Uwe Reinhold’s research while affiliated with University of Bonn - Medical Center and other places

We present the case of an otherwise healthy 34‐year‐old man of Asian descent diagnosed with miliaria profunda after a 6‐week history of generalised anhidrosis after a trip to Mallorca in the summer.

Rowell Syndrome is a rare entity combining erythema exudativum multiforme (EEM) and lupus erythematosus (LE). Zeitouni et al. redefined Rowell Syndrome's diagnostic criteria. Major criteria include: (1) LE (systemic, discoid or subacute cutaneous), (2) EEM‐like skin lesions and (3) speckled pattern of antinuclear antibodies. Minor criteria comprise: (1) chilblains, (2) positive anti‐SSA/Ro or anti‐SSB/La antibodies and (3) positive rheumatoid factor. The diagnosis is achieved when all major criteria and at least one minor criterion are present. Prognosis and treatment regimens are those of EEM and LE, with reported good response to oral cortisone, azathioprine, cyclosporine, dapsone, antimalarials and methotrexate. We present a case of Rowell Syndrome in a young adult after a herpes simplex type 1 infection and unprotected sun exposure, with good response to both topical corticosteroids and calcineurin‐inhibitors.

Background Basal cell carcinomas (BCC) have classically been surgically removed. Alternative treatments for superficial BCC include local immunotherapy, topical chemotherapy and photodynamic therapy. Recent data suggest 1064 nm Nd:YAG laser as a new treatment for those lesions. Dynamic optical coherence tomography (D‐OCT) is an established imaging procedure analysing BCC margins and its vascular plexus. Objective Our goal is to further evaluate 1064 nm Nd:YAG laser therapy of BCC as a potential alternative treatment, employing D‐OCT and histopathology to standardise effective treatment protocols. Methods In this retrospective cohort study, 50 histologically confirmed superficial and nodular BCC with tumour thickness ≤1 mm were treated with 1064 nm Nd:YAG laser. Initial D‐OCT scans were performed and repeated for 3 months posttreatment. Tumoral clearance was histologically confirmed and local adverse effects, patient tolerability and satisfaction were recorded. Clinical remission was evaluated after 1 year. Results Complete clearance was achieved in 78% of BCC (39/50) at a 3‐month follow‐up. Treatment failures were slightly more likely to correspond to superficial BCC (91%, 10/11) of thickness ≤0.5 mm (73%, 8/11), located on the trunk (64%, 7/11). No treated lesions presented scarring. Patient satisfaction and tolerability displayed excellent results. Remission at 1 year occurred in 100% of initially cleared BCC (35/35, four patients were lost to follow‐up due to nonmedical reasons). Conclusion OCT‐assisted 1064 nm Nd:YAG laser treatment of superficial BCC is a safe and effective method with excellent patient satisfaction, tolerability, practicability and cosmetic end result.

Photodynamic therapy (PDT) with 5‐aminolevulinic acid hydrochloride (ALA) is an established method for the management of AK. PD P 506 A (brand name Alacare®) is an approved medicinal product for the treatment of AK located on scalp and face. It is a self‐adhesive, light‐proof patch loaded with 5‐ALA HCl and was developed for easy handling. AK located on arms, hands or trunk do not respond as well to ALA‐PDT as AK lesions on the head do. It has been reported that occlusion during ALA incubation can improve clinical outcome after ALA‐PDT for AK on hands and arms. We present the results of a first explorative pilot study involving 20 participants with a total of 145 treated (122 evaluable) AK lesions. The trial investigated the conduct of two ALA‐PDTs within 1‐2 weeks and involved all severity grades of AK. The model‐based percentage of complete clearance on lesion‐basis was estimated being 78.0 % (95 %‐CI: [64.6 %; 87.3 %]), and the by‐participant calculation (patient‐based clearance) led to similar results (78.7 % with a 95 %‐CI of [67.0 %; 90.3 %]). The treatment was well tolerated. Local reactions during ALA patch incubation were rare whereas nearly all patients showed the expected reactions during or after the illumination, primarily erythema and pain. The study results indicate that two PD P 506 A‐PDT sessions 1‐2 weeks apart are an efficacious treatment for AK on hands and arms. Especially mild but also moderate lesions responded very well to PDT treatment involving ALA incubation under occlusion.

Background Photodynamic therapy (PDT) with natural daylight is effective and less painful than conventional PDT when treating actinic keratosis (AK), however its weather dependency is restrictive. This prospective open-label observational single-arm study examined efficacy and safety of simulated daylight (SDL)-PDT using the IndoorLux® system in combination with 5-aminolevulinic acid gel (BF-200 ALA). Methods 12 patients with mild/moderate AK on the face or scalp received two SDL-PDTs. BF-200 ALA was applied prior to a 2h illumination with the IndoorLux® System. Patients evaluated pain during and after SDL-PDT on visual analogue scales (VAS). Primary endpoint was lesion count reduction three months after the second SDL-PDT. Secondary endpoint was pain during and after illumination. Results Median individual clearance rate was 83.75% (66.7-100.0%); 33.3% of the patients and 84.9% of the lesions were completely cleared. Median size of the remaining partially cleared lesions decreased by 42.9%. The first SDL-PDT was pain-free for 7 patients (58.3%, VAS=0). Median VAS during and after the first treatment was 0 (0.0-0.3). For the second SDL-PDT, median VAS was 0.1 (0.0-5.5, during) and 0 (0.0-4.5, after). Both SDL-PDTs were pain-free for 6 patients. Conclusion SDL-PDT was effective and nearly pain-free, emphasizing its advantages and potential for common practice.

Zusammenfassung Hintergrund Die aktinische Keratose (AK) ist ein epitheliales Carcinoma in situ der Haut. Aufgrund des Risikos einer malignen Transformation besteht ein frühzeitiger Behandlungsbedarf. Gerade die initiale Therapie sollte neben der Wirksamkeit eine gute Verträglichkeit und Anwenderfreundlichkeit aufweisen. Kaliumhydroxid (KOH)-Lösung ist als keratolytische Behandlungsoption bei hyperkeratotischen Hauterkrankungen, wie z. B. Mollusca contagiosa, bereits etabliert. Methodik Wirksamkeit und Verträglichkeit von KOH-5 %-Lösung zur Behandlung der leichten bis moderaten AK wurden in einer prospektiven, einarmigen, multizentrischen Medizinproduktestudie (Treatment of AK with KOH [TAKKOH]) untersucht. Die KOH-Lösung wurde 2‑mal täglich über 14 Tage aufgetragen mit anschließender Behandlungspause von 14 Tagen (≙ 1 Behandlungszyklus) für maximal 3 Behandlungszyklen oder mindestens bis zum Behandlungserfolg. Das primäre Zielkriterium „Behandlungserfolg“ wurde als komplette Remission (CR) aller AK-Läsionen eines Patienten definiert. Sekundäre Zielkriterien beinhalteten die Beurteilung der partiellen Remission (PR), der Anzahl an AK-Läsionen in Remission, die Wirksamkeitsbeurteilung anhand von Schulnoten durch Prüfärzte und Patienten sowie sicherheitsrelevante Endpunkte. Ergebnisse Es wurden 73 Patienten in die Studie eingeschlossen. Eine CR wurde von 54,9 % der Patienten erreicht, eine PR von 64,8 % bei einer Reduktion der Gesamtzahl an Läsionen um 69,9 %. Bei 46,6 % der Patienten wurden unerwünschte Ereignisse beobachtet. Diese überwiegend unerwünschten Wirkungen (82,6 %) stellten ausnahmslos transiente und milde lokale Hautreaktionen dar. Schlussfolgerung Die Studie liefert Hinweise auf die Wirksamkeit und Sicherheit von KOH-5 %-Lösung zur läsionsgerichteten topischen Therapie der AK.

Background Actinic keratoses (AK) may occur in all sun exposed skin areas. However, those occurring outside the head area are generally more resistant to treatment than those on the face. Objective To determine efficacy and safety of BF-200 ALA vs. vehicle in the treatment of mild to severe AK located on extremities/trunk/neck with red light photodynamic therapy (PDT). Methods The Phase III study had an intra-individual design with 50 patients in six centers in Germany. Each patient received a maximum of two field-directed PDTs. Clinical endpoints and 1-year follow-up results were recorded. Results BF-200 ALA was superior to vehicle with respect to total lesion clearance rates (86.0% vs. 32.9%, p<0.0001) and patient complete clearance per patient’s side (67.3% vs. 12.2%, p<0.0001). 1-year overall lesion recurrence rates were 14.1% vs. 27.4% (BF-200 ALA vs. vehicle, p=0.0068). Patients were more satisfied by the cosmetic outcome of the BF-200 ALA/PDT than by the vehicle/PDT. Adverse events were consistent with the known safety profile of BF-200 ALA/PDT. Limitations Small number of severe lesions; small sample size; unbalanced but representative distribution of AK in extremities/trunk/neck. Conclusion BF-200 ALA showed significantly higher AK clearance rates on extremities/trunk/neck than vehicle and was well-tolerated.