Digital transformation is fundamentally reshaping dermatology, creating new opportunities in diagnostics, therapy, and healthcare organization. Large datasets combined with Artificial Intelligence (AI) enable more precis...Digital transformation is fundamentally reshaping dermatology, creating new opportunities in diagnostics, therapy, and healthcare organization. Large datasets combined with Artificial Intelligence (AI) enable more precise classification and prognosis, particularly through the analysis of clinical and dermoscopic imaging. Increasingly, synthetically generated data is used to train new algorithms, though its clinical validity remains under evaluation. Teledermatology has established itself as an integral part of care. Video consultations and asynchronous image transfers enhance accessibility to dermatological expertise and can bridge care gaps, especially in structurally weak regions. Furthermore, mobile applications and digital platforms promote adherence, self-monitoring, and active patient engagement. Despite these opportunities, challenges regarding data protection, interoperability, and regulatory frameworks must be addressed to ensure sustainable implementation. Interdisciplinary collaboration between medicine, technology, and health economics is crucial. Physicians play a central role as subject matter experts in assessing data quality and providing clinical interpretation of digital systems. Continuous training of medical staff remains essential. Overall, digitalization offers significant potential to improve dermatological care, provided there are structured processes, quality assurance, and consistent patient involvement.
Prurigo pigmentosa (PP) is a rare inflammatory dermatosis, clinically characterized by intensely pruritic, erythematous papules and papulovesicles, with reticular hyperpigmentation upon healing. We herein report four cas...Prurigo pigmentosa (PP) is a rare inflammatory dermatosis, clinically characterized by intensely pruritic, erythematous papules and papulovesicles, with reticular hyperpigmentation upon healing. We herein report four cases in adults of different ethnic backgrounds, in which the disease was associated with ketogenic metabolic states due to fasting or carbohydrate-restricted diets. In all cases, treatment with doxycycline led to rapid clearance of all skin lesions. The findings highlight the importance of a thorough dietary history to avoid misdiagnosis and to initiate targeted therapy. Due to changing dietary trends, this dermatosis should be considered in patients with altered eating behavior and recent appearance of PP-suspicious skin lesions.
BACKGROUND AND OBJECTIVES: Trust in therapy impacts adherence and satisfaction in chronic inflammatory skin diseases, including atopic dermatitis (AD) and psoriasis (PSO). This study assessed and compared trust in skinca...BACKGROUND AND OBJECTIVES: Trust in therapy impacts adherence and satisfaction in chronic inflammatory skin diseases, including atopic dermatitis (AD) and psoriasis (PSO). This study assessed and compared trust in skincare and topical therapies and explored influencing factors among AD and PSO patients. PATIENTS AND METHODS: Cross-sectional surveys of AD or PSO patients were conducted at two dermatological university centers in Germany. Group differences were analyzed using Mann-Whitney U and Kruskal-Wallis tests; associations between trust (6-point Likert scale: 1 = very high, 6 = none) and demographics, disease severity, pruritus, pain, and quality of life (QoL) using Spearman correlations. All analyses were exploratory. RESULTS: Among 253 AD or PSO patients (median age 53.0 years, interquartile range 36.0-63.0; 43.9% female) median trust in skin care and topical therapies was moderate. AD patients reported significantly higher trust than PSO patients. In AD, trust in skin care correlated with pruritus intensity (p < 0.001), pain intensity (p < 0.05), and QoL (p < 0.001); trust in topical therapy correlated with QoL (p < 0.01). No significant correlations were observed in PSO. CONCLUSIONS: Trust levels were higher in AD than in PSO but tended to decline with increasing disease burden and poorer QoL. Enhancing patient education and shared decision-making may help improve trust and adherence.
Kind B, Siegels D, Ott H
… +15 more, Abraham S, Sachse R, Lönnecke K, Harder I, Heratizadeh A, Nemat K, Vogelberg C, Stölzl D, Gellhaus I, Lau S, Moridani MY, Werfel T, Weidinger S, Schmitt J, TREATgermany study group
BACKGROUND AND OBJECTIVES: The relationship between atopic dermatitis (AD), weight, height, and body mass index (BMI) in children and adolescents and the impact of systemic treatments is controversial. We report the dist...BACKGROUND AND OBJECTIVES: The relationship between atopic dermatitis (AD), weight, height, and body mass index (BMI) in children and adolescents and the impact of systemic treatments is controversial. We report the distribution of weight, height, and BMI in the German TREATkids cohort compared to a standardized German cohort (Kromeyer-Hauschild) and the impact of systemic glucocorticoids. PATIENTS AND METHODS: This multicenter, prospective study analyzed weight and height data from pediatric patients (2-17 years) with moderate-to-severe AD enrolled in TREATkids. RESULTS: According to Kromeyer-Hauschild metrics, the median height, weight, and BMI of the TREATkids cohort were 42nd, 52nd, and 59th percentiles, respectively. A height deficit was observed compared to the reference population. Despite shorter stature, the children exhibited weight percentiles comparable to the general population. This combination of reduced height and normal weight led to high BMI-for-age percentiles. A sensitivity analysis excluding patients who had received systemic corticosteroids showed similar results for height-for-age, weight-for-age, and BMI-for-age percentiles. CONCLUSIONS: Children and adolescents with moderate-to-severe AD in TREATkids exhibit distinct anthropometric patterns, characterized by height deficits but normal weight distribution, independent of systemic glucocorticoid treatment.
Mößner R, Cramer N, Gerdes S
… +15 more, Hüffmeier U, Körber A, Krause K, Kromer C, Langen KA, Philipp S, Schäkel K, Schön MP, Schultheis M, Sollfrank L, Staubach P, Sticherling M, Wohlrab J, Wilsmann-Theis D, Paul C
The S1 guideline "Therapy of generalized pustular psoriasis (GPP)" is a German guideline developed in accordance with the criteria of the AWMF. The full version addresses clinical presentation, pathogenesis, diagnosis an...The S1 guideline "Therapy of generalized pustular psoriasis (GPP)" is a German guideline developed in accordance with the criteria of the AWMF. The full version addresses clinical presentation, pathogenesis, diagnosis and differential diagnosis, comorbidities, and therapy. In addition, therapy recommendations for adults with GPP are provided. Both approved and off-label therapies are considered. The present article is a shortened version of the guideline, whose therapy recommendations are presented in full and without omission.
BACKGROUND AND OBJECTIVES: Eyelid reconstruction following tumor excision poses both functional and aesthetic challenges. Although complex surgical techniques are frequently employed, secondary intention healing remains...BACKGROUND AND OBJECTIVES: Eyelid reconstruction following tumor excision poses both functional and aesthetic challenges. Although complex surgical techniques are frequently employed, secondary intention healing remains a less commonly used option in periorbital surgery. This case series aimed to assess the functional and aesthetic outcomes in patients with eyelid defects treated with the laissez-faire approach. PATIENTS AND METHODS: A retrospective analysis was conducted of six patients with post-excisional eyelid defects who underwent secondary intention healing at the Department of Dermatology, Klinikum Ludwigshafen, between 2016 and 2024. Healing time, complications, functional and aesthetic outcomes were assessed after at least 6 weeks or 6 months postoperatively. RESULTS: The average patient age was 77 years. The indication for surgery was basal cell carcinoma or melanoma. The mean healing time was 6 weeks. All patients achieved good to excellent functional and aesthetic outcomes. Nearly no ocular-specific complications were observed. Secondary intention healing was well-tolerated by all patients. CONCLUSION: Secondary intention healing is a safe and effective alternative to complex reconstructive techniques for selected periorbital defects, particularly in elderly patients. The choice of reconstruction should be tailored individually, taking into account patient age, health status, defect characteristics, and patient preferences.
Burning mouth syndrome (BMS) is a chronic oral neuropathic pain disorder. We conducted a retrospective case series of 13 postmenopausal women with primary BMS treated with low-dose oral amitriptyline administered as liqu...Burning mouth syndrome (BMS) is a chronic oral neuropathic pain disorder. We conducted a retrospective case series of 13 postmenopausal women with primary BMS treated with low-dose oral amitriptyline administered as liquid drops, allowing flexible titration to the individual minimum effective dose. Pain intensity was assessed using a visual analog scale (VAS), and quality of life was measured with the Dermatology Life Quality Index (DLQI) at baseline and during follow-up (6-12 months). Mean baseline VAS was 7.4 and mean DLQI was 13.8. Clinically meaningful improvement was observed in 92.3% of patients, with complete remission in 6 cases and ≥50% pain reduction in 6 cases. Mean final VAS decreased to 1.7 and mean DLQI to 3.2. Symptomatic relief typically occurred within 2-4 weeks after reaching the effective dose and was maintained during follow-up. Low-dose amitriptyline administered with individualized titration appears to be a safe and effective option for refractory primary BMS.
BACKGROUND: Calciphylaxis is a severe condition with no established therapy, characterized by painful skin ulcerations and necrosis resulting from occlusion of small blood vessels. Given the high mortality rate, effectiv...BACKGROUND: Calciphylaxis is a severe condition with no established therapy, characterized by painful skin ulcerations and necrosis resulting from occlusion of small blood vessels. Given the high mortality rate, effective treatment strategies are urgently needed. We hypothesize that a combination of sodium thiosulphate with the prostaglandin analog iloprost and a low-molecular-weight heparin may be a beneficial treatment option for calciphylaxis. PATIENTS AND METHODS: In a retrospective data analysis, 19 patients with calciphylaxis were included who were treated in our clinic between 2019 and 2023. Demographic factors, clinical symptoms, comorbidities, laboratory results, histology, and treatment-related factors were collected. RESULTS: 68.4% were female and mean age was 67.8 years. In 63% of cases, a combination therapy consisting of sodium thiosulfate, iloprost and anticoagulation was used. In a cohort of 12 patients who underwent at least 2 treatment cycles complete healing occurred in 75.0% of cases and partial improvement in 25.0%. The median time to healing was 3.0 treatment cycles. The median duration until complete pain relief was 2.5 treatment cycles. CONCLUSIONS: In our cohort, a combination therapy consisting of sodium thiosulfate, iloprost, and anticoagulation was associated with favorable treatment response, good tolerability, improved wound healing, and pain relief.
BACKGROUND: Studies on the state of medical care for patients with cutaneous T-cell lymphoma (CTCL) are limited. To date, only secondary data analyses are available for Germany. PATIENTS AND METHODS: Cross-sectional stud...BACKGROUND: Studies on the state of medical care for patients with cutaneous T-cell lymphoma (CTCL) are limited. To date, only secondary data analyses are available for Germany. PATIENTS AND METHODS: Cross-sectional study conducted over a one-year recruitment period (01 March 2024 to 28 February 2025) in the dermatological department of a German university hospital. The physician questionnaire recorded the skin-related burden of disease using the mSWAT and data on disease course, while the patient questionnaire recorded socio-demographic and clinical parameters, patient satisfaction, and health-related quality of life using the Skindex-29. RESULTS: 121 patients (median age 63 years, 66.9 % male) with mycosis fungoides (95.0 %) and Sézary syndrome (5.0 %) were included. 30.0 % of the working patients reported sick leave due to CTCL and 51.7 % had already been hospitalized at least once for this indication. The Skindex-29 revealed an impairment in quality of life in 52.9 % of patients. Patients with higher disease stages (IIB-IVB according to EORTC/ISCL), lack of response to therapy, and an mSWAT ≥ 30 showed a significantly higher impairment in quality of life. A median of 4 follow-up appointments were attended annually, with 63.6 % of patients being treated exclusively at the university hospital. CONCLUSIONS: This study is the first to analyze the state of medical care of patients with mycosis fungoides and Sézary syndrome using primary data from routine care at a German university hospital and reveals a high burden of disease as well as a high need for care.
BACKGROUND AND OBJECTIVES: Artificial intelligence was shown to improve diagnostic accuracy for skin cancer detection. While most clinically approved models provide binary "benign/malignant" classifications, multiclass p...BACKGROUND AND OBJECTIVES: Artificial intelligence was shown to improve diagnostic accuracy for skin cancer detection. While most clinically approved models provide binary "benign/malignant" classifications, multiclass predictions may offer greater clinical utility. Yet, comparisons between multiclass convolutional neural networks (CNNs) and dermatologists are scarce. METHODS: In an international web-based reader study, dermatologists (n = 96) and a prototype multiclass CNN (FotoFinder Systems, Germany) assigned diagnoses to 100 skin lesions by using nine disease categories (melanoma; basal cell carcinoma; squamous cell carcinoma; intraepithelial carcinoma; melanocytic nevus; benign keratinocytic lesion; dermatofibroma; vascular lesion; "other"). The main outcome measure was overall mean sensitivity (micro-averaged percentage of correct diagnosis) of dermatologists versus multiclass CNN. RESULTS: Dermatologists achieved an overall mean sensitivity (95% CI) of 69.4% (68.4%-70.3%) with dermatoscopy-only data (level-I), which improved to 76.0% (75.2%-76.9%) when provided with full clinical information (level-II). The CNN's top-rank predictions showed a higher overall mean sensitivity of 82.0% (73.3%-88.3%). The CNN significantly outperformed all dermatologist subgroups, except for dermatoscopy experts at study level-II (overall mean sensitivity 81.1% [79.9%-82.3%], p = 0.0085). CONCLUSIONS: Multiclass CNN predictions outperformed most dermatologists in diagnostic accuracy, supporting their potential to enhance clinical decision-making, particularly in settings with limited dermatological expertise.