Journal Der Deutschen Dermatologischen Gesellschaft最新文献

Background and objectives: Psoriasis is a chronic inflammatory skin disease, and noninvasive diagnostic tools are essential for accurate diagnosis and treatment monitoring. Multiphoton microscopy (MPM) enables real-time, noninvasive skin imaging with submicron resolution. This study evaluated the diagnostic accuracy of MPM in psoriasis and its potential application in therapeutic monitoring.

Patients and methods: This prospective observational study enrolled 34 patients with psoriasis. It comprised three parts: (1) analysis of imaging features of lesional and nonlesional skin using multiphoton microscopy (MPM; Transcend Vivoscope); (2) evaluation of the diagnostic performance of MPM parameters compared with reflectance confocal microscopy (RCM); and (3) prospective monitoring of 24 patients treated with Benvitimod (Tapinarof) cream for 8 weeks (T0/T1/T2).

Results: MPM detected psoriasis characteristics (including hyperkeratosis, parakeratosis, an absent stratum granulosum, enlarged nucleus diameter, and absent bright rimming) with comparable diagnostic efficiency to RCM (AUC = 0.838, p < 0.001 vs. 0.824, p < 0.001). Psoriatic lesions showed significant perinuclear fluorescence accumulation compared to healthy skin (p < 0.001). All imaging features improved significantly after 8 weeks of treatment (p < 0.001). PASI/TLS scores showed correlations with the epidermal thickness (r = 0.403/0.492, p < 0.001), nuclear diameter (r = 0.4/0.375, p < 0.001), and fluorescence intensity (r = -0.419/-0.492, p < 0.001).

Conclusions: MPM is a novel and non-invasive imaging technique for psoriasis evaluation and treatment monitoring.

The development of immune checkpoint inhibitors and targeted therapies has fundamentally changed the treatment of cutaneous malignancies, especially in squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The latest neoadjuvant approaches have shown promising results in locally advanced stages. In squamous cell carcinoma, neoadjuvant PD-1 blockade with cemiplimab has demonstrated a high pathological response rate. Initial data additionally indicate a lowered risk of recurrence. Even greater progress has been made in melanoma: Neoadjuvant PD-1 blockade, both alone and in combination with a CTLA-4 blocker, significantly reduces the risk of recurrence. Both the randomized Phase II SWOG1801 study and the randomized Phase III NADINA study have demonstrated the superiority of the neoadjuvant approach over a pure adjuvant one. The results of the NADINA study showed that a deep pathological response to neoadjuvant therapy allows treatment de-escalation by omission of adjuvant therapy. Targeted therapies with BRAF-MEK inhibition also show adequate response rates in BRAF-mutated melanomas. In Merkel cell carcinoma, the neoadjuvant administration of PD-1 inhibitors like Nivolumab shows a high response rate and promising survival data. In summary, the data highlight the potential of neoadjuvant therapy in the treatment of locally advanced skin tumors, reducing the risk of recurrence and mortality, as well as providing new opportunities for therapy de-escalation.

Background and objectives: Diagnosing cicatricial alopecia is challenging. Even with histology, a definitive diagnosis cannot always be made. Line-field confocal optical coherence tomography (LC-OCT), a non-invasive imaging method with high resolution used in vivo, has proven helpful in diagnosing scarring alopecia. This study aims to evaluate the potential of LC-OCT for the differential diagnosis of different types of scarring alopecia.

Patients and methods: Images of 30 patients with scarring alopecia (10 Lichen planopilaris/Frontal fibrosing alopecia (LPP/FFA), 10 lupus erythematosus, 10 folliculitis decalvans/Folliculitis et perifolliculitis capitis suffodiens et abscedens (FD/FSA)) and 10 healthy controls were analyzed by two blinded independent examiners. Characteristic features and differential diagnoses were determined for each case.

Results: LC-OCT revealed distinct characteristics for each of the four subgroups, facilitating differential diagnosis with 100% sensitivity for lupus and 90% for LPP/FFA, FD/FSA, and the control group, and 100% specificity for LPP/FFA and 96.7% for the other groups. The features were used to generate a diagnostic algorithm tree.

Conclusions: With LC-OCT, specific criteria can be used to differentiate between subtypes of scarring alopecia. These preliminary findings provide a basis for hypothesis generation, which should be further explored in larger cohorts and in longitudinal studies assessing treatment response over time.

Background and objectives: Acne affects not only adolescents but also adults, significantly impacting their physical and mental health. This study aims to investigate the prevalence, incidence, and disability-adjusted life years (DALYs) of post-adolescent acne vulgaris among adults aged 25-49 years globally from the years 1990 to 2021.

Patients and methods: We collected information on all individuals aged 25-49 years with post-adolescent acne. Data from the Global Burden of Diseases (GBD) study (2021) for 204 countries and territories was analyzed. The study focused on prevalence, incidence, DALYs, and estimated annual percentage change for post-adolescent acne. Bayesian age-period-cohort models predicted incidence trends from 2022 to 2050.

Results: Globally, the age-standardized prevalence rate of post-adolescent acne increased from 1990 to 2021, with females having a higher burden than males. Germany reported the highest age-standardized prevalence rate, age-standardized incidence rate, and age-standardized DALYs rate. High socio-demographic index (SDI) regions had the highest rates, while low-middle SDI regions showed the most substantial increase. The number of adults with post-adolescent acne is projected to increase until 2050.

Conclusions: Post-adolescent acne vulgaris remains prevalent and is increasing globally. Comprehensive and targeted interventions are urgently needed to mitigate its impact, as projections indicate a continued rise in incidence.

Background and objectives: Complete lymph node dissection (CLND) is the standard of care in patients with regional nodal melanoma macrometastasis. However, evidence on surgical procedures in the era of adjuvant systemic therapies is lacking.

Patients and methods: This retrospective multi-center study included stage IIIB-D melanoma patients with nodal macrometastasis undergoing CLND or selective lymph node extirpation (LNE) prior to adjuvant therapy. CLND and LNE were compared regarding recurrence-free survival (RFS), nodal metastasis-free survival (NFS) and overall survival (OS).

Results: 320 melanoma patients were included (median age 62; 55.5% male). Patients received PD-1 monotherapy (77.8%), targeted therapy (21.3%) or both sequentially (0.9%), as well as adjuvant radiotherapy in 40.9%. RFS and OS did not differ significantly between patients receiving CLND or LNE, while NFS was significantly prolonged following CLND (HR 0.3917; p = 0.005). After adjustment for risk factors by multivariate Cox regression, a prolonged RFS for CLND vs. LNE was found (HR 0.676; p = 0.04), but no benefit for OS. The rate of complications was significantly higher in the CLND group.

Conclusions: CLND showed no OS benefit compared to LNE, while local control was improved. CLND can be recommended in the context of adjuvant therapies, however, the increased rate of complications should be considered.

Background: This study explored UV exposure and prevention behaviors among melanoma patients, focusing on occupational UV exposure, melanoma characteristics, risk awareness, and protective behaviors.

Patients and methods: This cross-sectional study analyzed demographics, melanoma characteristics, UV exposure, awareness, and preventive measures. Data were stratified by occupational exposure (indoor vs. outdoor) and analyzed using logistic regression to identify predictors for melanoma location.

Results: Among 406 patients (54% female; median age 57), 59 (15%) had a history of outdoor work. Outdoor workers were more likely to develop melanoma in sun-exposed areas. They also had a higher prevalence of facial melanoma (p = 0.020); those with facial involvement had worked outdoors twice as long as those with melanoma at other sites, indicating a dose-effect relationship. Logistic regression identified outdoor work (OR 2.47) and age (OR 1.05) as significant predictors of facial melanoma. A total of 229 patients (57%) were unaware of the potential harms of UV radiation before diagnosis. Among outdoor workers, only 3 (5%) reported frequent sun protection, while 33 (56%) used it rarely or never.

Conclusions: Outdoor work is a significant risk factor for facial melanoma in this cohort. Sun protection and UV awareness remain insufficient, particularly among outdoor workers, highlighting the need for targeted prevention.

Background: Erysipelas, caused by streptococci, should be treated with penicillin, while uncomplicated cellulitis (phlegmon), often caused by Staphylococcus aureus, requires penicillinase-resistant beta-lactam antibiotics, which have a higher risk of adverse effects. Distinguishing between these infections is important. Constitutional symptoms like chills and fever may help in diagnosis. Therefore, we have compared retrospectively how frequently patients with erysipelas versus patients with cellulitis have experienced constitutional symptoms and whether they responded to penicillin.

Patients and methods: We retrospectively evaluated patients with erysipelas or cellulitis admitted to the dermatology department of the university hospital Halle between January 2024 and January 2025. They had been managed according to an internal standard operation procedure for skin- and soft tissue infections.

Results: Of 76 erysipelas patients without other infections, 91.4% reported constitutional symptoms at or before erythema onset, among them 17 of 18 patients with recurrent erysipelas. In contrast, only 36.2% of 47 cellulitis patients experienced such symptoms, typically later and not before erythema. Of patients with erysipelas, 98.3% responded within 2 days to penicillin, including 21 patients who had experienced symptoms for already 4 to 10 days prior to therapy.

Conclusions: Our findings suggest that early constitutional symptoms and characteristic erythema are reliable indicators for erysipelas. Erysipelas do not tend to heal promptly and spontaneously but respond reliably to penicillin.