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Topical therapy is an important domain in the treatment of dermatological diseases in the 21st century. Because multiresistant bacteria are becoming an increasing issue in medical care of chronic diseases, it is important to develop appropriate therapeutic management for acute and chronic dermatoses. The current discussion about the skin microbiota shows the importance of preserving the resident skin flora. There is a need for alternatives to topical antibiotics, e. g. topical antiseptics, which should be safe, fast, and effective but not allergenic or toxic. Even with frequent and prolonged application it is important that they do not develop a resistance. This article focusses on the use of antiseptics for medical indications. Mechanisms of action, tolerability, maximum concentrations, and possible contraindications are discussed and examples of extemporaneous antiseptic preparations are provided.

The second part of this publication deals with varicella zoster virus (VZV) and presents an overview of new, rare, and atypical clinical manifestations, including photolocalized varicella, hemorrhagic bullae during varicella, the implication of VZV in immunoglobulin A vasculitis, VZV-related alopecia, ulcerative varicella skin lesions, childhood herpes zoster (HZ), prolonged prodromal pains, recurrent HZ, VZV implication in burning mouth syndrome, verruciform VZV lesions, the significance of satellite lesions during HZ, and late HZ complications, either neurological or internal. Furthermore, certain associations between the occurrence of HZ and subsequent internal pathologies, as well as risk factors for HZ and new developments in vaccination against HZ will be addressed.

Paraviral exanthems are skin diseases suspected to be caused by viruses, with a single virus-exanthem relationship not universally accepted. Although most paraviral exanthems are self-remitting, accurate diagnoses are important as some patients might develop complications. Some of the differential diagnoses might cause serious complications, and some paraviral exanthems might lead to complications for at-risk groups such as pregnant women. Moreover, some paraviral exanthems might be symptomatic such as the development of severe pruritus, with relief of such being crucial in the plan of management. Patients and carers of patients should also be counselled regarding the aetiologies, clinical features, and prognoses of the exanthems concerned.We covered the clinical manifestations and managements of pityriasis rosea, pityriasis lichenoides, and Gianotti-Crosti syndrome. Expert Commentary: Most patients with pityriasis rosea do not need any active intervention. Symptomatic relief of the pruritus would be adequate. For patients with pityriasis rosea that are serious, extensive, or causing severe impacts of their quality of life, oral acyclovir could be considered. For pityriasis lichenoides, managements would be depending on the type of the exanthem such as the acute form (pityriasis lichenoides et varioliformis acuta, also known as Mucha Habermann disease) the chronic form (pityriasis lichenoides chronic Juliusberg's disease), and the febrile ulceronecrotic Mucha-Habermann disease, which is a complication of the acute form. The management of Gianotti-Crosti syndrome is mainly symptomatic. The need for long-term follow-up for chronic complications of the underlying viral infections is still controversial.

In this article we present the case of a 2-day-old newborn girl in good general condition, with herpetic arranged pustules on the skin of her whole body. The case highlights the importance of a detailed diagnostic workup for newborns with pustular skin disease. Especially to differentiate between the diagnosis of incontinentia pigmenti and a congenital herpes infection.

A 24-year-old man with no significant medical history was admitted to this hospital because of an acute exanthema, myalgia and malaise. A fourth-generation screening test for HIV was reactive but the following confirmation test was not. Although the patient did not belong to a high risk group, we decided to perform a HIV-RNA-PCR. The result showed a high virus load so that we finally diagnosed a primary HIV infection.

Not only does genital "high risk HPV 16" play a significant role in cervical carcinomas, it is also the most commonly found mucosal virus in groups of well-defined but atypical infections on the skin. In this group are included 1. Bowen disease, 2. squamous cell carcinomas on fingertips and nail units, 3. squamous cell carcinomas of eyelids and conjunctiva, 4. papillomas and squamous cell carcinoma of the external auditory canal. Bowen disease is a carcinoma in situ with a good prognosis and usually does not turn into a Bowen carcinoma. There is a close relation to genital high risk HPV, but integration of HPV 16 DNA into the cellular genome is rarely found in Bowen disease, and seems to appear only when there is a development into Bowen carcinoma. It is unclear how mucosal HPV infect the skin. Most authors assume that genito-digital inoculation occurs. However, in many cases of cutaneous Bowen disease there is no evidence of genital change and in most reported cases there is no immunosuppression. Similarly, in the case of rare carcinomas of fingers and nail units HPV 16 and HPV 16 - related types seem implicated. There is an almost universal assumption that infection here occurs via genital-digital contact. Immunosuppression, for example due to organ transplant or HIV infection, accelerates the emergence and spread of carcinomas. The mechanism of these types of carcinogenesis appears to be similar to that of the formation of cervical carcinomas. Although the central role in triggering carcinogenesis is played by persistent HPV infection, as is the case in cervical carcinoma, further factors must play a part, for example the condition of the immune system. Loss of immunological control can lead to a lasting proliferation of HPV infected cells. Additional factors such as UV light and toxic substances may enhance carcinogenesis, by lowering local tissue immunity and thus reducing intra-cellular control.

HPV infections in the anogenital region may have very heterogeneous clinical features. Most often typical papillomatous condylomata acuminata are observed that usually present no differential diagnostic difficulty. In contrast, the clinical findings of higher grade intraepithelial dysplasias with flat papules and erythematous/ eczematous lesions are often quite inconspicuous and hardly characteristic. The goal of therapy is to prevent further progression to carcinoma, removal of bothersome tumors and avoidance of complications. Surgical methods are preferentially employed for extensive lesions, unfavorable locations and higher grade dysplasia. Options include removal with scissors or scalpel, laser therapy and electrocautery. For purely intraepithelial alterations, superficial ablative techniques are usually preferable over excision. Further developments such as argon plasma coagulation reduce the risk of unwanted deep thermal destruction with the accompanying complications. The risks for the surgeon and the surgical team during treatment should also not be neglected. With consideration of all relevant aspects, the combination of different methods may reduce the risk of complications and frequency of recurrences. Due to the high recurrence rate independent of the selected therapy, consistent follow-up after primary therapy is crucial for the long-term success.

The transmission of hepatitis viruses as a result of sexual activity is a common problem in medical practice. A system of stages is proposed to diagnose viral hepatitis. Testing for anti-HBc, HBsAg, anti-HAV and anti-HCV is sufficient for initial screening. Depending on the circumstances, this may be followed by further tests for HBV, HCV and HAV. If initial screening provides no evidence, further tests for HEV, Epstein-Barr virus, cytomegalovirus or other agents are conducted.

Prophylactic HPV L1 VLP quadrivalent and bivalent vaccines are of great importance for patients seen by dermatologists and venereologists. Both vaccines protect against HPV16- and HPV18-associated anogenital cancers, as well as cancers of the mouth, the upper respiratory tract and skin, especially of the fingers and periungual region. The quadrivalent HPV6, 11, 16, 18 vaccine also prevents anogenital warts (condylomata acuminata) which are the most common benign tumors of this body region. HPV-vaccination (Gardasil) has been approved in Germany since October 2006 for young girls between 9-16 and young women between 16-26 years of age. Many experts feel that boys and young men should also be vaccinated. Men would profit from a vaccine that protects against HPV infections, especially anogenital warts, as well as penile and anal carcinomas. In immunosuppressed organ transplant recipients and HIV-positive individuals, HPV can be widespread, chronic and often rapidly progressive to malignant tumors; thus these groups would greatly benefit from HPV immunization.

The primary infection with varicella-zoster virus (VZV) is manifest clinically as varicella. It is a common very contagious disease, normally appearing in childhood. VZV is a ubiquitous virus with a high prevalence. Clinically it is characterized by pleomorphic skin lesions. Normally antiviral therapy is necessary only in severe cases, in adults or in immunosuppressed patients. Herpes zoster, also caused by (VZV), is a neurodermal disease representing the endogenous relapse of the primary varicella infection. Herpes zoster is characterized by lesions concentrated in the innervation region of a cranial or spinal nerve. One of the most feared manifestations of herpes zoster is pain. Several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce risk and duration of postherpetic neuralgia in elderly patients. Therefore, antiviral therapy in combination with an adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.

Papillomaviruses are prevalent throughout the world. They can cause warts or papillomas. Some papillomaviruses are also involved in the pathogenesis of malignant tumors. Cutaneous and anogenital warts are the most frequent viral disease of the skin. The incidence of verrucae vulgaris and condylomata is estimated to be 7-10% in the European population and 1% in the American population. HPV infections can be verified by clinical examination, cytology and histology, detection of antibodies, molecular techniques and directly via viral structures. Antibodies against HPV are considered markers for prolonged infection and cumulatively high expression of viral particles since they persist with low titers years after a lesion has resolved. Sensitivity only reaches 50-60% even in HPV DNA-positive patients. Serodiagnosis does not appear to be appropriate for routine practice. No virustatic treatment exists. Depending on wart-specific factors, compliance of the patient, and experience of the attending therapist, all ablative, chemodestructive or novel immuno modulatory procedures are comparable. However, there are enormous differences in price and effort required for treatment, which should be considered when choosing the method.

The herpes simplex viruses type 1 and 2 (HSV 1 and 2) as typical members of the larger herpes virus group have the tendency to become latent after an inapparent primary infection. They are transmitted from person to person during episodes of reactivation. HSV 1 and 2 usually cause harmless mucosal infections. Usually HSV are kept in check by the immune system. An impaired immune response leads to HSV infections which can be life-threatening. Genital HSV infections are an important cause of genital ulcerations, and HSV 2 is a predisposing factor for HIV and AIDS. Worldwide the diagnostic possibilities for HSV are often inadequate. Despite the availability of modern chemotherapeutic agents, the treatment of HSV infections is in many cases less than satisfactory. Dermatologists play a major role in the early diagnosis and effective therapy of these infections. In this paper, the latest diagnostic and therapeutic, as well as prophylactic measures and vaccines, are reviewed.

Immunomodulators include both immunostimulatory and immunosuppressive agents. Obligate contact sensitizers such as diphencyprone or dinitrochlorobenzene have been used against viral and autoimmune diseases. Newer agents such as the toll-like receptor agonists imiquimod and resiquimod have been clinically used to treat viral infections and skin cancers in immunocompetent and immunosuppressed patients. On the other hand, the topical immunosuppressive agents tacrolimus and pimecrolimus have been used with great success in the treatment of chronic inflammatory diseases in children and adults. The introduction of this new class of drugs (i.e. Calcineurin inhibitors) marked the beginning of the post-cortisone era in clinical dermatology. Toll-like receptor agonists and calcineurin antagonists will supplement corticosteroids to improve specific dermatological therapy. Topical immunotherapy with both immunostimulatory and immunosuppressive agents show potential for effective and patient-friendly treatment of inflammatory, infectious and neoplastic skin diseases. Long-term evaluation will define the tolerability and the safety profile.