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Background Studies on patch testing with workplace materials and evaluation of current occupational relevance of positive patch test reactions are scarce in patients with occupational dermatitis (OD). Objectives To identify frequent sensitizations with occupational relevance and to determine the value of patch testing with workplace materials in OD patients. Patients and methods Results and clinical data of 654 patients with suspected OD patch tested between 2013 and 2017 were analysed. Results Occupational allergic contact dermatitis was diagnosed in 113 (17.3%) patients. Mechanics had the widest range of occupational sensitizations. Sensitization to epoxy resin was rated occupationally relevant in almost all handicraft trades. Among positive patch test reactions to workplace products, those to water-based metal working fluids and leave-on cosmetic products were most frequent. Despite frequent testing, protective gloves only rarely elicited positive reactions. Preservatives and rubber compounds were most frequently identified as currently occupationally relevant. Conclusions Rubber allergy is occupationally relevant especially in healthcare workers and cleaners. Generally, preservatives including formaldehyde releasers are important allergens in OD patients. Leave-on cosmetic products must not be forgotten as allergen sources. Patch testing both workplace materials and standardized test preparations has a complementary value and is beneficial for the diagnostic work-up of OD patients.

Background The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the ‘real‐life’ situation of health care for patients with AD. Objectives Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients. Methods Patients (≥18 years) with moderate‐to‐severe AD [objective (o)SCORAD > 20], or with current or previous anti‐inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0–72), the oSCORAD (0–83) and the Investigator Global Assessment (IGA; 6‐point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six‐step Likert scale]. Disease symptoms were assessed by the patient‐oriented eczema measure (POEM, 0–28) and numeric rating scales (NRS, 0–10). Health‐related quality of life was measured using the dermatological life quality index (DLQI, 0–30). Results A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either ‘current’ (12.1%) or ‘prescribed’ (31.4%) at baseline. Conclusions These ‘real‐life’ data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate‐to‐severe AD.

Background: Clinical registries may provide high-quality evidence on the use and effectiveness of therapeutic interventions under real-life conditions. Adults with moderate-to-severe atopic eczema (atopic dermatitis [AD]) are enrolled into TREATgermany and prospectively followed over at least 2years. This paper analyses the association between dermatological quality of life and work limitations.Materials and Methods: Treatment modalities and abroad set of physician- and patient-reported outcome measures are documented using validated instruments to assess clinical disease severity (EASI [Eczema Area and Severity Index], objective SCORAD [objective-SCORing Atopic Dermatitis]), quality of life (DLQI [Dermatology Life Quality Index]), symptoms (POEM [Patient-oriented Eczema Measure]), global disease severity, as well as patient satisfaction and work limitations including presenteeism (WLQ [Work Limitation Questionnaire]). From 06/2016 until 12/2017, 241 individuals (mean age 43 +/- 15years, 38.6% female) were enrolled at 19recruitment centers;69% of the patients were employed.Results: Employed persons had DLQI and WLQ scores of 10.6 +/- 6.9points and 17.7 +/- 18.1%, respectively. Mean presenteeism was substantial accounting for 9.2%. With coefficients of 0.39 and 0.33 WLQ and presenteeism scores significantly correlate with DLQI (p

Background Metalworkers occupationally exposed to metals, tools, metalworking fluids (MWFs), technical oils, gloves, skin care products etc. frequently suffer from occupational dermatitis (OD). Objectives To investigate occupational exposure and to identify relevant occupational sensitizers in metalworkers with OD, and to evaluate suitability of current German patch test recommendations for this occupational group. Patients and methods As part of the OCCUDERM project, occupational exposure of 230 metalworkers with suspected OD patch tested in the departments of dermatology in Gottingen and Osnabruck (both Lower Saxony, Germany) in 2012-2017 was recorded by questionnaire. These data, as well as results, of patch testing with standardized allergens and with workplace material were analysed. Results Metalworking fluids and skin care products were the most important exposures. Among MWF allergens, most frequently sensitizations to formaldehyde and formaldehyde releasers, colophony/abietic acid and monoethanolamine were observed. Sensitization to methylisothiazolinone (MI) was frequent, probably as part of the general European epidemic of contact allergy to MI in leave-on cosmetics. Sensitization to glove ingredients only played a minor role. Conclusions The known occupational allergen spectrum could largely be confirmed. In order not to miss relevant sensitizations, patch testing with material from the patients' workplaces in parallel to baseline and MWF series is recommended. Sensitizations diagnosed could not always be linked to particular occupational exposures.

Das atopische Ekzem des Kindesalters ist mit einer stadiengerechten topischen Therapie in der Mehrheit der Falle gut behandelbar. Herausforderungen stellen die schweren Verlaufsformen mit rezidivierenden Superinfektionen, das Management assoziierter Nahrungsmittelallergien sowie die psychosozialen Aspekte einer chronischen Erkrankung im Familienkontext dar. In dieser Altersgruppe liegt ein besonderer Fokus auf der Pravention – primar und im Hinblick auf die Entwicklung weiterer Erkrankungen des atopischen Formenkreises. In einigen dieser Bereiche haben sich in den letzten Jahren neue Aspekte ergeben, die das praktische Management des atopischen Ekzems im Kindesalter verandert haben oder in Zukunft verandern konnten.

Bacterial infections of the skin are often seen by dermatologists. The majority of infections are caused by the gram-positive bacteria Staphylococcus aureus and Streptococcus pyogenes. These induce blistering/erosive (impetigo, ecthymata) and abceeding (folliculitis) infections of the skin, respectively. Owing to their differences in virulence factors and host immunity, these strains can lead to varying presentations and courses of the infections. This review focuses on impetigo, folliculitis, perianal streptococcal dermatitis, and ecthymata.

Zusammenfassung Die uberwiegende Zahl der malignen Melanome („schwarzer Hautkrebs”) treten an der sichtbaren Haut auf. Werden sie rechtzeitig erkannt, ist die Behandlung nach Exzision mit Sicherheitsabstand abgeschlossen. Dagegen haben Patienten mit metastasiertem Melanom trotz neuer Therapien weiterhin eine sehr schlechte Prognose. Daher hat die Fruherkennung beim malignen Melanom einen sehr hohen Stellenwert. Der „weise Hautkrebs” ist aufgrund des geringen Metastasierungsrisikos prognostisch deutlich gunstiger, jedoch konnen auch hier durch fruhzeitige Behandlung eingreifende Therapien vermieden werden. Der Artikel gibt praktische Hinweise, auf welche Hautveranderungen Therapeuten bei ihren Patienten achten sollten.

larvae and usually occurs on the trunk or buttocks. Migration is less irregular and produces broad, less clearly demarcated tracks on the extremities (progressing up to 5 cm per hour, hence the name lar-va currens) and usually disappears rapidly. This guideline does not address larva currens. Cutaneous larva migrans should also be distinguished from the symptom “creeping eruption” which is a migrating subcutaneous swelling with redness and urticaria of the overlying skin. It occurs, for instance, in gnathostomiasis, cuta-neous paragonimiasis (

Bestimmte Dermatosen konnen von vorangehenden oder parallel bestehenden Infektionen ausgelost oder verschlechtert werden. Die Psoriasis vulgaris etwa kann Folge einer Streptococcus-pyogenes-Infektion sein, der Lichen ruber durch Hepatitis-C-Viren ausgelost werden.

Silikon ist ein in der Medizin vielfach eingesetztes Material und spielt unter anderem in der plastischen Rekonstruktion eine grose Rolle. Die Anwendung von Silikon kann jedoch fur den Patienten erhebliche, teils nicht abschatzbare Konsequenzen haben, von Schwellungen und Rotungen im Bereich der Injektionsstelle uber regionale Lymphadenopathie bis hin zur Entwicklung schwerer Hautlasionen, auch fern des Applikationsortes, wie im hier geschilderten Fall einer Patientin, die wenige Jahre nach Silikoninjektion in beide Gesashalften massive Ulzerationen gesasabwarts entwickelte. Daruber hinaus sind Systemreaktionen wie intrapulmonale Granulome, Embolien und assoziierte Pneumonien moglich. Auch ein Zusammenhang mit der Entwicklung von Autoimmunerkrankungen und Neoplasien wird diskutiert. Therapiemoglichkeiten bestehen in der operativen Entfernung des Materials sowie antiinflammatorischen Lokal- und Systemtherapien. Erstere ist jedoch angesichts einer diffusen Verteilung von Silikon haufig nicht vollstandig moglich, fur Zweitere fehlen Erfahrungswerte, vor allem im Langzeitverlauf. Flussiges Silikon zur kosmetischen Injektion ist daher weder in Europa noch in den USA zugelassen. Aber auch bei der Verwendung von Silikonimplantaten sollte stets eine sorgfaltige vorherige Abwagung und Aufklarung sowie eine Durchfuhrung nur durch fachlich geschultes Personal erfolgen. Daruber hinaus empfehlen sich regelmasige Nachsorgeuntersuchungen sowohl bei Implantattragern als auch jenen Patienten, denen in der Vergangenheit flussiges Silikon injiziert wurde.

Gender differences in the development and prevalence of human diseases have long been recognized. Immense interest grows in the understanding of the role of sex hormones in the homeostasis of immunity. Asthma predominates in boys before puberty and this gender preference reverses after puberty and in adulthood, when adult women tend to have a more severe disease, often recalcitrant to treatment. Atopic eczema in preschool children shows insignificant gender difference or male preponderance in different studies, with more adult females suffering from atopic eczema. The limited data on the prevalence of immediate hypersensitivity to hymenoptera venom show controversial results. Discrepancy exists regarding the gender difference in food allergy, with females reporting significantly more allergic reactions in questionnaire studies. In general, adverse reactions to nonionic iodinated radiocontrast media are more commonly observed in females. The course of allergic diseases varies unpredictably during pregnancy, whereas hormone replacement therapy in postmenopausal women usually has a favorable influence on the course of asthma. Experiments in rodents confirm an effect of estrogens on mast cell activation and allergic sensitization, while progesterone is shown to suppress histamine release but potentiate IgE induction. Dehydroepiandrosterone may antagonize the production of Th2 cytokines but the effect of testosterone and the other androgens remains less defined. Actual data from human studies are lacking.

Because of the increasing incidence of resistance to beta-lactam antibiotics, dermatologists will be increasingly confronted with methicillin-resistant S. aureus (MRSA) strains which display a great variability of their virulence factors. In view of the high mortality of systemic MRSA infections (estimated 700-1.500 deaths per year in Germany), dermatologists should be well aware of the various aspects of diagnosis, therapy and prevention of this problem bacteria. Adequate screening measures must be in place to identify high-risk patients and institute appropriate prophylactic measures and therapy. If only colonization is present, topical antiseptic measures are sufficient. If an infection is present, either systemic or topical therapeutic approaches may be indicated. We review the role of MRSA infection and colonization in skin diseases.

B-Zellen sind fur die Ausbildung einer humoralen Immunantwort verantwortlich. Sie proliferieren und differenzieren in den sekundaren lymphatischen Organen. IgE ist das Schlusselmolekul allergischer Erkrankungen vom Typ I und wird von B-Zellen nach Stimulation uber CD40 und IL-4/IL-13 produziert. Zahlreiche Molekule aus der Steroidhor-monrezeptorfamilie konnen die IgE-Produktion hemmen und stellen interessante therapeutische Zielstrukturen der Zukunft dar.

Specific immunotherapy (SIT) protocols for nutritional allergens have only recently been established with a focus on oral allergy syndrome because of pollen cross-reacting antibodies. For these patients, a substantial number of studies have been published suggesting benefits from SIT. The situation in true anaphylaxis to food allergens such as peanut allergy is more complex, and therapeutic strategies are based on individual protocols rather than controlled studies. However, in defined cases, SIT represents a promising approach for a durable protection from life-threatening risks after accidental ingestion. Keywords: allergen-specific immunotherapy, food allergy, long-term effect

Background: Regulatory T cells (T-reg cells) have been described as an important cell population in the UV treatment of inflammatory skin diseases. Methods: We have treated five patients with generalized atopic eczema (AE) using medium-dose (15 cycles of 50 J/cm2, total dose of 750 J/cm2) UVA1 therapy and have analyzed the skin-infiltrating T-cellular subsets before and after therapy. Skin biopsies were split for immunohistochemistry and Real-time PCR and analyzed for CD4, Fox-P3, GATA-3, and IL-10 transcription as well as for CD3, CD4, CD152, Fox-P3, and GITR staining. Results: In all the investigated patients, we observed a good clinical response to UVA1. As described previously, the number of epidermal T cells slightly declined after irradiation. However, we did not observe a general decrease in T cell numbers. Within the population of T cells, no specific difference in the kinetics of Fox-P3-positive cells and Fox-P3-specific mRNA was noted as compared with GATA-3 positive T cells. These results were paralleled by RT-PCR for IL-10 and staining for CD152, a surface molecule that has been described for T-reg cells. Conclusion: In our hands, the clinical benefit of UVA1 treatment in AE patients does not seem to be due to a preferential survival/proliferation of T-reg cells.

Die Kolonisierung mit Staphylococcus aureus der lasionalen und nicht lasionalen Haut der Patienten mit atopischem Ekezm (AE) ist einer der wichtigsten Einflussfaktoren bezuglich des Schweregrads und der Haufigkeit von Exazerbationen der Erkrankung. Atopische Haut ist besonders anfallig fur die Besiedelung mit S. aureus. Die Kolonisierung fuhrt zu einer dauernden Stimulation des Immunsystems der Patienten mit AE, insbesondere durch Staphylokok-kensuperantigene. Dies hat ein verstarktes Einwandern von T-Lymphozyten in die Haut sowie eine vermehrte IgE-Synthese zur Folge. Weiter ist in der Haut von Patienten mit AE die Produktion von hautspezifischen, antibakteriell wirksamen Peptiden wie LL-37, HBD-2 und HBD-3 vermindert. Die therapeutische Kontrolle der Besiedelung durch Staphylokokken ist daher eine wichtige Saule im Rahmen eines Therapiekonzepts des AE.

Background Microbial skin colonization with Staphylococcus aureus is known to play an important role in atopic eczema (AE). Recently, an antibacterial effect of silver-coated textiles on S. aureus colonization has been demonstrated. Objectives To investigate clinical efficacy and functionality of silver-coated textiles in AE, a multicentre, double-blind, placebo-controlled trial was conducted. Patients/methods From November 2001 to August 2002, 68 consecutive outpatients clinically diagnosed with generalized AE were included in the study. Inclusion criteria were the clinical diagnosis of AE with a moderate severity as measured by the scoring of atopic dermatitis (SCORAD) index with at least 20. Patients were instructed to wear either silver-coated (verum, 35 patients + 2 dropouts) or cotton garments (placebo, 22 patients + 9 dropouts) directly on the skin for 2 weeks. Only basic skin care and ongoing therapy with topical steroids or oral antihistamines was permitted. Clinical severity was assessed using the ‘SCORAD’ before, during and at the end of study. Quality of life (QOL), wearing comfort (WC) and functionality (FU) of study clothes were measured in parallel. Patients documented their subjective and objective symptoms daily. Results In the verum group, eczema improved significantly after 1 week with further enhancement until the end of study ( P = 0.03 and P < 0.001). Silver-coated textiles were comparable to cotton in WC and FU. Pruritus and self-assigned skin condition improved significantly more than with placebo ( P < 0.001 and P = 0.003). Conclusions In conclusion, silver-coated textiles are able to improve objective and subjective symptoms of AE significantly within 2 weeks, showing a good wearing comfort and functionality comparable to cotton.

Background: In atopic eczema (AE), skin colonization with Staphylococcus aureus is known to play a major triggering and possibly pathophysiological role. Methods: In this open-labeled controlled side-to-side comparative trial, affected sites (flexures of both elbows) in 15 patients diagnosed as having generalized or localized AE were evaluated regarding S. aureus colonization and clinical severity of AE over a 2-week period. Flexures of the elbows were covered with silver-coated textiles on one arm and cotton on the other for 7 days followed by a 7-day control period. Results: A highly significant decrease in S. aureus colonization could be seen on the site covered by the silver-coated textile already 2 days after initiation lasting until the end of the treatment. Seven days after cessation, S. aureus density remained significantly lower compared to baseline. In addition, significantly lower numbers of S. aureus were observed on the silver-coated textile site in comparison to cotton at the end of treatment as well as at the time point of control. Clinical improvement correlated with the reduction of S. aureus colonization. Conclusion: A superior improvement achieved by silver-coated compared to cotton textiles paralleled a potent anti-S.-aureus effect.

Background Tinea capitis is the most common dermatophytosis of childhood with increasing incidence. Whereas griseofulvin is considered by many as the mainstay of treatment, newer oral antifungal agents, including fluconazole, itraconazole and terbinafine have demonstrated higher efficacy, resulting in shorter treatment durations. Objectives We aimed to determine the optimum regimen for the treatment of childhood tinea capitis with itraconazole. Methods A mycological culture outcome-dependent combination of a 28-day continuous and facultative additional 14-day courses with itraconazole was used in 42 children (20 girls; 22 boys) aged 12–140 months (mean 66) with tinea capitis due to Microsporum canis (n = 26) and Trichophyton violaceum (n = 16). The drug was given orally according to the patients’ body weight (50 mg daily for

Fourteen patients suffering from acute, exacerbated atopic eczema were screened for changes in collagen I and collagen III metabolism in serum (n = 11), urine (n = 11) and skin biopsies (n = 9) before and after medium-dose ultraviolet (UV) A1 phototherapy (15 exposures of 50 J/cm2 over a 3-week period, total dose 750 J/cm2). Mature collagen I and, to a lesser extent, mature collagen III were found to be decreased after the therapy in skin samples from the irradiated patients. As markers of collagen I degradation, the cross-links pyridoline and deoxypyridoline were analysed in urine using high-performance liquid chromatography. Both cross-links were found to be mildly increased after UVA1 phototherapy, without reaching statistical significance. As markers of de novo collagen synthesis we screened for the procollagen I-carboxyterminal peptide (PICP) and procollagen III-aminoterminal peptide (PIIINP) levels in serum and skin. The ratio of PICP to PIIINP in serum dropped significantly after the UVA1 phototherapy, suggesting a different impact of UVA1 on the two collagens. These findings were paralleled by a diminished ratio of PICP to PIIINP in tissue samples. Staining for matrix metalloproteinase 1 (MMP-1) and its specific counterpart, tissue inhibitor of MMP-1 (TIMP-1), showed slight increases for both proteins by therapeutic UVA1; this was also seen in serum for TIMP-1 but not MMP-1. In our study, high-energy UVA1 doses induced changes of the skin collagens in patients with atopic eczema which are measurable by their metabolites in serum and urine.

Summary Background Ultraviolet (UV) A1 phototherapy is an effective anti-inflammatory treatment modality that influences fibroblast functions. Objectives To document the effects of UVA1 treatment in patients with localized scleroderma (LS) in a retrospective study (at least 6 months after UVA1 treatment) and in a prospective study before and immediately after medium-dose UVA1 irradiation. Methods In total, 30 patients (retrospective study n = 17, prospective study n = 13) with LS receiving UVA1 phototherapy five times weekly (for 3–6 weeks) were investigated. Improvement was documented using standardized questionnaires and clinical evaluation (using modified Rodnan skin score, Cutometer and 7·5-MHz ultrasound measurements). Levels of collagen I and collagen III metabolites were measured in serum and urine. Results In the retrospective study, medium-dose UVA1 phototherapy had been performed 6 months–3 years earlier (cumulative dose 750–1400 J cm−2; mean ± SD number of irradiations 19·3 ± 3·8). Fourteen of 17 patients (82%) reported an improvement in symptoms following UVA1 therapy. In the prospective study, skin elasticity increased in 77% of the patients following medium-dose UVA1 phototherapy (cumulative dose 750–1250 J cm−2; mean ± SD number of irradiations 20·8 ± 4·0). 7·5-MHz ultrasound measurements showed a mean reduction of lesional skin thickness of 13% compared with skin thickness before UVA1 phototherapy. The ratio of deoxypyridinoline to creatinine was significantly elevated in about two-thirds of the patients. Conclusions This open study showed a positive short- and long-term efficacy of UVA1 phototherapy in patients with LS, with a reduction in sclerotic plaques, an increase in skin elasticity and a reduction of lesional skin thickness. UVA1 phototherapy had a significant effect on collagen metabolism. UVA1 phototherapy can be regarded as a safe treatment modality for patients with LS.

Dear Editor: Pyoderma gangrenosum (PG) is part of the spectrum of the neutrophilic dermatoses, a group of inflammatory disorders of unknown aetiology that share a tendency towards pathergy and the presence of noninfectious neutrophilic infiltrates, mainly in the skin. In 40% to 50% of the cases, the formation of PG can be worsened by a nonspecific external stimulus such as a trauma or a surgery. This phenomenon, called pathergy, conduces to avoid any surgical excision of the lesion. However, the diagnosis is often omitted, and the rapid evolution of the cutaneous necrosis forces the surgeon to perform a surgical debridement of the wound as one of the main differential diagnoses is a necrotizing fasciitis that requires a fast surgical reaction. Then, it often causes an exacerbation of the lesion, and it can have disastrous consequences. Unlike PG, which may appear spontaneously or as a result of the pathergy phenomenon, postoperative PG (PPG) is clearly related to previous surgery. PPG, also known as postoperative progressive gangrene of Cullen, is a rare and rapidly developing complication of surgical procedures. Since the first description by Cullen in 1924, nearly 100 cases of PPG developing on surgical wounds have been reported. The diagnosis of PPG is based on clinical features and always requires exclusion of other conditions, as misdiagnosis exposes patients to risks associated with inappropriate treatment. Sequencing of 16S ribosomal (r)RNA is an accurate method for microbial detection, and identification to exclude an infectious origin in cases where cultures do not grow microorganisms and antibiotics have been previously given to patients. Nevertheless, histopathology of the skin is the most common investigation to confirm the diagnosis of PG. Here, we report a case of an abdominal PPG that occurred after laparoscopic sigmoidectomy. A 39-yearold patient was transferred to our hospital with a progressive ulceration at the lower abdomen 3 weeks after a laparoscopic sigmoid resection due to diverticulosis. Shortly after the initial surgical procedure, the patient emerged a wound infection at the site of the resection area of the sigmoid in the right lower abdomen. The initial bacterial culture showed an infection with Staphylococcus aureus that was sensitive for standard antibiotics. In the following, the patient was treated with piperacilline/sulbactam, but the wound situation didn’t improve. After surgical wound debridement and ongoing treatment with antibiotics but progressive phlegmon, the patient was transferred to our hospital due to a suspected infection with anaerobic bacteria and necrotizing fasciitis. The initial serum infection parameters showed a high leucocytosis of 19.76 G/l (standard value 6.0–9.0 G/l) and a C-reactive protein (CRP) of 13.6 mg/dl (standard value

Six patients (3 children and 3 adults) with acute exacerbated atopic eczema were treated with basic emollients in combination with chlorhexidine-soaked dressings over a period of three days using the "wet-pyjama" technique. Improvement of eczema was documented with the severity score "Scoring of Atopic Dermatitis" (SCORAD); most pronounced changes were found for the subjective parameters itch and sleep loss. Paralleling skin improvement a reduction of Staphylococcus aureus colonisation was noted. Improvement of skin changes lasted beyond the active treatment period. Wet-wrap dressings are an effective treatment modality for atopic eczema without use of corticosteroids and can be used easily on an outpatient basis when manufactured dressings are used.

Reticular erythematous mucinosis (REM) syndrome primarily affects young women; the skin lesions usually appear on the chest and upper back. REM is diagnosed on the basis of the clinical picture and histological findings. REM syndrome is often associated with lupus erythematosus tumidus. Both diseases respond well to treatment with chloroquin. Topical tacrolimus and the use of a pulsed dye laser have fewer side effects and have also proved to be effective.

Die Mechanismen der erhohten Staphylococcus-aureus-Kolonisation beim atopischen Ekzem sind nur teilweise geklart. Auf seiten des Erregers scheinen unterschiedliche extrazellulare Matrixkomponenten, auf seiten des Wirtes sind im Rahmen der Barrierefunktionsstorung epidermale Lipiddefizite von Bedeutung. Das immunologische und inflammatorische Potential des Erregers umfast die Bildung von Superantigenen, weiteren Exotoxinen und -enzymen und eventuell auch uber bakterielle DNA vermittelte Mechanismen. Die therapeutischen Moglichkeiten beinhalten eine systemische Antibiose bei Vorliegen eines generalisierten atopischen Ekzems, den kombinierten Einsatz von topischen Glukokortikoid-hochspezifischen Antibiotika-/Antiseptikazubereitungen bei Vorliegen eines lokalisierten impetiginisierten atopischen Ekzems sowie die grosflachige topische Antiseptikabehandlung bei Vorliegen eines mikrobiell beladenen atopischen Ekzems.

Lyme borreliosis is a common infectious disease that can affect myocardial muscle or the central nervous system if not treated at an early stage. Here we report a unique case of an atypical location of lymphocytoma cutis in a 3-year-old boy. Histologic and immunohistochemical analysis revealed the correct diagnosis.

The simultaneous occurrence of psoriasis driven by type 1 helper T (Th1) cells and type 17 helper T (Th17) cells and atopic eczema dominated by type 2 helper T (Th2) cells is rare. Here, we describe three patients with co-occurring psoriasis and atopic eczema with an antagonistic course and distinct T-cell infiltrates in lesions from psoriasis and those from atopic eczema. Sensitized patients with psoriasis had a reaction to epicutaneous allergen challenge, with clinically and histologically verified eczema lesions containing a large number of allergen-reactive T cells. These findings support a causative role for T cells triggered by specific antigens in both psoriasis and atopic eczema. (Supported by the German Research Foundation and others.)

Background: Most treatment protocols for vitiligo require a long treatment duration and usually do not result in complete repigmentation. Therefore, cosmetically acceptable and easily to handle alternatives are warranted. Objective: To evaluate the properties of dihydroxyacetone (DHA) in a new formulation for the treatment of vitiligo on exposed areas. Methods: We treated 10 patients suffering from vitiligo affecting the face and/or hands with a newly introduced, commercially available self-bronzing cream containing DHA 5%. DHA was applied every second day. Results: The characteristic pigmentation showed very satisfactory cosmetic results in 8 out of 10 patients after 2 weeks of treatment. Conclusion: The new DHA formulation is a practical and well-accepted treatment modality.

Importance of the field: Atopic eczema is highly colonized with Staphylococcus aureus in lesional as in non-lesional skin. Antimicrobial therapy as part of a comprehensive therapeutic concept in atopic eczema has been discussed for a long a time.Areas covered in this review: A complete literature review of the accessible publications concerning antibacterial and antiseptic therapy has been undertaken.What the reader will gain: This review covers the literature on antimicrobial therapy in atopic eczema and will try to weigh the different publications in the field.Take-home message: A beneficial role for antibacterial/antiseptic therapy on top of anti-inflammatory therapy in atopic eczema has to be questioned. However, a role in prevention of overt skin infection seems possible.

The present review aims at giving a condensed view on the current status of therapy of atopic eczema - a common chronically relapsing inflammatory skin disease. Atopic eczema is a multifactorial disease with a tendency for chronification. Owing to the associated genetic factors, therapeutic amelioration of skin symptoms is often only transient. Therefore, treatment basically focuses on symptomatic relief. Atopic eczema treatment should more than any other disease be guided by an individualized approach taking not only the phenotype and genotype of the disease but also psychosocial and gender aspects into account. Significant gains have been made in our understanding of atopic eczema, especially recent insights into genetic and immunologic mechanisms, but still, there is no single treatment to date that has proven to be the quantum leap for atopic patients. Novel treatments have been developed and trialled, however, more studies on novel therapies such as biologicals addressing efficacy, optimum dose and duration of treatment and the target phenotype are urgently needed. Hopefully, the tremendous progress in basic research in the last years will provide new targets for prevention and treatment in the future.

The family of toll-like receptors (TLRs) plays a central role in the cutaneous immune defense system. To date, different TLRs have been found on several major cell populations of the skin, such as keratinocytes, fibroblasts, antigen-presenting cells, and melanocytes. Activation of TLRs leads, via different intracellular signaling pathways, to the production of pro-inflammatory stimuli, and is considered a danger signal that should transform the skin in to the functional state of defense. However, TLRs have also been implicated in tissue homeostasis and renewal. Within the group of TLRs, two types have been identified: surface-expressed TLRs, which are predominantly active against bacterial cell wall compounds; and intracellular receptors, which preferentially recognize virus-associated pattern molecules. In addition, surface-expressed receptors trigger phagocytotic and maturation signals, while the intracellular TLRs lead to the induction of antiviral genes. Our review aims to outline the importance of TLRs in the pathogenesis of numerous skin diseases and the potential of TLR agonists as a treatment option for various skin diseases.

RATIONALE: Studies in humans and rodents have indicated a causative role for CD8(+) T cells in IgE-mediated allergic inflammation, but their function is still controversial. OBJECTIVES: To analyze the role of allergen-specific CD8(+) T cells during the development of allergic airway inflammation in two parallel but diverging outcome models. METHODS: We used H2-Kb SIINFEKL (OVA(257-264)) multimers to analyze induction, natural distribution, and phenotype of allergen-specific CD8(+) T cells in a murine C57BL/6 model of ovalbumin (OVA)-induced allergic airway inflammation using low-dose or high-dose OVA sensitization. MEASUREMENTS AND MAIN RESULTS: The low-dose protocol was characterized by a significant induction of total and OVA-specific IgE, eosinophilic airway inflammation, IL-4 levels in bronchoalveolar lavage fluid. And significant alterations in lung function. The high dose protocol was characterized by a significant reduction of the allergic phenotype. Using OVA(257-264) H2-Kb multimers, we observed lung and airway infiltrating OVA-specific CD8(+) T cells showing an effector/effector-memory phenotype. The high-dose protocol caused significantly higher infiltration of allergen-specific CD8(+) cells to the airways and enhanced their cytotoxicity. Adoptive transfer with CD8(+) T cells from transgenic OT-I mice to TAP1(-/-) or wild-type mice showed their migration to the lungs and TAP1-dependent proliferation after OVA-aerosol exposure. TAP1(-/-) mice defective in CD8(+) T cells showed exacerbated symptoms in the low-dose sensitization model. CONCLUSIONS: Allergen-specific CD8(+) T cells seem to protect from allergic inflammation in the lungs. Their number, which is dependent on the sensitization dose, appears to be a critical predictor for the severity of the allergic phenotype.

Wir berichten uber einen 26jahrigen Patienten mit seit 4 Jahren bestehender, seit 2 Jahren das Vollbild einer Purpura Schonlein-Henoch zeigender Purpura, fur die trotz wiederholter, sorgfaltiger Abklarung ein Ausloser nicht festzustellen war. Nachdem es unter verschiedenen therapeutischen Masnahmen, die u.a. die systemische Gabe von Glukokortikoiden und Azathioprin sowie Pentoxifyllin-Infusion beinhalteten, nicht gelungen war, die Gelenkschmerzen, die Magen-Darm-Symptomatik und die Hautveranderungen zu kontrollieren, wurde nach Kontrolle der Glukose-6-Phosphatdehydrogenase und unter Uberwachung des Methamoglobinspiegels eine Behandlung mit Dapson in einer Dosierung von 100 mg taglich durchgefuhrt. Hierunter kam es innerhalb von 2 Wochen zu Symptomfreiheit, die bis jetzt uber 6 Monate andauert. Dapson stellt somit bei therapieresistenter Purpura Schonlein-Henoch eine Therapiealternative dar.