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Berthold Rzany

Publications and source records attributed to Berthold Rzany.

18 recordsLinked to original sources
PubMed2006

A comparison of oral methylprednisolone plus azathioprine or mycophenolate mofetil for the treatment of pemphigus.

OBJECTIVE: To investigate the safety and efficacy of oral methylprednisolone combined with azathioprine sodium or mycophenolate mofetil for the treatment of pemphigus. DESIGN: A prospective, multicenter, randomized, nonblinded clinical trial to compare 2 parallel groups of patients with pemphigus (pemphigus vulgaris and pemphigus foliaceus) treated with oral methylprednisolone plus azathioprine or oral methylprednisolone plus mycophenolate mofetil. Settings Thirteen departments of dermatology in Germany. Patients We included patients with pemphigus vulgaris (n = 33) or pemphigus foliaceus (n = 7) evidenced by clinical lesions suggestive of pemphigus, intraepidermal blistering on histological analysis of skin biopsy specimens, intercellular deposition of IgG within the epidermis, and immunoblot analysis findings for antidesmoglein 3 and/or antidesmoglein 1 autoantibodies. MAIN OUTCOME MEASURES: The cumulative total methylprednisolone doses and rate of remission. Secondary outcome measures were safety profiles and duration of remission. RESULTS: In 13 (72%) of 18 patients with pemphigus receiving oral methylprednisolone and azathioprine, complete remission was achieved after a mean +/- SD of 74 +/- 127 days compared with 20 (95%) of 21 patients receiving oral methylprednisolone and mycophenolate mofetil in whom complete remission occurred after a mean +/- SD of 91 +/- 113 days. The total median cumulative methylprednisolone dose used was 8916 mg (SD, +/-29 844 mg) in the azathioprine group compared with 9334 mg (SD, +/-13 280 mg) in the mycophenolate group. In 6 (33%) of 18 patients treated with azathioprine, grade 3 or 4 adverse effects were documented in contrast to 4 (19%) of 21 patients who received mycophenolate mofetil. Conclusion Mycophenolate mofetil and azathioprine demonstrate similar efficacy, corticosteroid-sparing effects, and safety profiles as adjuvants during treatment of pemphigus vulgaris and pemphigus foliaceus.

Administration, Oral↗
PubMed2006

Efficacy and safety of 3- and 5-injection patterns (30 and 50 U) of botulinum toxin A (Dysport) for the treatment of wrinkles in the glabella and the central forehead region.

OBJECTIVE: To investigate the efficacy and safety of 2 injection site patterns (3- and 5-injection patterns [30 and 50 U]) of botulinum toxin A (Dysport; Ipsen Pharma, Ettlingen, Germany), in the treatment of glabellar and central forehead wrinkles. DESIGN: Multicenter, double-blind, placebo-controlled, randomized, 16-week trial. SETTING: Twenty-three German dermatologic centers. PATIENTS: Two hundred twenty-one patients with moderate or severe glabellar wrinkles when frowning maximally. Intervention Centers were randomly assigned to the 3-injection site pattern (3 injections of 10 U of botulinum toxin A or placebo) or 5-injection site pattern (5 injections of 10 U of botulinum toxin A or placebo). All centers used 3 sites in the procerus and corrugator muscles; the 2 additional sites were approximately 1-cm cranial from the corrugator sites. MAIN OUTCOME MEASURE: Wrinkle severity was graded by 4 independent experts blinded to the treatment received using digital photographs and a standardized clinical scale (range, 0 [no wrinkles] to 3 [severe wrinkles]). A reduction of at least 1 point between weeks 0 and 4 was considered a therapeutic success (responder). RESULT: One hundred ten patients (73 receiving botulinum toxin A vs 37 receiving placebo) received 3 injections; 111 patients (73 receiving botulinum toxin A vs 38 receiving placebo) received 5 injections. After 4 weeks, the proportions of responders were 86.1% vs 18.9% and 86.3% vs 7.9%, respectively (P<.001 for both). No major adverse effects were observed. CONCLUSIONS: The 3 central injection sites are essential for the treatment of glabellar wrinkles. The 2 additional injection sites in the forehead region, targeting the frontalis muscle, did not significantly improve efficacy.

Adolescent↗
PubMed2006

Reproducibility of two four-point clinical severity scores for lateral canthal lines (crow's feet).

BACKGROUND: Several clinical scoring systems have been used to evaluate the efficacy of botulinum toxin A in the treatment of hyperkinetic wrinkles. So far very few have been investigated for their reproducibility. OBJECTIVE: The aim of this study was to investigate the reproducibility of two clinical four-point scales for lateral canthal lines (crow's feet), at rest and at maximum smile. MATERIAL AND METHODS: Based on standardized photographs, a consensus atlas depicting the different severity grades [from 0 (none) to 3 (severe)] was developed. After training based on the atlas, 49 photographs at rest and 48 at maximum smile were graded by the same group of investigators on 2 consecutive days (n=9 on Day 1; n=8 on Day 2). The scores were compared for reproducibility using kappa statistics. RESULTS: Overall, reproducibility was good for both scales. Interobserver reproducibility showed an agreement of 0.6 at rest and 0.58 at maximum smile (unweighted kappa). Intraobserver reproducibility showed an agreement between 0.47 and 0.86 at rest and between 0.62 and 0.81 at maximum smile (unweighted kappa). Using weighted kappa analysis, the agreement ranged between 0.63 and 0.91 at rest and between 0.71 and 0.85 at maximum smile. CONCLUSION: The clinical scales using scores of 0 to 3 for crow's feet, both at rest and at maximum smile, show a good inter- and intraobserver reproducibility. The use of these scores in clinical trials can be recommended.

Cosmetic Techniques↗
PubMed2006

[Epidemiology of acne vulgaris].

Acne vulgaris is a common disease with prevalence up to 80 % during adolescence. Twin studies provide solid evidence of a genetic background for this disease. Similarly there is no doubt about the influences of hormones, especially androgens, on the disorder. Less clear, however, is the data on other risk factors as smoking and certain diets.

Acne Vulgaris↗
PubMed2005

[Development of the evidence-based guidelines for psoriasis--a project of the German Dermatological Society (DDG)].

Clinical guidelines have been defined as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances". They are designed to evaluate and implement the ever-increasing amount of evidence and opinion on best current practice. They can assist doctors and other health care professionals in making decisions about appropriate and effective care for their patients. Depending on the level of evidence, expert knowledge based and evidence-based guidelines can be distinguished. This article reviews the methods of guideline development, the state of international guidelines in dermatology and the state of the recent German psoriasis-guideline-project.

Evidence-Based Medicine↗
PubMed2005

Treatment of bullous pemphigoid with dapsone, methylprednisolone, and topical clobetasol propionate: a retrospective study of 62 cases.

Dapsone has been used successfully as adjuvant therapy for bullous pemphigoid (BP). The effectiveness of dapsone for this indication, however, remains controversial. We evaluated the effectiveness and adverse events of dapsone (1.0-1.5 mg/kg per day) in combination with oral methylprednisolone (tapering doses of 0.5 mg/kg per day) and topical clobetasol propionate (initially applied once daily on lesions only) in the treatment of BP. Sixty-two patients treated with this regimen were analyzed retrospectively. Patients were free of new blisters after a mean (+/- SD) of 22 +/- 13 days (median, 20 days). After 3 and 6 months of treatment, methylprednisolone could be reduced to less than 10 mg/d in 71% and 91% of patients, respectively; after 12 months of treatment, 53% of patients were in complete remission without receiving further therapy. Dapsone-related side effects were usually mild except in 3 patients (5%), 2 patients with anemia (hemoglobin level, <7 g/dL) and 1 with agranulocytosis. Our data suggest that dapsone used in combination with systemic and topical corticosteroids may be a relatively safe and effective treatment option for BP.

Administration, Oral↗
PubMed2004

[Online bedside teaching: multimedia, interactive and case-based teaching scenarios in dermatology].

The MeduMobile project or Mobiler Campus Charité was started in the beginning of 2003 to evaluate new, multimedia supported teaching and learning scenarios. The project focuses especially on acute and rare diseases to which students usually have are very limited access. During the teaching sessions the MeduOnCall team and the academic teacher communicate with the students who are equipped with individual notebooks through a wireless net. In dermatology the MeduMobile project focused in summer 2003 and winter 2003/2004 on bedside teaching. Despite some technical difficulties in the beginning the project was well received by teachers and students. The possibility of simultaneous online searches by Internet as well as the possibility to include photographs depicting the course of the skin disease was felt to be one of the main advantages of this project. Based on these positive experiences an attempt will be made to integrate the project further into the regular teaching of the Charite.

Case-Control Studies↗
PubMed2004

[Randomized, placebo-controlled, double blind clinical trial for the evaluation of the efficacy and safety of oral methantheliniumbromide (Vagantin) in the treatment of focal hyperhidrosis].

BACKGROUND: Methanthelinium bromide is a quaternary ammonium derivate with anticholinergic activity. Since 1951 it has been used to treat patients with hyperhidrosis. However, all efficacy data has so far been limited to case reports and case series. We here report on the results of the first randomised clinical controlled trial on the efficacy and safety of methanthelinium bromide. PATIENTS AND METHODS: A total of 41 patients with a mean age (+/- standard deviation) of 28 +/- 9.8 years (Range 18.7-54.8) were included, 31 (76%) of them were females. Main inclusion criteria were are focal hyperhidrosis of a one year or longer duration and a gravimetrically assessed sweat production of > or =50 mg/min. Patients were treated with 2 x 50 mg methanthelinium bromide or placebo orally daily for 4 weeks. The therapeutic effect was determined by repeated gravimetric measurement of sweat production and by recording the patients' degree of satisfaction. RESULTS: The efficacy was most pronounced for patients with an axillary hyperhidrosis of > or =50 mg/min (p = 0.02, chi2-test, two-sided). For the total group the main axillary sweat production decreased in the verum-treated arm from a mean value of 89.2 +/- 73.4 mg/min prior to therapy to 53.3 +/- 48.7 mg/min during therapy (p = 0.02, Wilcoxon test, two-sided). In contrast, no difference was detected in the placebo arm with 60.7 +/- 42.8 mg/min prior to and 59.1 +/- 40.6 mg/min during therapy (p = 0.92, Wilcoxon test, two-sided). For the palmar sweat production no difference between the verum- and the placebo-treated group was found. No serious adverse events were reported. As expected, dryness of the mouth, a known adverse reaction of anticholinergics, was reported significantly more frequently in the verum-treated arm. CONCLUSIONS: Methanthelinium bromide has been considered for many years as a therapeutic option for the treatment of focal hyperhidrosis. However, its efficacy and safety have not previously been investigated in controlled randomised studies. We demonstrated both a decline in axillary sweat production and good tolerance. Therefore, the treatment of axillary hyperhidrosis with methanthelinium bromide in a regimen of 50 mg twice daily can be recommended, especially in those cases which are refractory to topical treatment with for example aluminium chloride hexahydrate solution. In contrast, we found no evidence for a clinically relevant diminution of palmar sweating.

Administration, Oral↗
PubMed2004

In vivo determination of skin surface topography using an optical 3D device.

BACKGROUND/PURPOSE: Topography of the skin surface is a mirror of the functional skin status. Therefore, its evaluation is of great interest for dermatological research. In the present study, a new optical measuring system was applied to evaluate human skin surface topography in vivo and non-invasively, in order to determine elastotic and mimic wrinkles dependent on age, body site and therapy. METHODS: The measurements were performed on the back (n=5), the flexor forearm (n=14) of volunteers in different age groups and on the face of women (n=4) participating in an anti-wrinkle study. The evaluation of the three-dimensional-profiles was performed determining skin surface parameters (mean roughness (R(a)), mean depth of roughness (R(z)), maximum roughness (R(m)) and waviness (W(t))) and applying Fourier analysis. RESULTS: Significant increases in all surface parameters were obtained on the forearms with increasing age. Differences between the surface topographies of forearm and back were only expressed by the waviness and the Fourier analysis. The treatment with botulinum Toxin A led to a diminution of mimic wrinkles as reflected by the furrow profiles. CONCLUSIONS: The results show a significant dependence of the skin surface topography on the age of the volunteer and the body site measured. Particularly the waviness, the Fourier analysis and the furrow profiles reflect such dependencies. The system used also fulfils the requirements for the testing of therapies, as was demonstrated by the reduction of mimic wrinkles after treatment with botulinum Toxin A.

Adult↗
PubMed2003

[Efficacy, side effects and patient satisfaction with wrist conduction block anaesthesia prior to the treatment of palmar hyperhidrosis with botulinum toxin type A].

BACKGROUND: The treatment of palmar hyperhidrosis with botulinum toxin type A (BTX A) injections is one of the most effective therapeutic options. However, without adequate anaesthesia this treatment is not feasible in most patients. The anaesthesia of the radial, median and ulnar nerves (wrist block) is despite the absence of good data considered effective but risky. PATIENTS AND METHODS: Between 1.10.1999 and 30.9.2001 retrospectively the efficacy, side effects and the patient satisfaction regarding the overall performance of the wrist block prior to the treatment of the palmar hyperhidrosis with BTX A was investigated. The study took place at the department of dermatology in Mannheim. RESULTS: Of the 38 patients treated, 33 were finally included into the trial. The patients chose the average score of 7,9 +/- 2,1 (sd) on a scale from "0" to "10" (not at all effective--maximally effective) for the efficacy of the wrist block in reducing pain. The patients were very content with the wrist block and granted it the average score of 7,7 +/- 2,1 (sd) on a scale from "0" to "10" (not at all content--maximum content). Unwanted effects could be seen in 31/33 patients (93,9%): these were dizziness, headache or haematoma at the spot of injection as well as pain caused by the injections of the local anaesthesia or paresthesias such as tickling of the hand or arm. All side effects caused by the wrist block were reversible and lasted--except in one patient--only for a short time. 29/33 patients (87,9%) recommended the wrist block prior to treating palmar hyperhidrosis with BTX A and 28/33 patients (84,9%) could not imagine to agree to such a treatment without local anaesthesia. CONCLUSION: The wrist block effectively reduces pain due to the treatment of palmar hyperhidrosis with BTX A. Major side effects are rare; patient acceptance and satisfaction are high.

Adult↗
PubMed2003

Peripheral blood T-cell clonality in mycosis fungoides and nonlymphoma controls.

In mycosis fungoides (MF), T-cell clonality is reported in about 90% of skin and 40% of blood samples. However, identity of blood and cutaneous T-cell clone and prognostic relevance of blood T-cell clonality remain controversial. By PCR/fluorescence fragment analysis with estimation of clonal fragment lengths and relative peak heights, we objectively identified T-cell clonality unrelated to malignant lymphoproliferation in healthy donors (5/38), autoimmune dermatoses (3/8), and nonlymphoma skin cancer (9/39). This T-cell expansion of undetermined significance (TEXUS) was also found in 8/64 MF patients. Dissemination of neoplastic cells into blood, as identified by identical clonal fragment lengths in blood and skin, was detected in 23/64 MF patients. When monitoring for progression at TNM stage for a mean of 45.7 months, univariate analysis identified age of >60 years and detection of a related blood T-cell clone to be of prognostic relevance, whereas detection of TEXUS, sex, TNM stage at initial diagnosis, and detection of a cutaneous T-cell clone were irrelevant. Although multivariate analysis was not possible, further stratification clearly indicated an age of >60 years to be the predominating prognostic factor. In conclusion, investigation of T-cell clonality in skin and blood samples at the initial diagnosis cannot predict the clinical course of MF and the occurrence of TEXUS should be considered when assessing blood T-cell clonality.

Adult↗
PubMed2002

Risk factors for lethal outcome in patients with bullous pemphigoid: low serum albumin level, high dosage of glucocorticosteroids, and old age.

BACKGROUND: Although bullous pemphigoid (BP) is the most frequent autoimmune bullous disease and is associated with a considerable case-fatality rate, little is known about factors that influence its prognosis. OBJECTIVE: To identify prognostic factors for lethal outcome in the first year after the initial hospitalization in patients with BP. DESIGN: A multicenter retrospective cohort study. SETTING: Seven dermatologic university hospitals in Germany. PARTICIPANTS: A total of 369 patients diagnosed as having BP between January 1, 1987, and December 31, 1997. STATISTICS: Univariate (Kaplan-Meier) and multivariate (Cox regression) analysis. RESULTS: Of the 369 patients with BP, 209 (57%) died, 106 (29%) within the first year after hospitalization. Fifty-four percent were women. The mean +/- SD age at entry was 77.3 +/- 11.1 years. The patients with BP were followed up to 10.5 years, with a median time of 1.8 years to death or interview (25th and 75th quartiles, 0.5 and 4.0 years). The major risk factors for lethal outcome in the first year after hospitalization were an increased age, with a multivariate risk estimate of 3.2 (95% confidence interval [CI], 1.9-5.2) for age greater than 80.4 years (median); a daily glucocorticosteroid dosage of more than 37 mg (75th quartile) at discharge, with a multivariate risk estimate of 2.5 (95% CI, 1.5-4.3); serum albumin levels of 3.6 g/dL or less (25th quartile), with a multivariate risk estimate of 2.6 (95% CI, 1.5-4.4); and an erythrocyte sedimentation rate greater than 30 mm/h (75th quartile), with a multivariate risk estimate of 1.7 (95% CI, 1.1-2.8). CONCLUSIONS: There is a considerable case-fatality rate in patients with BP. Older patients who require a higher dosage of oral glucocorticosteroids at hospital discharge and who have low serum albumin levels are at greater risk of death within the first year after hospitalization. These prognostic factors should be considered in the care of patients with BP as well as in the design of future clinical trials.

Aged↗