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Oral mini pulse (OMP) corticosteroids and diphencyclopropenone (DPCP) contact sensitisation are commonly used treatment modalities in severe cases of Alopecia areata (AA) in children but with scarce studies comparing the two modalities in children. In this study we aimed to compare the effectiveness and safety of dexamethasone OMP with DPCP contact sensitization in severe non progressive AA in children. This randomized open label study was undertaken in 30 children less than 18 years of age with extensive non progressive AA divided in two groups. Group I included 15 patients who received dexamethasone (5 mg/week) OMP as five tablets of 0.5 mg dexamethasone (i.e., 2.5 mg dexamethasone) on two consecutive days in a week. Group II included 15 patients who were treated with DPCP contact sensitization. The treatment was continued in all patients for 24 weeks. Patients were followed up every 4 weeks and records were maintained. Response rate was 100% in OMP group and 53.3% in DPCP group at 24 weeks. In Group I, complete regrowth was seen in 20% patients, and cosmetically acceptable regrowth in 66.7% while in Group II, complete regrowth was not seen in any of the patients, and cosmetically acceptable regrowth in 20% (p = 0.001). Hair regrowth started at mean duration of 7.7 weeks in Group I, while 11.3 weeks in Group II. Response rate of treatment with dexamethasone OMP leads to a significantly faster and better hair regrowth compared to DPCP contact immunotherapy in non-progressive extensive AA in children.

Background The aim of this retrospective study was to compare the efficacy and safety of different phototherapeutic modalities in the treatment of cutaneous lichen planus (LP). Methods We retrospectively analyzed the chart data of 53 patients with generalized LP who had been subjected to narrowband UVB (NB-UVB) or photochemotherapy (PUVA) between January 1997 and April 2020. Of these, 30 patients had received NB-UVB, 18 patients oral PUVA and 5 patients bath PUVA. Results Fifty patients completed a full treatment course. The percentage of patients with a complete (>90% clearing) or good (51%-90% clearing) response was similar for NB-UVB versus PUVA (86.2% vs. 90.5%; P = 1.00). The number of exposures required for obtaining a complete or good response was also comparable for both treatment groups (NB-UVB: 28.9 ± 12.3 vs. PUVA: 25.4 ± 10.1; P = .209). Adverse events, in particular gastrointestinal upsets, were recorded in 26.1% of patients treated with oral PUVA while none were observed with NB-UVB. Conclusion The therapeutic outcome and the number of treatments required for achieving a complete or good response were comparable for NB-UVB and PUVA; however, PUVA therapy was associated with a substantially higher rate of moderate adverse events.

Photodynamic therapy (PDT) is an effective method for treating actinic keratosis (AK) with pain during illumination representing the major side effect. The efficacy of two different cooling methods for pain relief in PDT of AK in the head region was compared.Randomized, assessor-blinded, half side comparison study in 20 patients with symmetrically distributed AK on the head. Conventional PDT was performed on both halves of the scalp or face by applying 20% aminolevulinic acid cream (ALA) and subsequent illumination with incoherent red light. During illumination one side was cooled with a cold air blower (CAB) and the other with a standard fan (FAN) in a randomized fashion. Pain and skin temperature were recorded during and after PDT. The phototoxic skin reaction was evaluated up to seven days after PDT. The clearance rate of AK was assessed at 3 and 6 months after PDT.Mean pain (VASmean), maximum pain intensity (VASmax) and the mean skin temperature during PDT were significantly lower with CAB as compared to FAN (VASmean: 2.7 ± 1.4 vs. 3.7 ± 2.1, p = 0.003; VASmax: 3.8 ± 2.0 vs. 4.8 ± 2.5, p = 0.002; 26.8 ± 2.0 °C vs. 32.1 ± 1.7 °C; p=0.001). The severity of the phototoxic skin reaction and the clearance rate of AK did not differ between the two cooling methods.Cooling with CAB during PDT has a greater analgesic effect than cooling with FAN. Patients with a lower skin temperature during illumination tended to experience less pain, however, this effect did not reach the level of statistical significance.

Background Little is known about the effectiveness and drug survival associated with apremilast under real-world conditions. Objective To investigate the influence of patient and disease characteristics on drug survival associated with apremilast and to elucidate clinical effectiveness with regard to the psoriasis area and severity index (PASI) reduction. Methods This was an observational, retrospective, multicenter analysis from the Austrian Psoriasis Registry. Results Data from 367 patients were eligible for analysis. The 12-month drug survival rate associated with apremilast (ie, the proportion of patients on the drug) was 57.3% and decreased significantly in patients younger than 40 years (relative hazard ratio = 1.49, P = .007918). Sex; concomitant arthritis; previous biologic therapy; obesity; and palmoplantar, scalp, nail, and intertriginous involvement did not significantly affect drug survival. At 12 months, the response rates in patients receiving apremilast per protocol with a PASI of 50, 75, 90, and 100 were 80.0%, 56.4%, 38.2%, and 22.7%, respectively. Limitations Inclusion of a substantial number of patients with no record of absolute PASI at study entry and lack of PASI reduction follow-up data of 103 patients (28.1%) after starting apremilast treatment. Conclusion Apremilast is a robust antipsoriatic drug for which the drug survival is not strongly influenced by most patient- or disease-related factors except age. Drug survival is significantly shorter in patients younger than 40 years.

Background Photodynamic therapy (PDT) is an effective treatment for actinic keratoses (AK). PDT is usually performed with occlusion of the photosensitizer prior to subsequent illumination. Objectives This study aimed to compare the efficacy and tolerability of occlusive versus non‐occlusive application of a 5‐aminolevulinic gel (BT‐200 ALA) for PDT of multiple AK on the scalp or face. Methods Prospective, investigator‐blinded, within‐patient comparison study on 45 patients. PDT with occlusion of ALA was performed in a target area on one randomized side of the scalp or face. One week later a contralateral target area received the same treatment except that no occlusion of the ALA gel was performed. 3 and 6 months after PDT, the clearance rate of a predetermined target lesion and the total clearance rate of all AK within the treated areas were determined. PDT‐induced pain and skin phototoxicity and cosmetic outcome were also recorded. Results Clearance rate of the target AK and total AK clearance rate at 3 months after PDT was 88.4% and 90.6% for occlusive PDT and 58.1% (P = .001) and 70.4% (P = .04) for non‐occlusive PDT. The corresponding values at 6 months after PDT were 69.7% and 72.1% for occlusive PDT and 30.2% (P

So far, wIRA has primarily been used in the following dermatological conditions: wound healing, sclerosing skin diseases and common cutaneous warts. Accelerated healing of both acute (e.g., after surgery) and chronic (e.g., venous ulcers) wounds has been described in case reports, small case series and a randomized controlled trial. wIRA not only reduced pain and inflammation but also influenced wound secretion. It has also been shown to protect against infection and promote the formation of granulation tissue and wound re-epithelialisation. The therapeutic efficacy of wIRA in localized scleroderma and sclerotic cutaneous graft-versus-host disease is currently under investigation in a prospective Austrian two-center study. Previous reports on sclerosing skin disorders have indicated that wIRA might arrest disease activity, reduce skin sclerosis and improve joint motility. Finally, anecdotal evidence in immune-compromised twins and a randomized controlled trial on 80 patients have shown that wIRA might induce erradication of treatment-resistant common warts.wIRA appears to be a promising treatment approach for some challenging dermatological skin disorders. The treatment is easy to perform and devoid of any serious acute and chronic side effects. wIRA is well-accepted, since it generates a pleasant sensation in the skin.

ZusammenfassungWir berichten über ein 20 Monate altes Mädchen mit teils anulären, urtikariellen Hautveränderungen am gesamten Integument, die bis zu 1 Woche persistierten und dann an neuen Stellen auftraten. Die histologische Aufarbeitung zeigte ein urtikarielles Entzündungsmuster mit interstitiellem Ödem und einem Infiltrat mit Lymphozyten, Neutrophilen und vielen eosinophilen Granulozyten ohne Flammenfiguren. Das Labor war unauffällig. In Zusammenschau stellten wir die Diagnose eines eosinophilen anulären Erythems (EAE) im Kindesalter, das zu den eosinophilen Dermatosen zählt.

Background The effect of adalimumab and fumaric acid esters (FAE) on the cardiovascular risk associated with psoriasis has only been investigated scarcely in randomized controlled studies. Objective The aim of this prospective, randomized controlled head-to-head trial was to compare the influence of adalimumab and FAE on cardiovascular disease markers in psoriasis patients. Methods Sixty-five patients with moderate to severe plaque psoriasis were randomly assigned to adalimumab or FAE treatment for 6 months. Cardiovascular haemodynamic parameters [flow-mediated dilation (FMD), nitro-glycerine mediated dilation (NMD) and carotid intima-media thickness (CIMT), blood pressure] were assessed at baseline (v0) and after 6 months (v6). Cutaneous disease severity, inflammatory and lipid cardiovascular risk markers were analysed at baseline(v0), after 3 (v3) and 6 months (v6). Results After 6 months of treatment FMD in the adalimumab group increased significantly [v0 5.9% (6.4% SD), v6 8.0% (4.8% SD), P = 0.048) but not in the FAE group. (v0 7.0% (4.1% SD), v6 8.4% (6.1% SD), P = 0.753]. This was paralleled by a significant decrease of high sensitive C-reactive protein (hsCRP) in the adalimumab group in comparison to the FAE group (v0: 0.39 mg/dL (0.38 SD), v6: 0.39 mg/dL (0.48 SD), P = 0.043). No significant changes were observed in any other haemodynamic parameters. FAE, however, additionally decreased total cholesterol (P = 0.046) and apolipoprotein B (P = 0.041) levels compared to adalimumab. Mean Psoriasis Area and Severity Index (psoriasis area severity score) reduction was greater but not significant (P = 0.116) under adalimumab treatment compared to FAE treatment [-71.1% (29.9 SD) vs. -54.6% (45.7%)]. Conclusion In our study, both treatments were documented to exert effects on the cardiovascular system. While adalimumab showed anti-inflammatory effects and improved FMD, FAE interacted favourably with the cholesterol metabolism.

Recent experimental data suggest a role for apremilast in the treatment of alopecia areata. Small clinical studies have so far provided contradictory results. We retrospectively evaluated the efficacy and safety of apremilast in five cases of extensive and treatment-resistant alopecia areata. Apremilast was given at a dose of 30 mg, twice daily, over six months. The efficacy of apremilast treatment was determined by monthly assessment of the affected scalp surface area using SALT scoring. In four out of five patients, no sustained improvement in SALT score was observed within the treatment period. Two of these patients had a slight but only transient improvement after two months of treatment. One patient responded to apremilast treatment with a progressive and marked improvement, as reflected by an 83% reduction in SALT score. Our results are in line with the varying treatment responses in previous studies. Future studies on the efficacy of apremilast treatment in confirmed alopecia areata patient groups are warranted.

Background Actinic cheilitis (AC) is a variant of actinic keratosis (AK) affecting the lips and caused by chronic ultraviolet exposure. Objective Alacare is a self-adhesive, skin-coloured 5-aminolaevulinic acid patch that has been developed for use in photodynamic therapy (PDT) of mild-to-moderate AK. Based on promising preliminary results in the treatment of AC with Alacare patch PDT, we decided to extend our previous investigation to gain more data on the efficacy, tolerability, safety and cosmetic outcome of Alacare patch PDT for AC. Methods Twenty-one patients with a clinical diagnosis of mild-to-moderate AC were included in the study and subjected to one single session of PDT. After occlusion with the Alacare patch for 4 h, the AC lesions were illuminated for 10 min with red light at a dose of 37 J/cm2 . All patients received local anaesthesia prior to illumination. Additionally, all lesions were cooled during PDT with a cold air blower. PDT-induced pain and skin phototoxicity were monitored during and up to 7 days after PDT. Clinical assessment of efficacy, cosmetic outcome and global patient satisfaction was performed at 3, 6 and 12 months after treatment. Results Nineteen patients completed the study. Three months after PDT, 17 patients (89.5%) had achieved complete remission. Of these, one patient presented with recurrence of AC at the 6-month follow-up, whereas all other patients remained in remission until the end of the observation period. The complete clinical cure rate at 1 year after a single Alacare patch PDT thus was 84.2%. Pain during illumination and the phototoxic skin reaction were in general mild to moderate. The cosmetic outcome was excellent. Conclusion The present prospective study on Alacare patch PDT for AC confirms its high clinical efficacy, good tolerability and favourable cosmetic effects. Alacare patch PDT should be considered as a valid treatment option for patients with AC.

Background Drug‐induced photosensitivity refers to the development of cutaneous adverse events due to interaction between a pharmaceutical compound and sunlight. Although photosensitivity is a very commonly listed side‐effect of systemic drugs, reliable data on its actual incidence are lacking so far. Objectives A possible approach to evaluate the real‐life extent of drug‐induced photosensitivity would be an analysis of the frequency of exposure to a given photosensitizing drug combined with an indicator of its photosensitizing potential. This could serve as a basis for developing a pharmaceutical ‘heatmap’ of photosensitivity. Methods The present study investigated the number of reimbursed dispensed packages of potentially photosensitizing drugs in Germany (DE) and Austria (AT) between 2010 and 2017 based on nationwide health insurance‐based databases. In addition, an indicator for the photosensitizing potential was established for each drug based on the number of reports on photosensitivity in the literature. Results This analysis includes means of 632 826 944 (+/−14 894 918) drug dispensings per year in DE and 113 270 754 (+/−1 964 690) in AT. Out of these, the mean percentage of drugs that enlist photosensitivity as a potential side‐effect was 49.5% (±0.7) in DE and 48.2% (±1.2) in AT. When plotting the number of reimbursed dispensed packages vs. the number of reports on photosensitivity, two categories of drugs show high numbers for both parameters, that is diuretics and non‐steroidal anti‐inflammatory drugs (NSAIDs). Conclusions Diuretics and NSAIDs appear to be responsible for the greatest part of exposure to photosensitizing drugs with potential implication on public health.

Background Narrowband UVB phototherapy (NB‐UVB) is a mainstay in the treatment of numerous inflammatory dermatoses. Whereas, a wealth of studies has shown that NB‐UVB treatment increases 25‐hydroxyvitamin D3 (25(OH)D) levels, only sparse and controversial data exist on its effect on serum folate and cobalamin. Objectives To determine whether exposure to NB‐UVB alters serum folate or cobalamin levels. Methods A single‐centre, prospective, open observational study on 101 patients subjected to NB‐UVB phototherapy between late fall and early spring. Serum folate, 25(OH)D and cobalamin levels were measured after 0, 12, 24 and 36 NB‐UVB exposures. Results After 12 NB‐UVB exposures a significant decrease of mean serum folate (−1.0 nmol/L; P = 0.03) and cobalamin (−14.5 pmol/L, P = 0.03) levels was observed whereas serum levels of 25(OH)D showed a significant increase (35.4 nmol/L, P

Vitiligo ist eine häufige Hauterkrankung, die durch immunvermittelte Zerstörung der Melanozyten zustande kommt. Die nichtsegmentale Vitiligo, der häufigste klinische Subtyp, ist üblicherweise chronisch und oft mit erheblichen psychosozialen Folgen verbunden. Vitiligo erfordert eine frühzeitige Diagnose, Erkennung von Komorbidität, präzise Erfassung der Ausdehnung und Krankheitsaktivität, Einschätzung der Beeinträchtigung der Lebensqualität sowie umgehende Therapieeinleitung basierend auf den aktuell verfügbaren evidenzbasieren Behandlungsmöglichkeiten. Diese S1-Leitlinie hilft deutschen Dermatologen bei der Diagnose und Therapie der Vitiligo.

A 33-year-old female developed sclerotic graft-versus-host disease (GvHD) 2 years after allogeneic stem cell transplantation because of acute myeloid leukemia. Despite various systemic treatment attempts over more than 6 years (including glucocorticosteroids, cyclosporine, tacrolimus, sirolimus, rituximab and imatinib) cutaneous sclerosis progressed continuously and resulted in a marked reduction of motility of the large joints.