This evidence- and consensus-based guideline for the treatment of acne was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. This guideline is an update of the 2016 version. This is a short summary of the full version of the EuroGuiDerm Evidence-based Guideline for the Treatment of Acne. For the complete guideline text, detailed methods report, and comprehensive evidence report, please refer to the online full version. In this targeted update, the guideline group prioritized three key clinical questions considered most relevant for current practice: (a) For which types of acne and patient groups should isotretinoin be recommended versus systemic antibiotics, and with what strength of recommendation? (b) What is the appropriate duration for systemic antibiotic therapy? For which types of acne and patient groups should hormonal treatments and spironolactone be recommended, and with what strength of recommendation? For which types of acne and patient groups should new topical treatments, including trifarotene and clascoterone, be recommended and with what strength of recommendation? Additionally, the updated guideline provides revised recommendations regarding: safety of benzoyl peroxide (BPO), selection of systemic antibiotic therapy, treatment considerations during pregnancy, isotretinoin dosing strategies, and the use of hormonal antiandrogenic contraceptives or other combined hormonal contraceptives, as well as spironolactone. All other aspects remain unchanged from the 2016 guideline.

The present Part 2 of the updated German S3 guideline on the treatment of psoriasis vulgaris provides recommendations for therapy selection in special clinical situations and in the presence of comorbidities. A major focus of this update is the chapter on screening for tuberculosis as well as therapy selection and management in latent tuberculosis. The recommendations regarding the use of interferon-gamma release assays and the indication for chest radiography have been extensively revised. In addition, the guidance on the suitability of systemic psoriasis therapies in patients with latent tuberculosis and on the need for preventive antituberculous treatment has been thoroughly updated. In the chapter on inflammatory bowel diseases, risankizumab and guselkumab have been added as recommended treatment options, as both agents have recently been approved for the indications Crohn's disease and ulcerative colitis. Further substantial revisions are included in the chapters on patients with a history of malignancy and viral hepatitis.

BACKGROUND:Penile urethritis is a common medical condition, usually caused by sexually transmitted pathogens such as Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) or Mycoplasma genitalium (MG). Although the causative pathogens cannot be reliably distinguished based on the clinical presentation alone, symptom-oriented empirical antibiotic therapy is often administered in practical care. MATERIAL AND METHODS:This is a summary of the recommendations from the S3 guidelines on the management of male adolescents and adults with symptoms of urethritis. The development of the guidelines was funded by the Innovation Committee of the Federal Joint Committee (Innovationsausschuss des Gemeinsamen Bundesausschusses, G‑BA; grant number 01VSF21021). RESULTS:The guidelines present a symptom-oriented, evidence-based approach for suspected penile urethritis, considering pathogen epidemiology and possible coinfections and contains a flowchart for clinical management. This includes criteria for or against empirical antibiotic therapy before receiving pathogen detection results as well as guidance on the classification as gonococcal or non-gonococcal urethritis based on clinical and microscopic findings. The recommendations for empirical therapy advise against the use of azithromycin as first-line treatment of urethritis to avoid further promoting resistance in NG and MG. DISCUSSION:A detailed presentation of the recommendations and underlying evidence can be found in the freely accessible guideline publication at the Association of the Scientific Medical Societies in Germany (AWMF): https://register.awmf.org/de/leitlinien/detail/013-099 .

This first part of the updated German S3 guideline on the treatment of psoriasis vulgaris covers the sections on treatment recommendations, treatment goals, and monitoring of therapies. The recommendations are based on the current Cochrane network meta-analysis, the results of which are also summarized. When selecting systemic therapies for psoriasis vulgaris, the guideline emphasizes consideration of efficacy, safety, comorbidities, and individual patient factors. The decision framework is presented in the treatment options overview, and in this updated version, the possibility of first-line therapy with biologics or novel targeted small molecules is more prominently highlighted. Standardized instruments for assessing disease severity, as well as patient-centered treatment goals, are underscored. A Psoriasis Area and Severity Index (PASI) 75 response is defined as the minimum therapeutic target, while PASI 90 or an absolute PASI <2 are considered desirable goals. Since the last version, two newly approved agents, bimekizumab and deucravacitinib, have been incorporated, accompanied by specific usage recommendations. Among the established therapies, guidance on methotrexate has been extensively revised, particularly regarding administration, dosing, and monitoring. This guideline aims to provide clinicians with an evidence-based framework for therapy selection and monitoring, while strengthening shared decision-making with patients.

Der vorliegende Teil 1 der Aktualisierung der S3‐Leitlinie zur Therapie der Psoriasis vulgaris umfasst die Abschnitte „Therapieempfehlungen“, „Therapieziele“ sowie die „Monitoringempfehlungen“ zu den Therapien. Die Grundlage bildet die aktuelle Cochrane‐Netzwerkmetaanalyse, deren Ergebnisse ebenfalls dargestellt werden. Es wird empfohlen, Wirksamkeit, Sicherheit, Komorbidität und individuelle Patientenfaktoren bei der Auswahl einer systemischen Therapie bei Psoriasis vulgaris zu berücksichtigen. Der Entscheidungskorridor wird in der Übersicht der Therapieoptionen dargestellt und rückt in der aktuellen Fassung die Möglichkeit einer Erstlinientherapie mit Biologika beziehungsweise neuen zielgerichteten kleinen Molekülen weiter nach vorne. Die Leitlinie betont die Bedeutung standardisierter Instrumente zur Bestimmung des Schweregrades sowie patientenzentrierter Therapieziele. Als Mindestziel gilt ein Psoriasis‐Area‐and‐Severity‐Index (PASI) 75‐Ansprechen, während PASI 90 oder ein absoluter PASI <2 als anzustrebende Therapieziele gelten. Aufgenommen wurden die seit der letzten Fassung neu zugelassenen Wirkstoffe Bimekizumab und Deucravacitinib, für die spezifische Anwendungshinweise ergänzt wurden. Unter den bestehenden Kapiteln wurden insbesondere die Anwendungshinweise zu Methotrexat (MTX) umfangreich überarbeitet.

Die penile Urethritis ist ein häufiges, meist durch sexuell übertragbare Erreger wie Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) oder Mycplasma genitalium (MG) ausgelöstes Krankheitsbild. Auch wenn die verursachenden Erreger allein aufgrund des klinischen Bildes nicht zuverlässig zu unterscheiden sind, wird in der praktischen Versorgung oftmals eine symptomorientierte empirische Antibiotikatherapie durchgeführt. Es erfolgt die Zusammenfassung der Empfehlungen aus der S3-Leitlinie zum Management männlicher Jugendlicher und Erwachsener mit Symptomen einer Urethritis. Die Leitlinienentwicklung wurde vom Innovationsausschuss beim Gemeinsamen Bundesausschuss gefördert (Förderkennzeichen 01VSF21021). In der Leitlinie wird eine symptomorientierte, evidenzbasierte Herangehensweise bei Verdacht auf penile Urethritis unter Berücksichtigung der Erregerepidemiologie und möglicher Koinfektionen dargestellt, einschließlich eines übersichtlichen Flussdiagramms für das klinische Management. Dies umfasst Kriterien, die für oder gegen eine empirische Antibiotikatherapie noch vor Erhalt eines Erregernachweises sprechen, sowie Hinweise zur Klassifikation als gonorrhoische oder nicht-gonorrhoische Urethritis, basierend auf klinischen und mikroskopischen Befunden. Die Empfehlungen zur empirischen Therapie beinhalten den weitgehenden Verzicht auf Azithromycin in der Erstlinienbehandlung der Urethritis, um die Entstehung von Resistenzen bei NG und MG nicht weiter zu befördern. Eine ausführliche Darstellung der Empfehlungen und der zugrunde liegenden Evidenz findet sich in der frei zugänglichen Leitlinienpublikation bei der Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaften (AWMF): https://register.awmf.org/de/leitlinien/detail/013-099 .

Urethritis is a common condition predominantly caused by sexually transmitted pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium. It is not possible to differentiate with certainty between pathogens on the basis of clinical characteristics alone. However, empirical antibiotic therapy is often initiated in clinical practice. The aim of this clinical practice guideline is to promote an evidence-based syndrome-orientated approach to the management of male adolescents and adults with symptoms of urethritis. Besides recommendations for the diagnosis, classification and choice of treatment, this guideline provides recommendations for the indication to empirically treat patients with penile urethritis. A novel feature compared to existing, pathogen-specific guidelines is the inclusion of a flowchart for the syndrome- orientated practical management. For suspected gonococcal urethritis requiring empirical treatment, ceftriaxone is recommended. Due to the risk of Chlamydia trachomatis co-infection, doxycycline should also be prescribed, unless follow-up for the treatment of possible co-infections is assured. For suspected non-gonococcal urethritis, doxycycline is the recommended empirical treatment. In the empiric treatment of both gonococcal and non-gonococcal penile urethritis, azithromycin is reserved for cases where doxycycline is contraindicated. This guideline also includes detailed recommendations on differential diagnosis, pathogen-specific treatments and specific situations, as well as patient counselling and follow-up.

Urethritis is a common condition predominantly caused by sexually transmitted pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium. It is not possible to differentiate with certainty between pathogens on the basis of clinical characteristics alone. However, empirical antibiotic therapy is often initiated in clinical practice. The aim of this clinical practice guideline is to promote an evidence-based syndrome-orientated approach to the management of male adolescents and adults with symptoms of urethritis. Besides recommendations for the diagnosis, classification and choice of treatment, this guideline provides recommendations for the indication to empirically treat patients with penile urethritis. A novel feature compared to existing, pathogen-specific guidelines is the inclusion of a flowchart for the syndrome-orientated practical management. For suspected gonococcal urethritis requiring empirical treatment, ceftriaxone is recommended. Due to the risk of Chlamydia trachomatis co-infection, doxycycline should also be prescribed, unless follow-up for the treatment of possible co-infections is assured. For suspected non-gonococcal urethritis, doxycycline is the recommended empirical treatment. In the empiric treatment of both gonococcal and non-gonococcal penile urethritis, azithromycin is reserved for cases where doxycycline is contraindicated. This guideline also includes detailed recommendations on differential diagnosis, pathogen-specific treatments and specific situations, as well as patient counselling and follow-up.

Medizinische Leitlinien werden als systematische Entscheidungshilfen entwickelt, um eine angemessene ärztliche Vorgehensweise bei spezifischen Krankheitsbildern zu gewährleisten. In Deutschland werden dermatologische Leitlinien unter Federführung der Deutschen Dermatologischen Gesellschaft (DDG) und dem Berufsverband Deutscher Dermatologen (BVDD) entwickelt. Europäische dermatologische Leitlinien werden durch Organisationen wie das vom European Dermatology Forum (EDF) in Kooperation mit der Division of Evidence-Based Medicine an der Charité – Universitätsmedizin Berlin gegründete European Centre for Guidelines Development (EuroGuiDerm) herausgegeben. Überarbeitete oder erstmals herausgegebene dermatologische Leitlinien aus den Jahren 2021 und 2022 umfassen u. a. die deutschen Leitlinien zur Antikoagulation bei dermatochirurgischen Eingriffen, zu chronischem Pruritus, Kontaktekzem, Lasertherapie der Haut, Psoriasis vulgaris, Rosazea, extrakorporaler Photopherese, Onychomykose, Schleimhautpemphigoid und zur Prävention von Hautkrebs. Eine Auswahl der wichtigsten Empfehlungen und Neuerungen der dermatologischen Leitlinien werden im vorliegenden Review zusammengefasst.

Background In dermatology, a medical speciality with a relatively high number of rare diseases, physicians often have to resort to off-label treatment options. To avoid claims, physicians in Germany can file a cost-coverage request (off-label application, OL-A). Objectives Our aim was to investigate the extent to which the current regulations affect patient care. Material and methods Prospective cohort study among tertiary dermatology clinics throughout Germany, consecutively including OL-As (05/2019-09/2020) and assessing the follow-up correspondence. We modelled regressions to assess factors associated with cost-coverage decisions and the time needed by health insurers to process the OL-As. Results Thirteen clinics provided data on 121 OL-As, two of which applied for on-label treatments. Of the remaining 119 OL-As, 70 (58.8%) were immediately approved and 44 (37.0%) rejected. Including cases with one or more appeals, 87 of 119 OL-As (73.1%) were finally approved and 26 (21.9%) rejected. There was an association of the final approval rate with (1) the class of medication/treatment, with approval rates being significantly lower for JAK inhibitors than for biologics (OR 0.16, 95%-CI: 0.03-0.82); (2) German state, with approval rates being lower in eastern than in western states (OR 0.30, 95%-CI 0.12-0.76); and (3) cost of the intervention (no linear trend). However, none of these predictors was significant in our multiple logistic regression models. The median health insurer's processing time (first response) was 29 days (IQR 22-38). Our analyses showed no evidence of an association with the predictors we assessed. In cases approved, the median time from the decision to file an OL-A to the actual initiation of the treatment was 65.5 days (IQR 51-92). Conclusions Our study points to substantial delays and inequalities in the provision of timely health care for dermatological patients with rare diseases, often involving treatments for which there is no adequate approved therapy.

Background Melasma is a common dermatological condition. Although its relevance as a skin condition is primarily of a cosmetic nature, it may affect the patient’s wellbeing and quality of life. A broad range of treatment options is available, which makes it difficult to choose the most appropriate of those treatments. Objectives To summarize and critically appraise evidence from investigator-blinded randomized controlled trials (RCTs) on the efficacy and safety of self-applied topical interventions for melasma. Methods We systematically searched MEDLINE and the Cochrane CENTRAL trials database for RCTs on topical, self-administered interventions for patients diagnosed with melasma. Eligibility was limited to RCTs that explicitly stated in their methods section (i) how they generated the random allocation sequence, and (ii) that the study outcome assessor was blinded to the participants’ group allocation. Outcomes of interest included evaluator-assessed clinical scores (such as the Melasma Area and Severity Index), quality of life and patient-reported outcomes, as well as safety outcomes. The study findings were meta-analysed, pooling data from studies on the same comparisons, if this was possible. We assessed confidence in effect estimates using the GRADE approach. Results Our searches yielded 1078 hits. We included 36 studies reporting on 47 different comparisons of interventions. These included medical treatments such as ‘triple combination cream’ (TCC), over-the-counter cosmetic and herbal products, as well as sun creams covering different light spectra. Pooling data was possible for only two comparisons, topical tranexamic acid (TXA) vs. hydroquinone (HQ) and cysteamine vs. placebo. Direct comparisons were available for a variety of interventions; however, the reported outcomes varied greatly. Overall, our confidence in the effect estimates ranged from very low to high. Conclusions Our findings indicate that TCC and its individual components HQ and tretinoin are effective in lightening melasma. Besides these established self-applied treatment options, we identified further medical treatments as well as promising cosmetic and herbal product treatment approaches. Furthermore, evidence suggests that using broad-spectrum sunscreen covering both the visible and ultraviolet-light spectrum enhances the treatment efficacy of HQ. However, with mostly small RCTs comparing treatments directly using a broad range of outcomes, further research is needed to draw conclusions about which treatment is most effective. What is already known about this topic? Melasma is a common dermatological disease. Although it is primarily a cosmetic condition, it can severely affect the patient’s wellbeing and quality of life. Treatment options for melasma include a broad range of medical, cosmetic and herbal products. Given the large number of available interventions, it is difficult for clinicians and for patients to make informed decisions about which treatment to choose. What does this study add? We systematically assessed data from investigator-blinded randomized controlled trials of self-applied topical interventions. Our GRADE evaluations of confidence in the findings ranged from very low to high and may help clinicians and patients navigate treatment decisions. Besides the established self-applied medical treatment options, we identified promising cosmetic and herbal treatment approaches. Evidence suggests sunscreen covering the ultraviolet (UV)- and visible light spectra increases treatment efficacy compared with UV-only protection.