Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
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More than 2,000 different types of disease entities are treated in dermatology. Even for some of the more commonly occurring diseases there is no explicitly approved medication. Further limitations in the approval status can be found for skin diseases in children and adolescents, in pregnancy and with multiple comorbidities. Therefore, for medical and ethical reasons in many dermatological treatment situations prescription of medications off label is necessary. Against the background of the difficult formal and legal framework conditions for off-label prescription, knowledge of the regulations on off-label use is essential for dermatologists. ⋯ Prescriptions for off-label use are an integral component of qualified dermatological treatment. Despite regulatory and legal hurdles off-label use can be implemented with knowledge of the juridical and formal conditions.
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DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), also known as hypersensitivity syndrome (HSS), is a severe and potentially life-threatening drug reaction. The worldwide rate of mortality is about 10 %, its incidence is increasing. Drugs that most frequently induce DRESS are aromatic anticonvulsive drugs (carbamazepine, lamotrigine, phenobarbital), and more recently new retroviral therapies. ⋯ No specific clinical, histologic or laboratory parameter is available, so the diagnosis has to rely on the clinical appearance. The long latency period between start of drug intake and the initial manifestation of DRESS and the successive onset of skin and organ involvement complicates the early diagnosis. Although or even because DRESS represents a diagnostic challenge, detailed knowledge about this disease is of utmost importance to enable early therapeutic actions.
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Local anaesthesia often is insufficient for more extensive procedures. Instead of general anaesthesia or sedation, pediatricians, gynaecologists and dentists increasingly use nitrous oxide (N2O). This study evaluates the suitability of this form of anesthesia in dermatology. ⋯ The pronounced analgesia, the easy self-administration, the fast onset and complete recovery after a few minutes and the low ratio of side effects make the N2O/O2 inhalation to an ideal addendum in the management of larger painful procedures in dermatology as long as contraindications and safety precautions are respected.
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A 27-year-old woman presented with severe pruritus for a few weeks and diffuse urticarial erythema with pinhead-sized papules over the entire body. The skin lesions occurred directly after a stay in her secondary residence in London. The medical history, clinical picture and histological feature of an arthropod reaction in the skin biopsy, coupled with patient offering a bed bug specimen as evidence, secured the diagnosis of a cimicosis.
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Erythema scarlatiniforme desquamativum generalisatum (Féréol-Besnier disease) is a rare skin disease characterized by generalized erythematous rash with subsequent desquamation. An 86-year-old woman presented with generalized erythema followed by an extensive, scarlatiniform peeling especially of the hands and feet. This generalized episode may be followed by erythema scarlatiniforme desquamativum localisatum recidivans, which is a recurring variant of the disease, localized to the hands and feet.