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Glossodynia or orofacial pain disorder is known as burning mouth syndrome. It is a therapeutic challenge. Its etiology is not well defined. Recent studies show not only a correlation with neuropathic changes, but there are also indications of comorbidities such as depression, anxiety, and carcinophobia. These can also manifest as a reaction to the disease and are not necessarily considered causative. Burning mouth syndrome poses a diagnostic challenge since its differential diagnosis is broad. With regard to dermatological aspects, lichen planus mucosae, oral leucoplakia, pemphigus vulgaris, and aphthous mouth ulcers should be considered. Diabetes, anemia, vitamin deficiency, and endocrinological influences should be considered regarding the predominance of elderly and female patients. Meta-analyses of treatment studies usually show a low level of evidence of the randomized, controlled trials. According to the literature mainly psychotherapy and antidepressants are proposed for therapy. Alpha lipoic acid as a dietary supplement shows short-term improvement and low-level laser therapy might have some benefit.Die Glossodynie, die besser als orofaziales Schmerzsyndrom oder Burning-Mouth-Syndrom bezeichnet wird, stellt eine therapeutische Crux dar, da eine eindeutige Ätiopathogenese bisher nicht bekannt ist. Neuere Studien weisen auf einen Zusammenhang mit neuropathischen Veränderungen hin, außerdem sind Hinweise auf Komorbiditäten mit Depression, Angst und Karzinophobie evident. Diese sind zum Teil auch Folge der Erkrankung und nicht unbedingt als ursächlich anzusehen. Da eine vielfältige Differenzialdiagnostik durch klinische Untersuchungen ausgeschlossen werden sollte, ist die Glossodynie eine diagnostische Herausforderung. In Betracht kommen neben Lichen planus, Leukoplakien, Pemphigus vulgaris und Aphthen auch internistische Erkrankungen wie Diabetes oder Anämien oder Vitaminmangel und hormonelle Einflüsse bei den überwiegend älteren und überwiegend weiblichen Patienten. Metaanalysen über durchgeführte Therapiestudien zeigen einen niedrigen Evidenzgrad der vorhandenen randomisierten kontrollierten Studien (RCTs). Nach der Literatur werden v. a. Psychotherapie und Antidepressiva zur Behandlung vorgeschlagen. Alpha-Liponsäure als Nahrungsergänzung zeigt eine kurzfristige Besserung, und auch Low-Level-Lasertherapie scheint gewisse Effekte hervorzubringen.

Since the introduction of active vaccination against SARS-CoV-2 infection, there has been a debate about the risk of developing severe allergic or anaphylactic reactions among individuals with a history of allergy. Indeed, rare cases of severe allergic reactions have been reported in the United Kingdom and North America. By february 2021 a rate of 4,5 severe allergic reactions occurred among 1 million patients vaccinated with the mRNA-based COVID-19 vaccines, which is higher than the generally expected rate of severe allergic reactions to vaccinations of around 1 in 1 million.

Wie führt man die SARS-CoV-2-Impfungen mit möglichst minimalem Risiko für allergische Reaktionen durch? Tatsächlich können die aktuellen mRNA-Impfstofe selbst bei Allergikern meist ohne Weiteres verabreicht werden. Der folgende Beitrag legt dar, wann ein erhöhtes Risiko für schwere Anaphylaxien besteht und gibt praktische Tipps für die sichere Durchführung der Impfung.

International audience; Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrier-stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit-risk ratio. The IL-4R-blocker dupilu-mab is a safe, effective and licensed, but expensive, treatment option with potential ocular side-effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) only have limited effects on AD-related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient-specific, and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. Efficacy-proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults.

Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory comorbidities.1,2 Severely affected patients are often treated with immune-modulating systemic drugs.3,4 On March 11th 2020, the World Health Organization declared the 2019 novel coronavirus severe acute respiratory syndrome (SARS-Cov-2) epidemic to be a pandemic. The number of cases worldwide is increasing exponentially and poses a major health threat, especially for those who are elderly, immuno-compromised, or have comorbidities. This also applies to AD patients on systemic immune-modulating treatment. In these days of uncertainty, reallocation of medical resources, curfew, hoarding, and shutdown of normal social life, patients, caregivers and doctors ask questions regarding the continuation of systemic immune-modulating treatment of AD patients. The ETFAD decided to address some of these questions here.

Background Previous research has mainly used skin-manipulating methods to induce itch. In comparison, itch induced by audiovisual stimuli lacks direct skin manipulation. Objectives The aim of this double blind, noninferiority study was to test the experimental hypothesis that itch induced by audiovisual stimuli is noninferior to itch induced by histamine iontophoresis in case of priming and without priming. Methods In 80 of 160 healthy volunteers itch was induced by histamine iontophoresis, while in the other 80 itch was induced by audiovisual stimulation. Forty people in each group experienced either an initial resting phase or dermal priming. Itch intensity was measured by visual analogue scales, while scratch duration and frequency were video-recorded and evaluated by two independent raters. In addition, itch quality and location were measured by self-report. Results Itch induced by audiovisual stimuli was inferior to itch induced by histamine iontophoresis in the absence of dermal priming. However, in the case of priming, maximal itch induced by audiovisual stimuli was not inferior to maximal itch induced by histamine iontophoresis. Additionally, differences in itch quality and location were observed. Conclusions The finding that maximal audiovisually-induced itch was comparable with maximal histamine itch only after priming emphasizes that attention plays a dominant role in mentally-induced itch. The comparability of maximal histamine and audiovisually-induced itch in the case of priming opens up new research opportunities. What's already known about this topic? Itch is a multidimensional sensation that is altered by, among other things, attention. To induce itch in basic research, different methods are used, which are partially invasive or cause skin manipulation. Noninvasive audiovisual stimuli can be used to induce itch. What does this study add? This study investigated whether itch induced by audiovisual stimuli is noninferior to itch induced by histamine iontophoresis. Itch induced by audiovisual stimuli is noninferior with regard to maximal intensity in the case of priming. Noninferiority was not shown in the case of no priming, emphasizing the role of attention in itch induction. Histamine and audiovisually-induced itch differ in terms of quality and location, but not in affective reaction.

Anaphylaxis is an acute-onset, life-threatening, systemic hypersensitivity reaction. The acute reaction occurs due to a permanently immunologically altered response, which can result in mild to severe reactions and, in isolated cases, to fatal reactions upon allergen contact. The avoidance strategies required lifelong in affected individuals significantly impair quality of life. An expert analysis of the supportive care situation of anaphylaxis patients. The trigger of the reaction — mostly food, insect venom, or drugs — can normally be identified by means of allergy diagnostics. However, allergy workups unfortunately are not always performed in anaphylaxis patients. Unequivocal diagnosis and/or causal classification of the trigger is not always easy, particularly in the presence of summation factors, such as physical exertion or the use of analgesics or alcohol. Complex cases present too rarely in allergy centers with appropriate experience. Following anaphylaxis patients are given guidance on allergen avoidance and after obligatory instruction from a medical expert, receive a prescription for an emergency self-medication kit. However, studies show that allergen avoidance often fails and patient self-medication is frequently not performed. Therefore, the German working group on anaphylaxis training and education (Arbeitsgemeinschaft Anaphylaxie Training und Education, AGATE) formulated a structured written interdisciplinary educational training program that is currently used in 24 registered centers in Germany. In a multicenter study using control groups, the anaphylaxis training program showed significant efficacy in terms of practical emergency management and reduced anxiety. The nationwide implementation of the training program and cost-coverage by statutory health insurances appear reasonable given the potentially life-threatening nature of this disease. Since statutory health insurances have not guaranteed cost-coverage to date, it is not possible to offer the training program to all patients in need. Subject to region and center, there are good treatment options for anaphylaxis patients in Germany. However, these options are not always sufficiently implemented.

Atopic dermatitis (AD) represents a chronic inflammatory skin disease showing a 1-year prevalence of 2-3% during adulthood. In a national randomized, controlled multicenter study initiated by the "Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter" (ARNE, Working Group on Educational Training for Adults with Atopic Dermatitis) a program for structured patient education conducted by a multiprofessional team was developed and evaluated. At 1‑year follow-up, coping behavior with respect to itch (assessed by the "Juckreiz-Kognitions-Fragebogen", p 0.001) and in quality of life (Skindex-29, p 0.001) significantly improved in patients who had participated in this 12 h patient educational program (n = 168) compared to the waiting control group (n = 147). Moreover, the training led to a significantly greater reduction in disease severity (SCORAD Index, p 0.001). In this first randomized, controlled multicenter study on effects of patient education in adulthood AD, significant beneficial effects on both psychosocial parameters and the disease severity could be demonstrated.

This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti-inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long-term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long-term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti-inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.

Introduction Le concept de prurigo etant tres vague et donc tres variable selon les pays, la task force de l’EADV sur le prurit a organise des reunions de consensus pour obtenir une definition, une classification et une terminologie sur le prurigo chronique qui soient communes et fassent donc autorite. Materiel et methodes Des discussions sur des cas ont organisees. La methode Delphi a ete utilisee pour obtenir un consensus sur les differents items. Les resultats ont ete adoptes apres deux seminaires. Resultats Une premiere notion importante degagee par ce consensus d’experts est qu’il faut considerer le prurigo chronique comme une maladie autonome. Le prurigo chronique est ainsi une maladie distincte definie par la presence d’un prurit chronique depuis au moins 6 semaines, des antecedents et/ou des signes de grattage repete et de multiples lesions cutanees prurigineuses, localisees ou generalisees (papules blanchâtres ou rosees, nodules et/ou plaques). Le prurit chronique survient a cause d’une sensibilisation neuronale au prurit et du developpement d’un cercle vicieux prurit-grattage. Le prurigo chronique peut etre d’origine dermatologique, systemique, neurologique, psychiatrique/psychosomatique, mixte ou indeterminee. Cinq formes cliniques ou types sont decrits : le prurigo chronique peut etre papuleux, nodulaire, en plaques, ombilique ou lineaire. Ces differents types peuvent co-exister ou se succeder. Le prurigo nodulaire est la forme la plus frequente et habituellement la forme ultime. Discussion Cette classification et cette definition permettent de clarifier nettement la situation. La definition souligne que le prurigo chronique a une evolution et des facteurs physiopathologiques qui lui sont propres, quelle que soit l’origine initiale du prurit. Les mecanismes en cause sont la sensibilisation peripherique et la sensibilisation centrale au prurit. La sensibilisation peripherique est liee a une hyperexcitabilite des terminaisons nerveuses cutanees, qui est augmentee par le grattage chronique. La sensibilisation centrale est liee a une diminution des controles inhibiteurs par les interneurones dans la moelle epiniere et a des modifications de la connectivite cerebrale. Conclusion Issus d’un consensus europeen obtenu avec une methodologie rigoureuse, ces resultats permettent de realiser des essais cliniques dans de bonnes conditions, a l’heure ou de multiples traitements du prurit chronique apparaissent possibles et alors que l’indication retenue par les agences officielles est le prurigo chronique.

Psoriasis (PS) is a frequent skin disease accompanied by itch, a symptom that has been shown to be related to depression and self-consciousness. PS patients describe themselves as more agreeable than healthy controls (HC), a trait that might be protective against impulsive scratching. This study is the first to analyze the relationship between agreeableness and induced scratching and between depression, self-consciousness, and induced itch in PS patients. Twenty-four PS patients and 24 HC were shown two videos: an itch-inducing experimental video (EV) and a non-itch-inducing control video (CV). Induced itch/scratching was determined by calculating the difference in itch intensity/number of scratch movements between EV and CV. Validated questionnaires were used to measure agreeableness, depression, and self-consciousness. In accordance with our hypothesis, in PS patients, public self-consciousness was significantly positively associated with induced itch (r = 0.564; p

The continued high prevalence of allergic diseases in Western industrialized nations combined with the limited options for causal therapy make evidence-based primary prevention necessary. The recommendations last published in the S3-guideline on allergy prevention in 2009 have been revised and a consensus reached on the basis of an up-to-date systematic literature search. Evidence was sought for the period between May 2008 and May 2013 in the Cochrane and MEDLINE electronic databases, as well as in the reference lists of recent review articles. In addition, experts were surveyed for their opinions. The relevance of retrieved literature was checked by means of two filter processes: firstly according to title and abstract, and secondly based on the full text of the articles. Included studies were given an evidence grade, and a bias potential (low/high) was specified for study quality. A formal consensus on the revised recommendations was reached by representatives of the relevant specialist societies and (self-help) organizations (nominal group process). Of 3,284 hits, 165 studies (one meta-analysis, 15 systematic reviews, 31 randomized controlled trials, 65 cohort studies, 12 case-control studies and 41 cross-sectional studies) were included and evaluated. Recommendations on the following remain largely unaltered: full breastfeeding for 4 months as a means of allergy prevention (hypoallergenic infant formula in the case of infants at risk); avoidance of overweight; fish consumption (during pregnancy/lactation and in the introduction of solid foods for infants); vaccination according to the recommendations of the German Standing Committee on Vaccination (Standige Impfkommission, STIKO); avoidance of air pollutants and tobacco exposure and avoidance of indoor conditions conducive to the development of mold. The assertion that a reduction in house-dust mite allergen content as a primary preventive measure is not recommended also remains unchanged. The introduction of solid foods into infant diet should not be delayed. In the case of children at risk cats should not be acquired as domestic pets. Keeping dogs is not associated with an increased risk of allergy. The updated guideline includes a new recommendation to consider the increased risk of asthma following delivery by cesarean section. Additional statements have been formulated on pre- and probiotic agents, psychosocial factors, medications, and various nutritional components. Revising the guideline by using an extensive evidence base has resulted not only in an endorsement of the existing recommendations, but also in modifications and in the addition of new recommendations. The updated guideline enables evidence-based and up-to-date recommendations to be made on allergy prevention. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s40629-014-0022-4 and is accessible for authorized users.

ZusammenfassungEine mögliche Assoziation von Klinefelter-Syndrom und essenziellem Tremor legten wenige Kasuistiken nahe. Wir geben eine Übersicht über die Publikationen von Fallberichten zur Prävalenz des essenziellen Tremors bei Patienten mit Klinefelter-Syndrom, zu den tremorverstärkenden Faktoren und zur Substitutionsbehandlung mit Testosteron bei Klinefelter-Syndrom sowie zur Behandlung des Tremors durch Entspannungsverfahren und Biofeedback. Wir stellen den Fall eines Patienten mit essenziellem Tremor vor, der vergesellschaftet ist mit einem von dem Patienten verleugneten Klinefelter-Syndrom und einer Migräne. Eine stationäre psychosomatische Komplexbehandlung mit tiefenpsychologisch fundierter Psychotherapie half dem Patienten, die hinter den tremorverstärkenden Affekten stehende Psychodynamik zu erarbeiten und so mehr Akzeptanz für die Erkrankung und mehr Kontrolle über die Symptomatik zu erreichen, sodass es zu tremorfreien Intervallen von mehreren Stunden kam.

Rosazea ist eine häufige chronisch-entzündliche Hauterkrankung, die typischerweise bei Erwachsenen vorkommt und das Gesicht betrifft. Synonyme der Rosazea sind Acne rosacea, Kupferfinne, Rotfinne, Couperose und Rosacea. Die Erkrankung ist durch einen chronischen und schubartigen Verlauf gekennzeichnet und wird durch ein genetisch prädisponiertes, multifaktorielles Geschehen bedingt. Ein vermehrtes Auftreten wird bei hellem Hauttyp und positiver Familienanamnese verzeichnet. Die charakteristischen Rosazea-Symptome manifestieren sich vorwiegend, aber nicht ausschließlich zentrofazial, wobei Stirn, Nase, Kinn und die Wangen maßgeblich betroffen sind. Dabei werden unterschiedliche Hauptsymptome voneinander unterschieden, anhand derer eine Klassifikation der verschiedenen klinischen Bilder vorgenommen werden kann. Eine Klassifizierung wird oftmals jedoch nicht der klinischen Realität gerecht, da die verschiedenen Symptome häufig gemeinsam auftreten. Diese Übersichtarbeit führt in die Pathogenese und Klinik der Rosazea ein und plädiert für einen symptomorientierten Therapieansatz.

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.

It is widely accepted, that stress can induce or exacerbate atopic dermatitis. The physiological mechanisms that mediate this negative influence of stress on atopic dermatitis are not clearly understood. This topic has been actively investigated in recent years focusing on neuroimmunological, psychoendocrinological studies and examination of integrity and function of skin barrier under stress. Different neuropeptides and neurotrophins seem to play an important role in stress-induced neurogenic inflammation and connection of nervous and immune system. Mast cells play a key role in the development of inflammatory reaction to stress. Skin barrier is altered by stress by means of increased cortisol level.Thereby lamellar body secretion is decreased and epidermal expression of antimicrobial peptides (β-defensin and cathelicidin) is down-regulated. We review recent investigations in this field.

Background. Psoriasis vulgaris is a chronic inflammatory skin disease with a substantial impairment of quality of life. Interdisciplinary outpatient educational programs are an innovative supplementary therapy form for the management of this disorder. Subjects and Methods. The Task Force on Dermatological Prevention developed a concept for outpatient instruction of psoriasis patients. Five 2-hour classes by dermatologists, psychotherapists/psychologists and dieticians focus on central topics relevant for the patients and the management of the disease. Results. The results presented are based on own experiences with this educational program. The interdisciplinary program is accepted very well and seen as helpful by the concerned. A structure analysis of the effects in a greater number of cases is a current goal. In some areas, health insurance companies are paying for the classes. Conclusion. The educational program for the management of psoriasis vulgaris according to the rules ofthe Task Force on Dermatological Prevention is a supplement of the treatment of patients with this chronic skin disease. Broader implementation in Germany is desirable.

Atopic eczema (AE) is a common, chronically relapsing, inflammatory skin disease with an early onset during infancy associated with a high loss of quality of life and socioeconomic burden. In the past few years, an Atopic Eczema Prevention Program was established to improve disease management and the quality of life of patients with atopic eczema. In Germany, the Task Force on Education Programs for Atopic Eczema (AGNES = Arbeitsgemeinschaft Neurodermitis Schulung) for children, youths, and parents was founded as well as the Task Force on Dermatological Prevention (ADP) for adults. These groups ensure structure and process quality of the prevention programs and organize train-the-trainer workshops. In a randomized prospective controlled trial (the German Randomized Intervention Multicenter Study = GRIMS), we are currently comparing the effectiveness of an atopic eczema group intervention program in (1) parents of atopic eczema children aged 0-7 years, (2) parents and children 7-12 years old, and (3) youths with AE aged between 13 and 18 years. The groups were randomized and compared with a waiting control group. The design and first results will be reported.

Modern therapeutic concepts for atopic eczema reflect the multifactorial background by individual, complex and interdisciplinary measures. Aim of the present study was to determine long-term effects in patients who were treated according to the Schwelm concept by taking objective and subjective outcomes into account. The concept of the Schwelm therapeutic model is based on an ambulant group therapy focussing on areas of allergy, nutrition, education and prevention, and psychotherapy. Between 1990 and 1991, a total of 70 patients were treated in Schwelm. Fourty-four of these patients (response 63%, 25 children < 14 years) could be followed for up to 9 years. At all points of examination (TO = inclusion, T1 -3 = after 1, 4 and 9 years), extent as well as severity of typical morphological changes and itching were recorded. In addition, use of the medication for the examination intervals was determined. Relevant blood parameters like total IgE, leukocytes and eosinophilic granulocytes were determined at inclusion and after 1 year. Non-parametric statistics for paired samples were used. In the group of children, the percentage of affected skin surface decreased from 46% in the beginning to 14% after I and 6% after 9 years (p < 0.001 ). Similarly, the results for itching (5.8, 1.4, 1.0), erythema (6.5, 1.8, 1.3), scaling (4.0, 1.5, 0.4), erosion (5.4, 1.8, 1.5) and infiltration (6.0, 1.9, 0.6) were significantly reduced after 1, 4 and 9 years, respectively (p < 0.01). The use of external corticosteroids decreased from 50% to 8.3% over the entire observation period (p = 0.002). Similarly, the use of anthistamines decreased from 16.7% to 12.5%, but without statistical significance. In the group of adults, the affected skin surface decreased from 43% (TO) to 3% (Tl) (p < 0.01) after 1 year and increased slightly thereafter (14%, T3, n.s.). The results for itching (9.8, 1.5, 1.8), erythema (7.1, 1.1. 1, 1.7), scaling (5.9, 3.0, 0.8), erosion (4.7. 0.9, 1.7), and infiltration (4.6, 0.4, 1.5) decreased also significantly after 1, 4 and 9 years, respectively (p < 0. 01). A marked reduction of the use of external (58% vs. 16%, p = 0.02) and internal corticosteroids (21% vs. 5%, n.s.) was reported. The use of antihistamines in adults remained unchanged over the observation period (21%). No significant change was observed for any of the laboratory parameters. The interdisciplinary therapeutic concept yielded a significant and long-lasting reduction of objective and subjective symptoms of atopic eczema and could thereby reduce the need for side medication.

SummaryBackground The aetiology of hand dermatoses (HD) is very heterogeneous. Psychological influences on severity and coping in hand eczema have been only rarely investigated. Objectives To investigate whether psychological factors correlate with somatic factors, in order to be able to estimate the possible need for psychosocial treatment of these patients. Methods In a cross-sectional study 101 hand dermatosis patients (49F, 52M) with psoriasis (n = 26), vesicular hand eczema (n = 33) or contact dermatitis (n = 42) were examined with regard to dermatological [diagnosis, severity, Erlanger Atopy Score (EAS)], allergic (patch test) and psychological aspects [Coping with Chronic Skin Diseases questionnaire (CSD), Allover Depression Scale (ADS), Social Readjustment Rating Scale (SRRS), questionnaire for measuring Factors of Aggression (FAF)],and Visual Analogue Scales (VAS) concerning itching, scratching and impairment. Subgroups of high stress responders (high-SR) vs. low stress responders (low-SR) were also examined. Results Of the patients with HD, 47·52% are convinced that ‘stress’ influences the course of their disease. Analysis of variance shows that the subjective reaction to stress (high-SR) correlates with higher severity scores, more itching, higher depression scores and more life events. High-SRs were younger and the onset of the disease was earlier compared with patients without a subjective reaction to stress (low-SR). In the CSD those with especially high-SR but negative patch-test results stated significantly higher values for itching, helplessness and search for information. Conclusions Psychological factors should be taken into consideration in the treatment of patients with HD. High-SR patients with a negative patch-test seem to require more adjuvant psychological care.

Using the Trier Stress Inventory and based on a comparison between tinnitus and psoriasis patients, it is evaluated to what extent chronic stress is a definable influencing factor among tinnitus sufferersPsychological assessment of 114 tinnitus and 103 psoriasis inpatients was conducted using a test battery consisting of the tinnitus questionnaire (Tinnitus-Fragebogen, TF), the Trier Stress Inventory (Trierer Inventar zum chronischen Stress, TICS), a questionnaire about social support (Fragebogen zur sozialen Unterstützung, F-SozU) and the Patient Health Questionnaire (PHQ).On average, hospitalized tinnitus patients have significantly higher values than the normative group on the following scales: social tensions, excessive work demands, chronic anxiety, professional strain, professional discontent, lack of social acceptance and social isolation, as well as on the overall screening scale. The measured stress values of tinnitus patients did not significantly differ from those of the comparison group, i.e. the hospitalized psoriasis patients. Although both groups show increased stress levels as measured by TICS, the hospitalized tinnitus patients had significantly more psychological comorbidities. No relationship exists between the raised stress values and hearing status.Stress also has an influence on tinnitus suffering and is therefore certain to be of therapeutic relevance. In this respect, there is no significant difference between tinnitus and psoriasis patients; stress alone cannot explain the psychological comorbidity.

Itching is a subjective symptom which is reported to occur in 75% of all skin diseases. Although repeatedly postulated, psychological correlations with itching have rarely been investigated. In cooperation with a public television company which prepared a scientific program on itching, interested persons were invited to participate in a public lecture: ‘Itching – what’s behind it?’. The aim of the lecturers was to initially present an itch-inducing lecture to the still uninformed audience, followed by a neutral verbal and visual stimulation to feel comfortable. Accordingly, the first part included slides that induce itching, while the second part showed slides that induce relaxation and sense of well-being. At the same time, the listeners’ tactile reactions were recorded by television cameras all around to allow rating of the scratch impulses. In an ABA design could be shown that itching measured by self-rating scales (n = 24) could be induced by the itch-inducing verbal and visual intervention. The frequency of scratching recorded by the television cameras was evaluated independently by two raters. The t-test confirmed a significant mean difference in the expected direction. In total, this study confirms the previous assumption that itching can be induced by psychic factors.

The present study investigated how patients with acne vulgaris cope with their disease. By means of questionnaires, relations and interactions between acne and psyche were evaluated. In addition to the evaluation of a specific questionnaire for patients with chronic skin disorders (CSD), assessing psychosocial impairment by the disease, depression and social anxiety were investigated in patients with acne. The study included 50 patients with acne. The CSD showed significant correlations with Beck’s depression inventory, the interaction-anxiety questionnaire and the health locus of control scale. The CSD revealed significant differences compared to a control group of 33 patients with healthy skin. Furthermore the patients’ attitudes towards triggering factors and disease-related limitations in everyday life are presented. The results of the study demonstrate that patients with acne suffer from emotional distress and psychosocial problems caused by their disease; however, impairment is not correlated with the objective severity of acne.

Immunological and biochemical alterations in atopic dermatitis have been attributed to a deficient conversion of omega-6 fatty acids (i.e. linoleic acid, gamma-linolenic acid, and dihomo-gamma-linolenic acid) to prostaglandin (PG) E1. In patients with atopic dermatitis, however, the formation of PGE1 has not been evaluated so far. We therefore measured plasma concentrations of 15-keto-13,14-dihydro-PGE1, which reflects endogenous PGE1 release, by gas chromatography-mass spectrometry in 31 patients with atopic dermatitis (aged 18-41 years, median 26 years) and in 31 healthy, age- and sex-matched control subjects. In order to exclude a metabolic shift from PGE1 to PGE2, we also measured the plasma levels of 15-keto-13,14-dihydro-PGE2. There was no difference between patients and control subjects with respect to plasma concentrations of 15-keto-13,14-dihydro-PGE1 (3.9-49.6, median 10.3 pg/ml vs. 3.2-80.4, median 8.3 pg/ml, P = 0.22), 15-keto-13,14-dihydro-PGE2 (11.6-201.0, median 24.8 pg/ml vs. 8.6-201.0, median 19.6 pg/ml, P = 0.10), and the ratio of 15-keto-13,14-dihydro-PGE1 to 15-keto-13,14-dihydro-PGE2 (0.17-1.39, median 0.41 vs. 0.2-1.17, median 0.45, P = 0.29). These results indicate that the endogenous formation of both PGE1 and PGE2 is normal in our patients. The results do not confirm the pivotal role that other authors have attributed to a deficient PGE1 formation in the pathogenesis of atopic dermatitis.

Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP).To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012.In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments.Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.