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Dupilumab is a monoclonal antibody that binds to the common alpha chain of the IL‑4 and IL-13 receptor and blocks the Th2 signaling pathway, which plays a key role in the development of atopic dermatitis. We report on the case of a 40-year-old man, who developed histologically confirmed psoriasis after 6 weeks of dupilumab therapy. The arbitrary, abrupt stopping of the unusual, not guideline-based oral steroid therapy, together with the blockade of the Th2 signaling pathway by dupilumab were apparently the relevant trigger factors for the newly developed psoriasis in our patient.

Psoriasis is a chronic inflammatory disorder of the epidermis, which can be induced by systemic factors, such as streptococci infections or drugs. In addition, psoriasis can be caused by a local cutaneus trauma, known as Koebner phenomenon. Here, we describe a woman with psoriasis in remission, who developed a new psoriatic lesion due to a cutaneous infection with Borrelia burgdorferi. After causal therapy with doxycycline, the erythema migrans and psoriasis lesions disappeared.

Background: Psoriasis is a human leukocyte antigen (HLA)-associated T‑cell-mediated disorder., Objectives: The role of the main psoriasis risk allele HLA-C*06:02 in disease manifestation and the mechanisms which activate the pathogenic T‑cell response in the skin of psoriasis patients remained elusive., Materials and Methods: Key to the immune pathogenesis of psoriasis was the analysis of the specificity of the infiltrating lesional psoriatic CD8(+) T cells, Results and Conclusion: Analyses of the lesional psoriatic T‑cell reactivity demonstrate that psoriasis is an autoimmune disease. It is based on an autoimmune response against melanocytes which is preferentially mediated by HLA-C*06:02 through autoantigen presentation. Here we discuss the mechanisms of this autoimmune response in the context of the polygenic psoriatic predisposition.

Background: The causal association between hepatitis virus infections and lichen planus (LP) remains a matter of controversy. Reliable figures for German patients are still lacking., Patients and Methods: We analyzed the prevalence of serum antibodies against hepatitis B and C viruses (HBV, HCV) in 265 LP patients and compared the results to 257 patients with chronic urticaria (URT) and 222 patients with malignant melanoma (MM). Additionally, we analyzed age- and sex-specific differences., Results: The prevalence of HBV (13.2 % or 14.7 %) antibodies was significantly higher in patients with LP and URT patients than in the MM control group (HBV: 5.4 %, p < 0.001). The prevalence of HCV antibodies among LP and URT patients (2.6 % or 0.8 %) was not significantly greater (p > 0.05) than in MM patients (0.4 %). The prevalences of HBV and HCV in the MM control group were comparable to those in the general German population (HBV: 5-8 %, HCV: 0.4-0.7 %). An analysis by sub-groups showed that these differences resulted from sex- and age-dependent prevalences. HBV antibodies were significantly more common only in male LP patients (16.1 %) and in male (20.0 %) and female URT patients (15.6 %) aged 31-60 years. The greater prevalence of HCV in female LP patients older than 60 years of age was not significant., Conclusions: LP is not specifically associated with hepatitis B or C antibodies in the Caucasian population of Germany. The higher prevalences of HBV antibodies found in LP and URT patients may be a reflection of age- and sex-related factors rather than disease-specific exposure to HBV infections. The increased prevalences seen in patients with LP or URT compared to MM patients may suggest that HBV infection serves as an unspecific trigger for a specific immune reaction of another origin., (© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.)

Background: Psoriasis, an inflammatory disorder of the skin, can significantly impact on a patient's quality of life, affecting their daily activities and families. The onset of psoriasis in childhood is quite common; however, the treatment of moderate-to-severe disease in this population is challenging, with a paucity of data reported and few licensed agents available., Methods: A Delphi survey was conducted among a panel of European expert dermatologists and physicians with a particular interest in pediatric inflammatory disorders. The survey covered the aspects of psoriasis types, psoriatic arthritis, diagnosis and treatment options in childhood., Results: A series of consensus opinions were reached, detailing the current practice in Europe for the diagnosis and treatment of psoriasis in childhood. These opinions are presented in the context of evidence from the literature and the current licensure status and indications of therapies for psoriasis in childhood., Conclusions: These data provide detailed information on the current practices in Europe for treating psoriasis in childhood., (© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.)

Biologics have been available in Germany for the treatment of moderate to severe chronic plaque psoriasis and/or psoriatic arthritis since 2004. They include chimeric (human/mouse) or fully human monoclonal antibodies or recombinant fusion proteins. The currently available biologics are cytokine antagonists, which neutralize either TNF-alpha or the interleukins IL-12 and IL-23. Unexpected adverse events result either from their potential immunogenicity or from their mode of action, which consists in neutralizing the biologic activity of the respective cytokines. In particular the increased risk for severe infections that may take an atypical course during biologic therapy deserves attention in daily clinical practice.

Infections with Streptococcus pyogenes are highly relevant among the environmental factors that contribute to first onset or relapses of psoriasis in predisposed individuals. Streptococcal angina or pharyngitis, but also perianal streptococcal dermatitis, vulvovaginitis or balanoposthitis are potential causes. Several mechanisms such as molecular mimicry or superantigens may be involved. Many patients develop a chronic streptococcal infection or colonization that may result from the ability of streptococci for intracellular uptake and persistence in epithelial cells. Whether and under what conditions a curative treatment of streptococcal infection by tonsillectomy or antibiotic treatment may affect the course of psoriasis, as proposed by several observations, needs to be determined in more detail by clinical trials.

The recently published German S3- guidelines for the treatment of psoriasis vulgaris offer an extensive evidence-based documentation and evaluation of currently available treatment modalities. In order to incorporate this detailed information into the actual treatment decisions in individual patients, we have transformed the recommendations regarding phototherapy and systemic therapies into an algorithm. This algorithm should allow a stepwise treatment approach in adult patients with moderate to severe psoriasis, in whom topical therapy is not sufficient. It can also facilitate documentation of treatment. In our hands the treatment algorithm proved to be feasible and reliable in a large number of patients.

Efalizumab is a humanized monoclonal CD11a-antibody. It inhibits T-cell migration and activation which are essential steps in the immunopathogenesis of psoriasis. Clinical studies have demonstrated that efalizumab is efficient and safe in the treatment of chronic plaque psoriasis. Approximately 30% of patients achieve an improvement in PASI of > or =75% within 12 weeks, with further clinical benefit noted with continued therapy. Efalizumab thus appears as an important option in the long-term management of chronic plaque psoriasis.

During recent years the understanding of psoriasis pathogenesis has changed essentially. Psoriasis is now considered as a T cell mediated inflammation of the skin. Genetic predisposition and microbial environment cooperate in the induction of an antigen-specific T cell mediated immune response which may persist lifelong. The phenotype of the psoriatic inflammation is determined by the particular functional differentiation of the pathogenic T cells. The progress in understanding the pathogenesis of psoriasis has identified T cells and T cell-derived cytokines as targets for causal treatment approaches that in the near future will change psoriasis therapy considerably.

A 31-year-old male presented with widespread itchy papules, especially on the legs, which had appeared 4 weeks previously. He reported that his wife and both daughters had developed similar lesions during the last week. Numerous small beetle larvae had been detected in his apartment, which were identified as museum beetle Anthrenus museorum L. Prick test with a larva extract caused a positive prick-test reaction, followed by a papular delayed type hypersensitivity reaction. History, clinical and histological examination led to the diagnosis of papular Anthrenus-dermatitis. Eradication of the beetle larvae from the patient's apartment, followed by topical glucocorticoid therapy led to a permanent remission of the dermatitis in all household members.