Dermatologie (Heidelberg, Germany)最新文献

Psoriasis and atopic dermatitis are among the most frequent chronic, inflammatory skin diseases of childhood and adolescence. Regarding profound consequences for the physical and psychosocial development of affected patients, a timely and individually adapted therapy has to be initiated, in case of severe disease systemic treatment. Modern, targeted, highly efficient and well-tolerated agents are currently available. Overlapping psoriasis and atopic dermatitis have been appreciated recently, both idiopathic and therapeutically induced. Their prevention or early detection is mandatory for optimal management of patients.

Allergic rhinokonjunctivitis or asthma bronchiale and urticaria with or without angioedema are the most prevalent allergic diseases in childhood. Symptomatic relief can be achieved with antihistamines, corticosteroids and partially with the anti-immunoglobulin E (IgE) antibody omalizumab. Bradykinin-dependent angioedema, especially in childhood as the primary manifestation of hereditary angioedema (HAE), has to be ruled out as a differential diagnosis of histamine-induced angioedema. For HAE different therapy options in acute attacks and long-term prophylaxis are available. Timely initiation of specific immunotherapy for IgE-mediated allergy to aeroallergens, sublingually or subcutaneously (SCIT) applied, should be considered. Insect venom allergy can be treated with SCIT. Diagnosis of eosinophilic esophagitis is often delayed. Bolus events may be indicative of the disease. Elimination diets, proton pump inhibitors, topical corticosteroids and dupilumab may be used.

Sarcoidosis is a noninfectious, inflammatory multisystem disorder characterized by the idiopathic formation of granulomas. The pathogenesis of sarcoidosis remains only partially understood, although various clinical risk factors and extrinsic triggers have been identified, alongside a maintained Th1-mediated immune response. Clinically, sarcoidosis can present with specific manifestations associated with sarcoidal granulomas observable in histological examinations, as well as nonspecific manifestations. Histology is pivotal for diagnosis. In cases of cutaneous sarcoidosis, systemic involvement must be evaluated. Therapeutic approaches are tailored to the most affected organ. For cutaneous sarcoidosis, treatment options vary based on clinical findings and include local therapies as well as systemic interventions. These encompass corticosteroids and other immunosuppressive or immunomodulatory agents.

In many cases, chronic inflammatory dermatoses are accompanied by changes of the nails or periungual region. Sometimes nail changes occur even before the onset of the particular skin disease. In some cases, specific lesions of the nails and the perionychium can contribute to the diagnosis. This review describes the most common nail and periungual changes in chronic inflammatory dermatoses and the corresponding treatment options. Among others, this review deals with nail changes in collagenoses, autoimmune bullous dermatoses, alopecia areata, lichen planus and atopic eczema. Nail psoriasis is not discussed here, as this special edition contains a review devoted entirely to the complex topic of nail psoriasis.

"Histamine intolerance" is often based on a self-diagnosis. Due to the known range of reactions that can be mediated by the messenger substance histamine, it is postulated that food histamine can trigger the same reactions. Results of studies with double-blind, placebo-controlled oral provocation tests do not confirm this, but rather show that orally administered histamine does not trigger reproducible reactions and that symptoms often occur after placebo, indicating a strong nocebo effect. Without reproducibility, however, the definition for an adverse reaction to food is not fulfilled. As many sufferers are severely affected by their self-diagnosis due to a massive restriction of their food choice, quality of life, and social interaction, allergy societies in German-speaking countries have published a guideline which describes a pragmatic diagnostic and therapeutic approach. The primary aim is to alleviate symptoms by improving digestive function and to expand the choice of foods, rather than to exclude the suspected diagnosis. Collaboration with a dietician/nutritionist with allergological expertise is therefore strongly recommended.

Background: Hereditary ichthyoses are rare, etiologically and clinically heterogeneous epidermal keratinization disorders that are characterized by excessive dryness with scaling of the skin and in some cases increased palmoplantar keratinization. Additional inflammation is common and there are forms associated with blistering. In terms of differential diagnosis, ichthyoses with associated erythroderma in particular must be distinguished from primary atopic diseases with immunodeficiency.

Aim: The aim is to provide basic knowledge of the classification and nomenclature of ichthyoses and of current guideline-based and approved therapies. Readers should also be made aware of the difficulties of treating this rare skin disease in children and adolescents with only a few approved therapies. New and innovative treatment options are described and thereafter the reader should be able to confidently identify potential patients for approved and novel therapies.

Materials and methods: The current guidelines as well as the current literature and expert consensus on systemic therapies for ichthyosis with a focus on pediatric patients are discussed.

Results: Precise phenotyping, endotyping and the inclusion of the patient's expectations with regard to therapy currently allow comprehensive treatment to alleviate symptoms with good interdisciplinary cooperation. In the absence of causal therapy options, hereditary ichthyosis usually requires lifelong symptomatic individualized therapy. The basis of therapy is local therapy. Acitretin is currently the only approved systemic therapy. Pathophysiologically driven and therefore personalized and targeted therapies, in the form of topical replacement proteins or lipids, small molecules with a variety of target structures and biologics to address inflammation, are the focus of new therapeutic options. Causal therapeutic approaches, such as gene therapies, are currently under development.