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Perianal dermatitis (anal eczema, perianal eczema) is one of the most common proctological conditions. It may occur as a sequela or a presenting symptom of various proctological, dermatological, allergic or pathogen-induced disorders. The three main types of anal eczema are irritant-toxic, atopic and allergic contact dermatitis. Adequate and successful treatment requires a comprehensive diagnostic workup to determine disease etiology and includes treatment/elimination of causative factors as well as nonpharmacological interventions (avoidance of aggravating factors). In addition, adjuvant topical anti-inflammatory and/or specific symptomatic treatment may be required. The present guidelines contain recommendations for the diagnostic and therapeutic management of perianal dermatitis. Target users of these guidelines are clinicians in the fields of dermatology and proctology, as well as all other specialties involved in the management of patients with perianal dermatitis, both in hospital and office-based settings.

Background: Skin cancer removal surgery involving the tip or dorsum of the nose often results in large-sized defects with exposure of cartilage. In such cases, the paramedian forehead flap is a frequently used reconstruction technique; however, this method is complex and can result in a cosmetically unsatisfying outcome. Objective: To describe the folded transposition flap as an aesthetically pleasing alternative to the paramedian forehead flap for large nasal defects with exposed cartilage. Methods: The folded transposition flap is a 2-stage surgical modification of the transposition flap. In the first stage, an overlong axial cheek pedicle is used to cover the defect. In the second stage, the flap is thinned and the nasal scars are revised. Results: All 4 patients experienced aesthetically pleasing results. Conclusion: The folded transposition flap is an alternative for reconstructing large surgical defects of the nasal tip or distal dorsum of the nose.

Somatic mutations in the MYD88 gene are involved in the molecular pathogenesis of different subtypes of Non-Hodgkin B-cell lymphomas such as diffuse large B-cell lymphoma, lymphoplasmacytic lymphoma and Waldenstrom′s macroglobulinemia1. Albeit with much lower frequency, the key driver mutation MYD88 (c.794T>C, p.L265P) has also been identified in non-cutaneous marginal zone lymphomas and chronic lymphocytic leukemia. The increasing knowledge about such molecular aberrations and their consecutive biological effects has already been implemented within the clinical routine. This article is protected by copyright. All rights reserved.

Multilayer argon plasma coagulation (APC) is a new effective method for the treatment of genital warts. We assessed the generation of aerosols containing human papilloma virus (HPV) DNA during treatment of genital warts with multilayer APC and with CO2 laser ablation. Surveillance petri dishes, swabs from the glasses and nasolabial folds of the operating physician, and swabs taken from the suction units used during CO2 laser ablation were tested by HPV PCR. HPV DNA corresponding to patient derived HPV types of genital warts was not found in any of the petri dishes and swabs obtained during APC treatment. HPV DNA was detected in none of the petri dishes obtained during CO2 laser treatment, but in suction filters. In conclusion, both CO2 laser ablation with plume suction and APC treatment seem to have a low risk of HPV contamination of the operation room.

Split-skin grafting is a routine reconstructive technique associated with large variation in practice. Grafts from the thigh, buttock, or abdomen take a long time to heal and may leave unpleasant, hypopigmented scars. Retrospective reports favor the scalp as a donor site in burn patients.Evaluation of duration of healing, cosmetic outcome, and safety of split-skin grafting from the scalp in patients receiving dermatologic surgery.One hundred sixty-six consecutive patients (85 men, 81 women) were treated for coverage of chronic leg ulcers or other large skin defects with a split-skin graft taken from the posterior scalp. Area and thickness of the graft, healing time, and adverse events were documented.Mean healing time until complete reepithelization was 5.4+/-1.0 days for a single harvest (median 5 days). No major complications occurred. Spotted alopecia was a rare event. Almost all (96.5%) of the patients would undergo split-skin harvesting from the occipital scalp again if needed.Advantages of the scalp as a donor site include rapidity of wound healing, low risk of complications, and excellent cosmetic results. The large number of hair follicles containing the epidermal stem cell pool can explain these advantages.

Ein 70-jahriger Patient stellte sich mit einer seit 6 Monaten bestehenden, ausgedehnten, grosenprogredienten perianalen Erosion vor. Daruber hinaus fanden sich einige kleinere Erosionen mit umgebender weislich retikularer Zeichnung am Penis. Die klinische Diagnose eines erosiven Lichen ruber wurde histologisch bestatigt. Nach Versagen mehrerer topischer Therapien und Absetzen des β-Blockers konnte der Befund durch 3 Zyklen einer Dexamethason-Pulstherapie (100 mg Dexamethason i.v. an 3 aufeinanderfolgenden Tagen in 4-wochigen Abstanden) zur langfristigen Abheilung gebracht werden.

Zusammenfassung Hintergrund: Bei ausgedehntem anogenitalen Warzenbefall werden nach den Leitlinien der Deutschen STD-Gesellschaft als mogliche Behandlungsformen mit vergleichbaren Rezidivraten die Kryotherapie, exzidierende Verfahren, die Elektrodesikkation, CO2- und Nd:YAG-Laserabtragung empfohlen. Bei diesen Verfahren besteht ein unterschiedlich hohes Risiko von Blutungen, Freisetzung potentiell infektionsfahiger Viruspartikel in die Raumluft, tiefer thermischer Destruktion, langer Wundheilungszeit und Vernarbung. Methode: Mit der Argon-Plasma-Koagulation werden anogenitale Warzen kontrolliert schichtweise abgetragen. Dabei wird Hochfrequenzstrom kontaktlos durch ionisiertes Argon auf die Gewebeoberflache ubertragen, wodurch eine oberflachliche Koagulation mit nahezu konstanter Eindringtiefe erreicht wird. Ergebnisse: Wir behandelten in der Zeit von Januar 2001 bis Marz 2003 54 Patienten mit ausgedehntem genitalen, analen oder kombinierten Befall von Warzen. Nach einmaliger Therapie waren 66 % der Patienten bis zum Abschlus der Kontrolluntersuchungen nach 4 Monaten erscheinungsfrei. Rezidive wurden bei 13 Patienten (24 %) nach 4 Wochen und bei weiteren 5 Patienten (9 %) zu einem spateren Zeitpunkt beobachtet. Nach weiteren Abtragungen sowie ggf. zusatzlicher Behandlung mit Imiquimod-Creme (n = 9, 17 %) waren alle Patienten erscheinungsfrei. Schlusfolgerung: Die Behandlung mittels Argon-Plasma-Koagulation stellt im Vergleich zu den anderen Verfahren eine besser kontrollierbare, risikoarme und rasch durchfuhrbare Methode der Behandlung anogenitaler Warzen dar. In Abhangigkeit vom Befallsmuster und individuellen Risikofaktoren erscheint im Einzelfall eine Nachbehandlung mit Imiquimod-Creme sinnvoll. Summary Background: According to guidelines of the German STD Association, appropriate treatment of extensive anogenital warts with comparable recurrence rates includes cryotherapy, surgical excision, electrosurgery, CO2- and Nd:YAG-laser vaporisation. All these procedures are associated with varying degrees of risk for bleeding, release of potentially infectious aerosol, deep thermal destruction, slow wound healing, and scarring. Methods: Using argon-plasma coagulation anogenital warts can be removed in layers in a controlled manner. High frequency current flows through the argon plasma to the tissue, allowing well-controlled, superficial tissue destruction. Results: From January 2001 to March 2003, 54 patients with extensive genital, anal or anogenital warts were treated. After one treatment, 66 % of the patients remained disease-free in the following 4 months. Thirteen patients (24 %) showed early recurrence after 4 weeks, five patients (9 %) at a later date. In these patients, further treatment, in 9 cases combined with topical imiquimod cream, were necessary for complete remission. Conclusion: Compared to other therapeutic procedures, argon-plasma coagulation is a better controlled, quick and low-risk option for the treatment of anogenital warts. Depending on the type of involvement and individual risk factors, postoperative treatment with topical imiquimod cream may be useful.

p53 is a central tumor suppressor protein and its inhibition is believed to be a prerequisite for cancer development. In approximately 50% of all malignancies this is achieved by inactivating mutations in the p53 gene. However, in several cancer entities, including melanoma, p53 mutations are rare. It has been recently proposed that tyrosinase related protein 2 (TRP2), a protein involved in melanin synthesis, may act as suppressor of the p53 pathway in melanoma. To scrutinize this notion we analyzed p53 and TRP2 expression by immunohistochemistry in 172 melanoma tissues and did not find any correlation. Furthermore, we applied three different TRP2 shRNAs to five melanoma cell lines and could not observe a target specific effect of the TRP2 knockdown on either p53 expression nor p53 reporter gene activity. Likewise, ectopic expression of TRP2 in a TRP2 negative melanoma cell line had no impact on p53 expression. In conclusion our data suggest that p53 repression critically controlled by TRP2 is not a general event in melanoma. © 2014 Houben et al.

Schwannoma is usually a subcutaneous benign neoplasm that derives from nerve sheath. Pain and neurologic symptoms are uncommon, and exclusively dermal tumors are very rare. Solitary schwannoma has a traumatic origin in some cases, and rarely occur as a part of neurofibromatosis or schwannomatosis. An association of deeply located schwannoma with foreign material has been reported in very few cases. To our knowledge, we present the first case of a painful dermal schwannoma in association to foreign material.

Langerhans cell histiocytosis (LCH) mainly affects children and rarely occurs in adults [1]. Mostly, LCH presents as single system disease (SS) affecting only one organ system; in multisystem disease (MS), bone, skin, mucosae, lung, liver, spleen, bone marrow, lymph nodes, hypothalamus and the pituitary gland can be involved [1-3]. We report two patients with perianal skin ulcerations as the initial symptom of LCH. Both were successfully treated with intravenous vinblastine and oral prednisone, according [...]