Alexander V. Kuznetsov

Photodynamic Therapy for Granuloma Annulare: More than a Shot in the Dark

Background: Granuloma annulare (GA) is a benign granulomatous and inflammatory skin disorder. The pathogenesis remains enigmatic and convincingly effective treatment options are not available. Inspired by a report showing photodynamic therapy (PDT) to be effective in a single patient with GA, we sought to evaluate this benefit in a series of patients with GA. Observations: PDT was performed in 7 consecutive patients with histologically confirmed GA located at the extremities. First, 20% ALA gel was applied under an occlusive dressing for 5 h, followed by illumination with 100 J/cm2 by a standard red-light source. In total, 2–3 PDT sessions were performed, with an interval of 2–4 weeks between each session. Treatment was stopped when complete remission was achieved or when GA lesions remained unchanged after 2 consecutive PDT sessions. The overall response rate was 57%. In 2 patients (29%), GA cleared completely, in 2 patients (29%) the skin lesions improved markedly and in 3 patients (43%) no clinical response could be observed. Conclusion: These promising results should be evaluated in larger controlled studies. In selected patients, PDT might be a valuable recruit for the sparse armory available to treat GA.

Disseminated Eruptive Giant Mollusca Contagiosa in an Adult Psoriasis Patient during Efalizumab Therapy

Molluscum contagiosum is a common viral skin infection in children with atopic diathesis and not rare in HIV patients. We report a 45-year-old psoriasis patient who developed eruptive mollusca contagiosa during an antipsoriatic treatment with efalizumab.

Palmoplantar pustulosis is not inevitably associated with antigliadin antibodies

1 Landry M, Winkelmann RK. An unusual tubular apocrine adenoma: histochemical and ultrastructural study. Arch Dermatol 1972; 105:869–79. 2 Umbert P, Winkelmann RK. Tubular apocrine adenoma. J Cutan Pathol 1976; 3:75–87. 3 Torbio J, Zulaica A, Petrio C. Tubular apocrine adenoma. J Cutan Pathol 1987; 14:114–17. 4 Ansai S, Watanabe S, Aso K. A case of tubular apocrine adenoma with syringocystadenoma papilliferum. J Cutan Pathol 1989; 16:230–6. 5 Ishiko A, Shimizu H, Inamoto N, Nakamura K. Is tubular apocrine adenoma a distinct clinical entity? Am J Dermatopathol 1993; 15:482–7. 6 Nakamura Y, Fujimoto A, Mori T et al. Basal cell carcinoma, tubular apocrine adenoma and apocrine adenocarcinoma developed on sebaceous nevus: report of a case. Rinsho Derma (Tokyo) 2001; 43:321–3 (in Japanese). 7 Ahn BK, Park YK, Kim YC. A case of tubular apocrine adenoma with syringocystadenoma papilliferum arising in nevus sebaceus. J Dermatol 2004; 31:508–10. 8 Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: a study of 596 cases. J Am Acad Dermatol 2000; 42:263–8.

Fathers’ knowledge of and attitude towards human papillomavirus infection, genitoanal warts, cervical cancer and HPV vaccine

We read the paper by Perkins et al. (2011) with great interest because it highlighted a very important issue about fathers’ attitudes towards HPV infection and their intentions regarding HPV vaccine. No surveys have been published yet demonstrating the extent of fathers’ knowledge of HPV and HPV vaccine together with its acceptance in Germany. In an attempt to fill this gap, we would like to share our findings from a recent pilot survey investigating the awareness of HPV infection and related health outcomes as well as HPV prevention by vaccination, in fathers and non-fathers attending the Munich University outpatient clinic (non-sexually transmitted infections/HIV or genito-urinary medicine). Between January and February 2010, consecutive male German-speaking patients who were 18 years of age or older were asked to participate in an anonymous cross-sectional survey on HPV, HPV vaccination and genitoanal neoplasms. Multiple regression was used to analyse the association between age, family status, education and parental status, and HPV-related knowledge, reporting adjusted odds ratios (ORs) with their 95% confidence intervals (95% CI). A p value \0.05 was considered as significant. Statistical analyses were performed using the PASW Statistics 18 software (SPSS, Chicago, IL). The survey was approved by the Ethics Committee of the Medical Faculty of LudwigMaximilian University. The final sample included 243 respondents (75.9% out of 320 questionnaires handed out). The median age of the participants was 44.4 (mean = 43.8, standard deviation ±15.2) years; almost half (43.6%, n = 106) of the respondents were married, 32.1% (n = 78) single, 45.7% (n = 111) fathers, one-third had a college (34.4%, n = 83) or university education (29%, n = 70), and 61.2% (n = 148) were in employment. Less than one-third (29.2% out of 243) of the participants had heard of HPV and only 14% of HPV vaccine. The HPV and genitoanal warts-related knowledge in the whole sample and by parental status is presented in Table 1. About half of our respondents were fathers who had, on average, 1.8 children (median = 2). Only 19.8% of fathers were aware of HPV, 8.2% had heard of HPV vaccine and only two of them let their daughters have the HPV vaccination; five would let their daughter get vaccinated if they had one. Non-fathers were significantly more aware of HPV and HPV vaccination than fathers (Table 1). Being a father was associated with an increased probability of not having heard of HPV (OR = 2.33, 1.29–4.19; n = 241), HPV vaccine (OR = 2.64, 1.17–5.94; n = 237) and not knowing of the causal link between HPV and genitoanal warts (asked as a one term) (OR = 2.03, 1.19–3.46; n = 234) compared to non-fathers. The study showed a very limited knowledge in males and especially in fathers regarding HPV infection and vaccination. In an Italian study, 76.9% fathers (of n = 1,093) had heard of HPV (Pelucchi et al. 2010) and in an American study, 85% (of n = 111) were aware of HPV vaccine (Cates et al. 2010). The majority of our respondents who were aware of HPV correctly indicated the most common HPV L. Kuznetsov (&) S. A. Zippel A. V. Kuznetsov HIV/STI Prevention Research Group, Department of Dermatology & Allergology, Ludwig-Maximilian University, Munich, Germany e-mail: laura.kuznetsov@med.uni-muenchen.de

Knowledge and attitude regarding human immunodeficiency virus/ acquired immunodeficiency syndrome in dermatological outpatients

Background  Dermatologists are often the first‐line specialists who recognize and diagnose human immunodeficiency virus (HIV) infection because of pathognomic skin signs. It is therefore important to investigate attitudes and knowledge regarding HIV/acquired immunodeficiency syndrome (AIDS) amongst dermatological patients in order to provide information for dermatologists and to draw their attention to the issues.

What is the accurate knowledge of the German population regarding sexual HIV transmission

Objectives:HIV incidence in Germany is increasing even though the German Federal Centre for Health Education reported that the entire German population (99 %) has sufficient knowledge of sexual HIV transmission. We tried to find out the reason for this discrepancy.Methods:HIV transmission knowledge was investigated in a Munich population (n = 317) and the findings compared with a nationwide study.Results:No differences in knowledge regarding needle sharing and HIV/AIDS curability were found but, in relation to sexual HIV transmission, only 55.5 % of Munich respondents had sufficient knowledge of vaginal, anal and oral transmission routes.Conclusions:The knowledge level reported in the nationwide study is overestimated as a result of the ambiguous character of the questions used.

Progressive macular hypomelanosis Guillet-Hélénon: structural and immunohistochemical findings

In 1985 and 1988, Gerard Guillet and Raymond Helenon, with colleagues, described a novel acquired hypopigmentation disorder in dark-skinned immigrants from the Caribbean which they named progressive macular hypomelanosis (PMH).1 2 Over the past 20 years, many other terms have been coined for this condition, including cutis trunci variata, nummular and confluent hypomelanosis, Creole dyschromia, or idiopathic multiple large-macule hypomelanosis.3 More than 600 PMH patients have been reported in the literature with skin phototypes II–VI, but the debate about the aetiology of this disorder is still open. We present an immunohistochemical and ultrastructural study on disseminated PMH extending beyond the trunk. No Propionibacterium colonisation of skin was found despite extensive examination. The evidence for a bacterial origin is discussed in consideration of the literature. A 29-year-old Romanian female patient (skin phototype III), who had relocated to Germany 8 years earlier, presented with a mottled hypopigmentation of her skin that had progressed over the past 12 years. At the age of 17, macules started to appear on the abdomen and then spread gradually to the flanks, axillae and back. Over the past 2 years, the patient had noticed a rapid progression to the neck, decollete and groin without any subjective symptoms. Physical examination revealed multiple partially coalescing oval or irregular hypopigmented …

Sexuell übertragene Erkrankungen

Nach jungsten Angaben der Bundesregierung reprasentieren Migrantinnen und Migranten etwa 20 Prozent der in Deutschland lebenden Bevolkerung. Bei insgesamt rund 14,5 Millionen auslandischen Mitburgern, Eingeburgerten, Aussiedlern oder Kindern aus binationalen Ehen gehoren Patientinnen und Patienten mit Migrationshintergrund und eine internationale und multi-ethnische Zusammensetzung des Personals in Kliniken und Arztpraxen zum Alltag.