Dermatologie (Heidelberg, Germany)最新文献

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.

Pregnancy is a special state for the expectant mother. Not only is a human being growing, but the pregnant woman's body is also constantly changing during the 40-week pregnancy. One organ that is frequently affected by these changes is the skin. As diagnosis and treatment during pregnancy can present treating physicians with particular challenges, it is important to know the relevant pregnancy dermatoses, to recognize and diagnose them reliably, and to observe red flags in order to protect the pregnant women and the unborn child. In this article, the most important changes in the skin of pregnant patients are explained and potential warning signs are presented. In addition to aspects of altered pigmentation, the influence of pregnancy on pre-existing inflammatory dermatoses and their improvement or worsening is also described. The occurrence of so-called specific pregnancy dermatoses over the course of pregnancy is also explained. Finally, the extent to which autoimmune diseases of the mother can also affect the unborn child and to what extent skin changes in the newborn can indicate a disease of the mother are described. The respective "red flags" are presented as leading symptoms and their relevance is discussed.

Vaccinations are an important pillar of public health. They have high benefits for individuals and society as a whole by specifically preventing or mitigating infectious diseases. In many cases, they offer benefits that go beyond protection against the disease in question, e.g., protective cardiovascular effects. Vaccination recommendations in Germany are drawn up by the Standing Committee on Vaccination (STIKO), while the European Medicines Agency (EMA) is responsible for the approval of vaccines in the EU. Vaccinations may be carried out by physicians regardless of their specialty. In dermatology, vaccinations against varicella (chickenpox), herpes zoster, and human papillomavirus are established. The development of vaccines against other dermatologically relevant diseases and cancer vaccines is the subject of intensive research. Particularly in the case of immunosuppression, the physician must also take into consideration which vaccinations are possible and useful or contraindicated. Type I or type IV allergies to components of vaccinations are very rare, but reactions at the injection site often occur as a dermatological side effect. Urticarial reactions are also possible, as does the worsening of underlying dermatological conditions such as psoriasis vulgaris.

The treatment of dermatological diseases during pregnancy and breastfeeding poses particular challenges for the therapist for medical and legal reasons. Maternal and fetal influencing factors must be taken into account and the special need for protection of the fetus, infant, and mother must be considered in the treatment decision, usually outside of the approval process. Due to the lack of or insufficient evidence for most therapies during pregnancy and breastfeeding, an individual risk-benefit assessment should always be carried out, which also takes into account the risk of nontreatment. In the case of difficult or potentially momentous decisions, information from relevant databases, intercollegiate consultation and, if possible, advice from a clinical ethics committee should be obtained. In any case, the parents, and in particular the mother, should be carefully informed and their consent should be obtained and documented. Recommendations can be made for common chronic inflammatory and infectious dermatoses, but these should be reviewed on a case-by-case basis. For other therapy situations, an individual analysis and decision-making process is necessary. Overall, however, it can be stated that digital data processing and availability, combined with careful analysis, empathetic consideration and information for those affected, enables a successful treatment decision to be made in the vast majority of cases.

It may be necessary for patients to undergo (dermato-)surgical procedures during pregnancy or lactation. Often, there are no drug approvals or guidelines in this context. The following article describes the most common dermatologic surgical conditions during pregnancy and lactation, as well as the special therapeutic considerations and risks to be aware of during treatment. Dermatosurgical procedures are subject to strict indications. Most of these procedures can be performed during pregnancy, but the risks to the mother and fetus must be carefully weighed against the disadvantages of nonsurgical therapy. Although surgery can be performed safely in any trimester, the second trimester and immediate postpartum period are optimal. Surgery should not be delayed for melanoma or high-risk skin cancer. Perioperative positioning and choice of analgesics, antiseptics, anesthetics and antibiotics must be considered carefully to avoid risks to the patient, fetus and infant.

Superficial angiomyxoma is a rare, benign neoplasm consisting of spindle-shaped fibroblasts in a myxoid, vascularized stroma. Diagnostic clarification is usually based on histology and immunohistochemistry and is of particular importance depending on the clinical presentation, as malignant tumors may also be considered in the differential diagnosis. Herewith, we present a patient with a solitary, superficial angiomyxoma of the sole of the foot. Although it often occurs as an independent entity, it is recommended to exclude syndromes such as Carney complex.

Mycosis fungoides (MF) is defined as the most common cutaneous T‑cell lymphoma (CTCL). The bullous form is considered one of its numerous variants. Only a few cases of this rare entity have been described. We report the case of a man with an aggressive course of bullous MF, which led to lethal outcome within a few weeks due to a fulminant sepsis.