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The article presents a case study of a 67-year-old man with treatment-resistant mycosis fungoides (MF), successfully treated with combined chlormethine gel and low-dose radiation therapy (RT) in addition to extracorporeal photopheresis (ECP). Topics discussed include the efficacy and safety of chlormethine gel in MF treatment, the use of low-dose RT in tumour-stage MF, and the potential benefits of combining chlormethine gel with other treatment modalities like ECP.

Background: Tinea capitis is a highly contagious infectious disease caused by dermatophytes. In Central Europe, it is mainly caused by zoophilic dermatophytes, as, for example Microsporum (M) canis or Trichophyton (T) mentagrophytes and increasingly by anthropophilic fungi. T tonsurans was commonly related to the Tinea gladiatorum, where transmission occurred between infected persons or via contaminated floors. Objective: Reporting the transmission of this highly contagious dermatophyte for the first time via beard shaving and hairdressing in barber shops in Germany. Patients and methods: 18 young male patients developed tinea capitis and/or barbae shortly after shavings of the beard and/or hair in a barber shop. Native, cultural and molecular diagnostics as well as tissue biopsies and resistance tests were performed of skin and hair samples. Results: In all samples, T tonsurans could be identified. The medical history and the clinical picture suggest a transmission through contaminated hairdressing tools. The patients were treated with terbinafine or itraconazole in combination with or exclusively with topical antimycotics. Conclusion: The transmission and a resulting increase in the incidence of infections with T tonsurans may be due to shavings with direct skin contact of insufficiently disinfected hairdressing tools. This path of infection has already been observed in Africa and is now being described for the first time in Germany. Knowledge of the pathogen and its transmission ways are essential to interrupt the chain of infection. [ABSTRACT FROM AUTHOR]

More data on erythema annulare centrifugum induced by COVID-19 vaccination It will be interesting to see if rare skin conditions such as EAC reported in association with COVID-19 vaccination will reappear during the ongoing worldwide booster campaign. Erythema annulare centrifugum (EAC) is a rare skin disease appearing as recurrent erythematous annular eruptions. [Extracted from the article]

Zusammenfassung Hintergrund Nach Ausschöpfung von klassischen Behandlungsverfahren wie Chemo- und Strahlentherapie existieren bei ausgedehnten Hauttumoren oder Hautmetastasen nur wenige Optionen einer lokalen Tumorkontrolle. In diesen Fällen kann die Elektrochemotherapie als Therapiealternative in Erwägung gezogen werden. Patienten und Methodik Im Rahmen einer retrospektiven Studie wurden klinische Charakteristika, Ansprechen und Bedingungen des Ansprechens sowie Nebenwirkungen von 56 Patienten untersucht, die an sechs deutschen Hautkliniken behandelt wurden. Ergebnisse Das mittlere Alter des Kollektivs (14 Männer, 42 Frauen) lag bei 69,3 Jahren. Insgesamt wurden 20 Patienten mit Hautmetastasen bei fortgeschrittenem malignen Melanom, 13 Patienten mit Hautmetastasen bei Mammakarzinom, 15 Patienten mit primären Plattenepithelkarzinomen der Haut oder kutan metastasierten Karzinomen unterschiedlicher Genese sowie 8 Patienten mit primär kutanen Lymphomen oder Sarkomen eingeschlossen. Die Therapie-Ansprechrate lag im Kollektiv bei 44,6 % (10,7 % komplette Abheilung; 33,9 % partielles Ansprechen). Demgegenüber zeigte sich bei 31 (55,4 %) Patienten kein Ansprechen (12,5 % unveränderter klinischer Befund, 42,9 % Tumorprogredienz). Melanome und kutane Lymphome oder Sarkome sprachen signifikant besser an als Karzinome. In etwa einem Viertel der Patienten kam es zu einer Besserung von tumorbedingter Exsudation, Foetor oder chronischer Blutung. Schlussfolgerungen Die Elektrochemotherapie ist eine nebenwirkungsarme Therapieoption, die bei fortgeschrittenen, vortherapierten Tumorerkrankungen in etwa der Hälfte der Fälle erfolgreich war. Das Therapieansprechen scheint auch von der Tumorentität abzuhängen. [ABSTRACT FROM AUTHOR]

Background and objectives Once classic treatments such as chemotherapy or radiation therapy have been exhausted, only few therapeutic options remain for extensive skin tumors or cutaneous metastases. In such cases, electrochemotherapy may be considered as alternative therapy. Patients and methods In this retrospective study, clinical features, treatment response, and adverse effects were evaluated in 56 patients treated with electrochemotherapy at six German dermatology departments. Results The mean age of the patient cohort (14 men, 42 women) was 69.3 years. Included were 20 patients with skin metastasis of advanced malignant melanoma, 13 patients with breast cancer metastases, 15 patients with primary squamous cell carcinoma of the skin or cutaneous metastases of other carcinoma types, and 8 patients with cutaneous lymphoma or sarcoma. The overall response rate was 44.6% (10.7% complete response; 33.9% partial response). By contrast, 31 (55.4%) patients did not respond (12.5% had stable disease; 42.9%, tumor progression). Patients with melanoma and cutaneous lymphoma or sarcoma responded significantly better than those with carcinoma. Roughly one quarter of patients showed an improvement in tumor-related exudation, fetor, and chronic bleeding. Conclusion Showing only few adverse effects, electrochemotherapy was effective in about one half of the patients with advanced tumors. Treatment response appears to depend on the tumor entity. [ABSTRACT FROM AUTHOR]

Localized scleroderma (LS) is a connective skin disease with marked sclerosis of the skin as the most prominent feature. Transforming growth factor beta (TGF-β) plays a central role in the pathogenesis of sclerotic skin diseases. Recently, special attention was contributed to a family of transcription factor proteins involved in TGF-β signal transduction from cell surface to the nucleus, the so-called SMADs. Ultraviolet (UV) irradiation has been reported to alter TGF-β/SMAD pathway in human skin. We sought to investigate the effects of UVA1 on the gene and protein expressions of the TGF-β/SMAD pathway in LS. UVA1 phototherapy was performed in eight LS patients five times weekly for 8 weeks resulting in a total of 40 treatment sessions (single dose 50 J/cm², cumulative dose 2,000 J/cm²). TGF-β1, SMAD3, SMAD4, and SMAD7 mRNA expressions were determined by semiquantitative real-time reverse transcription polymerase chain reaction in lesional and unaffected skin of patients with LS. Additionally, immunohistochemical staining was performed in lesional skin before and after irradiation. Skin status markedly improved in all patients, resulting in a significant reduction of the clinical score from baseline to the end of treatment. Inhibitory SMAD7 mRNA was significantly higher in lesional skin as compared to unaffected skin, and significantly decreased after UVA1 phototherapy. In contrast, SMAD7 mRNA levels remained unchanged in irradiated, healthy skin after UVA1. Both TGF-β and SMAD3 mRNA levels decreased after UVA1, whereas SMAD4 mRNA increased. However, changes in TGF-β, SMAD3, and SMAD4 mRNA after UVA1 did not reach statistical significance. Immunohistochemical investigation did not reveal significant changes in the protein expression of SMADs after UVA1. Similar to scleroderma, SMAD7-mediated negative regulation seems to be impaired in LS. UVA1 phototherapy demonstrated the alteration of SMAD7 gene expression in LS, as SMAD7 mRNA levels normalized after UVA1. The pathogenetic relevance of SMAD7 levels with respect to clinical improvement needs further investigation. [ABSTRACT FROM AUTHOR]

Objective: During the last decades,management of intertriginous psoriasis (IP) has been unsatisfactory because of the adverse effects associated with long-term corticosteroid application and the lack of alternatives. Recently, both pimecrolimus and tacrolimus have been investigated for this indication and shown to be safe and effective. So far, to our knowledge, a comparison of one of these drugs with standard regimens for IP has not been performed. Design: A single-center, 4-week, double-blind, randomized, vehicle-controlled comparison study to assess the safety and efficacy of 1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone valerate in the treatment of IP. Setting: Dermatologic hospital at Ruhr University of Bochum. Patients: Eighty adults with IP. Interventions: Treatment of IP with 1% pimecrolimus, 0.005%calcipotriol, 0.1% betamethasone, or the vehicle once daily for 28 days. Main Outcome Measures: Mean reduction of the Modified Psoriasis Area and Severity Index (M-PASI) score after 28 days of treatment was considered the primary outcome measure, which was analyzed on an intention-to-treat basis. The secondary outcome was a visual analog scale score for itching. Results: After 4 weeks of treatment, the 3 active compounds and the vehicle resulted in a significant decrease in mean M-PASI score (86.4% for 0.1% betametha-sone, 62.4% for 0.005% calcipotriol, 39.7% for 1% pimecrolimus, and 21.1% for vehicle). The 0.1% betamethasone was significantly more effective than 1% pimecrolimus during the study period (P .05). No significant difference was found between 0.005% calcipotriol and 0.1% betamethasone and between 0.005% calcipotriol and 1% pimecrolimus. The visual analog scale score for pruritus decreased by 78% for 0.1% betamethasone, 57% for 0.005% calcipotriol, 35% for 1% pimecrolimus, and 43% for the vehicle, again demonstrating a clear advantage for the corticosteroid (P .05). Conclusions: The 1% pimecrolimus was shown to be less potent than 0.1% betamethasone in the treatment of IP. Considering the adverse-effect profile of long-term application of corticosteroids, occasional or intermittent rescue therapy with short-term topical corticosteroids and maintenance with a less potent agent, such as 1% pimecrolimus or 0.005% calcipotriol, might be appropriate for patients with IP in general practice. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented describing subacute cutaneous lupus erythematosus.