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PubMed2003

[Ultrasound diagnostic techniques in dermatologic angiology and phlebology].

The diagnostic uses of high-resolution ultrasonography (7.5-20 MHZ) have dramatically advanced in the past 20 years. We present representative examples of ultrasound diagnosis, based on our experience with over 15,000 examinations. For example, peripheral arterial disease was identified in 30% of older patients with venous diseases, while peripheral emboli and vasculitis can lead to widespread skin disease. Ultrasonographic diagnosis is required for appropriate interdisciplinary treatment. In addition, regular evaluation of the supra-aortic vessels and coronary arteries as well as arteries and veins of the limbs is needed in some forms of vasculitis. The causes of peripheral venous disease can be subdivided into four groups based on sonographic findings: Primary or secondary epi- and/or subfascial venous insufficiency, thrombotic venous occlusion, venous compression syndrome and arteriovenous-lymphatic malformations. The diagnosis and therapeutic approach to lymphedema and soft tissue diseases, with or without lymphadenopathy, requires careful sonographic evaluation. Ultrasonography is an essential part of dermatologic oncology, both for planning primary therapy and for follow-up. A sound command of ultrasonography is today an essential aspect of dermatologic diagnosis and therapy.

Algorithms↗

PubMed2003

[Laser surgery in dermatology. Risks and chances].

With the introduction of selective photothermolysis with pulsed laser irradiation, the quality of the dermatological laser therapy was clearly improved in the past decade. Above all the high risk of scar formation was clearly reduced. To minimize the fundamental risks that laser surgery entails such as hypo- and hyper pigmentation and scar formation, the indication should be checked precisely before any treatment. In addition, the physician must be aware of the specific side effects of the laser and its correct application. For the dermatologist, there is a wide range of indications on two levels: medical treatment of skin diseases and on the other side the use of laser technology for treatment of cosmetic-aesthetic skin disorders. Laser devices with the same effect and side effects are used for both indication groups. Thus dermatologic training should cover all laser indications.

Cicatrix↗

PubMed2003

[Lasers and aesthetic dermatology].

The improved understanding of laser-tissue interaction along with the latest advances of laser technology have led to the development of sophisticated, safe, and user-friendly laser systems that provide effective treatment for a variety of aesthetic skin conditions. The use of lasers and their tissue-specific capabilities in the treatment of pigmented and vascular lesions has been greatly expanded to include rhytides, photoaged skin, atrophic scars, and unwanted hair. In addition, laser techniques have been employed in traditional "rejuvenating" procedures of aged skin, e.g., face-lifting, blepharoplasty, and hair transplantation, decreasing the intra-operative time and limiting the recovery period. These advances have led to a wide acceptance of cutaneous laser surgery by the dermatologic community and have created an increasing popularity among the public. The purpose of this article is to review the applications of lasers in aesthetic dermatology and discuss their limitations and potential side effects.

Blepharoplasty↗

PubMed2003

[Topical immunomodulators in dermatology].

Immunomodulators include both immunostimulatory and immunosuppressive agents. Obligate contact sensitizers such as diphencyprone or dinitrochlorobenzene have been used against viral and autoimmune diseases. Newer agents such as the toll-like receptor agonists imiquimod and resiquimod have been clinically used to treat viral infections and skin cancers in immunocompetent and immunosuppressed patients. On the other hand, the topical immunosuppressive agents tacrolimus and pimecrolimus have been used with great success in the treatment of chronic inflammatory diseases in children and adults. The introduction of this new class of drugs (i.e. Calcineurin inhibitors) marked the beginning of the post-cortisone era in clinical dermatology. Toll-like receptor agonists and calcineurin antagonists will supplement corticosteroids to improve specific dermatological therapy. Topical immunotherapy with both immunostimulatory and immunosuppressive agents show potential for effective and patient-friendly treatment of inflammatory, infectious and neoplastic skin diseases. Long-term evaluation will define the tolerability and the safety profile.

Adjuvants, Immunologic↗

PubMed2004

[Bacterial colonization of chronic wounds. Studies on outpatients in a university dermatology clinic with special consideration of ORSA].

In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA.

Aged↗

PubMed2004

[Aesthetic dermatology. Botulinumtoxin A and soft tissue augmentation].

Younger and younger patients are undergoing aesthetic procedures to achieve "wrinkle-free" aging. This has had great impact on the field of aesthetic dermatology. The rapid development of new indications and filler materials requires a critical approach to the available substances particularly concerning side effects and long-term effects. The quality of the chosen approach depends on the applied filler substance, clear indication the compliance of the patient and the experience of the physician. The growing expectations of patients require a critical analysis of the available therapy options. Botulinum toxin A is one of the preferred treatments for wrinkles secondary to facial expression. In addition there are a variety of biologically inert and completely resorbable filler materials such as collagen and hyaluronic acid and autologous materials such as fat implants or plasma gel available. This article gives an overview about the most common fillers and their use in aesthetic dermatology.

Adipose Tissue↗

PubMed1995

[Interleukin 7 in dermatology. Molecular, immunologic and preclinical aspects].

The vast body of knowledge on interleukin-7 (IL-7) that has accumulated over the last few years, i.e. since its discovery in 1988, is of increasing relevance for dermatologists. Because of its particular immunological effects, IL-7 is of particular interest in two areas of dermatology. First, IL-7 can be a valuable addition to immunotherapeutic approaches to the treatment of malignant melanoma. A first pilot study of IL-7 gene-modified autologous tumour cells in the treatment of metastatic melanoma is therefore currently being initiated by the authors. Then, keratinocytes are efficient IL-7-secreting cells and there is evidence that IL-7 can modulate the presence and proliferation of normal and malignant lymphopoietic cells in the dermis. In addition, IL-7 is presently the most potent growth factor for in vitro cultivation of Sézary cells and for the establishment of Sézary cell lines. This report reviews molecular, immunological and preclinical properties of IL-7, with special reference to the possible therapeutic efficacy of this cytokine in dermatology.

Genetic Therapy↗

PubMed1995

[The Malignant Melanoma Central Register of the German Society of Dermatology 1983-1993. Epidemiologic developments and current therapeutic management of malignant melanoma of the skin].

The Central Malignant Melanoma Registry of the German Dermatological Society was founded in 1983 and has meanwhile developed into a major continuously updated multicentre project. Up to June 1994, 19,250 reports of cutaneous melanoma had been received, from 41 departments of dermatology in the former Federal Republic of Germany, from 14 departments in the former German Democratic Republic, from 2 departments in Austria, and from 1 department in Switzerland. Analysis of the data revealed some epidemiological trends over time during the years 1983 to 1993. (1) During the last 10 years the percentage of male patients has steadily increased, from an average of 38% in the year 1983 to 46% in 1993. (2) Early diagnosis of malignant melanoma improved during the period of time investigated. The percentage of diagnoses of primary tumour alone increased between 1983 and 1993. The mean tumour thickness (Breslow) decreased in the West Germany from 1.8 mm to 1.3 mm and in East Germany from 2.5 mm to 1.7 mm. The proportion of nodular melanoma decreased correspondingly from 29% to 14% in the former Federal Republic of Germany and from 40.6% to 22.6% in the former Germany Democratic Republic. During the years 1990 and 1993, 64% of melanoma patients with the primary tumour alone were operated on in two consecutive sessions in the former Federal Republic of Germany and 34.2% of those in the former Germany Democratic Republic. During this period 73.7% of all melanoma patients were operated on under local anaesthesia. In recent years surgical operations were more often performed in two consecutive sessions, mostly under local anaesthesia and with decreasing safety margins, in keeping with the decrease in tumour thickness. The present analysis shows that the Central Malignant Melanoma Registry is an important instrument for investigating trends in clinical epidemiology and treatment of malignant melanoma in the German-speaking countries.

Adult↗

PubMed1996

[Treatment of atopic eczema in interdisciplinary cooperation between dermatology and psychosomatic medicine. An individual case report].

Atopic eczema is one of the most frequent dermatological diseases, with a still increasing incidence. Although its etiopathogenesis is still not completely understood, a variety of triggering factors are known. The following case report describes the clinical course of atopic dermatitis in a 2-year-old boy in whom both IgE-mediated allergic reactions and psychological factors were involved in triggering and maintenance of skin lesions. This demonstrates how important both dermatological therapy and close cooperation with the field of psychosomatic medicine can be.

Child, Preschool↗

PubMed1997

[Cutis marmorata teleangiectatica congenita. Important aspects for dermatologic practice].

Cutis marmorata telangiectatica congenita (van Lohuizen) is a rare skin disease in newborn or very young children. From the dermatological point of view, therapy is either not necessary or uncomplicated. However, the dermatologist and/or the pediatrician need to search for possibly associated anomalies. Clinical characteristics of 15 patients examined in the Fachklinik Hornheide within the last 11 years are presented. By giving a survey of the anomalies associated with cutis marmorata telangiectatica congenita, we demonstrate the need of neuropediatric, ophthalmologic and orthopedic examinations in addition the pediatric and dermatologic examinations.

Diagnosis, Differential↗

PubMed1998

[Current status of laser therapy in dermatology].

Indications for dermatological laser therapy have been enlarged during the last few years. In this article the physics and biophysics of laser therapy and the common laser systems in dermatology are described. Modern pulsed laser systems are combined with little side effects. Nevertheless, successfully used alternative methods should not be neglected.

Adult↗

PubMed1999

[Prevalence of psychological symptoms in dermatologic patients of an acute clinic].

There is a lot of information in the literature about psychological disturbances in somatic diseases. For dermatological patients such data are not available. In early spring 1998 we studied the psychological changes in 247 hospitalized patients in the dermatological department of the Ruhr University Bochum. We used the German version of the internationally accepted Hospital Anxiety and Depression Scale. We found the prevalence of psychological alterations ranged between 25.9% and 31%. The prevalence of psychological disturbances was a little higher than that seen in oncological, cardiological or neurological patient populations. Surprisingly skin cancer patients were less affected than patients with chronic inflammatory or angiological diseases. These results underline the necessity of improved psychological therapeutical strategies which must be standardized and evaluated.

Adult↗

PubMed1999

[Effects of combined dermatological and behavioural medicine therapy in hospitalized patients with psoriasis and atopic dermatitis].

The present study examined the effectiveness of combined dermatological and behavioural medicine therapy on the skin status and disease-specific stress of eighty-six patients with psoriasis and fifty-eight patients with atopic dermatitis who were hospitalized in the PsoriSol Clinic, Hersbruck, Germany. In addition to receiving instruction about their stain disease, the patients were offered, practice in relaxation techniques, social contacts and scratching control as well as individual psychological counselling. The clinical change was assessed by PASI and SCORAD, respectively. The Marburg questionnaire for coping with skin diseases (MHF) and a questionnaire for health-related control attributes (GKU-S) served as psychometric measures. Patients showed significant improvement in skin status and psychosocial parameters in pre-post comparison. Social fears, avoidance and helplessness were reduced by significant improvement of the emotional status in both groups. Patients with psoriasis also showed an increase in internal control attributes. Dermatological treatment combined with behavioural medicine therapy can be considered an effective method in patients with atopic dermatitis and psoriasis.

Adaptation, Psychological↗

PubMed2000

[Laser therapy in dermatology and esthetic medicine. Side effects, complications and treatment errors].

Many different laser systems are used in dermatology. To wisely choose the correct laser for a given problem, one must be aware of both the spectrum of disorders for which each laser is suited and the potential side effects. We compare the side effect and complication profiles of the common laser systems pointing out their possibilities and limitations. Typical treatment errors will be pointed out. Dermatological training, extensive experience in laser therapy and compliance with quality guidelines are prerequisites for safe and successful treatment.

Humans↗

PubMed2000

[High dosage steroid pulse therapy. Is there an indication in dermatology?].

In recent years, high-dose steroid pulse therapy has been considered an effective treatment regimen in a number of non-dermatological diseases. This review addresses in the first part the pharmacological basics and mechanisms of action of high-dose glucocorticosteroid therapy. In the second part, we discuss the clinical experience using this treatment for dermatological diseases including pemphigus vulgaris, pyoderma gangrenosum, alopecia areata, and dermatomyositis.

Autoimmune Diseases↗

PubMed2003

[Selected dermatological diseases of the genital region].

Physicians who are not trained in dermatology often experience difficulty interpreting skin lesions. There seem to be a number of similar lesions, which are difficult to categorize. Thus, in this presentation the various dermatological diagnoses of cutaneous genital diseases are not listed systematically, e.g., cutaneous infections, cutaneous tumors. This presentation is based on the so-called "Effloreszenzen". They are lesions such as macules, papules, and ulcers, which are typical for various skin diseases. Knowledge of these skin lesions is helpful in categorizing skin diseases, not only those of the genital region.

Diagnosis, Differential↗

PubMed1997

Skin and bones: dermatologic conditions with skeletal abnormalities.

OBJECTIVE: Radiologists should be aware of the fact that many dermatologic conditions have associated skeletal abnormalities. This pictorial essay seeks to acquaint radiologists with these associations. DESIGN: Twenty-four skin and bone conditions are portrayed and discussed under the headings of: disorders of the epidermis, disorders of the dermis, disorders of the sebaceous glands, disorders of pigmentation, disorders of the nails, tumors, the phakomatoses, immunologic-allergic disorders, and infections. In addition, a table is provided as an expanded listing of conditions with such associations. CONCLUSION: This pictorial essay will help radiologists and other practitioners become familiar with dermatologic conditions that have associated skeletal abnormalities.

Arthrography↗

PubMed2002

A review of antibiotics in dermatology.

BACKGROUND: Since the early 1930s when antibiotics were first introduced, they have revolutionized the way physicians treat infections. Skin conditions from acne to leprosy, which were once shunned by society, are now easily treated with oral antibiotics. OBJECTIVE: Antibiotics are chemicals derived from bacteria and fungi that uniquely have antibacterial action. The most notable example is penicillin, which is derived from a mold. With hundreds of antibiotics available to the practicing physician, improper use of these drugs has become widespread and expensive and has spawned resistant strains. For the dermatologist, antibiotics are vital weapons in the drug armamentarium for treating various skin conditions. CONCLUSION: This review explores the newest and most common oral, parenteral, and topical antibiotics used in dermatology, their indications, adverse effects, dosage, and spectrum of activity. Furthermore, systemic antibacterial prophylaxis and vaccines pertinent to dermatology are discussed. The penicillins, cephalosporins, tetracyclines, macrolides, fluoroquinolones, sulfonamides, aminoglycosides, lincosamides, folate inhibitors, and a new synthetic class of drugs, the oxazolidinones, are reviewed. These antibiotics are used to treat a variety of organisms.

Anti-Bacterial Agents↗