Stefanie Reich-Schupke

Intravenous immunoglobulin for pyoderma gangrenosum

nazole against dermatophytes causing tinea pedis and tinea cruris ⁄corporis such as T. rubrum, T. mentagrophytes and M. canis as demonstrated in vitro and in animal models is confirmed by these studies in patients. Although we realize that the number of patients in this trial is limited, there is a tendency for a better response towards T. rubrum than towards M. canis. Many studies have been performed with different oral antifungals in tinea infections, most of them with treatment schedules ranging from 2 to 6 weeks. Itraconazole trials using shorter treatment schedules of 1 or 2 weeks and doses ranging from 100 to 400 mg daily have been published. Pramiconazole, applied in treatment schedules of short duration, most probably owes its efficacy to its favourable kinetics, i.e. prolonged half-life in blood and possibly lower protein binding than its predecessor molecule itraconazole. In conclusion, these phase IIa trials suggest that pramiconazole possesses properties that warrant further clinical studies for short-term treatment in patients with tinea pedis and tinea cruris ⁄corporis.

Compression and venous ulcers

Compression therapy is considered to be the most important conservative treatment of venous leg ulcers. Until a few years ago, compression bandages were regarded as first-line therapy of venous leg ulcers. However, to date medical compression stockings are the first choice of treatment. With respect to compression therapy of venous leg ulcers the following statements are widely accepted: (1) Compression improves the healing of ulcers when compared with no compression; (2) Multicomponent compression systems are more effective than single-component compression systems; (3) High compression is more effective than lower compression; (4) Medical compression stockings are more effective than compression with short stretch bandages. Healed venous leg ulcers show a high relapse rate without ongoing treatment. The use of medical stockings significantly reduces the amount of recurrent ulcers. Furthermore, the relapse rate of venous leg ulcers can be significantly reduced by a combination of compression therapy and surgery of varicose veins compared with compression therapy alone.

Impact on wound healing and efficacy of various leg ulcer debridement techniques.

Aim: To evaluate the evidence on the impact of different debridement techniques on healing and their efficacy in the treatment of leg ulcers.

Review of Published Information on Foam Sclerotherapy

BACKGROUND New data on foam sclerotherapy of varicose veins has been recently published. OBJECTIVE To identify the current treatment modalities and their effectiveness in use of foam sclerotherapy. MATERIALS AND METHODS Review of the recent literature regarding clinical treatment of varicose veins using foam sclerotherapy, with emphasis on safety and efficacy. RESULTS Foam sclerotherapy of the great saphenous vein is more effective than liquid. Higher sclerosant concentrations tend to induce higher occlusion. Catheter‐assisted sclerotherapy may further improve occlusion rates. To achieve adequate occlusion, vein diameter and volume of foam must be matched. If a critical foam volume is exceeded, the risk of deep venous thrombosis increases. Foam sclerotherapy offers the possibility of using lower sclerosant concentrations than with liquids. Foam sclerotherapy can also be used in venous malformations and periulcerous tributaries. Side effects are hyperpigmentation, skin necrosis, scotoma, and thromboembolic events. Thromboembolism prophylaxis is necessary only in patients with special risk factors. CONCLUSION Foam sclerotherapy has significantly better efficacy than liquid. It is essential to select the correct concentration and the correct foam volume. In the hands of an experienced physician, foam sclerotherapy is a safe and effective option for treating varicose veins. This study was funded by Kreussler & Co.

MRSA in dermatology – Prospective epidemiological study in employees and patients of a dermatological department of a university hospital

Background: In recent years, the prevalence of MRSA has increased worldwide. There is a lack of systematic epidemiological studies evaluating the prevalence of MRSA in dermatology in Germany.

Histopathological findings in varicose veins following bipolar radiofrequency-induced thermotherapy – results of an ex vivo experiment

Objective To describe the histopathological changes of the vein wall caused by bipolar radiofrequency-induced thermotherapy (RFITT), and to examine influence of power and application time on the histopathological changes. Material and methods Twenty vein specimens atraumatically extracted near the saphenofemoral junction were treated by RFITT ex vivo. RFITT was applied with fixed (2 seconds) and varied (up to an impedance of 400 Ω) application time and increasing power (5, 10, 15, 20, 25 W). Specimens were processed histologically. Results RFITT induced coagulation of collagen bundles, shrinking of muscles, splitting and necrosis of the vein wall. Circumferential necrosis of intima and media was reached by a power of 20–25 W and an application time up to an impedance of 400 Ω. Only heterogeneous necrosis of intima and media in parts of the vessel was reached by lower power with long application time. Conclusion A homogeneous necrosis of the circumferential vein wall needs high power and sufficient application time.

Epikutantestung bei Patienten mit Ulcus cruris unter besonderer Berücksichtigung moderner Wundprodukte

BACKGROUND Patients with leg ulcers often have contact sensitizations. Modern wound care products claim low allergic potential. OBJECT To analyze the patch test results in leg ulcer patients with focus on modern care wound products. MATERIAL AND METHODS 95 leg ulcer patients were tested with the standard German patch test series as well as frequently used wound care products. RESULTS 61% of the patients had at least one positive reaction. Most frequent reactions were seen with tert-butylhydroquinone, povidone iodine, balsam of Peru, a hydrogel, fragrance mix I and II, Amerchol L101 and gentamicin. There were 14 reactions to modern wound care products with highest sensitization rates for hydrocolloids and hydrogels. Patients sensitized to wound care products had significantly more positive patch test reactions. CONCLUSION There are sensitisations against modern wound care products, especially hydrogels. That should be considered in patch test of leg ulcer patients.

What do we know of post-thrombotic syndrome? Current status of post-thrombotic syndrome in adults

The post‐thrombotic syndrome (PTS) is a common but not completely understood and rarely studied sequela of an acute deep vein thrombosis. The influence of several risk factors on the incidence or severity of PTS is controversial. The therapeutic options for PTS are still limited. Appropriate medical compression stockings can reduce the incidence (–50 %) as well as the severity of PTS. In the case of severe, symptomatic PTS, they should be worn lifelong. As PTS is a chronic and often progressive disease, patients need regular clinical follow‐up and encouragement to continuously wear their compression therapy. New strategies for treating PTS are needed.

Thick legs – not always lipedema

Due to its increased presence in the press and on television, the diagnosis of lipedema is on the way to becoming a trendy diagnosis for those with thick legs. Despite this, one must recognize that lipedema is a very rare disease. It is characterized by disproportional obesity of the extremities, especially in the region of the hip and the legs, hematoma development after minimal trauma, and increased pressure‐induced or spontaneous pain. Aids for making the correct diagnosis are (duplex) sonography, the waist‐hip index or the waist‐height index and lymphoscintigraphy. Important differential diagnoses are constitutional variability of the legs, lipohypertrophy in obesity, edema in immobility, edema in chronic venous insufficiency and rheumatic diseases.

New concept: different types of insufficiency of the saphenofemoral junction identified by duplex as a chance for a more differentiated therapy of the great saphenous vein

Even though the item ‘saphenofemoral junction’ (SFJ) is anatomically well defined, the incontinence of the SFJ is often incompetently described in clinical practice and studies. Especially with regard to the optimal therapy of the great saphenous vein, it might be of importance to have a more distinct regard to the SFJ as it is known that about 10–30% of the saphenous refluxes have no femoral origin. Considering the terminal and preterminal valve three types of incompetence of the SFJ may be differentiated: Type 1: Incompetent terminal, but competent preterminal valve; Type 2: Competent terminal, but incompetent preterminal valve; Type 3: Incompetent terminal and preterminal valve (complete incompetence). A review on prior studies and reports leads to the assumption that the differentiation of the distinct types of SFJ-incompetence allows a more individual and – perhaps – more effective therapy. Finally, studies are necessary to evaluate the here given new concept.