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Hidradenitis suppurativa (HS) causes a significantly compromised quality of life. Assessment of the psychological burden of HS is crucial for evidence-based allocation of resources. We examined methods to easily assess the psychological burden in HS patients. A total of 110 HS patients were assessed with respect to sociodemographic data, Hurley scale, and modified Sartorius score. Patients were asked to provide information on time of first diagnosis, previous therapies, surgical intervention, and pre-existing conditions. Distributed questionnaires were the Dermatology Life Quality Index (DLQI) and the Skindex-29, the Visual Analogue Scale (VAS) for pain, and the German version of the Hospital Anxiety and Depression Scale (HADS-D) for evaluation of anxiety (HADS-D/A) and depression (HADS-D/D). Of the 110 patients with HS (mean age: 38 ± 12 years; range: 18 to 75), 61 were female and 49 were male. We found a statistically significant correlation between HADS-D/A and VAS (p = 0.009), between Skindex-29 and Sartorius score (symptoms: p = 0.024; emotions: p = 0.019; functional status: p = 0.002), as well as between Skindex-29 and VAS (symptoms: p = 0.000; emotions: p = 0.001; functional status: p = 0.000). Additionally, VAS correlated significantly with DLQI (p = 0.000) and body mass index with Sartorius score (p = 0.038). Our study shows that HS patients experience a high level of psychological distress. Interestingly, a clear correlation between psychological burden and HS patients was inferred by the VAS for pain. HS patients require active management for their physical as well as psychological health.

A 51-year-old man suffered from an acute eczematous rash confined to the air- and light-exposed areas of the skin. As a construction worker he was exposed to common occupational allergens such as epoxy resins, but there was also remarkable holiday-associated sun exposure. He did not use any sunscreen agents. Several weeks before the onset of skin eruptions, conservative treatment of Peyronie's disease with oral PotabaTM (potassium paraaminobenzoate) had been started. Airborne contact dermatitis to volatile allergens was ruled out, while photopatchtesting revealed photoallergy to paraaminobenzoic acid (PABA). In sunscreens, PABA has mostly been abandoned due to its known topical photosensitization properties, but it has not yet been recognized as a systemic photosensitizer.

In the medical community lectures and publications about nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity have led to an increasing awareness and diagnosis of this condition. Frequently, the diagnosis NSAID hypersensitivity is based only on history, which is a vague and unreliable indicator. A two-stage diagnostic procedure with skin tests (to exclude IgE-mediated allergy) followed by single-blinded, placebo-controlled oral challenges was carried out on patients attending our clinic from 1997 to 2003 with the diagnosis of a NSAID hypersensitivity. Out of 260 patients tested, 61.5% described their NSAID hypersensitivity as cutaneous (urticaria, angioedema), 24.2% had respiratory symptoms (asthma, rhinitis), 3.5% had anaphylactoid reactions, and 10.8% described uncertain signs. In fact 55.0% of all patients previously labelled as NSAID sensitive tolerated NSAID when assessed by oral challenge, whereas 13.8% were truly NSAID sensitive. In 31.2% of patients the challenge test with the suspicious drug was either not done or rejected by the patient; but all showed a proven tolerance of alternative NSAID. Our study demonstrates that oral challenge tests are safe, practical and useful in ruling out NSAID hypersensitivity in approximately 50% of the patients who have previously been labelled as such.

Lichen striatus (LS) is an uncommon disease of unknown origin characterised by a linear inflammatory papular eruption with spontaneous regression. We here review a series of 12 consecutive cases of LS. Diagnosis was supported by histological examination. Ten of our 12 patients were children aged 6 months to 12 years. The male gender predominated by 9:3. The lower limb was involved more often than the upper limb and trunk. The duration of the disease until regression ranged from 4 months to 4 years (median, 12 months). Postinflammatory hypopigmentation was noted in 5, and hyperpigmentation in 4 patients. Two patients showed nail involvement (onychodystrophy, longitudinal ridging) which appeared simultaneously with the skin lesions and resolved completely. A personal history of atopic disorders was found in 7 of 12 patients. From this series we can confirm that LS mainly affects children. Both skin and nail lesions disappear completely even if they last longer than one year. Compared with other studies, our series showed differences with regard to sex ratio, predilection sites and after effects.

Paraneoplastic pemphigus (PNP) is an autoimmune, mucocutaneous bullous disease associated with underlying malignancies. We report a patient with Waldenström's macroglobulinemia who developed clinical, histological and immunopathological features typical of PNP. The patient was treated twice with i.v. dexamethasone and cyclophosphamide pulse therapy (day 1: cyclophosphamide 500 mg i.v.; day 1-3: dexamethasone 100 mg i.v.) at 3-week intervals. Therapy was continued with oral cyclophosphamide (50 mg/d). Two weeks after initiation of treatment, significant improvement of the cutaneous and mucosal lesions was noted. The therapy also had beneficial effects on the macroglobulinemia in terms of a marked reduction of the IgM lambda serum level. Three months after the second pulse, severe stomatitis recurred but the patient rejected any further systemic therapy. The initial response of the usually recalcitrant mucosal and skin lesions of PNP makes dexamethasone/cyclophosphamide pulse therapy an interesting therapeutic option.