Allergen immunotherapy (AIT) is-when allergen avoidance is not sufficient-the only causative therapy of IgE-mediated allergies against aeroallergenes and Hymenoptera venoms. Allergens can be administered by either subcut...Allergen immunotherapy (AIT) is-when allergen avoidance is not sufficient-the only causative therapy of IgE-mediated allergies against aeroallergenes and Hymenoptera venoms. Allergens can be administered by either subcutaneous injection (SCIT) or sublingual application (SLIT); furthermore, oral immunotherapy in food allergy was also recently approved. Besides correct indication (positive history and diagnostics of IgE-mediated allergy, insufficient allergen avoidance) particular attention has to be payed to potential contraindications and risks. Furthermore, unwanted side effects, which may be life-threatening, can occur. In the following, frequently asked questions (FAQs) and facts in regard to the decision-making process for the implementation as well as the risk management of AIT are discussed.
Allergen immunotherapy (AIT) is the only causal therapy of IgE-mediated allergies if allergen avoidance is not feasible. Already well established are subcutaneous (SCIT) and sublingual (SLIT) allergen application, and re...Allergen immunotherapy (AIT) is the only causal therapy of IgE-mediated allergies if allergen avoidance is not feasible. Already well established are subcutaneous (SCIT) and sublingual (SLIT) allergen application, and recently the first oral immunotherapy (OIT) for treating peanut allergy was approved. Interesting and promising new forms of allergen administration are intralymphatic (ILIT) and epicutaneous (EPIT) immunotherapy. Immunologic and clinical efficiency in terms of tolerance induction have been investigated in animal and clinical studies, including the first phase 3 studies. The findings as well as advantages and disadvantages, potential risks and challenges that still have to be addressed before routine clinical application can be envisioned will be comprehensively presented and discussed.
BACKGROUND: Actinic keratosis (AK) is an epithelial carcinoma in situ of the skin. There is a need for early treatment due to the risk of malignant transformation. In addition to being effective, the initial therapy in p...BACKGROUND: Actinic keratosis (AK) is an epithelial carcinoma in situ of the skin. There is a need for early treatment due to the risk of malignant transformation. In addition to being effective, the initial therapy in particular should be well tolerated and user-friendly. Potassium hydroxide (KOH) solution is already established as keratolytic treatment option for hyperkeratotic skin diseases such as mollusca contagiosa. MATERIALS AND METHODS: A prospective single-arm, multicentre medical device study (Treatment of AK with KOH, TAKKOH) was conducted to investigate the efficacy and safety of KOH 5% solution for the treatment of mild to moderate AK. Patients applied KOH solution twice daily for 14 days with a subsequent off-treatment phase of 14 days (≙ one treatment cycle) for a maximum of three treatment cycles or at least until treatment success was achieved. Treatment success, defined as complete remission (CR) of all AK lesions of a patient, was the primary objective. Secondary objectives included the evaluation of partial remission (PR), the number of AK lesions in remission, efficacy assessment by investigators and patients with a 6‑point grading system and several safety parameters. RESULT: In all, 73 patients were enrolled in the study. CR was achieved in 54.9% of patients, whereas PR was observed in 64.8% with a 69.9% reduction in lesion numbers. With respect to safety, 46.6% of the patients experienced adverse events. Most of these events (82.6%) were adverse reactions comprising exclusively short-lived and mild local skin reactions. CONCLUSIONS: The study provides an indication of the efficacy and safety of KOH 5% solution for the lesion-directed topical therapy of AK.
The basis of allergen immunotherapy (AIT) is the diagnosis of the eliciting allergen sources, which is a challenge, especially in the case of multiple sensitizations. Molecular allergy diagnostics can be of special help,...The basis of allergen immunotherapy (AIT) is the diagnosis of the eliciting allergen sources, which is a challenge, especially in the case of multiple sensitizations. Molecular allergy diagnostics can be of special help, since detection of "marker allergens", usually important major allergens, allows to distinguish between primary sensitization and cross-reactions. Thus, the indication and extract selection for AIT can be facilitated. While molecular diagnosis is particularly useful for double-sensitized hymenoptera venom and polysensitized pollen allergic patients, the benefit is probably lower in case of house dust mite allergy.
BACKGROUND: The goal was to report incidence, prevalence, and treatment patterns in adult atopic dermatitis (AD) patients in the German statutory health insurance system. PATIENT AND METHODS: Anonymized claims data were...BACKGROUND: The goal was to report incidence, prevalence, and treatment patterns in adult atopic dermatitis (AD) patients in the German statutory health insurance system. PATIENT AND METHODS: Anonymized claims data were evaluated at patient level for 3.3 million persons insured by six different statutory health insurance companies (SHI). Patients for whom the ICD-10 diagnosis code L20 (AD) was applied at least twice were analyzed and data on prescription patterns for AD were reported for the years 2011-2015. RESULTS: AD prevalence in adults was 1.6-1.9% in 2012-2015. Annual incidence was 0.28%. In Q3/Q4 2015, 44.2% of the adult population with AD diagnosis by a dermatologist received prescriptions for AD medications: 1.6% low-potency topical glucocorticoids (without previous prescription of systemic drugs), 46.9% moderate or high-potency topical glucocorticoids or topical calcineurin inhibitors, 23.9% current systemic therapy (systemic glucocorticoids, ciclosporin, methotrexate, azathioprine, mycophenolate mofetil) and 27.6% systemic therapy in the past. CONCLUSIONS: The AD prevalence estimate was in the range of previous reports (1.35-4%) that used different methodologies. Based on treatment proxy, it appeared that almost more than half of AD patients treated with prescription ready-to-use drugs had a severe form of AD which required treatment with systemic drugs.
Acne vulgaris is one of the most frequent dermatological diseases with a lifetime prevalence of about 85%. The clinical spectrum shows a great variety. Key factors of pathogenesis are increased sebum production, hyperker...Acne vulgaris is one of the most frequent dermatological diseases with a lifetime prevalence of about 85%. The clinical spectrum shows a great variety. Key factors of pathogenesis are increased sebum production, hyperkeratinization of the follicular infundibulum, inflammatory processes, and a dysbiosis of the skin microbiome. In addition to endogenous factors (e.g., disturbances of the androgen metabolism) or other hormonal changes, exogenous factors (e.g., diet, mechanical irritation or the use of inappropriate cosmetics) can also play an important role. The clinical spectrum is broad, extending from neonatal Acne (A.) to adult A., from comedonal A. to fulminant A., from cosmetic A. to A. excoriée (skin picking disorder). The psychological effects of acne can be profound and can cause a severe reduction in quality of life. Therefore, in addition to an effective therapy with regular medical check-ups and good adherence, it is always necessary to consider psychological aspects.
We present the results of a retrospective data analysis of a practice cohort of 44 patients with atopic dermatitis treated with the IL-4/13 receptor antibody dupilumab for up to 3 years. Patients were followed up over a...We present the results of a retrospective data analysis of a practice cohort of 44 patients with atopic dermatitis treated with the IL-4/13 receptor antibody dupilumab for up to 3 years. Patients were followed up over a period of 21 months during specialized consultation hours named Immunodermatology, which was established to guarantee comprehensive documentation. The patient's characteristics regarding age and sex distribution, severity and duration of disease were comparable with the patient collectives in large, pivotal studies. The therapeutic efficiency however was high (percentage of patients with EASI50, -75, -90 after 16 weeks: 94, 84, 60%, respectively) and long lasting (86% EASI90 after 52 weeks on therapy) under everyday conditions in the clinical setting. Approximately half of the patients had facial skin or eye involvement either in their history or at the start of treatment. This group of patients proved to need more and intense care because facial dermatitis and periocular dermatitis, which often involved conjunctivitis, took longer to heal, relapses occurred, and an additional topical treatment was often required. We did not observe any severe side effects during the 48 patient-years analyzed in this study. Dupilumab proved to be a safe and efficient treatment for atopic dermatitis in dermatological practice.
Lipophilic Malassezia yeasts are an important part of the human resident skin flora, especially in seborrheic areas. Besides mutualistic interactions with the host they are also linked to diseases although the specific c...Lipophilic Malassezia yeasts are an important part of the human resident skin flora, especially in seborrheic areas. Besides mutualistic interactions with the host they are also linked to diseases although the specific causes are not yet comprehensively understood. The amount of available lipids on the skin correlates with the Malassezia density and also with the occurrence of certain diseases like tinea versicolor. Here, the naturally produced lipids of the sebaceous glands play a role. Hardly studied thus far is the impact of topically applied lipids. Here, growth promotion as well as inhibition of Malassezia cells as well as the production of new metabolites through ester cleavage are possible. One example is the release of antimicrobial fatty acids from hydroxypropyl caprylate through the action of Malassezia lipases. This "self-kill" principle results in the reduction of the amount of Malassezia cells and can be applied as new therapy option for dandruff treatment. A better understanding of the interaction between topica and Malassezia would increase their skin tolerance and open new therapy options.
The treatment of patients with chronic wounds is a multiprofessional challenge. Based on a comprehensive diagnosis and integrated into a causal treatment concept, patients should always be treated with a modern wound the...The treatment of patients with chronic wounds is a multiprofessional challenge. Based on a comprehensive diagnosis and integrated into a causal treatment concept, patients should always be treated with a modern wound therapy. This wound therapy should try to take into account many different factors such as the wound healing phases, infection status, exudate levels, but also individual patient wishes. Especially in the case of chronic wounds of the lower extremities and edema, compression therapy is also very important for therapy and recurrence prophylaxis. In addition, the pain, which is usually very distressing, should be recorded and adequately treated or avoided. Modern moist wound therapy can then support the healing of patients with chronic wounds, reduce complications and thus improve their quality of life.
In daily practice, nail pigmentation can be a diagnostic challenge, especially if the dermoscopic findings are nonspecific. We present examples of cases, in which optical coherence tomography-a rapid, noninvasive imaging...In daily practice, nail pigmentation can be a diagnostic challenge, especially if the dermoscopic findings are nonspecific. We present examples of cases, in which optical coherence tomography-a rapid, noninvasive imaging method-showed typical changes that were indicative for the diagnosis.
Patients affected by acne inversa (hidradenitis suppurativa) initially notice skin changes in atypical areas of the skin. These changes can include purulent inflammation, painfully filled and red-discolored bumps or oozi...Patients affected by acne inversa (hidradenitis suppurativa) initially notice skin changes in atypical areas of the skin. These changes can include purulent inflammation, painfully filled and red-discolored bumps or oozing and strongly smelling, small to larger openings. In order to be able to receive medical help, patients must present to the general practitioner, report their complaints and also show the lesions. This represents an enormous inhibition threshold for those affected. However, the disease is usually recognized too late. This less known skin condition is often confused with other skin diseases. Even after diagnosis, adequate treatment is not always guaranteed. On the patient side, too, fear and feelings of shame prevent the patient from visiting the doctor, long-term therapies without success create a feeling of hopelessness, and fear of losing one's job are reasons for seeking therapy too late. The quality of life is lowest compared to individuals with other dermatoses. In addition to interdisciplinary treatment, the diverse situations experienced by those who are affected need to be acknowledged in social and medical settings.
This article reports on a patient suffering from terbinafine-resistant tinea corporis acquired in Asia. Trichophyton mentagrophytes type VIII was first isolated in India. In the past few years, it has gained clinical rel...This article reports on a patient suffering from terbinafine-resistant tinea corporis acquired in Asia. Trichophyton mentagrophytes type VIII was first isolated in India. In the past few years, it has gained clinical relevance by causing terbinafine-resistant tinea corporis and cruris. Therefore, in cases of recalcitrant tinea in persons returning from Asia, systemic itraconazole should be started. Specially formulated itraconazole enables high bioavailability despite lower dosage.
Hidradenitis suppurativa/acne inversa (HS) has a multifactorial pathogenesis. In addition to a sporadic form, a familial form is reported in around 40% of patients, for whom an autosomal dominant (AD) inheritance with re...Hidradenitis suppurativa/acne inversa (HS) has a multifactorial pathogenesis. In addition to a sporadic form, a familial form is reported in around 40% of patients, for whom an autosomal dominant (AD) inheritance with reduced gene penetrance is assumed. The phenotype of the disease with inflammatory nodules, abscesses and secreting sinus tracts suggests an infectious origin, but the exact role of the bacteria detected in HS pathogenesis remains unclear. Smoking and metabolic syndrome are regarded as important trigger factors in HS, with obesity and hormonal changes playing a pathogenic role in the latter. Ultimately, Toll-like receptors, antimicrobial peptides, immune cells and key cytokines are involved in the excessive inflammatory reaction of HS and are also the targets of future therapies.
Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory skin disease whose treatment includes both conservative and surgical treatment options. In Hurley stages II and III, surgical resection of irreversi...Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory skin disease whose treatment includes both conservative and surgical treatment options. In Hurley stages II and III, surgical resection of irreversibly destroyed tissue should be the objective. For this purpose several resection techniques exist, which differ primarily with regard to their invasiveness and tendency to recur. To date, there is no generally accepted consensus on the use of different resection and reconstruction techniques or the inclusion of drug therapies in the overall therapeutic concept.