We present a clinical case of a patient with acutely exacerbated erythrodermic psoriasis vulgaris after symptomatic infection with SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2). Various factors are already...We present a clinical case of a patient with acutely exacerbated erythrodermic psoriasis vulgaris after symptomatic infection with SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2). Various factors are already known that can lead to an exacerbation of psoriasis, such as drugs or infections with, for example, streptococcus. An association between psoriasis and an infection with SARS-CoV‑2 has been described so far in individual case reports, in which, however, drug treatment with for example hydroxychloroquine, a known trigger of psoriasis, often took place. Later cases of exacerbation of psoriasis, partly as pustular psoriasis have been published also without drug induction. However we present for the first time a case of erythrodermic psoriasis triggered by COVID-19 (coronavirus disease 2019) without an obvious drug trigger.
The legal basis for describing the regional care situation is based on the adjusted supply rate of the 'demand planning guideline'. However, it provides only limited information about the accessibility of medical care wh...The legal basis for describing the regional care situation is based on the adjusted supply rate of the 'demand planning guideline'. However, it provides only limited information about the accessibility of medical care which is crucial for the reality of patients' lives. The aim of this review is to present geographic approaches that spatially measure access to dermatological care in its physical and digital dimension. Here, on the one hand, the classical geographic parameter 'accessibility' is addressed, and on the other hand, data from the Federal Ministry of Transport and Digital Infrastructure (BMVI) on broadband coverage are presented as access parameters of teledermatological applications. In addition to the methodological approach, limitations and potentials in the interpretation of the results, minimum standards are also considered. The access parameters presented here make it possible to investigate spatial disparities and to present them clearly via cartographic representations. While the example of accessibility with a car shows almost area-wide access to the nearest dermatology practice (≤ 30 min), investigations on public transport accessibility reveal rather heterogeneous accessibility. Particularly in the identification of 'dual care gaps', sub-areas with poor physical and digital accessibility, these approaches could support and advance the application of alternative care models. However, the approaches presented here focus on potential accessibility. Further dimensions on actual physician utilisation or availability-also with regard to minimum standards-should be the subject of future research.
The association between geographic and medical aspects is a well-known phenomenon, which also occurs in dermatological research. This article reviews the field of health geography, the history of the association between...The association between geographic and medical aspects is a well-known phenomenon, which also occurs in dermatological research. This article reviews the field of health geography, the history of the association between spatial location and health, and focuses on current areas of research. Research focusing on explaining regional variations in health refer to individual aspects and needs, population factors, environmental factors, and health care delivery structures in specific regions, as well as the interaction between them. Regional healthcare research is primarily concerned with access to health services and on the utilisation of those services. Methodologically, the analysis of geodata and the application of geographic information systems (GIS) and spatial modelling play a major role in this field. Dermatological research and dermatological practice can benefit from the findings of the regional analysis of access, utilisation, and variations in order to obtain a more detailed picture of care and thus to optimise care.
BACKGROUND: Studies show a spatial variation in skin cancer frequencies, but the causes have not been fully understood. When analysing spatial patterns and correlations, different approaches need to be considered, as the...BACKGROUND: Studies show a spatial variation in skin cancer frequencies, but the causes have not been fully understood. When analysing spatial patterns and correlations, different approaches need to be considered, as the data have special features due to their spatial structure. AIM OF THE STUDY: Why the spatial consideration of skin cancer frequencies is important at all, and which methods of analysis are useful is considered in more detail in this article. The article provides an introduction and overview of statistical methods that are important for the spatial analysis of skin cancer frequencies. MATERIALS AND METHODS: At first it is shown which descriptive methods, such as statistical smoothing, can be applied. Next, spatial cluster and regression analyses will be discussed. Testing for spatial autocorrelation will be considered. RESULTS: In particular, the spatial dependence of the data on neighbouring regions, which if ignored can lead to biased estimates, is of particular importance in the analysis of spatial data and requires special spatial analysis methods. DISCUSSION: This article provides an introduction and overview of statistical methods relevant to the spatial analysis of skin cancers.
BACKGROUND: The aim of health geographical research is to identify regional variations in health and care and their causes. Regional differences are also evident in skin cancer incidence, but knowledge about small-scale,...BACKGROUND: The aim of health geographical research is to identify regional variations in health and care and their causes. Regional differences are also evident in skin cancer incidence, but knowledge about small-scale, inner-city variations is not yet available. OBJECTIVES: How can the inner-city variations in skin cancer incidence in Hamburg, Germany, be described and how can initial indications of their causes be identified? METHODS: The study area is the city of Hamburg and the data source is the Hamburg City Health Study with N = 10,000 persons aged 45-74 years. Descriptive methods are used to characterise the regional variation in skin cancer prevalence adjusted for age and sex. A correlation analysis provides information on possible associations with sociodemographic conditions in the city districts and district clusters. RESULTS: Skin cancer prevalence varies within the urban area with high prevalences (maximum 13.8%) in the north-east and south-west of Hamburg. Weak to medium correlations with selected sociodemographic variables are found. For example, the higher the living space per inhabitant (r = 0.35), the higher the skin cancer prevalence in the district. CONCLUSIONS: The Hamburg City Health Study shows regional and inner-city disparities and possible associations between skin cancer prevalence and local sociodemographic conditions. However, further and methodologically more extensive studies are necessary in order to make detailed statements.
BACKGROUND: Psoriasis (Pso) and atopic dermatitis (AD) are chronic skin diseases that result in significant physical and psychological impairment, financial burden, and loss of quality of life. According to previous data...BACKGROUND: Psoriasis (Pso) and atopic dermatitis (AD) are chronic skin diseases that result in significant physical and psychological impairment, financial burden, and loss of quality of life. According to previous data, there are regional differences in healthcare. OBJECTIVES: The aim was to analyse the epidemiology as well as the treatment of insured people with Pso and AD in Germany in a regional comparison. METHODS: Data of the insurance company Techniker Krankenkasse for the year 2019 regarding treatment prevalences as well as drug prescriptions on the regional level for all physicians were examined. RESULTS: In 2019 the overall prevalence of Pso was 2.5% (about 2 million insured people in Germany) and AD was 4.2% (about 3.6 million insured people). In Pso, new guideline-compliant drugs were frequently utilised, yet systemic glucocorticosteroids (GCS) were still disproportionally prescribed. Regionally, there were pronounced disparities with higher prescription rates of the new drugs in the north and east. Insured people with AD most frequently received topical GCS (approx. 88%), of which most were class III (66%), and significantly less frequently calcineurin inhibitors (< 10%), which also conform to guidelines. Systemically, GCS were by far most commonly used (about 25% of all insured people with drug prescriptions). Dupilumab, the only long-term drug approved in 2019, was very rarely prescribed, accounting for less than 1%. Again, large regional differences similar to Pso were found. CONCLUSION: Pso and AD show relevant disparities and gaps in drug care in the regional comparison despite uniform national guidelines and patient needs. The barriers to appropriate modern pharmaceuticals need to be clarified and mitigated.
BACKGROUND: Limited timely, cost-effective, and regional availability of healthcare data is considered one of the limiting factors for timely analyses in the field of health services research and thus for healthcare deli...BACKGROUND: Limited timely, cost-effective, and regional availability of healthcare data is considered one of the limiting factors for timely analyses in the field of health services research and thus for healthcare delivery to the general population. Thus, Internet search engine analyses are coming into focus in this context. OBJECTIVES: What contribution can data on the volume of Internet searches for various diseases make to the health care of the German population? Where is the potential and where are the limitations? METHODS: A review of the current literature and a selective overview of Internet search engine analyses of dermatological, allergological, and infectious diseases published in the last 4 years in Germany were performed. RESULTS: By analyzing web search data, temporal developments such as seasonality, months with the highest interest, and geographical differences can be mapped at the national, state (Bundesländer), and city level and major points of interest (e.g., skin cancer of the eye or anal itching) regarding a certain health topic can be identified. In addition, some studies were able to show correlations between search volume and external factors (e.g., temperature, care structure) and to registered cases (e.g., skin cancer, Lyme disease). CONCLUSION: Web search data, given the limitations noted, are able to directly provide spatiotemporal mapping regarding the needs of the Internet-using population. They are particularly useful in situations where traditional health data are limited or unavailable.
Since the first report of allergen-specific immunotherapy (AIT) by Noon et al. 110 years ago, a multitude of clinical and in vitro studies have been performed to identify the effects of the only curative treatment for al...Since the first report of allergen-specific immunotherapy (AIT) by Noon et al. 110 years ago, a multitude of clinical and in vitro studies have been performed to identify the effects of the only curative treatment for allergies. However, in atopic dermatitis (AD), one of the most prevalent skin diseases, it is rarely used, despite evidence showing that aeroallergens can contribute to disease exacerbation. This review gives an overview about the studies, meta-analyses, and current guideline recommendations regarding AIT in AD patients. There is a distinct heterogeneity in the study designs, different allergens and application forms, endpoints and patient cohorts, which hinders the comparability of studies. Several trials depict a beneficial effect of AIT in AD patients suggesting that at least a subgroup of patients can benefit from treatment. Further developments in the field of AIT may advocate broader use in AD patients.
BACKGROUND: In recent years, the introduction of the E‑Health Act and the relaxation of the ban on remote treatment has improved the framework for telemedicine in Germany. OBJECTIVES: The aim of this article is to presen...BACKGROUND: In recent years, the introduction of the E‑Health Act and the relaxation of the ban on remote treatment has improved the framework for telemedicine in Germany. OBJECTIVES: The aim of this article is to present an overview of the evidence of different areas of application for teledermatology. MATERIALS AND METHODS: A narrative review of national and international studies and projects on the use of teledermatology for diagnosis, monitoring of diseases, triage between primary care physicians (PCPs) and dermatologists, and its use in facilities with reduced organizational and/or geographical access to specialist care was conducted. RESULTS: Diagnostic applications allow teledermatological assessment in a large proportion of cases, with high concordance of diagnosis and patient satisfaction. For the monitoring of patients, the majority of studies demonstrated no difference in effectiveness between on-site and remote consultation, while patients are spared travel distance and waiting time. For programs enabling triage most of the patients with dermatologic conditions were able to remain with the PCP, while acute patients requiring direct referral to a dermatologist were identified. In special facilities, such as prisons, dermatological teleconsultations are successfully utilized. CONCLUSION: An adequate framework and promising evidence for the use of teledermatology exist. The areas of application are described in detail within the German S2k guideline for teledermatology. However, there is a potential risk for decreased access to telemedicine services for certain population groups.
Optoacoustic imaging (OAB) has developed steadily in recent years. By means of partly pulsed light, in a wide variety of wavelengths, different colour carriers (chromophores) are excited to form sound waves. These in tur...Optoacoustic imaging (OAB) has developed steadily in recent years. By means of partly pulsed light, in a wide variety of wavelengths, different colour carriers (chromophores) are excited to form sound waves. These in turn are detected by the newly developed systems and converted into three-dimensional images by means of various algorithms. The technique is characterised by a good ratio between contrast and penetration depth and can create macro-, meso- and microscopic images due to its scalability. Optoacoustic macroscopy broadly irradiates the area to be examined with laser light. This can produce images with a high penetration depth, but only with a moderate resolution. Clinically interesting fields of application are for example the results of sentinel lymph nodes (SLNs) examined ex vivo using macroscopic optoacoustics. Due to the ability of OAB to visualise melanin, the detection rate of metastases was superior to previous methods, but not to histology. The ability to visualise dermal and epidermal structures, especially vessels, with good resolution makes optoacoustic mesoscopy useful in the examination of inflammatory skin diseases and could contribute to the verification of the success of therapy, e.g., with biologics for psoriasis vulgaris or atopic eczema (AE), in the future. Optoacoustic microscopy, which has so far been limited mainly to preclinical in vivo research, could be used in the future to detect even finer vascular structures and their changes. The clinical possibilities of OAB seem to be of great benefit and continue to be the subject of intensive research.
BACKGROUND: Visual data, such as clinical photographs or pictures from imaging examination methods, such as ex vivo confocal laser scanning microscopy (CLSM), are particularly suitable for machine learning techniques. OB...BACKGROUND: Visual data, such as clinical photographs or pictures from imaging examination methods, such as ex vivo confocal laser scanning microscopy (CLSM), are particularly suitable for machine learning techniques. OBJECTIVES: The aim was to find out whether data have already been published on this innovative application in ex vivo CLSM and what potential challenges and limitations could arise. MATERIAL AND METHODS: Review of the literature and summary of current knowledge and personal experience on the use of artificial intelligence (AI) in ex vivo CLSM. RESULTS: Successful integration of digital hematoxylin-eosin-like staining has made ex vivo CLSM significantly more accessible for digital assessments. Several machine learning techniques have been developed to date in such a way that they have been able to identify malignant skin lesions on clinical photographs and pathological microscopic images with similar accuracy compared to experts, or even find visual patterns that have been overlooked by experts and that correlate with certain dermatological diseases. One study on the use of AI in ex vivo CLSM for automated tumor detection has been published to date. Several challenges and limitations can arise when using AI in ex vivo CLSM. CONCLUSIONS: The already digitized ex vivo CLSM, which was established for rapid section examination purposes, is a predestined method for the development and use of new applications with machine learning in the healthcare sector. The results of further studies on this topic are anticipated with great hope.
BACKGROUND: Ex vivo confocal laser scanning microscopy (CLSM) enables bedside histology and offers the surgeon a direct intraoperative tissue examination. OBJECTIVES: To determine whether this innovative, ultra-fast diag...BACKGROUND: Ex vivo confocal laser scanning microscopy (CLSM) enables bedside histology and offers the surgeon a direct intraoperative tissue examination. OBJECTIVES: To determine whether this innovative, ultra-fast diagnostic tool can be expanded beyond nonmelanoma skin cancer, particularly basal cell carcinoma, to other indications including melanocytic lesions and autoimmune diseases. MATERIALS AND METHODS: Review of literature and summary of the current knowledge and experience of the use of ex vivo CLSM in melanocytic lesions and in autoimmune diseases. RESULTS: Up to date experience of the use of ex vivo CLSM in melanocytic lesions and in autoimmune diseases is limited but promising. Current knowledge on melanocytic lesions in ex vivo CLSM and their examples together with classic ex vivo CLSM features are presented. Previous results on the use of ex vivo CLSM in autoimmune dermatoses are presented, and future application possibilities of ex vivo CLSM are discussed. CONCLUSIONS: The method is particularly suitable for the rapid examination of basal cell carcinomas during Mohs surgery but could also be used in the future for the intraoperative examination of melanocytic and autoimmune skin lesions.
Optical coherence tomography (OCT) has been able to establish itself in recent years not only in academic-scientific, but also in everyday dermatological practice. Its focus lies on epithelial tumors of the skin, which c...Optical coherence tomography (OCT) has been able to establish itself in recent years not only in academic-scientific, but also in everyday dermatological practice. Its focus lies on epithelial tumors of the skin, which can be diagnosed intuitively and within a few seconds. Thus, basal cell carcinomas, actinic keratoses, and different stages of field cancerization can be diagnosed and monitored for response to therapy or possible recurrence. This often helps to avoid invasive sample extraction. Recently, the field of OCT and its latest advancement, dynamic OCT (D-OCT), has been expanded to include non-oncologic dermatological diseases. This encompasses inflammatory dermatoses and the analysis of physiological skin parameters such as hydration. Thanks to automated vascular imaging and the measurement of objective parameters such as epidermal thickness, blood flow at depth, optical attenuation coefficient, and skin roughness, more and more characteristics of the skin can be studied in a noninvasive and standardized way. New potential areas of application are eczema, contact allergic dermatitis, psoriasis, rosacea, telangiectasia, acute and chronic wounds, melasma and nevus flammeus but also melanocytic lesions.
We report a case of a patient with erythema multiforme major following COVID-19 (coronavirus disease 2019) vaccination. Lesions on skin and mucous membranes developed 48 h after the second dose of the mRNA-vaccine BNT162...We report a case of a patient with erythema multiforme major following COVID-19 (coronavirus disease 2019) vaccination. Lesions on skin and mucous membranes developed 48 h after the second dose of the mRNA-vaccine BNT162b2 (Tozinameran, Comirnaty®). Under the application of external glucocorticoids complete resolution was achieved within 3 weeks.
Optical coherence tomography (OCT) and confocal laser microscopy (CLSM) are established non-invasive methods in clinical dermatological routine diagnosis. Whereas CLSM is especially useful to distinguish between nevi and...Optical coherence tomography (OCT) and confocal laser microscopy (CLSM) are established non-invasive methods in clinical dermatological routine diagnosis. Whereas CLSM is especially useful to distinguish between nevi and melanoma, OCT is suitable for the diagnosis and differentiation of non-melanoma skin cancer. Line-field confocal optical coherence tomography (LC-OCT) is a new innovative device, which has better cellular resolution than OCT and a higher penetration depth than CLSM. Similar to CLSM, LC-OCT also allows 3D images in real time to be taken. Therefore LC-OCT is very useful for the examination of skin lesions of all kinds, since it unites the features of CLSM and OCT.
Anaphylaxis is a suddenly occurring potentially life-threatening systemic allergic reaction. In childhood, food allergens play a major role but insect stings and drugs are also potential triggers. The symptoms appear in...Anaphylaxis is a suddenly occurring potentially life-threatening systemic allergic reaction. In childhood, food allergens play a major role but insect stings and drugs are also potential triggers. The symptoms appear in minutes up to few hours on the skin, airways, gastrointestinal tract and/or the cardiovascular system. Intramuscular adrenaline is the drug of first choice due to its rapid effectiveness and its low side effect potential. A detailed patient history and the determination of potential IgE antibodies must be carried out to identify the triggers. The register for anaphylaxis has improved knowledge on epidemiology. An education in anaphylaxis is useful for every patient as well as parents and caregivers. Allergen-specific immunotherapy is currently the only causal treatment option; however, at the present time it is only available for insect bites and peanut allergy.