BACKGROUND AND OBJECTIVES:Atopic dermatitis (AD) has a highly variable clinical phenotype and ancestry can contribute to this heterogeneity. This study aims to identify clinical phenotypes of AD in children from diverse ancestry groups, evaluate clinical outcomes and response to treatment, and define phenotypic clusters with potential relevance. PATIENTS AND METHODS:Multicenter, descriptive, observational study of patients with moderate-to-severe AD treated in eight Spanish hospitals. Patient ancestry was based on self-reported parental origin and country of birth. Phenotypic clusters were identified through analysis of demographic, clinical, and morphological variables. Systemic treatment response was assessed using validated AD scales. RESULTS:157 children were categorized into five ancestry groups: American Indian, Asian, Black, Mixed, and White. Three phenotypic clusters were identified. Cluster 1 had varied ancestries and the highest rate of Th2 comorbidities. Cluster 2 patients were mostly Asian with a predominantly non-classic morphologies, and a higher rate of hospital admissions. Cluster 3 were mostly white with fewer Th2 comorbidities. Systemic treatments yielded differential responses across clusters. Cluster 1, slower response; Cluster 2, fastest improvement; Cluster 3, milder disease and consistent improvement. CONCLUSIONS:We propose a clinically based clustering framework to refine pediatric AD phenotypes and support individualized care across diverse ancestries.
Digital transformation is fundamentally reshaping dermatology, creating new opportunities in diagnostics, therapy, and healthcare organization. Large datasets combined with Artificial Intelligence (AI) enable more precise classification and prognosis, particularly through the analysis of clinical and dermoscopic imaging. Increasingly, synthetically generated data is used to train new algorithms, though its clinical validity remains under evaluation. Teledermatology has established itself as an integral part of care. Video consultations and asynchronous image transfers enhance accessibility to dermatological expertise and can bridge care gaps, especially in structurally weak regions. Furthermore, mobile applications and digital platforms promote adherence, self-monitoring, and active patient engagement. Despite these opportunities, challenges regarding data protection, interoperability, and regulatory frameworks must be addressed to ensure sustainable implementation. Interdisciplinary collaboration between medicine, technology, and health economics is crucial. Physicians play a central role as subject matter experts in assessing data quality and providing clinical interpretation of digital systems. Continuous training of medical staff remains essential. Overall, digitalization offers significant potential to improve dermatological care, provided there are structured processes, quality assurance, and consistent patient involvement.
BACKGROUND AND OBJECTIVES:The relationship between atopic dermatitis (AD), weight, height, and body mass index (BMI) in children and adolescents and the impact of systemic treatments is controversial. We report the distribution of weight, height, and BMI in the German TREATkids cohort compared to a standardized German cohort (Kromeyer-Hauschild) and the impact of systemic glucocorticoids. PATIENTS AND METHODS:This multicenter, prospective study analyzed weight and height data from pediatric patients (2-17 years) with moderate-to-severe AD enrolled in TREATkids. RESULTS:According to Kromeyer-Hauschild metrics, the median height, weight, and BMI of the TREATkids cohort were 42nd, 52nd, and 59th percentiles, respectively. A height deficit was observed compared to the reference population. Despite shorter stature, the children exhibited weight percentiles comparable to the general population. This combination of reduced height and normal weight led to high BMI-for-age percentiles. A sensitivity analysis excluding patients who had received systemic corticosteroids showed similar results for height-for-age, weight-for-age, and BMI-for-age percentiles. CONCLUSIONS:Children and adolescents with moderate-to-severe AD in TREATkids exhibit distinct anthropometric patterns, characterized by height deficits but normal weight distribution, independent of systemic glucocorticoid treatment.
The S1 guideline "Therapy of generalized pustular psoriasis (GPP)" is a German guideline developed in accordance with the criteria of the AWMF. The full version addresses clinical presentation, pathogenesis, diagnosis and differential diagnosis, comorbidities, and therapy. In addition, therapy recommendations for adults with GPP are provided. Both approved and off-label therapies are considered. The present article is a shortened version of the guideline, whose therapy recommendations are presented in full and without omission.
BACKGROUND AND OBJECTIVES:Trust in therapy impacts adherence and satisfaction in chronic inflammatory skin diseases, including atopic dermatitis (AD) and psoriasis (PSO). This study assessed and compared trust in skincare and topical therapies and explored influencing factors among AD and PSO patients. PATIENTS AND METHODS:Cross-sectional surveys of AD or PSO patients were conducted at two dermatological university centers in Germany. Group differences were analyzed using Mann-Whitney U and Kruskal-Wallis tests; associations between trust (6-point Likert scale: 1 = very high, 6 = none) and demographics, disease severity, pruritus, pain, and quality of life (QoL) using Spearman correlations. All analyses were exploratory. RESULTS:Among 253 AD or PSO patients (median age 53.0 years, interquartile range 36.0-63.0; 43.9% female) median trust in skin care and topical therapies was moderate. AD patients reported significantly higher trust than PSO patients. In AD, trust in skin care correlated with pruritus intensity (p < 0.001), pain intensity (p < 0.05), and QoL (p < 0.001); trust in topical therapy correlated with QoL (p < 0.01). No significant correlations were observed in PSO. CONCLUSIONS:Trust levels were higher in AD than in PSO but tended to decline with increasing disease burden and poorer QoL. Enhancing patient education and shared decision-making may help improve trust and adherence.
BACKGROUND AND OBJECTIVES:Eyelid reconstruction following tumor excision poses both functional and aesthetic challenges. Although complex surgical techniques are frequently employed, secondary intention healing remains a less commonly used option in periorbital surgery. This case series aimed to assess the functional and aesthetic outcomes in patients with eyelid defects treated with the laissez-faire approach. PATIENTS AND METHODS:A retrospective analysis was conducted of six patients with post-excisional eyelid defects who underwent secondary intention healing at the Department of Dermatology, Klinikum Ludwigshafen, between 2016 and 2024. Healing time, complications, functional and aesthetic outcomes were assessed after at least 6 weeks or 6 months postoperatively. RESULTS:The average patient age was 77 years. The indication for surgery was basal cell carcinoma or melanoma. The mean healing time was 6 weeks. All patients achieved good to excellent functional and aesthetic outcomes. Nearly no ocular-specific complications were observed. Secondary intention healing was well-tolerated by all patients. CONCLUSION:Secondary intention healing is a safe and effective alternative to complex reconstructive techniques for selected periorbital defects, particularly in elderly patients. The choice of reconstruction should be tailored individually, taking into account patient age, health status, defect characteristics, and patient preferences.
BACKGROUND:Calciphylaxis is a severe condition with no established therapy, characterized by painful skin ulcerations and necrosis resulting from occlusion of small blood vessels. Given the high mortality rate, effective treatment strategies are urgently needed. We hypothesize that a combination of sodium thiosulphate with the prostaglandin analog iloprost and a low-molecular-weight heparin may be a beneficial treatment option for calciphylaxis. PATIENTS AND METHODS:In a retrospective data analysis, 19 patients with calciphylaxis were included who were treated in our clinic between 2019 and 2023. Demographic factors, clinical symptoms, comorbidities, laboratory results, histology, and treatment-related factors were collected. RESULTS:68.4% were female and mean age was 67.8 years. In 63% of cases, a combination therapy consisting of sodium thiosulfate, iloprost and anticoagulation was used. In a cohort of 12 patients who underwent at least 2 treatment cycles complete healing occurred in 75.0% of cases and partial improvement in 25.0%. The median time to healing was 3.0 treatment cycles. The median duration until complete pain relief was 2.5 treatment cycles. CONCLUSIONS:In our cohort, a combination therapy consisting of sodium thiosulfate, iloprost, and anticoagulation was associated with favorable treatment response, good tolerability, improved wound healing, and pain relief.
BACKGROUND:Studies on the state of medical care for patients with cutaneous T-cell lymphoma (CTCL) are limited. To date, only secondary data analyses are available for Germany. PATIENTS AND METHODS:Cross-sectional study conducted over a one-year recruitment period (01 March 2024 to 28 February 2025) in the dermatological department of a German university hospital. The physician questionnaire recorded the skin-related burden of disease using the mSWAT and data on disease course, while the patient questionnaire recorded socio-demographic and clinical parameters, patient satisfaction, and health-related quality of life using the Skindex-29. RESULTS:121 patients (median age 63 years, 66.9 % male) with mycosis fungoides (95.0 %) and Sézary syndrome (5.0 %) were included. 30.0 % of the working patients reported sick leave due to CTCL and 51.7 % had already been hospitalized at least once for this indication. The Skindex-29 revealed an impairment in quality of life in 52.9 % of patients. Patients with higher disease stages (IIB-IVB according to EORTC/ISCL), lack of response to therapy, and an mSWAT ≥ 30 showed a significantly higher impairment in quality of life. A median of 4 follow-up appointments were attended annually, with 63.6 % of patients being treated exclusively at the university hospital. CONCLUSIONS:This study is the first to analyze the state of medical care of patients with mycosis fungoides and Sézary syndrome using primary data from routine care at a German university hospital and reveals a high burden of disease as well as a high need for care.
BACKGROUND AND OBJECTIVES:Artificial intelligence was shown to improve diagnostic accuracy for skin cancer detection. While most clinically approved models provide binary "benign/malignant" classifications, multiclass predictions may offer greater clinical utility. Yet, comparisons between multiclass convolutional neural networks (CNNs) and dermatologists are scarce. METHODS:In an international web-based reader study, dermatologists (n = 96) and a prototype multiclass CNN (FotoFinder Systems, Germany) assigned diagnoses to 100 skin lesions by using nine disease categories (melanoma; basal cell carcinoma; squamous cell carcinoma; intraepithelial carcinoma; melanocytic nevus; benign keratinocytic lesion; dermatofibroma; vascular lesion; "other"). The main outcome measure was overall mean sensitivity (micro-averaged percentage of correct diagnosis) of dermatologists versus multiclass CNN. RESULTS:Dermatologists achieved an overall mean sensitivity (95% CI) of 69.4% (68.4%-70.3%) with dermatoscopy-only data (level-I), which improved to 76.0% (75.2%-76.9%) when provided with full clinical information (level-II). The CNN's top-rank predictions showed a higher overall mean sensitivity of 82.0% (73.3%-88.3%). The CNN significantly outperformed all dermatologist subgroups, except for dermatoscopy experts at study level-II (overall mean sensitivity 81.1% [79.9%-82.3%], pequivalence = 0.0085). CONCLUSIONS:Multiclass CNN predictions outperformed most dermatologists in diagnostic accuracy, supporting their potential to enhance clinical decision-making, particularly in settings with limited dermatological expertise.
BACKGROUND AND OBJECTIVES:Chronic pruritus (CP) significantly impairs quality of life (QoL), but existing patient-reported QoL tools are either not specific for CP or are very extensive. PATIENTS AND METHODS:The 5-item pruritus life quality (5PLQ, range: 5-25, 7-day recall) was developed to assess key itch-related QoL domains (sensory symptoms, impact on daily life, social interactions, sleep and psychological well-being). Adult patients with CP across nine European centers (n = 471) completed the 5PLQ twice, 60 minutes apart, and itch intensity (numerical rating scale/visual analogue scale) and QoL (Dermatology Life Quality Index/ItchyQol) scales. Construct and structural validity, internal consistency, convergent and external validity and test-retest reliability were analyzed. ROC analysis evaluated discrimination across QoL impairment levels. RESULTS:Mean 5PLQ scores were 15.0 ± 4.8 and 14.8 ± 5.0. The scale revealed good internal consistency reliability (Cronbach α: 0.816), weak to strong correlations across items (r = 0.343-0.619, p < 0.001) and strong to very strong correlations between single items and total score (r = 0.640-0.809, p < 0.001), strong correlations with QoL (r = 0.706-0.745, p < 0.001) and itch intensity (r = 0.407-0.608, p < 0.001), and high test-retest reliability (interclass correlation for single measures: 0.669). A cut-off of 13 best discriminated none/mild from moderate/severe impairment. CONCLUSIONS:The 5PLQ is a brief, validated, reliable and user-friendly tool for assessing itch-related QoL in CP.
BACKGROUND:The Psoriasis Area and Severity Index (PASI) is the standard measure for psoriasis severity but reflects only a single time point and may underestimate long-term disease burden. To assess whether the highest-ever recorded PASI (PeakPASI) can serve as a marker of historical disease severity and correlate with treatment burden and comorbidities. PATIENTS AND METHODS:A cross-sectional analysis of 308 psoriasis patients from a German university hospital was conducted. Data on PASI, PeakPASI, therapies, and comorbidities were obtained from self-report and medical records. Group comparisons used non-parametric tests; Poisson regression assessed PeakPASI as a predictor of systemic therapy use and comorbidity burden. RESULTS:Median PeakPASI (11.4 [IQR 5.9-17.0]) exceeded current PASI (2.0 [IQR 1.0-5.1]). PeakPASI ≥ 10 was associated with more systemic therapies (p < 0.001), phototherapy (p < 0.001), smoking (p = 0.021), and diabetes (p = 0.020). PeakPASI correlated with number of systemic (ρ = 0.296), topical therapies (ρ = 0.367), and hospital visits (ρ = 0.186). It significantly predicted systemic therapy use (β = 0.355, p < 0.001), but not comorbidity burden. CONCLUSIONS:PeakPASI may complement current measures by reflecting historical severity and informing treatment. While not a cumulative burden marker, it may prevent underestimation of long-term disease impact. Prospective validation is warranted.
BACKGROUND AND OBJECTIVES:Despite receiving similar information about outpatient dermatologic surgical procedures, some patients still hold misconceptions about the nature of their lesions and the treatment. No studies have been done to understand this difference in the perception of surgery. Therefore, this study aimed to assess patients' perceptions of their condition and the planned surgical intervention, to identify potential influencing factors, and to evaluate the concordance between preoperative information and postoperative experience. PATIENTS AND METHODS:A single-center descriptive observational study was conducted using surveys provided to patients who underwent dermatologic surgery between September 2023 and August 2024. RESULTS:A total of 302 patients were enrolled. Significant differences were found when evaluating disease perception based on the nature of the lesion, emotional responses depending on sex and previous surgical history. Differences were also observed in patients' perceptions of the surgery based on the operative technique used in terms of duration and complexity. Finally, wound care perception also showed significant differences depending on the surgical technique used. CONCLUSIONS:Patients' perceptions of dermatologic surgery are primarily shaped by the information provided and their own expectations. Several factors may influence and explain the differences and misconceptions observed among patients.
BACKGROUND:Full-thickness nasal defects of the tip, soft triangle, and ala are commonly reconstructed using a paramedian forehead flap with cartilage grafts or an epithesis. However, these approaches may be associated with donor-site morbidity and psychological burden. Cartilage grafts are generally considered necessary to prevent nostril collapse during inspiration. The aim of this study was to assess whether cartilage grafting is required to prevent nasal collapse and to evaluate patient satisfaction, complications, and functional and aesthetic outcomes. PATIENTS AND METHODS:This case series analysed postoperative outcomes in 10 patients following two-stage folded paramedian forehead flap reconstruction without cartilage grafts. Median follow-up was 14 months. Outcomes included patient satisfaction as well as functional and aesthetic results. RESULTS:All patients reported being satisfied or very satisfied with their long-term postoperative outcomes. Nasal airflow on the reconstructed side was preserved without impairment. No cases of nostril collapse during inhalation were observed. Additionally, no hypertrophic scarring or tissue necrosis occurred. CONCLUSIONS:Two-stage reconstruction of full-thickness nasal defects using a folded paramedian forehead flap without cartilage grafts provides good functional and aesthetic outcomes with high patient satisfaction. In most cases, additional cartilage grafting appears unnecessary.
BACKGROUND AND OBJECTIVES:Closed venereology wards existed in both Western and Eastern European dictatorships. These institutions isolated, disciplined, and "educated" individuals with Sexually Transmitted Infections (STI) or suspected infections. In 2024, 220 patient records from the closed venereology ward of Dresden-Friedrichstadt Hospital were discovered in the Dresden City Archive. The records were analyzed to gain insight into the care of girls and women admitted under coercion. PATIENTS AND METHODS:The patient records were critically reviewed and descriptively analyzed. Data collected included: referring institution, reason for admission, type of treatment, and admission/discharge dates. RESULTS:Most records date from 1969. A total of 84 women were admitted with a diagnosed STI, 70 for a "social indication" (vagrancy), and 77 for a dermatological condition. Patients with an STI or a "social indication" underwent daily gynecological smear tests. They also received three to four provocation procedures intended to activate latent infections for diagnostic detection. Confirmed STIs were treated with penicillin. CONCLUSIONS:The Dresden ward reflects the GDR system of closed venereology wards: underage girls and women were forcibly admitted, disciplined, and isolated. Many admissions were unlawful. The closed venereology ward of Dresden-Friedrichstadt Hospital represents a chapter in Europe's history of politicized medicine.
BACKGROUND AND OBJECTIVES:Melanocytic nevi show distinct age-related dermoscopic patterns. However, data on age-related patterns of melanomas are lacking. This study aimed to identify age-related static and dynamic dermoscopic patterns of melanomas. PATIENTS AND METHODS:Explorative cross-sectional cohort study between October 1996 and May 2012, including 832 patients at increased melanoma risk monitored by total body photography (TBP) and sequential digital dermoscopy (SDD). Patients were categorized into age groups I: < 31 years (n = 308), II: 31-50 years (n = 340), and III: > 50 years (n = 184). Dermoscopic features of melanoma-suspicious lesions were prospectively characterized before excision. RESULTS:During the study, 1,770 of 14,896 monitored lesions were excised. Histopathology confirmed 190 (10.7%) melanomas. In comparison to melanomas of other age groups, we found "signature features" for age group I: "blue whitish veil" and "symmetrical enlargement without globules", age group II: appearance of "irregular pigmentation" and "irregular dots/globules", and age group III: "regression structures" and appearance of "atypical pigment network", "atypical vascular pattern", and "blue whitish veil". In contrast, unique age-related features of excised nevi were "symmetrical enlargement with globules" in age group I, and "no enlargement" in age group III. CONCLUSIONS:Our explorative study identified a number of age-related static and dynamic dermoscopic features that might be helpful to detect melanomas.
BACKGROUND AND OBJECTIVE:Pemphigus treatment has seen significant advancements, yet long-term remission remains a challenge. Comparative data on the long-term effectiveness of available therapies are limited. We compared 10-year relapse rates in pemphigus patients treated with azathioprine or cyclophosphamide plus high-dose IV corticosteroids PATIENTS AND METHODS: In this retrospective single-center cohort study, we analyzed 91 patients with pemphigus vulgaris/foliaceus treated between 1985 and 2022. 43 patients received oral azathioprine, 48 received intermittent intravenous and oral cyclophosphamide. All patients also received intermittent high-dose IV corticosteroids for ≥ 1 year. As rituximab became widely available only after 2019, follow-up was insufficient to include it in this analysis. RESULTS:Remission occurred equally quickly in both groups, but patients treated with cyclophosphamide suffered from significantly fewer relapses: 27% of cyclophosphamide patients had ≥ 1 relapse vs. 80.6% with azathioprine (p < 0.001). 70% of cyclophosphamide patients remained relapse-free and were off therapy for an average of 7 years. CONCLUSIONS:Aggressive initial immunosuppressive therapy with cyclophosphamide is associated with a significantly lower long-term relapse rate in pemphigus. While routine use is limited by its toxicity, these findings underscore the potential for durable remission and the importance of long-term disease control as a treatment goal.
