R M Szeimies

University Hospital Regensburg, Regensburg, Bavaria, Germany

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Publications (128)254.39 Total impact

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    ABSTRACT: Topical aminolaevulinic acid-based photodynamic therapy (ALA-PDT) has recently been tried in small open studies for several inflammatory dermatoses including psoriasis. The purpose of this randomized, within patient comparison study was to investigate whether topical ALA-based PDT using a range of light doses can induce a satisfactory response in localized psoriasis. Twenty-nine patients with chronic plaque type psoriasis were enrolled in the study. After keratolytic pretreatment three psoriatic plaques in each patient were randomly allocated to PDT with 1% ALA and a light dose of 5 J cm(-2), 10 J cm(-2) or 20 J cm(-2), respectively. Treatment was performed twice weekly until complete clearance or for a maximum of 12 irradiations. As a measure of clinical response the psoriasis severity index (PSI) of the three target plaques was assessed separately by an observer blinded to the treatment at baseline, before each PDT treatment and 3-4 days after the last irradiation. Eight patients withdrew prematurely from the study. Keratolytic pretreatment alone reduced the baseline PSI in all three dose groups by about 25%. Subsequent PDT with 20 J cm(-2) resulted in a final reduction of PSI by 59%, PDT with the lower doses of 10 J cm(-2) and 5 J cm(-2) decreased the baseline PSI by 46% and 49%, respectively. The difference in clinical efficacy between 20 J cm(-2) and 10 J cm(-2) or 5 J cm(-2) was statistically significant (P = 0.003; P = 0.02), whereas no difference was found between 10 J cm(-2) and 5 J cm(-2) (P = 0.4). All patients reported some degree of PDT-induced stinging or burning during irradiation. The unsatisfactory clinical response and frequent occurrence of pain during and after irradiation renders topical ALA-based PDT an inadequate treatment option for psoriasis.
    British Journal of Dermatology 03/2005; 152(2):279-83. · 3.76 Impact Factor
  • T. Maisch, R.-M. Szeimies, N. Lehn, C. Abels
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    ABSTRACT: Grundlage der photodynamischen Inaktivierung von Bakterien ist die Generierung von reaktiven Sauerstoffspezies durch einen zellulär lokalisierten Photosensibilisator in Anwesenheit von Sauerstoff, der durch Licht der entsprechenden Wellenlänge angeregt wird. Im Hinblick auf mögliche Indikationen in der Dermatologie wird die Anwendung der photodynamischen Inaktivierung von Bakterien bei lokalen Haut- und Wundinfektionen oder zur Reduktion einer nosokomialen Besiedelung multiresistenter Bakterien von Hautarealen diskutiert. Der entscheidende Vorteil bei der lokalen Applikation von Photosensibilisatoren mit anschließender Bestrahlung liegt darin, dass unabhängig vom Resistenzmuster eines Bakteriums eine Inaktivierung ähnlich wie bei einem Antiseptikum erfolgt. In der vorliegenden Arbeit werden die physikalisch-chemischen sowie biologischen Grundlagen der antibakteriellen photodynamischen Therapie und mögliche dermatologische Indikationen beschrieben.
    Der Hautarzt 01/2005; 56(11):1048-1055. · 0.50 Impact Factor
  • R.-M. Szeimies, S. Karrer, H. Bäcker
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    ABSTRACT: Zusammenfassung Die Inzidenz epithelialer Tumoren und ihrer Vorstufen ist weltweit über die letzten Jahre stark angestiegen. Mittlerweile sind auch zunehmend jüngere Patienten betroffen, die Risikofaktoren sind bekannt. Die Wahl des für den jeweiligen Individualfall adäquaten Behandlungsverfahrens spielt daher eine große Rolle. Bei der Wahl der Therapie sollten die hohe therapeutische Effektivität, eine möglichst niedrige Langzeitrezidivrate und ein geringes Nebenwirkungsprofil der Behandlung ausschlaggebend sein. Im Folgenden werden unterschiedliche Therapieverfahren bei aktinischen Keratosen, Morbus Bowen, Basalzellkarzinom und spinozellulärem Karzinom dargestellt und kritisch gewürdigt.
    Hautarzt. 01/2005; 56(5):430-440.
  • A. L. Branzan, M. Landthaler, R.-M. Szeimies
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    ABSTRACT: Zusammenfassung Hautveränderungen bei Patienten mit Tumorerkrankungen können viele Ursachen haben und sind nicht leicht einzuteilen. Chemotherapieassoziierte kutane Nebenwirkungen sind meist toxischer Genese und zeigen oft charakteristische Reaktionsmuster, die sich dem dermatologisch geschulten Auge erschließen. Schwerwiegende chemotherapieassoziierte Reaktionen die zur Dosisreduktion, zum Um- oder Absetzen des Zytostatikums zwingen, sind dabei sehr selten, meist handelt es sich um reversible, selbstlimitierende Krankheitsbilder. Im vorliegenden Beitrag werden die häufigsten Krankheitsbilder besprochen.
    Hautarzt. 01/2005; 56(6):591-603.
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    ABSTRACT: Fluorescence endoscopy is a promising new method for detection and treatment of premalignant and malignant lesions. The aim of this pilot study was to investigate the feasibility of hexaminolevulinate-based photodetection of rectal adenoma and cancer, including safety, dose finding, and efficacy. Ten patients with known rectal adenoma or cancer were sensitized by instillation of 3.2 mM of hexaminolevulinate as an enema. Fluorescence endoscopy was performed after retention of the enema for 30 to 60 minutes, followed by a rest time of up to 30 minutes before endoscopy. Biopsy specimens were taken from fluorescent and non-fluorescent areas and fluorescence microscopy studies were performed to assess the distribution of protoporphyrin IX fluorescence in different tissue layers. Adverse events were reported by direct questioning of all patients; skin photosensitivity, changes in biochemical tests of liver function, blood pressure and heart rate, and the occurrence of GI symptoms (nausea, vomiting) were recorded for 5 patients. Hexaminolevulinate-induced fluorescence endoscopy produced selective fluorescence of all rectal adenomas with intraepithelial neoplasia. For rectal cancer, there was only weak fluorescence or none at all. No hexaminolevulinate-induced side effect was observed. In two patients, fluorescence differentiated adenomas and hyperplastic polyps. Hexaminolevulinate-based fluorescence endoscopy (3.2 mM administered as an enema) in patients with rectal cancer and adenoma was well tolerated and produced no significant skin sensitivity or other side effects. The optimal duration of application is 30 to 45 minutes, with a rest time of 30 minutes. Selective fluorescence of adenoma with intraepithelial neoplasia suggests that hexaminolevulinate-based fluorescence endoscopy may be useful for detection of premalignant lesions.
    Gastrointestinal Endoscopy 10/2004; 60(3):449-54. · 5.21 Impact Factor
  • V. Schleyer, S. Meyer, M. Landthaler, R.-M. Szeimies
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    ABSTRACT: Mastozytosen sind eine heterogene Gruppe von Erkrankungen, die durch Proliferation und Akkumulation von Mastzellen in der Haut und in inneren Organen gekennzeichnet sind. Man unterscheidet die kutanen Mastozytosen von den systemischen Formen, die mit oder ohne Hautveränderungen auftreten können, vom Mastzellsarkom sowie den extrakutanen lokalisierten benignen Mastozytomen. Bei den systemischen Mastozytosen sind neben der Haut v. a. das Knochenmark, der Gastrointestinaltrakt, das Skelettsystem, Lymphknoten, Milz und Leber betroffen. Während die indolenten Formen der systemischen Mastozytose symptomatisch v. a. mit Antihistaminika, Glukokortikosteroiden und PUVA-Therapie behandelt werden, sind bei einem aggressiveren Verlauf bis hin zur Mastzellleukämie auch zytostatische Therapien erforderlich. Wir berichten über einen 53-jährigen Patienten mit beginnender ,,smouldering systemic mastocytosis“, der nach erfolglosen Therapieversuchen unter anderem mit hoch dosierten systemischen Glukokortikosteroiden und Interferon-α eine deutliche Besserung des Hautbefundes, einen signifikanten Rückgang der Serumtryptase und eine Konstanz der Knochenmarksinfiltration unter Gabe von Cladribin zeigte.
    Der Hautarzt 06/2004; 55(7):658-663. · 0.50 Impact Factor
  • M. Meurer, M. Stumvoll, R.-M. Szeimies
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    ABSTRACT: Diabetes mellitus ist die häufigste Stoffwechselerkrankung. In Deutschland leiden knapp 5 Mio. Menschen daran. Es werden 4 Typen von Diabetes mellitus unterschieden: Typ-1-Diabetes, Typ-2-Diabetes, andere spezifische Diabetesformen und Gestationsdiabetes. Viele Merkmale des Diabetes mellitus, darunter auch Hautveränderungen, finden sich bereits im ,,vordiabetischen“ Stadium der eingeschränkten Glukosetoleranz, sodass jede Erhöhung des Blutzuckers als pathologisch betrachtet werden muss. Die Hautveränderungen bei Diabetes mellitus können 4 Krankheitsgruppen zugeordnet werden: Hautinfektionen, Hauterkrankungen mit überhäufiger Assoziation zu Diabetes mellitus, durch diabetische Komplikationen bedingte Hautveränderungen und Reaktionen auf die antidiabetische Therapie.
    Der Hautarzt 05/2004; 55(5). · 0.50 Impact Factor
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    Diabetes Care 04/2004; 27(3):794-5. · 7.74 Impact Factor
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    ABSTRACT: In the past 15 years the number of malignant melanomas and non-melanoma skin cancer, (i.e. squamous cell carcinoma, basal cell carcinoma), have increased dramatically throughout the whole world, in particular among people with white skin. For example, in Germany the number of new cases of melanoma is about 10 to 12 per 100,000 people, (for basal cell carcinoma as a non-melanoma skin cancer 140 per 100,000), the absolute number of annual new cases of melanoma is an estimated 9,000 to 10,000, and the increasing rate is 5 to 10%. However, there are more than 40 differential diagnoses for skin cancer which makes it difficult even for expert dermatologists to give correct diagnosis, (estimated 75% correct diagnoses). This figure is even worse for doctors from other specialities. There is only a chance of high cure rates when skin tumours are detected at an early stage. The prognosis of skin cancer is dependent very much on the thickness, (as a sign of invasiveness), of the tumour and the number of mitotic figures in the tumour, (as a sign of proliferation activity). However, the final diagnosis of skin cancer is usually done by biopsy, the sample being investigated by a specialist. This is an invasive method, which is painful for the patient and might require several cuts and samples taken before being absolutely certain. Due to the potential risk of dissemination of tumour cells, taking an incisional biopsy is obsolete in malignant melanoma. Therefore the correct diagnosis of malignant melanoma can be made only after a total removal of the lesion and consecutive histopathological examination. The EDISCIM project intends to develop a system for the early diagnosis of skin cancer which uses confocal imaging for the non-invasive diagnosis of the upper layers of the skin that aids the physician in the analysis of the images and therefore with the diagnosis, allows for potential remote diagnosis by specialist dermatologists via tele-diagnosis if need be. The objectives of the system are Captures microscopic images of the skin by confocal imaging, Processes and records these images in real time, Compares these images against a knowledge base of known skin symptoms, Displays the results in a suitable interface to the physician performing the diagnosis, And supports the online telematic support by specialists.
    Studies in health technology and informatics 02/2004; 103:279-86.
  • Source
    Diabetes Care. 01/2004; 27(7):1850-1850.
  • Zeitschrift Fur Gastroenterologie - Z GASTROENTEROL. 01/2004; 42(06).
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    ABSTRACT: Actinic keratoses (AKs) are the most common premalignant tumors. Without treatment, a significant number of patients with AK will experience squamous cell carcinoma. Photodynamic therapy (PDT) using the new highly selective photosensitizer methyl 5-aminolevulinate is a promising new treatment modality for AK. We investigated the complete response rates, cosmetic outcome, and patient satisfaction after photodynamic therapy (PDT) using methyl 5-aminolevulinate (Metvix) versus cryotherapy in the treatment of AKs. Patients were randomized to receive either cryotherapy with liquid nitrogen spray or PDT using methyl 5-aminolevulinate cream 160 mg/g, 3 hours application time, and red light (75 J/cm(2)). Efficacy results from 193 patients with 699 lesions (92% face/scalp and 93% thin/moderately thick) were analyzed. Overall complete response rates after 3 months were 69% for PDT and 75% for cryotherapy. Both treatments gave higher response rates in thin lesions (PDT 75%, cryotherapy 80%). PDT gave better cosmetic results and higher patient satisfaction than cryotherapy. PDT using methyl 5-aminolevulinate is an attractive treatment option for patients with AK, with a response rate similar to that of cryotherapy, but with superior cosmetic results and high patient satisfaction.
    Journal of the American Academy of Dermatology 09/2002; 47(2):258-62. · 4.91 Impact Factor
  • A Gottlob, C Abels, M Landthaler, R M Szeimies
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    ABSTRACT: The determination of concentrations of exogenous or endogenous substances in the dermis, e.g. for pharmacokinetic studies, is technically difficult. Performing skin biopsies or inducing suction blisters results in the disintegration of the tissue and allows only single measurements. Recently, cutaneous microdialysis, a new simple and minimally invasive technique for continuously measuring of substances in the dermis in vivo, has been introduced in dermatological research. According to the principle of dialysis, a semipermeable membrane is inserted in the dermis and due to a concentration gradient between the interstitial space and a perfusate, substances diffuse through the pores of the membrane and can be analyzed in the dialysate. Cutaneous microdialysis represents a useful technique for pharmacokinetic or pharmacodynamic studies as well as for investigations regarding cutaneous physiology and pathophysiology.
    Der Hautarzt 04/2002; 53(3):174-8. · 0.50 Impact Factor
  • A. Gottlob, C. Abels, M. Landthaler, R.-M. Szeimies
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    ABSTRACT: Bisher war die Bestimmung exogener oder endogener Substanzen in der Dermis z. B. im Rahmen pharmakokinetischer Untersuchungen nur mit Einschränkungen möglich. Die zur Verfügung stehenden Methoden wie die Entnahme einer Hautbiopsie oder die Hautblasentechnik (“suction-blister”) sind mit einer Verletzung des Gewebes verbunden und können lediglich punktuelle Messungen liefern. Mit der kutanen Mikrodialyse steht nun eine neue, einfach durchzuführende und minimal-invasive Methode zur Verfügung, die erstmals eine kontinuierliche Messung von Substanzen in der Haut in vivo erlaubt. Basierend auf dem Prinzip der Dialyse wird eine semipermeable Membran in die Haut eingebracht, über die Substanzen durch freie Diffusion aufgrund eines Konzentrationsgefälles zwischen interstitiellem Raum der Dermis und einer Dialyseflüssigkeit gewonnen werden. Sowohl bei pharmakokinetischen und pharmakodynamischen Studien als auch bei der Erforschung physiologischer und pathophysiologischer Vorgänge in der Haut eröffnet die kutane Mikrodialyse zahlreiche neue Aspekte. The determination of concentrations of exogenous or endogenous substances in the dermis, e.g. for pharmacokinetic studies, is technically difficult. Performing skin biopsies or inducing suction blisters results in the disintegration of the tissue and allows only single measurements. Recently, cutaneous microdialysis, a new simple and minimally invasive technique for continuously measuring of substances in the dermis in vivo, has been introduced in dermatological research. According to the principle of dialysis, a semipermeable membrane is inserted in the dermis and due to a concentration gradient between the interstitial space and a perfusate, substances diffuse through the pores of the membrane and can be analyzed in the dialysate. Cutaneous microdialysis represents a useful technique for pharmacokinetic or pharmacodynamic studies as well as for investigations regarding cutaneous physiology and pathophysiology.
    Der Hautarzt 02/2002; 53(3):174-178. · 0.50 Impact Factor
  • C Abels, S Karrer, M Landthaler, R M Szeimies
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    ABSTRACT: A 80-year-old male presented with a long time history of a localized red-brown macule with superficial lichenification and slight scaling in the right groin. An earlier skin biopsy revealed the presence of amyloid deposits. The patient therefore had a complete internal checkup including a rectal biopsy for exclusion of systemic amyloidosis. However, the laboratory data did not reveal any specific abnormalities including immunoglobulins and Bence-Jones protein. The rectal biopsy was also nonspecific. After skin examination, a rebiopsy was performed at our department showing acanthosis and spongiosis of the epidermis with parakeratosis. A homogenous eosinophilic deposit was present in the upper dermis and stained positive with thioflavine. At the second visit the patient wore a truss for a right inguinal hernia, perfectly matching the area of the skin lesion. Thus, the diagnosis of a localized macular amyloidosis was confirmed very likely due to permanent local friction. The classification of localized cutaneous amyloidoses should include local trauma as a cause to avoid unnecessary and exhausting internal checkups to exclude systemic involvement.
    Der Hautarzt 11/2001; 52(10 Pt 2):970-3. · 0.50 Impact Factor
  • C. Abels, S. Karrer, M. Landthaler, R. M. Szeimies
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    ABSTRACT: Zusammenfassung Konsiliarisch wurde ein 80-jhriger Patient wegen eines seit langem bestehenden, mig juckenden, unscharf begrenzten, leicht schuppenden, rot-braunen lichenifizierten Fleck in der rechten Leiste vorgestellt. Da eine auswrtige Hautbiopsie Amyloidablagerungen zeigte, war eine komplette internistische Untersuchung einschlielich einer Rektumbiopsie erfolgt. Smtliche laborchemischen Untersuchungen, auch Immunglobuline und Bence-Jones-Proteine, sowie die Rektumbiopsie hatten keinen spezifischen Befund ergeben. Eine erneut durchgefhrte Hautbiopsie zeigte eine ausgeprgte Akanthose und Spongiose der Epidermis mit Parakeratose. Des weiteren fanden sich homogene eosinophile Ablagerungen im oberen Korium, die in der Thioflavin-Frbung positiv waren. Bei der Wiedervorstellung trug der Patient rechts inguinal wegen einer Hernie ein Bruchband. Es wurde die Diagnose einer makulsen Amyloidose, induziert durch das chronische Scheuern des Bruchbandes, gestellt. In Anbetracht der Entstehung dieser makulsen Amyloidose sowie der aktuellen Literatur sollte die Einordnung der primren kutanen Amyloidosen neu diskutiert werden, um unntige und umfangreiche internistische Untersuchungen zum Ausschluss einer systemischen Beteiligung zu vermeiden.
    Der Hautarzt 09/2001; 52:970-973. · 0.50 Impact Factor
  • S Karrer, E Holler, R M Szeimies
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    ABSTRACT: Graft-versus-host disease (GvHD) is a severe complication of allogeneic stem cell transplantation. GvHD can arise at various time points: acute GvHD occurs during the first 100 days after transplantation in up to 50% of graft recipients. Chronic GvHD develops less frequently in about 30% after the 3rd month following transplantation involving the skin, the liver, the gastrointestinal tract, the eyes, and the neuromuscular apparatus. Early diagnosis of GvHD can be difficult, as drug reactions, viral infections and cutaneous reactions to radiation therapy may have clinical and histological similarities. In this review, the various cutaneous manifestations of GvHD, the histopathologic features, prophylaxis, and therapies of acute and chronic GvHD are discussed according to the recent literature.
    Medizinische Klinik 09/2001; 96(8):457-66. · 0.34 Impact Factor
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    ABSTRACT: Anti-inflammatory actions of ciclopirox, an antifungal agent, have been described previously. We assessed the effectiveness of ciclopirox in the treatment of viral warts. Twenty-three immunocompetent patients (age 9-61 years) with common warts at the hands, feet and in the face resistant to conventional therapy were treated. Following keratolysis with a salicylic acid-containing patch, an 8% ciclopirox lacquer was applied 1-2 times daily. At the beginning and the end of the treatment lesions were photographed and the time span (minimum 4 weeks) until complete resolution was documented. In 7 patients complete remission, and in 12 patients partial remission was achieved. Only 4 patients did not show any effect under topical ciclopirox treatment (mean duration of therapy 3.2 +/- 2.1 months). The overall response rate was 82.6%. Local side effects like erythema or pruritus were not reported. Our data suggest that a ciclopirox lacquer may be helpful in the treatment of common warts. However, the data have to be confirmed in a randomized controlled trial in the future.
    Der Hautarzt 07/2001; 52(6):489-91. · 0.50 Impact Factor
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    ABSTRACT: Indocyanine green (ICG) is a clinically approved dye for diagnostic purposes, which has an absorption peak in the near infrared and remains intravascular due to a high plasma protein binding. Its therapeutic potential in combination with a diode laser was studied for well vascularized cutaneous tumors. Six male patients (mean age 49.2 years) with AIDS-related Kaposi sarcomas (n = 30) received ICG (2 x 2 mg/kg i.v.) followed directly by irradiation with a diode laser (lambda = 805 nm, 100 J/cm2, 3 W/cm2). All macular and plaque-type lesions (n = 27) showed primarily blister- and crust formation and healed within 14 days. Only one out of the 3 nodular lesions treated showed complete remission. The only side effect recognized was a mild burning sensation during irradiation. Nineteen lesions resolved completely leaving a slight atrophic scar, in three lesions a transient postinflammatory hyperpigmentation occurred. Within the follow-up period of 2 years no recurrence was detected. The ICG-mediated photochemotherapy is an effective palliative therapeutic modality with a low rate of side effects in the treatment of macular or plaque-type cutaneous Kaposi sarcomas.
    Der Hautarzt 05/2001; 52(4):322-6. · 0.50 Impact Factor
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    ABSTRACT: Barrett's oesophagus is associated with an increased risk of cancer. As dysplasia is not visible during routine endoscopy, random biopsies in the four quadrants every 1-2 cm are recommended. Endoscopic fluorescence detection (EFD) after sensitisation with 5-aminolaevulinic acid (5-ALA) with different modes and concentrations was assessed to optimise the technique for detection of dysplasia or early cancers. 5-ALA is converted intracellularly to protoporphyrin IX which accumulates in malignant tissue and can be detected by typical red fluorescence after illumination with blue light. In 47 patients with Barrett's oesophagus, 10 with known dysplasia, 58 fluorescence endoscopies were performed after sensitisation with different concentrations of 5-ALA given orally (5, 10, 20, 30 mg/kg) or locally (500-1000 mg) by spraying the mucosa via a catheter. EFD was performed 4-6 hours after systemic and 1-2 hours after local sensitisation using a special light source delivering white or blue light. A total of 243 biopsies of red fluorescent (n=113) and non-fluorescent areas (n=130) were taken. In three patients, two early cancers and dysplasia, not visible during routine endoscopy, were detected by EFD. Thirty three biopsies revealed either low or high grade dysplasia. Sensitivity for detection of dysplastic lesions ranged from 60% after local sensitisation with 500 mg to 80%, 100%, and 100% after systemic application of 5-ALA 10, 20, and 30 mg/kg, respectively. However, specificity was best for local sensitisation (70%) while systemic administration revealed values between 27% and 56%. Using 5 mg/kg, no red fluorescence in dysplastic lesions was found. No severe side effects were noted. EFD is a promising tool to detect non-visible dysplastic lesions in Barrett's oesophagus using 5-ALA sensitisation. A randomised controlled study is now indicated to compare the efficacy of EFD with the standard technique of four quadrant random biopsies.
    Gut 04/2001; 48(3):314-9. · 10.73 Impact Factor

Publication Stats

2k Citations
254.39 Total Impact Points

Institutions

  • 1997–2012
    • University Hospital Regensburg
      • Klinik für Dermatologie
      Regensburg, Bavaria, Germany
  • 1993–2012
    • Universität Regensburg
      • • Lehrstuhl für Dermatologie und Venerologie
      • • Lehrstuhl für Innere Medizin I
      Regensburg, Bavaria, Germany
  • 1992
    • Ludwig-Maximilian-University of Munich
      • Department of Dermatology and Allergology
      München, Bavaria, Germany