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Granuloma annulare is a relatively common non-infectious disease with unknown aetiology sometimes associated with systemic conditions. It is characterized by a necrobiotic granulomatous inflammation. A rare manifestation of the disease is granuloma annulare giganteum exhibiting as hard plaques with lesions up to 20 centimetres. We report a 44-year old male patient with a granuloma annulare giganteum et disseminatum. Despite topical therapy with glucocorticosteroids and repeated intralaesional steroid-injections further progression was observed. After beginning of treatment with fumaric acid ester (FAE) with the dosage recommended for treatment of psoriasis, a slow amelioration occured. Increasingly the patient reported sickness and diarrhea when the treatment reached four tablets of FAE per day. Finally a hyperthyroidism was confirmed with delay since the complaints initially were related to the treatment with FAE. As consequence by being aware of an increase of diarrhea, a fast loss of weight and tachycardia the development of a hyperthyroidism should be considered.

Background: Despite new treatment options with systemic disease modifiers, topical therapy - especially as combination therapy - plays an important role in psoriasis treatment. Methods: Antipsoriatic efficacy of methylprednisolone aceponate ointment (MPA), tacrolimus 0.1% ointment (FK506) and their combination (MPA+FK506) were investigated in a double-blind randomized pilot study using the psoriasis plaque test. Agents and corresponding placebos were applied once daily under occlusion for 11 days. Test sites were evaluated by sum score (erythema, scaling, infiltration), objective assessment by 20-MHz-sonography and optical coherence tomography (OCT). Results: After 11 days, the sum score significantly improved from baseline value in FK506-treated skin (9.6 vs. 2.9, p < 0.0001). MPA led to a significant improvement of the sum score (9.4 vs. 0.6, p < 0.0001). Combination therapy showed results similar to MPA monotherapy (9.4 vs. 0.4, p < 0.0001). These findings were confirmed by 20-MHz-sonography and OCT data. Conclusion: FK506 is moderately effective in chronic plaque-type psoriasis in our model. Combination therapy with FK506+MPA has no additive effect compared to MPA alone.

Der eosinophile Granulozyt (e. G.) ist angesichts seiner morphologischen und funktionellen Eigenschaften in Abwehrmechanismen, immunologische Reaktionen und proentzundliche/neoplastische Prozesse eingebunden. Die zunehmende Identifikation pathophysiologischer Vorgange in den e. G. auf molekularer Ebene gestattet heute weitaus haufiger die Abgrenzung zwischen reaktiver (sekundarer) und klonaler Eosinophilie einschlieslich des idiopathischen Hypereosinophiliesyndroms. Es soll in diesem Beitrag auf das Spektrum dermatologischer Krankheitsbilder hingewiesen werden, die haufig mit einer Eosinophilie assoziiert sind. Zusatzlich werden dermatologische Erkrankungen mit persistierender Eosinophilie charakterisiert. Beide Gruppen sind den reaktiven Eosinophilieformen zuzuordnen. Im Hinblick auf die differenzialdiagnostische Bedeutung erfolgt eine Berucksichtigung des Hypereosinophiliesyndroms, zumal hier aktuell selektive Targets erkannt (z. B. IL-5, CD52) und durch monoklonale Antikorper wie Mepolizumab, Alemtuzumab oder SCH55700 genutzt werden konnen.

Der anlagebedingte Haarausfall, auch androgenetische Alopezie (AGA) oder Alopecia androgenetica genannt, stellt im Erwachsenenalter bei beiden Geschlechtern die haufigste Ursache von Haarverlust dar. Eine Option in der Behandlung der AGA bei Mannern und Frauen ist Alfatradiol, ein topisch wirksames Estrasterid ohne Hormonwirkung, das uber die Hemmung der 5a-Reduktase direkt kausal in den Pathomechanismus des Haarverlustes eingreift. In einer multizentrischen offenen Studie mit 233 Patienten (192 Frauen, Alter 14 ± 76 Jahre; 41 Manner, Alter 17 ± 56 Jahre) konnten nach 7,5 Monaten topischer Behandlung mit Alfatradiol (0,025 %) Trichogramme von 11 2 Patienten (92 Frauen, 20 Manner) ausgewertet werden. Unter der Therapie mit Alfatradiol nahm frontal die Anagenhaarrate im Vergleich zum Ausgangswert statistisch signifikant zu, bei den Frauen von 69 % auf 77 % (Mittelwerte) und bei den Mannern von 56 % auf 65 %. Der Anteil der telogenen Haare verring erte sich entsprechend. Bei 12 % der Frauen und 21 % der Manner nahm die Anagenhaarrate unter der Behandlung weiter ab. Lediglich drei Patienten (1,3 %) berichteten von leichten lokalen Unvertraglichkeitsreaktionen. Damit erwies sich die topische Behandlung der AGA mit Alfatradiol bei Mannern und Frauen als wirksames und sicheres Prinzip.

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis vulgaris. Making the diagnosis is not trivial even today. In contrast to older data, relatively high rates of disease progression and joint damage have been found in recent trials. Whether this originates from erroneously included patients with rheumatoid arthritis or true severity of PsA needs to be confirmed. The ClASsification criteria for Psoriatic Arthritis criteria are now widely accepted and used in the setting of clinical studies. Their further validation and development is conducted by Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Correct diagnosis and classification is a prerequisite for valid conclusions from therapeutic and prognostic clinical trials and optimal care for individual patients. This article reviews clinical presentation, diagnostic tools, classification criteria, differential diagnosis and treatment options in PsA.

The scalp is the most common site of disease involvement at the onset and throughout the course of psoriasis. For many patients, psoriasis of the scalp is the most difficult aspect of their disease; yet, despite a wide range of therapy options and an extensive literature base, scalp psoriasis remains difficult to treat, highlighting a long-standing unmet need for the effective treatment of scalp psoriasis. A review of past and current medical literature reveals that a number of interesting therapeutic approaches have been used in the treatment of scalp psoriasis. The diverse and sometimes extreme therapeutic approaches, the marginal benefit of many topical agents, the paucity of controlled studies evaluating the efficacy of topical agents in the treatment of scalp psoriasis and the high level of patient dissatisfaction with currently available treatments for psoriasis all support the need for new, effective and well-tolerated treatment options for scalp psoriasis.

The calcipotriol/betamethasone dipropionate two-compound product Dovobet/Daivobet/Taclonex(LEO Pharma A/S, Ballerup, Denmark) has been shown to be safe and effective in the treatment of psoriasis for up to 8 weeks. As psoriasis is a chronic disease, long-term treatment may be required, so there is a need to investigate the safety of its use over a longer period of time.To investigate the safety of two treatment regimens involving use of the two-compound product over 52 weeks in the treatment of patients with psoriasis.Patients (n = 634) were randomized double-blind to treatment with: (i) 52 weeks of the two-compound product (two-compound group); (ii) 52 weeks of alternating 4-week periods of the two-compound product and calcipotriol (alternating group); or (iii) 4 weeks of the two-compound product followed by 48 weeks of calcipotriol (calcipotriol group). Treatments in all groups were used once daily when required.Adverse drug reactions (ADRs) occurred in 45 (21.7%) patients in the two-compound group, 63 (29.6%) in the alternating group and 78 (37.9%) in the calcipotriol group. The odds ratio for an ADR in the two-compound group relative to the calcipotriol group was 0.46 (95% confidence interval 0.30-0.70; P0.001). ADRs of concern associated with long-term topical corticosteroid use occurred in 10 (4.8%) patients in the two-compound group, six (2.8%) in the alternating group and six (2.9%) in the calcipotriol group; those with the highest incidence were skin atrophy, occurring in four (1.9%), one (0.5%) and two (1.0%) patients, respectively, and folliculitis, in three (1.4%), one (0.5%) and no patients, respectively.Treatment with the two-compound product for up to 52 weeks appears to be safe and well tolerated whether used on its own or alternating every 4 weeks with calcipotriol treatment.

Dapsone (4, 4' diaminodiphenylsulfone) is an efficient antiinflammatory agent. Its therapeutic use may result in a variety of adverse effects. The most frequent unwanted reactions are hemolytic anemia and methemoglobinemia. By oral route dapsone is mainly metabolized to monoacetyldapsone (MADDS) and hydroxylamine dapsone (DDS-NOH). We report a 76-year-old female patient with linear IgA dermatosis who developed a dapsone-induced photosensitivity 8 weeks after initiation of sulfone therapy. She showed a widespread erythematous eruption in UV-exposed skin area. After clearing of skin lesions the photopatch test revealed positive reactions to dapsone, MADDS and DDS-NOH. Dapsone-induced photosensitivity to date has been described only in leprosy patients. We demonstrate for the first time that this adverse reaction is not restricted to leprosy and that dapsone metabolites may also contribute to the mechanism of photosensitivity like the parent sulfone. Dapsone-induced photosensitivity is a rare, not dose-related adverse effect of the sulfone and can also occur in patients with inflammatory skin disorders.

Nail changes often represent diagnostic hallmarks for a variety of systemic diseases. The awareness of drug-induced nail injuries is important in order to avoid unnecessary diagnostic activities. We observed a 21-year-old female patient with Hodgkin's lymphoma, who developed transverse leukonychia of all fingernails associated with polychemotherapy.

Ciclopirox is a broad-spectrum antifungal agent with antiphlogistic properties [6, 8]. Chemically, it belongs to the hydroxy-pyridone derivatives [7]. Clinical and in vitro studies have shown that ciclopirox and ciclopiroxola-mine are effective in treating mycoses of both the skin and the nails [3–5, 8, 9]. Much interest has been focused on the development of special topical formulations for the treatment of affected nails. Experimental studies have elicited that ciclopirox easily penetrates into and through human nails [1, 2]. Ciclopirox 8% nail lacquer has been proven to be effective in the therapy of onychomycosis [8]. The aim of the present investigation was to determine the optimum frequency of application of ciclopirox 8% nail lacquer in patients with onychomycosis.

Systemic retinoids are effective in a variety of inflammatory dermatoses. Disorders in which polymorphonuclear leukocytes (PMN) are involved, such as psoriasis and acne, respond particularly well to various retinoids. However, side-effects restrict the use of systemic retinoids to severe manifestations. Topical application might provide the possibility of avoiding the systemic side-effects of these compounds. In this communication we report on the modulation of transepidermal migration of PMN by topical application of all-trans-retinoic acid, 13-cis-retinoic acid, arotinoid methyl sulphone and arotinoid ethyl sulphone. Test areas of healthy volunteers were pre-treated with these retinoids in a cream base and with corresponding placebo creams, and intraepidermal accumulation of PMN was quantified 24 h after epicutaneous challenge with leukotriene B4 (LTB4), using elastase as a marker enzyme. Topical treatment with 13-cis-retinoic acid resulted in a marked and statistically significant inhibition of the LTB4-induced migration of PMN. All-trans-retinoic acid, arotinoid methyl sulphone and arotinoid ethyl sulphone reduced the accumulation of PMN slightly, but not statistically significantly. Topical treatment with arotinoid methyl sulphone had no effect.