L R Braathen

University of Innsbruck, Innsbruck, Tyrol, Austria

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Publications (124)347.08 Total impact

  • Journal of the European Academy of Dermatology and Venereology 03/2014; · 2.69 Impact Factor
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    ABSTRACT: Topical photodynamic therapy (PDT) is a widely used non-invasive treatment for certain non-melanoma skin cancers, permitting treatment of large and multiple lesions with excellent cosmesis. High efficacy is demonstrated for PDT using standardized protocols in non-hyperkeratotic actinic keratoses, Bowen's disease, superficial basal cell carcinomas (BCC) and in certain thin nodular BCC, with superiority of cosmetic outcome over conventional therapies. Recurrence rates following PDT are typically equivalent to existing therapies, although higher than surgery for nodular BCC. PDT is not recommended for invasive squamous cell carcinoma. Treatment is generally well tolerated, but tingling discomfort or pain is common during PDT. New studies identify patients most likely to experience discomfort and permit earlier adoption of pain-minimization strategies. Reduced discomfort has been observed with novel protocols including shorter photosensitizer application times and in daylight PDT for actinic keratoses.
    Journal of the European Academy of Dermatology and Venereology 11/2012; · 2.69 Impact Factor
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    ABSTRACT: In addition to established indications in non-melanoma skin cancer in immunocompetent patients, photodynamic therapy (PDT) has been studied for the treatment, and possible prevention, of superficial skin cancers in immunosuppressed patients. As a topical photosensitizer can be applied over large areas, PDT is also increasingly used for field cancerization in photodamaged skin, with evidence of potential to delay the development of actinic keratoses and basal cell carcinoma, although direct evidence of prevention of invasive squamous cell carcinoma remains limited. PDT has been studied in patch/plaque-stage cutaneous T-cell lymphoma, with efficacy more likely in unilesional disease. Accumulating evidence supports the use of PDT in acne and several other inflammatory/infective dermatoses including cutaneous leishmaniasis, although protocols are still to be refined. Despite proven efficacy, PDT is not widely used in viral/genital warts, where pain during treatment can be intense. PDT is a therapeutic option for photorejuvenation, with improvement in fine wrinkles, mottled hyperpigmentation, roughness and sallowness reported.
    Journal of the European Academy of Dermatology and Venereology 11/2012; · 2.69 Impact Factor
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    Lasse R Braathen
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    ABSTRACT: Abstract is missing (Letter).
    Acta Dermato-Venereologica 08/2012; 92(6):652-653.
  • G. E. Clénin, M. M. van Rooijen, L. R. Braathen
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    ABSTRACT: Die medikamenteninduzierte leukozytoklastische Vaskulitis als eine der Hypersensitivitätsvaskulitiden ist klinisch charakterisiert durch den Befall kleiner Gefässe und die im Vordergrund stehenden Hautveränderungen, v.a. die palpablen Purpura. Die oft von Fieber, Malaise und Myalgien begleitete Erkrankung kann in jeder Altersgruppe auftreten und befällt beide Geschlechter gleichermassen. Neben der obgenannten typischen klinischen Manifestation kann sie sich auch in Form makulöser, papulöser, vesikulöser, bullöser, subkutane Knoten bildender und als intermittierende oder chronisch urtikarielle Morphen bildende Hautveränderungen manifestieren. Andere Organsysteme können ebenfalls betroffen sein. Aus der Anamnese ergeben sich mögliche Hinweise auf das ätiologische Agens. Kommt ein Medikament in Frage, können wir mit Hlilfe des positiven Lymphozytentransformationstestes (LTT) unsere Hypothese stützen. Wir berichten über eine 55jährige Patientin mit einer ANA- und anti-Histonantikörpern-positiven leukozytoklastischen Vaskulitis mit wahrscheinlicher Nierenbeteiligung nach dreiwöchiger Einnahme von Ibuprofen. Drei Monate nach Absetzen der Medikation ist die Patientin vollkommen beschwerdefrei, hat ein unauffälliges Urinsediment und normalisierte Immunautoantikörper. Drug-induced leucocytoclastic vasculitis is clinically characterised by inflammation of small vessels and skin alterations, typically palpable purpura. Often the vasculitis is accompanied by fever, myalgia and malaise. All ages and sexes are equally affected. Besides the mentioned clinical features it may also present as macules, papules, vesicules, bullae, subcutaneous nodules or intermittent or chronic urticarial eruptions. Other organ systems may be affected. The patient's history is helpful in identifying the etiologic agent. If a drug is suspected as etiologic agent, a positive lymphocyte transformation test (LTT) supports the hypothesis. A 55 year old femal patient developed an ANA and anti-histone antibody positive leukocytoclastic vasculitis with probable concomittant renal involvement after three weeks treatment with ibuprofen. Three months after discontinuation of the medication, the patient is without complaints and has a normal urine sedimentation and normalized immunoautoantibodies.
    Der Hautarzt 04/2012; 51(9):678-681. · 0.50 Impact Factor
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    ABSTRACT: Field cancerization is a term that describes the presence of genetic abnormalities in a tissue chronically exposed to a carcinogen. These abnormalities are responsible for the presence of multilocular clinical and sub-clinical cancerous lesions that explains the increased risks of multiple cancers in this area. With respect to the skin, this term is used to define the presence of multiple non-melanoma skin cancer, its precursors, actinic keratoses and dysplastic keratinocytes in sun exposed areas. The multiplicity of the lesions and the extent of the area influence the treatment decision. Providing at least equivalent efficacy and tolerability, field directed therapies are therefore often more worthwhile than lesion targeted approaches. Photodynamic therapy (PDT) with its selective sensitization and destruction of diseased tissue is one ideal form of therapy for this indication. In the following paper the use of PDT for the treatment of field cancerized skin is reviewed and recommendations are given for its use.
    Journal of the European Academy of Dermatology and Venereology 01/2012; 26(9):1063-6. · 2.69 Impact Factor
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    ABSTRACT: Photodynamic therapy (PDT) is an attractive therapy for non-melanoma skin cancers including actinic keratoses (AKs) because it allows treatment of large areas; it has a high response rate and results in an excellent cosmesis. However, conventional PDT for AKs is associated with inconveniently long clinic visits and discomfort during therapy. In this article, we critically review daylight-mediated PDT, which is a simpler and more tolerable treatment procedure for PDT. We review the effective light dose, efficacy and safety, the need for prior application of sunscreen, and potential clinical scope of daylight-PDT. Three randomized controlled studies have shown that daylight-mediated PDT is an effective treatment of thin AKs. Daylight-mediated PDT is nearly pain-free and more convenient for both the clinics and patients. Daylight-mediated PDT is especially suited for patients with large field-cancerized areas, which can easily be exposed to daylight. Further investigations are necessary to determine at which time of the year and in which weather conditions daylight-mediated PDT will be possible in different geographical locations.
    Journal of the European Academy of Dermatology and Venereology 12/2011; 26(6):673-9. · 2.69 Impact Factor
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    ABSTRACT: Photodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is an effective treatment for multiple actinic keratoses (AKs). Pain, however, is a major side-effect. To compare pain intensity, efficacy, safety and cosmetic outcome of MAL PDT with two different light sources in an investigator-initiated, randomized, double-blind study. Eighty patients with multiple AKs grade I-II were assigned to two groups: group 1, MAL PDT with visible light and water-filtered infrared A (VIS+wIRA); group 2, MAL PDT with light from light-emitting diodes (LEDs), with a further division into two subgroups: A, no spray cooling; B, spray cooling on demand. MAL was applied 3 h before light treatment. Pain was assessed before, during and after PDT. Efficacy, side-effects, cosmetic outcome and patient satisfaction were documented after 2 weeks and 3, 6 and 12 months. Where necessary, treatment was repeated after 3 months. Seventy-six of the 80 patients receiving MAL PDT completed the study. Patient assessment showed high efficacy, very good cosmetic outcome and high patient satisfaction. The efficacy of treatment was better in the group of patients without spray cooling (P=0·00022 at 3 months, P=0·0068 at 6 months) and showed no significant differences between VIS+wIRA and LED. VIS+wIRA was significantly less painful than LED: the median of maximum pain was lower in the VIS+wIRA group than in the LED group for PDT without spray cooling. Pain duration and severity assessed retrospectively were less with VIS+wIRA than with LED, irrespective of cooling. All treatments showed high efficacy with good cosmetic outcome and high patient satisfaction. Efficacy of treatment was better without spray cooling. VIS+wIRA PDT was less painful than LED PDT for PDT without spray cooling.
    British Journal of Dermatology 09/2010; 163(3):607-15. · 3.76 Impact Factor
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    ABSTRACT: Photodynamic therapy (PDT) using methyl aminolevulinate (MAL) is an effective first-line treatment for actinic keratoses. A reduced incubation period may have practical advantages. This study aims to evaluate the effect of incubation time (1 vs. 3 h), MAL concentration (160 mg/g vs. 80 mg/g) and lesion preparation in the setting of MAL-PDT for treatment of actinic keratosis (AK). Open, randomized, parallel-group multicentre study. Outpatient dermatology clinics. One hundred and twelve patients with 384 previously untreated AK. Most lesions (87%) were located on the face and scalp and were thin (55%) or moderately thick (34%). Lesions were debrided, and MAL cream (160 mg/g or 80 mg/g) was applied before illumination with red light (570-670 nm; light dose, 75 J/cm2). Patients were followed up at 2 and 3 months. Sixty patients (54%) were re-treated and assessed at 6 months. Complete lesion response rates 3 and 12 months after last treatment. For lesions on the face/scalp, lesion complete response rates were 78% for thin AK and 74% for moderately thick AK lesions after 1 h vs. 96% and 87% after 3 h incubation with MAL 160 mg/g. Lesion recurrence rates at 12 months after two treatments were similar [19% (3 of 16) with 1 h vs. 17% (3 of 18) with 3 h 160 mg/kg MAL-PDT] and lower than for 80 mg/g MAL-PDT (44-45%). MAL-PDT using a 1-h incubation may be sufficient for successful treatment of selected AK lesions.
    Journal of the European Academy of Dermatology and Venereology 06/2009; 23(5):550-5. · 2.69 Impact Factor
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    ABSTRACT: Acne inversa (hidradenitis suppurativa) is a chronic inflammatory and cicatricial disorder that affects skin areas rich in apocrine glands and terminal hairs, such as perineum and axillae. The exact pathogenesis of the disease is not well understood and the mechanisms by which bacterial superinfection contributes to the disease progression are not clear. Toll-like receptors (TLRs) expressed by inflammatory cells play a crucial role in the innate immune response to bacteria. We sought to investigate the role of TLR2 in the pathogenesis of acne inversa. We investigated the expression of TLR2 using real-time polymerase chain reaction analysis and immunohistochemical stainings of tissue samples from patients with acne inversa. Furthermore, we phenotypically characterized the infiltrating cells and their expression of TLR2. Compared with normal skin, a highly increased in situ expression of TLR2 in acne inversa skin lesions was found at both the mRNA and the protein level. The most abundant cells in the dermal infiltrate of acne inversa were CD68+ macrophages, CD209+ dendritic cells (DCs) and CD3+ T cells. CD19+ B cells and CD56+ natural killer cells were found only in small numbers. Double staining with fluorescence-labelled antibodies showed that TLR2 was expressed by infiltrating macrophages (CD68+) and DCs (CD209+). Flow cytometric analysis of isolated infiltrating cells further confirmed surface expression of TLR2 by macrophages and DCs. These data indicate that the enhanced expression of TLR2 by infiltrating macrophages and DCs may contribute to the pathogenesis of inflammatory lesions of acne inversa.
    British Journal of Dermatology 05/2008; 158(4):691-7. · 3.76 Impact Factor
  • U Costanzo, M Streit, L R Braathen
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    ABSTRACT: Non-healing leg ulcers represent a treatment problem. Investigate grafting of autologous suction blister roofs as treatment. Twenty-nine chronic, non-healing leg ulcers of various aetiologies in 18 inpatients were treated by autologous epidermal grafting using the roofs of suction blisters. 55% of ulcers completely healed 2 to 6 weeks after grafting. A 50-90% reduction in size was documented in 34% and no change was observed in 11% of ulcers. Twelve weeks after grafting, 89% of ulcers were healed completely. In most ulcers, we observed a stimulation of reepithelialization from the wound edge ('edge effect') and an accelerated formation of healthy granulation tissue. During a follow-up period of 12 months, 90% of the ulcers remained healed. Grafting of autologous suction blister roofs is an effective treatment option for non-healing leg ulcers. The advantages of the method are its lack of pain, low costs and immediate availability.
    Journal of the European Academy of Dermatology and Venereology 02/2008; 22(1):7-10. · 2.69 Impact Factor
  • Der Hautarzt 12/2007; 58(11):923-4. · 0.50 Impact Factor
  • Der Hautarzt 10/2007; 58(11):923-924. · 0.50 Impact Factor
  • D Simon, L R Braathen, H-U Simon
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    ABSTRACT: Atopic dermatitis (AD) is based on a genetic predisposition, but environmental factors may trigger skin inflammation. According to the hygiene hypothesis, decreased exposure to microbial products in early childhood does not allow sufficient maturation of the immune system that is associated with an increased risk of atopic sensitization. The effect of lipopolysaccharide (LPS) on the cytokine production of peripheral blood mononuclear cells (PBMC) of AD patients and nonatopic controls was studied. PBMC were isolated from heparinized blood of 10 patients with AD and 10 nonatopic individuals, suspended in culture medium and stimulated with LPS. Cytokine levels in the supernatants were measured by immunoassays. Results Upon stimulation with LPS, PBMC from AD patients produced significantly higher amounts of tumour necrosis factor-alpha, interferon-gamma and interleukin (IL)-10 compared with control PBMC. LPS stimulation blocked the increased spontaneous production of IL-4 and IL-5 by PBMC from AD patients, but had no effect on IL-13 production. These results demonstrate that the effects of LPS stimulation depend on both the type of cytokine and the origin of PBMC. Endotoxin exposure is suggested to modulate the disease course of AD.
    British Journal of Dermatology 10/2007; 157(3):583-6. · 3.76 Impact Factor
  • D Simon, L R Braathen, H-U Simon
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    ABSTRACT: In a number of diseases with eosinophilia, elevated interleukin (IL)-5 levels are detected in the peripheral blood and/or tissues. IL-5 plays an important role in regulating the production, differentiation, recruitment, activation, and survival of eosinophils. Therefore, neutralizing IL-5 by blocking antibodies seems a promising approach in the treatment of eosinophilic diseases. Clinical trials have demonstrated that anti-IL-5 therapy results in a rapid decrease in peripheral blood eosinophil numbers. Moreover, improvement of symptoms in patients with lymphocytic variants of hypereosinophilic syndromes, in eosinophilic esophagitis and chronic rhinitis with nasal polyposis has been observed. In contrast, in patients with bronchial asthma or atopic eczema, anti-IL-5 therapy showed only moderate or no clinical effects. Future studies will have to identify those eosinophilic diseases in which anti-IL-5 antibodies are effective, perhaps with the help of newly developed biomarkers.
    Der Hautarzt 03/2007; 58(2):122, 124-7. · 0.50 Impact Factor
  • Der Hautarzt 02/2007; 58(1):68-71. · 0.50 Impact Factor
  • D. Simon, L.R. Braathen, H.-U. Simon
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    ABSTRACT: Bei einer Reihe von Erkrankungen, die durch eine Eosinophilie charakterisiert sind, findet man erhhte Spiegel von Interleukin- (IL-)5 im Blut und/oder Gewebe. IL-5 spielt eine wichtige Rolle in der Regulierung von Produktion, Differenzierung, Rekrutierung, Aktivierung und berleben eosinophiler Granulozyten. Daher stellt die Neutralisation von IL-5 durch blockierende Antikrper einen vielversprechenden neuen Ansatz in der Therapie dieser Erkrankungen dar. Erste klinische Studien zeigten, dass es nach Applikation von Anti-IL-5-Antikrpern zu einem raschen Abfall der Eosinophilenzahlen im peripheren Blut kommt. Eine Abnahme der Beschwerden wurde bei der lymphozytren Form hypereosinophiler Syndrome, bei eosinophiler sophagitis und bei chronischer Rhinitis mit nasaler Polyposis beobachtet. Im Gegensatz dazu zeigte eine Anti-IL-5-Antikrper-Behandlung von Patienten mit Asthma bronchiale oder mit atopischem Ekzem nicht den erwarteten klinischen Effekt. Zuknftige Studien werden zeigen, bei welchen eosinophilen Erkrankungen eine Anti-IL-5-Therapie wirksam ist und welche Patientengruppen auf diese Therapie ansprechen.In a number of diseases with eosinophilia, elevated interleukin (IL)-5 levels are detected in the peripheral blood and/or tissues. IL-5 plays an important role in regulating the production, differentiation, recruitment, activation, and survival of eosinophils. Therefore, neutralizing IL-5 by blocking antibodies seems a promising approach in the treatment of eosinophilic diseases. Clinical trials have demonstrated that anti-IL-5 therapy results in a rapid decrease in peripheral blood eosinophil numbers. Moreover, improvement of symptoms in patients with lymphocytic variants of hypereosinophilic syndromes, in eosinophilic esophagitis and chronic rhinitis with nasal polyposis has been observed. In contrast, in patients with bronchial asthma or atopic eczema, anti-IL-5 therapy showed only moderate or no clinical effects. Future studies will have to identify those eosinophilic diseases in which anti-IL-5 antibodies are effective, perhaps with the help of newly developed biomarkers.
    Der Hautarzt 01/2007; 58(2):122-127. · 0.50 Impact Factor
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    ABSTRACT: Eosinophilic esophagitis (EE) is often associated with concomitant atopic diseases. In children with EE in whom food allergens have been identified as causative factors, elemental and elimination diets result in an improvement or resolution of symptoms. Most adult EE patients are sensitized to aeroallergens, which cross-react with plant-derived food allergens, most commonly to grass pollen and cereals. To investigate the clinical relevance of the sensitization to wheat and rye, and the efficacy of an allergen-specific elimination diet in adult EE patients. Six patients (five men, one women) with permanently active EE sensitized to grass pollen and the cereals wheat and rye underwent a double-blind placebo-controlled food challenge and were kept on an elimination diet avoiding wheat and rye for 6 weeks. The challenge tests with wheat and rye did not provoke any EE symptoms in all patients. The elimination diet failed in reducing disease activity. Although one patient noticed an improvement of symptoms, endoscopic and histopathologic findings remained unchanged. In adult EE patients, sensitization to wheat and rye does not seem causative for EE. Elimination diet is not a reliable and efficient therapeutic measure in EE patients sensitized to wheat and rye. Low specific immunoglobulin-E levels to wheat and rye may be a consequence of the underlying grass pollen allergy.
    Allergy 01/2007; 61(12):1480-3. · 5.88 Impact Factor
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    ABSTRACT: Ohne Zusammenfassung
    Der Hautarzt 12/2006; 58(1):68-71. · 0.50 Impact Factor
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    ABSTRACT: Pemphigoid nodularis (PN) is a rare clinical variant of pemphigoid characterized by prurigo-like skin lesions and antibodies against BP180 and BP230 characteristic for bullous pemphigoid. Interestingly, most PN patients never develop blisters. This condition is often resistant to treatment. We describe a female patient who was initially diagnosed with hypereosinophilic dermatitis. Later on, in the presence of eosinophilic infiltrations in the gastrointestinal tract, obstructive ventilation disorder, pericardial and pleural effusions, the diagnosis of idiopathic hypereosinophilic syndrome was made. During the following 3 years she developed recalcitrant PN.
    Der Hautarzt 06/2006; 57(5):434-6. · 0.50 Impact Factor

Publication Stats

2k Citations
347.08 Total Impact Points

Institutions

  • 2012
    • University of Innsbruck
      Innsbruck, Tyrol, Austria
  • 2011
    • Bispebjerg Hospital, Copenhagen University
      • Department of Dermatology
      Copenhagen, Capital Region, Denmark
  • 1994–2010
    • Inselspital, Universitätsspital Bern
      • Department of Dermatology
      Bern, BE, Switzerland
  • 2007
    • RWTH Aachen University
      • Department of Dermatology
      Aachen, North Rhine-Westphalia, Germany
  • 2006–2007
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
  • 1992–2007
    • Universität Bern
      • • Institute of Pharmacology
      • • University Clinic for Rheumatology, Clinical Immunology, and Allergology
      • • Institute for Immunology
      Berna, Bern, Switzerland
  • 2001
    • Harvard Medical School
      Boston, Massachusetts, United States