1
|
Sticherling M, Franke A, Aberer E, Gläser R, Hertl M, Pfeiffer C, Rzany B, Schneider S, Shimanovich I, Werfel T, Wilczek A, Zillikens D, Schmidt E. An open, multicentre, randomized clinical study in patients with bullous pemphigoid comparing methylprednisolone and azathioprine with methylprednisolone and dapsone. Br J Dermatol 2017; 177:1299-1305. [PMID: 28494097 DOI: 10.1111/bjd.15649] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Current treatment of bullous pemphigoid (BP) is based on the long-term use of topical and/or systemic corticosteroids, which are associated with a high rate of adverse events and increased mortality. OBJECTIVES To study the corticosteroid-sparing potential of azathioprine and dapsone. METHODS This was a prospective, multicentre, randomized, nonblinded clinical trial that compared the efficacy and safety of two parallel groups of patients with BP treated with oral methylprednisolone 0·5 mg kg-1 per day in combination with either azathioprine 1·5-2·5 mg kg-1 per day or dapsone 1·5 mg kg-1 per day. Nine German and Austrian departments of dermatology included 54 patients based on clinical lesions, positive direct immunofluorescence (IF) microscopy and detection of serum autoantibodies by indirect IF microscopy, immunoblotting or enzyme-linked immunosorbent assay. The primary end point was the time until complete tapering of methylprednisolone, and the most important secondary end point was the cumulative corticosteroid dose. RESULTS In eight patients (five azathioprine, three dapsone), methylprednisolone could be discontinued after a median time of 251 days in the azathioprine group and 81 days in the dapsone group. The median cumulative corticosteroid dose was 2·65 g for azathioprine compared with 1·92 g for dapsone (P = 0·06). The median numbers of days when corticosteroids were applied were 148 and 51, respectively (P = 0·24). No significant difference in the number of adverse events was seen between the treatment arms. Four patients (8%) died within the observation period of 12 months. CONCLUSIONS Due to the lower than intended number of patients, the results of the primary and secondary end points were not or only barely significant. Dapsone appeared to have a moderately higher corticosteroid-sparing potential than azathioprine. The combination regimen of either drug with oral methylprednisolone is associated with a relatively low 1-year mortality in this vulnerable patient population.
Collapse
Affiliation(s)
- M Sticherling
- Department of Dermatology, University of Leipzig, Leipzig, Germany.,Department of Dermatology, University of Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany
| | - A Franke
- Center for Clinical Trials, University of Leipzig, Leipzig, Germany
| | - E Aberer
- Department of Dermatology, University of Graz, Graz, Austria
| | - R Gläser
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - M Hertl
- Department of Dermatology, University of Erlangen, Ulmenweg 18, D-91054, Erlangen, Germany.,Department of Dermatology, University of Marburg, Marburg, Germany
| | - C Pfeiffer
- Department of Dermatology, University of Dresden, Dresden, Germany.,Department of Dermatology, University of Ulm, Ulm, Germany
| | - B Rzany
- Department of Dermatology, Charité-Medical University Berlin, Berlin, Germany
| | - S Schneider
- Department of Dermatology, University Münster, Münster, Germany.,Department of Dermatology, University of Mannheim, Mannheim, Germany
| | - I Shimanovich
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - T Werfel
- Department of Dermatology, Medical University, Hannover, Germany
| | - A Wilczek
- Department of Dermatology, University of Leipzig, Leipzig, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Würzburg, Würzburg, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
2
|
Rzany B. Botulinumtoxin A – was gibt es Neues? Akt Dermatol 2017. [DOI: 10.1055/s-0043-113428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungNach über 20 Jahren Anwendung von Botulinumtoxin A in der Ästhetischen Medizin gibt es wenig neue Herausforderungen. Die Standardindikationen, die Standardinjektionspunkte und die Dosierungen sind klar und ermöglichen eine wirksame und sichere Behandlung unserer Patienten. Um die Behandlungszufriedenheit kontinuierlich zu verbessern, müssen individuelle Wünsche und die jeweilige anatomische Konstellation im Injektionsplan berücksichtig werden. Mit jedem neuen Patienten wachsen unsere Erfahrungen. Wir sehen mehr, verstehen mehr und lernen unsere Patienten besser zu behandeln. Mit den neuen Toxinen aus Asien und den vorverdünnten Toxinen wird sich der Markt für Botulinumtoxine in den nächsten Jahren beleben. Die Behandlungen mit Botulinumtoxin werden mit großer Wahrscheinlichkeit durch das vermehrte Angebot der Botulinumtoxine günstiger für unsere Patienten werden.
Collapse
Affiliation(s)
- B. Rzany
- RZANY & HUND Privatpraxis, Berlin
| |
Collapse
|
3
|
Rzany B. Adverse reactions to fillers should be published - on the consensus statement on adverse effects following hyaluronic acid-based fillers. J Eur Acad Dermatol Venereol 2017; 31:1087. [DOI: 10.1111/jdv.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
4
|
|
5
|
Düker D, Erdmann R, Hartmann V, Nast A, Rzany B, Bachmann F. The impact of adverse reactions to injectable filler substances on quality of life: results from the Berlin Injectable Filler Safety (IFS) - study. J Eur Acad Dermatol Venereol 2016; 30:1013-20. [DOI: 10.1111/jdv.13594] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/27/2015] [Indexed: 11/24/2022]
Affiliation(s)
- D. Düker
- Division of Evidence Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - R. Erdmann
- Division of Evidence Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - V. Hartmann
- Division of Evidence Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Nast
- Division of Evidence Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - B. Rzany
- Division of Evidence Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin; Berlin Germany
- RZANY & HUND; Privatpraxis für Dermatologie und Ästhetische Medizin; Berlin Germany
| | - F. Bachmann
- Division of Evidence Based Medicine; Department of Dermatology; Charité - Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
6
|
Kreyden OP, Rzany B, Becker-Wegerich P, Boudny-Frey C, Carrozza-Merlani P, Hess-Schmid M, Schlagenhauff B. [The satisfied patient in aesthetic dermatology. Consensus work on patient satisfaction in botulinum toxin A treatment]. Hautarzt 2015; 66:131-6. [PMID: 25608700 DOI: 10.1007/s00105-014-3572-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient satisfaction is an important factor for successful therapy. Many consensus reports have been published regarding correct treatment with botulinum toxin A (BTX-A). However, the focus of most of these publications has been on technical aspects and the important topic of patient satisfaction was often only one aspect among others. The Swiss Group of Esthetic Dermatology and Skincare (SGEDS) pursued these questions in a two-day consensus meeting. Patients of aesthetic dermatology are healthy and therefore place higher demands in contrast to ill patients of medical dermatology. This demands a great deal of the physician, the practice staff and the conditions in the practice to accommodate the special requirements of aesthetic clients. Informative consultation and patient education are of major importance; this also holds true for clinical performance and care before, during and after treatment with BTX-A. This publication aims at finding ways to gain greater patient satisfaction in daily practice.
Collapse
Affiliation(s)
- O P Kreyden
- Praxis Methininserhof, Dermatologie und Venerologie FMH, Speziell Dermatochirurgie, ästhetische Dermatologie und Laser-Therapie, Baselstrasse 9, 4132, Muttenz, Schweiz,
| | | | | | | | | | | | | |
Collapse
|
7
|
Rzany B, Griffiths T, Walker P, Lippert S, McDiarmid J, Havlickova B. Reduction of unwanted submental fat with ATX-101 (deoxycholic acid), an adipocytolytic injectable treatment: results from a phase III, randomized, placebo-controlled study. Br J Dermatol 2014; 170:445-53. [PMID: 24147933 PMCID: PMC4232897 DOI: 10.1111/bjd.12695] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2013] [Indexed: 12/01/2022]
Abstract
Summary What's already known about this topic? What does this study add?
Collapse
Affiliation(s)
- B Rzany
- Division of Evidence-Based Medicine in Dermatology, Charité-Universitätsmedizin, and RZANY & HUND, Privatpraxis und klinisches Studienzentrum für Dermatologie, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
8
|
|
9
|
Müller C, Berensmeier A, Hamm H, Dirschka T, Reich K, Fischer T, Rzany B. Efficacy and safety of methantheline bromide (Vagantin(®) ) in axillary and palmar hyperhidrosis: results from a multicenter, randomized, placebo-controlled trial. J Eur Acad Dermatol Venereol 2012; 27:1278-84. [PMID: 23004926 DOI: 10.1111/j.1468-3083.2012.04708.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Focal hyperhidrosis can severely affect quality of life. So far, knowledge on the effect of systemic therapy of focal hyperhidrosis is limited. OBJECTIVE To assess the efficacy and safety of methantheline bromide (MB) in the treatment of axillary and palmar-axillary hyperhidrosis. METHODS A multicenter controlled randomized double-blind clinical trial was conducted in patients with axillary or palmar-axillary hyperhidrosis defined by a sweat production >50 mg/5 min. Patients received 3 × 50 mg MB daily or placebo over a period of 28 ± 1 days. Main outcome criterion was the reduction of sweat as measured by gravimetry on day 28 ± 1. Quality of life was assessed by Dermatology Life Quality Index (DLQI) and Hyperhidrosis Disease Severity Score (HDSS). RESULTS A total of 339 patients were randomly assigned to receive MB or placebo. On day 28 ± 1, the mean axillary sweat production was 99 mg for MB and 130 mg for placebo compared with 168 mg and 161 mg respectively at baseline (P = 0.004). Patient's HDSS score decreased in the MB group from 3.2 to 2.4 compared with 3.2 to 2.7 for placebo (P = 0.002). Similar results could be obtained for the DLQI with 9.7 for MB and 12.2 for placebo, which decreased from 16.4 or 17 respectively (P = 0.003). Tolerability was good for both groups. The most frequent adverse event was dry mouth. CONCLUSION Fifty milligrams methantheline bromide three times a day is an effective and safe treatment of axillary hyperhidrosis.
Collapse
Affiliation(s)
- C Müller
- Department of Medical Science and Operations, RIEMSER Arzneimittel AG, Greifswald, Germany Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany Private Dermatological Practice Centre, Wuppertal, Germany SCIderm Research Institute and Dermatologikum Hamburg, Hamburg, Germany Skin and Laser Center Potsdam, Potsdam, Germany Division of Evidence-Based Medicine, Klinik für Dermatologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
10
|
Nast A, Dréno B, Bettoli V, Degitz K, Erdmann R, Finlay AY, Ganceviciene R, Haedersdal M, Layton A, López-Estebaranz JL, Ochsendorf F, Oprica C, Rosumeck S, Rzany B, Sammain A, Simonart T, Veien NK, Zivković MV, Zouboulis CC, Gollnick H. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol 2012; 26 Suppl 1:1-29. [PMID: 22356611 DOI: 10.1111/j.1468-3083.2011.04374.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- A Nast
- Division of Evidence-Based Medicine, Klinik für Dermatologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Lucka TC, Pathirana D, Sammain A, Bachmann F, Rosumeck S, Erdmann R, Schmitt J, Orawa H, Rzany B, Nast A. Efficacy of systemic therapies for moderate-to-severe psoriasis: a systematic review and meta-analysis of long-term treatment. J Eur Acad Dermatol Venereol 2012; 26:1331-44. [PMID: 22404617 DOI: 10.1111/j.1468-3083.2012.04492.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite the chronicity of psoriasis, most systematic reviews focus on short-term treatment. METHODS The systematic search strategy and results from the German Psoriasis Guidelines were adapted. To update the data a literature search in Medline, Embase and the Cochrane Library was conducted. The proportion of participants achieving ≥75% decrease in Psoriasis Area and Severity Index (PASI) as well as Dermatology Life Quality Index (DLQI) reduction at different time points were assessed. Trials were summarized with respect to time periods and study designs. Suitable trials were included in a meta-analysis. Particular attention was paid to statistical approaches of handling dropouts. RESULTS A total of 33 articles including 27 trials totaling 6575 patients with active treatment were included in the systematic review. Seven randomized controlled trials were eligible for the meta-analysis. Over a 24 week treatment period infliximab [risk difference (RD) 78%, 95% confidence interval (CI) 72-83%] and ustekinumab 90 mg every 12 weeks (RD 77%, 95% CI 71-83%) were the most efficacious treatments. Adalimumab (RD: 60%, 95% CI 45-74%) showed results within the range of different etanercept dosages (etanercept 50 mg once weekly: RD 62%, 95% CI, 52-72%), (etanercept 25 mg twice weekly: RD 45%, 95% CI 34-56%), (etanercept 50 mg twice weekly: RD 56%, 95% CI 49-62%) and (etanercept 50 mg twice weekly until week 12, then 25 mg twice weekly: RD 50%, 95% CI 42-57%). After 24 weeks a decrease in efficacy for inflximab, adalimumab and etanercept was observed. CONCLUSIONS More sufficient data is required to draw reliable conclusions in extended long-term treatment and head-to-head comparisons are necessary.
Collapse
Affiliation(s)
- T C Lucka
- Division of Evidence Based Medicine, and Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin, Berlin
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Nast A, Rosumeck S, Sammain A, Sporbeck B, Rzany B. Methods report on the development of the European S3 guidelines for the treatment of acne. J Eur Acad Dermatol Venereol 2012; 26 Suppl 1:e1-41. [DOI: 10.1111/j.1468-3083.2011.04375.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Bachmann F, Erdmann R, Hartmann V, Rzany B. Consecutively injected fillers in the same region do not pose an increased risk for adverse reactions. J Eur Acad Dermatol Venereol 2011; 25:737-8. [DOI: 10.1111/j.1468-3083.2011.04052.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Pathirana D, Nast A, Ormerod AD, Reytan N, Saiag P, Smith CH, Spuls P, Rzany B. On the development of the European S3 guidelines on the systemic treatment of psoriasis vulgaris: structure and challenges. J Eur Acad Dermatol Venereol 2010; 24:1458-67. [DOI: 10.1111/j.1468-3083.2010.03671.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15
|
Bachmann F, Erdmann R, Hartmann V, Becker-Wegerich P, Wiest L, Rzany B. Adverse reactions caused by consecutive injections of different fillers in the same facial region: risk assessment based on the results from the Injectable Filler Safety study. J Eur Acad Dermatol Venereol 2010; 25:902-12. [PMID: 21054567 DOI: 10.1111/j.1468-3083.2010.03878.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F Bachmann
- Division of Evidence Based Medicine, Department of Dermatology, Charité-Universitätsmedizin Berlin, Charité, Charitéplatz 1, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
16
|
Ascher B, Talarico S, Cassuto D, Escobar S, Hexsel D, Jaén P, Monheit GD, Rzany B, Viel M. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) - part II: wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol 2010; 24:1285-95. [DOI: 10.1111/j.1468-3083.2010.03728.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Ascher B, Talarico S, Cassuto D, Escobar S, Hexsel D, Jaén P, Monheit GD, Rzany B, Viel M. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit) - part I: upper facial wrinkles. J Eur Acad Dermatol Venereol 2010; 24:1278-84. [DOI: 10.1111/j.1468-3083.2010.03631.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Pathirana D, Sammain A, Nast A, Rzany B. Reply to Alberto Giannetti, MD, PhD commentary regarding the European S3-Guidelines on the systemic treatment of Psoriasis. J Eur Acad Dermatol Venereol 2010. [DOI: 10.1111/j.1468-3083.2009.03559.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Rzany B, Ascher B, Monheit G. Treatment of glabellar lines with botulinum toxin type A (Speywood Unit): a clinical overview. J Eur Acad Dermatol Venereol 2010; 24 Suppl 1:1-14. [PMID: 19930409 DOI: 10.1111/j.1468-3083.2009.03475.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Azzalure (Galderma) is a newly approved European botulinum neurotoxin type A (BoNT-A) specifically designed for aesthetic usages. It is sourced from Dysport (Ipsen Ltd.), which has a 20-year product consistency and has been used widely for various therapeutic and aesthetic applications. Azzalure and Dysport are collectively referred to as BoNT-A (Speywood Unit; s.U) (or abobotulinumtoxinA in the U.S.) after their biological activity unit, which is unique and not interchangeable with units of other commercial BoNT-A preparations. Azzalure is approved for the treatment of moderate-to-severe glabellar lines, with a total dose of 50 s.U distributed evenly among 5 injection points. To ensure optimal treatment outcomes with BoNT-A (s.U), it is crucial for injectors to adopt proper methods of reconstitution and injection, which can be acquired through training. We review here the method of reconstitution for BoNT-A (s.U), as well as the injection dose, points and techniques for glabellar line treatment. We also review the efficacy and safety results of BoNT-A (s.U) demonstrated in 11 clinical studies, most of which were randomized, double-blind and placebo-controlled. The studies included assessments after single injections as well as after up to 6 repeated treatment sessions. We summarize the clinical efficacy results, which include the responder rate 1 month post-injection, onset of response and duration of action, as well as safety results, which include incidence of treatment-emergent adverse events and specifically eyelid ptosis. The efficacy and safety profiles reported here are unique to BoNT-A (s.U) and cannot be generalized to other BoNT-A products.
Collapse
Affiliation(s)
- B Rzany
- dEBM, Klinik für Dermatologie, Charité-Universitätsmedizin, Berlin, Germany.
| | | | | |
Collapse
|
20
|
Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, Barker J, Bos JD, Burmester GR, Chimenti S, Dubertret L, Eberlein B, Erdmann R, Ferguson J, Girolomoni G, Gisondi P, Giunta A, Griffiths C, Hönigsmann H, Hussain M, Jobling R, Karvonen SL, Kemeny L, Kopp I, Leonardi C, Maccarone M, Menter A, Mrowietz U, Naldi L, Nijsten T, Ortonne JP, Orzechowski HD, Rantanen T, Reich K, Reytan N, Richards H, Thio HB, van de Kerkhof P, Rzany B. European S3-Guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009; 23 Suppl 2:1-70. [DOI: 10.1111/j.1468-3083.2009.03389.x] [Citation(s) in RCA: 467] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
21
|
Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, Barker J, Bos JD, Burmester GR, Chimenti S, Dubertret L, Eberlein B, Erdmann R, Ferguson J, Girolomoni G, Gisondi P, Giunta A, Griffiths C, Hönigsmann H, Hussain M, Jobling R, Karvonen SL, Kemeny L, Kopp I, Leonardi C, Maccarone M, Menter A, Mrowietz U, Naldi L, Nijsten T, Ortonne JP, Orzechowski HD, Rantanen T, Reich K, Reytan N, Richards H, Thio HB, van de Kerkhof P, Rzany B. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009. [PMID: 19712190 DOI: 10.1111/j.1468-3083.2009.03389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.
Collapse
|
22
|
Nast A, Erdmann R, Hofelich V, Reytan N, Orawa H, Sterry W, Rzany B. Do guidelines change the way we treat? Studying prescription behaviour among private practitioners before and after the publication of the German Psoriasis Guidelines. Arch Dermatol Res 2009; 301:553-9. [DOI: 10.1007/s00403-009-0978-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 06/18/2009] [Accepted: 06/24/2009] [Indexed: 11/29/2022]
|
23
|
Nast A, Spuls P, Ormerod AD, Reytan N, Saiag P, Smith CH, Rzany B. A critical appraisal of evidence-based guidelines for the treatment of psoriasis vulgaris: ‘AGREE-ing’ on a common base for European evidence-based psoriasis treatment guidelines. J Eur Acad Dermatol Venereol 2009; 23:782-7. [DOI: 10.1111/j.1468-3083.2009.03166.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
24
|
Pathirana D, Hillemanns P, Petry KU, Becker N, Brockmeyer N, Erdmann R, Gissmann L, Grundhewer H, Ikenberg H, Kaufmann A, Klußmann J, Kopp I, Pfister H, Rzany B, Schneede P, Schneider A, Smola S, Winter-Koch N, Wutzler P, Gross G. Short version of the German evidence-based Guidelines for prophylactic vaccination against HPV-associated neoplasia. Vaccine 2009; 27:4551-9. [DOI: 10.1016/j.vaccine.2009.03.086] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/19/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022]
|
25
|
Nast A, Schäfer-Hesterberg G, Zielke H, Sterry W, Rzany B. Online lectures for students in dermatology: a replacement for traditional teaching or a valuable addition? J Eur Acad Dermatol Venereol 2009; 23:1039-43. [PMID: 19368617 DOI: 10.1111/j.1468-3083.2009.03246.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVE Although the Internet, podcasts and multimedia have become a natural part of our life, these instruments still do not find widespread use in medical education. We aimed to increase the percentage of students benefiting from our lectures during their 6-month principal training period in dermatology by making lectures available online. METHODS To establish a baseline, we started to count and calculate the average percentage of students attending face to face classes. For the next semester, with a new student generation, we made recordings of about half of the lectures and made them available online. After this testing period, we informed the next new student population at the beginning of the following semester that all lectures would be recorded and made available online. Students' attendance was documented during these periods, and in addition, questionnaires were used to assess students' acceptance and use of the online lectures. RESULTS At the end of the project, 66% of the students (n = 256) indicated that they had used the online lectures, and 12% of all students stated that they were usually unable to attend lectures due to conflicting obligations, but could now participate thanks to the e-learning programme. An additional 44.9% of all respondents indicated that they welcomed the e-learning programme as a way to view specific lectures. The average attendance of face-to-face lectures did not decrease. CONCLUSION Online lectures in dermatology were highly welcomed by our students and may be a good means to improve the education of students in dermatology.
Collapse
Affiliation(s)
- A Nast
- Division of Evidence Based Medicine in Dermatology, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | | | | |
Collapse
|
26
|
Nast A, Reytan N, Rosumeck S, Erdmann R, Rzany B. Low prescription rate for systemic treatments in the management of severe psoriasis vulgaris and psoriatic arthritis in dermatological practices in Berlin and Brandenburg, Germany: results from a patient registry. J Eur Acad Dermatol Venereol 2008; 22:1337-42. [PMID: 18624864 DOI: 10.1111/j.1468-3083.2008.02841.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Many treatment options are available for the management of psoriasis vulgaris. However, detailed data on prescription behaviour in Germany, especially with regard to the use of new treatment options (e.g. biologics) in private practices, are lacking. OBJECTIVE To assess the treatment choices being made in the management of psoriasis vulgaris and psoriatic arthritis in private dermatological practices. METHODS We established a patient registry that documented the treatment decisions taken during 4797 patient visits between January 2006 and September 2006 with regard to disease activity and concomitant psoriatic arthritis. RESULTS Corticosteroids were the most frequently prescribed topical treatment, and methotrexate and fumaric acid esters were the most frequently prescribed systemic treatments. Biologics were prescribed in only 2% of patient visits. Systemic treatments were prescribed in only 31% of visits made by patients suffering from moderate to severe psoriasis (which was diagnosed in 48% of all patient visits) and in only 58% of visits made by patients suffering from psoriatic arthritis (which was diagnosed in 12% of all patient visits). CONCLUSIONS Anti-psoriatic treatment was too often limited to topical agents. The rather small percentage of patients with moderate to severe psoriasis or psoriatic arthritis who received systemic therapy indicates that the use of systemic treatments in our sample was too restrictive. Novel therapeutic options such as biologics were rarely used in private practices. New strategies to improve the quality of care provided to patients suffering from severe psoriasis are needed.
Collapse
Affiliation(s)
- A Nast
- Division of Evidence Based Medicine, Klinik für Dermatologie, Charité- Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | | | | |
Collapse
|
27
|
Heinz BC, Ladhoff U, Kahl C, Rzany B, von Mallek D. Vorkommnismeldungen zu injizierbaren Füllmaterialien. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:787-92. [DOI: 10.1007/s00103-008-0587-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
28
|
Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version). Arch Dermatol Res 2007; 299:111-38. [PMID: 17497162 PMCID: PMC1910890 DOI: 10.1007/s00403-007-0744-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 02/14/2007] [Indexed: 11/30/2022]
Abstract
Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).
Collapse
Affiliation(s)
- A Nast
- Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie, Allergologie, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
BACKGROUND The purpose of this study was to evaluate a possible association between tinea pedis (interdigital mycosis) and hyperhidrosis by a case-control-study. PATIENTS AND METHODS 30 otherwise healthy patients (age 22-56 years, 30% female) with mycologically proven tinea pedis and 51 control patients were included. RESULTS 53.3% of the patients with tinea pedis and 33.3% of the control-patients had focal hyperhidrosis defined by gravimetry (definition as > or =30 mg sweat/min) (p-value=0.08). To control for possible confounding variables a multivariate analysis was performed including possible risk factors such as gender, regular visits in sauna and/or swimming pools. Multivariate analysis found a 3.5-fold increased risk for patients with tinea pedis to have hyperhidrosis. CONCLUSION The study supports an association between tinea pedis or interdigital mycosis and focal plantar hyperhidrosis and therefore lends credence to the treatment of hyperhidrosis in patients with tinea pedis.
Collapse
Affiliation(s)
- I Boboschko
- Charité-Universitätsmedizin Berlin, Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie
| | | | | | | |
Collapse
|
30
|
Weber A, Heger S, Sinkgraven R, Heckmann M, Elsner P, Rzany B. Psychosocial aspects of patients with focal hyperhidrosis. Marked reduction of social phobia, anxiety and depression and increased quality of life after treatment with botulinum toxin A. Br J Dermatol 2005; 152:342-5. [PMID: 15727649 DOI: 10.1111/j.1365-2133.2004.06334.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary focal hyperhidrosis (PFH) is defined as excessive sweating typically localized to specific body areas such as axillae, hands and feet. An association between PFH and anxiety as well as depressive syndromes has been suggested. OBJECTIVES To investigate a possible association between PFH and anxiety, depression, social phobia and quality of life, and to study the effect of treatment with botulinum toxin A on these factors. METHODS PFH was confirmed clinically and by gravimetry. To measure anxiety and depressive syndromes several German versions of standardized questionnaires were used: State-Trait Anxiety Inventory G Form X2 (STAI), Social Phobia Scale (SPS), Symptom Checklist of Derogatis (SCL-90-R), subscales 'Social Insecurity', 'Depression', 'Anxiety' and 'Phobia', and Hospital Anxiety and Depression Scale (HADS-D). Quality of life was assessed using Skindex. Two analyses were performed. The first analysis included all patients with PFH, the second analysis only patients with PFH who were treated with botulinum toxin A. In the latter group the questionnaires were repeated 2-4 weeks after treatment. RESULTS For the total group at baseline the values for STAI, SCL-90-R, HADS-D and SPS were well within the normal range. However, in the group of patients treated with botulinum toxin A, the mean +/- SD SPS score was 17.6 +/- 15.5, i.e. above the normal range. Quality of life was impaired, with a mean +/- SD Skindex score of 24.3 +/- 5.7 at baseline. Treatment with botulinum toxin A led to a significant reduction in all investigated symptoms. CONCLUSIONS Despite an impaired quality of life, patients with PFH in general do not show increased symptoms of anxiety, depression or social phobia. Only in the subgroup of patients treated with botulinum toxin A was the SPS increased at baseline. Treatment with botulinum toxin A led to a marked improvement in all factors investigated.
Collapse
Affiliation(s)
- A Weber
- Department of Psychosomatic Medicine, Central Institute of Mental Health, D-68072 Mannheim, Germany
| | | | | | | | | | | |
Collapse
|
31
|
Sterry W, Barker J, Boehncke WH, Bos JD, Chimenti S, Christophers E, De La Brassinne M, Ferrandiz C, Griffiths C, Katsambas A, Kragballe K, Lynde C, Menter A, Ortonne JP, Papp K, Prinz J, Rzany B, Ronnevig J, Saurat JH, Stahle M, Stengel FM, Van De Kerkhof P, Voorhees J. Biological therapies in the systemic management of psoriasis: International Consensus Conference. Br J Dermatol 2004; 151 Suppl 69:3-17. [PMID: 15265063 DOI: 10.1111/j.1365-2133.2004.06070.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long-term management of psoriasis can be complicated by treatment-related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.
Collapse
Affiliation(s)
- W Sterry
- Department of Dermatology and Allergy, University Hospital Charité, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Abstract
BACKGROUND Focal injections of botulinum toxin A are used successfully for the treatment of hyperkinetic facial wrinkles. Efficacy can be measured by several methods. However, so far none has been investigated for its reproducibility. Objectives To investigate the reproducibility of a clinical 0-3 score for glabellar frown lines. METHODS In the first part of the study, a standardized photographic documentation of glabellar frown lines was produced. Based on the results of this phase, a consensus atlas of glabellar frown lines was developed and participants were trained using this atlas. In the main study, 50 standardized photographs were shown on two consecutive days to 28 dermatologists. The reproducibility of the score was investigated by conventional kappa statistics. RESULTS In the main study, we found an unweighted kappa according to Fleiss of 0.62 for interobserver reproducibility. Intraobserver reproducibility showed an unweighted kappa according to Cohen of between 0.57 and 0.91 for each observer, and a weighted kappa according to Cicchetti and Allison of between 0.68 and 0.94. CONCLUSIONS The clinical 0-3 score for glabellar frown lines shows a good inter- and intraobserver reproducibility.
Collapse
Affiliation(s)
- P Honeck
- Medical School Mannheim, University of Heidelberg, Germany
| | | | | | | |
Collapse
|
34
|
Jung M, Rzany B. Evidenzbasierte Medizin in der Dermatologie. Akt Dermatol 2002. [DOI: 10.1055/s-2002-32053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
35
|
Fuchslocher M, Rzany B. [Oral anticholinergic therapy of focal hyperhidrosis with methanthelinium bromide (Vagantin). Initial data on effectiveness]. Hautarzt 2002; 53:151-2. [PMID: 11963197 DOI: 10.1007/s00105-001-0328-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
36
|
Hahn-Ristic K, Rzany B, Amagai M, Bröcker EB, Zillikens D. Increased incidence of pemphigus vulgaris in southern Europeans living in Germany compared with native Germans. J Eur Acad Dermatol Venereol 2002; 16:68-71. [PMID: 11952295 DOI: 10.1046/j.1468-3083.2002.00384.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The two major subtypes of pemphigus include: pemphigus vulgaris (PV) and pemphigus foliaceus. Only limited data are available on the epidemiology of these diseases. OBJECTIVE The aim of the present study was to estimate the gender- and age-specific incidences of PV in two well-defined regions of Germany and to compare the incidences among native Germans with those in citizens from other countries living in Germany. METHODS We performed a retrospective review of records from all patients that were diagnosed with PV at the Departments of Dermatology in Würzburg and Mannheim between 1989 and 1997. RESULTS During the observation period, 14 patients were diagnosed with PV coming from an area with 1.46 million residents. With regard to the patients' age, the highest incidence for women was found in the 51-65-year-old-age group with 2.34 [95% confidence interval (CI): 0.36; 7.76] new cases per 1 million inhabitants per year. The highest incidence for men was observed in the over 65-year-old age group with 3.72 (95% CI: 0.95; 9.8) cases/million peryear. In the 51-65-year-old age group,we found a 25-foldhigher incidence of PV in foreigners living in Germany compared with native Germans. The age-adjusted incidence of PV was ninefold higher in foreigners compared with native Germans. Interestingly, all non-German patients came from two southern European countries (Turkey and Italy). CONCLUSIONS The age-adjusted incidence of PV differs between native Germans and foreigners living in Germany. Further studies are necessary to address the risk factors (genetic and/or environmental) that contribute to this difference.
Collapse
Affiliation(s)
- K Hahn-Ristic
- Department of Dermatology, University of Würzburg, Germany
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Glorer E, Rzany B, Jung EG. [Extensive ulcerated basalioma. Irradiation with ionizing radiation after electrocautery debridement]. Hautarzt 2001; 52:646-8. [PMID: 11475648 DOI: 10.1007/s001050170107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Soft X-Ray (Dermopan) is an effective and gentle treatment for large basal cell carcinomas of the face. It is an useful alternative to extensive and often cosmetically unsatisfactory surgery, especially in large basal cell carcinomas covering an area of more than 4 cm2. A 79-year-old man presented with a 4,5-year history of an extensive basal cell carcinoma on the right temple, which was treated by soft x-ray after removal of excessive tumor tissue with electrocautery. A total dosage of 48 Gy was employed.
Collapse
Affiliation(s)
- E Glorer
- Universitäts-Hautklinik, Fakultät für Klinische Medizin Mannheim, Universität Heidelberg
| | | | | |
Collapse
|
39
|
Abstract
BACKGROUND AND OBJECTIVE Pemphigus is a rare intraepidermal autoimmune bullous disease. Two major variants, pemphigus vulgaris (PV) and pemphigus foliaceus (PF), are distinguished. The aim of this study was to document the clinical and immunopathological findings in all pemphigus patients who were diagnosed in the Department of Dermatology at the University of Würzburg over the past 10 years. PATIENTS/METHODS Based on a retrospective study, clinical and immunopathological findings in 48 patients with pemphigus were recorded. All patients had positive findings by direct and/or indirect immunofluorescence microscopy. RESULTS Between January 1989 and August 1998, 48 patients were diagnosed with pemphigus at our institution; 31 patients had PV and 17 PF. The average age (+/- standard deviation) of PV patients was 55 (+/- 17) and of PF patients 60 (+/- 12) years. All PV patients showed involvement of mucous membranes and in 65% of cases, the skin was also involved. In contrast, PF patients had involvement only of the skin. By direct immunofluorescence microscopy, intercellular deposits of IgG and C3 were detected in 89% and 78% of PV cases, respectively. In PF, intercellular deposits of IgG were found in 94% and of C3 in 75% of cases. By indirect immunofluorescence microscopy on monkey esophagus, 94% of the PV and 88% of the PF patients revealed circulating serum antibodies. In 30 patients, we characterized the immune response by ELISA using recombinant desmoglein 1 and 3. All PF sera showed autoantibodies against desmoglein 1 and all PV sera against desmoglein 3. In PV with both mucous membrane and skin involvement, antibodies to both desmoglein 3 and 1 were detected. CONCLUSIONS Our results confirm the correlation of the autoantibody profile with the clinical phenotype of pemphigus.
Collapse
Affiliation(s)
- K Hahn
- Klinik und Poliklinik für Haut- und Geschlechtskrankheiten, Universität Würzburg
| | | | | | | | | | | |
Collapse
|
40
|
Philipp A, Wolf GK, Rzany B, Dertinger H, Jung EG. Interferential current is effective in palmar psoriaris: an open prospective trial. Eur J Dermatol 2000; 10:195-8. [PMID: 10725817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Interferential current (IFC) has been shown to improve psoriasis in a small case series. So far no formal clinical trial had been conducted. As IFC is associated with slight prickling sensations a blinded study design was not feasible. Therefore, an open type prospective study was conducted with the assumption of 18% spontaneous remission rate. A response rate of 50% or less was judged as indicating no effect (hypothetical control), while 80% or more was considered as success (alternative hypothesis). In this "quasi-controlled" study 12 patients with therapy resistant palmar psoriasis received local treatment with IFC during a 12 week period. Treatment was performed at low current density in two daily sessions, each of 6 minutes duration. Erythema, scaling, induration, fissures and pustules were recorded in separate scores every 4 weeks. Response of a patient was judged positive when the total score of these criteria was reduced at least by two points at the end of treatment. After 12 weeks of treatment, 11 of 12 patients were cured or showed marked remission with the median overall score reduced by 4 points. An interim analysis was performed in order to decide whether the results had already reached significance (a < 0.05). The analysis revealed a statistically significant response rate of 90% (95% confidence interval 62-99%). These results are highly encouraging and should focus attention on this new therapy modality, which, in contrast to other treatments is not associated with side effects and discomfort.
Collapse
Affiliation(s)
- A Philipp
- Universitäts-Hautklinik, Klinikum gGmbH, Universitätsklinikum, Fakultät für klinische Medizin Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer, D-68135 Mannheim, Germany.
| | | | | | | | | |
Collapse
|
41
|
Abstract
Bullous pemphigoid (BP) is an autoimmune bullous disease of the elderly. Patients' auto-antibodies are directed against BP180, a transmembrane hemidesmosomal glycoprotein of basal keratinocytes. Between 1989 and 1998, we identified 115 patients with BP in the Department of Dermatology at the University of Würzburg. This is one of the largest groups of patients with BP studied to date. In all patients, direct and/or indirect immunofluorescence microscopy studies were positive. The average age (+/- standard deviation) of the patients was 75 +/- 12 years, the median was 78 years. The youngest patient was 39 years of age; the oldest, 99 years. 54% of the patients were female and 46% male. In 24% of the patients, an involvement of oral, and in 7% of genital mucous membranes was seen. 98% of the patients complained about pruritus. By direct immunofluorescence microscopy, linear deposits of C3 and/or IgG were detected at the basement membrane zone of perilesional skin biopsies. By indirect immunofluorescence microscopy using NaCl-separated human skin, 87% of cases revealed circulating serum antibodies whereas on monkey esophagus, only 72% of sera were found positive. In 85% of the patients, we detected elevated serum levels of total IgE before the initiation of treatment. In those sera that were analyzed for reactivity with BP180, autoantibodies to the immunodominant NC16 A domain of BP180 were detected in 89% by immunoblot analysis and in 93% by ELISA. Therefore, in most patients, BP can be diagnosed serologically.
Collapse
Affiliation(s)
- W Kippes
- Klinik und Poliklinik für Haut- und Geschlechtskrankheiten, Universität Würzburg
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
Renal insufficiency is one of the most severe outcomes of systemic lupus erythematosus (SLE). The aim of this study was to identify baseline predictors of the development of renal insufficiency in a cohort of patients with SLE. 281 patients from the The Hopkins Lupus Cohort (HLC) enrolled between 1987-1994 were followed for the occurrence of renal insufficiency, defined as a serum creatinine 1.6 mg/dl for men and 1.4 mg/dl for women. Over a mean (+/-s.d.) of 3. 3+/-2.1 y of follow up, 46 (16%) of the 281 patients developed renal insufficiency. Using a multivariate Cox proportional hazard model, we found the risk of renal insufficiency associated with younger (0-19 y) or older (40 y) age at baseline (relative risk (95% CI) 5.1 (1.4, 18.8) and 4.1 (2.1, 8.2)) and longer duration of SLE before referral to the cohort (RR 1.25 [1.05, 1.5] for every five years). Additional predictive variables were borderline elevation of serum creatinine at baseline (RR 3.1 (1.4, 6.6) for a serum creatinine 1. 4-1.5 mg/dl for men and 1.2-1.3 mg/dl for women), and mean proteinuria (RR 3.6 (1.8, 7.4) for trace-3+ and 10.6 (3.8, 30.0) for 3+ (urine dipstick level)). Socioeconomic status, race, autoantibodies and complement were not significantly associated with the risk of renal insufficiency. This study supports early referral of SLE patients to rheumatologists and emphasizes the importance of early signs of renal involvement as predictors of later renal insufficiency in SLE patients.
Collapse
Affiliation(s)
- B Rzany
- Department of Dermatology, Medical School Mannheim, University of Heidelberg, Germany
| | | | | | | |
Collapse
|
43
|
Jung M, Kippes W, Messer G, Zillikens D, Rzany B. Increased risk of bullous pemphigoid in male and very old patients: A population-based study on incidence. J Am Acad Dermatol 1999; 41:266-8. [PMID: 10426901 DOI: 10.1016/s0190-9622(99)70061-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
No data are available on gender- and age-specific incidences for bullous pemphigoid (BP). The aim of this study was to calculate incidences for different gender- and age-strata and to assess risk differences between these strata in BP. A retrospective population-based cohort was recruited from all patients diagnosed with BP in 2 well-defined regions of Germany. The average population number was 1.7 million, and the observation period was 9 years (1989-1997). Incidences were calculated as newly diagnosed cases for a population of 1 million per year. Confidence intervals (CI) were estimated based on a Poisson distribution. For evaluation of risk between different age and gender strata a Poisson regression analysis was used. The highest incidence was calculated for individuals older than 90 years, with 398 (CI: 360, 439) new cases of BP per 1 million residents for men, and 87 (CI: 70, 108) new cases per 1 million residents for women. Risk (95% CI) was 1.9 (1.3, 2.9) fold higher in men than in women. In addition, the risk for BP was increased for patients above the age of 60 years. The highest risk was found for patients older than 90 years. For this age group, the risk was 297 (CI: 107, 826) fold higher than in patients 60 years of age and younger. Men are affected by BP almost twice as often as women. The risk for BP increases rapidly beyond the age of 60 years. Because the structure of the European population is shifting towards the aged, more people are expected to suffer from BP in the coming decades.
Collapse
Affiliation(s)
- M Jung
- Department of Dermatology, Mannheim Medical School, Ruprechts-Karls-University of Heidelberg, Mannheim, Germany
| | | | | | | | | |
Collapse
|
44
|
Rzany B, Correia O, Kelly JP, Naldi L, Auquier A, Stern R. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study. Study Group of the International Case Control Study on Severe Cutaneous Adverse Reactions. Lancet 1999; 353:2190-4. [PMID: 10392983 DOI: 10.1016/s0140-6736(98)05418-x] [Citation(s) in RCA: 185] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is still controversy about whether all antiepileptic drugs are associated with the severe cutaneous reactions Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We have studied the role of antiepileptic drugs in SJS and TEN, taking into account potential cofactors that might confound or modify the risk. METHODS The case-control study in France, Italy, Germany, and Portugal identified cases of SJS/TEN that developed when the patient was not in hospital and were validated by an expert committee. Controls were patients admitted to the same hospital as the case for an acute illness or an elective procedure. FINDINGS 73 (21%) of the 352 SJS/TEN cases and 28 (2%) of the 1579 controls reported intake of antiepileptic drugs. Among the 73 exposed SJS and TEN patients, 36 reported intake of phenobarbital, 14 of phenytoin, 21 of carbamazepine, 13 of valproic acid, and three of lamotrigine. Risk was highest in the first 8 weeks after onset of treatment. For individual antiepileptic drugs the univariate relative risk of SJS/TEN for 8 weeks or less of use was 57 (95% CI 16-360; multivariate risk 59 [12-302]) for phenobarbital; 91 (26-infinity) for phenytoin; 120 (34-infinity) for carbamazepine; 25 (5.6-infinity) for lamotrigine, and 24 (5.9-infinity) for valproic acid. The result for valproic acid was based on four case users, all of whom reported concurrent use of other associate drugs. The univariate relative risk for more than 8 weeks of use was 6.2 (2.4-17.0; multivariate risk 2.1 [0.5-9.3]) for phenobarbital, 1.2 (0-5.4) for phenytoin, 0.4 (0.02-2.1) for carbamazepine, and 7.0 (2.4-21.0; multivariate risk 2.0 [0.3-15.0]) for valproic acid. INTERPRETATION SJS and TEN are associated with short-term therapy with phenytoin, phenobarbital, and carbamazepine. The association with valproic acid seems to be confounded by concomitant short-term therapy with other causal drugs. Lamotrigine also has the potential for severe skin reactions. The period of increased risk is largely confined to the first 8 weeks of treatment.
Collapse
Affiliation(s)
- B Rzany
- Department of Dermatology, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany.
| | | | | | | | | | | |
Collapse
|
45
|
Bayerl C, Dorfner B, Rzany B, Fuhrmann E, Coelho CC, Jung EG. Heat shock protein HSP 27 is expressed in all types of basal cell carcinoma in low and high risk UV exposure groups. Eur J Dermatol 1999; 9:281-4. [PMID: 10356405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
HSP 27, a marker of differentiation and proliferation, helps the cell in repair processes after environmental stress such as heat, UV-irradiation and oxidative stress. So far, its role on carcinogenesis is not yet understood. HSP 27 was studied immunohistochemically in different types of primary, untreated basal cell carcinoma (BCC) in two populations with different UV exposure habits: descendents from Germany, "Pommern", living in Brazil (Pommeranos, n = 15), rural workers with high UV exposure and Germans from the region Baden-Württemberg with indoor jobs (n = 14). Age distribution and type of BCC were similar between the Pommeranos and the Germans. Specimens of BCC (n = 15 solid, n = 6 keratotic, n = 4 adenoid, n = 4 fibrotic) were evaluated in cryostat and paraffin sections for HSP 27, HSP 72 and bcl-2. In Pommeranos in Brazil (UV high risk group) versus (vs) inhabitants from Baden-Württemberg (UV low risk group), HSP 27 was expressed in 93% vs 79% in all histological subclasses, HSP 72 in 20% vs 21% and bcl-2 in 93 % in both groups. Antibodies against HSP 27, but not HSP 72, labeled BCC of all types. In contrast to the lack of HSP 27 in squamous cell carcinoma reported in the literature, we found HSP 27 and bcl-2 positive cells in BCC which might characterize the tumour as relatively benign and slow progressing.
Collapse
Affiliation(s)
- C Bayerl
- Department of Dermatology, Mannheim Medical School, University of Heidelberg, Theodor Kutzer Ufer 1-3, D-68167 Mannheim, Germany.
| | | | | | | | | | | |
Collapse
|
46
|
|
47
|
Hering O, Mockenhaupt M, Rzany B, Schröder W, Schöpf E. The dermal type of erythema multiforme: a rare variant of Stevens-Johnson syndrome or cases of clinical misclassification? Acta Derm Venereol 1997; 77:217-8. [PMID: 9188874 DOI: 10.2340/0001555577217218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Since 01.04.90 the Dokumentationszentrum schwerer Hautreaktionen (dZh) in Freiburg has registered cases of severe skin reactions like erythema exsudativum multiforme majus, Stevens-Johnson syndrome and toxic epidermal necrolysis in Germany. With the largest study so far of histological slides from patients included in this registry we were able to show that the epidermal type of erythema multiforme described by Orfanos et al. is the histopathological correlated of these severe skin reactions. Except two biopsies all of the specimens taken from the registered patients showed histological characteristics of this type of erythema multiforme. These two cases are now reported. Clinical data and photographic documentation did not prove authentic erythema multiforme. The lesions of both patients were described as atypical macules and papules; mucosal sites were only locally involved. Biopsies taken from the patients had the characteristics of the dermal type of erythema multiforme (Orfanos et al.). We conclude that histomorphological characteristics of the dermal type, in addition to an atypical clinical course, favour another diagnosis, such as multiforme-like eruption.
Collapse
Affiliation(s)
- O Hering
- Department of Dermatology, University of Freiburg, Germany
| | | | | | | | | |
Collapse
|
48
|
Rzany B, Hering O, Mockenhaupt M, Schröder W, Goerttler E, Ring J, Schöpf E. Histopathological and epidemiological characteristics of patients with erythema exudativum multiforme major, Stevens-Johnson syndrome and toxic epidermal necrolysis. Br J Dermatol 1996; 135:6-11. [PMID: 8776350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The clinical and histopathological classification of erythema exudativum multiforme major (EEMM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are difficult, due to the lack of clear-cut criteria. Based on a new clinical classification, 149 of 219 (68%) histopathological specimens, from a total of 534 patients with EEMM, SJS and TEN, have been reviewed. A comparison was made with the clinical picture, and any past history of infection or drug intake. All patients had been included in the German Registry of Severe Skin Reactions between April 1990 and December 1993. No differences could be found between the biopsies examined and the total number of histopathological specimens, concerning clinical diagnosis, gender and age. Sections from 28 of 149 specimens were not diagnostic or were too old to be properly evaluated. In nine cases, other diagnoses were proposed. One hundred and eleven of the histological slides with the diagnosis of EEMM (n = 16), SJS (n = 34) and TEN (n = 61), were classified as epidermal type of erythema multiforme. In these 111 slides, necrotic keratinocytes could be found, ranging from individual cells to confluent epidermal necrosis. The epidermo-dermal junction showed changes ranging from vacuolar alteration up to subepidermal blisters. The dermal infiltrate was superficial and mostly perivascular. It was sparse in SJS and TEN, and more pronounced in EEMM. Oedema in the papillary dermis was evident occasionally in all clinical groups. In 59 of 111 cases (53%), at least one eosinophil was present in the dermis. In 11 of 111 (10%), more than 10 eosinophils per field could be seen. Eosinophils were less common in the patients with the most severe forms of TEN, in whom there was detachment of more than 30% of the skin surface area. No differences in the history for drug intake, or for infection with Mycoplasma pneumoniae, herpes simplex and other organisms, could be detected between patients with or without eosinophils in their skin sections. This dermatopathological study of patients with EEMM, SJS and TEN indicates that the epidermal type of erythema multiforme is the pathological correlate for these diseases.
Collapse
Affiliation(s)
- B Rzany
- Department of Dermatology, University of Freiburg, Germany
| | | | | | | | | | | | | |
Collapse
|
49
|
Rzany B, Mockenhaupt M, Baur S, Schröder W, Stocker U, Mueller J, Holländer N, Bruppacher R, Schöpf E. Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990-1992): structure and results of a population-based registry. J Clin Epidemiol 1996; 49:769-73. [PMID: 8691227 DOI: 10.1016/0895-4356(96)00035-2] [Citation(s) in RCA: 232] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The severe skin reactions erythema exsudativum multiforme majus (EEM with mucosal involvement, EEMM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) are difficult to study as they are very rare diseases with an incidence of about two cases per 1 million inhabitants per year. We report on the structure of a registry with the aim of ascertaining all hospitalized cases of EEMM, SJS, and TEN in western Germany and Berlin. The registry is structured as an intensive reporting system, regularly contacting more than 1500 departments including 100% of the burn units (n = 34), departments of pediatrics (n = 241), departments of dermatology (n = 106), and 100% of all internal medicine departments in hospitals with intensive care facilities or with more than 200 beds (n = 1161). With a coverage rate up to 95% based on the number of responding departments between April 1, 1990 and December 31, 1992, from a total of 767 reported cases 353 patients with EEMM, SJS, and TEN were finally included in the registry. Most of these patients were directly reported to the registry; only 2.54% (9 of 353) were primarily registered by the German spontaneous reporting systems. Assuming an average population of 64.5 million for western Germany and Berlin an incidence up to 1.89 per 1 million inhabitants per year could be calculated for SJS and TEN.
Collapse
Affiliation(s)
- B Rzany
- Department of Dermatology, University of Freiburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, Auquier A, Bastuji-Garin S, Correia O, Locati F, Mockenhaupt M, Paoletti C, Shapiro S, Shear N, Schöpf E, Kaufman DW. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. Am J Ophthalmol 1996. [DOI: 10.1016/s0002-9394(14)70298-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|