Patients' perspective, quality of life and treatment goals in Hailey-Hailey disease: Lessons learned from the German National Registry

BACKGROUND

Hailey-Hailey disease (HHD) remains a difficult-to-treat dermatosis and little is known about the patient's perception of the disease activity, the treatment success and its impact on quality-of-life (QoL).

OBJECTIVE

To obtain better understanding of HHD patients' needs regarding their medical condition, financial burden, QoL, subjective well-being and treatment thereof as well as satisfaction to evaluate common treatments' 'real-life' relevance.

METHODS

With initiation of the national registry for Darier's disease (DD; Morbus Darier, MD) and Hailey-Hailey disease (HH) MDHHgermany, patients with HHD diagnosis were included starting June 2020. To assess subjective symptoms, patients filled out questionnaires such as the DLQI (dermatological life quality index), numeric rating scale (NRS) for itch, pain and burning sensation, as well as the SWLS (satisfaction with life scale) questionnaire to quantify overall satisfaction in life. Additionally, data on therapies were collected along with the patients' satisfaction of those and their medical care. Furthermore, patients assessed financial aspects and work ability.

RESULTS

One hundred and two patients were recruited from dermatology clinics, office-based dermatologists and self-help platforms across Germany between June 2020 and February 2023, 90 were eligible and analysed (mean: 49.91 years, 73.33% females, 26.67% males). 39.77% stated according to the DLQI their life is severely/very severely affected. Satisfaction with life was mediocre. Burning sensation was most pronounced among subjective symptoms (NRS 5.85 ± 2.80). Systemic treatments were rated as ineffective according to 56.92%, 25.56% had never received one. Most prescribed systemic treatments were corticosteroids (73.8%), followed by low-dose naltrexone (LDN) (26.2%), retinoids (15.4%) and antibiotics (13.8%). Satisfaction with medical care was generally low.

CONCLUSION

Our 'real-life' data state a major disease burden and impact on the QoL for affected individuals, as well as limited disease control due to inadequate therapies. MDHHgermany can provide insights into improvement of healthcare support with this debilitating disease and improve QoL. In the long term, it aims to provide basis for further clinical trials, epidemiological studies and immunological investigations.

Raster-scanning optoacoustic mesoscopy biomarkers for atopic dermatitis skin lesions

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease worldwide. Its severity is assessed using scores that rely on visual observation of the affected body surface area, the morphology of the lesions and subjective symptoms, like pruritus or insomnia. Ideally, such scores should be complemented by objective and accurate measurements of disease severity to standardize disease scoring in routine care and clinical trials. Recently, it was shown that raster-scanning optoacoustic mesoscopy (RSOM) can provide detailed three-dimensional images of skin inflammation processes that capture the most relevant features of their pathology. Moreover, precise RSOM biomarkers of inflammation have been identified for psoriasis. However, the objectivity and validity of such biomarkers in repeated measurements have not yet been assessed for AD. Here, we report the results of a study on the repeatability of RSOM inflammation biomarkers in AD to estimate their precision. Optoacoustic imaging analysis revealed morphological inflammation biomarkers with precision well beyond standard clinical severity metrics. Our findings suggest that optoacoustic mesoscopy may be a good choice for quantitative evaluations of AD that are inaccessible by other methods. This could potentially enable the optimization of disease scoring and drug development.

Increasing the COVID-19 immunization rate through allergy testing

BACKGROUND

Vaccination of the population is required to combat the COVID-19 pandemic. Allergy testing could reduce anxiety towards COVID-19 vaccination and thereby may increase vaccination rate, however, its effectiveness remains unclear.

METHODS

One hundred and thirty prospective real-life patients in need of but not daring to get vaccinated asked for allergy workup for COVID-19 vaccine hypersensitivity in 2021/2022. Characterization of patients, identification of anxieties, decrease of patient's anxiety levels, overall vaccination rate and adverse reactions after vaccination were assessed.

RESULTS

Tested patients were characterized by being female (91.5%) and having a high rate of previous allergies (e.g. to food 55.4%, drugs 54.6%, or previous vaccinations 50%) and dermatological disease (29.2%) but not always had medical contraindications for COVID-19 vaccination. Sixty one patients (49.6%) were highly concerned (4-6, Likert scale 0-6) about vaccination and 47 (37.6%) expressed resolving thoughts about vaccinaion anaphylaxis (3-6, Likert scale 0-6). However only 35 patients (28.5%) were scared of getting COVID-19 within 2 months (4-6, Likert scale 0-6) and only 11 (9%) patients had high expectations of getting COVID-19 (4-6, Likert scale 0-6). Allergy testing significantly (p < 0.01 to p < 0.05 respectively) reduced the median anxiety of allergic symptoms following vaccination: dyspnoea (4.2-3.1), to faint (3.7-2.7), long-term consequences (3.6-2.2), pruritus (3.4-2.6), skin rash (3.3-2.6) and death (3.2-2.6). After allergy testing, most patients (108/122, 88.5%) let themselves be vaccinated within 60 days. Revaccinated patients with previous symptoms experienced a reduction of symptoms (p < 0.05) upon revaccination.

CONCLUSIONS

Patients not daring to get vaccinated have more anxiety towards vaccination than to acquire COVID-19. For those, allergy testing excludes vaccine allergy, and is a tool to increase vaccination willingness and thereby helps to combat vaccination hesitancy.

Spatial transcriptomics landscape of lesions from non-communicable inflammatory skin diseases

Abundant heterogeneous immune cells infiltrate lesions in chronic inflammatory diseases and characterization of these cells is needed to distinguish disease-promoting from bystander immune cells. Here, we investigate the landscape of non-communicable inflammatory skin diseases (ncISD) by spatial transcriptomics resulting in a large repository of 62,000 spatially defined human cutaneous transcriptomes from 31 patients. Despite the expected immune cell infiltration, we observe rather low numbers of pathogenic disease promoting cytokine transcripts (IFNG, IL13 and IL17A), i.e. >125 times less compared to the mean expression of all other genes over lesional skin sections. Nevertheless, cytokine expression is limited to lesional skin and presented in a disease-specific pattern. Leveraging a density-based spatial clustering method, we identify specific responder gene signatures in direct proximity of cytokines, and confirm that detected cytokine transcripts initiate amplification cascades of up to thousands of specific responder transcripts forming localized epidermal clusters. Thus, within the abundant and heterogeneous infiltrates of ncISD, only a low number of cytokine transcripts and their translated proteins promote disease by initiating an inflammatory amplification cascade in their local microenvironment.

Microbial dysbiosis in a mouse model of atopic dermatitis mimics shifts in human microbiome and correlates with the key pro-inflammatory cytokines IL-4, IL-33 and TSLP

BACKGROUND

Cutaneous bacterial dysbiosis is a characteristic hallmark of atopic dermatitis (AD) and it decisively influences the severity of the disease. Despite this, frequently used murine models of AD have not been characterized regarding the changes in skin microbiome communities.

OBJECTIVE

To analyze the skin microbiome of two frequently used murine models for AD for assessing their applicability in translational research.

METHODS

AD was induced in mice by topical application of calcipotriol, or oxazolone. Following comparable elicitation of AD-like dermatitis, including IgE induction, the skin microbial communities were analyzed and compared with human AD.

RESULTS

We detected critical differences in the microbiota composition of diseased skin. In contrast to calcipotriol treatment, application of oxazolone induced significant changes of the cutaneous microbiota and a drastic drop of bacterial richness. Furthermore, an expansion of Staphylococci, particularly S. xylosus was observed in the oxazolone group, also displaying positive correlations with AD key markers including pH, TEWL, IL-4, TSLP and IL-33.

CONCLUSIONS

In this article we show that i) the model of choice to investigate AD needs to be characterized for the cutaneous microbiota if applicable and ii) the oxazolone-mediated mixed Th1-Th2 immune response triggers microbiota-induced alterations which share similarities to dysbiosis in human AD and represents therefore a suitable model for translational research on AD if alterations of the microbiome are in the focus of the investigation.

Atopic Dermatitis: Disease Characteristics and Comorbidities in Smoking and Nonsmoking Patients from the TREATgermany Registry

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke.

OBJECTIVES

In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients.

METHODS

TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers.

RESULTS

Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet.

CONCLUSIONS

German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

Addictions in patients with atopic dermatitis: a cross-sectional pilot study in Germany

BACKGROUND

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease worldwide and displays many atopic, but also non-atopic comorbidities. Among the latter, mental health disorders such as depression have been extensively studied. However, data on addictions are still rare.

OBJECTIVES

The aim of this study was to assess the prevalence of different kinds of addictions in adult AD patients using a single-centre approach.

METHODS

This non-interventional cross-sectional study was performed from 03/2020 to 05/2020 at the Department of Dermatology of a large German university hospital. Participants with a diagnosis of AD confirmed by a dermatologist answered questions about disease severity (patient-oriented eczema measure, POEM), quality of life (Dermatology Life Quality Index, DLQI) and smoking habits. They were screened for problematic alcohol consumption, drug abuse, internet addiction and pathological gambling using internationally established and validated questionnaires.

RESULTS

157 patients (56.1% female; mean age of 49.9 ± 20.4) with an average POEM of 13.7 ± 7.5 and DLQI of 6.1 ± 5.4 were evaluated. 14.1% were identified as regular smokers, 12.1% screened positive for alcohol dependency, 6.4% for drug use disorders, 4.5% for Internet addiction and 3.2% for pathological gambling. Co-occurrences of different addictions were observed, and a positive correlation was noted between DLQI scores and smoking.

CONCLUSIONS

In summary, this study hints at elevated positive screening rates for problematic alcohol consumption, drug use disorders, Internet addiction and problem gambling compared with the general population. Screening routinely for addictions may improve patient-centred health care of AD patients.

Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD Registry TREATgermany

BACKGROUND

The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the 'real-life' situation of health care for patients with AD.

OBJECTIVES

Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients.

METHODS

Patients (≥18 years) with moderate-to-severe AD [objective (o)SCORAD > 20], or with current or previous anti-inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0-72), the oSCORAD (0-83) and the Investigator Global Assessment (IGA; 6-point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six-step Likert scale]. Disease symptoms were assessed by the patient-oriented eczema measure (POEM, 0-28) and numeric rating scales (NRS, 0-10). Health-related quality of life was measured using the dermatological life quality index (DLQI, 0-30).

RESULTS

A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either 'current' (12.1%) or 'prescribed' (31.4%) at baseline.

CONCLUSIONS

These 'real-life' data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate-to-severe AD.

Optoakustische Bildgebung – Licht rein, Schall raus?

Die optoakustische Bildgebung ist eine neuartige Bildgebungsmodalität, welche auf der Aufzeichnung und Verarbeitung von Ultraschallsignalen basiert, die im Gewebe durch Absorption von Laserlicht entstehen. Die Methode vereint guten, auf Lichtabsorption beruhenden Kontrast mit hoher Eindringtiefe und ermöglicht sowohl morphologische als auch molekulare und funktionelle Bildgebung. Sie kann mit oder ohne Kontrastmittel eingesetzt werden und ist frei von ionisierender Strahlung. Darüber hinaus ist die Technik skalierbar und kann somit zur makroskopischen, mesoskopischen und mikroskopischen Bildgebung verwendet werden.

In den letzten Jahren wurden eine Reihe verschiedener Systeme zur optoakustischen Bildgebung entwickelt und in vielfältigen Bereichen der präklinischen und klinischen Forschung eingesetzt. In der Dermatologie zeigten sich vielversprechende Anwendungsgebiete der Optoakustik insbesondere in der Untersuchung von Melanomen, Wächterlymphknoten und nicht-melanozytärem Hautkrebs sowie in der Charakterisierung von entzündlichen Hauterkrankungen.

In diesem Review sollen die technischen Grundlagen der optoakustischen Bildgebung erläutert sowie der derzeitige Stand der Forschung hinsichtlich Anwendungsbereiche makroskopischer, mesoskopischer und mikroskopischer optoakustischer Systeme beschrieben und diskutiert werden.

Happiness in dermatology: a holistic evaluation of the mental burden of skin diseases

BACKGROUND

According to the World Health Organization, mental health is a state of well-being and not merely the absence of disease. However, studies exploring subjective well-being in patients with skin diseases are very rare.

OBJECTIVES

To assess subjective well-being, i.e. 'happiness', in patients with different skin diseases and to compare them to other patient groups and healthy controls.

METHODS

A cross-sectional study was conducted from 12/2017 to 04/2019. Patients receiving in- or outpatient care for psoriasis, atopic eczema, nummular eczema, mastocytosis, skin cancer (malignant melanoma and keratinocyte carcinoma), human immunodeficiency virus (HIV) or chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis) were recruited at two hospitals in Bavaria, Germany. Healthy individuals living in or near Munich served as a control group. All participants filled in a questionnaire assessing happiness, measured as positive affect (PA), negative affect and satisfaction with life (SWL; together representing subjective well-being) and a heuristic evaluation of one's own happiness.

RESULTS

Data from 229 dermatologic patients (53.3 ± 18.5 years, 48% women), 49 patients with inflammatory bowel diseases (48.9 ± 18.7 years, 43% women), 49 patients with HIV (46 ± 10.1 years, 10% women) and 106 healthy controls (38.4 ± 13.4 years, 49% women) were analysed. Compared to the controls, dermatologic patients reported lower heuristic happiness (P = 0.023) and PA (P = 0.001) but higher SWL (P = 0.043). Patients with psoriasis and atopic eczema reported the lowest happiness, as they reported significantly lower PA (P = 0.032 and P < 0.001) and heuristic happiness (P = 0.002 and P = 0.015) than the control group. Patients with skin cancer reported higher SWL than the control group (P = 0.003). Dermatologic patients reported lower happiness than patients with HIV but reported greater happiness than patients with IBD.

CONCLUSIONS

Dermatologic patients experience lower levels of happiness, especially PA, compared to healthy controls. As PA is linked to desirable health outcomes, targeting PA could be a promising holistic approach for the treatment of skin diseases.

Granulomatöse Dermatitis bei einem 5 Monate alten Mädchen mit Omenn-Syndrom (atypisches SCID)

In der Dermatologie sehen wir auch pädiatrische Patienten mit Syndromen im Rahmen hereditärer schwerer Immundefekte. Die unverzügliche Diagnosestellung und Überweisung in spezialisierte Zentren ist entscheidend für die Prognose. Wir beschreiben ein bei Diagnosestellung 5 Monate altes Mädchen mit Omenn-Syndrom bei atypischem schwerem kombinierten Immundefekt (SCID). Klinisch führend waren eine Dermatitis, eine chronische, antibiotikaresistente Atemwegsinfektion und eine chronisch entzündliche Darmerkrankung. Laborchemisch bestand in der Routinediagnostik eine milde Lymphozytopenie mit Eosinophilie und erhöhtem Serum-IgE. Nach Anbindung an das nationale Versorgungsprojekt Translate-NAMSE wurde in der immunologischen Spezialdiagnostik ein atypischer Tlow Blow NK + SCID, verursacht durch eine hypomorphe homozygote IL7RA-Mutation, diagnostiziert und eine kurative haploidente allogene hämatopoietische Stammzelltransplantation eingeleitet.

Birch pollen allergy in Europe

Birch and other related trees of the families Betulaceae and Fagaceae (alder, hazel, oak, hornbeam, chestnut, and beech) constitute the birch homologous group. This grouping is primarily based on the extensive IgE cross-reactivity of allergen homologs to the major birch allergen Bet v 1. Birch pollen is the most dominant tree pollen in Northern and Central Europe and is a major cause of allergic rhinitis and, possibly, asthma symptoms. Over the last few decades, levels of birch pollen have risen and the period of exposure has increased due to climate changes. Subsequently, the prevalence of birch pollen sensitization has also increased. The cross-reactivity and sequential pollen seasons within the birch homologous group create a prolonged symptomatic allergy period beyond birch pollen alone. Furthermore, many plant food allergens contain homologs to Bet v 1, meaning that the majority of patients with birch pollen allergy suffer from secondary pollen food syndrome (PFS). As a result, the negative impact on health-related quality of life (HRQoL) in patients allergic to birch pollen is significant. The purpose of this manuscript was to narratively review topics of interest such as taxonomy, cross-reactivity, prevalence, clinical relevance, PFS, and HRQoL with regard to birch pollen allergy from a European perspective.

50 Jahre Universitäts-Hautklinik am Biederstein in München

Die Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein der Technischen Universität München (TUM) wurde 1969 in Betrieb genommen und feiert daher im Jahr 2019 ihr 50-jähriges Bestehen. Die Ursprünge dieser Klink gehen aber wie an vielen Orten auf ältere Versorgungsstrukturen zurück. Anlässlich des 50-jährigen Bestehens soll dieser Artikel die Entwicklung und aktuelle Ausrichtung der Klinik illustrieren und dabei auch die Wertschätzung für unsere Vorgänger ausdrücken, die sich auf den verschiedenen Positionen für unsere Patienten eingesetzt und so die Basis für eine erfolgreiche Klinik in Krankenversorgung, Forschung und Lehre geschaffen haben. Die Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein gehört zum Universitätsklinikum, dem Klinikum rechts der Isar, der Technischen Universität München (TUM), sie selbst liegt jedoch links der Isar, im schönen Schwabing unweit des Englischen Gartens. Sie ist eine von 3 Hautkliniken in München, die im Rahmen der Münchner Dermatologischen Gesellschaft (MDG e. V.) regelmäßig Fortbildungen ausrichten. Die MDG am Biederstein wird sich im Jahr 2019 neben der Fortbildung auch dem Jubiläum dieser Klinik widmen.

Die Klinik als universitäre Einrichtung umfasst den Bereich medizinische Versorgung mit 74 Betten auf 4 Stationen, einen ambulanten Bereich mit einer großen Poliklinik für Allgemein- und Privatpatienten (jährlich mehr als 60 000 Patientenbesuche), den Bereich Forschung mit verschiedenen Forschungsgruppen und großen Laboratorien sowie den Bereich Lehre, Weiter- und Fortbildung. Ein Schwerpunkt in der klinischen Versorgung und in der Forschung war bereits zur Zeit der Gründung der Klinik 1969 die Allergologie. Weiterhin bestehen Schwerpunkte im Bereich der entzündlichen Hauterkrankungen, der Dermatoonkologie, der Dermatoinfektiologie, der Dermatochirurgie und der Wundversorgung. Die Klinik hat das Comprehensive Allergy Center der Technischen Universität München (ACTUM) und EU-Exzellenz-Zentrum für Allergie auf den Weg gebracht und ist Teil der Krebszentren Comprehensive Cancer Center München der Technischen Universität München (CCC MünchenTUM) und des Comprehensive Cancer Center München (CCCM). Pro Semester werden etwa 450 Studenten im Rahmen von Vorlesungen, Seminaren und Praktika betreut. Neben Kongressen wie der Jahrestagung der Arbeitsgemeinschaft Dermatologische Forschung (ADF) im Jahr 2019 oder der European Society for Dermatological Research (ESDR) im Jahre 2016 richten die Klinik und der Lehrstuhl regelmäßige Fortbildungsveranstaltungen im Rahmen des Biedersteiner Symposiums, des Biedersteiner Kolloquiums und der MDG aus.

Soja in der veganen Ernährung – Lifestyleprodukte mit Gefahrenpotenzial für Birkenpollenallergiker?

Bei 10 % aller Birkenpollenallergiker wurden allergische Reaktionen auf die Sojabohne nachgewiesen. Typischerweise manifestieren diese sich in Form eines milden oralen Allergiesyndroms. Wir stellen 4 Patienten (1 Mann, 3 Frauen, 50 – 72 Jahre) mit primärer Birkenpollenallergie aus unserer Allergieabteilung vor, bei denen sich jedoch nach Verzehr von Sojamilch/-drink schwere allergische Reaktionen bis hin zur Anaphylaxie entwickelten. Diese Patienten litten unter einer Rhinoconjunctivitis allergica im Frühjahr und zusätzlichen pollenassoziierten Nahrungsmittelallergien. Haut-Pricktestungen auf Sojaprodukte waren positiv. Bei 3 von 4 Patienten war die Sojaallergie lediglich durch spezifische IgE-Antikörper auf das birkenpollenhomologe PR-10-Protein Gly m 4 nachweisbar, jedoch nicht auf den Sojagesamtextrakt (< 0,35 KU/l). Bei einer Patientin, die Sojaprodukte bisher immer vertragen hatte, wurde die Sojaallergie erst durch orale Provokationstestung nachgewiesen. Es handelt sich bei allen Patienten um eine sekundäre birkenpollenassoziierte Sojaanaphylaxie nach Einnahme großer Mengen an geringgradig verarbeiteten Sojaprodukten (Sojadrink). Diese stellt für Birkenpollenallergiker mit IgE-vermittelten Allergien sowohl auf das Birkenpollenallergen Bet v 1 als auch auf das homologe Gly m 4 in der Sojabohne aufgrund einer Kreuzreaktion ein Risiko dar.

Isolierte Ziegen- und Schafsmilchallergie

Ein 23-jähriger Patient erlitt mehrere anaphylaktische Reaktionen nach dem Verzehr von Schafsmilch- und Ziegenmilchkäse bei gleichzeitiger Toleranz von Kuhmilchprodukten. Die Pricktestung und die serologische Diagnostik zeigten eine Sensibilisierung gegen Ziegen- und Schafsmilch. Eine orale Provokation mit Kuhmilch sowie Rohmilch wurde vertragen. Wir diagnostizierten eine isolierte Ziegenmilch- und Schafsmilchallergie und empfahlen eine konsequente Meidung von Ziegenmilch- und Schafsmilchprodukten.

Alopecia syphilitica diffusa − eine seltene Manifestationsform der Frühsyphilis

Die Syphilis wird als das Chamäleon der Medizin bezeichnet, da sie viele Organe befallen und insbesondere an der Haut viele Erkrankungen imitieren kann. Weniger bekannt sind die durch die Syphilis bedingten Formen des Haarausfalls. Dabei ist die diffuse Form der syphilitischen Alopezie besonders selten und kann leicht übersehen werden.

Hier berichten wir über einen jungen, HIV-positiven Mann mit der klinischen Präsentationsform einer Alopecia syphilitica diffusa. Nach erfolgreicher Therapie mit 2,4 Millionen Einheiten Benzylpenicillin i. m. zeigte sich innerhalb weniger Monate eine vollständige Normalisierung des Haarwuchses. Die Alopecia syphilitica präsentiert sich klinisch typischerweise als diffuser Haarverlust, als umschriebener Haarausfall mit fleckig imponierendem, sog. Mottenfraßmuster oder durch eine Kombination von beidem. Dabei kann die syphilitische Alopezie das einzige klinische Symptom einer Syphilisinfektion sein und sowohl klinisch als auch in der Histopathologie eine Alopecia areata imitieren. Die Dermatoskopie oder der immunhistochemische Nachweis von Treponema pallidum im Haarfollikel können weitere hilfreiche Methoden zur Diagnostik des syphilitischen Haarausfalls sein, entscheidend ist jedoch die serologische Diagnostik.

[Microbiome, atopic eczema and blockade of type 2 immunity]

Atopic dermatitis affects roughly 20% of children and 3% of adults in Germany and other industrial countries, with an increasing prevalence. Its causality has still not been conclusively clarified but a type‑2 T‑helper cell mediated immunity reaction (type 2 immunity) dominates cutaneous inflammation. In the quest for the underlying pathogenic mechanisms and the development of improved prevention and treatment options, attention is also increasingly being paid to the influence of microbial colonization. This is facilitated by the rapid development of microbial analysis by sequencing. An increasing number of studies have shown that there is a link between disorders of the skin microbiome and the occurrence of atopic eczema and some also point towards the intestinal microbiome. In particular, a loss of diversity regarding the composition of the microbiome has been observed.

A simplified fabrication technique for cellularized high-collagen dermal equivalents

Human autologous bioengineered skin has been successfully developed and used to treat skin injuries in a growing number of cases. In current clinical studies, the biomaterial used is fabricated via plastic compression of collagen hydrogel to increase the density and stability of the tissue. To further facilitate clinical adoption of bioengineered skin, the fabrication technique needs to be improved in terms of standardization and automation. Here, we present a one-step mixing technique using highly concentrated collagen and human fibroblasts to simplify fabrication of stable dermal equivalents. As controls, we prepared cellularized dermal equivalents with three varying collagen compositions. We found that the dermal equivalents produced using the simplified mixing technique were stable and pliable, showed viable fibroblast distribution throughout the tissue, and were comparable to highly concentrated manually produced collagen gels. Because no subsequent plastic compression of collagen is required in the simplified mixing technique, the fabrication steps and production time for dermal equivalents are consistently reduced. The present study provides a basis for further investigations to optimize the technique, which has significant promise in enabling efficient clinical production of bioengineered skin in the future.

Non-invasive imaging in dermatology and the unique potential of raster-scan optoacoustic mesoscopy

In recent years, several non‐invasive imaging methods have been introduced to facilitate diagnostics and therapy monitoring in dermatology. The microscopic imaging methods are restricted in their penetration depth, while the mesoscopic methods probe deeper but provide only morphological, not functional, information. ‘Raster‐scan optoacoustic mesoscopy’ (RSOM), an emerging new imaging technique, combines deep penetration with contrast based on light absorption, which provides morphological, molecular and functional information. Here, we compare the capabilities and limitations of currently available dermatological imaging methods and highlight the principles and unique abilities of RSOM. We illustrate the clinical potential of RSOM, in particular for non‐invasive diagnosis and monitoring of inflammatory and oncological skin diseases.