Joachim Fluhr

• Doctor of Medicine
• Dermatolologist and Allergologist at Charité Universitätsmedizin Berlin

Healthy skin is structured to maintain water balance by maximizing water retention and minimizing evaporative loss. The water-holding and barrier functions of the skin can be impaired by several factors that lead to xerosis cutis (dry skin); however, they can also be restored by basic emollients that act through the physicochemical properties of th...

Contact urticaria (CoU) is an immediate contact reaction occurring within minutes to an hour after exposure to specific proteins or chemicals. CoU is categorized into non-immunologic (NI-CoU) and immunologic (I-CoU) types, with I-CoU potentially leading to anaphylaxis. Both forms of CoU can be associated with protein contact dermatitis and the cont...

Skin acts as a dynamic interface with the environment. Pathological alterations in the skin barrier are associated with skin diseases. These conditions are characterized by specific impairments in epidermal barrier functions. Despite its protective nature, the skin can be a relevant route of drug administration, both for topical and transdermal the...

Introduction The integrity of the stratum corneum (SC) is crucial for the skin's barrier function, protecting against environmental stressors and minimizing transepidermal water loss. Advances in skincare formulations have introduced multilamellar systems designed to emulate the SC's lipid composition and organization. This study hypothesizes that...

Introduction Stratum corneum (SC) is essential for skin barrier function, mitigating water loss and shielding against potentially harmful substances and allergens. The SC's lipid matrix, arranged in a lamellar structure, is integral to its protective role. Our study explores the restoration effects of a multilamellar cream with an acidic pH compare...

Xerosis is highly prevalent in the population aged over 50 years and substantially impacts quality of life due to the associated stigma, related pruritus, and potential sequelae. We propose that the term mature xerosis be used for subjects over 50 who suffer from age‐related xerosis and replace senile xerosis to describe the phenomenon. The etiolog...

Chronic spontaneous urticaria (CSU) is a debilitating, inflammatory skin condition characterized by infiltrating immune cells. Available treatments are limited to improving the signs and symptoms. There is an unmet need to develop therapies that target disease‐driving pathways upstream of mast cell activation to inhibit or delay the progression of...

Heat application is known to activate transient receptor potential (TRP) channels, which play a crucial role in sensory perception, including itch. In this study, the effect of a 5-s, 49°C heat application on itch intensity in atopic dermatitis (AD) patients was evaluated. The study comprised 2 parts: a controlled trial investigating the impact of...

Introduction and aims: Non-invasive measurement of the stratum corneum hydration (SCH) with capacitance-based instrumentation is established in dermatological and cosmetic studies. We wanted to test the reliability of non-invasive self-measurements for SCH performed under real-life conditions by volunteers with a Bluetooth-based (wireless) probe C...

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) exacerbated respiratory disease (N-ERD) is associated with chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and NSAID hypersensitivity. An overproduction of leukotrienes characterizes the pathomechanism of the disease. N-ERD patients often report breathing difficulties after consu...

Background There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities. Methods We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guid...

The effects of air pollution on health are gaining increasing research interest with limited data on skin alterations available. It was suggested that air pollution is a trigger factor for sensitive skin (SS). However, this data was based on surveys with a lack of experimental data. SS is related to altered skin nerve endings and cutaneous neurogen...

The stratum corneum (SC)—the outermost layer of the epidermis—is the principal permeability and protective barrier of the skin. Different components of the SC, including corneocytes, natural moisturizing factor, a variety of enzymes and their inhibitors, antimicrobial peptides and lipids, work interactively to maintain barrier function. The main ba...

During the course of acute ZIKV infection, pruritus is a cardinal symptom widely documented in the literature. Its frequent association with dysesthesia and several dysautonomic manifestations, suggests a pathophysiological mechanism involving the peripheral nervous system. The aim of this study was to develop a functional human model to potentiall...

Background: Chronic spontaneous urticaria (CSU) is held to be autoimmune (aiCSU; type IIb CSU) in at least 8% of patients, i.e., associated with mast cell-activating IgG autoantibodies. Basophil tests, i.e., the basophil activation test (BAT) and the basophil histamine release assay (BHRA) are considered the best single tests for aiCSU diagnosis....

Background Instrumentation technology for transepidermal water loss measurements has not been substantially modified since its introduction by Nilsson in 1977. Recent progress in sensor development allowed a new sensor arrangement using a matrix of 30 sensors. Raw measurement values are processed with spatial statistical analysis. We aimed to compa...

Introduction: Along with climate changes, we see an increase in allergic symptoms and the number of pollen-allergic patients in many countries. Increased allergic symptoms are associated with an elevated ozone exposure which may be linked by impaired epithelial barrier function. This study aimed to quantify the clinical effect of ozone and pollen...

This publication is the second part of the German-language S3 guideline on urticaria. It covers the management of urticaria and should be used together with Part 1 of the guideline on classification and diagnosis. This publication was prepared according to the criteria of the AWMF on the basis of the international English-language S3 guideline with...

Background: Severe asthma (SA) with comorbid chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently associated with type 2 (T2) inflammatory endotype. Consequently, therapeutic targets are T2 biologics. The present retrospective study aimed to analyze and compare the clinical efficacy of mepolizumab, benralizumab, omalizumab, and dupiluma...

Zusammenfassung Die vorliegende Publikation ist der zweite Abschnitt der deutschsprachigen S3‐Leitlinie Urtikaria. Sie umfasst das Management der Urtikaria und sollte gemeinsam mit Teil 1 der Leitlinie zur Klassifikation und Diagnostik genutzt werden. Diese Publikation wurde auf der Basis der internationalen englischsprachigen S3‐Leitlinie unter be...

Die Lebenszeitprävalenz für Urtikaria, die zu den schweren allergischen Erkrankungen zählt, liegt bei nahezu 20%. Sie schränkt nicht nur die Lebensqualität der Betroffenen ein, sondern die generelle Leistungsfähigkeit in Beruf und Alltag. Die vorliegende Publikation ist der erste Abschnitt der Leitlinie Urtikaria. Dieser Teil der Leitlinie umfasst...

The lifetime prevalence of urticaria, a severe allergic disease, is almost 20%. It not only limits the quality of life of those affected, but also their general performance at work and in their daily activities. This publication is the first section of the Urticaria Guideline. It covers the classification and diagnosis of urticaria, taking into acc...

The multiple protective functions of the skin derive from the interactions between epithelial skin and immune cells as well as the commensal microbiota. Developed in the last trimester of intrauterine life, the skin barrier adapts dynamically after birth. Specific differences in the structure and physiology have been disclosed between infant and ad...

The epidermal protective functions are closely associated with skin hydration homeostasis. The understanding of different states of water binding is a rising concept in assessing topically applied formulations and their interaction within the stratum corneum (SC). In addition to global water content, primary bound water, partially bound water, and...

Introduction: Skin microbiome and skin physiology are important indicators of the epidermal homeostasis status. Stress models can reveal pathological conditions and modulating effects. Here we investigated the cutaneous microbiome in relation to skin physiology after mild tape stripping (TS) without treatment compared to two cosmetic leave-on loti...

Systemic allergic reactions to vaccines are very rare. In this study we assessed the management and outcome of suspected SARS-CoV-2 vaccine hypersensitivity. 334 individuals underwent an allergy work up regarding SARS-CoV-2 vaccination (group A: 115 individuals suspected to be at increased risk for vaccine related reactions before vaccination and...

Starting in 2010, an extended criteria catalog was developed for the allergy centers based on the Comprehensive Cancer Centers, including the already known GA²LEN criteria. As part of this initiative, the Charité was the first center to be certified in 2014. Recertification took place in 2018 and 2020. The CACC currently includes the following cent...

The atopic dermatitis (AD) complex pathogenesis mechanism reveals marked changes of certain signaling factors as well as some morphological alterations in the epidermis. Reduced resilience against environmental factors and oxidative stress often makes the treatment with corticosteroids or tacrolismus ointments indispensable. In view of the correlat...

Background: The biological role of Immunoglobulin E (IgE) is important in allergic diseases. The monoclonal anti-IgE antibody omalizumab has been approved for treatment of severe perennial asthma in 2005, for chronic spontaneous urticaria in 2013 and recently for severe uncontrolled chronic rhinosinusitis with nasal polyposis (CRSwNP). This study p...

Chronic rhinosinusitis (CRS) with (CRSwNP) or without nasal polyps (CRSsNP) is a persistent, heterogeneous inflammatory condition affecting the upper respiratory tract. The present study aimed to improve the characterization of CRS endotypes based on the chemokine and cytokine expression pattern in the CRS tissues. Concentrations of chemokines and...

Background and Objectives Patients frequently complain of mild, transient, unpleasant skin sensations that cannot be diagnosed as common neuropathies. Dermatologists have termed these symptoms “sensitive skin syndrome.” This narrative review was performed for a better knowledge by other specialists. Databases and Data Treatment Publications on pai...

Mast cells (MCs) play important roles in normal immune responses and pathological states. The location of MCs on the boundaries between tissues and the external environment, including gut mucosal surfaces, lungs, skin, and around blood vessels, suggests a multitude of immunological functions. Thus, MCs are pivotal for host defense against different...

Introduction La peau sensible est un syndrome se manifestant par la survenue de sensations anormales (picotements, brûlures, douleurs, prurit, fourmillements) en réaction à des stimulus qui ne devraient normalement pas déclencher de telles sensations. Elle n’est pas expliquée par des lésions attribuables à une pathologie cutanée spécifique. Ce synd...

Introduction En raison de la pandémie de COVID-19, le gouvernement français a imposé un confinement strict du 17 mars au 11 mai 2020. Dans les hôpitaux, seules les consultations d’urgence et les téléconsultations (TC) ont été autorisées en ambulatoire. Matériel et méthodes Un questionnaire standardisé a été élaboré pour analyser le niveau de satis...

Introduction Très strict, le premier confinement a eu des conséquences psychologiques sur tous. Après nous être intéressés aux conséquences strictement professionnelles, nous avons voulu savoir quelles les conséquences psychologiques pour les dermatologues. Matériel et méthodes Du 39e au 55e et dernier jour du confinement, nous avons mené une enqu...

Background: The skin microbiome and skin physiology are important indicators of the epidermal homeostasis status. Stress models are used to reveal pathological conditions and modulating effects. The recovery phase served to investigate the cutaneous microbiome in relation to skin physiology after mild tape stripping without treatment compared to tw...

Systemic allergic reactions to vaccines are very rare. In this study we assessed the management and outcome suspected SARS-CoV-2 vaccine hypersensitivity. We present data of 219 individuals, who experienced symptoms suspicious for an allergic reaction after the first (n=214) or the second vaccination (n=5). 195 reactions occurred after the first ap...

Atopic diathesis encompassing atopic dermatitis (AD), allergic rhinoconjunctivitis, food allergy, eosinophilic esophagitis, and asthma is a widely prevalent condition with a broad heterogeneity in clinical course, age of onset, and lifespan persistence. A primary event in AD is the commonly inherited epidermal barrier dysfunction. Together with the...

Until recently, itch pathophysiology was poorly understood and treatments were poorly effective in relieving itch. Current progress in our knowledge of the itch processing, the numerous mediators and receptors involved has led to a large variety of possible therapeutic pathways. Currently, inhibitors of IL‐31, IL‐4/13, NK1 receptors, opioids and ca...

Background Skin, and epidermis, is innervated by sensory nerve fibres. Interactions between them and signal transduction are only partially elucidated in physiological/pathological conditions, especially in pruritus. Objectives To study the mechanisms involved in pruritus in vitro, we developed a skin explant model re-innervated by sensory neurons...

Purpose of Review Atopy is defined as the genetic predisposition to react with type I allergic diseases such as food-, skin-, and respiratory allergies. Distinct molecular mechanisms have been described, including the known Th2 driven immune response. IL-17A (IL-17) is mainly produced by Th17 cells and belongs to the IL-17 family of cytokines, IL-1...

Ciguatera fish poisoning (CFP) and neurotoxic shellfish poisoning syndromes are induced by the consumption of seafood contaminated by ciguatoxins and brevetoxins. Both toxins cause sensory symptoms such as paresthesia, cold dysesthesia and painful disorders. An intense pruritus, which may become chronic, occurs also in CFP. No curative treatment is...

Background: In chronic spontaneous urticaria (CSU), the guidelines recommend very limited diagnostic procedures during the routine workup, although additional investigations might be indicated in some CSU patients. For physicians treating CSU patients, it is often difficult to decide which diagnostic tests are useful. Objective: To provide recom...

Background Sensitive skin is related to environmental factors. Objectives We aimed to investigate the roles of poorly known associated and triggering factors on sensitive skin in a large global population. Methods A survey was administrated to a representative sample of the adult population aged 18–75 years in five different countries (Brazil, Ch...

The French government imposed the first COVID-19 pandemic lockdown from March 17 until May 11, 2020. Only emergency cases and teledermatology (TD) were allowed in outpatient settings. A standardized questionnaire was developed to compare the satisfaction level of patients and their treating physicians. Our main question was whether the patients wou...

Aim: To evaluate the extent to which COVID-19-related lockdown affected dermatologists. Methods: An anonymous online survey was proposed to all French dermatologists and dermatology residents to assess the impact of COVID-19 lockdown on their professional activity, their level of stress and their psychological state, as well as their coping strateg...

Severe allergic reactions to vaccines are very rare. Single severe reactions have occurred worldwide after vaccination with the new mRNA-based COVID-19 vaccines. PEG2000 is discussed as a possible trigger. We provide guidance on risk assessment regarding COVID-19 vaccination in patients with allergic diseases and suggest a standardized, resource-or...

Sensitive skin is commonly assessed on the basis of self-reports from patients, and sometimes questionnaires, such as the Sensitive Scale-10, are used. The severity of sensitive skin follows a continuum, from the absence of sensitive skin to very sensitive skin. The aims of this cross-sectional study were to compare subjects with and without sympto...

The pathophysiology of contact dermatitis includes specific morphological and physiological changes in the skin as a result of the direct toxic effect of exogenous agents and the subsequent inflammatory cascade. These reactions can be quantified by a variety of noninvasive devices. Classical biophysical methods such as the assessment of transepider...

Red tides involving Karenia brevis expose humans to brevetoxins (PbTxs). Oral exposition triggers neurotoxic shellfish poisoning, whereas inhalation induces a respiratory syndrome and sensory disturbances. No curative treatment is available and the pathophysiology is not fully elucidated. Protease-activated receptor 2 (PAR2), cathepsin S (Cat-S) an...

Introduction Pendant le confinement, la vie professionnelle des médecins a été bouleversée. Nous avons voulu savoir ce qu’il en était pour les dermatologues. Matériel et méthodes Du 39e au 55e et dernier jour du confinement, nous avons mené une enquête anonyme en ligne grâce aux listes de courriels de la SFD, de la FFCDV et des FDVF, en utilisant...

Background: Psoriasis is a systemic inflammatory disease characterized by hindered antioxidant defense and increased formation of free radicals. There are limited data on the skin carotenoids in psoriatic skin as well as their modulation during narrow-band UVB (NB-UVB) phototherapy of the disease. Aim: The aim of this prospective study is to rev...

In parallel to the advances of psoriasis treatment, a growing number of patients refer to alternative and complementary therapy methods driven by the patient expectations, the life‐long disease course, and socio‐economic aspects [1]. Balneotherapy has been a popular treatment modality with minimal adverse effects. Mineral water exerts anti‐inflamma...

Sweating, also named perspiration, is the physiologic process of the secretion of water together with the diluted sweat compounds through the openings of the sudoriferous glands. Perspiration is a key element in the metabolism and contributes to the body homeostasis. The transformation of sweat constituents by skin microflora plays an important rol...

Noninvasive measurements of skin physiology or dermometrology is a fascinating discipline looking for the contribution of many researchers coming from diverse scientific horizons. Fundamental researches, applied researches, and translational investigations have explored many facets of biophysical properties of skin. Routine use of bioengineering de...

The sun emits a continuous spectrum, which extends from high-energy X-ray radiation to low-energy heat radiation. Only UVB, UVA, visible, and infrared radiation reach the surface of the earth. The other spectral parts are absorbed by the earth’s atmosphere.

The chronological (intrinsic) and extrinsic aging demonstrate typical macroscopic, histological, and functional characteristics. The relative improvement in different parameters characterizing aging skin can be used in efficacy proof of antiaging and anti-wrinkle cosmetic products. Different approaches to investigate the efficacy of antiaging produ...

The formation of skin hydration is a complex and multifactor process including the natural sources of skin moisturization and the effect of exogenously applied substances on the skin. An objective evidence for the claimed effect of a moisturizer/emollient is required. A variety of noninvasive methods for the evaluation of skin hydration exist; howe...

The cover image is based on Professor Ronald Marks of Cardiff (1935‐2020), founder of the research field bioengineering and the skin and the International Society for Bioengineering and the Skin (ISBS) formed in 1979. https://doi.org/10.1111/srt.12904.

Background: The association of acetylsalicylic acid (ASA) intolerance, chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, or chronic urticaria is known as NSAID-exacerbated respiratory disease (N-ERD). N-ERD patients often suffer from recurrent nasal polyps, severe asthma or also from urticaria. The aim of the present study was to retrospe...

Skin physiology assessment is moving from a descriptive approach to a deeper understanding of biophysical and biochemical processes in the stratum corneum, such as epidermal barrier function and stratum corneum hydration. New, non-invasive approaches offer reliable and reproducible methods for product testing in the pharmaceutical and cosmetic indu...

Biomechanics of the skin is an important subject in skin research. It has been studied for many decades involving various technologies and methods to characterize and quantify mechanical properties of the skin under different in vivo conditions. The present EEMCO paper reviews the current rel-evant information, providing practical orientation to re...

The special interest group on sensitive skin of the International Forum for the Study of Itch previously defined sensitive skin as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus and tingling sensations) in response to stimuli that normally should not provoke such sensations. This additional paper fo...

Hintergrund: Der Klimawandel hat in den letzten Jahren zu Veränderungen im Auftreten wichtiger luftgetragener allergener Pollen und damit zu einer Verstärkung der Symptomatik von Pollenallergikern geführt. Es ist vorstellbar, dass Reizgase wie Ozon durch eine Beeinträchtigung der Schleimhäute zu einer zusätzlichen Symptomverstärkung führen. Dies is...

Background: The early detection of skin cancer is still challenging and calls for objective, fast diagnostic, and ideally non-invasive methods in order to leave the potentially malignant tumor cells unaltered. In this paper, the parelectric spectroscopy was applied to evaluate the potential of a non-invasive detection of basal cell carcinoma (BCC)...

Background and objective Pruritus is a major symptom of many inflammatory diseases and impacts greatly the quality of life in patients. We aimed to specify the characteristics of experimentally induced pruritus in normal skin and in experimentally induced inflammatory dermatitis in healthy volunteers. Methods Skin inflammation was induced by the r...

Background: Atopic diseases constitute a major health challenge for industrialized countries, and elevated levels of interleukin 4 (IL-4) frequently characterize these disorders. Previous in vitroanalyses have indicated that IL-4 strongly upregulates the expression of IL-4-sensitive genes in human monocytes. Objective: To explore whether similar...

Background Analgesic intolerance (AI) is an important diagnostic feature of disease progression in patients with chronic rhinosinusitis (CRS) accompanied by nasal polyps (CRSwNP) and asthma. Objective The aim of the present study was to determine whether increasing the concentration of acetylsalicylic acid (ASA) used in the diagnostic nasal challe...

Sustainable development is an overarching objective that requires an interdisciplinary approach in order to address the societal challenge concerning climate action, environment, resource efficiency and raw materials. In this context, valorization of abundant and available bio-wastes with high potential to manufacture value-added products is the fi...

Diese evidenz- und konsensbasierte Leitlinie wurde entsprechend den Methoden der Cochrane und der Grading of Recommendations Assessment, Development and Evaluation (GRADE)-Arbeitsgruppen entwickelt. Die Leitlinien-Konferenz fand am 1. Dezember 2016 statt. Sie ist eine gemeinsame Initiative der European Academy of Allergology and Clinical Immunology...

Some patients have immediate hypersensitivity responses to olaparib therapy. A gradual increase in oral doses over a 2-day period was successful at desensitization.

In recent years, the importance of the microbiome in maintaining healthy skin has become apparent. Both the classic microbiology cultivation techniques used since the early 1970s and the next-generation sequencing procedures refined in the past decade reveal the importance of skin microbiome in healthy and diseased skin. To strengthen and eventuall...

The act of birth and the growth of an infant in consecutive months are critical for the baby's adaptation from intrauterine life to the relatively dry and gaseous environment. These adaptive changes have not only effects on structural components but also subsequent functional consequences. The formation of acid mantel is important for the integrity...

Purpose of review: To summarize the current knowledge on the morphology, functionality and biochemical composition of the skin in allergic reactions. We address novel noninvasive techniques that promise to disclose intimate mechanisms of skin allergy in vivo. Epidermal barrier is not just a static wrap of the organism but rather a dynamic field fo...

Chronic inducible urticaria (CIndU) is a group of chronic urticarias characterized by the appearance of recurrent wheals, recurrent angioedema or both, as a response to specific triggers. CIndU includes both physical (symptomatic dermographism, cold and heat urticaria, delayed pressure urticaria, solar urticaria, and vibratory urticaria) and nonphy...

Background Psoriasis is a multi-systemic inflammatory disease that results from dysregulation between epidermal keratinocyte homeostasis and both innate and acquired immunity. Epidermal barrier defect has been described in psoriatic lesions. Furthermore an imbalance between pro-oxidative stress and antioxidant defense mechanisms are known in psoria...