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A central goal of the adrenal insufficiency management is the prevention of acute adrenal insufficiency (also known as adrenal crisis or Addison crisis). This consensus document was generated in order to achieve better implementation and harmonization of measures for the prevention and treatment of acute adrenal insufficiency in Austria. The following measures are generally recommended for all patients with adrenal insufficiency and are outlined in this manuscript: (1) Provision of a "steroid emergency card" and possibly also a medical alert bracelet or necklace (or similar identification). (2) Provision of a hydrocortisone injection kit (or alternative glucocorticoid preparations) for emergency use plus sufficient oral glucocorticoid doses for stress situations/illness. (3) Education of patients and relatives on glucocorticoid stress dosing and "sick day rules" as well as on self-injection of hydrocortisone. (4) Provision of a treatment guideline (information leaflet) for the prevention and therapy of the adrenal crisis, which should also be shown to healthcare staff if necessary. (5) Provision of an emergency phone number (contact details) of the responsible endocrine specialist team or other trained staff. (6) Reinforcement of patient education on a regular basis (preferably yearly). This consensus document also includes recommendations for glucocorticoid dosing in the perioperative setting as well as in various other stress situations.

Sunscreens provide excellent protection against erythema and against chronic damage such as photoaging and skin cancer. Today's challenges concern safety of the products and improved methods for standardizing the evaluation of their efficacy. Other important topics are the further development of sunscreen products, as well as personalization of use. Personalized sun protection based on the phenotype, the genetic profiles and moreover the skin's microbiome - all linked to the identification of certain consumer susceptibility factors - is an exciting new area of research. In particular, the expansion with innovative topical agents such as DNA repair liposomes in improved galenic formulations with UV filters tailored to the skin phototype and new topical antioxidants could in future provide even more comprehensive sun protection. New antioxidants and other agents such as nicotinamide could increase systemic photoprevention. Sustainability will also be an important aspect to protect consumers, but also the environment (i.e. especially marine wildlife) from toxic effects of sunscreens.Sonnenschutzmittel schützen hervorragend gegen Erythem und gegen chronische Schäden wie die Lichtalterung (Photoaging) und Hautkrebs. Aktuelle Herausforderungen betreffen die Sicherheit der Produkte und verbesserte Methoden, um ihre Wirksamkeit standardisiert zu bewerten. Weitere wichtige Themen sind die Weiterentwicklung von Sonnenschutzmitteln sowie die Personalisierung der Anwendung. Personalisierter Lichtschutz, der auf dem Phänotyp, den genetischen Profilen und darüberhinausgehend dem Mikrobiom der Haut – allesamt verbunden mit der Identifikation von bestimmten Suszeptibilitätsfaktoren der Verbraucher – beruht, ist ein spannendes neues Forschungsfeld. Insbesondere die Erweiterung mit innovativen topischen Agenzien wie DNS(Desoxyribonukleinsäure)-Reparatur-Liposomen in verbesserten galenischen Formulierungen mit auf den Hauttyp abgestimmten UV-Filtern und neuen topischen Antioxidanzien könnte zukünftig einen noch umfassenderen Sonnenschutz ermöglichen. Neue Antioxidanzien und andere Agenzien wie beispielsweise Nicotinamid könnten die systemische Photoprävention noch verstärken. Nachhaltigkeit wird zudem ein wichtiger Aspekt, um die Verbraucher, aber auch die Umwelt (d. h. insbesondere die marine Tier- und Pflanzenwelt) vor toxischen Auswirkungen von Sonnenschutzmitteln zu bewahren.

Summary Background: Numerous studies have confirmed the short-term effectiveness of 8-methoxypsoralen bath PUVA therapy in patients with chronic palmoplantar dermatoses; however, little is known about long-term results. Patients and methods: In this retrospective study we examined the long-term results in 79 patients (mean age: 48 years) with chronic palmoplantar dermatoses who were treated with bath PUVA three times a week over an 8-year period. A good clinical response (a reduction of more than 50% of the skin lesions) occurred after a mean of 23 treatments and a mean cumulative UVA dose of 39 J/cm2 in 51 patients (65%). In 2007 a questionnaire was sent to these 51 patients to assess the long-term outcome. Results: With bath PUVA treatment, the best results were found in patients with hyperkeratotic eczema (17/22; 77% good clinical response) followed by patients with palmoplantar psoriasis (26/41; 63%) and patients with dyshidrotic eczema (8/16; 50%). Thirty-four patients (67%) answered the questionnaire after a mean follow-up interval of 4.3 years (10–87 months). Among these patients, 36% reported an improved course of disease after PUVA therapy with reduced frequency and/or intensity of the skin rash, and 29% of patients reported continued complete clearance. 79% of our patients reported a long-term reduction in the use of topical corticosteroids during the follow-up period (mean: 4.3 years). In addition, 67% of patients reported a lasting improvement in quality of life. Conclusions: These data show that bath PUVA may have a long-term, beneficial influence on the course of disease in a majority of patients with recalcitrant chronic palmoplantar dermatoses.

Actinic prurigo is a rare, often difficult-to-treat, idiopathic photodermatosis. Actinic prurigo is divided into a hereditary form appearing in the Native American population and a sporadic form occurring in non-Native Americans. We present a 28-year-old Caucasian woman who developed typical clinical signs and symptoms of actinic prurigo, just as had her mother and grandmother. The patient and her mother were HLA-A24 and HLA-DR 4 with the subtype HLA-DRB1*0408. Based on clinical symptoms and the HLA pattern, the diagnosis of actinic prurigo was made. Treatment with thalidomide led to resolution of the disease. This case report of a Caucasian woman suffering from a hereditary form of actinic prurigo questions the established classification of actinic prurigo into a hereditary Native American form and a sporadic form occurring in the non-Native American population.