BACKGROUND AND OBJECTIVES: Skin diseases can greatly impair quality of life (QoL) of pediatric patients and their families. The Infants and Toddlers Dermatology Quality of Life questionnaire (InToDermQoL) is the first sk...BACKGROUND AND OBJECTIVES: Skin diseases can greatly impair quality of life (QoL) of pediatric patients and their families. The Infants and Toddlers Dermatology Quality of Life questionnaire (InToDermQoL) is the first skin-generic instrument assessing QoL in children ≤ 4 years, as reported by their caregiver. This study aimed to psychometrically validate the German version of the InToDermQoL. PATIENTS AND METHODS: The psychometric properties of the InToDermQoL were examined in a sample of 148 children with various skin diseases (age groups [n]: < 1 [44]; 1-2 [68]; 3-4 [36]). RESULTS: Exploratory factor analysis suggested a unidimensional structure of the version for children < 1 year, and a two- and three-factor structure for the two older age groups, respectively. Internal consistency was excellent (Cronbach's alpha, 0.904-0.922). Two-week test-retest reliability was good, except in children aged 1-2 years (intraclass correlation coefficient [ICC], 0.430). The InToDermQoL demonstrated good convergent validity with other QoL questionnaires. CONCLUSIONS: The German InToDermQoL is a valid and reliable QoL measure in children ≤ 4 years with any skin disease. Application of the tool in research and clinical practice will contribute to a better understanding of the impact of pediatric dermatoses, and optimize care and support for affected families.
BACKGROUND AND OBJECTIVES: Psoriasis is a chronic inflammatory skin disease, and noninvasive diagnostic tools are essential for accurate diagnosis and treatment monitoring. Multiphoton microscopy (MPM) enables real-time,...BACKGROUND AND OBJECTIVES: Psoriasis is a chronic inflammatory skin disease, and noninvasive diagnostic tools are essential for accurate diagnosis and treatment monitoring. Multiphoton microscopy (MPM) enables real-time, noninvasive skin imaging with submicron resolution. This study evaluated the diagnostic accuracy of MPM in psoriasis and its potential application in therapeutic monitoring. PATIENTS AND METHODS: This prospective observational study enrolled 34 patients with psoriasis. It comprised three parts: (1) analysis of imaging features of lesional and nonlesional skin using multiphoton microscopy (MPM; Transcend Vivoscope); (2) evaluation of the diagnostic performance of MPM parameters compared with reflectance confocal microscopy (RCM); and (3) prospective monitoring of 24 patients treated with Benvitimod (Tapinarof) cream for 8 weeks (T0/T1/T2). RESULTS: MPM detected psoriasis characteristics (including hyperkeratosis, parakeratosis, an absent stratum granulosum, enlarged nucleus diameter, and absent bright rimming) with comparable diagnostic efficiency to RCM (AUC = 0.838, p < 0.001 vs. 0.824, p < 0.001). Psoriatic lesions showed significant perinuclear fluorescence accumulation compared to healthy skin (p < 0.001). All imaging features improved significantly after 8 weeks of treatment (p < 0.001). PASI/TLS scores showed correlations with the epidermal thickness (r = 0.403/0.492, p < 0.001), nuclear diameter (r = 0.4/0.375, p < 0.001), and fluorescence intensity (r = -0.419/-0.492, p < 0.001). CONCLUSIONS: MPM is a novel and non-invasive imaging technique for psoriasis evaluation and treatment monitoring.
BACKGROUND AND OBJECTIVES: Diagnosing cicatricial alopecia is challenging. Even with histology, a definitive diagnosis cannot always be made. Line-field confocal optical coherence tomography (LC-OCT), a non-invasive imag...BACKGROUND AND OBJECTIVES: Diagnosing cicatricial alopecia is challenging. Even with histology, a definitive diagnosis cannot always be made. Line-field confocal optical coherence tomography (LC-OCT), a non-invasive imaging method with high resolution used in vivo, has proven helpful in diagnosing scarring alopecia. This study aims to evaluate the potential of LC-OCT for the differential diagnosis of different types of scarring alopecia. PATIENTS AND METHODS: Images of 30 patients with scarring alopecia (10 Lichen planopilaris/Frontal fibrosing alopecia (LPP/FFA), 10 lupus erythematosus, 10 folliculitis decalvans/Folliculitis et perifolliculitis capitis suffodiens et abscedens (FD/FSA)) and 10 healthy controls were analyzed by two blinded independent examiners. Characteristic features and differential diagnoses were determined for each case. RESULTS: LC-OCT revealed distinct characteristics for each of the four subgroups, facilitating differential diagnosis with 100% sensitivity for lupus and 90% for LPP/FFA, FD/FSA, and the control group, and 100% specificity for LPP/FFA and 96.7% for the other groups. The features were used to generate a diagnostic algorithm tree. CONCLUSIONS: With LC-OCT, specific criteria can be used to differentiate between subtypes of scarring alopecia. These preliminary findings provide a basis for hypothesis generation, which should be further explored in larger cohorts and in longitudinal studies assessing treatment response over time.
BACKGROUND AND OBJECTIVES: Acne affects not only adolescents but also adults, significantly impacting their physical and mental health. This study aims to investigate the prevalence, incidence, and disability-adjusted li...BACKGROUND AND OBJECTIVES: Acne affects not only adolescents but also adults, significantly impacting their physical and mental health. This study aims to investigate the prevalence, incidence, and disability-adjusted life years (DALYs) of post-adolescent acne vulgaris among adults aged 25-49 years globally from the years 1990 to 2021. PATIENTS AND METHODS: We collected information on all individuals aged 25-49 years with post-adolescent acne. Data from the Global Burden of Diseases (GBD) study (2021) for 204 countries and territories was analyzed. The study focused on prevalence, incidence, DALYs, and estimated annual percentage change for post-adolescent acne. Bayesian age-period-cohort models predicted incidence trends from 2022 to 2050. RESULTS: Globally, the age-standardized prevalence rate of post-adolescent acne increased from 1990 to 2021, with females having a higher burden than males. Germany reported the highest age-standardized prevalence rate, age-standardized incidence rate, and age-standardized DALYs rate. High socio-demographic index (SDI) regions had the highest rates, while low-middle SDI regions showed the most substantial increase. The number of adults with post-adolescent acne is projected to increase until 2050. CONCLUSIONS: Post-adolescent acne vulgaris remains prevalent and is increasing globally. Comprehensive and targeted interventions are urgently needed to mitigate its impact, as projections indicate a continued rise in incidence.
J Dtsch Dermatol Ges
· 2026 Apr · PMID 41580899
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The development of immune checkpoint inhibitors and targeted therapies has fundamentally changed the treatment of cutaneous malignancies, especially in squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The la...The development of immune checkpoint inhibitors and targeted therapies has fundamentally changed the treatment of cutaneous malignancies, especially in squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The latest neoadjuvant approaches have shown promising results in locally advanced stages. In squamous cell carcinoma, neoadjuvant PD-1 blockade with cemiplimab has demonstrated a high pathological response rate. Initial data additionally indicate a lowered risk of recurrence. Even greater progress has been made in melanoma: Neoadjuvant PD-1 blockade, both alone and in combination with a CTLA-4 blocker, significantly reduces the risk of recurrence. Both the randomized Phase II SWOG1801 study and the randomized Phase III NADINA study have demonstrated the superiority of the neoadjuvant approach over a pure adjuvant one. The results of the NADINA study showed that a deep pathological response to neoadjuvant therapy allows treatment de-escalation by omission of adjuvant therapy. Targeted therapies with BRAF-MEK inhibition also show adequate response rates in BRAF-mutated melanomas. In Merkel cell carcinoma, the neoadjuvant administration of PD-1 inhibitors like Nivolumab shows a high response rate and promising survival data. In summary, the data highlight the potential of neoadjuvant therapy in the treatment of locally advanced skin tumors, reducing the risk of recurrence and mortality, as well as providing new opportunities for therapy de-escalation.
BACKGROUND: This study explored UV exposure and prevention behaviors among melanoma patients, focusing on occupational UV exposure, melanoma characteristics, risk awareness, and protective behaviors. PATIENTS AND METHODS...BACKGROUND: This study explored UV exposure and prevention behaviors among melanoma patients, focusing on occupational UV exposure, melanoma characteristics, risk awareness, and protective behaviors. PATIENTS AND METHODS: This cross-sectional study analyzed demographics, melanoma characteristics, UV exposure, awareness, and preventive measures. Data were stratified by occupational exposure (indoor vs. outdoor) and analyzed using logistic regression to identify predictors for melanoma location. RESULTS: Among 406 patients (54% female; median age 57), 59 (15%) had a history of outdoor work. Outdoor workers were more likely to develop melanoma in sun-exposed areas. They also had a higher prevalence of facial melanoma (p = 0.020); those with facial involvement had worked outdoors twice as long as those with melanoma at other sites, indicating a dose-effect relationship. Logistic regression identified outdoor work (OR 2.47) and age (OR 1.05) as significant predictors of facial melanoma. A total of 229 patients (57%) were unaware of the potential harms of UV radiation before diagnosis. Among outdoor workers, only 3 (5%) reported frequent sun protection, while 33 (56%) used it rarely or never. CONCLUSIONS: Outdoor work is a significant risk factor for facial melanoma in this cohort. Sun protection and UV awareness remain insufficient, particularly among outdoor workers, highlighting the need for targeted prevention.
BACKGROUND AND OBJECTIVES: Complete lymph node dissection (CLND) is the standard of care in patients with regional nodal melanoma macrometastasis. However, evidence on surgical procedures in the era of adjuvant systemic...BACKGROUND AND OBJECTIVES: Complete lymph node dissection (CLND) is the standard of care in patients with regional nodal melanoma macrometastasis. However, evidence on surgical procedures in the era of adjuvant systemic therapies is lacking. PATIENTS AND METHODS: This retrospective multi-center study included stage IIIB-D melanoma patients with nodal macrometastasis undergoing CLND or selective lymph node extirpation (LNE) prior to adjuvant therapy. CLND and LNE were compared regarding recurrence-free survival (RFS), nodal metastasis-free survival (NFS) and overall survival (OS). RESULTS: 320 melanoma patients were included (median age 62; 55.5% male). Patients received PD-1 monotherapy (77.8%), targeted therapy (21.3%) or both sequentially (0.9%), as well as adjuvant radiotherapy in 40.9%. RFS and OS did not differ significantly between patients receiving CLND or LNE, while NFS was significantly prolonged following CLND (HR 0.3917; p = 0.005). After adjustment for risk factors by multivariate Cox regression, a prolonged RFS for CLND vs. LNE was found (HR 0.676; p = 0.04), but no benefit for OS. The rate of complications was significantly higher in the CLND group. CONCLUSIONS: CLND showed no OS benefit compared to LNE, while local control was improved. CLND can be recommended in the context of adjuvant therapies, however, the increased rate of complications should be considered.
J Dtsch Dermatol Ges
· 2026 Jun · PMID 41562377
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BACKGROUND: Erysipelas, caused by streptococci, should be treated with penicillin, while uncomplicated cellulitis (phlegmon), often caused by Staphylococcus aureus, requires penicillinase-resistant beta-lactam antibiotic...BACKGROUND: Erysipelas, caused by streptococci, should be treated with penicillin, while uncomplicated cellulitis (phlegmon), often caused by Staphylococcus aureus, requires penicillinase-resistant beta-lactam antibiotics, which have a higher risk of adverse effects. Distinguishing between these infections is important. Constitutional symptoms like chills and fever may help in diagnosis. Therefore, we have compared retrospectively how frequently patients with erysipelas versus patients with cellulitis have experienced constitutional symptoms and whether they responded to penicillin. PATIENTS AND METHODS: We retrospectively evaluated patients with erysipelas or cellulitis admitted to the dermatology department of the university hospital Halle between January 2024 and January 2025. They had been managed according to an internal standard operation procedure for skin- and soft tissue infections. RESULTS: Of 76 erysipelas patients without other infections, 91.4% reported constitutional symptoms at or before erythema onset, among them 17 of 18 patients with recurrent erysipelas. In contrast, only 36.2% of 47 cellulitis patients experienced such symptoms, typically later and not before erythema. Of patients with erysipelas, 98.3% responded within 2 days to penicillin, including 21 patients who had experienced symptoms for already 4 to 10 days prior to therapy. CONCLUSIONS: Our findings suggest that early constitutional symptoms and characteristic erythema are reliable indicators for erysipelas. Erysipelas do not tend to heal promptly and spontaneously but respond reliably to penicillin.
BACKGROUND: Digital technologies offer opportunities for dermatological care, but there is a lack of systematic data on their use and acceptance, particularly with regard to digital health applications (DiGA) and large l...BACKGROUND: Digital technologies offer opportunities for dermatological care, but there is a lack of systematic data on their use and acceptance, particularly with regard to digital health applications (DiGA) and large language models (LLMs). PATIENTS AND METHODS: From November 2024 to January 2025, an anonymous online survey was conducted among German dermatologists as part of continuing education courses. The survey covered the use of and attitudes towards telemedicine, DiGA and LLMs, as well as competence assessments and education needs. RESULTS: 100 dermatologists participated (64% female, average age 40.6 years). 58% stated that they did not currently offer telemedicine services; only 5% regularly used video consultations. 21% had already prescribed DiGA, with the majority (78%) seeing this as the responsibility of general practitioners. 96% of dermatologists believed that DiGA could improve medical care. The main barriers cited were lack of knowledge (76%), lack of time (74%), insufficient remuneration and a complex prescription process (43% each). 45% of respondents had used LLMs in a professional context. 76% rated the impact of digitalization on patient care as positive, and 80% expressed a desire for training opportunities on the use of digital technologies in everyday medical practice. CONCLUSION: Digitalization and, in particular, DiGA are viewed positively by most dermatologists, but digital services are hardly used at present. Targeted knowledge expansion and specific training opportunities could significantly promote the implementation of digital technologies in everyday dermatological practice.
BACKGROUND AND OBJECTIVES: Palmoplantar pustulosis (PPP) is a chronic and refractory inflammatory skin disorder with unclear pathogenesis. PATIENTS AND METHODS: Ten PPP patients treated with upadacitinib were monitored t...BACKGROUND AND OBJECTIVES: Palmoplantar pustulosis (PPP) is a chronic and refractory inflammatory skin disorder with unclear pathogenesis. PATIENTS AND METHODS: Ten PPP patients treated with upadacitinib were monitored to assess efficacy and safety. Immunofluorescence and immunohistochemistry were employed to evaluate Th1, Th2, and Th17 cell expressions, along with their associated cytokines in lesions on palms or soles from 16 PPP patients, 10 chronic eczema (CE) patients, 10 psoriasis vulgaris (PV) patients, and 7 healthy controls (HC). RESULTS: In PPP patients receiving upadacitinib, the shortest time to achieve PPPASI75 and PPPASI90 was 4 weeks and 8 weeks, respectively. The rates of patients achieving PPPASI90 at week 16, week 24, and week 52 was 70 %, 100 %, and100 %, respectively. Th1 cells and IFN-γ levels in PPP were comparable to CE and PV, and higher than HC. Th2 cells, IL-4, and IL-13 levels in PPP were similar to CE, and greater than HC and PV. Th17 cells, IL-17, and IL-36γ levels in PPP were comparable to PV, and more abundant than HC and CE. CONCLUSIONS: Upadacitinib is a safe and effective option for PPP patients, which may be attributed to the complex Th1, Th2, and Th17 inflammatory responses associated with PPP.
BACKGROUND AND OBJECTIVES: People with skin disease often experience stigmatization in health and body care settings, significantly impacting their quality of life. This parallel-group randomized controlled trial evaluat...BACKGROUND AND OBJECTIVES: People with skin disease often experience stigmatization in health and body care settings, significantly impacting their quality of life. This parallel-group randomized controlled trial evaluated a face-to-face group seminar aimed at reducing stigma towards people with skin disease among health and body care professionals (HBCPs). PATIENTS AND METHODS: Cosmetologists, hairdressers, nurses, and physical therapists were randomized into an intervention (IG; n = 64) or control group (CG; n = 65). The IG received a seminar consisting of self-awareness exercises, education and a patient encounter; the CG followed a seminar on "health at work". Stereotype agreement, disease-related misconceptions, desire for social distance, and behavioral intentions were assessed at baseline (t0), post-intervention (t1), and 3 months follow-up (t2). RESULTS: The intervention group showed significant reductions over time in disease-related misconceptions (t0-t1: 0.398, p < 0.001; t0-t2: 0.225, p < 0.001; ηp = 0.12) and in stereotype endorsement (t0-t1: 0.392, p < 0.001; t0-t2: 0.299, p = 0.002; ηp = 0.12). In both groups, the desire for social distance decreased immediately after the seminar (t0-t1: 0.186, p < 0.001; t0-t1: 0.135, p = 0.012) but returned to baseline at follow-up (t0-t2: 0.097, p = 0.35; t0-t2: 0.016, p = 1.00). CONCLUSIONS: The seminar improved skin disease-related stigmatizing beliefs and attitudes of HBCPs. Its integration into vocational training curricula or delivery in workshops to increase knowledge about skin diseases and to reduce prejudices in various professional groups is promising.
Sander M, Augustin M, Andrees V
… +2 more, Hischke S, Augustin J
J Dtsch Dermatol Ges
· 2026 May · PMID 41543192
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BACKGROUND AND OBJECTIVES: Prevalence rates of atopic diseases (atopic dermatitis [AD], allergic asthma [AA], and allergic rhinoconjunctivitis [ARC]) have increased in Germany. However, there is a lack of simultaneous co...BACKGROUND AND OBJECTIVES: Prevalence rates of atopic diseases (atopic dermatitis [AD], allergic asthma [AA], and allergic rhinoconjunctivitis [ARC]) have increased in Germany. However, there is a lack of simultaneous consideration and of precise data on the spatiotemporal variation of these diseases. This study investigates the spatiotemporal variation of atopic diseases in Germany. METHODS: Analyses based on outpatient care data (2011-2020) of all statutory health insured persons in Germany. Spatiotemporal analyses of prevalence rates were performed on county levels and statistical smoothing were applied. RESULTS: Prevalence rates increased for all three diseases. Moderate but significant (p < 0.05) correlations were among others observed between ARC and AA (r = 0.47). Correlations with the east-west gradient were significant for all diseases, meaning higher prevalence rates of AD in the east and higher prevalence rates of AA and ARC in the west. The correlation coefficients showed significant values between the north-south gradient and AD, as well as between the north-south gradient and AA, implying higher prevalences in northern Germany. CONCLUSIONS: Prevalence rates for atopic diseases have increased over the past decade. Regional patterns are different for AD and the other atopic diseases. The reasons for the increase and the variations need to be analysed in detail with a view to improving prevention and health care.
Nast A, Altenburg A, Augustin M
… +23 more, Bachmann F, Boehncke WH, Cornberg M, Geerdes-Fenge H, Häcker B, Härle P, Klaus J, Köhm M, Köllner A, Mrowietz U, Ockenfels HM, Pennitz A, Philipp S, Richter T, Rosenbach T, Schaberg T, Schlaeger M, Schmid-Ott G, Sebastian M, Thölken K, von Kiedrowski R, Willuhn U, Zeyen C
J Dtsch Dermatol Ges
· 2026 Jan · PMID 41531416
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This first part of the updated German S3 guideline on the treatment of psoriasis vulgaris covers the sections on treatment recommendations, treatment goals, and monitoring of therapies. The recommendations are based on t...This first part of the updated German S3 guideline on the treatment of psoriasis vulgaris covers the sections on treatment recommendations, treatment goals, and monitoring of therapies. The recommendations are based on the current Cochrane network meta-analysis, the results of which are also summarized. When selecting systemic therapies for psoriasis vulgaris, the guideline emphasizes consideration of efficacy, safety, comorbidities, and individual patient factors. The decision framework is presented in the treatment options overview, and in this updated version, the possibility of first-line therapy with biologics or novel targeted small molecules is more prominently highlighted. Standardized instruments for assessing disease severity, as well as patient-centered treatment goals, are underscored. A Psoriasis Area and Severity Index (PASI) 75 response is defined as the minimum therapeutic target, while PASI 90 or an absolute PASI <2 are considered desirable goals. Since the last version, two newly approved agents, bimekizumab and deucravacitinib, have been incorporated, accompanied by specific usage recommendations. Among the established therapies, guidance on methotrexate has been extensively revised, particularly regarding administration, dosing, and monitoring. This guideline aims to provide clinicians with an evidence-based framework for therapy selection and monitoring, while strengthening shared decision-making with patients.
Chessa MA, Robuffo S, Brunetti T
… +6 more, Rapparini L, Piraccini BM, Misciali C, Raone B, Neri I, Filippi F
J Dtsch Dermatol Ges
· 2026 May · PMID 41531022
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BACKGROUND AND OBJECTIVES: Wells syndrome (WS) is a rare inflammatory skin disorder typically characterized by erythematous, edematous, and pruritic plaques. Despite its distinct histopathological features, WS remains an...BACKGROUND AND OBJECTIVES: Wells syndrome (WS) is a rare inflammatory skin disorder typically characterized by erythematous, edematous, and pruritic plaques. Despite its distinct histopathological features, WS remains an underdiagnosed disease due to its variable clinical presentations and overlap with other dermatological conditions. This study aims to provide a comprehensive overview of WS to enhance diagnostic and management. PATIENTS AND METHODS: A retrospective analysis for the period 2018-2023 was conducted on 48 patients with WS at the Dermatology Unit of the University of Bologna, Italy. Data collected included demographics, clinical manifestations, hematological findings, histopathological characteristics, therapies, and outcomes. Descriptive statistics were used to analyze and summarize the data. RESULTS: The mean onset age was 60.7 years, with 56% of patients having localized WS and 44% generalized WS. The most common subtype was urticaria-like WS (38%), followed by papulonodular, vesiculobullous, granuloma annulare-like, and cellulitis-like forms. First-line treatments included topical and systemic corticosteroids. In contrast, recurrence was observed in 29% of cases during the follow-up. CONCLUSIONS: WS is a heterogeneous underdiagnosed condition requiring clinical-histologic correlation for accurate diagnosis. Tailored therapeutic strategies are essential, particularly for generalized or refractory cases. Future research should explore the immunological mechanisms underlying WS and identify predictive factors for recurrence.