We present a case of walnut allergy in a 24-year-old man. The allergy work up revealed sensitization to walnut including a positive skin prick test and a high value of walnut-specific IgEs. The patient showed an anaphyla...We present a case of walnut allergy in a 24-year-old man. The allergy work up revealed sensitization to walnut including a positive skin prick test and a high value of walnut-specific IgEs. The patient showed an anaphylactic reaction during the double blind placebo-controlled food challenge, to a cumulative dose of 3.723 g of walnut protein. The oral food challenge resulted in counseling regarding strict walnut avoidance and optimization of the emergency management. At follow-up the patient reported that having adhered to the recommended dietary measures resulted in no further allergic reactions.
Acute skin and soft tissue infections are among the most frequent infections in medicine. There is a broad spectrum including simple local infections as well as severe and life-threatening diseases. Along with Staphyloco...Acute skin and soft tissue infections are among the most frequent infections in medicine. There is a broad spectrum including simple local infections as well as severe and life-threatening diseases. Along with Staphylococcus aureus, group A Streptococci are mainly responsible for these illnesses. The therapeutic approach ranges from antiseptic local treatments to administering systemic antibiotics or emergency surgery. Treating physicians often face challenges when presented with soft tissue infections due to a great discrepancy between the first impression of the disease compared to a possibly quick progression as well as the wide range of sometimes confusing historic terms and definitions being used in the English and German language, for instance pyoderma, erysipelas or phlegmon. A recently more popular collective term emphasized by clinical trials is "acute bacterial skin and skin structure infections" (ABSSSI).
Benign skin tumors represent a wide category of diseases. The diagnosis is usually provided by the clinical aspect and the patient history. The pathological examination is not always considered necessary and in most case...Benign skin tumors represent a wide category of diseases. The diagnosis is usually provided by the clinical aspect and the patient history. The pathological examination is not always considered necessary and in most cases the treatment is removal of the lesion by cryotherapy, electrosurgery or laser ablation. Deep phenotyping, including genetic and epigenetic findings, provided the basis of a new understanding of the pathogenetic mechanisms. Some benign skin tumors can be part of syndromes and the dermatologist should be aware of the extracutaneous associations defining these rare disorders: epidermal nevus can be associated with vascular malformations; nevus sebaceous can be associated with cerebral, ocular, and skeletal defects; nevus Becker is associated with cerebral, ocular, and skeletal defects; pilomatricomas appear earlier than colorectal cancer in Gardner's syndrome; tuberous sclerosis complex can associate not only central nervous system lesions but also pulmonary, cardiac or renal manifestations.
The nomenclature used today in wound treatment varies widely across different disciplines and professions. Therefore, it is a mission of the professional association Initiative Chronische Wunde (ICW) e. V. to exactly and...The nomenclature used today in wound treatment varies widely across different disciplines and professions. Therefore, it is a mission of the professional association Initiative Chronische Wunde (ICW) e. V. to exactly and comprehensibly describe terms that were previously unclear. Therefore, the experts of the ICW defined in a consensus procedure debridement of chronic wounds as the removal of adherent, dead tissue, scabs or foreign bodies from wounds. There are various therapy options for this, which can be differentiated into autolytic, biosurgical, mechanical, osmotic, proteolytic/enzymatic and technical debridement. In the case of surgical debridement, a distinction is also made between sharp debridements that can usually be performed on an outpatient basis, such as minor surgical procedures, and surgical debridements with adequate anaesthesia in an operating theatre. Wound irrigation is defined by the ICW as the removal of non-adherent components on wounds with sterile solutions. Debridement and/or wound irrigation are often the first step in phase-appropriate modern wound treatment. Several methods are suitable for use in a combined or successive therapy. When deciding which therapeutic option to use, a number of individually different factors should be taken into account, depending on the patients to be treated but also on the therapists. The final individual decision for a method should be made together with the patient in each case and then adequately documented.
BACKGROUND: Health-related quality of life is negatively affected in patients with food allergies. AIM: Analysis of health-related quality of life of adults allergic to tree nuts or peanuts. METHODS: Health-related quali...BACKGROUND: Health-related quality of life is negatively affected in patients with food allergies. AIM: Analysis of health-related quality of life of adults allergic to tree nuts or peanuts. METHODS: Health-related quality of life was analysed via the Food Allergy Quality of Life Questionnaire - Adult Form (FAQLQ-AF) and the Short Form 12 (SF12) questionnaire. In addition, a diagnostic workup including a detailed patient history, skin prick test and analysis of specific IgE was performed. An oral food challenge was offered to all patients. RESULTS: Food allergic patients (n = 63) reported an average burden of 3.91 ± 1.41 points on the FAQLQ-AF and 3.31 ± 1.03 points on the Food Allergy Independent Measure (FAIM), a measure for the perceived disease severity. A higher mean FAIM score was the most important predictor of higher results (worse quality of life) in the FAQLQ-AF. The SF12 questionnaire was not able to discriminate between food allergic patients and healthy controls (n = 16). CONCLUSION: A tree nut and/or peanut allergy was perceived as an impairment of health-related quality of life, which is directly associated with the perceived severity of disease. Disease-specific quality of life questionnaires can capture the burden associated with peanuts or tree nuts allergies.
Patients with a variety of dermatologic conditions, ranging from mild to life-threatening course of disease, present to the dermatological emergency service. The article provides an overview of prevalent conditions and r...Patients with a variety of dermatologic conditions, ranging from mild to life-threatening course of disease, present to the dermatological emergency service. The article provides an overview of prevalent conditions and recommendations for diagnosis and treatment according to guidelines. Major acute allergic diseases such as anaphylaxis, urticaria, angioedema and cutaneous drug reactions are discussed. In the field of infectious skin diseases, herpes zoster and erysipelas are common reasons for dermatological consultation. In recent years, scabies has reemerged. Educating patients properly about scabies management can prevent further treatment failures. Finally, the article focuses on sexually transmitted infections including urogenital gonorrhea and chlamydia.
BACKGROUND: The advantages and disadvantages of the nationwide skin cancer screening which was introduced in 2008 are regularly discussed. OBJECTIVES: Do missed skin cancer screenings change the tumor depths? METHODS: Ev...BACKGROUND: The advantages and disadvantages of the nationwide skin cancer screening which was introduced in 2008 are regularly discussed. OBJECTIVES: Do missed skin cancer screenings change the tumor depths? METHODS: Evaluation and analysis of office data from the second quarters of 2019, 2020 and 2021 were compared using the one-way analysis of variance (ANOVA) with Welch's F test. RESULTS: There was a significant increase in the tumor thickness in squamous cell carcinoma and basal cell carcinoma, while there was only a tendency due to the small amount of data available for malignant melanoma. CONCLUSIONS: The results of the analysis emphasize the importance of the skin cancer screening as a method of early detection and reduction of mutilating operations and expensive immunotherapies by the prompt detection of malignant tumors.
Benign cutaneous vascular and cutaneous neoplasms arising from muscle or adipose tissue are rare. Their definition and classification are still controversially discussed. Histopathological and immunohistochemical studies...Benign cutaneous vascular and cutaneous neoplasms arising from muscle or adipose tissue are rare. Their definition and classification are still controversially discussed. Histopathological and immunohistochemical studies, together with the new genetic tests, contribute significantly to the correct description of the various benign neoplasms of cutaneous origin. Clarifying whether a lesion is benign is fundamental for prognosis and therapeutic management. In most cases, surgical excision is the treatment of choice. Dermatologists should be familiar with the classifications of the most common benign cutaneous neoplasms of vascular, muscular, and adipose tissue and be able to recommend the procedures currently used for an accurate diagnosis. Ensuring that a lesion is benign and a good surgical outcome are essential for the patient.
There are many different types of skin neoplasms in children and most are benign. Dermatologists should be able to differentiate between the various types of benign skin neoplasms and be able to recommend optimal treatme...There are many different types of skin neoplasms in children and most are benign. Dermatologists should be able to differentiate between the various types of benign skin neoplasms and be able to recommend optimal treatment to concerned patients. Surgical removal of benign skin neoplasms is often the only treatment option. The aim of this paper is to provide a general overview of epidermal lesions (e.g., inflammatory linear verrucous epidermal nevus [ILVEN], nevus sebaceous), tumors of the epidermal appendages (e.g. pilomatrixoma), cutaneous neoplasms (e.g. angiofibroma), fibromatoses (e.g., knuckle pads), tumors comprised of fat, muscle, or bone tissue (e.g., osteoma cutis, subungual exostosis), epidermal cysts and pseudocysts, and pathologic fibrosis reactions after dermal injury (keloid). Scientific data are scarce and only in the last decade has it been possible to perform histopathological examinations and genetic studies together with detailed phenotyping to gain new understanding of the pathogenetic mechanisms.
Metabolic reprogramming mediated by hypoxia-inducible factors and its downstream targets plays a crucial role in many human malignancies. Excessive proliferation of tumor cells under hypoxic conditions leads to metabolic...Metabolic reprogramming mediated by hypoxia-inducible factors and its downstream targets plays a crucial role in many human malignancies. Excessive proliferation of tumor cells under hypoxic conditions leads to metabolic reprogramming and altered gene expression enabling tumors to adapt to their hypoxic environment. Here we analyzed the metabolic signatures of primary cutaneous melanomas with positive and negative sentinel node status in order to evaluate potential differences in their metabolic signature. We found a positive correlation of the expression of glucose transporter 1 (GLUT-1) with tumor thickness and ulceration in all melanomas with subgroup analyses as well as in the subgroup with a negative sentinel node. Furthermore, the expression of vascular endothelial growth factor (VEGF) was positively correlated with the presence of ulceration in melanomas with positive sentinel node.
Driven by the approval of new targeted therapies, significant progress has been made in recent years in the clinical management of cutaneous T‑cell lymphomas. Although there are no curative treatment options for cutaneou...Driven by the approval of new targeted therapies, significant progress has been made in recent years in the clinical management of cutaneous T‑cell lymphomas. Although there are no curative treatment options for cutaneous T‑cell lymphomas, response rates are often encouraging, in particular when using combination therapies. The decision for the appropriate form of treatment depends on the specific diagnosis, disease stage, and the history of prior therapies. This article provides a comprehensive overview of current treatment options in mycosis fungoides and Sézary syndrome, based on the recently published, revised German S2k guidelines on cutaneous lymphomas (update 2021). In addition, we present promising, yet-to-be-approved therapies that at least in part can be already used off-label in clinical practice today.
Benign cutaneous neoplasms are well defined histologically with absence of all of the following features: architectural disorder, necrosis, cytologic atypia, and atypical mitotic figures. The clinical appearance of any n...Benign cutaneous neoplasms are well defined histologically with absence of all of the following features: architectural disorder, necrosis, cytologic atypia, and atypical mitotic figures. The clinical appearance of any neoplasm is a very important diagnostic factor. The classification of the lesion determines the therapeutic options. This article summarizes the clinical aspects and treatments of the most common benign tumors of the epidermis and its appendages.
Excisions and biopsies are firmly anchored in everyday dermatology. The biopsy, excision or diagnostic-therapeutic confirmation of the clinical diagnosis of neoplasms or inflammatory diseases is decisive for the dermatop...Excisions and biopsies are firmly anchored in everyday dermatology. The biopsy, excision or diagnostic-therapeutic confirmation of the clinical diagnosis of neoplasms or inflammatory diseases is decisive for the dermatopathological diagnosis of tissue samples. Dermatopathology, however, is not a magic box into which a tissue sample can be placed without comment or information and receive-within 24 h at the latest-a complete, high-quality diagnosis. The present article describes problems, hurdles, and challenges in everyday dermatopathology that occur on the way to the microscope, even before the actual dermatopathological diagnosis takes place.