retrospective study 20 patients underwent sequential surgeries for skin cancer. Wound closures were performed using Integra® (single layer) and immediate split-thickness skin graft.
Twenty-two tumors (6 malignant melanomas, 10 squamous cell carcinomas, 2 pleomorphic sarcomas, 1 basal cell carcinoma, 2 Merkel cell carcinomas, and 1 trichoblastic carcinoma) were resected. The mean defect size was 41.4 cm2. All transplants were (65–100 %) vital; however, defects in the midface (cheek and infra-orbital area) often healed with esthetically disturbing, dense, pillow-like scars.
With the use of Integra®, the duration of hospitalization was decreased, patients with multi-morbidities were effectively treated, and functionally- and esthetically-satisfactory outcomes were achieved. On the basis of these observations, we discuss points of handling those patients who require rapid and effective surgery and undergo dermatologic surgery using dermal substitutes.
In Germany, drugs are to a large extent provided by pharmacies. Thus, investigations in pharmacies permit drug usage studies both on patients receiving prescribable drugs and using self-medication. The current study evaluated the quality of medical care, disease burden and spectrum of treatments for patients with psoriasis in a nationwide network of pharmacies.
A nationwide cross-sectional study was conducted in 61 pharmacies. Patients with psoriasis vulgaris who came to the pharmacy to obtain antipsoriatic drugs or basic ointments were consecutively recruited, interviewed and asked to complete a standardized questionnaire. The questionnaire focused on socio-demographic characteristics and prior therapies for psoriasis. Furthermore, data on the patient's treatment satisfaction, disease-related burden, and treatment adherence were evaluated. In addition, the proportion and significance of health care providers for psoriasis as well as the number of patients using self-medication were assessed.
The data on 241 patients show a high and long-lasting disease-related burden. A high utilization of resources was found. Dermatologists were the most frequently consulted providers (reported by 77.1 % of patients), followed by general practitioners (10.4 %). 3.5 % of patients were using self-medication. Self-reported adherence with treatment was moderate (71.6 %). Patient satisfaction varied considerably and demonstrated the need for improvement.
Psoriasis is a socio-economically relevant disease. Health care is provided primarily by dermatologists. Surveying patients in a national network of pharmacies is a unique and effective way of collecting relevant “real world” data. Selection biases related to the health care setting are minimized.
During the recent decades allergies have become more frequent all over the world. However, it is unclear how important the topic of allergies is for the general German population and how appropriately patients with allergies are treated.
A telephone survey was performed on a representative random sample of n = 1,004 adults in Germany. The survey was performed by the Forsa Institute for Social Research and Statistical Analysis, Berlin, Germany, in the period from 31 January to 2 February 2012.
Of the interviewees 52 % responded that the topic of allergies concerned them; in 33 % actually an allergy had been diagnosed by a physician. The proportion of allergies in the population correlated with the level of school education and was higher among people with a higher educational status. No differences in allergy rates were found between Eastern and Western Germany. Among allergic persons, 53 % reported to be burdened by their allergy, 48 % suffered from impaired performance because of their allergic symptoms. Among people suffering from pollen allergy, only 28 % received sublingual immune therapy, with which 70 % were satisfied. While 58 % practiced self-medication, only 21 % of the allergic persons were treated with anti-allergic drugs during their allergy flares.
Allergic diseases are a common, often burdensome problem in the German population, but nevertheless the medical treatment of people affected is still insufficient. The proportion of patients receiving sublingual immune therapy as causal treatment is comparatively low. Active steps are needed to improve the utilization behavior of patients, e. g. to take advice of an allergy specialist.
The early diagnosis and excision of cutaneous melanoma is essential for an improved prognosis of the disease. Besides the investigation of pigmented lesions with the unaided eye and conventional dermatoscopy, long-term sequential digital dermatoscopy has been shown to improve the sensitivity of melanoma detection, especially in high-risk patients. In addition to the static clinical and dermatoscopic assessment, the sequential digital dermatoscopy strategy helps to detect changes over time. This review summarizes the latest developments in the field of sequential digital dermatoscopy, describes current strategies for the selection of patients and lesions to monitor, and suggests objective criteria that should lead to an excisional biopsy.
Background: The epidemiology and clinical features of brachioradial pruritus are variably described in the literature. We sought to analyze these features in a large group of Brazilian patients.
Patients and Methods: In a descriptive, observational study, we identified all patients with a final diagnosis of brachioradial pruritus seen over a one-year period and re-trospectively reviewed their records. The diagnosis was made after clinical-laboratory investigation had ruled out other causes of chronic pruritus. Demographic and clinical variables were collected along with pruritus characteristics, and analyzed using des-criptive statistics.
Results: Forty-three patients were identified; their mean age was 55.9 years, with predominance of women (81.4 %) and Caucasians (86 %). In 52 %, the pruritus worsened with heat and sun exposure; 58.1 % had intermittent complaints; the ice-pack sign was present only in 20.9 %. The arms involving dermatomes C5-C6-C7-C8 (62.8 %) were the most affected sites, while psychoactive drugs were the most frequently prescribed therapy.
Conclusions: Although uncommon, brachioradial pruritus should not be neglected in dermatological diagnosis. This case series analysis indicated that Brazilian patients from a tropical climate show characteristics similar to those described in other series from more temperate regions.
Background: To optimize preventive measures to control MRSA, we investigated retrospectively the suitability of a multiple site screening model and the optimal sampling technique to detect MRSA in a university-based phlebology and skin cancer center in Germany.
Patients and Methods: During 4.5 years samples of 3 712 inpatients in a dermatologic department were analyzed for MRSA by conventional microbiologic cultures and in parallel by PCR. Samples were taken from nares, wounds and skin lesions.
Results: MRSA was detected in 60 inpatients (1.6%). 268 of 7 269 (3.7%) samples at admission and during hospital stay were found positive – 96 (35.8%) of these were swabs of nares, 59 (22.0%) surveillance swabs, 53 (19.8%) wound swabs and 42 (15.7%) from other dermatologic lesions. Twenty-five of 60 patients (41.7%) were found positive only in the nares, 10 (16.7%) patients only in wounds and 4 (6.7%) patients only in lesions. 166 (61.9%) of all positive culture samples became positive 24 hours after cultivation, 86 (32.1%) after 48 hours, and 16 (6.0%) after 72 hours.
Conclusions: Highest sensitivity to detect MRSA can be reached by combining three swabs: nares, wounds and skin lesions (“triple-test”). Culture of screening specimens for 72 hours is recommended.
Severe atopic dermatitis has a profound effect on many aspects of the patient's life, and a combination of topical and systemic treatment is often necessary to control the disease. Systemic corticosteroids are rapidly effective, but should only be used short term for severe exacerbations because of their many long term side effects. In chronic cases, starting another systemic immunosuppressant therapy while tapering off corticosteroids should be considered. The usefulness of cyclosporin A, azathioprine, and methotrexate has been documented in clinical trials. Cyclosporin A is rapidly effective, but has a narrow therapeutic index and possible renal toxicity. Azathioprine and methotrexate have a slower onset of action and are good treatment options for many patients, but are not always tolerated. Mycophenolate mofetil, mycophenolate sodium and biologicals are other alternatives, but need to be assessed in larger randomized trials. Despite the available therapeutic repertoire, there remain patients with very severe disease in whom we are unable to obtain satisfactory control. The therapy for patients with severe psoriasis has been revolutionized during the last decade, due to the development of targeted biological therapy, and it is indeed the hope that a similar process is about to emerge also for patients suffering from severe atopic dermatitis.
PATHOWIKI (http://www.pathowiki.org) is a new specialized information system in the form of a web-based wiki with content from all sub-disciplines of human pathology. Essential components are articles and specimens which are located thematically in dermatopathology. The project is presented on the basis of impressive examples and possibilities. The ability to link all kinds of content and integrate pattern analysis theories creates an effective tool for teaching and training in dermatopathology. Collaborative work ensures the effective usage of available resources and a continually growing amount of content, the quality of which depends on the number of users and should be as high as possible. Therefore, all interested colleagues are invited to support the project.