Christina Rogalski

Panarteritis cutanea benigna – an entity limited to the skin or cutaneous presentation of a systemic necrotizing vasculitis? Report of seven cases and review of the literature

Objective  In 1931 Lindberg described a limited and benign subcutaneous form of panarteritis nodosa, which, in contrast to systemic panarteritis, only affects the skin. The terms panarteritis nodosa cutanea benigna, cutaneous polyarteritis nodosa, apoplexia cutanea Freund as well as livedo with nodules are used synonymously for this vasculitis which predominantly affects women in the fifth decade of life. Cutaneous lesions characteristically comprise painful subcutaneous nodules or vasculitis racemosa at the lower extremities. The cutaneous panarteritis may be regarded as its own entity or an isolated skin manifestation within systemic panarteritis nodosa.

Bullous Pyoderma Gangrenosum Complicated by Disseminated Intravascular Coagulation with Subsequent Myelodysplastic Syndrome (Chronic Myelomonocytic Leukemia)

A 33‐year‐old woman developed a bullous PG precursing a chronic myelomonocytic leukemia (CMML) complicated by life‐threatening, disseminated, intravascular coagulation after administration of systemic corticosteroids in combination with immunosuppressant and antibiotic agents. Although the association between PG and leukemia, as well as the coincidence of disseminated intravascular coagulation (DIC) and leukemia, is well known, a premonitoring effect of PG in combination with DIC preceding the diagnosis of chronic myelomonocytic leukemia in the same patient has not been reported recently.

Meta-analysis of published data on incompletely excised basal cell carcinomas of the ear and nose with introduction of an innovative treatment strategy

Background: Auricular/nasal basal cell carcinomas (BCC) often require more surgical procedures than BCCs at other sites.

Extensive striae distensae as a result of topical corticosteroid therapy in psoriasis vulgaris.

Sir, Rifampicin is a semi-synthetic broad-spectrum antibiotic widely used in the treatment of tuberculosis and leprosy. Considering its enormous clinical use, cutaneous side effects are rare; it is seen in less than 5% of patients (1). Here, we report a patient who experienced a severe burning sensation all over the body following rifampicin use. To the best of our knowledge, this unusual rifampicin-induced side effect has not been reported previously. A 32-year-old female patient was admitted with extensive psoriasis. She also had a history of left-sided chest pain, cough and low grade fever over the course of 2 months. Her baseline investigations including peripheral blood smear, cell counts, liver and renal function tests; other biochemical parameters were within normal limits. A skiagram of her chest and pleural fluid analysis revealed a diagnosis of pulmonary tuberculosis, for which she was started on antitubercular drugs (rifampicinzisoniazidezethambutolzpyrazinamide). After baseline investigations, her psoriasis was managed with acitretin 25 mg twice daily. A week after starting antitubercular drugs, the patient complained of a severe intractable burning sensation all over the body, which would characteristically start in the morning. It was not relieved with antihistamines (hydroxyzine hydrochloride, doxepine) and sedatives (diazepam). The burning sensation gradually subsided by the evening, only to recur the next morning. This continued over the next 3 days. On the 4th day, the patient noticed that these symptoms started after she had taken rifampicin on an empty stomach in the morning. Rifampicin was therefore withheld for 2 days, during which she was completely asymptomatic. Next day, a challenge dose of rifampicin was administered. The patient experienced similar symptoms of intolerable burning all over body beginning 30 min after rifampicin intake, and this lasted for between 6 and 8 h. Subsidence of the burning sensations on stopping rifampicin and recurrence on challenge confirmed rifampicin as the culprit behind her disabling symptoms. Various cutaneous side effects observed with rifampicin are acniform lesions, Steven-Johnson syndrome, maculopapular rash, erythema multiforme, pemphigus, urticaria, exfoliative dermatitis, porphyria cutanea tarda and fixed drug eruption (2). There is a single report of pruritis associated with intravenous use of rifampicin (3). In another report, Aziz et al. (4) described burning palms as an adverse effect to rifampicin containing antitubercular drugs. Initially, we were unable to find a cause for such burning sensations and considered it to be related to the acitretin. But on the patient’s own observation, rifampicin was suspected and confirmed by stopping and rechallenging. In describing a hitherto unknown side effect of rifampicin, this report emphasizes the importance of listening carefully to what the patient has to say and also of the role of continuous pharmacovigilance in clinical practice (5).

[Vacuum therapy in dermatology: a review].

Modern wound therapy is developing continuously. Vacuum therapy is an estab‐lished procedure to treat wounds. Available on the market is, among others, the V.A.C.® (Vacuum Assisted Closure) therapy system. Here, we report the various effects of the vacuum therapy on wounds such as reducing the bacterial contamination, improving granulation and microcirculation and focus on the practical use of the V.A.C.®, possible complications, contraindications and the economic aspects of the therapy. Since V.A.C.® therapy allows rapid mobilization of patients especially with postoperative or posttraumatic wounds, infrequent dressing changes and relative analgesia, this treatment modality is well‐accepted by patients with acute or chronic wounds. One explanation for the high acceptance on part of the therapists and the widespread use of the method are the excellent clinical results.

Cutaneous extramedullary hematopoiesis in idiopathic myelofibrosis.

A 67‐year‐old German woman presented with a 2‐month history of indolent erythematous macules and livid papulonodules of 0.5–1.5 cm in diameter scattered on her abdomen ( Fig. 1 ). On physical examination, the patient was alert, the liver was palpable 3 cm below the right costal margin, and the spleen was enlarged 3 cm below the left costal margin. There was no lymphadenopathy.

Treatment of plaque‐type psoriasis with the 308 nm excimer laser in combination with dithranol or calcipotriol

Purpose: The combination of excimer laser and topical treatment has not been studied in clinical trials. This within‐patient comparison study evaluates the response rates of plaque‐type psoriasis after treatment with topical only (dithranol or calcipotriol), laser only, and combination therapy with topical medication and laser. Materials and methods: A total of 61 patients with psoriatic plaques located at symmetric body areas (PASI ≥ 6) were screened, 59 were enrolled, 54 completed treatment and 45 completed the 6 months follow‐up. Treatments with the excimer laser were performed twice weekly until resolution or a maximum of 15 treatments. Each ointment was applied on one of the test lesions, which had to be at least 10 cm apart from each other. Efficacy was rated with a modified PASI score. Results: At the end of the treatment phase only one patient in both topical therapy regimens met the criteria of partial clearance (modified PASI ≤ 2). The combined therapies resulted in 23 cases of partial clearance in both treatment arms. Four areas treated with calcipotriol, respectively six areas treated with dithranol resulted in total clearance at the end of the treatment phase. The average reduction of modified PASI scores was higher in combination than in topical treatment alone (49.8% calcipotriol + excimer versus 22.9% calcipotriol, 49.7% dithranol + excimer versus 26.8% dithranol). After six months there was a total clearance of 30.5% dithranol + excimer. Conclusions: Treatment of plaque‐type psoriasis with laser in combination with topical treatment is a safe and effective therapy. The best long‐term results can be obtained by the application of dithranol and excimer laser.

Gesundheitsökonomische Studien in der Dermatologie – Review der Literatur, Bewertung und zugrunde liegende Aspekte der Durchführung

Hintergrund: Behandlungsergebnisse werden mittels gesundheitsökonomischer Evaluationen objektiviert, um sie in einen wirtschaftlichen Kontext zu bringen. Gesundheitsökonomische Studien stellen einen abstrahierenden Prozeßärztlichen und pflegerischen Handelns dar, der den rationalen Umgang mit knappen Ressourcen unterstützen soll, und sollten daher vermehrt durchgeführt werden.

Die Vakuumtherapie in der Dermatologie: ein Überblick

Modern wound therapy is developing continuously. Vacuum therapy is an established procedure to treat wounds. Available on the market is, among others, the V.A.C.® (Vacuum Assisted Closure)-therapy system. Here, we report the different effects of the vacuum therapy on wounds such as reducing the bacterial contamination, improving granulation and microcirculation and focus on the practical use of the V.A.C.®, possible complications, contraindications and the economic aspects of the therapy. Since V.A.C. ® - therapy allows rapid mobilization of patients especially with postoperative or posttraumatic wounds, infrequent dressing changes and relative analgesia, this treatment modality may gain high acceptance by patients suffering from acute or chronic wounds. One explanation for the high acceptance on part of the therapists and the widespread use of the method are the excellent clinical results.

Changes in treatment of squamous cell carcinoma over time. A process analysis

BACKGROUND The incidence of squamous cell carcinoma is rapidly increasing and requires process-optimized treatment dependent on the course of the patients individual disease. Patient-based data on squamous cell carcinoma were used to analyze the treatment modalities before DRGs were introduced, after their introduction and after discussion about process-optimization in context of clinical pathways. PATIENTS AND METHODS From the recorded data in the department of dermatology, all squamous cell carcinoma cases were identified and evaluated. In addition to patient characteristics, parameters describing the process, for example, length of stay in hospital, pre- and post-interventional days, were collected. RESULTS Between 1998-2002, 2004-2006 and January to June 2007, 658 patients were treated for squamous cell carcinoma. In contrast to the times before DRGs, the treatment process has been significantly optimized, reducing the pre- and post-operative days and thus the duration of stay. Analysis of clinical pathways as part of the continuous improvement process was hardly able to detect further improvement. However, the weekly distribution of the admitted patients has been improved. CONCLUSIONS Patients with squamous cell carcinoma requiring surgical excision benefit from an optimized process, just as do impatient facilities. However, optimized treatment modalities carry hardly any potential of improvement by the invention of clinical pathways.