Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
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Localized scleroderma or morphea is a sclerosing connective tissue disease of the skin, which may affect underlying tissues such as subcutis, muscle and bone. Many patients show extracutaneous symptoms and antinuclear antibodies, however, secondary transformation into systemic sclerosis does not occur. Localized scleroderma usually begins in childhood with a wide variation in its clinical spectrum. ⋯ A genetic background is suspected, while triggers such as trauma, vaccinations and infections may lead to secondary immunologic phenomena. Localized scleroderma often remains unrecognized for a long time, resulting in substantial delay in treatment. The combination of systemic corticosteroids and methotrexate has been established as first-line therapy for progressive (usually linear) disease, whereas phototherapy (UVA-1 or UVB-narrow band) is suitable for adolescents with superficial circumscribed subtypes.
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Hyperhidrosis is characterized by localized or general excessive sweating which is severe enough to be perceived as pathological. Since excessive sweating often starts in childhood and adolescence, usually in children between 6 and 16 years of age, hyperhidrosis is an important disorder for children and juveniles. ⋯ In addition, therapy is often challenging since many treatment modalities are not approved for children. Nonetheless, there are still effective therapeutic options for children with hyperhidrosis.
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During the induction of anesthesia for strabismus correction, a six-year-old boy suffered anaphylaxis with hypotension. Midazolam, propofol, sufentanil, rocuronium, dexamethasone and ibuprofen had been administered. ⋯ Intracutaneous testings with drugs used for anesthesia and other muscle relaxants verified a positive reaction to rocuronium as well as to cisatracurium, mivacurium, vecuronium and atracurium. There was no reaction to suxamethonium.
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The pathogenesis of rosacea - a common, chronic inflammatory skin disease mainly affecting the central portions of the face - is only partly understood. In affected skin the expression of cathelicidin - an antimicrobial peptide and effector of innate immunity - is strongly increased. In addition, the activity of cutaneous proteases is greatly increased leading to the generation of cathelicidin peptide fragments with pro-inflammatory activity. ⋯ Retinoids, azelaic acid and doxycycline inhibit both skin proteases and TLR expression and could mediate their anti-inflammatory effects in rosacea through these mechanisms. These data increase our understanding of the pathogenesis and therapy of rosacea. Also, these insights might uncover novel targets for innovative therapies of this common, stigmatizing skin disease.
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Sarcoidosis is a granulomatous multisystemic disease of unclear etiology, which can affect any organ. The cutaneous manifestations are variable, but ulcerative cutaneous sarcoidosis is very rare. ⋯ A 58-year-old woman with a long history of cutaneous, nodal and pulmonary sarcoidosis suddenly developed ulcerations within the disseminated skin lesions on her legs. The combination of systemic hydroxychloroquine and modern wound management lead to complete healing of the ulcers and a significant improvement in the remaining skin lesions.