Andreas Epple

The dermatology life quality index as a means to assess life quality in patients with different scar types

Measuring quality of life through questionnaires is a common method to evaluate the impact of different afflictions on the patients well‐being, especially in the field of dermatology where appearance changing afflictions are common.

Comparison of Two Kinds of Lasers in the Treatment of Acne Scars.

Acne scars are common and stigmatizing for the affected patients. Besides surgery, chemical peels, microdermabrasion, and microneedling, the treatment with fractional laser is a standard therapy. The results of reducing acne scars treated either with a fractional Er:YAG (erbium-doped yttrium-aluminum-garnet [Er:Y3Al5O1]) or a carbon dioxide (CO 2 ) laser at different wavelengths were compared and evaluated in the pilot study presented here. Fourteen patients with severe scars on both cheeks were treated four times in a random split-face approach: on one side with Er:YAG laser and on the contralateral side with CO2 laser following a standardized protocol. Therapeutic success was evaluated through the use of a high-resolution, 3D small-field capture system (PRIMOS), digital photography, and the Patient and Observer Scar Assessment Scale (POSAS) questionnaire. The evaluation was performed by a blinded investigator. Treatment results displayed a higher efficacy of the fractional CO2 laser compared with the Er:YAG laser as displayed by digital photographs. Additionally, objective (high-resolution, 3D small-field capture; PRIMOS) and subjective (POSAS) measuring results correlated positively in certain qualities (color, stiffness, thickness, surface, overall opinion). Using a novel scientific approach, we evaluated the therapeutic efficacy of different fractional lasers on acne scars using a rater-blinded approach. Compared with an Er:YAG laser, better skin smoothening was achieved by fractional CO2 laser treatment.

DLQI and POSAS Scores in Keloid Patients.

The treatment of keloids remains complex and challenging. A multitude of different treatment options exists. While current guidelines frequently promote the combination of intralesional triamcinolone acetonide (TAC) and cryotherapy as a first-line therapy for keloids, its efficacy has mainly been proven clinically and objective evaluation is widely missing. Here, we aimed to evaluate the efficacy of TAC and cryotherapy for the improvement of keloids by employing two well-recognized questionnaires for the evaluation of scar appearance and patients quality of life. Twenty keloid patients from our outpatient scar clinic were treated with individual doses of TAC and cryotherapy in four consecutive sessions. Retrospectively, Patient and Observer Scar Assessment Scale (POSAS) and Dermatology Life Quality Index (DLQI) questionnaire data from those patients were analyzed to evaluate changes over five visits (one baseline, four after treatment). Both overall patient and observer scores of the POSAS significantly decreased (41.10 ± 9.771 to 29.85 ± 11.42 [p < 0.001] and 33.75 ± 6.231 to 22.70 ± 5.992 [p < 0.001], respectively), while DLQI scores significantly declined over the time period studied, indicating significant improvements in scar appearance. Objective evaluation confirmed the clinically demonstrated improvements of scar appearance and symptoms after treatments with TAC and cryotherapy which was associated with significant improvements in quality of life as indicated by DLQI measures. Standardized questionnaires help in objectifying clinical improvements; however, more detailed options for scar documentation, such as objective imaging, may be additionally required for an in-depth analysis of treatment progress.

Objective and subjective treatment evaluation of scars using optical coherence tomography, sonography, photography, and standardised questionnaires

BackgroundCurrently, different types of treatments for pathological scars are available, however, to date, there is no established method of measurement to objectively assess therapeutic outcome. Treatment success is usually evaluated clinically by the physician and patient. Non-invasive imaging techniques, such as HD-OCT (high-definition optical coherence tomography), may represent a valuable diagnostic tool to objectively measure therapeutic outcome.ObjectivesTo compare HD-OCT with ultrasound and subjective evaluation tools, such as questionnaires.Materials & methodsIn total, eight patients with pathological scars were treated in this pilot study with cryotherapy and intralesional steroid injections, and evaluated pre- and post-treatment using clinical examination, photography, sonography, and HD-OCT. The analysis of objective and subjective measuring methodswas used to draw direct comparisons.ResultsHD-OCT revealed reduced epidermal and dermal thickness of the scar after four treatments with triamcinolone acetonide and cryotherapy. Based on sonography, a total reduction in scar height and reduction in scar depth was demonstrated. Both methods correlated well with the injected amount of triamcinolone acetonide. In addition, a positive correlation between well-established subjective and objective evaluation methods was found.ConclusionWe demonstrate that HD-OCT may be used as an objective diagnostic instrument to evaluate skin thickness under therapy for pathological scars, and serves as a valuable adjunctive device in combination with ultrasound and subjective evaluation tools. This provides additional information for the therapist concerning the quality and success of the applied treatment.

At first sight or second glance: clinical presentation of mosaic manifestations of autosomal dominant skin disorders – a case series

Several autosomal dominant disorders may manifest in mosaic patterns with cutaneous involvement. Genomic mosaicism results from postzygotic autosomal mutations, giving rise to clonal proliferation of two genetically distinct cell groups, which clinically present as lesions following the lines of Blaschko.

Hyalinosis cutis et mucosae: A clinical investigation with special regard to mucosal changes: Correspondence

Hyalinosis cutis et mucosae (HCM) is a rare genetic disorder following an autosomal recessive mode of inheritance. To date, mucosal changes have not been studied in detail. We therefore present clinical data of a patient with extensive involvement of the vocal cords as well as the pharyngeal and esophageal mucosae. A 32-year-old male patient of Greek descent and child of non-consanguineous parents, who had previously been diagnosed with HCM [1], presented ten years after his first visit to our outpatient department. He reported an increase in verrucous papular lesions of the skin and oral mucosa since the last surgical intervention (dermabrasion) ten years earlier, as well as steadily progressive hoarseness. Since his last presentation, the patient had developed no other medical issues related to the deposition of hyaline material in internal organs. There were no neuropsychiatric abnormalities; no other family members were affected by the disease. Physical examination revealed yellowish-brown, waxy, verrucous papules, nodules and plaques symmetrically distributed on the knees (Figure 1a), elbows (Figure 1b), and the dorsal aspects of the fingers (Figure 1c). The patient reported the lesions to be pruritic and painful. Small yellowish papules were also found at both corners of the mouth and along the palpebral margins. The lips and tongue were distinctly thickened and dry (Figure 1d). For a more detailed investigation of the mucosal changes, flexible laryngoscopy was combined with stroboscopy in order to visualize the vocal cords. The procedure revealed massive thickening of the vocal cords, which were covered by verrucous layers of whitish tissue (Figure 2a). Vocal cord vibration and vocal fold closure were markedly impaired. Esophagogastroduodenoscopy and colonoscopy showed widespread, pale-white papular lesions and polypous thickening of the mucous membranes of the lips, tongue, pharynx (Figure 2b, c), larynx, and proximal esophagus (Figure 2d). Earlier, histological examination of skin lesions [1] had revealed a swollen papillary dermis with only few cells and extensive deposition of homogenous PAS-positive hyaline material surrounding blood vessels and adnexa. Electron microscopic examination of the lesions had shown multiple concentric rings of reduplicated basement membranes along the dermoepidermal junction and surrounding blood vessels [1]. Also known as Urbach-Wiethe disease or lipoid proteinosis, HCM is a rare autosomal recessive disorder [2]. First described by Urbach and Wiethe in 1929 [3], HCM shows a broad variety of mucocutaneous and also extracutaneous symptoms. It usually manifests itself in infancy, with thickening as well as acneiform or varicella-like scarring of the skin and mucous membranes accompanied by hoarseness [1, 4]. Approximately 50–75 % of patients show neurological symptoms (for example, epilepsy, mental retardation) with

Druckdolenter, subkutaner Tumor an der Handinnenfläche

Hautarzt 2018 · 69:960–963 https://doi.org/10.1007/s00105-018-4270-y Online publiziert: 4. September 2018

Impetiginized facial dermatitis covered with yellow-brown crusts in an 85-year-old man: Case for Diagnosis

An 85-year-old man presented with severe facial dermatitis covered with crusts. The lesions had appeared approximately seven days earlier and were associated with burning pruritus. Fever, chills, or general malaise were denied. Thorough questioning failed to elicit any triggering factors or new medications. His medical history included atrial fi brillation, chronic heart failure, type 2 diabetes, and Parkinson’s disease.