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Background: Diagnostic work-up of leg ulcers is time- and cost-intensive. This study aimed at evaluating ulcer location as a diagnostic criterium and providing a diagnostic algorithm to facilitate differential diagnosis., Patients and Methods: The study consisted of 277 patients with lower leg ulcers. The following five groups were defined: Venous leg ulcer, arterial ulcers, mixed ulcer, arteriolosclerosis, and vasculitis. Using computational surface rendering, predilection sites of different ulcer types were evaluated. The results were integrated in a multinomial logistic regression model to calculate the likelihood of a specific diagnosis depending on location, age, bilateral involvement, and ulcer count. Additionally, neural network image analysis was performed., Results: The majority of venous ulcers extended to the medial malleolar region. Arterial ulcers were most frequently located on the dorsal aspect of the forefoot. Arteriolosclerotic ulcers were distinctly localized at the middle third of the lower leg. Vasculitic ulcers appeared to be randomly distributed and were markedly smaller, multilocular and bilateral. The multinomial logistic regression model showed an overall satisfactory performance with an estimated accuracy of 0.68 on unseen data., Conclusions: The presented algorithm based on ulcer location may serve as a basic tool to narrow down potential diagnoses and guide further diagnostic work-up., (© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

In recent years, our knowledge of congenital melanocytic nevi (CMN) has greatly expanded. This has led to a paradigm shift. The present article represents a commentary by an interdisciplinary group of physicians from German-speaking countries with extensive experience in long-term care and surgical treatment of children and adults with CMN (CMN surgery network, "Netzwerk Nävuschirurgie", NNC). The authors address aspects such as the indication for treatment as well as treatment planning and implementation under these new premises. Adequate counseling of parents on conservative and/or surgical management requires an interdisciplinary exchange among physicians and individualized planning of the intervention, which frequently involves a multi-stage procedure. Today, the long-term aesthetic outcome is at the center of any therapeutic endeavor, whereas melanoma prevention plays only a minor role. The premise of "removal at any cost" no longer holds. Potential treatment-related adverse effects (hospitalization, wound healing disorders, and others) must be carefully weighed against the prospects of a beneficial outcome. In this context, the use of dermabrasion in particular must be critically evaluated. At a meeting of the NNC in September 2018, its members agreed on a consensus-based position on dermabrasion, stating that the procedure frequently leads to impaired wound healing and cosmetically unfavorable or hypertrophic scarring. Moreover, dermabrasion is considered to be commonly associated with considerable repigmentation that usually occurs a number of years after the procedure. In addition, the NNC members saw no benefit in terms of melanoma prevention. In the future, physicians should therefore thoroughly caution about the potential risks and often limited cosmetic benefits of dermabrasion., (© 2019 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Background/aims: The laser Doppler imager (LDI) is a device that maps the local distribution of the laser Doppler flux of tissues. To facilitate the interpretation of LDI measurements, we investigated their reproducibility., Methods: We measured 10 arterial ulcers, 10 venous ulcers and their adjacent skin by the use of a LDI. The means were calculated of individual coefficients of variation ± standard error of mean (meanCV ±SEM) of measurements on the same day, on 5 different days and at specific time points (0, 30, 60, 90 and 120 min) during the application of PGE, on 2 different days., Results: The meanCV ±SEM of measurements on the same day were 9.3±0.9% (ulcer), 9.8±0.9% (skin), and on 5 different days they were 21.9±1.9% (ulcer) and 28.6±2.4% (skin). Ulcer measurements on 5 different days were significantly more reproducible than skin measurements, if differences were calculated for all 20 patients or for the 10 patients with venous ulcers separately (P<0.05). During the application of PGE, for 120 min, meanCV ±SEM ranged from 19.2±4.0% to 26.9±5.0% (ulcer) and from 20.5±4.1% to 29.5+3.9% (skin). CV of skin measurements of all 20 patients at 0 min were significantly lower than those after 120 min of PGE(1) -application (P<0.05)., Conclusion: Our results show an excellent reproducibility of LDI measurements on a single day. The reproducibility of measurements on 5 different days or during the application of PGE1 over a period of 120 min was poorer. Because of the poorer reproducibility, more patients are needed to study long-term or drug effects.

Isotretinoin (13-cis-retinoic acid) is commonly used for the treatment of acne vulgaris. We included 55 patients in this prospective study, and inspected them before, while and after therapy with isotretinoin regarding ocular side effects. Careful slit-lamp inspection, measurement of break-up-time and Schirmer-test and microbiological investigations of the conjunctival flora were performed. While staphylococcus aureus was cultured from the conjunctival sac before application of isotretinoin in 7.3%, this percentage increased to 61.8% during therapy. A pathological decrease of break-up-time was realized in 69.1% of the cases, the development of blepharitis in 40%. But in spite of the alteration of conjunctival flora, bacterial conjunctivitis developed in just 7.3% of the cases. However, only 34.5% of the patients showed symptoms of a conjunctivitis sicca, in spite of the impressive diminution of break-up-time in so many cases. All ocular side effects of isotretinoin were treatable and disappeared completely within 1 month after stopping therapy.