Renz Mang

Successful treatment of solar urticaria by extracorporeal photochemotherapy (photopheresis) – a case report

Abstract: Solar urticaria is characterized by erythema and whealing immediately after exposure to ultraviolet radiation and/or visible light. We report about a patient with severe solar urticaria, who was highly sensitive to both UVA radiation and visible light with a Minimal Urticaria Dose (MUD) of 7 J/cm2 UVA. Management of this patient was extremely difficult because standard treatment with oral antihistamines, hardening with UVA, UVB, visible light or oral PUVA and even oral cyclosporin A were completely ineffective. We therefore decided to perform extracorporeal photochemotherapy (photopheresis, ECP). After nine treatment cycles with photopheresis the MUD increased from 7 J/cm2 UVA before treatment to 22 J/cm2 UVA. This hardening effect was associated with a significant decrease of the frequency and severity of whealing and the accompanying symptoms (pain, fatigue, pruritus).

UVA-1 phototherapy

Ultraviolet (UV) radiation has been used for decades with success at a constantly increasing frequency in the management of skin diseases. A major breakthrough has been the introduction of selective spectra, which greatly improved the efficacy and safety of phototherapy. The two most prominent examples illustrating this development are 311 nm or narrow-band UVB-phototherapy and UVA-1 phototherapy. This review will provide an update of UVA-1 phototherapy.

Response of Severe Psoriasis to Infliximab

A 41-year-old male patient with a 23-year history of clinically and histologically proven chronic psoriasis and psoriatic arthritis was referred to our department because of an acute erythrodermic exacerbation (fig. 1). The blood examination revealed signs of inflammation whereas more specific parameters, such as rheumatoid factor and HLA-B27 were negative. Bone scintigraphy and X-ray of the hands showed an acute mutilating psoriatic arthritis (fig. 1). Previous unsuccessful treatment included glucocorticosteroids, methotrexate, cyclosporine, fumaric acid, retinoids, phototherapy and photochemotherapy. In order to reduce inflammation and pain of the joints, NSAIDs, such as indomethacin or more recently rofecoxib, have been administered for years. Due to the recalcitrant character of the disease, treatment was started with the humanized anti-tumour necrosis factor-alpha (TNF-·) monoclonal antibody infliximab (Remicade®, Essex Pharma, München, Germany). Infliximab was given intravenously as a single infusion at a dose of 3 mg/kg body weight which has to be repeated every 3–4 weeks. Dramatic improvement of both psoriatic lesions and arthritis was observed already 2 weeks after the first infusion. The Psoriasis Activity and Severity Index (PASI) was 64.9 before treatment, and was found to be reduced to 32.4 within the first 2 weeks after infusion. After six infusions, the PASI was 13.6 (fig. 2) and after 10 infusion complete remission could

Dermoscopic changes in melanocytic nevi during use of melanotan II

For cosmetic reasons, a 24-year-old man performed subcutaneous autoinjections with a preparation having alpha-MSH-like effects (melanotan II) purchased via the internet. The changes of patients nevi were documented by sequential videodermoscopy before and during treatment. The observed dermoscopic changes made it difficult to differentiate a nevus from a melanoma.

[Mondor's disease].

ZusammenfassungWir berichten über das Auftreten eines Morbus Mondor bei einem 31-jährigen Patienten. Das klinische Bild dieser oberflächlichen strangförmigen Thrombophlebitis sowie differenzialdiagnostische und pathogenetische Aspekte werden diskutiert.AbstractA 31-year-old man presented with Mondor disease. The clinical picture of this superficial cord-like thrombophlebitis, the differential diagnosis, and the pathogenetic aspects are discussed.

Dermatoskopische Veränderungen von melanozytären Nävi unter Verwendung von Melanotan II

For cosmetic reasons, a 24-year-old man performed subcutaneous autoinjections with a preparation having alpha-MSH-like effects (melanotan II) purchased via the internet. The changes of patients nevi were documented by sequential videodermoscopy before and during treatment. The observed dermoscopic changes made it difficult to differentiate a nevus from a melanoma.

Effektiver Sonnenschutz für jeden Hauttyp

ZusammenfassungEs ist unzweifelhaft, dass ultraviolette Strahlung kausal an der Entstehung von Hautkrebs, vorzeitiger Hautalterung und an der Manifestation einer Vielzahl von Fotodermatosen beteiligt ist. In unserer Gesellschaft findet sich ungebrochen der Wunsch nach einer „gesunden Urlaubsbräune“ und damit verbunden die Tendenz, den Urlaub in sonnenreichen, sonnenscheinsicheren Regionen zu verbringen. Dadurch wird die menschliche Haut vermehrt UV-induzierten gesundheitsschädlichen Effekten ausgesetzt. Die Konnotation der Urlaubszeit als „schönste und damit wichtigste Zeit des Jahres“ besitzt große gesellschaftspolitische Bedeutung. Deshalb kommt der effektiven Verhinderung der unerwünschten UV-Wirkungen eine stetig zunehmende Bedeutung zu. Grundlegende und aktuelle Aspekte des effektiven Sonnenschutzes werden im vorliegenden Beitrag diskutiert.

Dermatoskopische Veränderungen von melanozytären Nävi unter Verwendung von Melanotan II@@@Dermoscopic changes in melanocytic nevi during use of melanotan II

For cosmetic reasons, a 24-year-old man performed subcutaneous autoinjections with a preparation having alpha-MSH-like effects (melanotan II) purchased via the internet. The changes of patients nevi were documented by sequential videodermoscopy before and during treatment. The observed dermoscopic changes made it difficult to differentiate a nevus from a melanoma.

Neurokutane Melanose und malignes Melanom

ZusammenfassungEin 36-jähriger Patient zeigte am unteren Rücken und im Glutealbereich einen kongenitalen Riesenpigmentnävus sowie multiple disseminierte Nävuszellnävi am gesamten Integument. Bei dem bislang unauffälligen Patienten kam es zu neurologischer Symptomatik (Grand-mal-Anfall) durch Auftreten einer zerebralen Metastase eines malignen Melanoms ohne Nachweis eines Primarius. Daher wurde die Diagnose einer neurokutanen Melanose mit zerebraler Metastasierung gestellt. Trotz verschiedener Therapiemaßnahmen (Operation, Bestrahlung und Chemotherapie) kam es zu einem rasch progredienten, letalen Verlauf mit Hirndrucksymptomatik, Hydrozephalus und spinaler Metastasierung.AbstractA 36-year-old man presented with a giant congenital melanocytic nevus and multiple disseminated melanocytic nevi. After he had developed neurological symptoms (grand mal seizures), a cerebral metastasis of a malignant melanoma without a primary melanoma was found. The patient was diagnosed as having a neurocutaneous melanosis with a cerebral metastasis. In spite of a variety of therapeutic attempts (surgery, radiation therapy and chemotherapy) he followed a rapidly progressive, lethal course with increased intracranial pressure, hydrocephalus and spinal metastases.

Ein Update zur Freiluftsaison 2014

Hautkrebs hat einen wichtigen Stellenwert in der täglichen dermatologischen Sprechstunde. Eng verknüpft mit diesem Thema ist die Lichtschutzberatung, wobei die Therapie und Prävention der po-lymorphen Lichtdermatose, des Lupus erythematodes und anderer photosensitiver Dermatosen ebenso detaillierte Kenntnisse über Lichtschutzpräparate verlangen.