{"title":"Hinschauen, lernen, anwenden","authors":"M. Mader","doi":"10.1159/000499016","DOIUrl":"https://doi.org/10.1159/000499016","url":null,"abstract":"Eine Blickdiagnose, Alltagsstress und Weiterbildung sowie digitale Tools für Ärzte und Patienten: Das sind die Themen des DermaCampus in der aktuellen Ausgabe KARGER KOMPASS DERMATOLOGIE . Alltagsstress und Weiterbildung deshalb, weil für uns Ärzte neben Arbeitsund Dienstbelastung oft genug kaum Zeit für kontinuierliches Lernen und Lesen bleibt. Aber es ist enorm wichtig, sich ständig weiterzubilden. Damit das gelingt, dazu leistet die von Dr. Marco Fuchs und mir gegründete DERFO einen Beitrag. Wie genau das von statten geht, danach hat mich die Redaktion des KARGER KOMPASS DERMATOLOGIE im Interview gefragt, nachzulesen hier im DermaCampus. Für uns ist klar, Fortbildung muss vor allem in den alltäglichen Ablauf integriert werden können. Das gilt im Übrigen auch für digitale Tools, die bei der Differenzialdiagnose unterstützen sollen. Die Tools hören auf Namen wie Isabel Healthcare, Symptoma oder visualDx. Was diese im Einzelnen leisten, wird im Beitrag «Digitale Tools zur Unterstützung der Differenzialdiagnose für Ärzte und Patienten» zusammengefasst. Und schließlich bietet der DermaCampus auch noch eine kleine Herausforderung: Welche Diagnose vermuten Sie hinter dem in der Rubrik Blickdiagnose geschilderten Fall? Karger Kompass Dermatol 2019;7:82–85 DOI: 10.1159/000499016","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130707268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Obliterierende subkutane Arteriolosklerose nicht spezifisch für ein Ulcus hypertonicum Martorell","authors":"M. Stücker","doi":"10.1159/000498877","DOIUrl":"https://doi.org/10.1159/000498877","url":null,"abstract":"Background: The histological characteristic of hypertensive leg ulcers (HLU) is the presence of ‘arteriolosclerosis.' The pertinence of performing a skin biopsy to diagnose HLU is questionable, as cutaneous arteriolosclerosis may be related to patient comorbidities. The objective here was to evaluate the frequency of arteriolosclerosis in skin leg biopsies performed in patients without ulcer and in control patients with HLU. Methods: We performed a retrospective study between January 2013 and July 2014. Patients were included if they had undergone a deep skin biopsy on the lower limbs, in the absence of any leg ulcer. Controls were patients with typical HLU. Results: Fifty-eight patients and 6 controls were included. Hypertension was present in 25 patients (43%). Arteriolosclerosis, defined as fibrous endarteritis, was present in 35 out of 58 patients (60%) and in all of the controls. No hyalinosis or hyperplastic proliferative arteriolosclerosis was observed in the patients or controls. Only age was an independent factor associated with the presence of cutaneous arteriolosclerosis (p < 0.0001). Conclusion: Cutaneous arteriolosclerosis is significantly and independently associated with age. Thus, skin biopsy seems not to be necessary for the diagnosis of HLU but only for a differential diagnosis.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132483255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Political Incorrectness","authors":"H. Walach","doi":"10.1159/000499417","DOIUrl":"https://doi.org/10.1159/000499417","url":null,"abstract":"Zuerst, indem er der pharmazeutischen Industrie vorgeworfen hat, sich wie die Mafia zu benehmen [1]. Dann, indem er der Psychiatrie vorgeworfen hat, sie würde sich von der Industrie korrumpieren lassen und wissentlich mit gefährlichen und unbrauchbaren Substanzen arbeiten [2]. Und schließlich, indem er den Cochrane Review über die Effektivität der HPV-Impfung zur Prävention des Zervixkarzinoms zerrissen hat, weil dieser nur die Hälfte aller Daten berücksichtigt hätte und die Autoren gegen Cochrane Regeln zur Vermeidung von Interessenskonflikten verstoßen hätten [3, 4]. Gøtzsche wurde auf Betreiben des CEO von Cochrane aus seiner Stelle als Internist am Reichskrankenhaus in Kopenhagen entfernt und geht dagegen mit rechtlichen Mitteln vor [4]. Konsequen-","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114219412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Caspase-14 als mögliches therapeutisches Ziel beim chronischen Handekzem","authors":"C. Traidl‐Hoffmann","doi":"10.1159/000497753","DOIUrl":"https://doi.org/10.1159/000497753","url":null,"abstract":"Aim: To investigate whether the skin barrier function is impaired with regard to the pH value, water content, transepidermal water loss (TEWL), and the integrity of the stratum corneum, and whether the expression of caspase-14 is altered in moderate to severe chronic hand eczema (CHE). Methods: Thirty patients with moderate to severe CHE treated at our institute and 30 healthy volunteers were included in this study. The pH value, water content, TEWL, and the integrity of the stratum corneum were measured in all subjects. Results: Significantly increased pH value, decreased water content, elevated TEWL, and impaired integrity of the stratum corneum were observed in the lesional skin of CHE patients compared with the nonlesional skin of CHE patients and the normal skin of healthy volunteers. The expression of caspase-14 decreased in the lesional and nonlesional skin of CHE patients compared with the normal skin of healthy volunteers, especially prominent in the nonlesional skin. The mean optical density (OD) value of immunohistochemical staining for caspase-14 was significantly lower in the nonlesional skin than in the lesional skin and normal skin (p < 0.01 for both). Although the mean OD value was lower in the lesional skin than in the normal skin, the difference was not statistically significant (p > 0.05). Conclusion: Skin barrier dysfunction indeed occurs in CHE patients, which may be related to mechanisms associated with a downregulated expression of caspase-14.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124359895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Versorgungsqualität und Praktikabilität in der Teledermatologie","authors":"N. Kirsten","doi":"10.1159/000498878","DOIUrl":"https://doi.org/10.1159/000498878","url":null,"abstract":"A decreasing number of dermatologists and an increasing number of patients in Western countries have led to a relative lack of clinicians providing expert dermatologic care. This, in turn, has prolonged wait times for patients to be examined, putting them at risk. Store-and-forward teledermatology improves patient access to dermatologists through asynchronous consultations, reducing wait times to obtain a consultation. However, live video conferencing as a synchronous service is also frequently used by practitioners because it allows immediate interaction between patient and physician. This raises the question of which of the two approaches is superior in terms of quality of care and convenience. There are pros and cons for each in terms of technical requirements and features. This viewpoint compares the two techniques based on a literature review and a clinical perspective to help dermatologists assess the value of teledermatology and determine which techniques would be valuable in their practice.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130022078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"pH-Wert und mikrobielle Infektionen","authors":"F. Rippke, Enzo Berardesca, Teresa M. Weber","doi":"10.1159/000496719","DOIUrl":"https://doi.org/10.1159/000496719","url":null,"abstract":"Ein durchgängig saurer pH-Wert im Stratum corneum ist ein wesentlicher Bestandteil des Schutzsystems der Haut, der eine feindliche Umgebung für die Besiedelung durch pathogene Mikroorganismen schafft. Doch diese Barriere kann bei gesunder und umso mehr bei geschädigter Haut durchbrochen werden. Mykosen, Windel-/Inkontinenz-assoziierte Dermatitis und Wundheilung sind Beispiele für Situationen, in denen durch veränderte Haut- oder Umgebungsbedingungen eine mikrobielle Infektion begünstigt wird. Pilze verfügen über ein komplexes System, mit dem sie den pH-Wert ihrer Umgebung erfassen, um durch entsprechende Stoffwechselreaktionen ihre Adhäsion, Vermehrung und Invasion zu gewährleisten, indem mikrobielle Metaboliten den pH-Wert der Haut weiter erhöhen, bis schließlich eine klinisch manifeste Infektion (Mykose) vorliegt. Menschen mit Diabetes, bei denen der pH-Wert der Haut in intertriginösen Bereichen erhöht ist, sind besonders anfällig für Candidosen. Bei Windeldermatitis und Inkontinenz-assoziierter Dermatitis ist die Ursache für den erhöhten pH-Wert der Haut und die Schädigung der Hautbarrierefunktion der Kontakt mit Urin und Fäzes, ob unter Okklusion oder nicht, und durch Wirts- und mikrobielle Enzyme und Metaboliten wird dieser Zustand aufrechterhalten. Das führt zur Dezimierung der schützenden residenten Mikroflora und ihrer Überwucherung durch Pilze, meist Candida albicans. Die Hautpflege mit leicht sauren Produkten kann helfen, diese Form von Dermatitis zu verhindern und zu behandeln. Der Prozess der Wundheilung ist eine komplexe Abfolge biologischer Ereignisse, die mit dem pH-Wert der Umgebung korrelieren, welcher die verschiedenen Phasen der Wundheilung beeinflusst. Der pH-Wert ist für die adäquate Aktivität von Immunzellen und wichtigen Enzymen ebenso bestimmend wie für die Biofilmbildung. Wenn der Heilungsprozess gestört wird, können Wunden chronisch werden und sind dann durch einen neutralen bis leicht alkalischen pH-Wert gekennzeichnet. Vor diesem Hintergrund könnten die Überwachung des pH-Wertes und die Herstellung eines sauren Milieus als Wundbehandlungsmaßnahme sinnvoll sein.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125690193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Kaleidoskop","authors":"C. Zielinski","doi":"10.1159/000498903","DOIUrl":"https://doi.org/10.1159/000498903","url":null,"abstract":"Natriumchlorid beeinflusst offenbar allergische Immunreaktionen. Christina Zielinski, Professorin am Institut für Virologie der Technischen Universität München (TUM) sowie Fachärztin für Dermatologie, und ihr Team konnten in einer aktuellen Studie zeigen, dass Natriumchlorid menschliche TZellen in einen Zustand versetzen kann, in dem sie vermehrt Botenstoffe wie Interleukin-4 (IL-4) und Interleukin-13 (IL-13) ausschütten [1]. T-Zellen, die eigentlich der Immunabwehr dienen, können durch den Salzeinfluss zu Th2-Zellen umprogrammiert werden. Diese können allergische Entzündungen der Haut, zum Beispiel eine Neurodermitis, verursachen. Diese Veränderungen sind rückläufig, sobald die T-Zelle wieder weniger hohen Salzmengen ausgesetzt ist. «Signale der Ionen aus dem Salz spielen somit eine Rolle für die Entstehung und Steuerung von Th2-Zellen», erläutert Zielinski. Ihr Team Karger Kompass Dermatol 2019;7:98–101 DOI: 10.1159/000498903","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129813175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Depressive Psoriasis-Patienten können ein schlechteres Ansprechen auf Etanercept zeigen","authors":"W. Sondermann","doi":"10.1159/000496272","DOIUrl":"https://doi.org/10.1159/000496272","url":null,"abstract":"Background/Aims: This study aimed to investigate the predicting values of depression and anxiety symptoms for clinical response to etanercept treatment in psoriasis patients. Methods: A total of 85 psoriasis patients who received 6 months of etanercept treatment were consecutively enrolled in this prospective cohort study. The Psoriasis Area and Severity Index (PASI) score was evaluated at month 0 (M0), M1, M3, and M6, and the corresponding PASI 75/90 response at each visit was assessed. Also, anxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS) at M0, M1, M3, and M6. Results: Depression symptoms were observed to correlate with female gender (p = 0.004), longer disease duration (p = 0.018), and higher PASI score (p < 0.001), and anxiety symptoms were seen to be associated with female gender (p = 0.017), larger psoriasis-affected body surface area (p = 0.049), and higher PASI score (p = 0.017) in psoriasis patients. After etanercept treatment, HADS-Depression (HADS-D) and HADS-Anxiety (HADS-A) scores were both decreased at M1, M3, and M6 (all p < 0.001) compared with M0. Most importantly, baseline depressed patients presented with a lower PASI 75 response rate at M3 (p = 0.014) and M6 (p = 0.005), and a reduced PASI 90 response rate at M6 (p = 0.045) compared with baseline non-depressed patients. Furthermore, multivariate logistic regression analyses revealed that depression symptoms at baseline were an independent predictive factor for the lower possibility of both PASI 75 response (p = 0.048) and PASI 90 response (p = 0.048) achievements at M6 in psoriasis patients. However, no correlation of baseline anxiety symptoms with PASI 75/90 responses was observed. Conclusion: Depression symptoms at baseline independently predict a worse clinical response to etanercept treatment in psoriasis patients.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132043371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
