Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
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Ainhum (dactylolysis spontanea) is a distinct clinical and radiological disorder of dark-skinned people characterized by a progressive development of a constricting band encircling the toe which usually results in spontaneous amputation. Ainhum mainly occurs in African natives, but in times of global migration and tourism, Ainhum is likely to be more often encountered outside Africa. Even though the clinical presentation can mimic more common entities such as arthritis and trauma, the correct diagnosis and treatment is easy if one knows this unusual entity.
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J Dtsch Dermatol Ges · Sep 2007
ReviewAssessment of publications using methods of evidence-based medicine: an introduction using a dermatological clinical study.
Evidence-based medicine is the explicit use of the currently best available scientific data for decision-making in the management of individual patients, with guidelines being among the instruments for its implementation. Publication of the German S3 guideline on the treatment of plaque-type psoriasis is a mile-stone for German dermatology, as it is the first dermatologic guideline at this highest level of evidence. ⋯ This article explains the principles of such an analysis, so the reader can gain insight into the methodology of a crucial aspect of guideline generation. This information is of general relevance, as it provides help for every physician who wishes to critically read original scientific publications.
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J Dtsch Dermatol Ges · Aug 2007
Practice Guideline[Implementation of the S3-guidelines for systemic and UV therapy of moderate to severe psoriasis vulgaris by an algorithm].
The recently published German S3- guidelines for the treatment of psoriasis vulgaris offer an extensive evidence-based documentation and evaluation of currently available treatment modalities. In order to incorporate this detailed information into the actual treatment decisions in individual patients, we have transformed the recommendations regarding phototherapy and systemic therapies into an algorithm. ⋯ It can also facilitate documentation of treatment. In our hands the treatment algorithm proved to be feasible and reliable in a large number of patients.
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The introduction of biologics has not only broadened the therapeutic armamentarium for psoriasis but also stimulated discussion about the treatment of this common skin condition. The recently presented German S3 psoriasis guideline contains detailed information on the efficacy of the different products and describes important safety and practical aspects of psoriasis treatments. Patient surveys and recent studies in Germany indicate a relatively high mean severity of skin symptoms and low quality of life among affected patients. ⋯ If, after a defined period of time, an at least 50 % reduction of the baseline Psoriasis Area and Severity Index (PASI) and a Dermatology Life Quality Index of ( not less-than 5 is not reached, patients should be switched to another therapy, after a balanced discussion. Whenever necessary, a continuous maintenance therapy should be instituted with special attention to these goals. Patients should carefully be monitored for the presence of psoriatic arthritis and comorbidities because these may need to be integrated in the planning of treatment goals on an interdisciplinary basis.