Search

Background and Objectives: Treatment of severe dermatological autoimmune diseases and toxic epidermal necrolysis (TEN) with high-dose intravenous immunoglobulin (IVIg) is a well-established procedure in dermatology. As treatment with IVIg is usually considered for rare clinical entities or severe cases, the use of immunoglobulin is not generally based on data from randomized controlled trials usually required for evidence-based medicine. Since the indications for the use of IVIg are rare, it is unlikely that such studies will be available in the foreseeable future. Because first-line use is limited by the high costs of IVIg, the first clinical guidelines on the use of IVIg in dermatological conditions were established in 2008 and renewed in 2011., Methods: The European guidelines presented here were prepared by a panel of experts nominated by the European Dermatology Forum (EDF) and European Academy of Dermatology and Venereology (EADV). The guidelines were developed to update the indications for treatment currently considered effective and to summarize the evidence for the use of IVIg in dermatological autoimmune diseases and TEN., Results and Conclusion: The current guidelines represent consensual expert opinions and definitions on the use of IVIg reflecting current published evidence and are intended to serve as a decision-making tool for the use of IVIg in dermatological diseases.

Background and Objectives: Treatment of severe dermatological autoimmune diseases and toxic epidermal necrolysis (TEN) with high-dose intravenous immunoglobulin (IVIg) is a well-established procedure in dermatology. As treatment with IVIg is usually considered for rare clinical entities or severe cases, the use of immunoglobulin is not generally based on data from randomized controlled trials usually required for evidence-based medicine. Since the indications for the use of IVIg are rare, it is unlikely that such studies will be available in the foreseeable future. Because first-line use is limited by the high costs of IVIg, the first clinical guidelines on the use of IVIg in dermatological conditions were established in 2008 and renewed in 2011., Methods: The European guidelines presented here were prepared by a panel of experts nominated by the EDF and EADV. The guidelines were developed to update the indications for treatment currently considered effective and to summarize the evidence for the use of IVIg in dermatological autoimmune diseases and TEN., Results and Conclusion: The current guidelines represent consensual expert opinions and definitions on the use of IVIg reflecting current published evidence and are intended to serve as a decision-making tool for the use of IVIg in dermatological diseases., (© 2016 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.)

Background: No consistent data are available on the currently employed diagnostic tools for autoimmune bullous diseases in Germany. The aim of this survey was to describe currently performed diagnostic methods for bullous autoimmune diseases in German dermatology departments., Methods: A standardized questionnaire evaluated the available diagnostic methods i. e. direct immunofluorescence microscopy (IFM), indirect IFM, commercial ELISA systems, and non-commercial serological tests as well as the number of samples per year in all 34 university and 39 non-university dermatology departments., Results: The overall return rate was 89 %, 100 % and 79 % for the university and non-university departments, respectively. Direct IFM was the most frequently used method and was applied in 98 % of the responding departments. In 74 % of the responding departments, indirect IFM was used mainly on monkey esophagus and human salt-split skin. Commercial ELISA systems were employed in 58 % of the clinics; all of them used anti-desmoglein ELISA, while anti-BP180 and anti-BP230 ELISA were established in 49 % and 48 % of departments, respectively. Non-commercial analytic methods were only performed in 22 % of the departments., Conclusions: The high return rate of this survey allows a relatively precise description of the current diagnostic methods used in German dermatology departments. Standard diagnostic tests are available nationwide and in bullous pemphigoid and pemphigus, the antigen-specific detection of autoantibodies is routinely performed in half of the departments. Rare disorders may be diagnosed by cooperation with some specialized centers., (© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.)

The treatment of severe autoimmune skin diseases and of toxic epidermal necrolysis (ICD: L51.2) with high-dose intravenous immunoglobulins (IVIg) is an established therapeutic procedure in dermatology. As IVIg are usually only administered in rare autoimmune diseases or in particularly severe disease courses, use of immunoglobulins in dermatology is commonly not based on experience from controlled and randomized studies typically demanded by evidence-based medicine. In face of the rarity of indications for IVIg it is improbable that such studies will be performed in the foreseeable future. Further, as the high costs of IVIg treatment limits its use as first-line therapy, no clear guidelines exist yet on IVIg use in skin diseases. The present recommendation is based on a consensus of the Working Group on European Guidelines of the EDF (European Dermatology Forum) and the EADV (European Association of Dermato-Venereology) and should provide aid in decision making for the use of IVIg in treating dermatologic diseases

Lorenz Julius Kuhls,1 Jeta Demiri,1 Adam Weidlich,1 Susanne Weidlich,1 Janin Trinkaus,1 Kerstin Steinbrink,2 Matthias Augustin,3 Athanasios Tsianakas1 1Department of Dermatology and Allergology, Fachklinik Bad Bentheim, Bad Bentheim, Germany; 2Department of Dermatology, University Hospital Münster, Münster, Germany; 3Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyCorrespondence: Athanasios Tsianakas; Lorenz Julius Kuhls, Department of Dermatology and Allergology, Fachklinik Bad Bentheim, Bad Bentheim, 48455, Germany, Tel/Fax +49 5922 74-52 10, Email A.tsianakas@fk-bentheim.de; L.Kuhls@fk-bentheim.dePurpose: During the COVID-19 pandemic, infections could also be detected among the staff and patients of the dermatological hospital Bad Bentheim (Germany). This retrospective analysis aims to better understand the impact of the pandemic on health care workers. The results could help improve future pandemic plans and measures to protect health care workers.Patients and Methods: In 2020, the whole staff (460 participants) of the dermatological hospital Bad Bentheim had been offered the option to be tested with respect to the antibody status on SARS-CoV-2 (IgG, IgM). The data were collected by means of a blood sample and subsequent questionnaires (22 questions for employees with positive SARS-CoV-2 serology) regarding disease severity, symptoms, disease duration, chains of infection, psychological and physical burden. Both groups were divided by positive or negative serology and data analysis was performed using an independent t-test.Results: It was shown that a COVID-19 Infection clinically presented itself as a respiratory tract infection, differed significantly in severity and duration, but also the long-term consequences in employees with proven COVID-19 disease (n=14, 3.7%) from the employees with non-COVID-19 respiratory diseases (33.6% of the seronegative employees). In addition, there was a significant psychological impairment and burden of COVID-19-affected employees. Our study showed unique insights into infection chains, disease courses, disease severity, symptoms and a significant psychological impairment and burden of COVID-19-affected employees among the COVID-19 positive staff.Conclusion: Our study shows deep insights into infection chains, disease courses, disease severity and symptoms among the COVID-19 positive staff and led to change of behavior with the disease itself and among the health care professionals. This knowledge has the potential to positively influence the handling of similar future events.Plain Language Summary: Due to the nature of the Corona pandemic with massive effects, especially in the environment of health care facilities, we provide a detailed insight into the stresses on employees in a dermatological acute and rehabilitation clinic. To recognize their stress and to monitor the maintenance and quality of patient care, it is important to focus especially on the effects of an infection with SARS-CoV-2 of these employees and to analyze them. This revealed insights into the disease trajectories of staff infected with COVID-19 with significant differences compared to healthy individuals. Starting with physical symptoms and ending with psychological stress.Keywords: COVID-19, SARS-CoV-2, immunoassay, infection chain, hospital staff

Background The treatment of severe dermatological autoimmune diseases and toxic epidermal necrolysis ( TEN) with high-dose intravenous immunoglobulin ( IVIg) is a well-established procedure in dermatology. As treatment with IVIg is usually considered for rare clinical entities or severe clinical cases, the use of immunoglobulin is not generally based on data from randomized controlled trials that are usually required for the practice of evidence-based medicine. Owing to the rarity of the indications for the use of IVIg, it is also unlikely that such studies will be available in the foreseeable future. Because the high costs of IVIg treatment also limit its first-line use, the first clinical guidelines on its use in dermatological conditions were established in 2008 and renewed in 2011. Materials and methods The European guidelines presented here were prepared by a panel of experts nominated by the EDF and the EADV. The guidelines were developed to update the indications for treatment currently considered as effective and to summarize the evidence base for the use of IVIg in dermatological autoimmune diseases and TEN. Results and conclusion The current guidelines represent consensual expert opinions and definitions on the use of IVIg reflecting current published evidence and are intended to serve as a decision-making tool for the use of IVIg in dermatological diseases. [ABSTRACT FROM AUTHOR]

VCAM-1 (vascular cell adhesion molecule-1) is a cytokine-inducible adhesion molecule which is known to mediate adhesion of mononuclear cells to endothelial cells in vitro via binding to the integrin VLA-4 (very late antigen-4). To further elucidate the role and regulation of VCAM-1 in vivo, we compared in vitro and in vivo expression of VCAM-1 in response to cytokines and investigated immunohistochemically the expression of VCAM-1 in three murine models of experimental inflammation. These models differed with regard to the pathogenetic mechanism and the subsequent infiltrate: allergic contact dermatitis (ACD) to DNFB as a T cell-controlled, DTH type of inflammation, cutaneous infection with Leishmania major as a chronic granulomatous inflammation and the cauterized cornea as a model for acute inflammation. VCAM-1 was found to be markedly enhanced on vascular endothelia in all types of inflammation and after subcutaneous administration of LPS and TNF-α. Administration of IL-4, however, failed to induce VCAM-1 both in vivo and in vitro. The increased VCAM-1 expression in the inflammatory models correlated with the appearance of infiltrating monocytes/macrophages. A concomitant influx of CD4-positive/CD8-positive lymphocytes was only observed in ACD and Leishmaniasis. [ABSTRACT FROM AUTHOR]