A 52-year-old female presented with an 8-month history of dyspnea, fever, muscle weakness, and arthralgia. Her past medical history was unremarkable. The patient did not report pruritus or a history of atopic disease or allergy. On clinical examination, we noted hyperkeratosis and fissures of the lateral aspects of fingers and fingertips consistent with mechanic’s hands (MH) (Figure 1a, b). She had symmetrically swollen and tender finger joints. The creatine kinase level and electrophysiological tests were normal. Testing for antinuclear antibodies (ANAs) revealed a speckled pattern with a titer of 1 : 320 and showed additional cytoplasmic fluorescence. Serological testing for antibodies yielded positive results for anti-Ro52 antibodies. Other antibodies to extractable nuclear antigens (ENAs), including anti-Ro60 (SS-A) antibodies as well as antisynthetase antibodies (anti-Jo1, anti-EJ, anti-OJ, anti-PL7 and anti-PL12) were negative on repeat testing. Computed tomography of the chest showed signs of interstitial lung disease (ILD) (Figure 1c, red arrowheads). Nailfold video capillaroscopy showed megacapillaries, elongations, and tortuosities consistent with a myositis pattern Clinical Letter
{"title":"Mechanic's hands in a patient with isolated anti‐Ro52 antibodies: antisynthetase syndrome without antisynthetase antibodies","authors":"P. Korsten, Jens Schmidt, Jörg Larsen, C. Seitz","doi":"10.1111/ddg.13985","DOIUrl":"https://doi.org/10.1111/ddg.13985","url":null,"abstract":"A 52-year-old female presented with an 8-month history of dyspnea, fever, muscle weakness, and arthralgia. Her past medical history was unremarkable. The patient did not report pruritus or a history of atopic disease or allergy. On clinical examination, we noted hyperkeratosis and fissures of the lateral aspects of fingers and fingertips consistent with mechanic’s hands (MH) (Figure 1a, b). She had symmetrically swollen and tender finger joints. The creatine kinase level and electrophysiological tests were normal. Testing for antinuclear antibodies (ANAs) revealed a speckled pattern with a titer of 1 : 320 and showed additional cytoplasmic fluorescence. Serological testing for antibodies yielded positive results for anti-Ro52 antibodies. Other antibodies to extractable nuclear antigens (ENAs), including anti-Ro60 (SS-A) antibodies as well as antisynthetase antibodies (anti-Jo1, anti-EJ, anti-OJ, anti-PL7 and anti-PL12) were negative on repeat testing. Computed tomography of the chest showed signs of interstitial lung disease (ILD) (Figure 1c, red arrowheads). Nailfold video capillaroscopy showed megacapillaries, elongations, and tortuosities consistent with a myositis pattern Clinical Letter","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88713351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years, there has been a continual increase in the number of minimally invasive aesthetic procedures. Even among plastic surgeons, injections with botulinum toxin A and soft-tissue fillers for wrinkle treatment have replaced conventional surgical procedures at the top of the list of the most frequently performed interventions [1]. Given that – unlike botulinum toxin A – said fillers are no prescription drugs but rather medicinal products, they can be purchased relatively easily. Thus, filler treatments are not only performed by physicians but increasingly frequently also by non-medical personnel, such as alternative (non-medical) practitioners or cosmeticians, or even by patients themselves [2, 3]. However, filler injections are not entirely risk free and may be associated with severe adverse effects, especially when done without the proper anatomical knowledge and medical expertise [2, 4–6]. In addition to infections and granulomas, vascular complications are undoubtedly among the more dramatic complications, as they can lead to skin necrosis, scarring and even vision loss [6–9]. Vascular complications are caused either by embolic occlusion due to direct intra-arterial filler injection or by functional arterial obstruction due to the injection of large volumes (of fillers) into the perivascular tissue. Especially critical arteries are those that provide the only – or at least primary – blood supply to certain skin areas. In case of their occlusion, adequate perfusion by collateral vessels is no longer ensured (functional end arteries). Other critical arteries include those from which there are potential anastomoses with the retinal vascular plexus. As a consequence, “risk sites” for filler injection are the areas along the course of the facial/angular artery, the nasal artery and the supratrochlear artery as well as the various temporal artery branches and include the glabella, the under-eye hollows, the nasal bridge and the temples. The vast majority of vascular complications following filler injections have been reported to occur in the aforementioned areas [2, 6–8]. This may be due to the fact that – unlike the depiction in anatomy textbooks – the course of virtually every facial vessel shows great interindividual variability. Consequently, it is not always possible to reliably locate any given facial vessel even if one has appropriate anatomical knowledge. Measures recommended to avoid vascular complications include aspiration and (slow) injection of small Clinical Letter
{"title":"Identification of facial vessels using Doppler ultrasound prior to cosmetic filler injection","authors":"P. Gerber, M. Barsch, T. Filler, A. Gerber","doi":"10.1111/ddg.13977","DOIUrl":"https://doi.org/10.1111/ddg.13977","url":null,"abstract":"In recent years, there has been a continual increase in the number of minimally invasive aesthetic procedures. Even among plastic surgeons, injections with botulinum toxin A and soft-tissue fillers for wrinkle treatment have replaced conventional surgical procedures at the top of the list of the most frequently performed interventions [1]. Given that – unlike botulinum toxin A – said fillers are no prescription drugs but rather medicinal products, they can be purchased relatively easily. Thus, filler treatments are not only performed by physicians but increasingly frequently also by non-medical personnel, such as alternative (non-medical) practitioners or cosmeticians, or even by patients themselves [2, 3]. However, filler injections are not entirely risk free and may be associated with severe adverse effects, especially when done without the proper anatomical knowledge and medical expertise [2, 4–6]. In addition to infections and granulomas, vascular complications are undoubtedly among the more dramatic complications, as they can lead to skin necrosis, scarring and even vision loss [6–9]. Vascular complications are caused either by embolic occlusion due to direct intra-arterial filler injection or by functional arterial obstruction due to the injection of large volumes (of fillers) into the perivascular tissue. Especially critical arteries are those that provide the only – or at least primary – blood supply to certain skin areas. In case of their occlusion, adequate perfusion by collateral vessels is no longer ensured (functional end arteries). Other critical arteries include those from which there are potential anastomoses with the retinal vascular plexus. As a consequence, “risk sites” for filler injection are the areas along the course of the facial/angular artery, the nasal artery and the supratrochlear artery as well as the various temporal artery branches and include the glabella, the under-eye hollows, the nasal bridge and the temples. The vast majority of vascular complications following filler injections have been reported to occur in the aforementioned areas [2, 6–8]. This may be due to the fact that – unlike the depiction in anatomy textbooks – the course of virtually every facial vessel shows great interindividual variability. Consequently, it is not always possible to reliably locate any given facial vessel even if one has appropriate anatomical knowledge. Measures recommended to avoid vascular complications include aspiration and (slow) injection of small Clinical Letter","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84849225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Extracorporeal photopheresis (ECP) has been increasingly used off label for the treatment of various inflammatory disorders [1–3]. At our center, one of the most common indications for ECP – second only to stem cell transplantation (SCTx) – is graft-versus-host disease (GVHD). Proposed mechanisms of action of ECP in patients with chronic GVHD include a shift in the immune response from Th1 to Th2 dominance, proliferation of regulatory T cells (Tregs) and induction of anti-inflammatory cytokines [4–6]. In particular, chronic sclerotic GVHD (sGVHD) of the skin is a disease variant that is extremely difficult to treat. It is associated with severe physical impairments and reduced quality of life. In addition to restricted overall mobility, patients complain of limited excursion of the thorax and associated dyspnea, as well as stiffening of the abdominal wall with impaired intestinal motility. Severe sclerosis of the extremities may result in irreversible contractures that are associated with further sequelae [7]. Objective assessment of treatment success in patients with sGVHD is often challenging, given that there are hardly any useful tools in everyday clinical practice with which the extent and severity of sclerosis can be measured during treatment. While surveying the standardized photos that had been taken of our patients over the course of their treatment, we realized that objective photographic assessment of clinical improvement (or deterioration) was indeed possible. This observation prompted us to review the entire patient data. Herein, we present a retrospective analysis of a case series of 13 patients with recalcitrant sGVHD who underwent ECP (Cellex®, Therakos® Inc.) at our department between 2005 and 2018 (Table 1). The patients had a median history of sGVHD of 22 months prior to initiation of ECP and had not responded to conventional immunosuppressive treatment prescribed by the treating hematologists. ECP was administered off label following prior approval by the competent health insurance funds. One cycle included two treatment sessions on two consecutive days. All patients received at least 6–8 cycles at 14-day intervals. Subsequently, the intervals were gradually extended based on each patient’s individual response to treatment. The extent of sclerosis was documented on a regular basis using standardized whole-body photography. The defined whole and partial body pictures were taken repetitively using the same settings: Canon EOS 1 Dx Mark II, aperture (f) 11, exposure (t) 1/125 at ISO 100 using two flashlights of 500 W each against a studio-gray background. Patients received a median of 37 ECP cycles (range: 10 to 90 cycles). In one female patient, ECP was discontinued after twelve cycles despite subjective improvement, as her health insurance declined further coverage of the procedure. In one male patient, ECP was terminated after 15 cycles due to disease progression. Patients reported subjective improvement, such as softer skin a
体外光疗(Extracorporeal photopheresis, ECP)已越来越多地用于治疗各种炎症性疾病[1-3]。在我们的中心，仅次于干细胞移植(SCTx)的ECP最常见的适应症之一是移植物抗宿主病(GVHD)。ECP在慢性GVHD患者中的作用机制包括免疫反应从Th1主导向Th2主导转变、调节性T细胞(Tregs)的增殖和抗炎细胞因子的诱导[4-6]。特别是，皮肤的慢性硬化性GVHD (sGVHD)是一种极难治疗的疾病变体。它与严重的身体损伤和生活质量下降有关。除了整体活动受限外，患者还主诉胸腔活动受限和相关呼吸困难，以及腹壁僵硬伴肠蠕动受损。四肢严重硬化可导致不可逆挛缩，并伴有进一步的后遗症[7]。客观评估sGVHD患者的治疗成功通常具有挑战性，因为在日常临床实践中几乎没有任何有用的工具可以在治疗期间测量硬化症的程度和严重程度。在对患者治疗过程中拍摄的标准化照片进行调查时，我们意识到对临床改善(或恶化)进行客观的照片评估确实是可能的。这一观察结果促使我们回顾了整个患者数据。在此，我们对2005年至2018年期间在我科接受ECP (Cellex®，Therakos®Inc.)治疗的13例顽固性sGVHD患者的病例系列进行了回顾性分析(表1)。患者在开始ECP之前的中位sGVHD病史为22个月，并且对治疗血液学家规定的常规免疫抑制治疗无反应。经主管健康保险基金事先批准，ECP在标签外实施。一个周期包括连续两天的两次治疗。所有患者每隔14天至少接受6-8个周期的治疗。随后，根据每个患者对治疗的个体反应，间隔逐渐延长。使用标准化的全身摄影定期记录硬化症的程度。所定义的全身和局部照片使用相同的设置重复拍摄:佳能EOS 1 Dx Mark II，光圈(f) 11，曝光(t) 1/125, ISO 100，使用两个500w的手电筒，在工作室灰色背景下。患者接受了中位37个ECP周期(范围:10至90个周期)。在一名女性患者中，尽管主观情况有所改善，但在12个周期后停用ECP，因为她的健康保险进一步减少了该手术的覆盖范围。在一名男性患者中，由于疾病进展，ECP在15个周期后终止。患者仅在6个ECP周期(治疗3个月)后就报告了主观改善，如皮肤更柔软，活动能力改善(表1)。根据照片记录，硬化症的客观改善首次出现在治疗开始后的中位数25个月(相当于25个ECP周期)(图1 - 3，表1)。可客观改变包括皮肤鹅卵石质地的回归以及与硬化症相关的皮肤凹陷;后者表明深硬化症消退并累及筋膜。同样观察到客观解剖变化，包括腹部皮肤硬化引起的“大肚”外观消退和脐变窄。地衣硬化样斑块-作为DOI: 10.1111/ddg.13976的标志体外光移植术成功治疗硬化性皮肤移植物抗宿主病临床快报
{"title":"Successful treatment of sclerotic cutaneous graft‐versus‐host disease using extracorporeal photopheresis","authors":"Daniel Wagenknecht, M. Ziemer","doi":"10.1111/ddg.13976","DOIUrl":"https://doi.org/10.1111/ddg.13976","url":null,"abstract":"Extracorporeal photopheresis (ECP) has been increasingly used off label for the treatment of various inflammatory disorders [1–3]. At our center, one of the most common indications for ECP – second only to stem cell transplantation (SCTx) – is graft-versus-host disease (GVHD). Proposed mechanisms of action of ECP in patients with chronic GVHD include a shift in the immune response from Th1 to Th2 dominance, proliferation of regulatory T cells (Tregs) and induction of anti-inflammatory cytokines [4–6]. In particular, chronic sclerotic GVHD (sGVHD) of the skin is a disease variant that is extremely difficult to treat. It is associated with severe physical impairments and reduced quality of life. In addition to restricted overall mobility, patients complain of limited excursion of the thorax and associated dyspnea, as well as stiffening of the abdominal wall with impaired intestinal motility. Severe sclerosis of the extremities may result in irreversible contractures that are associated with further sequelae [7]. Objective assessment of treatment success in patients with sGVHD is often challenging, given that there are hardly any useful tools in everyday clinical practice with which the extent and severity of sclerosis can be measured during treatment. While surveying the standardized photos that had been taken of our patients over the course of their treatment, we realized that objective photographic assessment of clinical improvement (or deterioration) was indeed possible. This observation prompted us to review the entire patient data. Herein, we present a retrospective analysis of a case series of 13 patients with recalcitrant sGVHD who underwent ECP (Cellex®, Therakos® Inc.) at our department between 2005 and 2018 (Table 1). The patients had a median history of sGVHD of 22 months prior to initiation of ECP and had not responded to conventional immunosuppressive treatment prescribed by the treating hematologists. ECP was administered off label following prior approval by the competent health insurance funds. One cycle included two treatment sessions on two consecutive days. All patients received at least 6–8 cycles at 14-day intervals. Subsequently, the intervals were gradually extended based on each patient’s individual response to treatment. The extent of sclerosis was documented on a regular basis using standardized whole-body photography. The defined whole and partial body pictures were taken repetitively using the same settings: Canon EOS 1 Dx Mark II, aperture (f) 11, exposure (t) 1/125 at ISO 100 using two flashlights of 500 W each against a studio-gray background. Patients received a median of 37 ECP cycles (range: 10 to 90 cycles). In one female patient, ECP was discontinued after twelve cycles despite subjective improvement, as her health insurance declined further coverage of the procedure. In one male patient, ECP was terminated after 15 cycles due to disease progression. Patients reported subjective improvement, such as softer skin a","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83531096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anuläre lichenoide Dermatitis der Jugend: Fallberichte von zwei Erwachsenen und einem Kind","authors":"Hamidreza Mahmoudi, Alireza Ghanadan, Shabnam Fahim, Samane Moghanlou, Ifa Etesami, Maryam Daneshpazhooh","doi":"10.1111/ddg.13974_g","DOIUrl":"https://doi.org/10.1111/ddg.13974_g","url":null,"abstract":"","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76656772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roberto Maglie, Lavinia Quintarelli, Marzia Caproni, Emiliano Antiga
wir haben den Artikel von Wilk et al. über die klinisch-pathologischen Aspekte und das Management der erosiven pustulösen Dermatose der Kopfhaut (EPDK) gelesen und sehr begrüßt [1]. Wir möchten gerne unsere Erfahrungen mit einem Fall einer EDPK teilen, bei dem es durch eine Monotherapie mit Lymecyclin gelang, ein beeindruckendes Ansprechen zu erzielen. Ein 75-jähriger Mann kaukasischer Abstammung mit bekanntem Diabetes mellitus Typ II, metabolischem Syndrom, Hypertonie und chronischer Herzinsuffizienz wurde mit einem schmerzhaften, seit zwei Monaten bestehenden Ausschlag des Kopfes vorstellig. Bei der klinischen Untersuchung fanden sich zahlreiche konfluierende Erosionen mit erythematösen Rändern und Pusteln frontal und parietal sowie am Scheitel des Kopfes (Abbildung 1a). Differenzialdiagnostisch wurden bakterielle oder Pilzinfektionen, ein Schleimhautpemphigoid Typ Brunsting-Perry, Folliculitis decalvans und erosive pustulöse Dermatose des Kopfes (EPDK) in Betracht gezogen. Bei der histopathologischen Untersuchung einer Hautbiopsie einer Läsion zeigte sich eine fehlende Epidermis und ein gemischtzelliges, aus Neutrophilen und Plasmazellen bestehendes entzündliches Infiltrat in der Dermis. Eine direkte Immunfluoreszenz von periläsionaler Haut sowie Bakterienund Pilzkulturen waren negativ. Aufgrund der klinischen und histologischen Befunde wurde die Diagnose EPDK gestellt. Der Patient wurde über die Dauer von vier Wochen einmal täglich mit Clobetasol-Salbe behandelt, ohne dass eine Verbesserung eintrat. Weitere topische Therapieversuche lehnte der Patient ab. Aufgrund der Komorbidität waren systemische Therapien mit Prednisolon, Acitretin oder Dapson kontrainduziert. Es wurde daher eine Therapie mit Lymecyclin (300 mg/d) begonnen, was innerhalb von vier Wochen zu einer vollständigen Abheilung der Läsionen führte (Abbildung 1b). Lymecyclin wurde daraufhin abgesetzt. Bei der Nachuntersuchung nach sechs Monaten war kein Rezidiv aufgetreten. Clinical Letter
{"title":"Beeindruckendes Ansprechen auf Monotherapie mit Lymecyclin bei erosiver pustulöser Dermatose der Kopfhaut","authors":"Roberto Maglie, Lavinia Quintarelli, Marzia Caproni, Emiliano Antiga","doi":"10.1111/ddg.13978_g","DOIUrl":"https://doi.org/10.1111/ddg.13978_g","url":null,"abstract":"wir haben den Artikel von Wilk et al. über die klinisch-pathologischen Aspekte und das Management der erosiven pustulösen Dermatose der Kopfhaut (EPDK) gelesen und sehr begrüßt [1]. Wir möchten gerne unsere Erfahrungen mit einem Fall einer EDPK teilen, bei dem es durch eine Monotherapie mit Lymecyclin gelang, ein beeindruckendes Ansprechen zu erzielen. Ein 75-jähriger Mann kaukasischer Abstammung mit bekanntem Diabetes mellitus Typ II, metabolischem Syndrom, Hypertonie und chronischer Herzinsuffizienz wurde mit einem schmerzhaften, seit zwei Monaten bestehenden Ausschlag des Kopfes vorstellig. Bei der klinischen Untersuchung fanden sich zahlreiche konfluierende Erosionen mit erythematösen Rändern und Pusteln frontal und parietal sowie am Scheitel des Kopfes (Abbildung 1a). Differenzialdiagnostisch wurden bakterielle oder Pilzinfektionen, ein Schleimhautpemphigoid Typ Brunsting-Perry, Folliculitis decalvans und erosive pustulöse Dermatose des Kopfes (EPDK) in Betracht gezogen. Bei der histopathologischen Untersuchung einer Hautbiopsie einer Läsion zeigte sich eine fehlende Epidermis und ein gemischtzelliges, aus Neutrophilen und Plasmazellen bestehendes entzündliches Infiltrat in der Dermis. Eine direkte Immunfluoreszenz von periläsionaler Haut sowie Bakterienund Pilzkulturen waren negativ. Aufgrund der klinischen und histologischen Befunde wurde die Diagnose EPDK gestellt. Der Patient wurde über die Dauer von vier Wochen einmal täglich mit Clobetasol-Salbe behandelt, ohne dass eine Verbesserung eintrat. Weitere topische Therapieversuche lehnte der Patient ab. Aufgrund der Komorbidität waren systemische Therapien mit Prednisolon, Acitretin oder Dapson kontrainduziert. Es wurde daher eine Therapie mit Lymecyclin (300 mg/d) begonnen, was innerhalb von vier Wochen zu einer vollständigen Abheilung der Läsionen führte (Abbildung 1b). Lymecyclin wurde daraufhin abgesetzt. Bei der Nachuntersuchung nach sechs Monaten war kein Rezidiv aufgetreten. Clinical Letter","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88576256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Augustin, D. Wilsmann-Theis, A. Körber, M. Kerscher, G. Itschert, M. Dippel, P. Staubach
Xerosis cutis (also referred to as xeroderma, dry skin, asteatosis) affects more than 10 million individuals in Germany. It is among the most common dermatological diagnoses and a cardinal symptom of many dermatological, internal and neurological diseases. Even though it has been established that basic skin care plays a significant role in the management of patients with xerosis cutis, there are as yet no evidence‐based algorithms for diagnosis and treatment.
{"title":"Diagnosis and treatment of xerosis cutis – a position paper","authors":"M. Augustin, D. Wilsmann-Theis, A. Körber, M. Kerscher, G. Itschert, M. Dippel, P. Staubach","doi":"10.1111/ddg.13906","DOIUrl":"https://doi.org/10.1111/ddg.13906","url":null,"abstract":"Xerosis cutis (also referred to as xeroderma, dry skin, asteatosis) affects more than 10 million individuals in Germany. It is among the most common dermatological diagnoses and a cardinal symptom of many dermatological, internal and neurological diseases. Even though it has been established that basic skin care plays a significant role in the management of patients with xerosis cutis, there are as yet no evidence‐based algorithms for diagnosis and treatment.","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90989953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Weins, T. Biedermann, K. Eyerich, S. Moeckel, C. Schnopp
Dyshidrotic eczema (DE) is a cutaneous reaction characterized by acute eruption of pruritic vesicles on the palms and soles. In severe cases vesicles may coalesce to form blisters, and secondary complications (e.g. painful erosions and rhagades) may also compromise the patients’ daily life. Dyshidrotic eczema is thought to be a variant of atopic dermatitis (AD) in most cases [1]. However, DE may also occur as a manifestation of allergic contact dermatitis or as a hyperergic reaction to dermatomycosis. The exact prevalence of DE is unknown, but probably accounts for up to 20 % of all cases of hand and foot eczema [1]. Dyshidrotic eczema typically affects young adults, but may also be seen in children [1]. Besides avoidance of aggravating factors and use of emollients, topical corticosteroids and phototherapy are still the mainstay of management of atopic DE, but the individual response is often limited [2, 3]. As not all patients achieve stable improvement or complete remission with these treatments, systemic therapy may be indicated – especially in very severe or chronic cases. Besides corticosteroid pulse therapy, immunosuppressive approaches with cyclosporine A (CyA), azathioprine or methotrexate (MTX) have been reported, mostly in adults [1, 2]. We describe the case of a 12-year-old boy with recalcitrant dyshidrotic eczema (DE) successfully treated with the human monoclonal antibody dupilumab. To the best of our knowledge this is the first pediatric case showing efficacy of dupilumab in the treatment of DE. The boy presented to our outpatient clinic with a 6-month history of painful vesicular eczema of the hands and feet. Before admission, he was treated with topical and systemic antimicrobials as well as UVA and topical corticosteroids (prednicarbate) without effect. Besides AD in early childhood there was no history of allergic rhinoconjunctivitis, asthma or other diseases. There was no evidence of contact allergy. Previous histopathology showed intraepidermal vesicles, epidermal spongiosis, parakeratosis and orthokeratosis as well as a mixed-cell perivascular dermal infiltrate, compatible with DE. Routine laboratory investigations revealed a slightly elevated level of total IgE (147 IU/ml), but no further pathology or signs of infection (swab, culture). Massive vesiculation with pruritus and painful erosions led to four in-patient treatments (> 35 days) with repeated school absences (> 75 days) and social withdrawal. The boy’s school performance dropped due to massively impaired concentration, manual skills (writing) and mobility, and finally he did not pass his grade. On examination, the palms and soles showed crops of clear to yellowish vesicles and bullae on an erythematous ground (Figure 1a, b). The rest of the skin was normal. With daily application of potent corticosteroids (mometasone furoate) extensive blistering continued. Transient remission was achieved with oral pulses of prednisolone (1 mg/kg bw) but tapering down prednisolone
{"title":"Successful treatment of recalcitrant dyshidrotic eczema with dupilumab in a child","authors":"A. Weins, T. Biedermann, K. Eyerich, S. Moeckel, C. Schnopp","doi":"10.1111/ddg.13929","DOIUrl":"https://doi.org/10.1111/ddg.13929","url":null,"abstract":"Dyshidrotic eczema (DE) is a cutaneous reaction characterized by acute eruption of pruritic vesicles on the palms and soles. In severe cases vesicles may coalesce to form blisters, and secondary complications (e.g. painful erosions and rhagades) may also compromise the patients’ daily life. Dyshidrotic eczema is thought to be a variant of atopic dermatitis (AD) in most cases [1]. However, DE may also occur as a manifestation of allergic contact dermatitis or as a hyperergic reaction to dermatomycosis. The exact prevalence of DE is unknown, but probably accounts for up to 20 % of all cases of hand and foot eczema [1]. Dyshidrotic eczema typically affects young adults, but may also be seen in children [1]. Besides avoidance of aggravating factors and use of emollients, topical corticosteroids and phototherapy are still the mainstay of management of atopic DE, but the individual response is often limited [2, 3]. As not all patients achieve stable improvement or complete remission with these treatments, systemic therapy may be indicated – especially in very severe or chronic cases. Besides corticosteroid pulse therapy, immunosuppressive approaches with cyclosporine A (CyA), azathioprine or methotrexate (MTX) have been reported, mostly in adults [1, 2]. We describe the case of a 12-year-old boy with recalcitrant dyshidrotic eczema (DE) successfully treated with the human monoclonal antibody dupilumab. To the best of our knowledge this is the first pediatric case showing efficacy of dupilumab in the treatment of DE. The boy presented to our outpatient clinic with a 6-month history of painful vesicular eczema of the hands and feet. Before admission, he was treated with topical and systemic antimicrobials as well as UVA and topical corticosteroids (prednicarbate) without effect. Besides AD in early childhood there was no history of allergic rhinoconjunctivitis, asthma or other diseases. There was no evidence of contact allergy. Previous histopathology showed intraepidermal vesicles, epidermal spongiosis, parakeratosis and orthokeratosis as well as a mixed-cell perivascular dermal infiltrate, compatible with DE. Routine laboratory investigations revealed a slightly elevated level of total IgE (147 IU/ml), but no further pathology or signs of infection (swab, culture). Massive vesiculation with pruritus and painful erosions led to four in-patient treatments (> 35 days) with repeated school absences (> 75 days) and social withdrawal. The boy’s school performance dropped due to massively impaired concentration, manual skills (writing) and mobility, and finally he did not pass his grade. On examination, the palms and soles showed crops of clear to yellowish vesicles and bullae on an erythematous ground (Figure 1a, b). The rest of the skin was normal. With daily application of potent corticosteroids (mometasone furoate) extensive blistering continued. Transient remission was achieved with oral pulses of prednisolone (1 mg/kg bw) but tapering down prednisolone ","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80274780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Weins, T. Biedermann, K. Eyerich, S. Moêckel, C. Schnopp
{"title":"Erfolgreiche Behandlung eines schweren dyshidrosiformen Ekzems mit Dupilumab bei einem Kind","authors":"A. Weins, T. Biedermann, K. Eyerich, S. Moêckel, C. Schnopp","doi":"10.1111/ddg.13929_g","DOIUrl":"https://doi.org/10.1111/ddg.13929_g","url":null,"abstract":"","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87793979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Die Zusammenarbeit der DDG mit den Sri Lankanischen Dermatologen","authors":"D. Reinel","doi":"10.1111/ddg.13969_g","DOIUrl":"https://doi.org/10.1111/ddg.13969_g","url":null,"abstract":"","PeriodicalId":14702,"journal":{"name":"JDDG: Journal der Deutschen Dermatologischen Gesellschaft","volume":"170 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75996365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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