Journal Der Deutschen Dermatologischen Gesellschaft最新文献

Background: Chronic spontaneous urticaria (CSU) significantly impairs patients' quality of life. Despite advances in diagnosis and therapy, treatment is still unsatisfactory. Telemedicine offers a promising solution to improve treatment. This pilot study assesses the acceptability and utilization of a digital health model for CSU, examines its impact on disease management, and identifies technical challenges.

Patients and methods: In this prospective pilot study, CSU patients at a university hospital in Germany were included. Over 12 months, participants interacted with physicians via a telemedicine platform, which was the study-specific intervention. After each three-month digital visit, symptoms and quality of life were assessed using electronic patient reported outcomes (ePROs) and online questionnaires. In the end, patients and doctors rated the overall satisfaction, the user-friendliness of the platform and the technical challenges.

Results: 24 patients completed the study. The majority (92%) reported that the digital concept could be a promising alternative to traditional consultations. Analysis from baseline to end of study revealed that disease control remained stable while quality of life improved. All physicians found the digital application reliable and time-saving.

Conclusions: This pilot study demonstrates the feasibility and high acceptance of a digital health model for the management of CSU. Further research with larger cohorts is needed and planned to determine broader applicability.

Background: Comprehensive skin cancer screening was introduced in Germany in 2008. It is unclear whether subsequently observed changes in the epidemiology of malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are due to the screening. Simulation models are used to compare different screening scenarios with each other and with observed incidence and mortality trends.

Methods: A microsimulation model for MM, SCC, and BCC was programmed and validated separately by sex on skin cancer-specific mortality data. In addition to the currently practiced screening (biennial offer, annual participation probability 15%), triennial screening, screening with increased participation, e.g., via invitation, and no screening were simulated. Incidence, mortality, costs, and life-years gained were simulated for 30 years from the start of screening.

Results: Compared with no screening, mortality is reduced by 13.8% in the simulation with current conditions. This effect occurs in the first years after screening starts before reaching a stable level. More screening allows for further increases in incidence, life-years gained, and costs and decreases in mortality. Comparing simulated and observed effects shows little agreement.

Conclusions: The model is useful for comparing screening scenarios to identify potential optimization opportunities in SCS. Additional, especially risk-adapted, screening scenarios should be investigated.

The incidence of skin cancer is rising continuously. The time of diagnosis is decisive for the morbidity and mortality risk of patients. An optimal screening procedure has yet to be established. Non-contact imaging methods are of great interest but have not yet been sufficiently developed and investigated for large-scale use. Compared to digital photography, infrared thermography offers the additional information of heat radiation from the skin surface, which correlates strongly with malignant changes. Literature on the current scientific status of screening, diagnosis and monitoring of skin cancer using thermographic procedures was identified in PubMed, Embase, and Google Scholar. From a technical and information technology point of view, infrared thermography is very well suited for use as a non-invasive, cost-effective, time-saving, and easy-to-use screening instrument. However, there is still a lack of reliable evidence and practical implementation in 3D systems suitable for mass use. Research in this area should be intensified in order to develop, test and establish applicable systems on a large scale.

Lichen sclerosus (LS) is a chronic, inflammatory dermatosis most commonly characterized by changes in skin pigmentation and pruritus, with associated dyspareunia and genital architectural changes. There are a variety of complications associated with LS, which further worsen a patient's health-related quality of life. A systematic review was conducted to summarize the literature regarding clinical features of LS, as well as LS-associated complications. In total, 900 studies were included, which represented 17,011 clinical presentations and 2,795 complications of LS in women, and 5,745 clinical presentations and 769 complications of LS in men. In both sexes, the majority of reported cases (77% in females, 99% in males) localized to the genitals. In women, presentations were spread amongst loss of normal architecture (14%), pigmentary changes (21%) and pruritus (18%), whereas in men a greater portion of cases presented with architectural alterations (34%), as well as pigmentary changes (15%) and urogenital symptoms (15%). Other classes of LS-associated presentations included textural changes, atrophy, pain/burning/discomfort, erosions/ulcerations/excoriations, bleeding/bruising/purpura, defecatory symptoms and bullae. A small portion of cases found in the literature presented with asymptomatic LS. LS-associated complications included skin neoplasms, urogenital issues and sexual dysfunction, including dyspareunia.

Background: Basal cell carcinoma (BCC) is a prevalent type of skin cancer in which the inherent subjectivity of dermoscopy poses diagnostic challenges. Existing AI systems, which provide mainly image-level insights, lack the interpretability that is crucial for effective clinical decisions and patient education.

Patients and methods: Our study developed a refined BCC dataset from the Human‒Machine Adversarial Model (HAM10000), which was annotated by clinicians to identify key diagnostic features. We integrated the ResNet50 and Mask R-CNN architectures to enhance the model's performance by synthesizing feature-related knowledge. Statistical evaluations, such as grouped bar charts and line graphs, validated the improvement in our clinical diagnosis evaluation scheme.

Results: The RFSD-BCC system significantly enhanced the diagnosis of BCC, with higher sensitivity, specificity, and accuracy. The system achieved an area under the precision-recall curve of 0.84, which closely matches physicians' diagnoses with high R² values and low MAEs. With the RFSD-BCC, the sensitivity increased by 7%, the specificity increased by 11%, the accuracy increased by 10%, and the intraclass correlation coefficient increased by 6%, which demonstrates the system's effectiveness in clinical settings.

Conclusions: The RFSD-BCC system improves BCC diagnosis by integrating feature combination models, which enhances both sensitivity and specificity. It offers interpretable diagnoses that bridge AI analysis with clinical practice, significantly improving clinicians' diagnostic accuracy and fostering better patient understanding.

Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of the heterogeneous group of cutaneous T-cell lymphomas (CTCL). With the expansion of the biologic treatment landscape, new treatment options have become available in recent years, most notably the C-C chemokine receptor 4 (CCR4)-directed monoclonal antibody mogamulizumab. Based on the phase III pivotal trial, mogamulizumab is recommended by the German S2k guidelines for the second-line treatment of stage IB and above SS and MF, after at least one prior systemic therapy. Since then, new insights on safety and efficacy of mogamulizumab were generated by post hoc analyses and real-world evidence. A panel of CTCL-experts discussed available literature and own experiences and developed relevant recommendations on the use of mogamulizumab in clinical practice in Germany. The recommendations cover patient criteria, prior therapies, use of mogamulizumab as monotherapy or combination therapy, management of side effects, duration of therapy, and monitoring schedules. The aim of these clinical recommendations is to support healthcare professionals in their decision-making and use of mogamulizumab in daily practice.

Port-wine birthmarks (PWB) are common vascular malformations in infants. Despite various laser and light-based treatments, comparative data on their effectiveness is limited. This study compares different treatments for PWB using a systematic review and network meta-analysis (NMA). We searched for randomized controlled trials (RCTs) and ongoing studies up to November 2023: Primary outcomes were patient satisfaction, investigator-assessed reduction in redness, and long-term adverse events (AEs). Risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. We identified 27 RCTs for qualitative analysis and twelve RCTs for the NMA, covering 1033 observations, 19 treatments, and three sub-networks. Seven studies reported on patient satisfaction. Hemoporfin-mediated photodynamic therapy was more effective in lesion clearance than PDL but had the highest risk of AEs. The 755 nm alexandrite laser and the combination of 595 nm PDL + 1064 nm Nd:YAG also showed high AE risks. Treatment discontinuation rates due to AEs did not significantly differ. Most studies had unclear bias risks, mostly owing to insufficient reporting. This study is the first NMA comparing laser- and light-based therapies for PWB. Further well-designed studies are warranted to determine optimal methods and patient-influencing factors for individualized treatments.

Background and objectives: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are common causes of cicatricial alopecia. While several studies have demonstrated the usefulness of non-invasive imaging methods such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) for the diagnosis of scarring alopecia, this study aimed to identify characteristic features of cicatricial alopecia in LPP/FFA using line-field confocal OCT (LC-OCT).

Patients and methods: Fifty-one patients (26 LPP, 24 FFA, 1 LPP and FFA) were prospectively analyzed with LC-OCT at three defined locations on the scalp: (1) scarring area = lesion, (2) scar-hair boundary = transition zone and (3) healthy area for the presence of the following pre-defined criteria: no hair follicles left, destructed hair follicles, dermal sclerosis, no rimming of the dermal papillae, epidermal and dermal inflammatory infiltrate, infundibular hyperkeratosis, dilated blood vessels, hypervascularization, melanophages, epidermal pigment incontinence.

Results: Comparison of the transition zone with healthy control sites revealed the four main LC-OCT features in LPP/FFA: dermal sclerosis (100%), dermal inflammatory infiltrate (90.2%), infundibular hyperkeratosis (60.8%) and hypervascularization (76.5%).

Conclusions: LC-OCT detects specific criteria of pathological changes in LPP/FFA around hair follicles in the epidermis and dermis and therefore can be used for further studies investigating scarring alopecia.