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SummaryBackground Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) is highly effective for treating actinic keratosis (AKs) on the face/scalp, but less effective on the extremities. Insufficient accumulation of protoporphyrin IX (PpIX) may cause these inferior efficacy rates. However, it is possible to increase PpIX accumulation by extending MAL application time and/or pretreating the skin with curettage. Objectives To investigate whether increased PpIX accumulation improves the effect of MAL-PDT for AKs in a randomized intraindividual study. Methods Twenty-two patients with 533 AKs on both hands were treated with MAL-PDT. To obtain different concentrations of PpIX, 4 symmetrical areas on each patient were randomly allocated to different regimens: (i) 3h MAL application without prior curettage (3hC-), (ii) 3h with curettage (3hC+), (iii) 21h without curettage (21hC-) and (iv) 21h with curettage (21hC+). Treatment efficacy was evaluated after 3 months, whereas PpIX fluorescence, pain and erythema were assessed during and after PDT. Results Extended MAL application with and without curettage increased PpIX accumulation significantly compared with the standard 3hC+ regimen (P=0.0001 and P=0.002, respectively). However, the median total clearance rates did not improve accordingly: 3hC+ (55.0%), 21hC- (55.0%) and 21hC+ (53.6%). Conversely, insufficient PpIX accumulation in the 3hC- regimen led to a significantly lower clearance rate (33.3%) than the other regimens (P

Rosacea is a field within dermatology with new insight within immunological research and new treatment-algorithm. Patient education on rosacea and appropriate treatments is an important aspect in helping patients succeed with therapy. Treatment should be tailored to each individual patient, taking into account: symptoms, trigger factors, patients’ wishes, most bothersome symptoms, psychological aspect, individual needs. A combination of clinical therapies to treat different symptoms concomitantly may offer the best possible outcomes for the patient. In this review article we describe these aspects.

Tattoos are well known to cause skin problems and the number of reported adverse reactions after tattooing has increased. Illegally imported tattoo ink is unrestrained and can contain unknown ingredients and contamination thereby posing a serious health hazard. We present a case illustrating the risk of pronounced phototoxic allergic reaction and other severe complications after using home kit tattoo ink.

Systemic mastocytosis (SM) is a rare, heterogeneous disorder characterized by infiltration and accumulation of mast cells within multiple organs, most commonly the skin. Given the rarity of the disease and the fact that many of its symptoms are shared by more common disorders, a diagnosis may be delayed or hindered. These patients have an elevated risk of developing potentially life-threatening anaphylactoid reactions, thus underscoring the importance of keeping SM in mind as a differential diagnosis when a patient presents with chronic, itchy skin lesions and a history of multiple allergic reactions to bites, drugs, and anesthesia. We present a case illustrating that features of SM common to many disorders may hinder or delay its diagnosis.

Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy, is a common benign dermatosis of pregnancy mainly affecting primigravidae and multiple pregnancies. We report here two cases of PEP with typical clinical and histological features presenting in the postpartum period.

Wegener´s granulomatosis (WG) is a rare, systemic vasculitis involving multiple organs. The clinical presentation is highly diverse, and there is considerable risk of mortality if diagnosis and treatment are delayed. We present a case illustrating that patients with WG may initially present with localized cutaneous symptoms and signs.

Hereditary angioedema (HAE) is often debilitating with a serious effect on quality of life (QOL). Treatment of acute HAE attacks is usually with C1 esterase inhibitor (C1-INH) concentrates; however, treatment can be delayed by patients' travel time for attending emergency units. We assessed the impact of self-administered home therapy with intravenous C1-INH concentrate on QOL in patients with HAE. Nine patients experiencing frequent or severe debilitating HAE attacks were offered self-administration of C1-INH concentrate. QOL was assessed prior to and following home therapy using the Dermatology Life Quality Index (DLQI) and 36-Item Short Form Survey (SF-36) questionnaires. Seven patients were recruited into the study. QOL was assessed at baseline and after 3 to 48 months of home therapy. The mean DLQI score fell from 12.6 +/- 4.65 to 2.7 +/- 1.38 (P < 0.001). Mean SF-36 scores for the individual and combined components also improved significantly. No serious complications were documented during a follow-up period of 27 to 72 months. Self-administration of C1-INH improved QOL on both physical and psychological parameters. Patients were able to resume a normal life without restrictions caused by the condition.

Hennatatoveringer er blitt svaert populaere, og det kan synes som om forekomsten av kontaktallergi oker. Vi har hatt flere pasienter med slike plager og vil gjerne gi en kort oversikt over fenomenet for at allmennleger og hudleger skal kunne stille riktig diagnose og gi adekvate rad til sine pasienter.

Acne vulgaris er en sykdom i talgkjertlenesom skyldes mikroorganismen Propionibac-terium acnes, talgkjertelhyperplasi og over-produksjon av talg (1). Den rammer80–85% av alle tenaringer og forsvinnersom regel for 25 ars alder. De mest alvorligetilfellene ses hos gutter i alderen 17–19 ar.Det er sammenheng mellom alvorlighets-graden av akne og darlig selvbilde, angst ogdepresjon, som igjen kan fore til fravaer fraskole og arbeidsplass. Vellykket behandlinggir markant forbedret psykisk helse (2).I denne artikkelen omtales behandling avmoderat til alvorlig acne vulgaris med saerligvekt pa systemiske legemidler.

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A middle-aged patient of Greenlandic origin was referred for skin infection of the leg. An initial minor trauma of the skin of the distal right lower extremity was complicated by bullous erysipelas which cultured positive for group A β-hemolytic streptococci (GABHS). The clinical condition deteriorated and necrotizing fasciitis developed despite relevant surgical and antibiotic treatment. Approximately 3 weeks later, the patient developed arthralgia, impaired renal function with azotemia, hypertension and severe nephrotic syndrome with periorbital and peripheral edema. A kidney biopsy demonstrated endocapillary glomerulonephritis. Concomitantly, carditis with chest pain, moderately reduced left ventricular ejection fraction and mitral regurgitation were noted. The patient had no signs of pharyngitis in the whole period. The patient thus contracted poststreptococ glomerulonephritis and furthermore she fulfilled the criteria of acute rheumatic fever following a GABHS skin infection. We suggest a possible relation between a virulent GABHS clone causing NF and ARF.