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Acne inversa is a chronic inflammatory destructive skin disease that affects about 1% of the population. The therapy should be personalized and consists of surgical and conservative procedures. Antibiotics are administered either topically or systemically. Combination therapy with clindamycin and rifampicin for 10-12 weeks can be very effective. Furthermore, TNF-α inhibitors show adequate efficacy and can be recommended. Adalimumab is the only approved drug product for systemic treatment of acne inversa. The efficacy of retinoids is controversial. Isotretinoin cannot be recommended for the treatment of acne inversa; however, acitretin has been proven to be more effective. Immune-modulating substances, like dapsone, cyclosporine A, methotrexate, colchicine, or corticosteroids, can be considered; however, the study data are insufficient for recommendation. Hormonal therapies can influence the course of the disease. Antiseptics are applied independent of the stage of disease. Patients should be informed about triggering factors.

Background: Acne inversa (AI) is a common chronic inflammatory disease that has a profound impact on the patientsí quality of life. We hypothesized a higher level of depression in AI patients compared to controls., Objectives: We studied depression in patients with AI and control subjects. Additionally, we evaluated whether the severity of the disease, anxiety, sexual distress and acute inflammation may have an influence on depression., Patients and Methods: The Hospital Anxiety and Depression Scale (HADS) was given to 90 voluntary study participants to assess depression in AI patients and in age-, gender-, and BMI-matched controls. Moreover, the correlation between depression and conjectural influencing factors was evaluated., Results: This study demonstrated that AI patients have a higher depression score than matched controls. Importantly, 38.6% of AI patients are affected by depression compared to 2.4% of the control subjects. In contrast to the duration of the disease and the AI patientsí age, anxiety and sexual distress showed a strong correlation with the degree of depression., Conclusions: Patients with AI have a higher risk of developing depression. Physicians should be alert to the possible development of depression when treating patients with this disorder., (© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.)

Psoriasis vulgaris is a frequent, chronically relapsing, immune-mediated, systemic disease with characteristic skin changes. Despite the importance of this disease there are currently limited therapeutic options indicating a need for effective, long-lasting treatment strategies with few side effects. The most recent discoveries regarding psoriasis pathogenesis, particularly our results regarding two cytokines - IL-22 and IL-20 - could prove to be the foundation for such therapies. Whereas IL-22 is mainly produced by activated T-cell sub-populations (Th22, Th1, Th17), monocytes, dendritic cells and keratinocytes produce IL-20. Blood and lesional skin samples from psoriasis patients demonstrate high levels of IL-22 and IL-20. Interestingly, both cytokines act principally on keratinocytes and do not impact the immune system. Similar to the changes in the psoriasis epidermis these cytokines inhibit the terminal differentiation of keratinocytes although they simultaneously increase their innate defense, mobility, and the production of some chemokines. Some IL-22 effects are amplified by TNF-α, IL-17, and IFN-α. IL-22/IL-20 lends the reconstructed epidermis a psoriasis-like appearance with acanthosis, hypogranularity, and hyperkeratosis. In addition, mice that constitutively express high levels of IL-22 or IL-20 demonstrate a psoriasis-like appearance. A therapy counteracting IL-22 and IL-20 would be an innovative treatment with the potential for few side effects that would act on the final phase of psoriasis pathogenesis., (© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.)

With a prevalence of 2-3 percent, psoriasis is one of the most common diseases in dermatology. Most patients can be treated sufficiently with topical emollients, but approximately 20 percent of all patients suffering from psoriasis need photo- and/or systemic therapies. Side effects, contraindications, insufficient clinical responses, and lack of long-term efficacy underline the need for novel and improved antipsoriatic therapies. Several biologics interfering with key steps in the immunopathogenesis of psoriasis bear the potential to meet this need with regard to treating moderate to severe psoriasis. Progress made in the understanding of the pathophysiology of psoriasis as T-cell mediated dermatosis does provide options for new, more precise therapeutic approaches. These immunological therapeutic strategies are targeted at the inhibition of T-cell activation, the depletion of activated T-lymphocytes, the inhibition of adhesion of inflammatory cells, the inhibition of effects of proinflammatory cytokines and the application of antiinflammatory cytokines. This article gives a summary of new biologicals used in the treatment of psoriasis. Clinical results received from first applications are inconclusive. Further results of the studies from phase II and phase III can be expected in the next few years, which should make it possible to achieve better assessments of the potential of these types of treatments. Some of these approaches could lead to the approval of new drugs to treat psoriasis and to enhance or replace already existing therapeutic options.

In recent years the investigation of cytokines has been a focus of scientific interest in order to understand the pathogenesis of a variety of diseases. In additions cytokines are increasingly being used for therapeutic purposes, including dermatologic disorders. IL-10 is a recently described cytokine with anti-inflammatory and immunosuppressive qualities which plays an important role in immunoregulation. The overexpression of this mediator has been proven in some inflammatory dermatoses as well as in various skin tumors. These observations help to understand down regulatory events in hyper-inflammatory conditions such as allergic or toxic dermatitis on the one hand and the suppression of an adequate anti-tumor response and thereby the progression of malignant tumors on the other hand. Recent investigations indicate a relative IL-10 deficiency in psoriasis. Initial therapeutic applications of IL-10 in psoriasis underline the pathophysiological importance of this cytokine.

In this model, splenectomy does not significantly influence the intra- and extraperitoneal tumor growth. Although the spleen accounts 25% of the cellular immune capacity, we found no difference in pro- or antiinflammatory cytokines but a significant increase of the white blood count after splenectomy compared with the control group. The influence of splenectomy on growth of intraperitoneal disseminated tumor cells must be investigated in further studies.

Background: Laparoscopic techniques are frequently used in patients with peritonitis or intra-abdominal inflammatory diseases although increased intraperitoneal pressure may cause sepsis by promoting bacteraemia and systemic inflammatory response., Methods: This experimental study investigates the influence of laparotomy and laparoscopy on bacteraemia, tumour necrosis factor (TNF)-alpha and endotoxin plasma levels. Standardized foecal inoculum was injected intraperitoneally and rats underwent either laparotomy (n = 20), laparoscopy (n = 20), or no further manipulation in the control group (n = 20)., Results: One hour after intervention, bacteraemia was significantly higher in both the laparotomy or laparoscopy groups than in the control group (P = 0.01). Foecal inoculum caused a significant increase in TNF-alpha and endotoxin plasma levels 1 h after intervention with the significantly highest levels after laparotomy (P < 0.05). In addition, the mean number of intraperitoneal abscesses were also significantly higher (P < 0.05) after laparatomy (n = 10) than after laparoscopy (n = 8) or in the control group (n = 5)., Conclusions: Laparotomy and laparoscopy increased the incidence of bacteraemia and systemic inflammation compared to control group. However, inflammatory response and intraperitoneal abscess formation were significantly higher in the laparotomy group than in the laparoscopy group.