C Ulrich

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (81)189.64 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Photodynamic Therapy (PDT) is one of the standard treatment modalities for actinic keratoses (AKs). Daylight PDT (DL-PDT) with MAL cream is a rather recent development, which, instead of an artificial light source, uses daylight for the activation of the photosensitizer. The present review summarizes available data based on a selective literature search, highlights practical aspects, and reflects the authors’ expert knowledge in using DL-PDT. With respect to efficacy, study data shows that DL-PDT is noninferior to conventional PDT (cPDT). However, given that DL-PDT is markedly less painful, it is significantly better tolerated than cPDT. In Europe, DL-PDT can be performed from March to October, on sunny as well as on cloudy days. UV protection of untreated areas of the body should be observed. Outside temperature should not fall below 10°C. On hot days, patients should be advised to stay in the shade if necessary. Representing a useful addition to current therapeutic options, DL-PDT with MAL cream is, among others, suitable for patients with field cancerization and/or those who have experienced severe pain associated with cPDT.
    No preview · Article · Dec 2015 · Journal der Deutschen Dermatologischen Gesellschaft
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    ABSTRACT: Die photodynamische Therapie (PDT) gehört zu den Standardverfahren in der Therapie aktinischer Keratosen (AK). Bei der Tageslicht-PDT (Daylight PDT, DL-PDT) mit MAL-Creme handelt es sich um eine neuere Entwicklung, bei der anstelle eines Belichtungssystems das Tageslicht zur Aktivierung des Photosensibilisators genutzt wird. Der vorliegende Review fasst die aktuelle Studienlage basierend auf einer selektiven Literaturrecherche zusammen, fokussiert auf praktische Aspekte in der Durchführung und reflektiert insbesondere auch die Expertenerfahrung der Autoren mit der DL-PDT. Studiendaten zeigen, dass die DL-PDT der konventionellen PDT in ihrer Wirksamkeit nicht unterlegen ist. Sie ist jedoch signifikant besser verträglich, da sie zu deutlich weniger Schmerzen während der Therapie führt. Sie kann in Mitteleuropa von März bis Oktober sowohl an bewölkten als auch an sonnigen Tagen durchgeführt werden. Hierbei ist auf UV-Schutz auch der nicht behandelten Körperareale zu achten. Die Außentemperatur sollte 10°C nicht unterschreiten. An heißen Tagen sollte ein Aufenthalt im Schatten, soweit erforderlich, eingeplant werden. Die DL-PDT mit MAL ist u. a. für Patienten mit Feldkanzerisierung und/oder negativer Schmerzerfahrung bei der cPDT geeignet und stellt eine sinnvolle Ergänzung der aktuellen Therapiemöglichkeiten dar.
    No preview · Article · Dec 2015 · Journal der Deutschen Dermatologischen Gesellschaft
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    ABSTRACT: Background Unmet needs exist in actinic keratosis (AK) treatment. Daylight photodynamic therapy (DL-PDT) has shown good efficacy and safety results compared to conventional PDT (c-PDT) in a recent Phase III multi-centre randomised controlled trial in Australia among 100 subjects with AKs.Objectives Demonstrate non-inferior efficacy and superior safety of DL-PDT compared to c-PDT in treating multiple mild and/or moderate facial/scalp AKs.Methods Phase III, 12 week, multi-centre, randomised, investigator-blinded, controlled, intra-individual study conducted at different latitudes in Europe. AKs of adult subjects were treated once with methyl aminolevulinate (MAL) DL-PDT on one side of the face and MAL c-PDT contralaterally. Endpoints for DL-PDT concerned efficacy (non-inferiority regarding complete lesion response at week 12) and safety (superiority regarding subject's assessment of pain after treatment, on an 11-point numeric rating scale). Safety evaluation also included incidence of adverse events. Subject satisfaction was described using a questionnaire at baseline and last visit.ResultsAt week 12, the total lesion complete response rate with DL-PDT was similar (non-inferior) to c-PDT (70% vs. 74%, respectively; 95% CI [−9.5; 2.4] in PP analysis, confirmed in ITT analysis). In addition, efficacy of DL-PDT was demonstrated regardless of weather conditions (sunny or cloudy). DL-PDT was nearly painless compared to c-PDT (0.7 vs. 4.4, respectively; P < 0.001), better tolerated and resulted in higher subject satisfaction.ConclusionDL-PDT in comparison with c-PDT was as effective, better tolerated and nearly painless with high patient satisfaction, and may be considered a treatment of choice to meet needs of patients with mild or moderate facial/scalp AKs.
    No preview · Article · Oct 2015 · Journal of the European Academy of Dermatology and Venereology
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    ABSTRACT: Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, squamous cell carcinoma in-situ, superficial and certain thin basal cell carcinomas. Recurrence rates are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as a lesional or as a field therapy and has the potential to delay/reduce the development of new lesions. PDT has also been studied for its place in the treatment of, as well as its potential to prevent, superficial skin cancers in immune-suppressed patients, although sustained clearance rates are lower than for immunocompetent individuals. Many additional indications have been evaluated, including photo-rejuvenation and inflammatory and infective dermatoses. This S2 guideline considers all current and emerging indications for the use of topical photodynamic therapy in Dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence. An unabridged version of this guideline is available online at: http://www.euroderm.org/edf/index.php/edf-guidelines.
    Full-text · Article · Jun 2015
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    ABSTRACT: In the age of multiresistant microbes and the increasing lack of efficient antibiotics, conventional antiseptics play a critical role in the prevention and therapy of wound infections. Recent studies have demonstrated the antiseptic effects of cold atmospheric pressure plasma (APP). In this pilot, study we investigate the overall suitability of one of the first APP sources for wound treatment focusing on its potential antimicrobial effects. The wound closure rate and the bacterial colonisation of the wounds were investigated. Patients suffering from chronic leg ulcers were treated in a clinical controlled monocentric trial with either APP or octenidine (OCT). In patients who presented with more than one ulceration in different locations, one was treated with APP and the other one with OCT. Each group was treated three times a week over a period of two weeks. The antimicrobial efficacy was evaluated immediately after and following two weeks of treatment. Wounds treated with OCT showed a significantly higher microbial reduction (64%) compared to wounds treated with APP (47%) immediately after the treatment. Over two weeks of antiseptic treatment the bacterial density was reduced within the OCT group (-35%) compared to a slight increase in bacterial density in the APP-treated group (+12%). Clinically, there were no signs of delayed wound healing observed in either group and both treatments were well tolerated. The immediate antimicrobial effects of the APP prototype source were almost comparable to OCT without any signs of cytotoxicity. This pilot study is limited by current configurations of the plasma source, where the narrow plasma beam made it difficult to cover larger wound surface areas and in order to avoid untreated areas of the wound bed, smaller wounds were assigned to the APP-treatment group. This limits the significance of AAP-related effects on the wound healing dynamics, as smaller wounds tend to heal faster than larger wounds. However, clinical wound healing studies on a larger scale now seem justifiable. A more advanced plasma source prototype allowing the treatment of larger wounds will address APP's influence on healing dynamics, synergetic treatment with current antiseptics and effects on multiresistant bacteria.
    No preview · Article · May 2015 · Journal of Wound Care
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    ABSTRACT: Background Cutaneous squamous cell carcinoma (cSCC) is a common cancer capable of metastasis. Sentinel lymph node biopsy (SLNB) may be a valuable adjunct for patients with cSCC at high risk for metastases. However, data on risk factors of metastasis and results of SLNB from patients with cSCC are limited.Objective The aim of this study is to evaluate risk factors for metastasis in patients with cSCC in a large cohort study with long-term follow-up and to determine the value of SLNB.Patients and methodsWe retrospectively analysed all records of patients who underwent excision of cSCC between 01/2005 to 08/2009 at a tertiary referral centre. 143 patients were included in the total cohort, including 17 patients with SLNB and a follow-up time of ≥ 24 monthsResultsTumour thickness greater than 4mm and recurrent cSCC were strongly associated with metastatic disease. All metastasis in this cohort occurred within 24 months of follow-up. SLNB showed a low sensitivity with regard to the development of metastasis. Six of 17 patients developed metastatic disease despite a negative SLN.Conclusions Patients with risk factors, i.e. cSCC with a tumour thickness of more than 4 mm or recurrent disease may develop metastases within the first 2 years despite a negative SLNB. Therefore these patients should be closely monitored during the follow-up. Based on our data SLNB does not provide a diagnostic value for patients with cSCC.This article is protected by copyright. All rights reserved.
    No preview · Article · Nov 2014 · British Journal of Dermatology
  • C Ulrich · U Hillen · R Gutzmer

    No preview · Article · Jul 2014 · Der Hautarzt
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    ABSTRACT: The incidence of non-melanoma skin cancer (NMSC) is increasing. Squamous cell carcinoma of the skin (SCC) is a tumor of the elderly. Due to the increasing life expectancy, SCC will become more and more frequent in the future. Generally SCC has a favorable prognosis. Standard therapy is microscopically- controlled excision. Therapy of advanced and metastatic SCC is still challenging. Patients with regional lymph node metastasis have ten-year survival rates less than 20 %; patients with distant metastases less than 10 %. Immunosuppression has been shown to be one of the key prognostic factors for metastasis. The article reviews SCC and focusses on patients being at risk for an unfavorable course.
    No preview · Article · Jun 2014 · Der Hautarzt
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    ABSTRACT: Background: European guidelines for the management of basal cell carcinoma (BCC) prepared by the former BCC subcommittee of the Guidelines Committee of the European Dermatology Forum (EDF) were published in 2006. Objectives: To present updated guidelines that include consensual expert definitions on various BCC types, prognosis and risk factors for BCC as well as review recommendations for diagnosis and treatment reflecting current published evidence. Methods: These guidelines (S1 type) were prepared by the new BCC subgroup of the European Dermatology Forum (EDF)'s Guidelines Committee through extensive literature review (up to 2012) and expert experience; they were extensively discussed within the EDF subcommittee and approved by peer reviewers of the EDF. Results BCC is a common tumour with an incidence rising worldwide. Three major clinical types of BCC are recognized: nodular, superficial and morpheaform. Four histological subtypes are defined: superficial, nodular, infiltrative and morpheaform. On the basis of the risk of relapse, three prognosis groups have been identified: high, intermediate and low risk. According to these classifications and evidence-based evaluation of the therapeutic strategies available, a decision tree is proposed for the management of BCCs. Conclusions: The guidelines offer a useful tool that will help dermatologists to select the most appropriate treatment for individual patients.
    Full-text · Article · Apr 2014
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    ABSTRACT: The immunosuppressants used in transplantation medicine significantly elevate the incidence of neoplasia, particularly in the skin. The cumulative incidence of non-melanocytic skin cancer (NMSC) in renal transplant recipients was 20.5% in a study carried out in German centers. Data on more than 35 000 renal transplant recipients in the USA document a cumulative NMSC incidence of over 7% after 3 years of immunosuppression. The authors selectively review publications obtained by a PubMed search to discuss the incidence of, and major risk factors for, skin tumors and infectious diseases of the skin in immunosuppressed patients. The main risk factors for skin tumors are age at the time of transplantation, light skin color, previous and present exposure to sunlight, and the type and duration of immunosuppressive treatment. Squamous-cell carcinoma (SCC) is the most common kind of skin tumor in immunosuppressed patients. Human herpesvirus 8 and Merkel-cell polyoma virus also cause neoplasia more often in immunosuppressed patients than in the general population. Surgical excision is the treatment of choice. Actinic keratosis markedly elevates the risk that SCC will arise in the same skin area (odds ratio 18.36, 95% confidence interval 3.03-111). Patients with multiple actinic keratoses can be treated with photodynamic therapy or with acitretin. To lower the skin cancer risk, organ transplant recipients should apply medical screening agents with a sun protection factor of at least 50 to exposed skin areas every day. 55% to 97% of organ transplant recipients have skin infections; these are treated according to their respective types. Squamous-cell carcinoma of the skin adds to the morbidity and mortality of transplant recipients and is therefore among the major oncological challenges in this patient group. Structured concepts for interdisciplinary care enable risk-adapted treatment.
    No preview · Article · Mar 2014 · Deutsches Ärzteblatt International
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    ABSTRACT: The effect of tissue-tolerable plasma (TTP) on inflammatory diseases such as psoriasis was investigated. Three plaques of six psoriatic patients were subjected to different treatments (A: TTP, brine baths (BB)+5% salicylic acid ointment (SAO); B: BB+SAO; C: BB, UV irradiation, SAO+dithranol). While redness and infiltration was reduced in groups A and C, scaling was reduced in group C. TTP temporarily reduced the bacterial colonization on the skin lesions. In summary, the treatment of psoriatic plaques with TTP showed no significant advantage over conventional therapies.
    No preview · Article · Nov 2013 · Clinical Plasma Medicine
  • Uwe Hillen · Claas Ulrich · Ralf Gutzmer · Jürgen C Becker

    No preview · Article · Jun 2013 · Journal der Deutschen Dermatologischen Gesellschaft
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    ABSTRACT: The results of the risk assessment of the tissue-tolerable plasma (TTP) jet kINPen med® and first results of pilot clinical studies are presented. Producing an atmospheric pressure plasma, this plasma jet entails no risk for humans in terms of temperature increase, UV radiation or free radical formation by the plasma. The antiseptic efficacy in vitro on porcine skin and in vivo on human skin was compared to that of octenidine. TTP could significantly reduce the bacterial load in comparison to untreated skin. However, the slightly reduced antiseptic properties of TTP are attributed to the current parameter set-up and technical limitations.
    Full-text · Article · Jun 2013 · Clinical Plasma Medicine
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    ABSTRACT: Eine der größten Herausforderung der Transplantationsmedizin war und ist die Kontrolle von Abstoßungsreaktionen. Die medikamentöse Inhibition der zellulären Immunüberwachung führt jedoch besonders an der Haut zu einer signifikanten Zunahme von Neoplasien. Invasive Plattenepithelkarzinome sind die am häufigsten diagnostizierten Malignome bei Organtransplantierten und können durch ihr multifokales Auftreten sowie das aggressive Wachstum eine Bedrohung für immunsupprimierte Patienten darstellen. Interdisziplinäre Nachsorgeprogramme basieren auf den epidemiologischen Analysen individueller dermatologischer Risikofaktoren für die Hauttumorgenese wie Alter, Hauttyp, Sonnenexposition sowie Art und Dauer der Immunsuppression. Neben Aufklärungsprogrammen und einer kausal orientierten Primärprophylaxe (Sonnenschutz) sowie der Verwendung einer risikoadaptierten Immunsuppression hat sich das proaktive Management präinvasiver Hauttumoren durch moderne Flächentherapien bewährt. Die am Beispiel der Organtransplantierten etablierten interdisziplinären Konzepte und Versorgungsstrukturen stehen hierbei exemplarisch für die ideale Nachsorge auch anderer immunsupprimierter Risikogruppen.
    No preview · Article · Jan 2013 · Der Nephrologe

  • No preview · Article · Oct 2012 · Journal der Deutschen Dermatologischen Gesellschaft
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    C Surber · C Ulrich · B Hinrichs · E Stockfleth
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    ABSTRACT: Ultraviolet radiation (UVR) exposure from the sun and artificial UV sources has been widely acknowledged as the major culprit for skin cancer and premature skin ageing. Skin cancers are among the most dangerous (cutaneous malignant melanoma) and the most numerous (basal cell carcinoma, actinic keratosis and invasive squamous cell carcinoma) of all neoplasms in the caucasian population worldwide. Skin cancers therefore have a significant impact on public health and healthcare costs, and will continue to do so. It is obvious that adequate photoprotection - seeking shade, wearing protective clothing and using sunscreens - is the key to reducing the harmful effects of UVR in both immunocompetent and immunocompromised people. This article provides background information on UVR, photoprotection (including the concept of topical sunscreen formulations), associated concerns regarding efficacy and safety, and behavioural and educational aspects of photoprotection and skin cancer prevention in immunocompetent and immunocompromised people. Certain persistent misconceptions and mistakes regarding photoprotection are also addressed.
    Full-text · Article · Aug 2012 · British Journal of Dermatology
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    ABSTRACT: Background  The incidence of actinic keratoses (AK) and non-melanoma skin cancer (NMSC) in organ transplant recipients (OTRs) is significantly higher than in immunocompetent patients. Rates of progression and recurrence following treatment are higher too, in part due to the effects of the immunosuppressant drugs. Conventional therapies for AK, using curettage, cryotherapy, surgical excision, topical therapies and photodynamic therapy (PDT), are often less effective, and may be inappropriate, for treating the greater numbers and extent of lesions in OTRs. Moreover, there are no specific protocols for treating this patient population that take into account the need for more frequent treatment and the increased pain associated with treating larger areas. Objectives  Recently, a pan-European group of dermatologists with expertise in this area met to share current best practice in PDT for the treatment of AK in OTRs. Methods  The group identified areas where PDT currently is not meeting the needs of these patients and discussed how these gaps might be addressed. Results/Conclusions  This position article summarizes those discussions and makes recommendations concerning a standardized protocol for treating OTRs, for a large randomized controlled trial to provide robust data on safety, efficacy and optimal pain control, and to provide pharmaco-economics data that can be used to support extended reimbursement in this patient group. The authors also recommend a second clinical trial to further investigate induced immunosuppression with PDT in healthy volunteers.
    No preview · Article · Dec 2011 · Journal of the European Academy of Dermatology and Venereology
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    Full-text · Article · Mar 2011 · Journal der Deutschen Dermatologischen Gesellschaft
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    ABSTRACT: Inhibitors of the epidermal growth factor receptor (EGFR) are increasingly used in the treatment of various entities of malignant tumors. Patients treated with EGFR inhibitors very likely develop cutaneous side effects. The development of a papulopustular, follicular exanthema during the first weeks of therapy correlates with therapeutic benefit. However, this exanthema and other cutaneous side effects can impair the quality of life of the patient and might limit the therapy with the EGFR inhibitor. For an optimal therapeutic benefit and quality of life an adequate management of cutaneous side effects is necessary. A panel of German dermatologists developed on the basis of personal experience and current literature consensus recommendations for the management of cutaneous side effects of EGFR inhibitors.
    Full-text · Article · Nov 2010 · Journal der Deutschen Dermatologischen Gesellschaft
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    ABSTRACT: Increasing incidence rates of cutaneous malignancies, paralleling rising survival times of grafts and patients in organ transplant recipients, represents an escalating challenge for dermatologists worldwide. Especially, invasive squamous cell carcinomas (SCC) in immuno-compromised patients are characterized by significantly increased morbidity and mortality and characteristically outnumber basal cell carcinoma in this population. Effective management of actinic keratoses (AK) could help to prevent the further development of invasive SCC. Diclofenac in hyaluronic acid has previously shown to be an effective and well tolerated option for the treatment of AK in immuno-competent patients. However, its safety and efficacy in organ-transplant patients has not been evaluated in a controlled study so far. 32 organ transplant patients (kidney (+/- pancreas), liver, heart) screened at our specialized transplant dermatology outpatient clinic were found eligible and were randomized to either active treatment (24) or vehicle (8). Patients who had stable status of the transplanted graft in the 12 months prior to entering the study and >/= 3 AK lesions in a contiguous 50 cm2 area on the face, forehead, hands or balding scalp were eligible for inclusion in the study. Treatment of AK with 3% diclofenac in 2.5% hyaluronic acid or placebo twice daily was conducted over a total of 16 weeks, followed by a final evaluation 4 weeks after last application of the study drug. Biopsies were taken from the treated areas at the final visit to verify clinical clearance. Patients were assessed for safety variables that included adverse events, local skin reactions, laboratory results, dosage of immunosuppressive medication and indication of graft rejection. A 24 months follow up was conducted after the end of treatment. 87% (n = 28/32) of the patients completed the 16 week treatment phase and presented for final evaluation 4 weeks after end of treatment. In the diclofenac 3% gel treatment group, a complete clearance of AK lesions was achieved in 41% (9/22) compared to 0% (0/6) in the vehicle group. Side effects in most of the patients included a mild erythema and a mild to moderate swelling of the areas treated. No graft rejections or trends for a deterioration of graft function were detected. No meaningful trends were observed in laboratory results. In 55% of the previously cleared patients, new AK developed in the study area after an average of 9.3 months. None of these patients developed invasive SCC in the study area within 24 months of follow-up. This study demonstrated a greater lesion clearance rate of AKs in OTRs treated with diclofenac 3% gel than with vehicle. Despite recurrent AK in 55% of the previously cleared patients, the 24 month results showed no invasive SCC in this group. This study suggests that diclofenac 3% gel is not only an efficient and well tolerated treatment for multiple AKs in OTRs but also may prevent invasive SCC in these high-risk patients.
    No preview · Article · Jul 2010 · European journal of dermatology: EJD

Publication Stats

2k Citations
189.64 Total Impact Points


  • 2003-2015
    • Charité Universitätsmedizin Berlin
      • Department of Dermatology, Venerology and Allergology
      Berlín, Berlin, Germany
  • 2010
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany
  • 2002-2008
    • Humboldt-Universität zu Berlin
      Berlín, Berlin, Germany
  • 2004
    • Mayo Clinic - Rochester
      • Department of Dermatology
      Rochester, Minnesota, United States
  • 2001-2003
    • Christian-Albrechts-Universität zu Kiel
      • Department of Dermatology, Venereology and Allergology
      Kiel, Schleswig-Holstein, Germany