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Biomedical subjects

S Ständer

Publications and source records attributed to S Ständer.

At least 19 recordsLinked to original sources
PubMed2007

Mycosis fungoides: a dermatological masquerader.

Mycosis fungoides (MF), a low-grade lymphoproliferative disorder, is the most common type of cutaneous T-cell lymphoma. Typically, neoplastic T cells localize to the skin and produce patches, plaques, tumours or erythroderma. Diagnosis of MF can be difficult due to highly variable presentations and the sometimes nonspecific nature of histological findings. Molecular biology has improved the diagnostic accuracy. Nevertheless, clinical experience is of substantial importance as MF can resemble a wide variety of skin diseases. We performed a literature review and found that MF can mimic >50 different clinical entities. We present a structured framework of clinical variations of classical, unusual and distinct forms of MF. Distinct subforms such as ichthyotic MF, adnexotropic (including syringotropic and folliculotropic) MF, MF with follicular mucinosis, granulomatous MF with granulomatous slack skin and papuloerythroderma of Ofuji are delineated in more detail.

Diagnosis, Differential↗
PubMed2006

[Brachioradial pruritus: a rare, localized, neuropathic form of itching].

We report on a female patient with brachioradial pruritus, in whom the cause could be verified by purposeful diagnostics (e. g., MRI). The clinical symptoms with localized itching result from circumscribed nerve root compression and hyperexcitation of the nerve fibers. Under treatment with gabapentin, an anticonvulsant with a very good analgesic and good antipruritic effect, the itch ceased and the skin changes healed. This case shows that this special form of neuropathic itch requires targeted therapy, which apart from symptomatic treatment should primarily focus on remedying the cause, if feasible.

Amines↗
PubMed2006

[Cutaneous lupus erythematosus. Part 1: clinical manifestations and classification].

Cutaneous lupus erythematosus (CLE) is a heterogenous disorder with a wide range of skin manifestations. Therefore, it has been difficult to develop a unifying concept for classifying CLE from the dermatologic perspective in the past. In 2004, the classification system was updated and includes now acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Additional rarely described variants are not listed as separate entities but are included in the classical forms. Diagnosis of the different subtypes of CLE is made by considering genetic, clinical, histopathologic, and immunoserologic findings, with a systematic analysis of individual criteria. In the past years, the etiology and pathogenesis of CLE has been subject of intensive research and it has been shown by several groups that exogenous factors, such as ultraviolet light and drugs, can induce CLE. The first part of this review will enable the reader to identify the various clinical manifestations of CLE and to employ characteristic criteria to assess differential diagnostic considerations.

Biopsy↗
PubMed2006

[Clinical classification of chronic pruritus. Interdisciplinary consensus proposal for a diagnostic algorithm].

Chronic pruritus is a frequent symptom in dermatology caused by a variety of dermatologic, neurologic and other systemic diseases. For adequate, economically-appropriate medical care of patients with chronic pruritus, a clinical classification of pruritus which also serves as a diagnostic algorithm is necessary. Currently suggested classifications are etiologic and not helpful in daily clinical routine. The proposed clinical classification is oriented at the clinical appearance of the patients and differentiates between disorders with or without primary or secondary skin lesions.

Algorithms↗
PubMed2006

[Rational symptomatic therapy for chronic pruritus].

Chronic pruritus is a difficult-to-treat problem which accompanies many dermatologic and systemic diseases. Frequently, therapy is ineffective and prolongs the pruritus. Thus significant costs arise for the health system, which are clearly lowered by a rational therapy concept. Extensive knowledge about both topical and systemic therapy of pruritus has been acquired in recent years. Currently, new therapeutic approaches are available, which intervene in different pruritogenic mechanisms. Substances can block the cutaneous pruritus induction (e.g. antihistamines, leukotriene antagonists, cannabinoid agonists) or mediate central effects such as the inhibition of pruritus transmission via the spinal cord (e.g. naltrexone, gabapentin) or the suppression of the cerebral itch perception (e.g. antidepressants, neuroleptics). Usually combining several therapeutic principles is necessary in order to suppress chronic pruritus with lasting effect. The most effective approach is to gradually combine therapies, always considering both the medical and financial impacts.

Aged↗
PubMed2006

[Pruritus].

Explore the source record for details and available documents.

Humans↗
PubMed2006

[Cutaneous lupus erythematosus. Part 2: diagnostics and therapy].

The diagnosis of cutaneous lupus erythematosus (CLE) requires a specific diagnostic approach to identify subtypes, to address differential diagnostic considerations, and to rule out systemic organ involvement. In addition to a detailed patient's history and clinical evaluation of the skin, histopathologic and immunofluorescent examination of a skin biopsy as well as laboratory screening are recommended. Photoprovocation tests can be performed to confirm the diagnosis of CLE and to assess photosensitivity in these patients. Recently, a scoring system for the activity of the cutaneous manifestations in CLE has been developed and validated which involves anatomical areas and morphologic signs of the skin lesions. In all subtypes of CLE, antimalarials are still the treatment of choice. Advances in biotechnology have led to the development of several novel agents for the treatment of autoimmune diseases; however, controlled trials have not been performed in patients with CLE. Furthermore, there is need for specific immunointervention, especially for patients who fail to respond to standard therapies. The second part of this review will enable the reader to differentiate CLE from other diseases and to suggest specific diagnostic procedures and treatment approaches.

Antimalarials↗
PubMed2006

[Topical cannabinoid agonists. An effective new possibility for treating chronic pruritus].

BACKGROUND: Chronic, therapy-resistant pruritus often fails to respond to standard measures so new therapeutic approaches are needed. Recently, the expression of cannabinoid receptors on cutaneous sensory nerve fibers was described, so cannabinoid agonists seem a rational therapeutic option for pruritus. PATIENTS: In an open application observation 22 patients with prurigo, lichen simplex and pruritus applied an emollient cream containing N-palmitoyl ethanolamine (PEA). RESULTS: In 14/22 patients a good antipruritic effect could be documented. The average reduction in itch was 86.4%. The therapy was well-tolerated by all patients; neither burning burn nor contact dermatitis was observed. CONCLUSIONS: Topical cannabinoid agonists represent an new effective and well-tolerated therapy for refractory itching of various origins. Creams with a higher concentration may be even more effective with broader indications.

Administration, Topical↗
PubMed2006

Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study.

BACKGROUND: It has been suggested that psychological factors such as repressing anger and altruistic interpersonal behaviour may play a role in the aetiology of chronic itching in prurigo nodularis (PN). Whether these issues are specific for PN or are also common in other chronic skin diseases, e.g. psoriasis, has not been investigated until now. OBJECTIVES: To investigate psychosomatic problem areas and psychiatric comorbidity in patients with PN in comparison with patients with psoriasis. METHODS: Ninety-four patients with PN and 91 patients with psoriasis were administered the Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, State-Trait Anger Expression Inventory, Inventory of Interpersonal Problems, Screening for Somatoform Disorders and the Whiteley Index for hypochondriasis. RESULTS: After Bonferroni post hoc adjustment, the metrical scales demonstrated no significant differences between patients with PN and those with psoriasis. There was only a tendency to less 'anger-out' and to less autocratic/dominant and more insecure/submissive behaviour in the patients with PN. Patients with PN were, in general, comparable with those with psoriasis with regard to alexithymia, somatization symptoms, hypochondriasis, anxiety and depression, with 18% cases of anxiety and 22% cases of depression. CONCLUSIONS: The hypotheses formulated in the literature on the specific aetiology of PN could not be proven for the majority of patients with PN in our study. Concerning their psychopathology, patients with PN were comparable with those with psoriasis. Therefore the clinical management of PN should include psychosomatic assessment.

Adult↗
PubMed2006

Psychosomatic cofactors and psychiatric comorbidity in patients with chronic itch.

BACKGROUND: While psychosomatic factors may be involved in eliciting as well as coping with chronic itch, psychiatric comorbidity often goes unrecognized in dermatological patients. AIM: To record psychiatric illness, psychiatric and psychotherapeutic pretreatment, and psychotherapy indication in dermatology inpatients with pruritus. METHODS: A consecutive sample of 109 dermatology inpatients with the symptom of pruritus were examined by interviews with consecutive ratings by experts (using psychiatric ICD-10 diagnoses, the Global Assessment of Functioning Scale and the Impairment Score) and self-assessment using the the Eppendorf Itch Questionnaire. RESULTS: In > 70% of the pruritus patients, 1-6 psychiatric diagnoses could be demonstrated. In > 60%, psychotherapeutic or psychiatric treatment was recommended. In contrast, almost 90% of the patients had had no previous psychotherapeutic experience. CONCLUSION: As psychiatric comorbidity in dermatology inpatients suffering from chronic itch is high, dermatology departments should aim for an improvement of their psychosomatic consultation and liaison services.

Adult↗
PubMed2005

[Acral pseudolymphomatous angiokeratoma of children (APACHE)].

Acral pseudolymphomatous angiokeratoma of children (APACHE) is a pseudolymphoma of posttraumatic origin which was first described in 1988. We report on a female patient with APACHE following a traumatic abrasion on her foot. Reddish papules developed that histologically were characterized by a wedge-shaped inflammatory infiltrate rich in capillaries. Conservative treatment was not successful.

Adult↗
PubMed2005

[Pruritus in pregnancy. A frequent diagnostic and therapeutic challenge].

Pruritus is the leading dermatological symptom during pregnancy. Besides preexisting or acquired dermatoses, there are a number of pregnancy-specific dermatological diseases such as PEP (polymorphic eruption of pregnancy, previously named PUPPP), pemphigoid (herpes) gestationis, and pruritus gravidarum that are accompanied by severe itching and scratching. Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration. The use of topical and systemic treatments depends on the underlying aetiology of pruritus and the stage and status of the skin. In general, emollients, topical anti-pruritics and topical corticosteroids appear to be the safest options for localised forms of pruritus in pregnancy whereas systemic treatments and/or UV phototherapy are adequate for generalized pruritus. Systemic corticosteroids and a restricted number of antihistamines may be administered in severe cases. This paper highlights the major aetiologies of pruritus during pregnancy and points out the cornerstones of antipruritic therapy in recognition of our own clinical experiences and the current literature.

Administration, Topical↗
PubMed2004

[Hydroxyethyl starch-(HES)-induced pruritus as secondary complication of an occupational accident].

A 29-year old employee (controller in the textile industry) had an occupational accident leading to a femoral fracture. After surgery, he developed acute respiratory distress syndrome (ARDS) necessitating intensive care treatment. Three weeks after the accident, he developed generalized severe itching on a daily basis unresponsive to systemic and topical treatments. After one year, the itching had decreased to approximately 50% of its initial intensity. Hydroxyethyl starch (HES)-induced pruritus was diagnosed, based on the typical history and clinical features, the proven administration of HES and its cutaneous tissue storage by electron microscopy. Drug-induced pruritus caused by the plasma expander hydroxyethyl starch can be a secondary consequence of an occupational accident and thus an issue in accident compensation claims.

Accidents, Occupational↗
PubMed2004

[Pruritus in childhood. A diagnostic and therapeutic challenge].

From the clinician's point of view, pruritus in children is quite frequent. It mainly occurs along with dermatoses but rarely with systemic diseases such as renal and liver failure or with genetic disorders. Mostly, it appears in the setting of atopic dermatitis (AD). Other frequent differential diagnoses comprise e.g. scabies, impetigo, varicella, tinea, urticaria, mastocytosis and psoriasis. In children, pruritus is most often associated with severe scratching leading to artefacts. This group of patients requires a therapeutical regimen of its own. The use of topical and systemic treatments depends on the underlying aetiology of pruritus and the stage and status of the skin. The physician has to consider that topically applied drugs may cause intoxication due to the different body volume/body surface proportion, especially in newborns and infants. The dosages of systemic drugs need to be adapted in children and UV phototherapy should be performed with caution due to possible longterm photo damage of the skin. Physicians feel more insecurity treating pruritus in children, especially when systemic treatments are taken into consideration. We want to highlight the major aetiologies of pruritus in children and point out the cornerstones of antipruritic therapy in this challenging group of patients in recognition of our own clinical experiences and the current literature.

Adolescent↗
PubMed2004

[Antipruritic therapy with the oral opioid receptor antagonist naltrexone. Open, non-placebo controlled administration in 133 patients].

BACKGROUND AND OBJECTIVES: The perception of pruritus is modified by endogenous and exogenous opioids via central opiate receptors and can be suppressed with opioid receptor antagonists. The aim of this investigation was to describe the efficacy and safety of naltrexone, an orally active opiate antagonist, in the treatment of severe, otherwise intractable pruritus of varying origins. PATIENTS: A total of 133 patients with pruritus caused by inflammatory skin diseases (asteatotic dermatitis, atopic dermatitis, prurigo, and psoriasis vulgaris), liver- and renal diseases, cutaneous lymphoma, as well as with pruritus of unknown origin were treated with naltrexone (Nemexin) 50 to 150 mg daily. RESULTS: A therapeutic response was achieved in 86 of the 133 (64.6%) patients. Naltrexone was most effective in prurigo nodularis, cutaneous lymphoma and pruritus of unknown origin. Tachyphylaxis occurred in 13% of the patients, but appeared late, and could be counterbalanced by raising the dosage. Adverse drug effects were restricted to the first two weeks of treatment and included mainly neurological (dizziness, headache, fatigue) and gastrointestinal (nausea, vomiting, diarrhea) symptoms. CONCLUSIONS: The oral opiate antagonists may well be an effective, well-tolerated therapy for intractable pruritus in many diseases.

Administration, Oral↗
PubMed2003

[Squamous epithelial carcinomas of the face with neurotropic growth].

BACKGROUND AND OBJECTIVE: Invasion of squamous cell carcinoma of the head and neck into cutaneous nerves is rare and can easily be missed. Perineural outgrowth into cerebral nerves may result in severe pain or neurological disturbances. In addition, these carcinomas more often recur or metastasize and therefore are associated with a poor prognosis. PATIENTS/METHODS: We report on two patients with squamous cell carcinoma of the dorsum of the nose and lower lip exhibiting neurotropic growth. RESULTS: Histology showed pleomorphic keratinocytes growing deep into the subcutaneous tissue and bone, respectively. The presence of few pleomorphic keratinocytes could be only confirmed by immunohistochemistry, though indicated by a perineural lymphocytic infiltrate. In both patients, several re-excisions were necessary to achieve cure. CONCLUSIONS: In neurotropic squamous cell carcinoma a consequent radical micrographic surgery as well as neurological and radiological investigations are mandatory. We also review the literature.

Aged↗
PubMed2003

[Antipruritic effects of pimecrolimus and tacrolimus].

The development of topical calcineurin inhibitors resulted in a significant improvement in the treatment of inflammatory skin diseases such as atopic dermatitis. In addition, an excellent amelioration of pruritus could be observed. Other itchy dermatoses such as chronic irritative hand dermatitis, rosacea, graft-versus-host-disease, renal pruritus, lichen sclerosus, prurigo simplex, prurigo nodularis, scrotal eczema, and inverse psoriasis also have been treated successfully with pimecrolimus and tacrolimus. The antipruritic effect currently is believed to be related to the inhibition of inflammatory cytokines. Furthermore, recent investigations indicate a release of neuropeptides from sensory nerve fibers and degranulation of mast cells mediated by pimecrolimus and tacrolimus. Similar effects have been observed during capsaicin treatment. These findings may provide a possible explanation for initially observed calcineurin inhibitors related side-effects such as burning and pruritus. Moreover, the antipruritic potency may be related to a direct effect on nerve fibers leading to suppression of itch mediated by unknown mechanisms.

Administration, Topical↗