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Eine Ernahrungsstorung resultiert aus einer quantitativ und/oder qualitativ inadaquaten Aufnahme (Unter-, Fehl- oder Uberernahrung) und/oder Metabolisierung (Malabsorptionssyndrome, enzymatische Defekte) von Nahrstoffen. Die Ursachen fur Ernahrungsstorungen konnen sowohl psychischer als auch physischer Natur sein. Eine Ernahrungsstorung kann isoliert einzelne Nahrstoffe (wie Kohlenhydrate, Fette, Proteine, Vitamine, Spurenelemente, Mineralstoffe) oder eine Nahrstoffkombination betreffen. Eine Ernahrungsstorung kann unmittelbar Hautveranderungen induzieren oder die Integritat des Gesamtorganismus verletzen und auf diesem Wege den Hautzustand beeinflussen. Ernahrungsstorungen betreffen keinesfalls nur Entwicklungslander; in Mitteleuropa sind Ernahrungsstorungen ebenfalls weit verbreitet, hier jedoch mit einem Schwerpunkt im Bereich der Essstorungen und der Hyperalimentation. Einen groben Anhalt uber den Ernahrungszustand konnen verschiedene Indizes liefern.

Telangiectatic leg veins (TLV) represent a common cosmetic problem. Near infrared lasers have been widely used in treatment because of their deeper penetration into the dermis, but with varying degrees of success, particularly because of different vessel diameters. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may present an alternative treatment option.This trial evaluates the efficacy of ICG+DL in the treatment of TLV and compares the safety and efficacy of therapy with the standard treatment, the long-pulsed neodymium-doped yttrium aluminium garnet (Nd:YAG) laser.In a prospective randomized controlled clinical trial, 29 study participants with TLV were treated with a Nd:YAG laser (λem = 1064 nm, 160-240 J cm(-2) , 65-ms pulse duration, 5-mm spot size) and ICG+DL (λem = 810 nm, 60-110 J cm(-2) , 48-87-ms pulse duration, 6-mm spot size; total ICG dose 4 mg kg(-1) ) in a side-by-side comparison in one single treatment setting that included histological examination in four participants. Two blinded investigators and the participants assessed clearance rate, cosmetic appearance and adverse events up to 3 months after treatment.According to both the investigators' and participants' assessment, clearance rates were significantly better after ICG+DL therapy than after Nd:YAG laser treatment (P0·05). On a 10-point scale indicating pain during treatment, participants rated ICG+DL therapy to be more painful (6·1 ± 2·0) than Nd:YAG laser (5·4 ± 2·0).ICG+DL therapy represents a new and promising treatment modality for TLV, with high clearance rates and a very good cosmetic outcome after one single treatment session.

Summary Background Safe and efficient options for removing unwanted hair are in great demand. Laser devices and intense pulsed light (IPL) sources are the most commonly used treatment modalities. Yet, only a few randomized controlled trials (RCTs) comparing laser and IPL devices are available, and RCTs with long-term results are missing from the literature. Objectives To compare the safety and long-term efficacy of diode lasers (DL) and IPL sources for axillary hair removal, we conducted an intrapatient, left-to-right, assessor-blinded and controlled trial. Methods IPL (Ellipse Flex PPT; Danish Dermatological Development, Hoersholm, Denmark; λem = 600–950 nm) and DL (LightSheer XC system; Lumenis Inc., Santa Clara, CA, U.S.A.; λem = 800 nm) treatments were evaluated in 30 study participants (skin type II–III) with unwanted axillary hair growth. Six treatments with each device were carried out at 4-week intervals. Final assessment was conducted 12 months after the last treatment by means of hair counts using close-up photographs. The primary endpoint was reduction in hair growth, analysed on an intention-to-treat and last-observation-carried-forward basis (n = 30), and secondary endpoints were patient-rated efficacy, treatment-related pain, adverse effects and treatment duration. Results Both devices significantly reduced hair counts. Mean reductions from baseline (3 and 12 months after the last treatment) were 59·7% and 69·2% for DL and 42·4% and 52·7% for IPL treatment (P

Background Indocyanine green (ICG)-augmented diode laser therapy (ICG + DL) represents a new treatment modality for capillary malformations (CM). However, an increase of the ICG-concentration or the use of an intense pulsed light (IPL) device as light source may further optimize treatment outcomes in CM. Objective : This proof-of-concept trial including 15 patients (skin type II to III) with CM evaluated the efficacy and safety of ICG-augmented diode laser therapy (808 nm) at a total dose of 4 mg/kg body weight (b.w.). Additionally, five patients with extensive CM received IPL therapy before and after ICG-administration (ICG + IPL). Methods ICG was intravenously administered to 15 patients with CM at a total dose of 4 mg/kg b.w. Immediately after ICG injection, diode laser pulses with different radiant exposures (20–110 J/cm2) were applied as one single treatment. Five patients with extensive CM additionally received IPL (555–950 nm) therapy. Safety and efficacy were assessed both 1 and 3 months after the single treatment by a blinded investigator and the patient. Furthermore, color of the CM was objectively measured by means of a color meter (colorStriker™, Eduard Mathai GmbH, Hannover, Germany). Treatment with the flashlamp-pumped pulsed dye laser (FPDL) and the IPL alone (five patients) served as reference treatment. Results According to the assessment by the patients and the blinded investigator, the clearance rate was slightly better after ICG + DL therapy than after FPDL treatment (P = 0.1, P = 0.8). In one out of five patients, IPL with and without ICG injection induced poor to moderate clearance of CM and persisting erythema in another patient. The correlation between the visual assessment by the blinded investigator and the colorimetric measurements was poor. Conclusion A minority of patients with CM may benefit from ICG + DL therapy, but efficacy cannot be improved by higher ICG doses. Lasers Surg. Med. 9999:XX–XX, 2013. © 2013 Wiley Periodicals, Inc.

ZusammenfassungEinleitung: Die nicht heilende Wunde stellt einen zunehmenden Kostenfaktor im Gesundheitssystem dar. Ziel der fachgerechten Wundtherapie ist es, die gestörte Wundhei-lung zu durchbrechen, um das Durchlaufen der physiologischen Abheilung zu ermögli-chen.Methoden: Es erfolgte eine selektive Literaturrecherche in den Datenbanken AWMF, PubMed und Cochrane Library mit den Schlüsselwörtern „chronic wound” oder „ulcer” in Kombination mit den Begriffen alginates, hydrofibre, hydrogel, collagen, foam.Ergebnisse: Die heute verfügbaren Wundtherapeutika erlauben es nicht, bei chronischen Wunden anstelle einer narbigen Reparatur eine physiologische Regeneration der Haut zu erreichen. Vor jeder Wundtherapie müssen mögliche Ursachen für die gestörte Wundhei-lung identifiziert werden und sofern möglich kausal therapiert werden. Zur topischen Therapie chronischer Wunden steht eine große Auswahl verschiedener Wundauflagen zur Verfügung. Die dezidierte Kenntnis dieser Wundtherapeutika ermöglicht deren differenzierten Einsatz, und ist damit die Voraussetzung für eine heilungsphasenadaptierte Anwendung.Schlussfolgerung: Die derzeitige Studienlage erlaubt kaum Rückschlüsse auf die Überlegenheit einzelner Wundauflagen bezüglich des Endpunktes Wundverschluss. Obwohl die mangelhafte Evidenz die Entscheidung bei den Behandelnden für oder gegen die einzelnen Produkte erschwert, zeigt es auch, dass teure Wundauflagen preiswerteren Alternativen nicht eindeutig überlegen sind.

Sudden sensorineural hearing loss is usually treated with systemic glucocorticoids. Intratympanic injections of glucocorticoids offer a possibly equivalent treatment alternative, avoiding adverse systemic effects on blood glucose. We, therefore, investigated the extent to which different doses of systemic glucocorticoid therapy affects blood glucose levels. We conducted a retrospective analysis of treatment courses in 179 patients from the Departments of Otorhinolaryngology, Ophthalmology and Dermatology who underwent short-course systemic glucocorticoid therapy. Patients were subdivided into three groups on the basis of their cumulative prednisolone dose from days 1 to 3 (Group 1:750 mg; Group 2: 750-1,499 mg; Group 3:1,499 mg); in addition, a distinction was made between diabetic and non-diabetic patients. Among the non-diabetic patients on days 2-4, diabetic levels of fasting blood glucose were detected significantly more often (P0.01) in Group 3 (67 %) than in Group 1 (28 %) and Group 2 (21 %). Furthermore, there was a highly significant mean Pearson correlation (r = 0.329; P0.01) between blood glucose levels and glucocorticoid dose. This correlation was even more pronounced in the diabetic patients (r = 0.51; P = 0.02). In this category, hyperglycemia was detected in 40 % of patients in Group 1, 63 % in Group 2 and 100 % in Group 3. The prevalence of glucocorticoid-induced hyperglycemia during systemic therapy is high and rises as the dose increases. This should be kept in mind when choosing the dosage. Besides, it should also be considered that even short-term hyperglycemia presents possible health risks and the risk of inducing diabetes. This is especially of interest as intratympanic therapy offers a possible alternative to the systemic application.

Summary Background Complete clearance of port-wine stains (PWS) is difficult to achieve, mainly because of the resistance of small blood vessels to laser irradiation. Indocyanine green (ICG)-augmented diode laser treatment (ICG+DL) may overcome this problem. Objectives To evaluate the feasibility of ICG+DL therapy of PWS and to compare the safety and efficacy of ICG+DL with the standard treatment, flashlamp-pumped pulsed dye laser (FPDL). Methods In a prospective randomized controlled clinical study, 31 patients with PWS were treated with FPDL (λem = 585 nm, 6 J cm−2, 0·45 ms pulse duration) and ICG+DL (λem = 810 nm, 20–50 J cm−2, 10–25 ms pulse duration, ICG-concentration: 2 mg kg−1 body weight) in a split-face modus in one single treatment setting that included histological examination (haematoxylin and eosin, CD34). Two blinded investigators and the patients assessed clearance rate, cosmetic appearance and side-effects up to 3 months after treatment. Results ICG+DL therapy induced photocoagulation of medium and large blood vessels (> 20 μm diameter) but not of small blood vessels. According to the investigators’ assessment, clearance rates and cosmetic appearance were better after ICG+DL therapy than after FPDL treatment (P = 0·114, P = 0·291, respectively), although not up to a statistically significant level, whereas patients considered these parameters superior (P = 0·003, P = 0·006, respectively). On a 10-point scale indicating pain during treatment, patients rated ICG+DL to be more painful (5·81 ± 2·12) than FPDL treatment (1·61 ± 1·84). Conclusion ICG+DL represents a new and promising treatment modality for PWS, but laser parameters and ICG concentration need to be further optimized.

Summary Background The field cancerization concept in photodamaged patients suggests that the entire sun-exposed surface of the skin has an increased risk for the development of (pre)-malignant lesions, mainly epithelial tumours. Topical photodynamic therapy (PDT) is a noninvasive therapeutic method for multiple actinic keratosis (AK) with excellent outcome. Objectives To evaluate the clinical, histological and immunohistochemical changes in human skin with field cancerization after multiple sessions of PDT with methylaminolaevulinate (MAL). Methods Twenty-six patients with photodamaged skin and multiple AK on the face received three consecutive sessions of MAL-PDT with red light (37 J cm−2), 1 month apart. Biopsies before and 3 months after the last treatment session were taken from normal-appearing skin on the field-cancerized area. Immunohistochemical stainings were performed for TP-53, procollagen-I, metalloproteinase-1 (MMP-1) and tenascin-C (Tn-C). Results All 26 patients completed the study. The global score for photodamage improved considerably in all patients (P

Alpha hydroxy acids (AHAs), in particular glycolic acid, are a class of chemical compounds frequently used in cosmetics and dermatology. This review summarizes the current knowledge regarding chemistry, mechanism of action as well as the different indications ranging from cosmetic skin hydration to acne proven by clinical trials. Overall AHAs depending on the concentration used present an ingredient for cosmetic products or medical devices with proven efficacy.

Background Telangiectatic leg veins, which affect about 40–50% of adults, represent a frequent cosmetic rather than a medical problem. Besides sclerotherapy, various laser devices are common treatment options. However, complete clearance rates can only be achieved in a small number of patients. Objective In this proof-of-concept study, the safety and efficacy of indocyanine green (ICG)-augmented diode laser therapy (808 nm) was evaluated for the treatment of telangiectatic leg veins. Methods ICG (2 mg/kg body weight) was intravenously administered in 15 female patients (skin type II to III) with telangiectatic leg veins (measuring between 0.25 and 3 mm in diameter). Immediately after ICG injection, diode laser pulses with different radiant exposures (50–110 J/cm2) were applied as one single treatment. Safety and efficacy were assessed 1 and 3 months after treatment by a blinded investigator and the patient. Treatments with the pulsed dye laser (PDL) and the diode laser without ICG served as reference therapies. Results The safety of ICG application and diode laser treatment was excellent in all patients with no persisting side effects. Vessel clearance was dose-dependent. Diode laser treatment at radiant exposures between 100 and 110 J/cm2 resulted in good vessel clearance, which even improved to excellent after the application of double pulses. Diode laser therapy without ICG and PDL treatment induced poor to moderate clearance of telangiectatic leg veins. Conclusion ICG-augmented diode laser therapy has proved to be a safe and effective treatment option for telangiectatic leg veins. Lasers Surg. Med. 44: 369–376, 2012. © 2012 Wiley Periodicals, Inc.

Basierend auf der 1916 von Albert Einstein inaugurierten Theorie der stimulierten Emission von Licht wurden in den 1960er-Jahren die ersten Laser entwickelt. Der erste klinische Einsatz eines Lasers in einer Universitatshautklinik in Deutschland erfolgte 1978 in der Dermatologischen Klinik der Ludwigs-Maximilian-Universitat Munchen unter der Leitung des damaligen Direktors, Herrn Prof. Dr. med. Dr. h.c. mult. O. Braun-Falco. Seitdem ist eine rasante Weiterentwicklung der Lasermedizin zu verzeichnen. Heute ist die Lasertechnologie eine interdisziplinar genutzte Therapieform, die insbesondere in der Dermatologie klinisch wie auch wissenschaftlich fest verwurzelt ist. Die Behandlung zahlreicher Indikationen der klassischen und auch der asthetischen Dermatologie erfolgt heute standardmasig – teilweise ausschlieslich – mittels Lasertechnologie. In der vorliegenden Arbeit soll auf aktuelle Entwicklungen der Lasermedizin eingegangen werden. Hier zeichnet sich in der jungsten Vergangenheit ein Trend zu Kombinationsbehandlungen ab. Mit dem Ziel der Wirkungsverstarkung werden hierbei verschiedene Lichtsysteme komplementar angewendet oder der Laser mit einer dezidierten Arzneimittelapplikation kombiniert.

Diabetes mellitus is the most common endocrine disorder with continuously increasing prevalence. Blood vessels, nerves, eyes, kidneys and skin are affected, which causes both an enormous financial burden and a reduced quality of life of the affected patients. Long-standing diabetes may impair skin homeostasis resulting in skin manifestations in at least one third of all diabetics. The skin involvement may be the first presenting sign of diabetes, thus the respective skin signs should lead to diabetes focused diagnostic. Besides, the skin signs may be considered as a marker for the course of the disease or for the success of therapeutic interventions.

Summary 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.

In wound healing, a variety of mediators have been identified throughout the years. The mediators discussed here comprise growth factors, cytokines and chemokines. These mediators act via multiple (specific) receptors to facilitate wound closure. As research in the last years has led to many new findings, there is a need to give an overview on what is known, and on what might possibly play a role as a molecular target for future wound therapy. This review aims to keep the reader up to date with selected important and novel findings regarding growth factors, cytokines and chemokines in wound healing.

Background Fumarates are approved for the systemic treatment of moderate and severe psoriasis vulgaris in Germany. However, a number of studies and case reports indicate their efficacy in the treatment of further inflammatory skin disorders or granulomatous skin diseases. Objectives To examine the efficacy and safety of fumarates for the treatment of granulomatous and inflammatory skin diseases other than psoriasis vulgaris. Patients and methods The therapeutic efficacy and side-effects of fumarate therapy were analysed retrospectively in patients with granuloma annulare (GA, n = 4), cutaneous sarcoidosis (SA, n = 1), lichen planus (LP, n = 3), pityriasis rubra pilaris (PRP, n = 1) or chronic discoid lupus erythematosus (CDLE, n = 1). Results Six patients (GA: 3/4; LP: 2/3; PRP: 1/1) showed complete clearance and two patients (GA: 1/3; SA: 1/1) had a partial response, and the CDLE patient showed stable disease under a combination therapy with hydroxychloroquine. Side-effects associated with fumarate therapy were seen in seven of ten patients and resolved spontaneously upon dose reduction or discontinuation of the therapy. Conclusion According to this data, fumarates may represent a new approach in the treatment of granulomatous and inflammatory skin diseases other than psoriasis vulgaris. For the first time, the successful treatment of LP and CDLE with fumarates is reported. Side-effects are not limiting in most cases, but can hamper a dose escalation.

The goal of this review is to provide an overview on laser treatment of benign skin tumours and recent developments in this field. Ablational laser systems are established treatment devices for benign skin tumours. They obtain good cosmetic results with mostly minimal side-effects. Recently, fractional laser devices or combination of laser therapy with photodynamic therapy has gained attention in this field. However, there is a lack of randomised, controlled trials for laser treatment of benign skin tumours.

In cutaneous wound healing, the role of oxygen in vivo is poorly understood. We studied wound surface pO(2) during physiological wound healing in humans. Split-thickness skin graft donor sites (n=12) served as standardized wound models. Wound surface pO(2) was measured at 1, 6 and 14days after split-skin harvesting using two-dimensional luminescence lifetime imaging (2D-LLI) of palladium(II)-meso-tetraphenyl-tetrabenzoporphyrin (Pd-TPTBP) in polystyrene-co-acrylonitrile (PSAN) particles on transparent foils. In another experiment, we removed the stratum corneum (SC) on the volar forearm (n=10) by tape strippings to study the impact of the SC on the epidermal oxygen barrier. Split-skin donor site pO(2) significantly decreased during the time course of physiological healing. Regional differences in pO(2) within donor site wounds were visualized for the first time in literature. No difference was found in pO(2) before and after SC removal, showing that the SC is not a major constituent of the epidermal oxygen barrier.

In the literature, non-ablative fractionated photothermolysis (nFP) is accredited with improvement of wrinkles and scars combined with a reduced downtime. The purpose of this work was to evaluate the impact of a combination laser (1,320/1,440 nm) for nFP on hypertrophic scars, acne scars, and facial wrinkles. Thirty-six patients suffering from hypertrophic scars (n = 7), acne scars (n = 9), and wrinkles (n = 20) were treated using a combination Nd:YAG laser [λ(em) = 1,320 and 1,440 nm, pulse duration: 3-ms single pulse, fluence: 8.0-9.0 J/cm(2) (1,320 nm); 2.0-2.5 J/cm(2) (1,440 nm)]. The appearance of the treated condition was evaluated in a retrospective study by two blinded investigators based on follow-up photographs and by patient self-assessment. The frequency of side-effects was also assessed. Both patients and blinded observers rated the treatment results for hypertrophic scars and acne scars as slight improvement, and for wrinkles as equal as compared to baseline. No serious side-effects were reported. The light device used did not lead to a considerable clinical improvement of hypertrophic scars, acne scars, or wrinkles in this study.

Amyloide sind in der Natur weit verbreitete Proteinaggregate mit teils krankheitsauslosenden, vielfach aber auch wichtigen biologischen Funktionen. Obwohl die Ultrastruktur von Amyloid extrem konserviert ist, bleibt der Mechanismus der Amyloidogenese weiterhin ein komplexes Forschungsfeld. Beim Menschen konnen Amyloidosen primar in der Haut entstehen oder diese sekundar betreffen. Eine akkurate Diagnostik ist entscheidend fur die Therapieplanung dieser heterogenen Gruppe an Krankheitsentitaten. Daher gibt diese Arbeit zunachst eine Ubersicht uber die verschiedenen Formen der Amyloidosen, um dann auf Diagnostik und mogliche Therapieoptionen einzugehen. Weiterhin wird die Unterscheidung zwischen funktionellen und krankheitsauslosenden Amyloiden vorgestellt.

Delayed wound healing is one of the major therapeutic and economic issues in medicine today. Cutaneous wound healing is an extremely well-regulated and complex process basically divided into 3 phases: inflammation, proliferation, and tissue remodeling. Unfortunately, we still do not understand this process precisely enough to give direction effectively to impaired healing processes. There have been many new developments in wound healing that provide fascinating insights and may improve our ability to manage clinical problems. Our goal is to acquaint the reader with selected major novel findings about cutaneous wound healing that have been published since the beginning of the new millennium. We discuss advances in areas such as genetics, proteases, cytokines, chemokines, and regulatory peptides, as well as therapeutic strategies, all set in the framework of the different phases of wound healing.

Background So far, pulsed dye lasers have been regarded as the gold standard in the treatment of port-wine stains (PWS). Recently, intense pulsed light (IPL) has been reported to achieve more pronounced fading in some patients. Objectives To evaluate the efficacy and the side effects of IPL treatment of PWS in a direct comparison to the short-pulsed dye laser (SPDL) and the long-pulsed dye laser (LPDL). Methods Test spots (n = 158) were applied with IPL (λem = 555–950 nm, pulse duration: 8–14 milliseconds (single pulse), fluence: 11–17.3 J/cm2), the SPDL (λem = 585 nm, pulse duration: 0.45 milliseconds, fluence: 6 J/cm2), and the LPDL (λem = 585/590/595/600 nm, pulse duration: 1.5 milliseconds, fluence: 12/14/16/18 J/cm2) in a side-by-side modus in untreated (n = 11) and previously treated (n = 14) patients with PWS. Lesion clearance was evaluated by three blinded investigators based on follow-up photographs 6 weeks after treatment. Incidence of side effects was assessed. Results In previously untreated PWS as well as in pretreated PWS, IPL treatments were rated significantly (P

For too long, amyloids have been under general suspicion to merely cause diseases. In recent years, we have learned that these interesting proteins may also fulfill important biological tasks. Moreover, recent publications show emerging evidence for a so-called brain–skin axis. This viewpoint paper aims to address the question what is known about the link between brain and skin based on the literature available for two diseases caused by amyloid formation: Alzheimer′s disease (AD) and cutaneous amyloidoses. In addition, we acquaint the reader with a different perspective on the role of amyloid in skin and brain.

In modern medicine chronic wounds are an interdisciplinary major therapeutic and financial issue. Essential for therapy is both the causal treatment of the underlying disease and the symptomatic treatment depending on the phase of wound healing. The physiological process of cutaneous wound healing is divided into three overlapping phases: inflammation, proliferation and tissue remodelling. The choice of a suitable therapy depends on the extent of the wound, the localization, exudation and bacterial infestation. In recent years a number of novel findings were made about this complex biological process and the insights gained have resulted in new therapeutic concepts. In the following article we give an overview about possible therapeutic options and present the various modern wound dressings.

Photodynamic therapy (PDT) has become an established treatment modality for dermatooncologic conditions like actinic keratosis, Bowen's disease, in situ squamous cell carcinoma and superficial basal cell carcinoma. There is also great promise of PDT for many non-neoplastic dermatological diseases like localized scleroderma, acne vulgaris, granuloma anulare and leishmaniasis. Aesthetic indications like photo-aged skin or sebaceous gland hyperplasia complete the range of applications. Major advantages of PDT are the low level of invasiveness and the excellent cosmetic results. Here, we review the principal mechanism of action, the current developments in the field of photosensitizers and light sources, practical aspects of topical PDT and therapeutical applications in oncologic as well as non-oncologic indications.

Oxygen is a prerequisite for successful wound healing due to the increased demand for reparative processes such as cell proliferation, bacterial defence, angiogenesis and collagen synthesis. Even though the role of oxygen in wound healing is not yet completely understood, many experimental and clinical observations have shown wound healing to be impaired under hypoxia. This article provides an overview on the role of oxygen in wound healing and chronic wound pathogenesis, a brief insight into systemic and topical oxygen treatment, and a discussion of the role of wound tissue oximetry. Thus, the aim is to improve the understanding of the role of oxygen in wound healing and to advance our management of wound patients.

Light is electromagnetic radiation and human beings encounter it on a number of levels. The versatility of the cutaneous biological effects allows the medical utilization of light to be used as a potential diagnostic and therapeutic tool. In almost all cases the light used is restricted to certain wavelengths and defined photophysical parameters. In terms of diagnostic purposes photo testing, Wood's light diagnostics and fluorescence diagnostics are frequently used tools. The therapeutic use of incoherent light can be divided in four main groups: (1) UV phototherapy, (2) photodynamic therapy (PDT), (3) treatment with light-emitting diodes (LEDs), and (4) treatment with intense pulsed light (IPL). Intense pulsed light (IPL) devices use flashlamps and bandpass filters to emit polychromatic, incoherent, high-intensity pulsed light of a determined wavelength spectrum, fluence, and pulse duration. Similar to lasers, the basic principle of IPL devices is the selective thermal damage of the target structure. This review summarizes the practical use of IPL devices and the current literature on IPL with regard to the treatment of unwanted hair growth, vascular lesions, pigmented lesions, acne vulgaris, and as a light source for PDT.

Background: Intense pulsed light (IPL) devices use flashlamps and bandpass filters to emit polychromatic incoherent high-intensity pulsed light of determined wavelength spectrum, fluence, and pulse duration. Similar to lasers, the basic principle of IPL devices is a more or less selective thermal damage of the target. The combination of prescribed wavelengths, fluences, pulse durations, and pulse intervals facilitates the treatment of a wide spectrum of skin conditions. Objective: To summarize the physics of IPL, to provide guidance for the practical use of IPL devices, and to discuss the current literature on IPL in the treatment of unwanted hair growth, vascular lesions, pigmented lesions, acne vulgaris, and photodamaged skin and as a light source for PDT and skin rejuvenation. Methods: A systematic search of several electronic databases, including Medline and PubMed and the authors experience on intense pulsed light. Results: Numerous trials show the effectiveness and compatibility of IPL devices. Conclusion: Most comparative trials attest IPLs similar effectiveness to lasers (level of evidence: 2b to 4, depending on the indication). However, large controlled and blinded comparative trials with an extended follow-up period are necessary. Lasers Surg. Med. 42:93–104, 2010. 2009 Wiley-Liss, Inc.

In the everyday practice of dermatology, we encounter light in many ways. The biological and physical interactions between light and skin make light a potent diagnostic and therapeutic tool when well directed. This contribution intends to illuminate the possible uses of light-emitting diodes and high-energy flashlamps in dermatology. Both sources of light have only recently been employed in dermatology and in addition to broadband ultraviolet (UV) light sources, high-pressure gas discharge lamps, and halogen lamps enrich the armamentarium of incoherent light sources.

A 12-month-old boy presented with a congenital, achromic patch involving the right shoulder, anterior chest, and right upper arm. The skin showed a uniform amelanosis with serrated, irregular borders. The amelonosis was viewed with both daylight (see Figure 1, and Figure 2, page 618) and under UVA light (Wood’s lamp). The examination revealed off-white accentuation without fluorescence and marked contrast between the unaffected skin and the affected area. Hyperemia could be evoked in the affected area by rubbing the skin. Therefore, perfusion-related hypopigmentaion, such as nevus anemicus or vasospasm, could be excluded.

An ex vivo porcine skin model was utilized to analyse the penetration of 5-aminolevulinic acid (5-ALA) contained in a nanoemulsion-based formulation BF-200 ALA (10% 5-ALA-hydrochloride) versus 16% aminolevulinate methyl ester-hydrochloride in a commercially cream (MAL cream) by fluorescence microscopy of their common metabolite protoporphyrin IX (PpIX) after 3, 5, 8 and 12 h. Fluorescence signals of PpIX in pig skin treated with BF-200 ALA were stronger than those for MAL cream. At 8 and 12 h, the PpIX fluorescence signals were 4.8- and 5.0-fold higher than those measured after MAL cream application. Fluorescence signals of PpIX after application of BF-200 ALA were detected in deeper tissue layers of the epidermis than after application of MAL cream (97.2 +/- 5.7 microm for BF-200 ALA vs 42.0 +/- 4.2 microm for MAL cream). These data implicate that BF-200 ALA in photodynamic therapy might lead to a superior therapeutically effect of intraepidermal (in situ) squamous cell carcinomas.

Summary Background The parascapular flap is a widely accepted and suitable option for covering defects in almost all anatomical areas. Here, we report our experience with the microvascular transfer of parascapular flaps for the coverage of large lower leg defects with reference to our retrospective study. Patients and methods Twenty patients with free parascapular flaps (17 male, three female, age: 43±17 years, BMI 26.1±3.5) were examined 3 months to 3 years after free tissue transfer. All procedures and examinations were performed by the same experienced surgeon (2002–2005). Flap dimensions ranged from 8×4cm to 30×13cm, with an average of 20.4±6.6cm×8.9±2.6cm. The parameters studied included perioperative morbidity, donor site morbidity, flap vitality, complications, functional shoulder tests, patient satisfaction (visual analog scale, VAS), the duration of the hospital stay and the long-term outcome. Results All of the 20 flaps remained vital. Adequate coverage and complete healing were obtained in all patients during the follow-up period and all patients were physically mobile. General patient satisfaction with the intervention was high (VAS: median 7.5; x 25 =6.0; x 75 =9.5); donor site morbidity was low, that is, only one patient presented with reduced range of motion and shoulder function compared to the preoperative status. The hospital stay after flap transfer was 20.8±9.8 days and the overall hospital stay was 32.1±15.0 days. Conclusions Our study confirms that the parascapular flap is a very versatile and safe flap for lower limb reconstruction with low donor morbidity.

Amyloid and amyloidosis describes a heterogeneous group of diseases which are characterized by the pathological extracellular deposition of autologous proteins. Basically, amyloidoses can be divided into systemic or organ-limited (e.g. cutaneous) forms and can be acquired or hereditary in nature. The subclassification discriminates between primary amyloidosis (in the absence of an obvious predisposing disease) and secondary amyloidosis (if caused by a certain underlying disease). The subclassification of amyloidoses is based on the main protein constituent and therefore on the chemical composition of the amyloid fibrils. However, the exact etiopathogenesis of amyloid formation remains unclear. In addition to the clinical presentation, histology, electron microscopy and biochemical-immunological differentiation are also decisive for a proper diagnosis. In cutaneous amyloidosis the deposition of amyloid either occurs along reticulin fibers and the basal membrane (perireticulary amyloidoses) or along collagen fibers (pericollagenous amyloidosis). The purpose of this article is to provide an up-to-date overview on the different kinds of cutaneous amyloidoses.

Background: Free flap transplantation is used more and more frequently in order to cover extensive wound defects. The basic prerequisite for successful flap salvage after flap failure is a short time interval from failure until revision. For this reason many different flap monitoring systems have been tested over the last years. But none of them has made the way into clinical routine. Objective: The aim of this clinical study was to study whether luminescence lifetime imaging (LLI) is an adequate method to assess flap viability during the postoperative period. In previous experiments LLI was proven to be a precise and non-invasive monitoring system for transcutaneous oxygen measurement. Methods: p tc O 2 of 9 patients was detected during a postoperative period of 72 hours. In all cases the transplantation was performed by the same experienced surgeon. During the first 4 hours almost constant p tc O 2 values were detected (53 ± 0.7 mmHg). During the following time intervals p tc O 2 values decreased and reached a more or less constant level after approximately 12 hours. The mean p tc O 2 decreased from 53 ± 0.7 mmHg to 39 ± 1.0 mmHg. In one case an immediate decrease of p tc O 2 below 10 mmHg was observed and a subsequently intervention was necessary to improve flap perfusion. Conclusion: In this clinical trial, perfusion dynamics after free flap transplantation as well as the detection of vascular complications were demonstrated using LLI. Based on these data, LLI seems to be a sensitive and adequate monitoring system for the evaluation of free flap viability.

Summary Background: Hymenoptera venom anaphylaxis is a frightening event that affects physical and psychical functioning. Patients and Methods: Retrospective survey of 182 Hymenoptera venom allergic patients living in a rural area using a questionnaire targeting on patients' satisfaction during therapy, fear of anaphylactic recurrences and changes in lifestyle before and after venom immunotherapy (VIT). Additionally, patients' self-assessment of quality of life, daily outdoor time and re-sting rate were recorded. Results: 146 patients returned the questionnaire (58.9% male, 41.1% female, 25.3% honey bee allergic, 67.8% wasp allergic, 41.1% re-sting rate, mean follow-up time 6.5 years).Measurement of the parameters fear,satisfaction and changes in lifestyle revealed a significant improvement after VIT.This correlated with the patients'self-assessment of quality of life,when 89.7% declared an improvement after VIT.Although the improvement was higher in patients with re-stings, also patients without re-stings clearly benefited from VIT. Interestingly,females were significantly more affected by Hymenoptera venom allergy than males,whereas both genders showed a similar improvement after VIT. Conclusions: Patients with Hymenoptera venom sting allergy significantly benefit from VIT in regard to both biological and psychological outcome. VIT should still be provided to all Hymenoptera venom allergic patients as standard of care.

The skin pH is crucial for physiological skin functions. A decline in stratum corneum acidity, as observed in aged or diseased skin, may negatively affect physiological skin functions. Therefore, glycolic acid-containing water-in-oil (W/O) emulsions adjusted to pH 4 were investigated regarding their effect on normal or increased skin pH. A pH 4 W/O emulsion was applied on three areas with pathologically increased skin surface pH in diabetics (n = 10). Further, a 28-day half-side trial (n = 30) was performed to test the long-term efficacy and safety of a pH 4 W/O emulsion (n = 30). In summary, the application of a pH 4 W/O emulsion reduced the skin pH in healthy, elderly and diabetic subjects, which may improve epidermal barrier functions.

BACKGROUND: Photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) is an effective and safe treatment option for the treatment of actinic keratosis (AK). Incoherent lamps are often used, matching the absorption maxima of ALA. OBJECTIVES: A comparative trial was performed to evaluate the efficacy of recently developed light-emitting diodes (LEDs). METHODS: Human epidermal keratinocytes were incubated for 24 h with ALA (100, 200, 300, 400 or 500 micromol L(-1)) and irradiated consecutively using either an incoherent halogen lamp (lambda(em) = 580-750 nm; 24 J cm(-2); 40 mW cm(-2)) or an LED system (lambda(em) = 633 +/- 3 nm; 3, 6, 12 or 24 J cm(-2); 40 mW cm(-2)). Topical ALA-PDT was performed on 40 patients with AK (n = 584) in a symmetrical distribution suitable for two-sided comparison. After incubation with ALA (20% in cream base) irradiation was performed with the incoherent lamp (100 J cm(-2); 160 mW cm(-2)) on one side and the LED system (40 J cm(-2); 80 mW cm(-2)) on the opposite side followed by re-evaluation up to 6 months. RESULTS: No significant differences between the LED system (3, 6, 12 or 24 J cm(-2)) and the incoherent light source (24 J cm(-2)) regarding cytotoxicity was found in vitro. The complete remission rate yielded in the in vivo investigation was also not significantly different at 6 weeks (P = 0.95), 3 months (P = 0.75) and 6 months (P = 0.61) following therapy. Six weeks following therapy complete remission rates of 84.3% (LED system) and 82.8% (incoherent lamp) were achieved. There was also no significant difference between both light sources regarding pain during light treatment (P = 0.67), patient satisfaction (P = 1.0) or cosmesis (P = 1.0) following therapy. CONCLUSIONS: These results show the efficacy of an LED system for ALA-PDT both in vitro and in vivo. ALA-PDT with the LED system showed a noninferiority regarding the clinical outcome in the treatment of AK compared with the incoherent lamp.

Ammoniumpersulfat ist ein potentes Bleich- und Oxidationsmittel, das in Haarbleichmitteln eingesetzt wird. Aufgrund der frequenten Verwendung von Haarbleichmittel durch Friseure kommt es in dieser Berufsgruppe gehauft zu Kontaktsensibilisierung gegenuber Ammoniumpersulfat. Auch uber asthmatoide oder rhinitische Beschwerden im Sinne einer Soforttypreaktion nach Einatmen von Ammoniumpersulfatdampfen wird berichtet. Ausgepragte systemische Reaktionen sind eher selten. In der vorliegenden Fallbeschreibung wird uber eine 24-jahrige Patientin berichtet, die wahrend ihrer Tatigkeit als Friseurin ein Handekzem nach Kontakt zu Haarbleichmitteln ausbildete. Nach Aufgabe ihres Berufes heilte das Handekzem ab. Spater kam es bei privatem Gebrauch von Ammoniumpersulfat enthaltenden Haarbleichmitteln zu einer schweren Soforttypreaktion mit Bewusstlosigkeit. In der klinischen Testung zeigte die Patientin 3 h nach Applikation eines Epikutantests mit Friseurstoffen abermals eine anaphylaktische Reaktion. Der Reibetest auf Ammoniumpersulfat (2,5%) ergab bei einer 1:100-Verdunnung in Vaselin eine 2fach positive Reaktion.

Topical photodynamic therapy (PDT) is a well-established treatment modality which has mainly shown to be effective for dermatooncologic conditions like actinic keratoses (AK), Bowen's disease, in situ squamous cell carcinoma and superficial basal cell carcinoma (BCC). However, a therapeutical benefit of PDT is also evident for inflammatory dermatoses like localized scleroderma, acne vulgaris and granuloma annulare. Recent work has been focused on the development and evaluation of topical photosensitizers like the heme precursor 5-aminolevulinic acid (5-ALA) or its methyl ester (methyl aminolevulinate) inducing photosensitizing porphyrins. These drugs do not induce strong generalized cutaneous photosensitization like the systemically applied porphyrins or their derivatives. For dermatological purposes, incoherent lamps or light-emitting diode arrays can be used for light activation. Depending on the applied light dose and the concentration of the photosensitizer either cytotoxic effects resulting in tumor destruction or immunomodulatory effects improving the inflammatory conditions occur. Treating superficial oncologic lesions (tumor thickness2-3 mm) cure rates achieved by PDT are equal to the cure rates of the respective standard therapeutic procedure. The benefits of PDT are the low level of invasiveness and the excellent cosmetic results after treatment.

Oxygen-dependent quenching of luminescence of metal porphyrin complexes has been used to image the pO(2) distribution over tumor and normal tissue.An experimental setup is described using a platinum(II)-octaethyl-porphyrin immobilized in a polystyrene matrix as transparent planar sensor.Sensitivity over a broad range is high at low pO(2) values (+/- 0.2 mm Hg at 0 mm Hg; +/- 1.5 mm Hg at 160 mm Hg pO(2)). Due to intrinsically referencing via lifetime encoding there was no modification of the sensor response in vivo in the dorsal skinfold chamber model with amelanotic melanoma (A-MEL-3) in awake hamsters when compared to the in vitro calibration. pO(2) measurements over normal tissue (25.8 +/- 5.1 mm Hg) and tumor tissue (9.2 +/- 5.1 mm Hg) were in excellent agreement with previous results obtained in this model using a surface multiwire electrode.Using the presented method the surface pO(2) distribution can be mapped with a high temporal resolution of approximately 100 ms and a spatial resolution of at least 25 mu m. Moreover, the transparent sensor allows the simultaneous visualization of the underlying microvasculature.