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Background Most data on chronic spontaneous urticaria (CSU) originate from highly selected patient populations treated at specialized centres. Little is known about CSU patient characteristics and the burden of CSU in routine clinical practice. AWARE (A World-wide Antihistamine-Refractory chronic urticaria patient Evaluation) is an ongoing global study designed to assess chronic urticaria in the real-life setting. Objective To describe the baseline characteristics of the first 1539 German AWARE patients with H1-antihistamine-refractory CSU. Methods This prospective non-interventional study included patients (18-75 years) with a diagnosis of H1-antihistamine-refractory CSU for > 2 months. Baseline demographic and disease characteristics, comorbidities, and pharmacological treatments were recorded. Quality of life (QoL) was assessed using the dermatology life quality index (DLQI), chronic urticaria QoL questionnaire (CU-Q(2)oL), and angioedema QoL questionnaire (AE-QoL, in cases of angioedema). Previous healthcare resource utilization and sick leave data were collected retrospectively. Results Between March and December 2014, 1539 patients were assessed in 256 sites across Germany. The percentage of females, mean age, and mean body mass index were 70%, 46.3 years, and 27 kg/m(2), respectively. The mean urticaria control test score was 7.9, one in two patients had angioedema, and the most frequent comorbidities were chronic inducible urticaria (CIndU;24%), allergic rhinitis (18.2%), hypertension (18.1%), asthma (12%), and depression (9.5%). Overall, 57.6% of patients were receiving at least one pharmacological treatment including second-generation H1-antihistamines (46.3%), first-generation H1-antihistamines (9.1%), and corticosteroids (15.8%). The mean DLQI, total CU-Q(2)oL, and total AE-QoL scores were 8.3, 36.2, and 46.8, respectively. CSU patients reported frequent use of healthcare resources, including emergency services (29.7%), general practitioners (71.9%), and additional allergists or dermatologists (50.7%). Conclusions and Clinical Relevance This study reveals that German H1-antihistamine-refractory CSU patients have high rates of uncontrolled disease, angioedema, and comorbid CIndU, are undertreated, have impaired QoL, and rely heavily on healthcare resources.

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatoiogic training, reiations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman-Yahr, MD, phD, Editor, Jet International M-154, PO Box 020010, Miami, FL 33102.

White piedra is a rare hair infection of man and certain animals, caused by the widespread Trichosporon fungi. The infection is characterized clinically by whitish, soft and easily removable coating of the hair shafts; however, the shafts may be destroyed by the pathogens invading at localized points. While all body hair may be affected, the pubic hair is most frequently affected. This paper is the first report genital white piedra in a 34-year-old Central European man. In all, 22 cases have been described world-wide in young men ranging in age from 20 to 40 years. Only 2 men, aged 42 and 53 years, do not fall in this range. Recently, a major African study disclosed this disease in women for the first time. In moderate latitudes, however, this infection appears to occur almost exclusively in young men.

Tinea capitis and corporis caused by Trichophyton soudanense were identified in a 6-year-old coloured boy who was born in Zaire and had been living for 3 years in Germany. This dermatophyte is very rarely seen outside the region in Africa where it is endemic. The disease is frequently overlooked at diagnosis because of the pathogen's capacity for causing chronic and oligosymptomatic infections. In our case the tinea did not a become apparent until the patient had been in Germany for 3 years. No-one else in his family had any comparable scalp or skin lesions. Consistent therapy with itraconazole (Sempera) dosed at 3 mg/kg body weight per day over a period of 4 weeks led to a permanent cure.

Thirty-eight compounds were isolated from the roots and stem bark of Piptostigma fugax , besides three fractions of mixtures of homologues of two 6′-acylated sterol glucosides and fatty acids, respectively. Structures were determined by spectroscopic and chemical methods. Mixtures of homologues were analysed by GC-mass spectrometry after derivatization. 5α-Cycloart-24-ene-3β,16β,21-triol, 4-hydroxy-4,7-dimethyl-1-tetralone and three onychine-type alkaloids (2,7-dihydroxyonychine, 7-hydroxy-2-methoxyonychine and 7-hydroxy-2,8-dimethoxyonychine) represent new compounds. N -Methylheteropsine has been isolated as a natural product for the first time.