Dermatologie (Heidelberg, Germany)最新文献

Genital herpes, caused by the herpes simplex virus (HSV), is one of the most common sexually transmitted infections worldwide and the leading cause of genital ulcers. The virus is globally primarily transmitted by HSV‑2, although HSV‑1, especially in Europe, is increasingly recognized as a cause of genital first-episode infections. Many infections are asymptomatic, making unnoticed viral shedding the most frequent mode of transmission. Infection is preferably confirmed using polymerase chain reaction (PCR) from intact vesicles. Early and comprehensive patient education regarding symptoms, treatment options, and potential implications for sexual health is of great importance. Antiviral therapy, preferentially with acyclovir and valacyclovir can reduce both the severity and duration of the infection. For recurrent infections, suppressive antiviral treatment is recommended to decrease the frequency of recurrences and the transmission risk. Specific recommendations should be followed for special patient groups such as pregnant women and immunocompromised individuals.

Porokeratosis ptychotropica is a very rare subtype of porokeratosis, which is a heterogeneous group of inherited keratinization disorders. It is associated with verrucous, extensive hyperkeratotic plaques in the perigenital, gluteal, and inguinal regions. Histologically, porokeratosis exhibits the pathognomonic hallmark known as cornoid lamellae. Treatment results are generally disappointing and recurrence rates are high.

Lichen planus pigmentosus inversus (LIPPI) is a rare variant of lichen planus, predominantly affecting intertriginous skin areas. Existing knowledge is mostly based on case reports, with few systematic reviews available. A systematic literature search identified 105 cases from case reports and series. Extracted data included demographics, clinical features, comorbidities, treatments, and outcomes. Statistical analysis included descriptive methods and uni-/multivariate logistic regression. The cohort was 64.8% female, with a median age of 58 years. Most lesions affected multiple inverse areas (55.2%). Pruritus was reported only in 44.8% of patients. Median time to diagnosis was 6 months. Treatment response was observed in 47.6% of cases, mostly with topical corticosteroids or calcineurin inhibitors. Pruritus proved to be a strong predictor of treatment response (odds ratio [OR] 4.17), as did, to a lesser extent, shorter disease duration until diagnosis (OR 0.93 per month). Ethnicity and comorbidities had no significant effect in multivariate analysis. LIPPI presents with considerable clinical and demographic variability. Pruritus and early diagnosis may be associated with better treatment outcomes and could serve as relevant prognostic indicators.

Background: Penile urethritis is a common medical condition, usually caused by sexually transmitted pathogens such as Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) or Mycoplasma genitalium (MG). Although the causative pathogens cannot be reliably distinguished based on the clinical presentation alone, symptom-oriented empirical antibiotic therapy is often administered in practical care.

Material and methods: This is a summary of the recommendations from the S3 guidelines on the management of male adolescents and adults with symptoms of urethritis. The development of the guidelines was funded by the Innovation Committee of the Federal Joint Committee (Innovationsausschuss des Gemeinsamen Bundesausschusses, G‑BA; grant number 01VSF21021).

Results: The guidelines present a symptom-oriented, evidence-based approach for suspected penile urethritis, considering pathogen epidemiology and possible coinfections and contains a flowchart for clinical management. This includes criteria for or against empirical antibiotic therapy before receiving pathogen detection results as well as guidance on the classification as gonococcal or non-gonococcal urethritis based on clinical and microscopic findings. The recommendations for empirical therapy advise against the use of azithromycin as first-line treatment of urethritis to avoid further promoting resistance in NG and MG.

Discussion: A detailed presentation of the recommendations and underlying evidence can be found in the freely accessible guideline publication at the Association of the Scientific Medical Societies in Germany (AWMF): https://register.awmf.org/de/leitlinien/detail/013-099 .

The incidence of sexually transmitted diseases continues to rise. According to the most recent European Centre for Disease Prevention and Control (ECDC) data, infections with Neisseria (N.) gonorrhoeae have increased by more than 300% over the past 10 years. The growing antimicrobial resistance of N. gonorrhoeae and Mycoplasma (M.) genitalium is leading to infections that are increasingly difficult to treat. Multidrug-resistant strains ("superbugs") cause persistent infections and increased transmission. Thus, a review of recent studies and current guidelines was conducted. N. gonorrhoeae is showing increasing resistance to penicillins, tetracyclines, and fluoroquinolones; furthermore, there is a growing reduction in susceptibility to the macrolide antibiotic azithromycin. Resistance rates to ceftriaxone, the current first-line therapy in many international treatment guidelines, and to cefixime, the peroral treatment option frequently used in outpatient settings, remain very low in German-speaking countries. For M. genitalium, increasing resistance is observed primarily to macrolides and, less commonly, to fluocinolones; cases of infections with combined resistance to both antimicrobial classes have been reported and regularly require the use of reserve antibiotics such as pristinamycin or sitafloxacin. Enhanced surveillance, molecular resistance testing, avoidance of overdiagnosis, rational and responsible antibiotic use (preventing overtreatment), and the development and implementation of new antimicrobial agents are crucial for sustainable infection control.

Chronic inflammatory dermatoses are among the most common skin disorders and can also affect the genitoanal region. In these locations, they are often recognized late, display a wide range of clinical manifestations, and require thorough dermatological evaluation. This article provides an overview of selected inflammatory dermatoses involving the genitoanal region, with particular emphasis on clinical presentation, diagnostic work-up, and therapeutic approaches.