The AWMF S1 guideline 013/056 "Occupational Skin Products: Protective Creams, Skin Cleansers and Skin Care Products" from 2014 has been revised and upgraded to S2K level. The aim was to develop a decision aid for the optimal use of occupational skin products for the prevention of hand eczema in the workplace. The multidisciplinary expert commission included representatives from dermatology, occupational medicine and dermopharmaceutical societies, as well as from German Social Accident Insurance. The update was conducted through a non-systematic review of current (inter)national scientific literature, focusing on randomized controlled clinical trials. The revised guideline integrates: (1) epidemiological studies demonstrating the effectiveness of skin protection and care, (2) results from the Cochrane Review on the primary prevention of occupational hand eczema, (3) skin physiological multicenter studies on the application and benefits of skin protection creams and the tolerability of skin cleansing products, (4) specific investigations on wet work, and (5) current positions on aluminum chlorohydrate and contact allergens based on opinions of the Scientific Committee on Consumer Safety (SCCS) and data from the Information Network of Departments of Dermatology (IVDK). The recommendations and key statements were agreed upon in a structured consensus conference using a nominal group process under professional moderation. The S2K guideline aims to improve the prevention of occupational hand eczema and promote the health of employees.

Background: Concern was raised within the International Contact Dermatitis Research Group (ICDRG) regarding the scoring of weak allergic versus doubtful patch test reactions. Objective: To investigate the degree of uniformity in patch test reading. Methods: Five series of fictive contact dermatitis cases were written up by the study organizer and presented to expert participants. Each series was sent electronically to participants one by one. All dermatitis cases underwent patch testing, and the test result was a reaction characterized by erythema and infiltration. Within each case series, there were 5 subcases that differed only in the size of the test area showing erythema and infiltration. Three nearly identical case series had 1 crucial difference: the result of a repeated open application test (ROAT), both in the cases and controls. The experts had to determine whether the patch test reaction indicated contact allergy, defined as an immunologically acquired delayed hypersensitivity. All other reactions (negative, doubtful, and irritant) were classified as no contact allergy. Results: There was a big intra- and inter-individual variation in the patch test reading. Nobody read according to any of the 2 existing ICDRG classifications. The ROAT results sometimes influenced the scoring. Conclusion: A new ICDRG classification is needed.

BACKGROUND:Hand eczema (HE) is a common and complex skin disease. A uniform set of core outcomes and related measures for use in clinical trials is lacking, making it difficult to compare results across HE studies. OBJECTIVE:To reach consensus on a set of core domains and subdomains that should be measured in future therapeutic HE trials. METHODS:In 2024, we conducted a two-round online Delphi (eDelphi) survey among international HE experts, including physicians, patients and their relatives, researchers and industry representatives. A domain/subdomain was included in the core set when ≥80% of participants rated is as 'critically important'; 50% agreement or less resulted in its exclusion. Results from 50% to 80% were deemed controversial and subject for further discussion. During a hybrid consensus meeting, the stakeholders reviewed, completed and, if necessary, revised the preliminary eDelphi consensus. RESULTS:In the first and second round of the eDelphi, 208 and 134 persons, respectively, participated. Forty participants from 18 countries attended the consensus meeting. Consensus was reached to include the core domains 'signs of HE' (with five core subdomains), 'symptoms of HE' (two subdomains), 'HE-related quality of life' (four subdomains) and 'HE control over time' (four subdomains). The subdomains 'desquamation/scaling' and 'emotional impact/mental health' remained controversial. Consensus was reached that the domains 'skin barrier function' and 'patient-reported treatment experience' and 28 subdomains should not be part of the core outcome set. CONCLUSIONS:To produce comparable and meaningful results, future trials evaluating the effectiveness of HE treatments should measure signs and symptoms of HE, HE-related quality of life and HE control over time as core outcome domains. The next step of the HE core outcome set initiative (HECOS) is to identify appropriate measurement instruments.

In dry skin (DS), skin-barrier function is easily disturbed and moisturizing factors in the stratum corneum are reduced. Despite being a common condition, DS is often overlooked in patients with advanced age or comorbid diseases. In September 2022, specialists in dermatology and skin care met to discuss unmet needs and management of patients with DS with existing medical conditions or DS induced by ongoing pharmacological treatments. There was consensus about the need to improve the current understanding and management of DS in patients with comorbidities, including type 2 diabetes, chronic kidney disease, radiodermatitis, and photodamaged skin. Clinical guidance related to optimal treatment of DS in patients with advanced age or comorbid diseases is needed. Dexpanthenol-containing emollients have been shown to provide rapid relief from the symptoms and clinical signs of skin inflammation and are well-tolerated and effective in terms of moisturizing and soothing DS and maintaining skin-barrier function. Thus, dexpanthenol-containing emollients may play an important role in future management of DS. Further research is needed to elucidate the efficacy of dexpanthenol across the spectrum of DS, irrespective of comorbidity status or age.

Mucocutaneous leishmaniasis is a severe infectious disease, predominantly endemic in Central and South America and is characterized by granulomatous, destructive mucosal lesions in the oral, nasal, and pharyngeal cavities. It is caused by protozoa of the genus Leishmania spp. transmitted to humans by sandflies. Mucocutaneous leishmaniasis occurs after untreated or inadequately treated cutaneous leishmaniasis and is more common in immunocompromised patients. The aim of this systematic review is to summarize all reported treatment options for mucocutaneous leishmaniasis. This review is based on all English, German, French, Spanish and Portuguese articles published in the databases "PubMed" and "Lilacs" from 1995 to 2020. Most of the medical literature is limited to case reports, small case series, retrospective studies, and a few randomized controlled trials. Various treatment options include pentavalent antimonates such as meglumine antimonate or sodium stibogluconate, amphotericin B (liposomal, deoxycholate, lipid complex, colloidal dispersion), miltefosine, and pentamidine. Other therapeutic options include itraconazole, fluconazole, ketoconazole, aminosidine sulfate, and azithromycin. The choice of drug depends primarily on its availability in the endemic area and the patient's comorbidities.

Zusammenfassung Die mukokutane Leishmaniose ist eine schwere Infektionskrankheit, die überwiegend in Zentral‐ und Südamerika endemisch ist und sich klinisch mit granulomatösen, destruierenden Schleimhautläsionen im Mund‐Nasen‐Rachenraum manifestiert. Sie wird durch Protozoen, Leishmania spp., ausgelöst, die durch Sandmücken auf den Menschen übertragen werden. Sie tritt nach vorangegangener kutaner Leishmaniose auf, wenn diese nicht oder nur unzureichend behandelt wurde und kommt gehäuft bei immunsupprimierten Patienten vor. Das Ziel dieser systematischen Übersicht besteht darin, alle publizierten Behandlungsmöglichkeiten für die mukokutane Leishmaniose zusammenzufassen. Sie basiert auf allen englischen, deutschen, französischen, spanischen und portugiesischen Artikeln, die in den Datenbanken „PubMed“ und „Lilacs“ von 1995 bis 2020 veröffentlicht wurden. Die medizinische Literatur beschränkt sich auf Einzelfallberichte, kleine Fallserien, retrospektive Studien und nur wenige randomisierte kontrollierte Studien. Zu den Therapieoptionen gehören pentavalente Antimonverbindungen wie Megluminantimonat oder Natriumstibogluconat, Amphotericin B (liposomal, Desoxycholat, Lipidkomplex, kolloidale Dispersion), Miltefosin und Pentamidin. Weitere mögliche Therapien sind Itraconazol, Fluconazol, Ketoconazol, Aminosidinsulfat und Azithromycin. Die Wahl des geeigneten Medikaments richtet sich in erster Hinsicht nach der Verfügbarkeit im Endemiegebiet und den begleitenden Erkrankungen des Patienten.

Psoriasis, a chronic inflammatory skin disease, goes beyond visible symptoms and affects the general well-being of patients. The aim of this study is to understand how patients with psoriasis perceive their skin characteristics and reactivity to allergens. The study population includes 11,283 participants within the European Dermato-Epidemiology Network (EDEN) Fragrance study, covering several European regions. The study compared perceptions of skin dryness, sensitivity, product avoidance and reactivity to allergens between patients with psoriasis and controls, evaluating the potential influence of psoriasis severity. The results showed that subjects with psoriasis reported dry skin (71.1%) and sensitive skin (49.4%) more often than did controls (51.6% and 38.5%, respectively). Psoriasis patients were more likely to avoid specific products. Interestingly, there were no significant differences in patch-test results between the 2 groups and the severity of psoriasis did not have a consistent impact on these perceptions. In conclusion, people with psoriasis tend to perceive their skin as drier and more sensitive. Notably, the severity of psoriasis did not consistently influence these perceptions and objective reactivity to allergens did not align with subjective perception. Understanding these aspects is crucial for tailoring treatments to improve the well-being of patients with psoriasis, which warrants further research to explore subjective perceptions of skin well-being in patients with psoriasis.

Zusammenfassung Anamnese Bei einer 57-jährigen Patientin traten nach wiederholter Gartenarbeit schmerzhafte Hautveränderungen auf. Bei der Vorstellung in der zentralen Notaufnahme zeigten sich Bullae, Striae und Erytheme an den lichtexponierten Arealen. Untersuchungen und Diagnose Laborchemisch zeigten sich leicht erhöhte Entzündungswerte. Die körperliche Untersuchung zeigte keine weiteren Besonderheiten. Es erfolgte die Übernahme durch die Dermatologie des Universitätsklinikums Jena. Aufgrund der Anamnese und des klinischen Befundes wurde die Diagnose Dermatitis bullosa pratensis (Wiesengräserdermatitis) gestellt. Therapie und Verlauf Es erfolgte neben lokaler Therapie mit Glukokortikosteroiden und sterilem Punktieren der Blasen eine intravenöse Therapie mit Prednisolon. Folgerung Dermatitis bullosa pratensis gehört zu den photophytotoxischen Dermatitiden und wird durch die Kombination von Photosensibilisatoren und ultraviolettem Licht ausgelöst. Es ist von Bedeutung, sich bei Kontakt mit Pflanzen, die Photosensibilisatoren enthalten, vor UV-Licht ausreichend zu schützen. Das Krankheitsbild ist leicht zu vermeiden, umso wichtiger ist es, das Risiko zu kennen und die notwendigen Schutzmaßnahmen einzuhalten.