J. Hafner

University of Zurich | UZH · Dermatologische Klinik und Poliklinik

Background: Forty percent of patients with chronic venous insufficiency (CVI) do not wear their indicated and prescribed compression stockings. Difficulties in donning and a feeling of constraint are the most common reasons for non-adherence. Objective: The aim was to develop a compression stocking system that is easy to don and dose adjustable. Me...

Background Antiepidermal growth factor receptor (EGFR)-targeted therapy is widely used in many epithelial cancer types. We investigated lapatinib effects on cutaneous squamous cell carcinoma (cSCC) scheduled for resection and in coexisting precursor lesions (actinic keratosis (AK) and Bowen's disease (BD)) in a phase 2 mode of action clinical trial...

Compression therapy is highly effective in the treatment of post-thrombotic syndrome and venous leg ulcer. On average, 50-60% of the patients cooperate with compression therapy. Therefore, it is necessary to improve the (it is not the user-friendliness of the patients but of the donnig devices!) user-friendliness. This prospective study investigate...

Restless legs syndrome (RLS) is characterised by an uncontrollable urge to move, in particular the lower limbs, often accompanied by discomfort or a painful sensation that occurs typically at night. It is categorized under the ICD-Classification of extrapyramidal and movement disorders. As patients often suffer from insomnia due to the involuntary...

Introduction: Complex regional pain syndrome (CRPS) is a relatively rare disorder, but one that is extremely serious for the affected patient. It usually occurs in the area distal to a primary limb injury. The clinical symptoms and the pain are out of all proportion to the inciting event and in approximately 10 % of CRPS patients, there is no trigg...

In acute and chronic wounds, pain represents a common and central medical problem. Wound pain can be caused by multiple factors, such as macro- or microvascular as well as inflammatory processes. The basic concept of pain management is based on the WHO pain ladder. Often this concept of pain therapy remains insufficient. Apart from the conventional...

Martorell hypertensive ischaemic leg ulcer (HYTILU) represents an important differential diagnosis of painful leg ulcerations. Stenotic subcutaneous arteriolosclerosis in patients with long-standing arterial hypertension finally leads to skin infarction. The typical histological changes are very similar in Martorell HYTILU and calciphylaxis. This r...

Martorell hypertensive ischaemic leg ulcer (HYTILU) represents an important differential diagnosis of painful leg ulcerations. Stenotic subcutaneous arteriolosclerosis in patients with long-standing arterial hypertension finally leads to skin infarction. The typical histological changes are very similar in Martorell HYTILU and calciphylaxis. This r...

Background: Basal cell carcinoma (BCC) is the most frequent skin cancer with increasing incidence and generally high cure rates. BCC can be quite aggressive and is difficult to treat. Objectives: To investigate BCCs with a focus on histological subtypes, treatment procedures and correlation to clinical progress to collect further information on...

Link: http://dermatologicahelvetica.com/de/archiven/?articlesID=92

Einleitung: Das komplexe regionale Schmerzsyndrom (CRPS) ist eine relativ seltene, jedoch für die Betroffenen äußerst gravierende Erkrankung, welche meist distal einer Extremitätenverletzung auftritt. Die klinischen Symptome sowie die Schmerzen stehen in keinem Verhältnis zum auslösenden Ereignis. Bei etwa 10% der Patienten liegt gar kein auslösend...

BACKGROUND: Leg ulcers are a symptom of a heterogeneous group of diseases. Their treatment causes substantial costs due to the long healing times and extensive wound care measures. There is a paucity of information about healing times and the necessity of hospital treatment for leg ulcers of different etiologies. MATERIALS AND METHODS: In this retr...

Leg ulcers are a symptom of a heterogeneous group of diseases. Their treatment causes substantial costs due to the long healing times and extensive wound care measures. There is a paucity of information about healing times and the necessity of hospital treatment for leg ulcers of different etiologies. In this retrospective study, healing times and...

OBJECTIVES: Venous pressure measurement using an intravenous catheter is the sole method for the diagnosis of venous hypertension in patients with chronic venous insufficiency. A noninvasive tool to quantify increased venous pressure is essential for studying venous pathophysiology. Aim of the study was to investigate the value of controlled compre...

Die Dermatologische Klinik des UniversitätsSpitals Zürich (DER USZ) nimmt innerhalb der dermatologischen Universitätskliniken Europas einen prominenten Platz ein. In den letzten Jahren rangierte sie an ihren wissenschaftlichen Arbeiten gemessen (Citation Index) konti­nuierlich unter den ersten drei Rängen. Im Zentrum stehen aber die Patienten, die...

To evaluate the efficacy of a plant-derived wound dressing, a mixture of hypericum oil (Hypericum perforatum) and neem oil (Azadirachta indica), in scalp wounds with exposed bone. A retrospective review was conducted of all patients presenting with scalp wounds with exposed bone following the excision of skin tumours and treated with a plant-derive...

Bei der Livedovaskulopathie handelt es sich um eine chronisch- rezidivierende,schmerzhafte Erkrankung der kutanen Mikrozirkulation der distalen unteren Extremität.

Das Ulcus hypertonicum Martorell (1) ist die häufigste Form von ischämischer subkutaner Arteriolosklerose. Zugrunde liegend findet sich bei Patienten mit einer langjährigen, meistens gut eingestellten arteriellen Hypertonie eine stenosierende Arteriolosklerose in der Subkutis, welche im Endstadium zu Hautinfarkten am Unterschenkel führt. Klinisch f...

Fachärzte und Wundexperten an 8 Schweizer Wundambulatorien führten seit der Einführung des pflanzlichen Wundsprays 1 Primary Wound Dressing® (ONE) konsekutive Anwendungsbeobachtungen bei 105 Patienten mit unterschiedlichen akuten und chronischen Wundtypen durch. Evaluiert wurden Behandlungsdauer, kompletter Wundverschluss, Granulationsgewebebildung...

Recent studies suggest that patients on mammalian target of rapamycin (mTOR) inhibitors experience a reduction in cutaneous carcinogenesis by an estimated 50% or more compared with calcineurin inhibitors. While randomized trials are running, organ transplant recipients are frequently switched from calcineurin inhibitors to mTOR inhibitors when cuta...

A clinical model to examine the hypothesis that venous hypertension of the lower leg per se can cause lower leg stasis dermatitis is described. To prove this concept, we retrospectively studied a consecutive series of 38 patients with lower leg dermatitis who underwent phlebological examination at our consultation over a period of four years. Among...

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading strains among multiresistant hospital microflora. In 2003, we noted an increase in the number of MRSA strain 35 among patients at the University of Zurich, Department of Dermatology. At the end of 2003, we implemented additional policies in hospital hygiene, which significantl...

Approximately one quarter of all patients with leg ulcers do not have a "vascular" ulcer, i.e. an ulcer of venous, mixed venous-arterial, or arterial origin. The differential diagnosis encompasses approximately 70 entities, amongst a selection of particular clinical relevance. Martorell hypertensive-ischemic leg ulcer and its two "imitators" pyoder...

Venous disorders have a high prevalence and require approximately 1% of health budgets of industrialized countries. The postthrombotic syndrome (PTS) is defined by subjective symptoms and morphologic trophical skin changes following deep venous thrombosis. Prevention of venous thromboembolism in risk situations, easy availability of diagnostic tool...

A shift in the etiology of chronic leg ulcers from venous to mixed venous-arterial to arterial to neuropathic-ischemic ulcers has taken place. The incidence and prevalence of „pure” venous leg ulcers declines. Only about 40 - 50 % of these ulcers are caused by venous cause alone. Mixed venous-arterial ulcers are on the increase. 20 % of all patient...

Das maligne Melanom, auch «schwarzer Hautkrebs» genannt, gehört zu den bösartigen Tumoren und entsteht durch Entartung der melaninbildenden Zellen (Melanozyten). Es stellt bei Weitem nicht die häufigste Hautkrebsart dar, doch steigt die Inzidenz seit mehr als zwei Jahrzehnten deutlich schneller an als bei anderen Tumoren. Es handelt sich um die bös...

Objective: The retromalleolar region is often the area with most pronounced skin damage caused by chronic venous insufficiency. Due to its concavity compression therapy remains locally ineffective. This study investigates the retromalleolar interface pressure with and without padding. Method: Ten healthy subjects had a compression bandage with 40 m...

Der retromalleoläre Raum ist von der chronischen venösen Insuffizienz oft besonders stark betroffen. Aufgrund seiner konkaven Form wird er von der Kompressionstherapie weitgehend ausgespart. Die vorliegende Arbeit hat zum Ziel, den Andruck von Kompressionsverbänden im retromalleolären Raum mit und ohne Pelotte zu untersuchen. Methode: Bei zehn gesu...

Zusammenfassung Der retromalleoläre Raum ist von der chronischen venösen Insuffizienz oft besonders stark betroffen. Aufgrund seiner konkaven Form wird er von der Kompressionstherapie weitgehend ausgespart. Die vorliegende Arbeit hat zum Ziel, den Andruck von Kompressionsverbänden im retromalleolären Raum mit und ohne Pelotte zu untersuchen. ,Metho...

Background: The prevalence of the factor V Leiden mutation in patients with venous ulcers is 23-26%. The present study investigates the prevalence of thrombophilia-associated factors of coagulation in patients with venous ulcers with and without postthrombotic syndrome. Patients and methods: Case-control study in 73 consecutive patients with venous...

Severe acne lead to inesthetic scars on the face of young adults. A new classification based on the morphology of acne scars allows to establish the more appropriate therapeutic strategy. The surgical technics are: punch-excision, punch-elevation, subcission, dermal graft or adipose tissue autotransplantation. Skin resurfacing by dermabrasion, CO2...

Hintergrund: Bei Patienten mit venösen Ulzera liegt diePrävalenz der Faktor-V-Leiden-Mutation bei 23 bis 26%.Wir untersuchten die wichtigsten Thrombophilie-assoziiertenGerinnungsparameter bei Patienten mit venösem Ulkusmit oder ohne postthrombotischem Syndrom. Patienten,Methodik: Fall-Kontroll-Studie mit 73 konsekutiven Patientenmit venösen Ulzera...

Zusammenfassung Hintergrund: Bei Patienten mit venösen Ulzera liegt die Prävalenz der Faktor-V-Leiden-Mutation bei 23 bis 26%. Wir untersuchten die wichtigsten Thrombophilie-assoziierten Gerinnungsparameter bei Patienten mit venösem Ulkus mit oder ohne postthrombotischem Syndrom. Patienten, Methodik: Fall-Kontroll-Studie mit 73 konsekutiven Patient...

Mesenchymal tumors are a heterogeneous group of tumors often arising in the skin and soft tissue. The tumors have been reclassified by the WHO in 2002. Benign mesenchymal tumors are about a hundred times more frequent than malignant mesenchymal tumors. Clinically, mesenchymal tumors often present as skin-colored nodes. Overall, elderly persons are...

Transplant recipients have an increased propensity to develop multiple actinic keratoses, which demonstrate an increased transformation rate into invasive squamous cell carcinoma. To evaluate the efficacy and tolerability of topical photodynamic therapy with the new highly tumour-selective photosensitizer methyl aminolaevulinate vs. placebo in the...

Baseline staging in patients with primary cutaneous malignant melanoma (MM) is routine, but the diagnostic accuracy and the impact on clinical outcome are still unclear. To evaluate the sensitivity and specificity of baseline staging in the early detection of regional lymph node metastases or distant metastases in patients with MM. One hundred cons...

Objective: We assessed the aetiology of leg ulcers in patients with connective tissue diseases and analysed the outcome after an appropriate causative treatment. Methods: Retrospective clinical study on 20 consecutive leg ulcer patients with rheumatoid arthritis (n = 12), progressive systemic sclerosis (n = 7), systemic lupus erythematodes (n = 1)....

Zusammenfassung Ziel: Wir beurteilten die Ätiologie von Ulcera crurum bei Patienten mit Kollagenosen und evaluierten den Heilungsverlauf nach gezielter, kausaler Behandlung. Methoden: Retrospektive klinische Studie mit 20 konsekutiven Patienten: rheumatoide Arthritis (n = 12), progressive systemische Sklerose (n = 7), systemischer Lupus erythematod...

Zusammenfassung Ziel: Wir beurteilten die Ätiologie von Ulcera crurum bei Patienten mit Kollagenosen und evaluierten den Heilungsverlauf nach gezielter, kausaler Behandlung. Methoden: Retrospektive klinische Studie mit 20 konsekutiven Patienten: rheumatoide Arthritis (n = 12), progressive systemische Sklerose (n = 7), systemischer Lupus erythematod...

Imiquimod is a topical immune response modifier that binds to Toll-like receptor-7 and -8, inducing interferon-alpha. We treated superficial basal cell carcinomas (BCC) with imiquimod 5% cream daily for 5-8 days. The BCC lesions were biopsied before treatment and following imiquimod treatment, when the lesion showed the signs of erosion. We applied...

A 34-year-old male patient was referred with a recalcitrant leg ulcer overlying an extensive vascular malformation, which had led several times to septic soft tissue infections. During his infancy he had been diagnosed to have Klippel-Trenaunay syndrome. Clinical examination revealed asymmetric hypertrophy of the lower extremities, an extensive por...

An 82-year-old female patient presented with a large perianal hyperkeratotic tumor extending into the anal canal. Staging did not reveal any metastatic spread. Diagnosis of verrucous carcinoma or Buschke-Löwenstein tumor, respectively, was based on typical clinical and histologic features. Moreover, human papillomavirus 6b DNA sequences could be de...

With the provision of life long immunosuppression after organ transplantation the survival time of the patients can exceed more than 20 years. However, an increased incidence of skin cancer parallels the extended survival rates. Within the first 5 years 40% of the transplant recipients develop premalignant and malignant skin lesions such as actinic...

A case of a 17-year old boy with extensive ulcers on both lower legs is presented. Clinical examination showed an unusually tall stature, obesity and eunuchoid habitus. Chromosomal analysis revealed a karyotype of 48,XXYY, a rare variant of Klinefelter's syndrome (47,XXY). After treatment with moist gauze and many recurrences, rapid ulcer healing c...

Several pathogenetic factors such as peripheral neuropathy, vasculopathy and infection are responsible for the development of diabetic foot ulcerations. An important factor contributing to the high infection risk in diabetic patients is a defect in neutrophil granulocytes. Deficiencies in neutrophil chemotaxis, phagocytosis and respiratory burst ac...

To determine the prevalence of the factor V Leiden mutation in patients with postthrombotic and non-postthrombotic venous ulcers. Case-control study. Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland. Seventy-three consecutive outpatients and inpatients with venous ulcers and 45 age- and sex-matched control subjects (mat...

Der diabetische Fuß entsteht durch das Zusammenwirken mehrerer pathogenetischer Faktoren: Periphere Neuropathie, Vaskulopathie und erhöhte Infektanfälligkeit. Ein entscheidender Faktor des erhöhten Infektrisikos beim zuckerkranken Patienten stellt ein Funktionsdefekt der neutrophilen Granulozyten dar. Dabei ist die neutrophile Chemotaxis sowie die...

This article deals with the conservative management of light and severe forms of varicosities as well as chronic venous insufficiency along with subjective symptoms and trophic skin changes. Approximately 40% of the population shows minor forms and another 10% shows major forms of varicosities. The prevalence of advanced stages of chronic venous in...

Immunosuppression profoundly influences the prevalence of skin disorders in transplant recipients. Skin tumors occur with high incidence and constitute a major part of transplantation-related morbidity and mortality. We report on 2 immunosuppressed patients presenting with rapidly growing epithelial and mesenchymal neoplasms after renal transplanta...

Selbst in einer Zeit streng limitierter Krankenkassenbudgets, zunehmendem arbeitsplatz-bedingtem Druck und sozialen Anforderungen, stellt die stationäre Behandlung dermatologischer Patienten eine essentielle Ergänzung des ambulanten Klinikbetriebes dar. Nicht zuletzt durch sie umfasst die europäische Dermatologie noch das breite Spektrum aller kuta...

Compression therapy of the leg is the cornerstone in the conservative treatment of venous ulcers. The application of compression bandages, however, is largely a matter of personal experience. To evaluate the interface pressure under compression bandages and to improve the technique. Six courses on wound healing with 24-28 participants as well as in...

Leg ulcers are a relatively frequent problem in patients with myeloproliferative disorders under treatment with hydroxyurea (HU). The pathogenesis is currently unknown and may be multifactorial. Concomitant arterial or venous disease may play a contributing role in the development of these wounds. Vasculitis, cryoglobulinemia and pyoderma gangrenos...

Acne is a multifactorial disease affecting the pilosebaceous follicles. It is a treatable condition for which the aims of therapy are to reduce social isolation and to prevent or minimise scarring. Propionibacterium acnes is an anaerobic bacterium strongly implicated in the pathogenesis of acne. A gradual increase in the resistance of P. acnes to m...

Diabetic neuropathy, osteoarthropathy, macro- and microangiopathy and susceptibility to infection are the major factors that contribute to the diabetic foot syndrome. Therefore, these patients benefit from a multidisciplinary treatment by the general practitioner, diabetologist, orthopaedic surgeon and shoemaker, angiologist and vascular surgeon. T...

We report on 7 patients with chronic alcohol abuse and ichthyosiform erythroderma. Dry skin (i.e. xerosis cutis) was a striking common feature in all patients who did not present any signs of fluid depletion. Two patients had exclusively exsiccational dermatitis; three had atopic disposition and one nummular eczema of the legs. In another patient a...

Introduction - management of leg ulcers. Part I Wound healing: molecular biology of chronic wounds cytokines in progressing stages of chronic venous insufficiency bacteriology of leg ulcers synthetic dressings therapy with growth factors cultured keratinocyte grafts. Part II Venous leg ulcers: epidemiology of leg ulcers postthrombbtic syndrome clas...

Summary

Most leg ulcers are of venous or arterial origin (85%). Advanced chronic venous insufficiency is the most common underlying condition (65%), followed by advanced peripheral arterial occlusive disease (10%), and combined chronic venous insufficiency and peripheral arterial occlusive disease (10%). Chronic ulcers in diabetic feet (5%) are of great so...

Actinic keratosis on sun-damaged skin are very common in individuals with fair complexion. Management encompasses cryosurgery, tretinoin or 5-fluorouracil-cream. Bowen's disease, however, requires surgical excision or radiotherapy. Basal cell carcinoma and squamous cell carcinoma are the two most common malignant skin tumours in Western Europe. Typ...

Calciphylaxis is a rare condition of rapidly extending ischemic skin necrosis or acral gangrene of fingers, toes or penis in patients with chronic renal failure. It may be accompanied by extensive metastatic calcification of soft tissues. Histology of infarcted tissues shows prominent medial calcification and intimal hyperplasia of subcutaneous art...

The purpose of this study was to develop and test an efficient culturing and grafting system for the treatment of leg ulcers. The culturing system consisted of a Petriperm culture vessel (20 cm2) aseptically placed in a larger standard Petri dish (60 cm2). Skin cultures were established and cultivated in the Petriperm dish. The cells grew on the bo...

Here we present two characteristic cases of cutaneous polyarteritis nodosa (cutaneous PAN). Cutaneous PAN is characterized by a chronic relapsing benign course over many years. In its mild form it presents with live-do and multiple painful nodular skin lesions mainly of the legs. In its more severe form painful skin ulcerations occur that are often...

We report the successful surgical treatment of a large and painful leg ulcer associated with systemic sclerosis (scleroderma). In addition, there was a long occlusion of the superficial femoral artery, and ankle systolic blood pressure was 80 mmHg (ankle-brachial-index 0.65). All conservative treatments including systemic antibiotics, nifedipine, i...

We report on two patients with granulomatous rosacea and another patient with granulomatous perioral dermatitis who responded well to dapsone. Dapsone has a pharmacological double function as both an antibiotic and an antiphlogistic drug. Before the introduction of isotretinoin, dapsone had its place in the treatment of severe acne. To date, its us...

A case of tufted hair folliculutis presenting as circumscribed, tender and inflamed areas in the occiput with residual tufted follicles in a 28-year old man is reported. Tufted hair folliculitis is a characteristic localized scarring bacterial folliculitis of the scalp due to Staphylococcus aureus. Histopathological studies reveal perifollicular in...