Aikaterini I. Liakou

Skin anti-aging strategies

Skin aging is a complex biological process influenced by a combination of endogenous or intrinsic and exogenous or extrinsic factors. Because of the fact that skin health and beauty is considered one of the principal factors representing overall “well-being” and the perception of “health” in humans, several anti-aging strategies have been developed during the last years. It is the intention of this article to review the most important anti-aging strategies that dermatologists have nowadays in hand, including including preventive measurements, cosmetological strategies, topical and systemic therapeutic agents and invasive procedures.

Acne-associated syndromes: models for better understanding of acne pathogenesis.

Acne, one of the most common skin disorders, is also a cardinal component of many systemic diseases or syndromes. Their association illustrates the nature of these diseases and is indicative of the pathogenesis of acne. Congenital adrenal hyperplasia (CAH) and seborrhoea‐acne‐hirsutism‐androgenetic alopecia (SAHA) syndrome highlight the role of androgen steroids, while polycystic ovary (PCO) and hyperandrogenism‐insulin resistance‐acanthosis nigricans (HAIR‐AN) syndromes indicate insulin resistance in acne. Apert syndrome with increased fibroblast growth factor receptor 2 (FGFR2) signalling results in follicular hyperkeratinization and sebaceous gland hypertrophy in acne. Synovitis‐acne‐pustulosis‐hyperostosis‐osteitis (SAPHO) and pyogenic arthritis‐pyoderma gangrenosum‐acne (PAPA) syndromes highlight the attributes of inflammation to acne formation. Advances in the understanding of the manifestation and molecular mechanisms of these syndromes will help to clarify acne pathogenesis and develop novel therapeutic modalities.

S1‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa (ICD‐10 Ziffer: L73.2)

Christos C. Zouboulis, Falk G. Bechara, Klaus Fritz, Hjalmar Kurzen, Aikaterini I. Liakou, Wolfgang C. Marsch, Annett Milling, Alexander Nast, Maurizio Podda, Klaus M. Taube, Volker Wienert, Thomas Winkler (1) Klinik für Dermatologie, Venerologie und Allergologie/Immunologisches Zentrum, Städtisches Klinikum Dessau, Dessau (2) Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum (3) Hautärzte und Laserzentrum Landau und Kandel, Landau (Pfalz)/Kandel; Universitätsklinik für Dermatologie, Inselspital Bern, Bern; Fachgebiet Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück (4) Niedergelassener Dermatologe, Freising (5) Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale) (6) Klinik für Dermatologie, Klinikum Frankfurt (Oder) GmbH, Frankfurt (Oder) (7) Abteilung für Evidenz-basierte Medizin, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin (8) Hautklinik, Klinikum Darmstadt (9) Früherer Leitlinie-Beauftragter, Aachen (10) Patientenvertreter, 1. Vorsitzender der Deutschen Interessengemeinschaft Akne inversa e.V., Ibbenbüren

Erythema Multiforme following Vaccination for Human Papillomavirus

Erythema multiforme (EM) is an acute self-limited immune-mediated reaction manifested by target skin lesions with mucous membrane involvement. The most common causes are infections and drugs. Vaccinations have been reported as a triggering factor, and they may be a frequent cause of EM in childhood. A 19-year-old female developed several target lesions of the hands and feet 10 days after the second dose of human papillomavirus (HPV) vaccine. Clinico-histologically, a diagnosis of EM minor was made. Treatment with topical corticosteroids and oral antihistamines resulted in complete clearance of the rash. Four months later, she received the last booster dose of the vaccine. A few subtle lesions appeared and disappeared spontaneously after a few days. Gardasil® is a non-infectious vaccine, developed for the prevention of cervical cancer, precancerous genital lesions and genital warts. It delivers the major capsid (L1) protein of HPV types 6, 11, 16 and 18. Mild local reactions are the main adverse events. The only serious events are very rare cases of anaphylaxis. In our patient, the temporal relationship between the development of EM and the vaccination suggests that the HPV vaccine probably was the causal agent. This is the first published case of EM following HPV vaccination.

Hauterkrankungen beim geriatrischen Patienten

ZusammenfassungIn den letzten Jahren hat die Inzidenz altersassoziierter Hauterkrankungen, insbesondere entzündlicher Dermatosen, Autoimmunerkrankungen, Tumoren und paraneoplastischer Syndrome progredient zugenommen. Diese bedeutende Entwicklung liegt in einer erhöhten Früh- und lebenslangen UV-Exposition sowie im demographischen Alterungsprozess begründet. Um den demographischen Wandel zukünftig als Chance zu erleben, sind ein besseres Verständnis der Pathomechanismen dieser speziellen Erkrankungen sowie eine frühzeitige Diagnose und Therapie essenziell. Darüber hinaus muss die breite Öffentlichkeit für diesen Themenkomplex sensibilisiert und der Patient individuell aufgeklärt werden. Diese Strategie beinhaltet frühzeitige, prophylaktische Maßnahmen und eine konsequente Überwachung von Hochrisikogruppen. In der vorliegenden Arbeit wird die erwähnte Beziehung zwischen Hautalterung und der Epidemiologie assoziierter Erkrankungen unter Berücksichtigung der Risikofaktoren im Detail dargestellt.AbstractThe incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.The incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.

Nutrition and skin

Nutrition has long been associated with skin health, including all of its possible aspects from beauty to its integrity and even the aging process. Multiple pathways within skin biology are associated with the onset and clinical course of various common skin diseases, such as acne, atopic dermatitis, aging, or even photoprotection. These conditions have been shown to be critically affected by nutritional patterns and dietary interventions where well-documented studies have demonstrated beneficial effects of essential nutrients on impaired skin structural and functional integrity and have restored skin appearance and health. Although the subject could be vast, the intention of this review is to provide the most relevant and the most well-documented information on the role of nutrition in common skin conditions and its impact on skin biology.

Quality of life and psychosocial impact of scarring and non-scarring alopecia in women.

Alopecia is a common dermatological condition with mostly cosmetic consequences that, nevertheless, has significant psychological and psychosocial impact.

Skin diseases in geriatric patients. Epidemiologic data

ZusammenfassungIn den letzten Jahren hat die Inzidenz altersassoziierter Hauterkrankungen, insbesondere entzündlicher Dermatosen, Autoimmunerkrankungen, Tumoren und paraneoplastischer Syndrome progredient zugenommen. Diese bedeutende Entwicklung liegt in einer erhöhten Früh- und lebenslangen UV-Exposition sowie im demographischen Alterungsprozess begründet. Um den demographischen Wandel zukünftig als Chance zu erleben, sind ein besseres Verständnis der Pathomechanismen dieser speziellen Erkrankungen sowie eine frühzeitige Diagnose und Therapie essenziell. Darüber hinaus muss die breite Öffentlichkeit für diesen Themenkomplex sensibilisiert und der Patient individuell aufgeklärt werden. Diese Strategie beinhaltet frühzeitige, prophylaktische Maßnahmen und eine konsequente Überwachung von Hochrisikogruppen. In der vorliegenden Arbeit wird die erwähnte Beziehung zwischen Hautalterung und der Epidemiologie assoziierter Erkrankungen unter Berücksichtigung der Risikofaktoren im Detail dargestellt.AbstractThe incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.The incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.

Recurrent subacute cutaneous lupus erythematosus following exposure to different drugs.

A 70-year-old woman presented with multiple infiltrating, erythematous scaly plaques on her chest and back (Fig. 1a). She also had a personal history of xerostomia and xerophthalmia, but no other symptoms were reported. The differential diagnosis included CLE, pityriasis rosea, autoimmune bullous dermatosis, and contact dermatitis following external application of a homeopathic tincture to the affected areas. Her medical history revealed four new drugs; amiodarone (an anti-arrhythmic), torasemide (a loop diuretic), losartan (an angiotensin II antagonist – anti-hypertonic), and phenprocoumone (a vitamin K antagonist – anticoagulant), initiated 10 days before the appearance of the lesions, prescribed due to an aortic valve replacement operation with biological prosthesis. The patient was also on long-term medication with bisoprolol (a β-blocker) and acetylsalicylic acid. The specific laboratory investigation detected an antinuclear antibody titre of 1:1280 (normal < 1:160) anti-Ro/SS-A autoantibodies > 240 units/ml (normal < 10 units/ml) and circulating immune complexes 70.9 g/ml (normal < 45.0 g/ml). ds-DNA, anti-histone and anti-nucleosome antibodies, myoglobin, creatine kinase, transglutaminase and gliadin antibodies, as well as complement and antibodies characteristic for autoimmune bullous diseases, were either normal or negative. Skin biopsies demonstrated superficial interface dermatitis, thus subacute CLE (SCLE), lichenoid drug reaction and erythema exsudativum multiforme came into consideration histologically. However, the associated increase in dermal mucinous material following application of Alcian blue stain favoured LE, namely SCLE of papulosquamous (psoriasiform) form, according to the classification of Gilliam & Sontheimer (4). The medical history also revealed similar clinical signs in 2005, after administration of terbinafine because of a tinea. Laboratory investigation had also detected an increased antinuclear antibody (ANA) titre at that time (1:1280), along with an increased anti-SS-A antibody titre. After discontinuation of terbinafine the patient rapidly became symptom-free. At the current admission, the suspected drugs could not be discontinued or replaced, due to the recent aortic valve replacement operation. The patient was treated with oral chloroquine, 250 mg/day, and mild and potent topical corticosteroids and antiseptics. Three months later there was marked improvement of the skin lesions, but complete healing did not occur (Fig. 1b).

Frontal Fibrosing Alopecia and Vitiligo: Coexistence or True Association

Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia characterized by a progressive band-like recession of the frontotemporal hairline and frequent loss of the eyebrows. It predominantly affects postmenopausal women. Coexistence of FFA and vitiligo is rarely reported in the literature. We retrospectively studied 20 cases diagnosed with FFA in a 14-month period in our Department. Among them, there were 2 cases, a 72-year-old woman and a 48-year-old man, who developed FFA on preexisting vitiligo of the forehead. Anatomical colocalization of the two dermatoses supports the notion that a causal link may exist and their association may not be coincidental. We suggest that interrelated immunologic events and pathologic processes may underlie both these skin conditions.