H Kerl

Medical University of Graz, Gratz, Styria, Austria

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Publications (545)1560.35 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The significance of the histological visualization of hemophagocytosis in tissues depends on the context, varying from a nonspecific phenomenon to a characteristic or diagnostic feature for certain disease entities. Hemophagocytosis is also one of the key features of macrophage activation syndrome (MAS) (hemophagocytic syndrome) a potentially life-threatening complication of underlying conditions such as infections, malignancy, and autoimmune disorders. Clinical manifestations of MAS are high fever, pancytopenia, liver dysfunction, and coagulopathy. These clinical symptoms are due to an abnormal activation of the immune system in a strong association with the cytokine milieu. The diagnosis of MAS may be easily missed; it is usually detected in the bone marrow, lymph node, liver, and spleen. Only few reports exist in the literature with histological description of cutaneous hemophagocytosis as a sign for MAS in patients with lymphoma and infection. In this report, the authors present the clinicopathological and immunohistochemical features of 3 patients with cutaneous hemophagocytosis, specifically erythrophagocytosis, associated with autoimmune disease, and discuss the relevance of these findings.
    The American Journal of dermatopathology. 07/2014;
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    ABSTRACT: : Follicular malignant melanoma (FMM) is a rare variant of melanoma arising on sun-damaged skin of elderly patients. It is characterized histopathologically by a prominent involvement of 1 or 2 adjacent hair follicles. The authors report 3 new cases of FMM (M:F = 2:1; age range, 23-67 years; median age, 50 years) located on the scalp, cheek, and upper back. Complete effacement of the hair follicle, replaced by neoplastic melanocytes, was observed in 1 case. The interfollicular epidermis and adventitial dermis were involved in all 3 cases. Our series shows that FMM is not restricted to elderly patients but may arise also in young individuals without association with chronic sun damage. FMM should be distinguished from folliculotropic metastases of melanoma and from atypical melanocytic nevi. Although the histopathological features and the term FMM may suggest a derivation from melanocytes of the hair follicle, the exact origin of neoplastic cells is yet unclear, and at least some of these cases may represent folliculotropic examples of primary epidermal malignant melanoma.
    The American Journal of dermatopathology 03/2014; · 1.30 Impact Factor
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    Daisy Kopera, Helmut Kerl
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    ABSTRACT: Background. Imiquimod 5% is licensed for the treatment of external genital warts, superficial basal cell carcinoma, and actinic keratosis (AK) and is being used experimentally in various other dermato-oncological conditions. Objective. This observational study shall show that nonmelanoma skin cancer can be detected at its earliest subclinical stage by its reaction with imiquimod and can be cleared by finishing the course of treatment. Material and Methods. In this single arm trial 15 patients with chronically sun-exposed skin who had no clinical evidence of AK were treated with 5% imiquimod cream on the face or scalp for 4 weeks three times per week. Results. During treatment, all patients developed multiple areas with mild to moderate inflammatory skin reactions, such as erythema, induration, and scaling. Biopsies obtained from 12 patients prior to treatment revealed no malignancies. However, in cases with more pronounced inflammation during treatment, targeted biopsies indicated very early malignant alterations. Conclusion. Topical imiquimod treatment of chronically sun-exposed skin without overt clinical signs of AK is able to detect subclinical actinic keratoses (SAK) and to completely clear the lesions, even before they can be clinically diagnosed as AK. In such patients, imiquimod might be able to prevent the evolution of SCC.
    BioMed Research International 01/2014; 2014:135916. · 2.88 Impact Factor
  • Journal of the American Academy of Dermatology 12/2013; 69(6):e307-9. · 4.91 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 12/2012; 10(s7). · 1.40 Impact Factor
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    ABSTRACT: Cutaneous melanomas are characterized by a range of histological appearances, and several morphological variants have been described. In this study, we report a variant of superficial spreading melanoma that is characterized by large, irregular junctional melanocytic nests. The junctional nests varied in shape and size, showed focal tendency to confluence, and were often surrounded by a cuff of epidermal keratinocytes. The melanocytes comprising the nests showed variable cytological atypia. In most of the cases, scant intraepidermal or junctional single melanocytes were seen, and other well-documented diagnostic criteria for melanoma were lacking, and as a result, histological recognition of these tumors as melanoma was difficult. Some cases were associated with an invasive dermal component or showed evidence of sun damage. To provide supporting evidence for malignancy, we analyzed these tumors for genomic aberrations. Using array comparative genomic hybridization (aCGH), we identified multiple genomic aberrations in all analyzed cases. A similar pattern of genomic aberrations was seen in a control group of bona fide superficial spreading melanomas, suggesting that these ‘melanomas composed exclusively or predominantly of large nests’ are indeed variants of superficial spreading melanoma. Fluorescence in-situ hybridization (FISH) was positive in 40% of the cases. However, using aCGH, the FISH-negative cases showed multiple genomic aberrations in regions that are not covered by FISH. The low sensitivity of the FISH test can be explained by the fact that FISH only evaluates four genomic loci for aberrations, whereas aCGH surveys the entire genome. In summary, we present histological and molecular genetic evidence for a morphological variant of superficial spreading melanoma. Awareness of the histological features will aid in their correct diagnosis as melanoma, and in difficult cases, judicious application of ancillary tests such as aCGH (rather than FISH) will assist accurate diagnosis.
    Modern Pathology 08/2012; 25(8):1178. · 5.25 Impact Factor
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    ABSTRACT: Das klinische Bild des Erythema ab igne (EAI) ist charakterisiert durch eine rotbraune, netzartige Färbung der Haut, hervorgerufen durch wiederholte Exposition mäßiger Hitze über längere Zeiträume. Typische Lokalisationen des EAI sind die Streckseiten der unteren Extremitäten, bedingt durch das Sitzen vor offenen Feuerstellen oder Kohleöfen sowie der Stamm von Patienten mit chronischen Leiden, die zur Linderung ihrer Schmerzen regelmäßig Wärmeflaschen oder Heizkissen benutzen. Das EAI kann einerseits ein diagnostisches Zeichen zugrundeliegender innerer Erkrankungen einschließlich maligner Tumoren sein, andererseits kann es auch selbst Ausgangspunkt eines kutanen malignen Geschehens sein. Wir berichten über eine 75jährige Patientin, bei der es nach chronischer Wärmeexposition über mehrere Jahre zum Auftreten eines EAI und in weiterer Folge zur Entstehung von mehreren thermischen Keratosen und Plattenepithelkarzinomen in eben diesem Areal gekommen ist. Erythema ab igne (EAI) is a red-brown netlike hyperpigmentation due to repetitive exposure to submaximal heat over a long period of time. This rash is typically seen on the anterior lower legs of people who sit in front of open fireplaces or coal stoves and on the trunk of patients with chronic disorders who seek pain relief by long-term use of hot-water bottles or heating pads. EAI can not only be a diagnostic sign for underlying internal diseases including malignant tumors but can also give rise to cutaneous malignancies. We report on a 75-year-old female patient who developed several thermal keratoses and squamous cell carcinomas at the site of erythema ab igne caused by chronic heat exposure over several years.
    Der Hautarzt 05/2012; 51(4):260-263. · 0.50 Impact Factor
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    ABSTRACT: Hintergrund und Fragestellung: Im Zuge eines Erysipels treten immer wieder Lokalkomplikationen (Blasen, Hämorrhagien, Nekrosen, Abszesse) auf. Derzeit gibt es keine verlässlichen Daten darüber, aufgrund welcher Merkmale ein Patient als komplikationsgefährdet einzustufen ist, wobei aber verschiedene Risikofaktoren, insbesondere Diabetes mellitus, vermutet werden. Anhand des Patientenguts der Grazer Hautklinik sollten klinische Risikofaktoren für einen komplizierten Erysipelverlauf erhoben werden. Patienten/Methodik: In einer retrospektiven Fall-Kontroll-Studie wurden von 766 Patienten, die in den Jahren 1986–1995 wegen eines Erysipels stationär behandelt worden waren, klinische Daten hinsichtlich Erysipelverlauf und möglicher Risikofaktoren erhoben und statistisch ausgewertet. Ergebnisse: Das Risiko eines komplizierten Erysipelverlaufs wird allgemein durch Lokalisation am Bein, durch Leber- und Nierenerkrankungen, Hyperurikämie und durch einen Diabetes mellitus erhöht. Lebererkrankungen und – in geringerem Maße Diabetes – disponieren speziell zu bullösen und hämorrhagischen Verläufen, eine periphere arterielle Verschlusskrankheit zu nekrotischen Läsionen. Schlussfolgerungen: Betroffene Körperregion sowie Leber- und Nierenerkrankungen scheinen die wichtigsten Risikofaktoren zu sein, während der Diabetes mellitus möglicherweise eine geringere Rolle spielt, als bisher angenommen. Background and objective: A complicated course of erysipelas is not uncommon. Bullous, haemorrhagic, necrotic and purulent lesions may be encountered. Today no reliable data exist as to which constitutional factors renders a patient at risk for developing complicated erysipelas though several risk factors, particularly diabetes mellitus, are often suggested. Based on the analysis of patients with erysipelas at the Department of Dermatology in Graz, factors determining the risk for complicated erysipelas should be identified. Patients/Methods: In a retrospective case-control study clinical data sheets of 766 in- patients treated at the department were evaluated with respect to the course of the erysipelas and with respect to potential risk factors. Results: General risk factors for local complications were location at the lower extremities, pre-existing hepatic or renal disease, hyperuricaemia, and diabetes mellitus. Hepatic and renal disease and – to a lesser extent – diabetes particularly predisposed for bullous and haemorrhagic lesions, while vascular occlusive disease enhanced the risk for ne- crotic lesions. Conclusions: Location and hepatic and renal disease are the most important risk factors, while diabetes is probably of less significance than previously suggested.
    Der Hautarzt 04/2012; 51(1):14-18. · 0.50 Impact Factor
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    ABSTRACT: Hintergrund und Fragestellung. Kutane Angiosarkome entwickeln sich in den meisten Fällen 1. idiopathisch im Kopf-Hals-Bereich älterer Menschen, 2. im Bereich länger bestehender Lymphödeme (lymphödemassoziierte Angiosarkome) oder 3. an Stellen, die vorher bestrahlt wurden (bestrahlungsinduzierte Angiosarkome). Angiosarkome werden einerseits sehr häufig – sowohl klinisch als auch histopathologisch – verkannt, andererseits sind wegen der extrem schlechten Prognose dieser Tumoren Früherkennung und Therapie äußerst wichtig. In der vorliegenden Arbeit werden Probleme bei der Diagnose von kutanen Angiosarkomen aufgezeigt, prognostische Faktoren diskutiert sowie auf die Effektivität verschiedener Therapiemöglichkeiten hingewiesen. Patienten/Methodik. Kutane Angiosarkome (11 Patienten), die in einem Zeitraum von 12 Jahren an der Universitätsklinik für Dermatologie und am Institut für Pathologie in Graz diagnostiziert wurden, werden in Bezug auf Klinik, histologische Subtypen, Therapie und Überlebenszeit analysiert. Ergebnisse. In nur einem der 11 Fälle wurde klinisch primär an ein Angiosarkom gedacht. Insgesamt lag die Überlebenszeit der 11 Patienten zwischen 1 und 24 Monaten. Drei Patienten, die radikal chirurgisch operiert wurden, weisen zum Zeitpunkt der Publikation keine Metastasierung auf. Schlussfolgerungen. Die klinische und histologische Diagnose von kutanen Angiosarkomen ist häufig sehr schwierig. Die Prognose ist sehr schlecht, die radikal-chirurgische Therapie scheint derzeit die beste therapeutische Möglichkeit zu sein. Background and Objectives. Angiosarcomas of the skin arise almost exclusively in the following clinical settings: 1. the face and scalp, usually in elderly individuals, 2. lymphedematous regions (lymphedema-associated angiosarcomas), and 3. skin that has been previously irrradiated (post-radiation angiosarcomas). Clinical and histopathologic diagnosis of angiosarcoma is difficult often resulting in great delay that obviates against early and possibly successful treatment of these very aggressive neoplasms. Diagnostic problems are described, and prognostic factors as well as the effect of different forms of treatment on the outcome are discussed. Patients/Methods. Retrospective study of 11 patients with cutaneous angiosarcomas. Clinical presentation, histopathology, therapy and survival time are analysed. Results. Only 1 of 11 cases cutaneous angiosarcoma was clinically identified. Survival time was 1–24 months. Three patients who received radical surgery have not developed metastases and are still alive. Conclusions. Clinical and histopathologic diagnosis of cutaneous angiosarcomas is often very difficult. Prognosis is very bad; radical surgery seems to be the best therapeutical option.
    Der Hautarzt 04/2012; 51(7):479-485. · 0.50 Impact Factor
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    ABSTRACT: Cutaneous melanomas are characterized by a range of histological appearances, and several morphological variants have been described. In this study, we report a variant of superficial spreading melanoma that is characterized by large, irregular junctional melanocytic nests. The junctional nests varied in shape and size, showed focal tendency to confluence, and were often surrounded by a cuff of epidermal keratinocytes. The melanocytes comprising the nests showed variable cytological atypia. In most of the cases, scant intraepidermal or junctional single melanocytes were seen, and other well-documented diagnostic criteria for melanoma were lacking, and as a result, histological recognition of these tumors as melanoma was difficult. Some cases were associated with an invasive dermal component or showed evidence of sun damage. To provide supporting evidence for malignancy, we analyzed these tumors for genomic aberrations. Using array comparative genomic hybridization (aCGH), we identified multiple genomic aberrations in all analyzed cases. A similar pattern of genomic aberrations was seen in a control group of bona fide superficial spreading melanomas, suggesting that these 'melanomas composed exclusively or predominantly of large nests' are indeed variants of superficial spreading melanoma. Fluorescence in-situ hybridization (FISH) was positive in 40% of the cases. However, using aCGH, the FISH-negative cases showed multiple genomic aberrations in regions that are not covered by FISH. The low sensitivity of the FISH test can be explained by the fact that FISH only evaluates four genomic loci for aberrations, whereas aCGH surveys the entire genome. In summary, we present histological and molecular genetic evidence for a morphological variant of superficial spreading melanoma. Awareness of the histological features will aid in their correct diagnosis as melanoma, and in difficult cases, judicious application of ancillary tests such as aCGH (rather than FISH) will assist accurate diagnosis.
    Modern Pathology 03/2012; 25(6):838-45. · 5.25 Impact Factor
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    ABSTRACT: The retinoid X receptor (RXR)-agonist bexarotene and the histone deacetylase inhibitor (HDACI) vorinostat are each established monotherapies for cutaneous T-cell lymphomas (CTCLs). We investigated the combination of HDACI and retinoic acid receptor (RAR)/RXR agonists in vitro and in a phase I, multicenter, open-label, two-part dose-escalation study. The combination of bexarotene with a HDACI in vitro leads to cooperative activation of gene transcription and reduction of cell viability in human tumor cell lines. The primary clinical objective was to determine the maximum tolerated dose (MTD) of bexarotene plus vorinostat in 23 patients with CTCLs. The MTD for part I was established at vorinostat 200 mg/day plus bexarotene 300 mg/m(2)/day. The MTD for part II was not reached. Four patients had an objective response and seven patients experienced pruritus relief. We conclude that concomitant administration of vorinostat and bexarotene is feasible only if lower doses of each drug are administered relative to the product label monotherapy doses.
    Leukemia & lymphoma 02/2012; 53(8):1501-8. · 2.61 Impact Factor
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    ABSTRACT: A detailed analysis of the results of the international annual International Committee for Dermatopathology-Union Européene des Médecins Specialistes dermatopathology examination was undertaken to identify clues for further improvement. The analysis covered 5 consecutive years (2006-2010) and involved a total of 860 questions (591 common questions and 269 uncommon questions) and 181 participants. It focused on the overall performance of the participants, the performance per part of the examination (theoretical or practical), the performance per format of question (multiple choice or open), the performance per dermatopathological topic, and the performance per professional background (dermatologist or pathologist). The overall performance of the participants was high (on average 75% correct answers in 2006 and 85% correct answers in the subsequent years). In the theoretical part of the examination, the topics of vascular diseases and lichenoid dermatoses scored better than the average of all topics, and the topics of cutaneous lymphoproliferative diseases and melanocytic disorders scored worse. In the first practical part (interpretation of images), dermatologists outperformed pathologists, especially on providing a diagnosis (open question format) of clinical images. In the second practical part (microscopical examination), the topics of vascular diseases, granulomatous diseases, including necrobiotic and degenerative and metabolic diseases scored better than the average of all topics, and the topic of infectious diseases scored worse. The results of this detailed analysis provide an excellent feedback to the examination committee that will be used to consider the adjustment of parts and/or topics of the examination that showed a deviant performance by the participants. In addition, it is recommended to give more attention to the postgraduate education of certain dermatopathological topics, including cutaneous lymphoproliferative diseases, melanocytic disorders, and infectious diseases.
    The American Journal of dermatopathology 02/2012; 34(5):471-7. · 1.30 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 09/2011; 9(9):723-36. · 1.40 Impact Factor
  • Journal der Deutschen Dermatologischen Gesellschaft 07/2011; 9(9):723-34. · 1.40 Impact Factor
  • Helmut Kerl, Lorenzo Cerroni
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    ABSTRACT: Diagnoses in dermatopathology are capable of improvement. Clinical pictures should be evaluated along with skin biopsy specimens whenever possible.
    Journal der Deutschen Dermatologischen Gesellschaft 06/2011; 9(9):721-2. · 1.40 Impact Factor
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    ABSTRACT: Actinic keratoses (AKs) arise after chronic sun exposure. Because long-term ultraviolet (UV) damage may induce proliferation of atypical keratinocytes, treatment of AKs is recommended. To compare 5-fluorouracil 0·5%/salicylic acid 10·0% [low-dose 5-FU/SA (Actikerall®)] with diclofenac 3% in hyaluronic acid (diclofenac HA) and vehicle for the treatment of AKs. This was a randomized, placebo-controlled, double-blind, parallel-group, multicentre trial. Patients received topical low-dose 5-FU/SA once daily, its vehicle or diclofenac HA twice daily for a maximum of 12 weeks. The final evaluation was at week 20. The primary objectives were to demonstrate the histological clearance rate of one predefined lesion. The secondary objectives were the improvement of treated lesions, tolerability and safety. There were 470 patients with 4-10 AK lesions each (grade I or II) on the face/forehead or bald scalp included in the study. Low-dose 5-FU/SA was superior to diclofenac HA (P < 0·01) and vehicle (P < 0·0001) for histological clearance of one representative lesion 8 weeks post-treatment. In 72·0%, 59·1% and 44·8% of patients in the low-dose 5-FU/SA, diclofenac HA and vehicle groups, respectively, the week-20 biopsy revealed no AKs. Significantly more lesions were cleared with low-dose 5-FU/SA (74·5%) compared with diclofenac HA (54·6%; P < 0·001) or vehicle (35·5%; P< 0·001). Low-dose 5-FU/SA was superior in terms of complete clinical clearance: 55·4%, vs. diclofenac HA (32·0%, P < 0·001) and vehicle (15·1%P < 0·001). Application-site disorders (mainly burning and inflammation) were more frequent with low-dose 5-FU/SA but mainly of mild to moderate intensity. Topical low-dose 5-FU/SA demonstrated higher histological and clinical clearance rates vs. diclofenac HA or vehicle. Low-dose 5-FU/SA is an effective lesion-directed treatment for AKs.
    British Journal of Dermatology 04/2011; 165(5):1101-8. · 3.76 Impact Factor
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    ABSTRACT: Ancient melanocytic nevus (AN) is an unusual but distinctive melanocytic neoplasm within the spectrum of simulators of malignant melanoma. This report describes 13 patients with AN where a long follow-up information was available. Histopathology is characterized by 2 populations of melanocytes, namely, one with large pleomorphic cells and the other with small melanocytes. A few mitotic figures may be present exceptionally. MIB-1 (Ki67) proliferation marker reveals an overall low nuclear labeling index. Additional important findings are stromal degenerative changes. AN must be especially differentiated from dermal melanoma arising in a nevus.
    The American Journal of dermatopathology 04/2011; 33(2):127-30. · 1.30 Impact Factor
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    ABSTRACT: Ancient melanocytic nevus (AN) is an unusual but distinctive melanocytic neoplasm within the spectrum of simulators of malignant melanoma. This report describes 13 patients with AN where a long follow-up information was available. Histopathology is characterized by 2 populations of melanocytes, namely, one with large pleomorphic cells and the other with small melanocytes. A few mitotic figures may be present exceptionally. MIB-1 (Ki67) proliferation marker reveals an overall low nuclear labeling index. Additional important findings are stromal degenerative changes. AN must be especially differentiated from dermal melanoma arising in a nevus.
    The American Journal of dermatopathology 02/2011; · 1.30 Impact Factor
  • 01/2011;
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    ABSTRACT: This work displays the bridging of two fields - namely dermatopathology and art. What is astonishing is that structures one sees through the microscope reveal aesthetic and artistic aspects and sometimes resemble in a startling way the designs of certain artists. Specific examples are illustrated to enhance the joy and appreciation of morphologic images.
    Journal der Deutschen Dermatologischen Gesellschaft 11/2010; 8(11):917-8. · 1.40 Impact Factor

Publication Stats

10k Citations
1,560.35 Total Impact Points

Institutions

  • 2004–2014
    • Medical University of Graz
      • Universitätsklinik für Dermatologie und Venerologie
      Gratz, Styria, Austria
  • 2012
    • Radboud University Nijmegen
      • Department of Anatomy
      Nijmegen, Provincie Gelderland, Netherlands
  • 2011
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
  • 1984–2009
    • Karl-Franzens-Universität Graz
      • Institute of Psychology
      Graz, Styria, Austria
  • 2008
    • Universidade Federal do Paraná
      • Hospital de Clínicas
      Curitiba, Estado do Parana, Brazil
    • Charité Universitätsmedizin Berlin
      • Department of Dermatology, Venerology and Allergology
      Berlin, Land Berlin, Germany
  • 2007
    • Roche
      Bâle, Basel-City, Switzerland
  • 2006
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2003–2004
    • University of Pavia
      Ticinum, Lombardy, Italy
    • University of Wuerzburg
      Würzburg, Bavaria, Germany
  • 1997–2004
    • University of Tuebingen
      • Department of Dermatology
      Tübingen, Baden-Wuerttemberg, Germany
  • 2002
    • Henan Medical University
      Nan-yang-shih, Henan Sheng, China
  • 1991–2002
    • Università degli Studi dell'Aquila
      Aquila, Abruzzo, Italy
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2000
    • Humboldt-Universität zu Berlin
      Berlín, Berlin, Germany
  • 1999
    • IST Austria
      Klosterneuberg, Lower Austria, Austria
  • 1995–1998
    • University of Vienna
      Wien, Vienna, Austria
  • 1993
    • Utrecht University
      Utrecht, Utrecht, Netherlands
    • University of Innsbruck
      • Institute of Biochemistry
      Innsbruck, Tyrol, Austria
  • 1992
    • Universität Ulm
      Ulm, Baden-Württemberg, Germany
  • 1990
    • Mayo Foundation for Medical Education and Research
      • Department of Dermatology
      Scottsdale, AZ, United States
  • 1989
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 1987
    • Generalitat de Catalunya
      Barcino, Catalonia, Spain