[75-year-old male with rapidly growing nodule on elbow].
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Aged↗
Biomedical subjects
Thomas Dirschka
Publications and source records attributed to Thomas Dirschka.
[Multifocal penile intraepithelial neoplasia--targeted treatment with imiquimod].
A 78-year-old male sought dermatologic consultation for multifocal persistent red lesions of the glans penis. Various topical treatments had proved unsuccessful. Histologic examination revealed penile intraepithelial neoplasia (PIN). Polymerase chain reaction (PCR) showed amplification of human papillomavirus type 16 (HPV-16) DNA. Urological consultants recommended amputation of the glans; the patient rejected this, as well as any other surgical procedure. Therefore, he was treated in our dermatologic practice with imiquimod 5 % cream administered daily over 12 weeks. After therapy was completed, no clinical or histologic evidence of residual tumor was found and HPV-16 DNA was no longer detectable. Local skin reactions such as erosions and edema of the glans accompanied by tingling and itching were well-tolerated by the patient. Imiquimod 5 % cream may represent an alternative local treatment option for multifocal PIN.
Administration, Topical↗
[Efalizumab--therapy of moderately severe to severe plaque-psoriasis in the dermatologist's practice].
Psoriasis is a chronic immune-mediated skin disease with highly variable patterns of presentation, both between patients and in individuals over time. Its course can be influenced by various triggers. Since there is no cure for psoriasis, patients with moderate-to-severe plaque-type psoriasis often require lifelong therapy to control their disease. Traditional approaches such as cyclosporine or methotrexate are problematic for long-term use because of organ toxicity, other side effects, drug interactions and a loss of efficacy over time. Efalizumab is a recombinant monoclonal IgG1-antibody, approved in Germany for the management of moderate-to-severe plaque-type psoriasis. Its efficacy and safety have been demonstrated in clinical trials with thousands of patients,especially with regard to long-term therapy. Therefore, a change of paradigm from the traditional therapy of inflammatory episodes to continuous control of psoriasis seems possible. This supplement deals with practical aspects of using efalizumab in the outpatient setting.
Anti-Inflammatory Agents, Non-Steroidal↗
Primary oral sarcoidosis preceding Lofgren's syndrome.
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Adrenal Cortex Hormones↗
The management of skin reactions in cancer patients receiving epidermal growth factor receptor targeted therapies.
The use of epidermal growth factor receptor (EGFR) inhibitors for the treatment of solid tumours is increasing. However, the tolerability profile for EGFR-inhibitors, such as the monoclonal antibody cetuximab and the tyrosine kinase inhibitor erlotinib, is characterised by a unique group of skin reactions dominated by an acneiform eruption, xerosis, eczema and changes in the hair and nails. The possibility that this skin toxicity correlates with anti-tumour activity offers the potential to titrate dosing on a case-by-case basis. These skin effects may constitute a significant obstacle to treatment compliance. Accordingly, there is a need for consistent, multi-disciplinary management strategies that will allow patients to receive the recommended dosages of such targeted therapies. The eruption responds well to some acne therapies and xerosis can be controlled by standard emollients. Here we present an overview of the treatment options for skin reactions that are available today, and evaluate some of the ways in which the treatment of such EGFR-inhibitor-related skin reactions may be improved in the future. Evidence-based studies are needed to determine the best way to manage these effects.
Antibodies, Monoclonal↗
Therapy of cutaneous squamous cell carcinoma in two retirement home residents.
The incidence of cutaneous squamous cell carcinomas (SCC) has been increasing by about 5% per year of the past 40 years in a population which is growing continuously older and as such presents a growing therapeutic challenge. We report on two elderly female residents of a retirement home with histologically confirmed SCC on the back of the hand. In one case the tumor was completely excised and covered with a graft. In the second case the patient refused all surgical and radiotherapeutic procedures. We sought an adequate therapeutic alternative considering the extent and thickness of the tumor. Topical application of the immune response modifier imiquimod appeared to represent an alternative solution because of its unique antineoplastic mode of action, even though there was no published experience with this approach. She has remained tumor-free for four years, justifying our decision. In both cases, a comparable cosmetic result with full functional capacity of the hands was obtained. Imiquimod 5% cream was approved last year for the treatment of superficial basal cell carcinoma.
Adjuvants, Immunologic↗
Topical cosmetics and perioral dermatitis.
BACKGROUND: Perioral dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. Both cosmetics and topical corticosteroids have been implicated. PATIENTS AND METHODS: 75 patients with PD and 125 randomly selected control patients with negative PD records were included in a questionnaire-based study focusing on cosmetics, their use, and topical corticosteroids. The patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX 1). RESULTS: There were no significant (p < 0.05) differences in facial skin cleansing between the two groups except for night-time cleansing, which was performed more often in the patient group. The use of skin care products yielded significant differences between the patient and control group in respect to skin care in the morning and the use of day creams. Otherwise, the groups did not differ in their skin care regime (number of skin care products used, type of product, frequency of care). The mean monthly expenditure on cosmetic products did not differ significantly between the two groups. 25.3% of the patients used topical corticosteroids which were initiated in all cases after the onset of the rash. Significantly (p < 0.001) higher values were found in the patient group regarding history of atopic diseases (49.3% vs. 15.2%), prick test reactivity (> or =2 reactive prick tests: 49.3% vs. 8.0%), and specific IgE against aeroallergens (CAP SX1 classes > or =2: 50.7% vs. 15.2%). CONCLUSIONS: The often heard argument that PD results mainly from external factors is no longer tenable. A variable interaction between external (e.g. cosmetics) and intrinsic factors (e.g. atopic constitution) appears to lead to PD, perhaps by subclinical repetitive irritation and final overtaxing of the reparative capacity of the epithelial barrier function.
Administration, Topical↗
[Periocular dermatitis].
BACKGROUND: Perioral dermatitis paradoxically sometimes spares the entire perioral region. There may be isolated periocular involvement (periocular dermatitis). PATIENTS/METHODS: The records of 23 patients with only periocular dermatitis were reviewed with respect to the following parameters: clinical findings, history of atopy, topical facial treatment, prick and patch tests, CAP-SX1, previous treatment, time to healing and relapses. 23 patients with no history of periocular dermatitis were matched for age and sex (case-control study). RESULTS: The predominant clinical finding in the affected group was micropapules primarily in the lateral corner of the eye and lower eyelid. The groups differed significantly (p < 0.05) with regard to the history of atopic diseases and reactive prick tests. 22 patients regularly used face-care or eye-care products. These patients did not differ significantly from the control group with regard to frequency and type of product used. 6 patients had been previously treated with topical corticosteroids. The time to healing was 2-8 weeks (median: 4 weeks). CONCLUSIONS: Periocular dermatitis is a variation on perioral dermatitis, where-by similar pathogenetic factors are observed. The elimination of topical corticosteroids and the gradual reduction of skin-care products regularly lead to clearing of the condition.
Adrenal Cortex Hormones↗
Glove perforation in outpatient dermatologic surgery.
BACKGROUND: Intact surgical gloves ensure protection of health-care employees and health-care recipients. Nevertheless, glove perforation is very common and puncture rates above 50% have been published in the literature. OBJECTIVE: It was our aim to evaluate the perforation rate of surgical gloves in outpatient dermatologic surgery. METHODS: Six-hundred and sixty latex surgical gloves used in outpatient dermatologic surgery were evaluated for perforations using the approved water-leak method. Perforations were analyzed microscopically. RESULTS: Twenty of the 660 gloves were found to have perforations, which corresponds to a perforation rate of 3.0%. Only 5 of these perforations (25%) were noticed by the wearer. Perforations were more numerous in nondominant-handed gloves. Microscopically, all perforations could be identified as needle stick injuries. CONCLUSION: The risk of glove perforation in outpatient dermatologic surgery is lower than in many other medical specialties. The relatively high number of surgical procedures performed successively in outpatient dermatologic surgery, however, emphasizes the decisive relevance of an intact barrier between surgeon and patient. In view of the major fact that most perforations go unnoticed by the wearer, dermatologic surgeons must balance the improved safety of double gloving with costs and the loss of sensitivity and dexterity.
Accidents, Occupational↗
Mondor's disease: a rare cause of anterior chest pain.
We report the case of a 52-year-old patient who sought a rheumatologic consultation for anterior chest pain of 2 weeks' duration. Radiology for trauma did not reveal any pathology. The laboratory findings focusing on rheumatologic diseases remained unhelpful and no abnormalities were found. After a cutaneous linear cordlike lesion at the right lateral chest wall occurred, the diagnosis of Mondor's disease could be made on the basis of clinical and histologic investigation. Because pain precedes the typical clinical manifestation, problems of diagnosis can occur in the early phase of the illness.
Chest Pain↗
Impaired skin barrier and atopic diathesis in perioral dermatitis.
BACKGROUND: Perioral dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. We investigated skin barrier function and various markers of the atopic diathesis to elucidate their impact on the development of perioral dermatitis. PATIENTS AND METHODS: Forty patients (24 to 69 years of age) with PD were evaluated. Transepidermal water loss was measured in three regions of the face (lateral chin, perinasal cheek and side of the nose) and the patients were assessed for clinical criteria for atopy. Prick tests were performed, and specific IgE against a mixture of aeroallergens (CAP SX1) was measured. The control group consisted of 62 individuals (20 to 68 years of age) without a history of PD or active disease. RESULTS: Transepidermal water loss was significantly increased (P < 0.001) on all regions of the face in the patient over the control group. Significantly (P < 0.001) higher values were also found for the patient group regarding history (52.5% vs. 17.7%) and clinical signs of atopic diathesis (> or = 4 features: 72.5% vs. 0%), prick test reactivity (> or = 2 reactive prick tests: 60% vs. 12.9%), and specific IgE against aeroallergens (CAP SX1 classes > or = 2: 60.0% vs. 17.7%). CONCLUSIONS: Our findings emphasize the relevance of impaired skin barrier function as a pathogenic factor in the causation of perioral dermatitis. The susceptibility of atopic skin to irritants increases as soon as the skin becomes eczematous. Therefore, we propose that atopic diathesis serves as an intensifier, supporting development and continued presence of perioral dermatitis after nonspecific irritant mechanisms have induced impaired skin barrier function.
Adult↗