Duisburg, Germany
Duisburg, Germany

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Radtke M.A.,Universitatsklinikum Hamburg Eppendorf | Mrowietz U.,Universitatsklinikum Schleswig Holstein | Feuerhahn J.,Universitatsklinikum Hamburg Eppendorf | Harter M.,Universitatsklinikum Hamburg Eppendorf | And 6 more authors.
JDDG - Journal of the German Society of Dermatology | Year: 2015

Psoriasis is associated with an increased rate of comorbidities, whose early detection has been adopted into the national healthcare goals. To date, agreed recommendations on early detection in the context of routine dermatological care are missing. The objective of this study was the interdisciplinary development of screening algorithms. Methods: The development of the consensus paper was based on a three-step process. First, the National Conference on Healthcare in Psoriasis, convening on behalf of the German Society of Dermatology (DDG) and the Professional Association of German Dermatologists (BVDD), developed a definition of the requirements, areas of application, conception, and methodology of a screening tool. Secondly, based on a literature search, individual working groups compiled evidence for the use of screening parameters. In a third step, an interdisciplinary working group adopted the algorithms in a Delphi consensus process. Results: The associated working groups evaluated more than 2,000 publications on 15 different comorbidities. A screening algorithm was agreed on for the following twelve indications: arterial hypertension, dyslipidemia, obesity, diabetes mellitus, metabolic syndrome, nonalcoholic steatohepatitis, depression, nicotine abuse, alcohol abuse, chronic inflammatory bowel disease, psoriasis arthritis, and malignant lymphoma. In this context, the requirements of everyday dermatological care were addressed in particular. Conclusions: With respect to screening for comorbidities in psoriasis, standardized and consented algorithms are available, which-on national level-may be implemented as a screening tool within the framework of "PsoNet-German Psoriasis Networks". © 2015 Deutsche Dermatologische Gesellschaft (DDG).


PubMed | Abteilung fur Dermatologie und Venerologie, Dermatologische Abteilung fur Haut und Geschlechtskrankheiten, Medical University of Vienna, German Electron Synchrotron and Dermatologische Praxis
Type: Journal Article | Journal: Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete | Year: 2016

We describe a 75-year-old patient with asymptomatic grey pigmentation on the face and fingers. He had worked over two decades in cutting high-voltage cables. The cutting procedures were performed without a face shield or protection gloves. The patient presented with gray punctate lesions beside some homogeneously stained zones.Histologically, the deposits presented in the dermal tissue in a horse-shoe, oval, or splinter-like shape. The foreign body material was embedded by a few CD68-positive macrophages. Undyed histological sections were investigated via two-dimensional micro-synchrotron X-ray fluorescence analysis (SRXRF). The deposits were identified as zinc (Zn), copper (Cu), nickel (Ni), and strontium (Sr), which were strongly associated with maximal sulfur (S) concentrations. This association is presumably induced by complex binding between thiol groups and metal ions such as Zn, Ni etc. However, the iron (Fe) distribution patterns were quite different to those of Zn, Cu, or Ni. These heavy metals are major components of the metal wires that the patient worked with in his profession.To the best of our knowledge, this is the first case report in the dermatological literature of intradermal metal deposits identified via SRXRF analysis.


Mettang T.,Fachbereich Nephrologie | Vonend A.,Dermatologische Praxis | Raap U.,Klinik fur Dermatologie
Hautarzt | Year: 2014

Background. Prurigo is seen in various dermatological diseases, but also in systemic and neurological diseases. Objectives. Which diseases in dermatology, internal medicine and neurology are linked to prurigo nodularis? Material and methods. We describe the various entities that are associated with prurigo and discuss pathogenetic and therapeutic implications. Results. In dermatology prurigo nodularis is most frequently seen in atopic dermatitis, but also in cutaneous lymphomas, mycobacterial skin infections and bullous diseases. Among systemic diseases, prurigo nodularis frequently is associated with pruritus of chronic renal or hepatic diseases. Prurigo nodularis is also seen in hematological and metabolic diseases (such as solid tumors, lymphoma, diabetes mellitus). The pathophysiology of prurigo is only partly understood. Treatment of prurigo nodularis is often challenging and a multimodal approach is advisable. Conclusion. Prurigo nodularis is a skin manifestation of chronic pruritus caused by various diseases in dermatology, internal medicine and neurology. An interdisciplinary approach should be taken for diagnosis and therapy. © 2014 Springer-Verlag.


Pfaltz K.,Kempf and Pfaltz Histological Diagnostics | Mertz K.,Kempf and Pfaltz Histological Diagnostics | Rose C.,University of Lübeck | Scheidegger P.,Dermatologische Praxis | And 2 more authors.
Journal of Cutaneous Pathology | Year: 2010

Background: Direct immunofluorescence (DIF) testing is an important procedure in the diagnosis of autoimmune bullous dermatoses. We investigated the expression of C3d in formalin-fixed, paraffin-embedded tissue of autoimmune bullous dermatoses. Methods: The immunohistochemical expression of C3d in bullous pemphigoid (BP) (n = 32), pemphigoid gestationis (PG) (n = 3), pemphigus (n = 14), dermatitis herpetiformis Duhring (DHD) (n = 10), linear immunoglobulin A (IgA) dermatosis (n = 4), mixed forms of BP and linear IgA dermatosis (n = 2), and 44 controls was analyzed on formalin-fixed tissue. Results: Thirty-one of 32 cases (97%) of BP and 3 out of 3 cases (100%) of PG showed a linear positivity of C3d along the basement membrane. Only 3 out of 14 (21%) cases of pemphigus showed an intraepidermal intercellular expression of C3d. The two mixed forms of linear IgA dermatosis and BP showed a linear positivity of C3d along the basement membrane. All cases of DHD, linear IgA dermatosis and all of the controls were negative for C3d. Conclusions: C3d immunohistochemistry is a valuable tool in the diagnosis of BP and PG of the skin with a sensitivity of at least 97%. Mixed forms of linear IgA dermatosis, and BP, DHD and linear IgA dermatosis can only be identified by DIF. A positive result may prompt serologic confirmation of BP without further need for DIF. © 2009 John Wiley & Sons A/S.


Jansen T.,Dermatologische Praxis | Janssen O.E.,Endokrinologikum | Plewig G.,Ludwig Maximilians University of Munich
Hautarzt | Year: 2013

Acne is one of the most common skin diseases in the general population, especially among adolescents. Acne tarda (adult acne) is defined as acne that develops (late-onset acne) or continues (persistent acne) after 25 years of age. The disease is more common in women. The clinical features are quite specific: inflammatory acne in the lower facial region or macrocomedones (microcysts) spread over the face. Involvement of the trunk is much more common in men. The etiology of acne tarda is still controversial, as cosmetics, drugs, smoking, stress, diet, and endocrine abnormalities have been implicated. Women with acne tarda and other symptoms of hyperandrogenism have a high probability of endocrine abnormalities such as polycystic ovary syndrome. Treatment is similar to that of acne in adolescence. Long-term treatment over years or decades may be required. © 2013 Springer-Verlag Berlin Heidelberg.


Bahmer F.A.,Dermatologische Praxis
Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete | Year: 2012

In his autobiography, Charles Bukowski (1920-1994) describes his severe acne conglobata, his experience with therapy, family conflicts and emotional tension. Despite the stigmatization by his acne scars, Bukowski became a philobatic writer and a true chronist of the American way of life in the second half of the 20th century, writing in a coarse and obscene language.


Actinic keratosis is a frequent disease. It may transform into a squamous cell carcinoma. 2013 a new drug called Ingenol mebutate gel has been approved. The effectiveness and manageability in the daily ambulant treatment has not been reported. An analysis of 62 patients treated with Ingenol mebutate gel has been investigated and analyzed. The lesions of 58 patients were examined before starting therapy, after 8 weeks and after 12 weeks using photographic documentation. The patients were questioned for afflictions during treatment. After 12 weeks 51.7% (30 patients) demonstrated complete remission of their lesions. 3.4% (2 patients) achieved ≥ 75 % clearance. The patients specified little discomfort during treatment. Ingenol mebutate gel has been applied to the skin for 3 consecutive days by the ambulance stuff. Ingenol mebutate gel is an effective, well-tolerated treatment for actinic keratosis in daily outpatient treatment. © Georg Thieme Verlag KG Stuttgart · New York.


The persisting high prevalence of allergic diseases in industrialized countries and limited causal therapeutic approaches demand evidence-based measures of primary prevention. The recommendations as published in the guideline of 2009 were updated and consented on the basis of a systematic literature search. Evidence was searched for the period May 2008 - May 2013 in the electronic databases Cochrane and MEDLINE as well as in reference lists of recent reviews and by contacting experts. The retrieved citations were screened for relevance first by title and abstract in a second step as full paper. Levels of evidence were assigned to each included study and the methodological quality of the studies was assessed as high or low. Finally the revised recommendations were formally consented (nominal group process) by representatives of relevant societies and organizations including a self-help group. Of originally 3,284 hits, 165 studies (15 systematic reviews, 1 metaanalysis, 31 RCTs, 65 cohort-, 12 case-control, and 41 cross sectional studies) were included and critically appraised. Grossly unchanged remained the recommendations on full breast feeding over 4 months for allergy prevention (alternatively hypoallergenic formulas for risk babies), avoidance of overweight, fish consumption (during pregnancy/breast feeding and as solid food in the first year), reduction of the exposure to indoor and outdoor air pollutants, avoidance of environmental tobacco smoke, avoidance of a mold-promoting indoor climate, and on vaccination according to current recommendations. The statement that a reduction of the house dust mite allergen load is not recommended as a measure of primary prevention also remained unchanged. Families with risk babies should not acquire a cat. Dogs in a household are not associated with an increased allergy risk. The recommendation, that the increased asthma risk in children born via Caesarean section should be considered, was newly introduced to this guideline. Further statements regarding pre and probiotics, psychosocial factors, drugs, and various food components were adopted. The revision of this guideline on a profound evidence basis led to a conformation of existing recommendations, substantial revisions, and new recommendations. This update should provide evidence-based and current recommendations for the primary prevention of allergies. © 2015 Dustri-Verlag Dr. Karl Feistle.


On a painting by Michael M. Prechtl, the arms of Ernest Hemingway are speckled with small brownish lesions, suggestive of actinic keratoses. However, such changes are not visible on photographs from Hemingway available in biographies as well as in the internet. Photos taken in Hemingway's late years show signs of actinic damage of his facial skin. In his famous novel "The old man and the Seao", Hemingway himself provides a vivid description of chronic actinic skin damage. Obviously, he was aware of the deleterious effects sunlight might have on human skin, however, his oeuvre testifies that he regarded tanned skin as an ideal of beauty. © Georg Thieme Verlag KG Stuttgart · New York.


Bahmer F.A.,Dermatologische Praxis | Bahmer J.A.,Institute For Rehaforschung Norderney
Hautarzt | Year: 2012

In his autobiography, Charles Bukowski (1920-1994) describes his severe acne conglobata, his experience with therapy, family conflicts and emotional tension. Despite the stigmatization by his acne scars, Bukowski became a philobatic writer and a true chronist of the American way of life in the second half of the 20th century, writing in a coarse and obscene language. © 2012 Springer-Verlag.

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