BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with high burden for patients and limited treatment options. We recently analyzed the efficacy of local treatment with LAight therapy, a c...BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with high burden for patients and limited treatment options. We recently analyzed the efficacy of local treatment with LAight therapy, a combination of intense pulsed light (IPL) and radiofrequency (RF). OBJECTIVES: The aim of the present survey was to compare care of HS patients under LAight with standard care prior to therapy. MATERIALS AND METHODS: The retrospective study included 111 patients who were treated with LAight at least 5 times between 01/2014 and 03/2017. Primary endpoint was the change in surgical interventions. Secondary endpoints included additional patient-reported outcomes, e.g., effects on their quality of life. RESULTS: In all, 50 completed surveys were available for evaluation. Under LAight therapy, the number of surgical interventions decreased from 3.2 to 0.3 per year (p < 0.001). Secondary endpoints were also significantly improved: The days of sick leave/year due to HS decreased from 30.4 to 7.2 (p = 0.002), and the number of doctor appointments due to HS flare ups was altered from 7.3 to 1.5 (p < 0.001). In line, patient-reported pain levels, general wellbeing and quality of life were also improved. CONCLUSION: This retrospective assessment of patient-reported treatment outcomes of 50 HS cases after treatment with LAight revealed a significant reduction of required surgical interventions and sick-days along with improved quality of life. Thus, it appears that IPL + RF treatment not only improves disease activity, but also secondary care aspects. Future studies will need to confirm these findings in a controlled setting.
BACKGROUND: A new generation of technologies is uncovering a large number of microorganisms that are closely associated with the skin. Any disturbance of the interaction between skin cells and colonizing microbes has del...BACKGROUND: A new generation of technologies is uncovering a large number of microorganisms that are closely associated with the skin. Any disturbance of the interaction between skin cells and colonizing microbes has deleterious consequences. The impoverishment of the diversity of microbiome has been progressing for decades as part of a modern, globalized lifestyle. In maintaining good health, the microbes living in and on the skin and other organs must also be taken into account in addition to genetic aspects. All epithelia, including the skin, are colonized with a large number of microbes. OBJECTIVE: The function of the microbiome in the skin and other organs is described. MATERIALS AND METHODS: Basic research papers are discussed. RESULTS: The microbiome of the skin is very important for maintaining healthy skin. CONCLUSIONS: We need to understand our body as a multiorganismic metaorganism in order to be able to react intelligently to the challenges of a continually changing environment.
BACKGROUND: Our skin is a very important and complex organ of the body. The microorganisms of the skin, the so-called microbiome, represent an important part of the healthy skin barrier and are influenced by various exte...BACKGROUND: Our skin is a very important and complex organ of the body. The microorganisms of the skin, the so-called microbiome, represent an important part of the healthy skin barrier and are influenced by various external and internal factors. AIM: The question to what extent the skin microbiome represents a diagnostic or even therapeutic target in the context of skin diseases is discussed. MATERIALS AND METHODS: A literature search was performed. RESULTS: Several diseases are associated with negative alterations of the skin microbiome. In atopic dermatitis, a correlation between severity and increased availability of Staphylococcus aureus is known, with a loss of bacterial diversity on the skin. In the future, S. aureus will not only be used as a diagnostic marker in atopic dermatitis, but also represents a promising target as a predictive marker for therapeutic success. The role of the skin microbiome in psoriasis has not yet been researched in depth. However, there is evidence that dysbiosis of the skin microbiome contributes to the course of psoriasis and that there is a disturbance in immune tolerance in patients. In the case of acne, the involvement of Cutibacterium acnes in the clinical picture is well known; however, recent findings show that it is not sufficient to identify the species, but certain characteristics of C. acnes strains are associated. CONCLUSION: Microbial biomarkers are currently only established in atopic dermatitis. For other diseases, this might be the case in the future; however combinations of microorganisms, single species and also strains with specific characteristics must be considered.
The new M WBO (Musterweiterbildungsordnung) has been developed for 6 years and will be put into force by most LÄK (Landesärztekammern) on 01.07.2020. Future training to become a dermatologist is competency-based. This is...The new M WBO (Musterweiterbildungsordnung) has been developed for 6 years and will be put into force by most LÄK (Landesärztekammern) on 01.07.2020. Future training to become a dermatologist is competency-based. This is to enable observable, successful problem solving in practice. Thus, the acquisition of competence is only dependent on whether the goal has been achieved. New procedures are required to determine achievement of the respective competencies, including annual continuing education interviews, workplace-based examinations, and an eLogbuch (electronic logbook). Minimum inpatient periods will be eliminated in the future. In principle, continuing education can take place entirely on an outpatient basis. The M WBO Dermatology comprises 14 thematic blocks with differentiated description of cognitive and methodological or action competencies. The guideline numbers of dermatological additional training courses have been shifted considerably into the period of basic training. Additional training courses can be acquired while working. Fachlich empfohlene Weiterbildungspläne (FEWP) are the concrete implementation regulations of the M WBO. They are not part of the WBO and can be adapted. In connection with this new approach, numerous questions are currently still open, such as documentation in practice or financing.
BACKGROUND: The environment is continuously subject to change. Exposures in the work environment and therefore the importance of occupational type I and type IV allergens may change. OBJECTIVES: The most important trends...BACKGROUND: The environment is continuously subject to change. Exposures in the work environment and therefore the importance of occupational type I and type IV allergens may change. OBJECTIVES: The most important trends concerning occupational allergens, new occupational allergens/allergen exposures, the diagnostic procedure to detect new allergens in practice and regulatory developments are presented. MATERIALS AND METHODS: Building on known relevant allergen exposures in occupational dermatology, published trends from clinical cohorts are evaluated and a systematic literature search (PubMed 2016-2021) for new occupational allergens is also performed RESULTS: Occupations with the highest incidence of occupational allergic contact urticaria and/or protein contact dermatitis include bakers, farmers and farm workers, veterinary technicians, veterinarians, cooks, dairy and livestock workers, gardeners, and hairdressers. The highest risk of developing occupational contact dermatitis is in health care, agriculture, metalworking occupations and machine operators, the food sector, service industries, and construction occupations. The search strategy "new occupational allerg*" yielded 603 hits and "novel occupational allerg*" 158 hits. A total of 25 papers included results relevant to the research question and were processed. New protein-based immediate-type allergens, as well as contact allergens (haptens) relevant for occupational dermatology, are presented. CONCLUSIONS: Current trends on known occupational allergens and new occupational allergens in the period 2016-2021 can be identified. Only a thorough individual workplace history and testing of patients' own materials can identify new allergens in occupational dermatology.
Occupational dermatology has become a vibrant and interesting specialty, particularly in recent years. This includes more than hand eczema (HE). The increasing prevalence of atopic dermatitis (AD) has led to an increase...Occupational dermatology has become a vibrant and interesting specialty, particularly in recent years. This includes more than hand eczema (HE). The increasing prevalence of atopic dermatitis (AD) has led to an increase of atopic hand eczema which can be worsened in certain occupations. New systemic therapies have improved the range of treatments for HE. The current guideline on hand eczema includes a variety of topical and systemic therapies. Nevertheless, in daily occupational dermatological practice, there are still chronic cases, especially vesicular hand eczema. They can often not be assigned to a clear cause, which is often a problem for those who are affected. In addition, co-factors such as chronic infectious comorbidities and psychological factors/illnesses must be considered. We present challenges in occupational dermatology by reporting special cases.
We present the case of a patient with a discreet acne and multiple keloids in the area of the upper trunk, histologically showing an unusual myofibroblastic differentiation. So far, the clinical course shows a poor respo...We present the case of a patient with a discreet acne and multiple keloids in the area of the upper trunk, histologically showing an unusual myofibroblastic differentiation. So far, the clinical course shows a poor response to the treatment, including cryotherapy, intralesional corticosteroid injections, occlusive silicone dressings and dye laser.
Tinea capitis is seen world-wide among children up to 12 years. The most severe type is Kerion Celsi with painful abscesses and lymphadenopathy. We report on an 11-year-old boy with Kerion Celsi, who was initially treate...Tinea capitis is seen world-wide among children up to 12 years. The most severe type is Kerion Celsi with painful abscesses and lymphadenopathy. We report on an 11-year-old boy with Kerion Celsi, who was initially treated using antibiotics under the common misdiagnosis of a bacterial infection. Mycological investigations could identify Microsporum canis. The patient was treated orally with griseofulvin, which resulted in complete mycological remission after 8 weeks. Cicatrical alopecia, however, could not be prevented. Purulent infections of the scalp should lead to early mycological diagnostics in children.
We report on three patients with inflammatory dermatoses as a result of a chronic inflammatory bowel disease (IBD). The diagnosis of IBD was based on the initial determination of the fecal calprotectin value. Although th...We report on three patients with inflammatory dermatoses as a result of a chronic inflammatory bowel disease (IBD). The diagnosis of IBD was based on the initial determination of the fecal calprotectin value. Although the patients did not report any intestinal complaints, the increased calprotectin value in the stool was the reason for further gastroenterological evaluation. This article highlights the importance of determining the fecal calprotectin value as another parameter in the diagnosis of inflammatory dermatoses.
BACKGROUND: Outdoor workers are occupationally exposed to significantly higher ultraviolet (UV) doses than the rest of the population. Recent data show a doubling of basal cell carcinoma (BCC) risk in outdoor workers wit...BACKGROUND: Outdoor workers are occupationally exposed to significantly higher ultraviolet (UV) doses than the rest of the population. Recent data show a doubling of basal cell carcinoma (BCC) risk in outdoor workers with high occupational UV exposure. OBJECTIVES: To examine the stability and robustness of BCC risk estimators. METHODS: Sensitivity analyses to test model assumptions considering socioeconomic status, influence of matching procedure, gender and latency, regional differences (east/west), urban/rural cases/controls, and dual diagnoses (squamous cell carcinoma [SCC]/actinic keratoses grade III [AKIII]/Bowen disease [BD] and BCC) were performed. RESULTS: BCC risk was consistently higher for high occupationally UV-exposed individuals than for intermediate UV-exposed individuals, regardless of matching procedure, latency, regional differences (east/west), urban/rural recruitment of cases/controls, and dual diagnoses (SCC/AKIII/BD and BCC), sex, and socioeconomic status. CONCLUSION: The risk estimator for the association between exposure to solar UV radiation at work and the risk of developing BCC showed a high degree of stability and robustness for all variables investigated. The analyses support the recently published findings on the doubling of BCC risk in outdoor workers with high occupational UV exposure.
BACKGROUND: In recent years, an increasing spectrum of systemic therapies has become available in the field of dermatology. Some of these drugs are used off-label, which for example can lead to problems with reimbursemen...BACKGROUND: In recent years, an increasing spectrum of systemic therapies has become available in the field of dermatology. Some of these drugs are used off-label, which for example can lead to problems with reimbursement. This article is therefore intended to provide an overview of the currently approved systemic therapies in dermatology and to point out further alternatives such as Compassionate Use and Early Access Programs. MATERIALS AND METHODS: The search for approved drugs in Germany was conducted online in the database for drugs of the Federal Institute for Drugs and Medical Devices. In addition, a comparison was made with the information provided from the Rote Liste. RESULTS: For a total of 50 dermatologically relevant diseases, the respective approved system therapies are presented in tabular form. CONCLUSIONS: It can be stated that the enormous developments over the last few years and the increasingly good evidence offer in many cases very promising systemic treatment concepts despite the frequent lack of clinical studies in the field of dermatology. However, the often necessary off-label use can cause difficulties in everyday clinical practice. The attending physician should therefore always be informed if a planned therapy involves off-label use. Previously approved alternatives should be considered and patients should be adequately informed.