Stephan Alexander Braun

A novel mutation within a transmembrane helix of the bile salt export pump (BSEP, ABCB11) with delayed development of cirrhosis.

The bile salt export pump (BSEP, ABCB11) is essential for bile salt secretion at the canalicular membrane of liver cells. Clinical phenotypes associated with BSEP mutations are commonly categorized as benign recurrent intrahepatic cholestasis (BRIC‐2) or progressive familial intrahepatic cholestasis (PFIC‐2).

Laser-assisted drug delivery: Enhanced response to ingenol mebutate after ablative fractional laser treatment

REFERENCES 1. Anuset D, Goutorbe C, Bernard P, Reguiai Z. Efficacy of oral alitretinoin for the treatment of Darier disease: a case report. J Am Acad Dermatol. 2014;71:e46-e48. 2. Letul e V, Herzinger T, Ruzicka T, Molin S. Treatment of Darier disease with oral alitretinoin. Clin Exp Dermatol. 2013;38: 523-525. 3. Zamiri M, Munro CS. Successful treatment with oral alitretinoin in women of childbearing potential with Darier’s disease. Br J Dermatol. 2013;169:709-710. 4. Barnstedt SE. [Successful treatment of Darier disease with oral alitretinoin]. Hautarzt. 2012;63:139-141. 5. Levin L. Publishing negative results sometimes it is more important!. Quintessence Int. 2014;45:635.

Erfolgreiche Behandlung eines Morbus Bowen mit Ingenolmebutat

ZusammenfassungIngenolmebutat ist ein Zytostatikum, das aus der Pflanze Euphorbia peplus extrahiert wird und in Deutschland seit November 2012 zur topischen Therapie von oberflächlichen aktinischen Keratosen zugelassen ist. Wir berichten über die erfolgreiche Therapie eines Morbus Bowen mit Ingenolmebutat bei einem Patienten mit metastasiertem, klarzelligem Nierenzellkarzinom unter Systemtherapie mit dem Multikinaseinhibitor Sunitinib.AbstractIngenol mebutate is a novel cytotoxic drug extracted from the plant Euphorbia peplus. Since November 2012 it is approved in Germany for the treatment of superficial actinic keratoses. We report the successful treatment of Bowen disease with ingenol mebutate in a patient being treated with the multikinase inhibitor sunitinib for to metastatic clear cell renal carcinoma.Ingenol mebutate is a novel cytotoxic drug extracted from the plant Euphorbia peplus. Since November 2012 it is approved in Germany for the treatment of superficial actinic keratoses. We report the successful treatment of Bowen disease with ingenol mebutate in a patient being treated with the multikinase inhibitor sunitinib for to metastatic clear cell renal carcinoma.

Erfolgreiche Behandlung von perianalen Condylomata acuminata mit Ingenolmebutat.

E-Mail: tancheng@medmail.com.cn Literatur 1 Kurashige Y , Kurashige K , Nagatani T , Hayashi M . Primary breast carcinoma en cuirasse derived from invasive lobular carcinoma: the first case report . J Dermatol 2014 ; 41 : 1122 – 3 . 2 Mahore SD , Bothale KA , Patrikar AD , Joshi AM . Carcinoma en cuirasse: a rare presentation of breast cancer . Indian J Pathol Microbiol 2010 ; 53 : 351 – 8 . 3 Endo Y , Matsumoto R , Taki R , Toda K . Cutaneous metastasis of gastric adenocarcinoma presenting as carcinoma “en cuirasse” . Eur J Dermatol . 2013 ; 23 : 287 – 8 . 4 Nashan D , Meiss F , Braun-Falco M , Reichenberger S . Cutaneous metastases from internal malignancies . Dermatol Ther 2010 ; 23 : 567 – 80 . 5 Mullinax K , Cohen JB . Carcinoma en cuirasse presenting as keloids of the chest . Dermatol Surg 2004 ; 30 : 226 – 8 . 6 Schwartz RA . Cutaneous metastatic disease . J Am Acad Dermatol 1995 ; 33 : 161 – 82 ; quiz 83–6. 7 Mordenti C , Peris KM , Fargnoli C et al. Cutaneous metastatic breast carcinoma: A study of 164 patients . Acta Dermatovenerologica Alpina, Panonica et Adriatica 2000 ; 9 : 143 – 148 .

Laser assisted Drug Delivery: Grundlagen und Praxis.

Die topische Applikation von Wirkstoffen ist eine zentrale Therapieoption der Dermatologie. Allerdings mindert die effektive Barrierefunktion der Haut die Bioverfügbarkeit der meisten Externa.

Cosmetic Effects of Ingenol Mebutate Gel in the Treatment of Field-Cancerized Photodamaged Skin.

Figure 1. (A) Scalp of an 82-year-old patient with actinic field cancerization and mottled pigmentation. In the marked area, 1 treatment cycle of ingenol mebutate 0.015% was applied. (B) After 6 weeks, the patient presented with clearance of all actinic keratoses andmottled pigmentation and a residual crust after an erosive inflammatory reaction in the center of the treated area. LETTERS AND COMMUNICAT IONS

Successful treatment of Bowen disease with ingenol mebutate

ZusammenfassungIngenolmebutat ist ein Zytostatikum, das aus der Pflanze Euphorbia peplus extrahiert wird und in Deutschland seit November 2012 zur topischen Therapie von oberflächlichen aktinischen Keratosen zugelassen ist. Wir berichten über die erfolgreiche Therapie eines Morbus Bowen mit Ingenolmebutat bei einem Patienten mit metastasiertem, klarzelligem Nierenzellkarzinom unter Systemtherapie mit dem Multikinaseinhibitor Sunitinib.AbstractIngenol mebutate is a novel cytotoxic drug extracted from the plant Euphorbia peplus. Since November 2012 it is approved in Germany for the treatment of superficial actinic keratoses. We report the successful treatment of Bowen disease with ingenol mebutate in a patient being treated with the multikinase inhibitor sunitinib for to metastatic clear cell renal carcinoma.Ingenol mebutate is a novel cytotoxic drug extracted from the plant Euphorbia peplus. Since November 2012 it is approved in Germany for the treatment of superficial actinic keratoses. We report the successful treatment of Bowen disease with ingenol mebutate in a patient being treated with the multikinase inhibitor sunitinib for to metastatic clear cell renal carcinoma.

A photoconverter gel-assisted blue light therapy for the treatment of rosacea

is dependent on physicians identifying the clinical signs in patients at risk. Dermatologists may be asked to see these patients due to suspicion of cutaneous vasculitis and should be aware of this rare differential. One 49-year-old male presented to my health service with a history of easy bruising and dyspnea. He lived with his mother and travelled frequently to Thailand. Admission blood tests revealed an acute normocytic anemia of 69, with normal platelets. Leukemia, lymphoma, myeloma, HIV, and hepatitis were all excluded by the acute medical team, a CT showed no evidence of internal bleeding, and an endoscopy demonstrated gastritis with notable bleeding at biopsy sites. A dermatology review was requested. On examination the patient offered further history of a longstanding terrible diet, consisting of cheese pizza, chicken, Weetabix, and coke. He had seen his dentist frequently for problems with his teeth, who had advised antibiotics. Clinical examination revealed perifollicular hemorrhages and bruising at his lower legs, peridontal ecchymoses, loose teeth, and corkscrew arm hairs. A clinical diagnosis of scurvy was made and vitamin C treatment instituted at 100 mg five times daily for one week, then 100 mg daily. On review at 2 weeks, the patient felt fit and well, his bruises had resolved, and his gums were much improved. On further reading into this condition, our patient was presenting in the fourth stage of scurvy, suggested by the above signs plus his dyspnea and the rapid drop in hemoglobin. By this stage in the disease, collagen synthesis has been disrupted, leading to the easy bleeding and also a drop in blood pressure, as patients cannot induce peripheral vasoconstriction in response to adrenergic stimuli. The lack of an appropriate adrenergic response is felt to be the most common cause for sudden death in scurvy. Ship physicians in the 1700s described patients suddenly expiring on the smallest physical exertion or on standing up after a period of lying flat. The entire scorbotic state can be reversed by instituting treatment with vitamin C, and until this treatment is underway, history advises us to avoid putting these patients under any sudden excessive physical or psychological strain.

Laser-assisted drug delivery: mode of action and use in daily clinical practice.

Topical application of pharmaceutical agents is a basic principle of dermatological therapy. However, the effective barrier function of the skin significantly impairs the bioavailability of most topical drugs. Fractional ablative lasers represent an innovative strategy to overcome the epidermal barrier in a standardized, contact‐free manner. The bioavailability of topical agents can be significantly enhanced using laser‐assisted drug delivery (LADD). In recent years, the principle of LADD has become well established for various dermatological indications. Herein, we review the current literature on LADD and present potential future applications.

Successful treatment of perianal condylomata acuminata with ingenol mebutate gel.

Condylomata acuminata (CA) have a high prevalence in the sexually active population with a severe impact on the patients’ quality of life [ 1 ] . Therapy is often painful or has to be applied for long time-periods with frustrating high rates of recurrence [ 2 ] . We report on a 53-year old man who developed multiple asymptomatic CA in the perianal area and on the mucosa of the distal part of the anal canal over the last six months (Figure 1 a). We conducted a topical treatment with ingenol mebutate (IM) gel in a concentration of 500 μ g/g by swabbing the gel on all visible warts and let it air-dry for 15 minutes. Eight hours after the initial treatment, the patient developed severe pain, fever, swollen inguinal lymph nodes and a pronounced infl ammatory reaction in the treated area with necrotizing changes (greyish epidermis) and blistering. On the next day the patient presented with an erosive dermatitis in the treated area (Figure 1 b). We started a topical therapy with a dexpanthenol-containing emollient. The symptoms rapidly regressed over the next four days with a signifi cant reduction of the mass of all treated warts. Subsequently, we repeated the treatment with IM on residual CA in a lower concentration of 150 μ g/g additional two times at weekly intervals. Local reaction and pain were much less severe as compared to the higher concentration. After four weeks all treated CA had clinically cleared (Figure 1 c). No scaring or any other persistent complications were observed. At a follow-up after three months, the patient did not show any recurrence. Genital warts are one of the most common sexual transmitted infections in the sexual active population. In more than 95 % of the cases they are caused by the low-risk human papilloma virus (HPV) subtypes 6 and 11 [ 3 ] . Due to their stigmatizing character and the possibility of coinfection with high-risk HPV subtypes (e. g. 16 and 18), masking underlying malignancies such as intraepithelial neoplasia of the vagina, penis or anus up to invasive carcinomas, consequent therapy is mandatory. Treatment options include various physical (cryosurgery, electrosurgery, scissors excision, curettage, laser) and topical (imiquimod 5 % cream, podophyllotoxin 0.5 % solution, sinecatechin 10 % ointment, trichloroacetic acid) measures. Nonetheless therapy often remains frustrating due to the high rates of recurrence and is often accompanied by painful local reactions and/or has to be applied over long-time periods (e. g. imiquimod cream up to 16 weeks) [ 3 ] . Ingenol mebutate has been FDAand EMA-approved for the fi eld-treatment of actinic keratosis. Moreover, there are now fi rst reports on the effects of IM on viral warts, such as mollusca contagiosa [ 4 ] . Here, we report the successful treatment of CA with IM. Potential mechanisms of the observed effects may include acute cytotoxic effects (necrosis) with or without the induction of a specifi c immunologic response, as described for actinic keratosis [ 5 ] . Latter could result in a sustained immunologic control and hence lower rates of recurrence as compared to surgical procedures. To conclude, we propose IM as a rapid and effective novel treatment option for the management of CA, even on mucosal surfaces such as in the perianal area.