E. von Stebut

Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity

A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking.

Resolving lesions in human cutaneous leishmaniasis predominantly harbour chemokine receptor CXCR3-positive T helper 1/T cytotoxic type 1 cells

Background  Cutaneous leishmaniasis (CL) is an epidemic disease affecting millions of individuals worldwide. Treatment options have several side‐effects and a vaccine does not exist at present.

Kutane Leishmaniasis als Reisedermatose

Leishmaniasis is a disease with worldwide increasing incidence, which in Germany is almost exclusively observed in patients who have travelled to classical endemic regions such as the Mediterranean basin. Cause of the disease is an infection with protozoan parasites of the genus Leishmania, which are transmitted by sand flies and replicate intracellularly within mammalian hosts. Depending on the inoculated parasite (sub-) species and the immune status of the host, a local cutaneous, diffuse cutaneous, mucocutaneous or visceral form of leishmaniasis will develop. Cutaneous leishmaniasis, which frequently appears only weeks after the bite of a sand fly, starts with the formation of a papule, which subsequently can turn into a skin ulcer. The latter may heal spontaneously after months leaving behind a scar or persist as chronic, non-healing cutaneous leishmaniasis. If cutaneous leishmaniasis is suspected, a sterile skin biopsy followed by appropriate diagnostic measures in a specialized laboratory to identify the pathogen should be performed. For the decision on the type of therapy, several clinical parameters (e.g. number and localization of lesions, immune status) and, most importantly, the underlying parasite (sub-) species need to be considered. Therapy can consist of a variety of topical measures or systemic drug treatment. A modern and safe vaccine does not yet exist.

Stellenwert der topischen Therapie in klinischen Behandlungssituationen

Topical therapy remains an important domain of dermatology. The choice of the base or vehicle for topical therapy has to be appropriate for both the skin disorder and the localization. In cases with intact skin barrier (horny layer, lipid barrier) lipophilic formulations are more suitable because of superior penetration, whereas hydrophilic creams should be favored when facing more acute, weeping skin conditions. Because of location-specific variations in the macro- and micro-anatomy and the microbiota of the skin, the topical agent that is chosen must have quite specific properties in order to function optimally. These location-specific differences and potential therapeutic principles will be discussed in greater detail.ZusammenfassungDie Lokaltherapie ist bis heute eine wichtige Domäne der Dermatologie. Die Wahl der Grundlage für die Lokaltherapie richtet sich nach dem Hautzustand und der Lokalisation. Bei intakter Hautbarriere (Hornschicht, Lipidbarriere) sind lipophile Träger wegen der besseren Penetration am besten geeignet und am effektivsten, während hydrophile Zubereitungen bei akuten, nässenden Hautzuständen vorzuziehen sind. Ortstypische Variationen in der Makro- und Mikroanatomie und dem Mikrobiom der Haut haben zur Folge, dass die angewandten Zubereitungen jeweils bestimmte Eigenschaften besitzen müssen, um optimal zu wirken. Im Folgenden soll auf diese lokalisationsspezifischen Unterschiede und mögliche Therapieprinzipien eingegangen werden.AbstractTopical therapy remains an important domain of dermatology. The choice of the base or vehicle for topical therapy has to be appropriate for both the skin disorder and the localization. In cases with intact skin barrier (horny layer, lipid barrier) lipophilic formulations are more suitable because of superior penetration, whereas hydrophilic creams should be favored when facing more acute, weeping skin conditions. Because of location-specific variations in the macro- and micro-anatomy and the microbiota of the skin, the topical agent that is chosen must have quite specific properties in order to function optimally. These location-specific differences and potential therapeutic principles will be discussed in greater detail.

Development of oil cysts after subcutaneous injection of interferon-α and interleukin-2

reported from India due to allergy to Parthenium hysterophorus. We asked that further enquiries be made regarding the local flora as we were unaware whether P. hysterophorus was also found in Pakistan. The patient’s nephew confirmed that this weed flourishes in and around Islamabad. Of particular relevance was the subsequent discovery of an article by Nadeem et al. that confirmed that P. hysterophorus is found growing in many parts of Pakistan including Lahore, Johar town and the Changa Manga forest. In some places it has replaced the native flora and has contaminated nearby grain-producing areas. They studied a total of 511 patients with contact dermatitis and 100 patients with other dermatological diseases (not eczema). On patch testing 391 patients demonstrated positive reactions to either the leaf or flower or to 1% parthenin in petrolatum base, as compared with five individuals in the control group. All the subjects were field workers and the reactions were therefore felt to be highly relevant. Parthenium hysterophorus is a wasteland weed which is hazardous to plants and humans (Fig. 1). Its common local names include congress weed, carrot weed, star weed, feverfew, white top, chatak chandani, bitter weed, ramphool and garghas. The plant is capable of growing in all types of soil and throughout the year due to low water requirements. As a consequence it can spread rapidly once established. This weed originates from countries bordering the Gulf of Mexico, but has been growing for centuries in many parts of the world including South Asia, the Americas, Australia and the West Indies. Parthenium is well recognized as a cause of airborne contact dermatitis in Northern India where it was introduced accidentally in the mid 1950s along with wheat grains from the U.S.A. Apart from an airborne distribution, contact sensitivity to parthenium can present as erythroderma and also as a more generalized chronic eczema. We highlight this case as there are no reports in the European literature of airborne contact dermatitis from P. hysterophorus occurring in Pakistan. However, it seems to be a growing problem in this country where in certain cities such as Islamabad and Lahore it has replaced the native flora. In view of the considerable amount of travel taken these days, patients travelling to or from this part of the world may present to our dermatological services. Awareness of the spread of this common plant allergen needs to be borne in mind when seeing patients from this part of the world.

Granulomatöse Erkrankungen der Haut

Granulomatöse Erkrankungen definieren sich durch das feingewebliche Korrelat einer granulomatösen Entzündung, und daraus folgt unmittelbar, dass es zur Diagnosestellung einer Gewebsentnahme zur histologischen Untersuchung bedarf. Kein weiteres Organ ist dabei so einfach zugänglich wie die äußere Haut. Der erste Schritt der Zuordnung zur Gesamtgruppe der granulomatösen Erkrankungen ist für den Dermatopathologen inderRegel recht einfach.Dann jedoch – wesentlich schwieriger – ist der zweite Schritt der genauen Diagnosestellung und die sichere Abgrenzung zu den Differenzialdiagnosen. Es bedarf einer sorgfältigen klinisch-pathologischen Korrelation unter Einbeziehung verschiedener Fachgebiete und des Abgleichs mit paraklinischen Befunden. Gelegentlich lässt sich anfangs nur eine deskriptive Arbeitsdiagnose formulieren, und erst im Krankheitsverlauf wird die exakte Diagnose klar.

Stellenwert der topischen Therapie in klinischen Behandlungssituationen@@@Significance of topical therapy in clinical situations: Lokalisationsspezifische Prinzipien@@@Location-dependent principles

Topical therapy remains an important domain of dermatology. The choice of the base or vehicle for topical therapy has to be appropriate for both the skin disorder and the localization. In cases with intact skin barrier (horny layer, lipid barrier) lipophilic formulations are more suitable because of superior penetration, whereas hydrophilic creams should be favored when facing more acute, weeping skin conditions. Because of location-specific variations in the macro- and micro-anatomy and the microbiota of the skin, the topical agent that is chosen must have quite specific properties in order to function optimally. These location-specific differences and potential therapeutic principles will be discussed in greater detail.ZusammenfassungDie Lokaltherapie ist bis heute eine wichtige Domäne der Dermatologie. Die Wahl der Grundlage für die Lokaltherapie richtet sich nach dem Hautzustand und der Lokalisation. Bei intakter Hautbarriere (Hornschicht, Lipidbarriere) sind lipophile Träger wegen der besseren Penetration am besten geeignet und am effektivsten, während hydrophile Zubereitungen bei akuten, nässenden Hautzuständen vorzuziehen sind. Ortstypische Variationen in der Makro- und Mikroanatomie und dem Mikrobiom der Haut haben zur Folge, dass die angewandten Zubereitungen jeweils bestimmte Eigenschaften besitzen müssen, um optimal zu wirken. Im Folgenden soll auf diese lokalisationsspezifischen Unterschiede und mögliche Therapieprinzipien eingegangen werden.AbstractTopical therapy remains an important domain of dermatology. The choice of the base or vehicle for topical therapy has to be appropriate for both the skin disorder and the localization. In cases with intact skin barrier (horny layer, lipid barrier) lipophilic formulations are more suitable because of superior penetration, whereas hydrophilic creams should be favored when facing more acute, weeping skin conditions. Because of location-specific variations in the macro- and micro-anatomy and the microbiota of the skin, the topical agent that is chosen must have quite specific properties in order to function optimally. These location-specific differences and potential therapeutic principles will be discussed in greater detail.

Kutane Leishmaniasis als Reisedermatose@@@Cutaneous leishmaniasis as travelers’ disease: Klinik, Diagnostik und Therapie@@@Clinical presentation, diagnostics and therapy

Leishmaniasis is a disease with worldwide increasing incidence, which in Germany is almost exclusively observed in patients who have travelled to classical endemic regions such as the Mediterranean basin. Cause of the disease is an infection with protozoan parasites of the genus Leishmania, which are transmitted by sand flies and replicate intracellularly within mammalian hosts. Depending on the inoculated parasite (sub-) species and the immune status of the host, a local cutaneous, diffuse cutaneous, mucocutaneous or visceral form of leishmaniasis will develop. Cutaneous leishmaniasis, which frequently appears only weeks after the bite of a sand fly, starts with the formation of a papule, which subsequently can turn into a skin ulcer. The latter may heal spontaneously after months leaving behind a scar or persist as chronic, non-healing cutaneous leishmaniasis. If cutaneous leishmaniasis is suspected, a sterile skin biopsy followed by appropriate diagnostic measures in a specialized laboratory to identify the pathogen should be performed. For the decision on the type of therapy, several clinical parameters (e.g. number and localization of lesions, immune status) and, most importantly, the underlying parasite (sub-) species need to be considered. Therapy can consist of a variety of topical measures or systemic drug treatment. A modern and safe vaccine does not yet exist.