German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version)

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 ).

Prospective, randomized controlled trial on Lactobacillus rhamnosus in infants with moderate to severe atopic dermatitis

BACKGROUND

A reduction of symptoms of atopic dermatitis (AD) in small infants by the administration of Lactobacillus rhamnosus has been reported in a few studies. One study with older children and adolescents failed to show any effect.

OBJECTIVES

We conducted a prospective study to reassess the efficacy of orally administered L. rhamnosus strain GG (LGG) in infants with AD.

METHODS

In a randomized, double-blind, placebo-controlled study, 54 infants aged 1-55 months with moderate to severe AD were randomized to daily 10 x 10(9) colony-forming units of LGG or to placebo during an 8-week intervention phase. Emollients, class I-II topical corticosteroids and antihistamines were permitted.

RESULTS

The treatment with LGG was well tolerated. At the end of treatment there were no significant differences between the groups with respect to clinical symptoms (SCORAD, pruritus, sleep loss), the use of topical corticosteroids and antihistamines, immunological parameters, or health-related quality of life of the parents.

CONCLUSIONS

Our results could not confirm LGG as an effective treatment of AD in infancy.

Psychosoziale Folgen der Psoriasis—eine empirische Studie über die Krankheitslast bei 3753 Betroffenen

BACKGROUND AND OBJECTIVE

The aim of this study was to determine the psychosocial consequences of psoriasis in a large sample in Germany.

PATIENTS AND METHODS

A questionnaire including the Psoriasis Disability Index (PDI) circulated by the German Psoriasis Alliance was answered by 3753 members representing a return rate of 42.3%. Psoriasis was graded-at the time of the examination-with less than 3% of the body surface affected as "mild", between 3 and 10% as "moderate," and more than 10% as "severe."

RESULTS

The general impact of the illness on everyday life was "mild" in about 27%, "problematic" in about 45%, and "severe" in about 25% of the respondents. About 50% of the participants in the study had, concerning the skin, "mild" (PDI=9), about 35% "moderate" (PDI=14), and about 15% "severe" psoriasis (PDI=19). The differences of the PDI values are significant (ANOVA: p<0.001).

CONCLUSIONS

This investigation confirms the enormous burden caused by the skin disease in the form of impairment and stigmatization, depending on the somatic severity, even when the current affection is rather mild. In connection with psychosocial consequences, future study should also focus on the disease burden of psoriasis.

Inhibition of dermatophytes by optical brighteners

The aim of this study was to investigate a possible effect of optical brighteners on the growth of dermatophytes. Typical strains of Trichophyton rubrum, T. mentagrophytes, Microsporum canis and Epidermophyton floccosum were grown on agar plates containing two different brighteners of stilbenedisulfonic acid type in concentrations between 5 x 10(-5) and 1 x 10(-2) mol l-1 and their thallus diameters were compared with controls. In addition, hyphae grown with brighteners were compared with controls by fluorescence microscopy and by transmission electron microscopy. Both brighteners had a significant dose-dependent growth-suppressive effect on all dermatophytes tested, that was complete at a concentration of 10(-2) and 10(-3) mol l-1, respectively. Fluorescence microscopy of hyphae showed a pronounced fluorescence of the septal areas and a less-intense staining of the outer cell walls. Electron microscopy revealed a marked thickening and blurred contours of the cell walls grown with brighteners. These new observations relate very well to an interference of optical brighteners with the formation of normal chitin fibrils as described previously. Optical brighteners of stilbenedisulfonic acid type may be rewarding objects for the development of new antifungal agents.

Cercarial dermatitis contracted via contact with an aquarium: case report and review

Cercarial dermatitis ('swimmer's itch') is an itchy inflammatory response to the penetration of the skin by non-human Schistosoma parasites. It is commonly contracted while swimming or wading in lakes. We report a biology teacher who developed the dermatitis after cleaning the school aquarium in which he kept a water snail and some fish.