C Ulrich

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (68)158.86 Total impact

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    ABSTRACT: Background Cutaneous squamous cell carcinoma (cSCC) is a common cancer capable of metastasis. Sentinel lymph node biopsy (SLNB) may be a valuable adjunct for patients with cSCC at high risk for metastases. However, data on risk factors of metastasis and results of SLNB from patients with cSCC are limited.Objective The aim of this study is to evaluate risk factors for metastasis in patients with cSCC in a large cohort study with long-term follow-up and to determine the value of SLNB.Patients and methodsWe retrospectively analysed all records of patients who underwent excision of cSCC between 01/2005 to 08/2009 at a tertiary referral centre. 143 patients were included in the total cohort, including 17 patients with SLNB and a follow-up time of ≥ 24 monthsResultsTumour thickness greater than 4mm and recurrent cSCC were strongly associated with metastatic disease. All metastasis in this cohort occurred within 24 months of follow-up. SLNB showed a low sensitivity with regard to the development of metastasis. Six of 17 patients developed metastatic disease despite a negative SLN.Conclusions Patients with risk factors, i.e. cSCC with a tumour thickness of more than 4 mm or recurrent disease may develop metastases within the first 2 years despite a negative SLNB. Therefore these patients should be closely monitored during the follow-up. Based on our data SLNB does not provide a diagnostic value for patients with cSCC.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 11/2014; · 3.76 Impact Factor
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    ABSTRACT: The immunosuppressants used in transplantation medicine significantly elevate the incidence of neoplasia, particularly in the skin. The cumulative incidence of non-melanocytic skin cancer (NMSC) in renal transplant recipients was 20.5% in a study carried out in German centers. Data on more than 35 000 renal transplant recipients in the USA document a cumulative NMSC incidence of over 7% after 3 years of immunosuppression. The authors selectively review publications obtained by a PubMed search to discuss the incidence of, and major risk factors for, skin tumors and infectious diseases of the skin in immunosuppressed patients. The main risk factors for skin tumors are age at the time of transplantation, light skin color, previous and present exposure to sunlight, and the type and duration of immunosuppressive treatment. Squamous-cell carcinoma (SCC) is the most common kind of skin tumor in immunosuppressed patients. Human herpesvirus 8 and Merkel-cell polyoma virus also cause neoplasia more often in immunosuppressed patients than in the general population. Surgical excision is the treatment of choice. Actinic keratosis markedly elevates the risk that SCC will arise in the same skin area (odds ratio 18.36, 95% confidence interval 3.03-111). Patients with multiple actinic keratoses can be treated with photodynamic therapy or with acitretin. To lower the skin cancer risk, organ transplant recipients should apply medical screening agents with a sun protection factor of at least 50 to exposed skin areas every day. 55% to 97% of organ transplant recipients have skin infections; these are treated according to their respective types. Squamous-cell carcinoma of the skin adds to the morbidity and mortality of transplant recipients and is therefore among the major oncological challenges in this patient group. Structured concepts for interdisciplinary care enable risk-adapted treatment.
    Deutsches Ärzteblatt International 03/2014; 111(11):188-94. · 3.54 Impact Factor
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    ABSTRACT: The results of the risk assessment of the tissue-tolerable plasma (TTP) jet kINPen med® and first results of pilot clinical studies are presented. Producing an atmospheric pressure plasma, this plasma jet entails no risk for humans in terms of temperature increase, UV radiation or free radical formation by the plasma. The antiseptic efficacy in vitro on porcine skin and in vivo on human skin was compared to that of octenidine. TTP could significantly reduce the bacterial load in comparison to untreated skin. However, the slightly reduced antiseptic properties of TTP are attributed to the current parameter set-up and technical limitations.
    Clinical Plasma Medicine. 06/2013; 1(1):5–10.
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    ABSTRACT: The effect of tissue-tolerable plasma (TTP) on inflammatory diseases such as psoriasis was investigated. Three plaques of six psoriatic patients were subjected to different treatments (A: TTP, brine baths (BB)+5% salicylic acid ointment (SAO); B: BB+SAO; C: BB, UV irradiation, SAO+dithranol). While redness and infiltration was reduced in groups A and C, scaling was reduced in group C. TTP temporarily reduced the bacterial colonization on the skin lesions. In summary, the treatment of psoriatic plaques with TTP showed no significant advantage over conventional therapies.
    Clinical Plasma Medicine. 01/2013;
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    ABSTRACT: Eine der größten Herausforderung der Transplantationsmedizin war und ist die Kontrolle von Abstoßungsreaktionen. Die medikamentöse Inhibition der zellulären Immunüberwachung führt jedoch besonders an der Haut zu einer signifikanten Zunahme von Neoplasien. Invasive Plattenepithelkarzinome sind die am häufigsten diagnostizierten Malignome bei Organtransplantierten und können durch ihr multifokales Auftreten sowie das aggressive Wachstum eine Bedrohung für immunsupprimierte Patienten darstellen. Interdisziplinäre Nachsorgeprogramme basieren auf den epidemiologischen Analysen individueller dermatologischer Risikofaktoren für die Hauttumorgenese wie Alter, Hauttyp, Sonnenexposition sowie Art und Dauer der Immunsuppression. Neben Aufklärungsprogrammen und einer kausal orientierten Primärprophylaxe (Sonnenschutz) sowie der Verwendung einer risikoadaptierten Immunsuppression hat sich das proaktive Management präinvasiver Hauttumoren durch moderne Flächentherapien bewährt. Die am Beispiel der Organtransplantierten etablierten interdisziplinären Konzepte und Versorgungsstrukturen stehen hierbei exemplarisch für die ideale Nachsorge auch anderer immunsupprimierter Risikogruppen.
    Der Nephrologe 01/2013; 8(3).
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    ABSTRACT: Ultraviolet radiation (UVR) exposure from the sun and artificial UV sources has been widely acknowledged as the major culprit for skin cancer and premature skin ageing. Skin cancers are among the most dangerous (cutaneous malignant melanoma) and the most numerous (basal cell carcinoma, actinic keratosis and invasive squamous cell carcinoma) of all neoplasms in the caucasian population worldwide. Skin cancers therefore have a significant impact on public health and healthcare costs, and will continue to do so. It is obvious that adequate photoprotection - seeking shade, wearing protective clothing and using sunscreens - is the key to reducing the harmful effects of UVR in both immunocompetent and immunocompromised people. This article provides background information on UVR, photoprotection (including the concept of topical sunscreen formulations), associated concerns regarding efficacy and safety, and behavioural and educational aspects of photoprotection and skin cancer prevention in immunocompetent and immunocompromised people. Certain persistent misconceptions and mistakes regarding photoprotection are also addressed.
    British Journal of Dermatology 08/2012; 167 Suppl 2:85-93. · 3.76 Impact Factor
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    ABSTRACT: Background  The incidence of actinic keratoses (AK) and non-melanoma skin cancer (NMSC) in organ transplant recipients (OTRs) is significantly higher than in immunocompetent patients. Rates of progression and recurrence following treatment are higher too, in part due to the effects of the immunosuppressant drugs. Conventional therapies for AK, using curettage, cryotherapy, surgical excision, topical therapies and photodynamic therapy (PDT), are often less effective, and may be inappropriate, for treating the greater numbers and extent of lesions in OTRs. Moreover, there are no specific protocols for treating this patient population that take into account the need for more frequent treatment and the increased pain associated with treating larger areas. Objectives  Recently, a pan-European group of dermatologists with expertise in this area met to share current best practice in PDT for the treatment of AK in OTRs. Methods  The group identified areas where PDT currently is not meeting the needs of these patients and discussed how these gaps might be addressed. Results/Conclusions  This position article summarizes those discussions and makes recommendations concerning a standardized protocol for treating OTRs, for a large randomized controlled trial to provide robust data on safety, efficacy and optimal pain control, and to provide pharmaco-economics data that can be used to support extended reimbursement in this patient group. The authors also recommend a second clinical trial to further investigate induced immunosuppression with PDT in healthy volunteers.
    Journal of the European Academy of Dermatology and Venereology 12/2011; · 2.69 Impact Factor
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    Journal der Deutschen Dermatologischen Gesellschaft 03/2011; 9(3):195-203. · 1.40 Impact Factor
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    ABSTRACT: Inhibitors of the epidermal growth factor receptor (EGFR) are increasingly used in the treatment of various entities of malignant tumors. Patients treated with EGFR inhibitors very likely develop cutaneous side effects. The development of a papulopustular, follicular exanthema during the first weeks of therapy correlates with therapeutic benefit. However, this exanthema and other cutaneous side effects can impair the quality of life of the patient and might limit the therapy with the EGFR inhibitor. For an optimal therapeutic benefit and quality of life an adequate management of cutaneous side effects is necessary. A panel of German dermatologists developed on the basis of personal experience and current literature consensus recommendations for the management of cutaneous side effects of EGFR inhibitors.
    Journal der Deutschen Dermatologischen Gesellschaft 11/2010; 9(3):195-203. · 1.40 Impact Factor
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    ABSTRACT: Skin cancer constitutes the most frequently reported post-transplant malignancy in solid organ transplant recipients (OTR) worldwide. Whereas the risk for malignant melanoma is only moderately increased, non-melanoma skin cancers (NMSC) seem to thrive on chronic immunosuppression and account for up to 95% of post-transplant cutaneous malignancies. Compared to the general population cutaneous squamous cell carcinoma (SCC) and actinic keratoses (AK) characteristically show even higher incidences than basal cell carcinoma (BCC) and act as an indicator for the development of multiple primary cutaneous neoplasias and locally recurrent cancers (field cancerization). Early diagnosis and therapy of pre-malignant cutaneous lesions is crucial for the secondary prophylaxis of further invasive and highly aggressive skin cancers. High quality interdisciplinary care and prophylactic modalities, including consistent and sufficient UV protection, topical immunmodulatory therapies of UV-damaged skin areas, retinoid chemoprevention as well as tapering immunosuppressive treatment or the selection of immunosuppressants with proposed antiangiogenic properties like mTor-inhibitors may help to reduce the multiplicity of subsequent primary skin cancers in high-risk patients. Apart from the continuous need for educational intervention of OTR in the primary prophylaxis of post-transplant skin cancers, dermatologic care occupies a central position within the field of transplantation medicine in terms of pre- and post-transplantation dermatologic evaluation and therapy as well as the implication of timely and effective secondary preventive approaches in the management of this high-risk patient population.
    Der Hautarzt 02/2010; 61(3):195-206. · 0.50 Impact Factor
  • Der Hautarzt 02/2010; 61(3):193-4. · 0.50 Impact Factor
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    ABSTRACT: Human papillomaviruses infect the squamous epithelia of the skin and cause warts, and are occasionally found in squamous cell carcinomas. Since cell-mediated immunity plays a crucial role in the control of HPV-infections, organ transplant recipients, unable to mount an adequate T-helper 1 cell-mediated immune surveillance, frequently develop widespread and resistant induced warts. Skin tumors, especially squamous cell carcinomas, are the most common post-transplantation neoplasm. Warts, actinic keratoses and invasive squamous cell carcinomas are known to develop at the same time in the areas. The role of HPV in the development of invasive squamous cell carcinoma under immunosuppression, remains to be elucidated in respect to common risk factors and increased numbers of warts potentially identifying patients at increased risk for carcinoma. We prospectively studied 1690 organ transplant recipients in the dermatology clinic at the Charité University Hospital in Berlin, to evaluate risk factors being involved in the development of HPV-induced warts and to assess a potential association of with the development of non-melanoma skin cancers in this population. The cumulative incidence of warts steadily increased throughout the post-transplant years. The presence of more than 10 verrucae was associated with the development of actinic keratoses, invasive squamous cell carcinoma and basal cell carcinoma. This study shows clear evidence that certain risk factors of skin carcinogenesis in organ transplant recipient such as increased age at transplantation, a high dose of immunosuppression related to a specific type of graft and use of azathioprine or cyclosporine are strongly associated with an increased incidence of warts. Furthermore, HPV-induced verrucae vulgares could be used as a potential predictor for the development of coincidental non melanoma skin cancer in organ transplant recipients and therefore could serve as an early identification marker of skin cancer high-risk patients. The challenging management of warts in organ transplantation patients is reviewed.
    Der Hautarzt 02/2010; 61(3):220-9. · 0.50 Impact Factor
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    ABSTRACT: Increasing incidence rates of cutaneous malignancies, paralleling rising survival times of grafts and patients in organ transplant recipients, represents an escalating challenge for dermatologists worldwide. Especially, invasive squamous cell carcinomas (SCC) in immuno-compromised patients are characterized by significantly increased morbidity and mortality and characteristically outnumber basal cell carcinoma in this population. Effective management of actinic keratoses (AK) could help to prevent the further development of invasive SCC. Diclofenac in hyaluronic acid has previously shown to be an effective and well tolerated option for the treatment of AK in immuno-competent patients. However, its safety and efficacy in organ-transplant patients has not been evaluated in a controlled study so far. 32 organ transplant patients (kidney (+/- pancreas), liver, heart) screened at our specialized transplant dermatology outpatient clinic were found eligible and were randomized to either active treatment (24) or vehicle (8). Patients who had stable status of the transplanted graft in the 12 months prior to entering the study and >/= 3 AK lesions in a contiguous 50 cm2 area on the face, forehead, hands or balding scalp were eligible for inclusion in the study. Treatment of AK with 3% diclofenac in 2.5% hyaluronic acid or placebo twice daily was conducted over a total of 16 weeks, followed by a final evaluation 4 weeks after last application of the study drug. Biopsies were taken from the treated areas at the final visit to verify clinical clearance. Patients were assessed for safety variables that included adverse events, local skin reactions, laboratory results, dosage of immunosuppressive medication and indication of graft rejection. A 24 months follow up was conducted after the end of treatment. 87% (n = 28/32) of the patients completed the 16 week treatment phase and presented for final evaluation 4 weeks after end of treatment. In the diclofenac 3% gel treatment group, a complete clearance of AK lesions was achieved in 41% (9/22) compared to 0% (0/6) in the vehicle group. Side effects in most of the patients included a mild erythema and a mild to moderate swelling of the areas treated. No graft rejections or trends for a deterioration of graft function were detected. No meaningful trends were observed in laboratory results. In 55% of the previously cleared patients, new AK developed in the study area after an average of 9.3 months. None of these patients developed invasive SCC in the study area within 24 months of follow-up. This study demonstrated a greater lesion clearance rate of AKs in OTRs treated with diclofenac 3% gel than with vehicle. Despite recurrent AK in 55% of the previously cleared patients, the 24 month results showed no invasive SCC in this group. This study suggests that diclofenac 3% gel is not only an efficient and well tolerated treatment for multiple AKs in OTRs but also may prevent invasive SCC in these high-risk patients.
    European journal of dermatology: EJD 01/2010; 20(4):482-8. · 1.95 Impact Factor
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    ABSTRACT: Hauttumoren stellen bei organtransplantierten Patienten weltweit die mit Abstand häufigste Tumorentität. Während maligne Melanome in den meisten Statistiken mit nur leicht erhöhten Inzidenzen angegeben werden, scheinen Keratinozytentumoren mit einem Anteil von über 95% am Hauttumoraufkommen von der chronischen Immunsuppression langzeittransplantierter Patienten besonders zu profitieren. Plattenepithelkarzinome (PEC) und aktinische Keratosen (AK) haben in dieser Patientengruppe charakteristischerweise jeweils noch höhere Inzidenzen als Basalzellkarzinome (BCC). AK und PEC dienen bei Organtransplantierten als Indikator für multilokulär auftretende, weitere PEC (Flächenkanzerisierung). Der Schlüssel in der Sekundärprophylaxe multifokal entstehender und hochaggressiv wachsender, invasiver PEC liegt in der frühzeitigen Therapie epithelialer Präkanzerosen. Interdisziplinäre Prophylaxe- und Therapieansätze wie die tägliche Verwendung medizinischer Sonnenschutzmittel, medikamentöse Flächentherapie aktinisch geschädigter Hautareale, systemische Retinoide sowie die Verwendung von Immunsuppressiva aus der Gruppe der mTOR-Inhibitoren können das Risiko auftretender Sekundär-PEC am Hautorgan deutlich senken. Innerhalb der Transplantationsmedizin kommen der Dermatologie neben der weiterhin notwendigen Aufklärungsarbeit zur Primärprophylaxe wesentliche Aufgaben im Kontext regelmäßiger Vorsorgeuntersuchungen sowie einer zeitnahen und suffizienten Sekundärprophylaxe bei Auftreten präinvasiver Hauttumoren zu. Skin cancer constitutes the most frequently reported post-transplant malignancy in solid organ transplant recipients (OTR) worldwide. Whereas the risk for malignant melanoma is only moderately increased, non-melanoma skin cancers (NMSC) seem to thrive on chronic immunosuppression and account for up to 95% of post-transplant cutaneous malignancies. Compared to the general population cutaneous squamous cell carcinoma (SCC) and actinic keratoses (AK) characteristically show even higher incidences than basal cell carcinoma (BCC) and act as an indicator for the development of multiple primary cutaneous neoplasias and locally recurrent cancers (field cancerization). Early diagnosis and therapy of pre-malignant cutaneous lesions is crucial for the secondary prophylaxis of further invasive and highly aggressive skin cancers. High quality interdisciplinary care and prophylactic modalities, including consistent and sufficient UV protection, topical immunmodulatory therapies of UV-damaged skin areas, retinoid chemoprevention as well as tapering immunosuppressive treatment or the selection of immunosuppressants with proposed antiangiogenic properties like mTor-inhibitors may help to reduce the multiplicity of subsequent primary skin cancers in high-risk patients. Apart from the continuous need for educational intervention of OTR in the primary prophylaxis of post-transplant skin cancers, dermatologic care occupies a central position within the field of transplantation medicine in terms of pre- and post-transplanation dermatologic evaluation and therapy as well as the implication of timely and effective secondary preventive approaches in the management of this high-risk patient population. SchlüsselwörterOrgantransplantation-Immunsuppression-mTOR-Inhibitoren-Hauttumoren-Aktinische Keratosen KeywordsOrgan transplantation-Immunosuppression-mTOR-Inhibitor-Skin cancer-Actinic keratosis
    Der Hautarzt 01/2010; 61(3):195-206. · 0.50 Impact Factor
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    Der Hautarzt 01/2010; 61(3):193-194. · 0.50 Impact Factor
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    ABSTRACT: Humane Papillomviren (HPV) zeigen für mehrschichtiges Plattenepithel der Haut einen ausgeprägten Epitheliotropismus. Neben der Induktion von Warzen werden HPV gelegentlich in Plattenepithelkarzinomen gefunden. Aufgrund einer inadäquaten Typ1-T-Zell-vermittelten Immunüberwachung bei organtransplantierten Patienten kommt es vermehrt zur Entwicklung von ausgedehnten und oftmals therapieresistenten Warzen. Hauttumoren, besonders Plattenepithelkarzinome, stellen die häufigste Neoplasie post transplantationem dar. Eine zeitliche sowie enge räumliche Assoziation zwischen dem Auftreten von Warzen sowie aktinischen Keratosen und invasiven Plattenepithelkarzinomen wurde beobachtet. In der Universitätsmedizin Berlin Charité wurden die prospektiv gesammelten Untersuchungsdaten von 1690 organtransplantierten Patienten ausgewertet. Primäres Ziel war die Evaluierung möglicher Risikofaktoren im Zusammenhang mit der Entstehung von Warzen. Sekundäres Ziel war die Überprüfung einer möglichen Korrelation zwischen dem Auftreten von Warzen und der Entwicklung epithelialer Hauttumoren. Die kumulative Inzidenz von Warzen steigt in den Jahren nach Transplantation stetig an. Eine Anzahl von mehr als 10Warzen war mit der zeitversetzten Entwicklung aktinischer Keratosen, invasiver Plattenepithelkarzinome und Basalzellkarzinome assoziiert. Etablierte Risikofaktoren der kutanen Karzinogenese bei Organtransplantierten korrelieren ebenfalls mit dem Auftreten von Warzen. Im 2.Abschnitt des Beitrags wird das therapeutische Management von Warzen bei Organtransplantierten vorgestellt. Human papillomaviruses infect the squamous epithelia of the skin and cause warts, and are occasionally found in squamous cell carcinomas. Since cell-mediated immunity plays a crucial role in the control of HPV-infections, organ transplant recipients, unable to mount an adequate T-helper 1 cell-mediated immune surveillance, frequently develop widespread and resistant induced warts. Skin tumors, especially squamous cell carcinomas, are the most common post-transplantation neoplasm. Warts, actinic keratoses and invasive squamous cell carcinomas are known to develop at the same time in the areas. The role of HPV in the development of invasive squamous cell carcinoma under immunosuppression, remains to be elucidated in respect to common risk factors and increased numbers of warts potentially indentifing patients at increased risk for carcinoma. We prospectively studied 1690 organ transplant recipients in the dermatology clinic at the Charité University Hospital in Berlin, to evaluate risk factors being involved in the development of HPV-induced warts and to assess a potential association of with the development of non-melanoma skin cancers in this population. The cumulative incidence of warts steadily increased throughout the post-transplant years. The presence of more than 10 verrucae was associated with the development of actinic keratoses, invasive squamous cell carcinoma and basal cell carcinoma. This study shows clear evidence that certain risk factors of skin carcinogenesis in organ transplant recipient such as increased age at transplantation, a high dose of immunosuppression related to a specific type of graft and use of azathioprine or cyclosporine are strongly associated with an increased incidence of warts. Furthermore, HPV-induced verrucae vulgares could be used as a potential predictor for the development of coincidental non melanoma skin cancer in organ transplant recipients and therefore could serve as an early identification marker of skin cancer high-risk patients. The challenging management of warts in organ transplantation patients is reviewed. SchlüsselwörterHumane Papillomviren-Verrucae vulgaris-Organtransplantation-Immunsuppression-Hauttumor KeywordsHuman papillomavirus-Verrucae vulgaris-Organ transplant-Oncogene-Skin cancer
    Der Hautarzt 01/2010; 61(3):220-229. · 0.50 Impact Factor
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    ABSTRACT: Export Date: 18 October 2014
    Managing Skin Cancer, 01/2010: pages 149-210;
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    ABSTRACT: Skin cancers represent a major challenge within the ever growing group of long time surviving organ transplant recipients (OTR) world wide. Especially UV-induced non-melanoma skin cancers (NMSC) like invasive squamous cell carcinomas (SCC) and actinic keratoses (AK), and basal cell carcinoma (BCC), outnumber every other form of cancer in organ transplant recipients. Despite encouraging reports of protective effects of broad-spectrum sunscreens in immunocompetent patients, evidence for the prevention of NMSC in immunocompromised patients is still missing. To assess preventive effects of regular sun-screen use on AK, SCC and BCC in chronically immunocompromised organ transplant recipients. Hundred and twenty matched (age, sex, skin type, graft, transplant duration, previous post-transplant skin malignancies) organ transplant recipients (40 heart, 40 kidney, 40 liver grafted) were recruited for this prospective, single-center study. Both groups received equally written and oral information on sun protection measures. Sixty patients were provided with a free broad spectrum study-sunscreen (SPF>50, high-UVA absorption) for daily application of 2 mg cm(-2) to the head, neck, forearms, and hands. All 120 patients completed the 24 months study. Within this 24 month study interval 42 of the 120 patients developed 82 new AK (-102 sunscreen group vs. +82 control; P<0.01), 8 new invasive SCC (0 vs. 8; P<0.01) and 11 BCC (2 vs. 9; ns). In spite of equal numbers of AK at baseline, a marked difference in favor of the intent-to-treat sunscreen group was recorded after 24 months (89 vs. 273; P<0.01, mean difference 3.07 [1.76-4.36]) and the lesion count was significantly lower as compared to the initial visit (89 vs. 191; P<0.01, mean difference 1.7 [0.68-2.72]). With an average of 5.6 applications per week throughout the 24 months the study sunscreen was generally well tolerated. Serum 25-hydroxy vitamin D levels as marker for vitamin D status were decreased in all patients without adequate substitution and 25(OH)D was found to be lower in the sunscreen-group as compared to the control group (mean value 53 ng mL(-1) vs. 60 ng mL(-1)). Regular use of sunscreens, as part of a consequent UV-protection strategy, may prevent the development of further AK and invasive SCC and, to a lesser degree, BCC in immune-compromised organ transplant recipients.
    British Journal of Dermatology 11/2009; 161 Suppl 3:78-84. · 3.76 Impact Factor
  • British Journal of Dermatology 11/2009; 161 Suppl 3:1-2. · 3.76 Impact Factor
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    ABSTRACT: Organ transplant recipients (OTRs) have an increased risk of developing skin cancer, especially epithelial tumours. A number of factors such as immunosuppression, age, ultraviolet radiation and skin type are considered as important in aetiology. The purpose of this study was to further evaluate the risk factors for OTRs regarding skin cancer after transplantation. A detailed investigation of the specific compounds of sun exposure was realised. A questionnaire-based study was performed in a specialist OTR dermatology clinic from January to April 2009. The subjects were 70 organ transplanted patients who had developed some form of skin cancer after transplantation. As controls served 69 organ transplanted patients who had no history of skin cancer. The controls were matched concerning age, transplanted organ and gender. Photo protection, sun exposure and transplantation data were part of the questionnaire. Statistical analysis was performed with Mann-Whitney-U-test, chi-square test or Fisher's exact test. The total sun burden (TSB) and the recreational sun exposure in particular attained higher scores in the skin cancer group (TSB-score: mean 11.8 vs. 10.0, P<0.05; recreational sun exposure: mean 6.3 vs. 5.1, P<0.05). The skin cancer group had fairer skin types than the control group (median skin type 2 vs. 3, P<0.05). The OTRs who developed skin cancer have been more likely to have a history or present intake of azathioprine (mean 42% vs. 21%, P<0.05). Also, the skin cancer group has been transplanted for a longer time (mean 12.3 vs. 7.2 years, P<0.001), analogously had a younger age at transplantation (mean 49.5 vs. 52.7 years, P<0.001). Recreational sun exposure is of central importance for OTRs. A long period of transplantation and thus immunosuppression presents a main risk factor for the development of skin cancer in OTRs. A multi disciplinary management with the best medication and a focus on sun protection is needed to prevent skin cancer in OTRs.
    British Journal of Dermatology 11/2009; 161 Suppl 3:85-9. · 3.76 Impact Factor

Publication Stats

1k Citations
158.86 Total Impact Points

Institutions

  • 2003–2014
    • Charité Universitätsmedizin Berlin
      • Department of Dermatology, Venerology and Allergology
      Berlín, Berlin, Germany
    • Christian-Albrechts-Universität zu Kiel
      • Department of Dermatology, Venereology and Allergology
      Kiel, Schleswig-Holstein, Germany
  • 2012
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
  • 2010
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 2002–2006
    • Humboldt-Universität zu Berlin
      Berlín, Berlin, Germany