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ABSTRACT: A 68-year-old woman presented with unilateral herpetiform skin lesions of the face. She also showed reduced eye lid and mimic function as well as hearing loss. In addition grouped vesicles were seen in the outer ear canal. We diagnosed Ramsay Hunt syndrome and administered intravenous acyclovir, prednisolone and pentoxifylline. Within a few weeks, there was complete remission including the neurological symptoms.
Der Hautarzt 11/2012; · 0.58 Impact Factor
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ABSTRACT: New therapeutic agents, i.e., biologicals, may induce a variety of novel cutaneous adverse reactions (CAR), which hardly can be assigned to existing classification systems. Basing on clinical examples, we present a recently established classification system for CAR to novel drugs. In addition, management strategies for CAR to tumor necrosis factor-α antagonists and to epidermal growth factor receptor inhibitors are discussed.
Der Internist 07/2012; 53(8):917-23. · 0.30 Impact Factor
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ABSTRACT: Heparininduzierte Hautnekrosen sind selten und können als Komplikation der immunologisch vermittelten heparininduzierten Thrombozytopenie
TypII (HITII) beobachtet werden. Wir berichten über eine 62-jährige Patientin, bei der sich 7Tage nach Beginn der subkutanen
Applikation des niedermolekularen Heparins Enoxaparin abdominal eine Nekrose entwickelte. Es ließen sich Antikörper gegen
den Platelet-factor-4-Komplex nachweisen, nicht jedoch eine Thrombozytopenie. Es kann spekuliert werden, dass es sich bei
der Hautnekrose um die Folge einer isolierten, antikörperbedingten Thrombosierung dermaler Hautgefäße im Rahmen einer HITII
handelte.
Most of the rare cases of skin necrosis following heparin injections are associated with the immunologically mediated form
of heparin-induced thrombocytopenia II (HIT II). We present a 62-year- old woman who developed a necrotic abdominal lesion
seven days after starting daily subcutaneous injections of the low molecular heparin enoxaparin. We detected circulating antibodies
against the platelet factor 4-complex but no concomitant thrombocytopenia. An isolated, antibody-mediated thrombosis of dermal
vessels is the likely underlying cause of the skin necrosis in HIT II.
SchlüsselwörterHeparininduzierte ThrombozytopenieII–Enoxaparin–Platelet-factor-4-Komplex (PF4-Komplex)–Heparininduzierte Plättchenaggregation (HIPA)–Review
KeywordsHeparin-induced thrombocytopenia II (HIT II)–Skin necrosis–Enoxaparin–Platelet factor 4-complex (PF4-complex)–Heparin-induced platelet aggregation (HIPA)–Review
Der Hautarzt 05/2012; 62(4):290-292. · 0.58 Impact Factor
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ABSTRACT: Die Necrobiosis lipoidica (NL) ist eine chronisch-entzündliche Hauterkrankung, deren Behandlung sich oft schwierig gestaltet.
Die Ätiologie ist unklar, Gefäßveränderungen und immunologische Faktoren scheinen bedeutsam zu sein. Wir berichten über die
topische Anwendung von Tacrolimus bei einer langjährig bestehenden NL mit multiplen vaskulären Risikofaktoren (Diabetes mellitus,
Protein-S-Mangel, Faktor-II-Mangel, Cardiolipin-Antikörper-Syndrom). Tacrolimus ist ein nichtatrophogener, topisch applizierbarer,
nichtsteroidaler Immunmodulator. Bei unserer Patientin mit langjähriger NL zeigte sich bereits nach 12Wochen unter der topischen
Therapie mit Tacrolimus (0,1%) eine deutliche Besserung.
Necrobiosis lipoidica (NL) is a chronic inflammatory skin disease that is difficult to treat. The etiology is unknown, but
vascular abnormalities and immunologic factors have been implicated. We treated a patient tiwth long-standing NL with multiple
vascular risk factors (diabetes mellitus, protein S-deficiency, and antiphospholipid syndrome) with topical tacrolimus, a
non-steroidal immunomodulator that causes no skin atrophy. After 12 weeks of topical tacrolimus (0.1%) ointment, our patient
already showed a good remission with a significant decrease in inflammatory signs.
SchlüsselwörterNecrobiosis lipoidica–Vaskuläre Risiken–Therapieresistenz–Tacrolimus–Immunmodulator
KeywordsNecrobiosis lipoidica–Vascular risk-factors–Resistance to therapy–Tacrolimus–Immunomodulator
Der Hautarzt 04/2012; 62(6):459-462. · 0.58 Impact Factor
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ABSTRACT: Die humane Seminalplasmaallergie (HSPA) ist eine seltene allergische Reaktion auf spezifische Proteinfraktionen des Seminalplasma,
wobei das prostataspezifische Antigen (PSA) als relevante allergene Determinante angesehen wird. Dabei treten in erster Linie
Typ-I-Immunreaktionen mit lokaler und generalisierter Urtikaria sowie anaphylaktische Schocksymptome auf. Die Diagnostik basiert
auf Anamnese, Klinik und Prick-Tests sowie Bestimmungen der spezifischen IgE-Werte nach Applikation von (un)fraktioniertem
Seminalplasma. Wir berichten über eine Patientin mit rezidivierendem Auftreten einer generalisierten Urtikaria nach ungeschütztem
Geschlechtsverkehr und 4fach positiver Prick-Test-Reaktion auf Seminalplasma.
Human seminal plasma allergy (HSPA) is a rare allergic reaction to specific protein fractions of seminal plasma, whereof PSA
seems to be a relevant allergen. Predominantly Type I-immunoreactions can occur. The main symptoms are localized and generalized
urticaria and sometimes anaphylactic symptoms. The diagnosis is based on history, skin tests and on the determination of specific
IgE-levels for (un)fractionated seminal plasma. Here we report a patient with recurrent episodes of generalized urticaria
after unprotected sexual intercourse and positive prick-test-reaction on seminal plasma.
Der Hautarzt 04/2012; 59(8):649-652. · 0.58 Impact Factor
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ABSTRACT: Wir berichten über einen 47-jährigen Patienten mit seit 2Jahren bestehenden, generalisierten, stark juckenden Hautveränderungen,
die eine fehlende Besserung auf Kortikosteroidapplikation zeigten. Der Nachweis zahlreicher Milben in den Schuppenkrusten
erbrachte die Diagnose einer Scabies norvegica. Die systemische Therapie mit Ivermectin (Stromectol®) sowie die topische Anwendung
von Permethrin (InfectoScab®) führten zur langsamen Rückbildung der Ekzemherde. Als auslösende Faktoren werden die immunsupprimierend
wirkende Kortikosteroidvorbehandlung sowie der anamnestisch bekannte Alkoholabusus vermutet.
A 47-year-old man presented with generalized pruritic lesions that had persisted for 2 years and shown no response to therapy
with topical corticosteroids. The identification of numerous mites in the patient’s scales led to the diagnosis of crusted
scabies. The lesions responded to systemic therapy with Ivermectin (Stromectol®) and topical application of Permethrin (InfectoScab®).
As underlying factors we suspect the immunosuppressive therapy attempts with topical corticosteroids as well as alcohol abuse.
SchlüsselwörterSkabies-Scabies crustosa-Diagnose-Permethrin-Ivermectin
KeywordsScabies-Crusted scabies-Diagnosis-Permethrin-Ivermectin
Der Hautarzt 04/2012; 61(5):439-442. · 0.58 Impact Factor
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ABSTRACT: Während die Entwicklung von Autoantikörpern im Zusammenhang mit einer Therapie mit TNF-α-Antagonisten häufig ist, so entwickeln
doch nur wenige Patienten einen durch diese Präparate induzierten klinisch manifesten Lupus erythematodes. Insbesondere bei
Einsatz des vollhumanisierten TNF-Antagonisten Adalimumab scheinen diese kutanen unerwünschten Wirkungen deutlich seltener
aufzutreten als bei anderen Präparaten. Wir berichten über eine Patientin mit rheumatoider Arthritis, bei der es 8Monate
nach Beginn einer Adalimumab-Therapie zu einem Lupus erythematodes tumidus an beiden Handrücken sowie zur Entwicklung von
Antihiston-Antikörpern kam.
Patients treated with TNF-α inhibitors frequently have serum autoantibodies, but only a few develop clinically apparent lupus
erythematosus. The TNF-α inhibitor adalimumab is a fully humanized antibody and seems to induce autoantibodies less frequently
than other drugs of this group. We report on a patient with rheumatoid arthritis, who developed anti-histone antibodies and
lupus tumidus after eight months on adalimumab therapy.
Der Hautarzt 04/2012; 60(10):826-829. · 0.58 Impact Factor
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ABSTRACT: Wir berichten über einen Patienten mit einer selten auftretenden anaphylaktischen Reaktion nach dem Verzehr roher Paprika.
Die allergologische Diagnostik zeigte ein komplexes Sensibilisierungsmuster, u.a. auf Gräser und Birke mit Hinweisen auf
eine pollenassoziierte Nahrungsmittelallergie. Am ehesten führen wir die Reaktion auf eine Bet-v-1-bedingte Kreuzreaktion
zurück. Im Westernblot zeigte sich eine Bindung des Patientenserums an ein 11-kDa-Protein, bei dem es sich möglicherweise
um ein bisher unbekanntes Allergen der Paprikapflanze handelt oder um ein Fragment des Bet-v-1-homologen Paprikaproteins.
We report on a patient with rare anaphylaxis after ingestion of raw bell pepper. A complex cluster of sensitization including
grass and birch pointed out a possible pollen-associated food allergy. We suggest that the severe reaction is due to cross-reactivity
towards Betv1. Western blot showed binding of the patient’s serum to an 11kDa protein, which has not been described yet
and might be a new allergenic structure of the bell pepper plant or a fragment of the Betv1-homologous bell pepper protein.
SchlüsselwörterPaprika-Anaphylaxie-Nahrungsmittelallergie-Betv1-11-kDa-Protein
KeywordsBell pepper-Anaphylaxis-Food allergy-Betv1-11kDa protein
Der Hautarzt 04/2012; 61(4):339-342. · 0.58 Impact Factor
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ABSTRACT: Plantare Ulzerationen eines Lichen ruber stellen eine ungewöhnliche Manifestation dar, die Patienten oft extrem einschränkt
und therapeutisch hartnäckig ist. Wir berichten über einen 71-jährigen Patienten, bei dem sich ein promptes und vollständiges
Ansprechen der Ulzerationen auf eine orale Ciclosporin-Therapie zeigte.
Plantar ulcerations of lichen planus are unusual manifestations that constrain the patient’s quality of life and are often
refractory to treatment. We report on a 71-year-old man in whom a prompt and complete healing of plantar ulcerative lichen
planus was achieved by treatment with oral cyclosporine.
Der Hautarzt 04/2012; 60(8):647-650. · 0.58 Impact Factor
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ABSTRACT: An increasing number of immediate type allergies after consumption of soy products have been reported during the last years. Due to cross reactions between the main birch pollen allergen Bet v 1 and soy allergen Gly m 4, patients sensitized to birch are at special risk for soy allergy. Severe immediate type reactions to soy have also been associated with sensitizations to storage proteins Gly m 5 and Gly m 6. Therapy should include avoidance of soy products with high protein content (i.e. drinks). A limited number of studies has investigated specific immunotherapy (SIT) against birch in patients with birch-associated food allergy, namely to apple or hazel. A therapeutic effect on birch- associated food allergy was shown in some of these trials. Results are discussed controversially with regard to number of patients, study design and investigational products. A multicenter trial (BASALIT) is currently investigating the effect of SIT with 80 µg of the folded variant of recombinant Bet v 1 on birch-associated soy allergy.
Der Hautarzt 04/2012; 63(4):307-12. · 0.58 Impact Factor
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Journal of the European Academy of Dermatology and Venereology 06/2011; 25(6):739-41. · 2.98 Impact Factor
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ABSTRACT: Necrobiosis lipoidica (NL) is a chronic inflammatory skin disease that is difficult to treat. The etiology is unknown, but vascular abnormalities and immunologic factors have been implicated. We treated a patient with long-standing NL with multiple vascular risk factors (diabetes mellitus, protein S-deficiency, and antiphospholipid syndrome) with topical tacrolimus, a non-steroidal immunomodulator that causes no skin atrophy. After 12 weeks of topical tacrolimus (0.1%) ointment, our patient already showed a good remission with a significant decrease in inflammatory signs.
Der Hautarzt 06/2011; 62(6):459-62. · 0.58 Impact Factor
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[show abstract]
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ABSTRACT: Most of the rare cases of skin necrosis following heparin injections are associated with the immunologically mediated form of heparin-induced thrombocytopenia II (HIT II). We present a 62-year- old woman who developed a necrotic abdominal lesion seven days after starting daily subcutaneous injections of the low molecular heparin enoxaparin. We detected circulating antibodies against the platelet factor 4-complex but no concomitant thrombocytopenia. An isolated, antibody-mediated thrombosis of dermal vessels is the likely underlying cause of the skin necrosis in HIT II.
Der Hautarzt 04/2011; 62(4):290-2. · 0.58 Impact Factor
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ABSTRACT: A 42-year-old man developed necrotizing fasciitis on the right leg. A multidrug-resistant Acinetobacter baumannii was cultivated from the deep wound. Following therapy with imipenem and tobramycin as well as extensive debridement, the lesions improved slowly. A. baumannii is today an important cause of nosocomial infections, especially in intensive care units.
Der Hautarzt 02/2011; 62(2):128-30. · 0.58 Impact Factor
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R Treudler
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ABSTRACT: Allergic diseases arising in pregnancy may pose a challenge. Skin test results may be influenced by hormonal factors and fetal risk due to the skin testing procedure cannot be excluded. Also, several anti-allergic drugs are not licensed or are even contraindicated in pregnancy. This paper reviews diagnostic and therapeutic procedures in pregnant women.
Der Hautarzt 11/2010; 61(12):1027-33. · 0.58 Impact Factor
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ABSTRACT: Long-wavelength UVA (340-400 nm UVA-1) phototherapy has been reported to be effective in atopic dermatitis, localized scleroderma and T-cell-derived skin diseases. We retrospectively investigated 70 patients with acute cutaneous GVHD after allogeneic haematopoietic cell transplantation or donor lymphocyte infusion. Complete and partial responses with a median duration of 10 months were achieved in 49 (70%) and 17 (24.3%) patients, respectively. Overall, 47 (67.1%) patients were not treated with systemic steroids. Furthermore, immunosuppression could be tapered in 24 (34.3%) patients while they were receiving UVA-1 treatment. Responses were seen irrespective of age or type of conditioning. Treatment was very well tolerated. After a median follow-up of 18 (range 10-60) months, three patients developed epithelial skin neoplasia. We conclude that UVA-1 therapy is feasible, well tolerated and can be an effective treatment for acute GVHD of the skin, thereby avoiding the use of systemic steroids and/or allowing a more rapid tapering of systemic immunosuppression in a substantial number of patients. The results of this retrospective analysis warrant larger, prospective studies and the effectiveness of UVA-1 therapy should be compared with other established treatment modalities.
Bone marrow transplantation 10/2010; 45(12):1741-8. · 3.00 Impact Factor
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ABSTRACT: A 47-year-old man presented with generalized pruritic lesions that had persisted for 2 years and shown no response to therapy with topical corticosteroids. The identification of numerous mites in the patient's scales led to the diagnosis of crusted scabies. The lesions responded to systemic therapy with Ivermectin (Stromectol) and topical application of Permethrin (InfectoScab). As underlying factors we suspect the immunosuppressive therapy attempts with topical corticosteroids as well as alcohol abuse.
Der Hautarzt 03/2010; 61(5):439-42. · 0.58 Impact Factor
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[show abstract]
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ABSTRACT: We report on a patient with rare anaphylaxis after ingestion of raw bell pepper. A complex cluster of sensitization including grass and birch pointed out a possible pollen-associated food allergy. We suggest that the severe reaction is due to cross-reactivity towards Bet v 1. Western blot showed binding of the patient's serum to an 11 kDa protein, which has not been described yet and might be a new allergenic structure of the bell pepper plant or a fragment of the Bet v 1-homologous bell pepper protein.
Der Hautarzt 06/2009; 61(4):339-42. · 0.58 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Patients treated with TNF-alpha inhibitors frequently have serum autoantibodies, but only a few develop clinically apparent lupus erythematosus. The TNF-alpha inhibitor adalimumab is a fully humanized antibody and seems to induce autoantibodies less frequently than other drugs of this group. We report on a patient with rheumatoid arthritis, who developed anti-histone antibodies and lupus tumidus after eight months on adalimumab therapy.
Der Hautarzt 03/2009; 60(10):826-9. · 0.58 Impact Factor
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Allergy 03/2009; 64(3):498-9. · 6.27 Impact Factor
