Dermatologie (Heidelberg, Germany)最新文献

Skin aging is divided into intrinsic and extrinsic aging, encompassing pigmentary, vascular, connective tissue, and fat tissue aspects that contribute to this complex process. Aging is genetically determined but is influenced by environmental factors such as ultraviolet radiation, air pollution, and smoking. Skin aging has not only cosmetic but also functional implications, as the loss of the extracellular matrix, especially hyaluronate, impairs the mechanical functions of the skin. Hyaluronate, which stabilizes skin structures, acts as a cushion and reduces susceptibility to skin tears. Dermatoporosis, a term coined by Saurat, describes the functional dimension of skin aging, manifesting in various stages from skin atrophy to severe complications like skin necrosis. It is increasingly observed in older patients, particularly from age 70 onwards. Prevalence ranges from 22% in women to 38% in men, with higher rates in patients undergoing chronic steroid therapy and certain conditions. Diagnosis is made through clinical examination and skin thickness measurement via ultrasound. Prevention involves limiting exposure to harmful factors and using specific treatments such as hyaluronic acid and topical retinoids to improve skin health.

In many disorders, skin and/or mucosal changes are dominated by blisters, wounds, or erosions. While these changes can be observed during infective, traumatic, metabolic, or inflammatory processes, these are normally clinical hallmarks of the disruption of the cytoarchitectural stability of the skin. Several proteins, such as those located in the dermal-epidermal junction zone and forming the hemidesmosomes, or those forming epidermal desmosomes are crucial for the maintenance of skin integrity. Defective function may be genetically determined due to impaired or absent production of specific proteins (i.e., epidermolysis bullosa) or due to autoimmune disorders that lead to the production of autoreactive antibodies targeting desmosomal or hemidesmosomal skin antigens. The latter group of diseases are classically named autoimmune blistering diseases of the skin. These can be divided in the pemphigoid group, where antigens are components of the hemidesmosomes, and pemphigus group, where desmosomal proteins are targeted. In this review, we provide a short vademecum of autoimmune skin disorders that are associated with skin fragility.

We report on two cases of nail tumors associated with onychorrhexis, distal V‑shaped onycholysis, and subungual keratosis. Surgical exposure was performed in each case to confirm the diagnosis. Histopathological examination revealed skin changes consistent with onychopapilloma. We describe two common surgical techniques in the treatment of onychopapilloma: classical longitudinal excision and alternative tangential excision with corresponding follow-up.

Erythema nodosum (EN) is the most frequently occurring form of acute panniculitis. It is characterized by painful red to livid raised nodules or bumps that typically occur symmetrically in the shin area. The cause of EN is often a reaction of the immune system to various triggers including infections, inflammatory diseases or medications. In approximately half of the cases no trigger can be identified. After treatment of the underlying pathology EN is typically self-limiting.

The skin's barrier function is primarily maintained by the cohesion of its layers and the specialized stratum corneum. Genetic and autoimmune disorders that result in skin fragility have significantly contributed to understanding the role of various molecular components in the skin. These conditions, characterized by blisters, erosions, wounds, and impaired wound healing, are rare but must be considered in clinical differential diagnoses. Key cutaneous adhesion structures include the epidermal basement membrane, anchoring fibrils, cell-matrix adhesions (e.g., hemidesmosomes and focal adhesions), and cell-cell adhesions (e.g., desmosomes and corneodesmosomes). These multiprotein suprastructures not only provide structural support but also participate in signaling processes and physiological or pathological conditions such as skin aging and wound healing. Additionally, dermal connective tissue plays a structural role and serves as a reservoir for proteases, growth factors, and cytokines. Modern techniques like single-cell and spatial transcriptomics, combined with artificial intelligence algorithms, are advancing the molecular mapping of human skin. Moreover, this review highlights the molecular composition of adhesion structures and the specific diseases associated with deficiencies in these components.

Introduction: Currently, only little data is available on the impact of the COVID-19 pandemic on inpatient dermatosurgical care in German dermatological clinics.

Methods: A retrospective analysis of all dermatosurgical cases that were treated in inpatient setting in nine German dermatological clinics in four federal states in 2019, 2020 and 2021 was performed. The diagnoses were recorded using the ICD-10 codes. In addition, demographic data such as age, gender and the length of inpatient stay were analysed.

Results: In 2019, 2020 and 2021, a total of 10,739, 9185 and 9828 dermatosurgical inpatients were treated respectively. Thus, the reduction of inpatient dermatosurgical cases was 14.5% in 2020 and 8.5% in 2021 compared to 2019. Inpatient surgical treatment of melanoma decreased by 10.1% of cases in 2020. This decrease was only 1.4% in 2021 compared to 2019. The number of inpatient surgeries performed for benign lesions such as melanocytic nevi or viral warts reduced sharply in both pandemic years.

Conclusion: Our data show for the first time how inpatient care for the entire spectrum of dermatosurgical diseases developed during the COVID-19 pandemic in Germany. After the initial marked decline in inpatient dermatosurgical cases in 2020, there was less difference in 2021 compared to 2019. This trend can be interpreted as an indication that there is still a strong need for inpatient dermatosurgical care that cannot yet be met on an outpatient basis.