Viral and paraviral exanthems are the most common exanthems in children and are often the reason for a medical evaluation, especially in pediatric primary care and emergency rooms. Familiarity with the various eruptions...Viral and paraviral exanthems are the most common exanthems in children and are often the reason for a medical evaluation, especially in pediatric primary care and emergency rooms. Familiarity with the various eruptions is important for early diagnosis and patient management as well as minimizing the risk of infection. In this review, we present the newly described entities reactive infectious mucocutaneous eruptions (RIME) and the pediatric inflammatory multisystem syndrome (PIMS). In addition, atypical manifestations of Gianotti-Crosti syndrome and hand, foot, and mouth disease are discussed.
Dermatological diseases are among the most common travel-associated diseases. In particular, viral infections not only with tropical and subtropical pathogens, but also with viruses common in Germany, which are often acc...Dermatological diseases are among the most common travel-associated diseases. In particular, viral infections not only with tropical and subtropical pathogens, but also with viruses common in Germany, which are often accompanied by skin rashes and general symptoms, are of great importance. In addition to an accurate travel history and possible risk exposures, epidemiological information on country-specific risks in combination with molecular and serological analyses is helpful in making the correct diagnosis. This article provides an overview of important virus-induced exanthems in returned travellers.
Venous ulcus cruris is usually a chronic disease and an extreme burden for patients and their families. An analysis based on a random statutory health insurance sample of the AOK Hessen/KV Hessen estimated the number of...Venous ulcus cruris is usually a chronic disease and an extreme burden for patients and their families. An analysis based on a random statutory health insurance sample of the AOK Hessen/KV Hessen estimated the number of affected people to be 400,000 in Germany. A venous ulcus cruris is always caused by an underlying chronic venous insufficiency (CVI). A spontaneous healing of this chronic disease without treatment is not to be expected. The conservative treatment includes an adequate compression treatment and exudate management. Surgical treatment is based on three pillars: an open surgical or endovenous approach to resolve the pathological venous reflux, uIcer surgery and in rare cases the various procedures of fascia surgery as well as defect coverage by a combination of negative pressure wound therapy and skin transplantation.
Alopecia areata is a common condition that leads to nonscarring hair loss. It can be severe and lead to complete hair loss of the scalp or the whole body. In more severe cases, the disease can be very recalcitrant to tre...Alopecia areata is a common condition that leads to nonscarring hair loss. It can be severe and lead to complete hair loss of the scalp or the whole body. In more severe cases, the disease can be very recalcitrant to treatment and result in a significant impairment of the quality of life of the patients. In recent years, there is increasing evidence on the potential of janus kinase (JAK) inhibitors to treat alopecia areata. In the beginning, this was based on case reports, but later, this potential was further established by large case series and in vitro and in vivo data. It is on this basis that JAK inhibitors are being tested specifically for the treatment of alopecia areata in phase 3, randomized, placebo-controlled trials, raising hopes that there will soon be a JAK inhibitor approved by the US Food and Drug Administration (FDA) for the treatment of alopecia areata. Here we provide a review of the information available on the use of JAK inhibitors to treat alopecia areata, and the potential benefits and risks of this class of medications.
Of the 15 currently known human polyomaviruses (HPyV), eight have been found on healthy skin. Merkel cell polyomavirus (MCPyV), HPyV6, HPyV7, and to a lesser extent Saint Louis polyomavirus (STLPyV) are considered part o...Of the 15 currently known human polyomaviruses (HPyV), eight have been found on healthy skin. Merkel cell polyomavirus (MCPyV), HPyV6, HPyV7, and to a lesser extent Saint Louis polyomavirus (STLPyV) are considered part of the human cutaneous virome. The most important cutaneous polyomavirus, MCPyV, causes the majority of Merkel cell carcinomas (MCC). MCC is a rare but very aggressive malignant skin tumor that affects both immunocompetent and immunosuppressed patients. A steady increase in incidence rates of this skin tumor has been observed in recent decades. MCC occurs primarily on sunlight-exposed skin of fair-skinned individuals. Risk factors for MCC development include immunosuppression and advanced age. In immunocompromised individuals, primary infection with trichodysplasia spinulosa-associated polyomavirus (TSPyV) can cause the very rare skin disease trichodysplasia spinulosa (TS). Keratin spines (spicules), mainly in the center of the face, clinically characterize this disease. Skin lesions associated with further HPyV have been described exclusively in immunocompromised individuals. For HPyV6 and HPyV7, cases of epithelial proliferation and pruritic dyskeratotic dermatitis have been published. HPyV9 and New Jersey polyomavirus (NJPyV-13) were each found in different skin lesions of individual patients. The role of these polyomaviruses in the development of the skin lesions is still unclear.
BACKGROUND: Herpes zoster (HZ) is a common skin disease resulting from a regionally limited reactivation of a latent infection with the varicella zoster virus (VZV). Despite its usually self-limiting course, HZ is associ...BACKGROUND: Herpes zoster (HZ) is a common skin disease resulting from a regionally limited reactivation of a latent infection with the varicella zoster virus (VZV). Despite its usually self-limiting course, HZ is associated with a considerable individual and public health burden of disease, particularly due to its high rate of postherpetic neuralgia (PHN). OBJECTIVES: To improve knowledge of the current recommendations for the prevention, diagnosis and treatment. MATERIALS AND METHODS: Narrative review and summary of current guideline recommendations. RESULTS: In Germany, the recombinant VZV subunit zoster vaccine is recommended for all adults of 60+ years and for immunocompromised persons of 50+ years. The diagnosis of HZ is clinical; in case of uncertainty, laboratory investigations can help confirm the diagnosis. For patients with HZ ophthalmicus, HZ oticus or neurological complications, an interdisciplinary approach is advantageous. Antiviral treatment should be started as early as possible; various factors, including the duration and location of the disease, the patient's age and signs of a complicated course, serve to determine the indication to initiate an antiviral medication. The choice of the appropriate treatment depends, among other factors, on the intravenous availability, comorbidities and intake preferences. Early and sufficient analgesic treatment according to the WHO pain ladder and, if required, with anticonvulsant adjuvants is necessary to treat acute pain and to reduce the risk for PHN. CONCLUSION: Implementation of the current recommendations for the prevention, diagnosis and treatment of HZ and PHN is important to reduce the high burden of disease and improve quality of life of the patients.
Coronavirus disease 2019 (COVID-19) is a systemic disease induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that frequently presents with skin manifestations. The five most common skin lesions are p...Coronavirus disease 2019 (COVID-19) is a systemic disease induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that frequently presents with skin manifestations. The five most common skin lesions are pseudo-chilblain and maculopapular, urticarial, vesicular, and livedo/necrotizing skin lesions. These skin lesions are of diagnostic and prognostic relevance. For example, in children, typical skin lesions may indicate a life-threatening inflammatory syndrome, which rarely occurs after corona infection. Skin lesions have also been described after COVID-19 vaccination. These usually show an uncomplicated, self-limiting course and therefore do not represent a contraindication for completing the vaccination status in the vast majority of cases.
The incidence of nonmelanoma skin cancer, the most common cancer in humans, continues to rise. The development of precancerous actinic keratoses and cutaneous squamous cell carcinoma (cSCC) is associated with infection w...The incidence of nonmelanoma skin cancer, the most common cancer in humans, continues to rise. The development of precancerous actinic keratoses and cutaneous squamous cell carcinoma (cSCC) is associated with infection with human papillomavirus (HPV) of genus beta (betaHPV). Persistent betaHPV infections in immunocompetent individuals are generally very well controlled by the immune system and largely asymptomatic. However, immunosuppression results in high levels of betaHPV in the skin and consequently increased viral oncoprotein activity, which in turn leads to a significantly increased risk for skin cancer. However, even in immunocompetent individuals, the risk of cSCC increases with age as a result of accumulated UV-induced DNA damage in the skin. In these patients, the mechanism of betaHPV-dependent carcinogenesis seems to be different from that observed in immunocompromised patients. The underlying mechanism of oncogenesis in immunocompetent patients is currently less well understood. This review summarizes the current research data, which provide compelling evidence that cutaneous papillomaviruses, particularly in interaction with UV light, promote skin carcinogenesis via a "hit-and-run" mechanism by enhancing the genotoxic effects of UV light in the initial phases of this multistep process. Furthermore, an overview of novel vaccination strategies against papillomaviruses that are currently tested in clinical trials is provided, which could significantly improve the treatment options for high-risk patients in the future.
Digital health applications represent a new form of care. The basis for the approval of digital health applications is the Digital Healthcare Act. In order to be included in the directory, the digital health applications...Digital health applications represent a new form of care. The basis for the approval of digital health applications is the Digital Healthcare Act. In order to be included in the directory, the digital health applications must undergo an extensive evaluation process by the Federal Institute for Drugs and Medical Devices. The focus is on proving added value for care, but also on the technical aspects. This strictly differentiates the digital health applications from the health apps. Cutting-edge apps enable a simple output of collected data to make doctor-patient interactions efficient. Appropriate remuneration and education could increase the acceptance by the medical profession and thus accelerate implementation; however, such instruments and incentives are not currently provided for in the system.
BACKGROUND AND OBJECTIVES: Microsurgical autologous hair transplantation, when performed as follicular unit transplantation, may permanently and naturally improve advanced androgenetic alopecia in men and women and also...BACKGROUND AND OBJECTIVES: Microsurgical autologous hair transplantation, when performed as follicular unit transplantation, may permanently and naturally improve advanced androgenetic alopecia in men and women and also non-active scarring alopecias. MATERIALS, METHODS AND RESULTS: Sufficient donor hair and realistic patient expectations as well as an individual surgical planning of the hair distribution are crucial prerequisites for a sustainable hair restoration. They should be determined and evaluated during a personal pre-examination and consultation with the hair surgeon. Natural results can be achieved by transplanting up to several thousands of follicular units with high densities into small micro-slits. This technique also allows for increasing the hair density without injuring surrounding original pre-existing hairs. In progressive, early or advanced androgenetic alopecia, additional medical therapy is highly recommended to stabilize the condition. Otherwise, depending on supply and demand of donor hair, only a partial hair restoration can be achieved with a satisfying density. CONCLUSIONS: Since hair transplantation requires a precise sequence of surgical steps and careful handling of the tiny grafts, the skills and experience of the hair surgeon and his or her team are crucial. The medical risks of an assembly-line way of performing this surgery by non-licensed, non-physician staff, as reported from national clinics and medical tourism, should not be underestimated. The German Association of Hair Surgeons and the International Society of Hair Restoration Surgery offer patient information, as well as continuous medical education and guidelines for interested physicians to ensure the highest quality standard of care.
The number of patients presenting with frontal fibrosing alopecia (FAA) is increasing not only in hair clinics. The recognition of the peculiar clinical pattern and associated symptoms is an important prerequisite to ens...The number of patients presenting with frontal fibrosing alopecia (FAA) is increasing not only in hair clinics. The recognition of the peculiar clinical pattern and associated symptoms is an important prerequisite to ensure adequate counseling and therapeutic management of the patients. Experimental studies and a range of case series give first insights into the pathogenesis, possible trigger factors, clinical course of disease and treatment options. The clinical spectrum of FFA extends beyond the typical recession of the frontal hair line initially observed in postmenopausal women. Younger women, men and rarely adolescents may also be affected. Band-like extension to the occiput, diffuse bitemporal hair thinning, eyebrow and body hair involvement as well as facial papules are part of the clinical spectrum. Similar to lichen planopilaris, inflammation and fibrosis with involvement of the stem cell region result in permanent loss of hair follicles. Which additional factors contribute to the characteristic pattern remains to be elucidated. Currently, therapeutic management largely relies on anti-inflammatory treatment with combined topical, intralesional and systemic administration depending on disease activity. The chronic progressive course, sometimes even in the absence of pronounced inflammation remains a challenge for both the affected individuals and the treating physicians. Controlled studies are required to develop evidence-based recommendations and to explore novel treatment strategies.
BACKGROUND: Platelet rich plasma (PRP) injections have been reported to be an effective and low side effect treatment for androgenetic alopecia (AGA). However, robust data concerning this therapy are lacking. AIM: We add...BACKGROUND: Platelet rich plasma (PRP) injections have been reported to be an effective and low side effect treatment for androgenetic alopecia (AGA). However, robust data concerning this therapy are lacking. AIM: We address some potentially critical aspects of PRP treatment and give some reasons why study results may differ. MATERIALS AND METHODS: In the following review we give a brief overview of the current literature and compare the results of the various trials. RESULTS: In recent years, several clinical trials have been published that have revealed different but rather positive results, which offers hope to those affected by AGA and to physicians as well. However, the results were observed in methodologically weak trials and data from randomized controlled trials are lacking. Differences in trial designs have made it difficult to draw concrete conclusions about its clinical efficacy. Even in the studies where no hair-growth-promoting effect could be observed, the majority of subjects were at least satisfied with the result. The combination of several treatment approaches seems to lead to optimal improvement in hair growth. CONCLUSION: There are many factors that could have influenced the results of the different studies. The results were observed in methodologically weak studies, giving reason for caution when drawing conclusions. Nevertheless, the majority of the subjects were at least satisfied with the result. Given the current low level of evidence, PRP treatments need to be further investigated in larger studies.
The mRNA-1273 vaccine against SARS-CoV‑2 was approved in Europe in early 2021. Meanwhile, there are a number of case reports of delayed local reactions after vaccination ("COVID arm"). In these reports, superficial lymph...The mRNA-1273 vaccine against SARS-CoV‑2 was approved in Europe in early 2021. Meanwhile, there are a number of case reports of delayed local reactions after vaccination ("COVID arm"). In these reports, superficial lymphocytic infiltrates were described, but no involvement of the deep dermis or subcutis. We report the case of a healthy 32-year-old man with involvement of the deep dermis and subcutis after vaccination with mRNA-1273. This case is the first to show a delayed T‑cell mediated reaction with a deep pattern of reaction, with the dermal perivascular and periadnexal infiltrate extending from the papillary dermis into the deep reticular dermis and subcutis. The infiltrate was predominantly lymphocytic with an admixture of histiocytes and neutrophil granulocytes, scattered mast cells and sparse eosinophil granulocytes.