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Die Hidradenitis suppurativa (HS) ist eine chronisch entzundliche Erkrankung, die mit Abszessbildung und mutilierenden Entzundungen mit Narbenbildung in den Korperfalten einhergeht. Der Leidensdruck ist immens und der Betreuungsbedarf hoch. In der dermatologischen ambulanten Betreuung stehen eine gute Aufklarung und die Ausbildung eines vertrauensvollen Arzt-Patienten-Verhaltnisses im Vordergrund. HS-Patienten werden sowohl konservativ als auch chirurgisch uberwiegend durch Dermatologen betreut, was ein umfassendes Wissen der Pathogenese, Triggerfaktoren, Komorbiditat und Therapie voraussetzt. Die Zusammenarbeit mit anderen Fachdisziplinen ist noch ausbaufahig. Neue physikalische Verfahren (Laser, Radiofrequenz, IPL [intensiv gepulstes Licht]), Lokal- und Systemtherapien ermoglichen ein gutes ambulantes Langzeitmanagement fast aller HS-Krankheitsstadien.

Pigmentation disorders are a frequent skin problem and incorporate a broad spectrum of diseases, caused by an abnormal melanin pigmentation or also non-melanin pigmentation of the skin. Both hypermelanosis and hypomelanosis can be hereditary or acquired. This article summarizes the treatment approaches that are used in the majority of acquired pigmentation disorders of the skin. The following forms of hypermelanosis are addressed: lentiginosis, hyperpigmentation due to endocrine disorders or other systemic diseases, drug-induced hyperpigmentation. Acquired hypomelanoses include postinflammatory hypomelanosis, chemical depigmentation, idiopathic guttate hypomelanosis and punctate leucoderma. With reference to non-melanin pigmentation, the exogenous pigmentation due to chemicals, metals and drug exposure are discussed. The treatment is primarily based on finding the cause of the alterations to the pigment. The affected area, age and ethnic origin are also important factors. The spectrum of therapeutic options is broad: topical agents, chemical peeling, systemic agents, laser and light-based treatment. As some of these treatment procedures can have side effects, the availability of a protocol that contains information on the drug concentration, dose, parameters for laser treatment and the number of sessions is important. For every disorder the specific dermatological treatment is presented even when some pigmentation alterations that occur in association with systemic diseases, are cured by the treatment of the primary disease. Most diseases are exacerbated by exposure to UV light. Therefore, sun protection is recommended and a cosmetic coverage is indicated.

With a clear increase in the incidence and a continuously earlier onset, the main risk factors for the development of basal cell carcinoma are still exposure to sunlight, fair skin, immunosuppression, carcinogens such as arsenic, chronic irritations and certain genodermatoses. Treatment options for localized resectionable basal cell carcinoma include micrographically controlled surgery, simple excision, curettage, laser ablation, cryosurgery, imiquimod, 5‑fluorouracil, photodynamic treatment and radiotherapy. Non-surgical treatment options are more suited for cases in which surgical procedures lead to disfigurement or functional impairments or for patients with a high surgical risk. Laser treatment, ablative and non-ablative as monotherapy or in combination can represent a meaningful treatment option in selected cases. In recent years there has been an increase in knowledge about the indications and effects of laser treatment of basal cell carcinoma; nevertheless, further studies with a high level of evidence are necessary.

There are no currently FDA/EMEA-approved dermatologic indications for spironolactone and its off-label uses are, among others, female acne, female pattern hair loss, hidradenitis suppurativa or hirsutism. The rationale behind these relays on the mechanism of action of spironolactone which interferes with the hormone-controlled sebum and sweat gland secretion and with androgen stimulated hair growth. The average dose used by the dermatologits is 50-100 mg daily. It should not be used in pregnant and lactating women and it is not used in men due to the risk of feminization. Although further studies to assess its efficacy and safety are necessary, currently spironolactone is regarded as a useful tool in the dermatologic treatment armamentarium.

Der 12jahrige Junge entwickelte innerhalb von zwei Jahren den vollen Symptomenkomplex eines Morbus Adamantiades-Behcet. Es handelte sich um die mukokutane Variante der Erkrankung mit rezidivierenden bis persistierenden oralen Aphthen mit Beteiligung der Rachenhinterwand, rezidivierenden Genitalulzera, perianalen Ulzerationen und ein positives Pathergie-Phanomen. Eine Augenbeteiligung sowie weitere, mit der Erkrankung asoziierte, Symptome wurden nicht nachgewiesen, allerdings wiesen das junge Alter beim Auftreten der Erkrankung und das mannliche Geschlecht eher auf eine schlechte Prognose hin. Beim Vater des jungen Patienten bestand ein Asthma bronchiale mit rezidivierenden Infekten der Atemwege. Es war ein IgG-3-Subklassendefekt bekannt. Die immunologischen Untersuchungen des Jungen sowie seines Vaters zeigten im Lymphozytentransformationstest jeweils eine stark erniedrigte Stimulation mit Anti-CD3-monoklonalem Antikorper bei normaler Stimulation mit PWM, CoA und PHA. Daruber hinaus war bei beiden Patienten der losliche Interleukin-6-Rezeptor im Serum stark reduziert.