Thomas Dirschka

Low-dose UVA1 phototherapy for treatment of localized scleroderma

BACKGROUND For treatment of localized scleroderma numerous treatments, including ones with potentially hazardous side effects, are currently used with only limited success. OBJECTIVE We attempted to determine the efficacy of low-dose UVA1 irradiation in patients with severe localized scleroderma. METHODS Patients were irradiated with 20 J/cm2 UVA1 for 12 weeks (total number of treatments: 30; cumulative UVA1 dose: 600 J/cm2). RESULTS Low-dose UVA1 irradiation induced significant clinical improvement (clearance of > 80% of lesions) in 18 of 20 patients. Clearance was documented by clinical score as well as by 20 MHz ultrasound and histopathologic analysis. CONCLUSION Low-dose UVA1 phototherapy can be highly effective for sclerotic plaques, even in patients with advanced localized scleroderma and with lesions rapidly evolving despite conventional therapy.

The management of skin reactions in cancer patients receiving epidermal growth factor receptor targeted therapies

The use of epidermal growth factor receptor (EGFR) inhibitors for the treatment of solid tumours is increasing. However, the tolerability profile for EGFR‐inhibitors, such as the monoclonal antibody cetuximab and the tyrosine kinase inhibitor erlotinib, is characterised by a unique group of skin reactions dominated by an acneiform eruption, xerosis, eczema and changes in the hair and nails. The possibility that this skin toxicity correlates with anti‐tumour activity offers the potential to titrate dosing on a case‐by‐case basis. These skin effects may constitute a significant obstacle to treatment compliance. Accordingly, there is a need for consistent, multi‐disciplinary management strategies that will allow patients to receive the recommended dosages of such targeted therapies. The eruption responds well to some acne therapies and xerosis can be controlled by standard emollients. Here we present an overview of the treatment options for skin reactions that are available today, and evaluate some of the ways in which the treatment of such EGFR‐inhibitor‐related skin reactions may be improved in the future. Evidence‐based studies are needed to determine the best way to manage these effects.

Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis.

Background  Rosacea and perioral dermatitis (PD) are common dermatoses, the aetiology and pathogenesis of which remain speculative.

Clinical performance of the Nevisense system in cutaneous melanoma detection: an international, multicentre, prospective and blinded clinical trial on efficacy and safety.

Even though progress has been made, the detection of melanoma still poses a challenge. In light of this situation, the Nevisense electrical impedance spectroscopy (EIS) system (SciBase AB, Stockholm, Sweden) was designed and shown to have the potential to be used as an adjunct diagnostic tool for melanoma detection.

Brief S2k guidelines – Basal cell carcinoma of the skin

Axel Hauschild*, Helmut Breuninger*, Roland Kaufmann, Rolf-Dieter Kortmann, Martin Klein, Jochen Werner, Julia Reifenberger, Thomas Dirschka, Claus Garbe (1) Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Germany (2) Department of Dermatology, Tubingen University Hospital, Germany (3) Department of Dermatology, Frankfurt University Hospital, Germany (4) Department of Radiation Therapy and Radio-oncology, Leipzig, Germany (5) Fachklinik Hornheide, Division of Oral and Maxillofacial Surgery, Plastic and Aesthetic Surgery, Munster, Germany (6) Department of Otolaryngology, Marburg University Hospital, Germany (7) Department of Dermatology, Dusseldorf University Hospital, Germany (8) Dermatology Practice, Dusseldorf, Germany (9) Department of Dermatology, Tubingen University Hospital, Germany

S2k-Leitlinie zur Therapie der Akne

To optimize the treatment of acne in Germany, the German Society of Dermatology (DDG) and the Association of German Dermatologists (BVDD) initiated a project to develop consensus-based guidelines for the management of acne. The Acne Guidelines focus on induction therapy, maintenance therapy and treatment of post-acne scarring. They include an evaluation of the most commonly used therapeutic options in Germany. In addition, they offer detailed information on how to administer the various treatments and on contraindications, adverse drug reactions, and drug interactions, taking into account gender and special conditions such as pregnancy and lactation. The Acne Guidelines were developed following the recommendations of the Association of Scientific Medical Societies in Germany (AWMF). The treatment recommendations were developed by an expert group and finalized by an interdisciplinary consensus conference. The first choice treatments for acute acne according to acne type are as follows: 1) comedonal acne: topical retinoids; 2) mild papular/pustular acne: fixed or sequential combinations of BPO and topical retinoids or of BPO and topical antibiotics; 3) moderate papular/pustular acne: oral antibiotic plus BPO or plus topical retinoid, or in a fixed combination 4) acne papulo-pustulosa nodosa and acne conglobata: oral antibiotic plus topical retinoid plus BPO or oral isotretinoin. For maintenance treatment: topical retinoid or its combination with BPO. Particular attention should be paid to compliance and quality of life. Additional treatment options are discussed in the main body of the text.

Open label randomized study comparing 3 months vs. 6 months treatment of actinic keratoses with 3% diclofenac in 2.5% hyaluronic acid gel: a trial of the German Dermatologic Cooperative Oncology Group

Background Actinic keratoses (AK) are carcinomata in situ with the potential to develop into invasive carcinoma. Several studies have demonstrated that 3% diclofenac in 2.5% hyaluronic acid gel (HA) is effective and well tolerated in the treatment of AK. To date there are no large randomized multicentre trials with treatment durations longer than 90 days and histopathological control of treatment outcome.

Short German guidelines: Basal cell carcinoma

JDDG | Supplement 1 ̇2008 (Volume 6) Journal compilation

Twenty MHz B-scan sonography for visualization and skin thickness measurement of human skin

As a non‐invasive method, ultrasound is a suitable diagnostic procedure for routine in vivo examination of the human skin in dermatology. In this study 40 healthy test subjects were examined with a 20‐MHz ultrasound scanner in order to determine the thickness and morphology of normal skin at 51 different sites. B‐mode ultrasonography permits us to measure both the individual layers of the skin and deeper structures and to assess their definition and echogenicity. In both sexes the greatest skin thicknesses were found on: the shoulder‐blade (mean thicknesses (mm), males 3.07/ females 2.47); the upper back (m, 3.04/f, 2.85); the chin (m, 3.04/f, 2.69); the lower lip (m, 2.66/f,2.50) and in the region of the lower back (m, 2.64/f, 2.39). Particularly thin skin was found on: the upper eyelid (m, 0.59/f, 0.64); the lower eyelid (m, 0.99/f, 0.86); in the groin (m. 0.97/f, 0.90); in the armpit (m, 1.01/f, 1.09) and on the forearm (m, 1.13/f. 1.00 mm). Knowledge of differences in the characteristic reflex patterns depending on the sex and age of the subject and the site of the skin examined forms the basis for assessment of pathological sonograms.

Electrical impedance spectroscopy as a potential adjunct diagnostic tool for cutaneous melanoma

Previous studies have shown statistically significant differences in electrical impedance between various cutaneous lesions. Electrical impedance spectroscopy (EIS) may therefore be able to aid clinicians in differentiating between benign and malignant skin lesions.