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Introduction: Currently, only little data is available on the impact of the COVID-19 pandemic on inpatient dermatosurgical care in German dermatological clinics., Methods: A retrospective analysis of all dermatosurgical cases that were treated in inpatient setting in nine German dermatological clinics in four federal states in 2019, 2020 and 2021 was performed. The diagnoses were recorded using the ICD-10 codes. In addition, demographic data such as age, gender and the length of inpatient stay were analysed., Results: In 2019, 2020 and 2021, a total of 10,739, 9185 and 9828 dermatosurgical inpatients were treated respectively. Thus, the reduction of inpatient dermatosurgical cases was 14.5% in 2020 and 8.5% in 2021 compared to 2019. Inpatient surgical treatment of melanoma decreased by 10.1% of cases in 2020. This decrease was only 1.4% in 2021 compared to 2019. The number of inpatient surgeries performed for benign lesions such as melanocytic nevi or viral warts reduced sharply in both pandemic years., Conclusion: Our data show for the first time how inpatient care for the entire spectrum of dermatosurgical diseases developed during the COVID-19 pandemic in Germany. After the initial marked decline in inpatient dermatosurgical cases in 2020, there was less difference in 2021 compared to 2019. This trend can be interpreted as an indication that there is still a strong need for inpatient dermatosurgical care that cannot yet be met on an outpatient basis., (© 2024. The Author(s).)

Background: Global climate and environmental changes impose a significant impact on human health by increasing prevalences of chronic and acute skin diseases. Climate-associated environmental changes can also trigger or intensify mental illnesses independently of a skin disease., Aim: Discussion of the effects of the climate and environmental changes on dermatological diseases applying the biopsychosocial model., Materials and Methods: A selective literature search in the PubMed database and other sources was conducted., Results: The biopsychosocial model considers complex interactions between biological, psychological, and social factors. In view of the consequences of climate and environmental changes, an extension of the model is proposed for the first time in order to address new challenges. The modified presentation supports the understanding of the dynamics and underscores that in dermatological care not only direct health effects of climate and environmental changes have to be dealt with, but also with an increasing number of mental illnesses, which in turn are to be regarded as direct and indirect health effects., Conclusion: Coping with the predicted increase in the burden of disease and the decline in the available labor force associated with demographic change poses a major challenge. In order to maintain the functionality of the healthcare system, the prompt implementation of resource-efficient, sustainable measures in all areas of society is essential. The integrative consideration of dermatological and psychological complaints in the context of climate and environmental changes requires the adaptation of content for the education, training, and continuing education of specialists., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Skin diseases are complex and cannot be explained solely by genetic or environmental factors but are also significantly shaped by social influences. This review illuminates the bidirectional relationship between social factors and skin diseases, demonstrating how social determinants such as socioeconomic status, living environment, and psychosocial stress can influence the onset and progression of skin conditions. Simultaneously, it explores how skin diseases can affect individuals' social lives and work capability, leading to a cycle of social withdrawal and further deterioration of the condition. The paper describes the need for a holistic approach in dermatology that goes beyond the biomedical perspective and incorporates social factors to develop effective prevention and treatment strategies. The increasing prevalence of skin diseases in Europe and the expected rise in allergies due to climate change make the consideration of social determinants even more urgent. The findings of this review aim to raise awareness of the complex interconnections between social factors and skin health and contribute to reducing social disparities in skin health., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objectives: Which theoretical and practical competences do the dermatological case histories of the Hippocratic Corpus convey?, Materials: The 431 Hippocratic case histories have been studied for reports and communication on diagnostics, therapy and prognosis of individuals and groups of patients suffering from skin diseases., Results: Within the seven books of the Hippocratic 'Epidemics', a total of 49 patients with dermatological symptoms are described; in 20 of these, skin disease was the leading suffering. The essential clinical signs were itching, red spots, blisters, pustules, aphthae, lichen, dandruff and hair loss. Most patients were male; one of the four women was pregnant, among the two children was a baby whose skin disease ended fatally. Eight patients were named. In addition, five waves of disease are reported, in the course of which the shape of the skin played an important role. The diagnostic workup was limited to inspection and palpation, but included the determination of the level of suffering. The follow-up checks often extended over months. Mostly, plasters and compresses with grain flour were primarily used for treatment., Conclusion: The Hippocratic doctor observed and described a large number of skin lesions and attempted to classify them in the differential diagnosis. In addition to changes in the color and tension of the skin, numerous lesions-for which the names are still often used in modern dermatology-are also described in detail. The skin manifestations associated with fever and abdominal symptoms are counted among the epidemic diseases. The condition of the skin was often regarded as an indicator of general health. In the case reports, conservative treatment adapted to the development of the disease dominated. In desperate cases, bloodletting was chosen as a last resort., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: With an ageing society the incidences of skin diseases increase., Objective: The most important skin diseases in geriatric patients are discussed., Material and Methods: A literature search was conducted using the PubMed database and standard dermatological textbooks., Results: Skin diseases in geriatric patients are often more susceptible to external influences and can be affected by visceral diseases. Due to a delayed diagnosis, malignant skin diseases in geriatric patients are first diagnosed at a higher stage., Conclusion: Physiological skin changes are to be treated with appropriate care. In the case of unclear skin changes, a timely dermatological check-up is to be done., (© 2022. The Author(s).)

Sarcoidosis is a systemic disease of unknown aetiology. Typical histology shows epithelioid cell granulomas, and typical immunopathology enhanced Th1 type immune responses in the involved organs. The disease occurs worldwide, but more frequently in northern countries than in the south. In Germany, the incidence is estimated to be 10 per 100,000, and the prevalence 44-48 per 100,000. Sarcoidosis usually affects adults under 50 years of age, but can also be seen in children, adolescents and in the elderly. Women are more frequently affected than men. Familial clusters can occur. The clinical presentation of sarcoidosis varies widely and depends on the manifestations in the individual organ. Systemic symptoms include fatigue, night sweats, weight loss, fever, arthralgia and myalgia. Organ-specific symptoms include cough and dyspnoea, with pulmonary involvement, headache and palsy in neurosarcoidosis, arrhythmias and heart failure in cardiac sarcoidosis, and manifold skin lesions with skin involvement. Relapses are rarely seen in acute sarcoidosis, whereas the chronic form tends to relapse more frequently. Löfgren's syndrome, a specific phenotype of acute sarcoidosis, is characterised by bihilar lymphadenopathy, ankle arthritis and erythema nodosum. Chronic sarcoidosis can be asymptomatic, despite radiological changes, which may be extensive. By definition, sarcoidosis has become chronic after 2 years of disease with ongoing signs of activity. The long-term prognosis is generally good, but depends on the different organ manifestations and complications., Competing Interests: Interessenkonflikt: Nein., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Over recent decades, both the incidence and prevalence of chronic inflammatory bowel disease have continued to rise in industrialized countries; the disease is frequently associated with extracutaneous involvement and comorbidity., Objectives: The purpose of this work was to investigate the frequency and specificity of mucocutaneous manifestations in Crohn's disease (CD) and ulcerative colitis (UC)., Materials and Methods: An extensive search in peer-reviewed journals via PubMed was performed; presented is a summary and analysis of various studies and data, including data of patients treated at our department., Results: CD and UC are frequently associated with mucocutaneous symptoms; however, primary/specific disease-associations are exclusively seen in CD patients. These include peri-anal and -stomal fistulas and ulcerations, "metastatic" Crohn's disease as well as oral granulomatous disease. Moreover, in both CD and UC, there occur several other inflammatory skin conditions such as erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa, chronic oral aphthous disease, Sweet syndrome, pyostomatitis vegetans, and bowel-associated dermatosis-arthritis syndrome. Malnutrition syndromes (zinc and vitamin deficiencies) are only rarely observed., Conclusion: On skin and oral/genital mucous membranes various different inflammatory manifestations may be observed during the course of CD or UC. However, most data about a direct pathogenic relationship of the gastrointestinal and dermatologic disorders are quite heterogeneous or even contradictory. Nevertheless, knowledge of these conditions and their possible association with CD and UC could be crucial for early diagnosis and initiation of an appropriate therapy and thus be essential to prevent secondary tissue damage.

Background: In 2014 the number of refugees and asylum seekers in Germany rose steeply. Therefore, the provision of sufficient medical care for this special group of people became a major topic. Up to now, data on the spectrum of illnesses in this group in Germany is scarce., Patients and Methods: Anonymized data of 548 ill refugees and asylum seekers were retrospectively evaluated. Cases from three different institutions and time periods were collected and summarized: 329 outpatients from the general medical clinic of REFUDOCS (RD, January to beginning of March 2015), 175 inpatients from the 1. medical department of the municipal hospital Schwabing (KS, June 2014 to February 2015) and 44 outpatients from the department of infectious diseases and tropical medicine of the Ludwig-Maximilians-University, Munich (AITM, 2014)., Results: Health problems seen at the RD general medical clinic mostly matched the usual spectrum seen by general practitioners. Respiratory illnesses especially by unspecific viral infections (152 visits), followed by neuropsychiatric (68), and gastrointestinal illnesses (56), as well as musculoskeletal (52) and skin problems (45), were common. Infectious diseases or diseases typical or specific for the tropics were mostly treated in the specialized centers. Cases of pulmonary and extrapulmonary tuberculosis (53), malaria (53), scabies, pneumonia, and schistosomiasis were prevalent., Conclusion: The results of this exemplary study mostly show the occurrence of illnesses in refugees and asylum seekers that are well known to German general practitioners and pediatricians. However, depending on the country of origin infectious / tropical diseases like tuberculosis, malaria, or relapsing fever have to be considered. Rapid diagnosis of these illnesses is warranted to prevent severe cases or further spreading of contagious diseases., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Although seldom diagnosed, post-traumatic stress disorder (PTSD) has a high prevalence in primary and tertiary care. In a consecutive cross-sectional study, the prevalence of traumatic experiences and the severity of post-traumatic symptoms as well as specific characteristics of traumatized patients in the context of the dermatological treatment were examined., Patients and Methods: Standardized questionnaires for assessing general psychopathology (Brief Symptom Inventory, BSI), coping with dermatological diseases (Adjustment to Chronic Skin Diseases Questionnaire, MHF) and diagnosis of trauma (Essen Trauma-Inventory, ETI) were used in 221 patients with different skin diseases., Results: In total, 85.1 % of the patients reported at least one potentially traumatic event in their lives, whereby psychometrically in 8.6 % of the cases the diagnostic criteria for a PTSD were met. Patients with suspected PTSD were more impacted by psychopathology, had more problems in coping with their skin diseases and attributed mental stress as having a greater influence on their skin disease than nontraumatized patients or traumatized patients without suspected PTSD. In addition, cumulative traumatization also leads to increased trauma symptomatology and greater difficulties in coping with skin diseases., Conclusion: The results emphasize the impact of a comorbid PTSD on a patient's ability to cope with skin diseases and underline the need for the inclusion of the differential diagnosis PTSD in dermatological treatment settings.

In the last 30 years the amount of white markings in the population of Franches-Montagnes horses (FM) has more than doubled which has led to some controversy, particularly in respect to the health of the horses. The objective of this study was to investigate if the coat colour and white markings have an impact on selected skin diseases and hoof horn abnormalities. To this purpose 974 three-year-old FM were subjected to a clinical examination during the field and station tests organized by the FM breeding association. In 16.9% of the horses, one or several equine sarcoids were detected, 15.2% of the horses showed clinical signs of pastern dermatitis, 1.1% of insect bite hypersensitivity and 18.0% of dermatitis of other aetiology. Abnormalities of the hoof horn were found in 20.1% of the horses. The prevalence of pastern dermatitis was 2.6 times higher in legs with white markings than in legs with pigmented skin (p <0.0001). The probability ofsuffering from sunburn and hoof horn of lesser quality was increased in animals with an elevated white marking index (WAI; p = 0.022 and p = 0.038), on the other hand, horses with sarcoids had a significantly lower WAI than sound horses (p = 0.038). Our study shows that FM horses with more pronounced white markings have an increased risk to suffer from pastern dermatitis, sunburns and hoof horn abnormalities. The coat colour was not associated with skin diseases.

Background: The volume of search engine queries about disease-relevant items reflects public interest and correlates with disease prevalence as proven by the example of flu (influenza). Other influences include media attention or holidays., Study Goal: The present work investigates if the seasonality of prevalence or symptom severity of dermatoses correlates with search engine query data., Methods: The relative weekly volume of dermatological relevant search terms was assessed by the online tool Google Trends for the years 2009-2013. For each item, the degree of seasonality was calculated via frequency analysis and a geometric approach., Results: Many dermatoses show a marked seasonality, reflected by search engine query volumes. Unexpected seasonal variations of these queries suggest a previously unknown variability of the respective disease prevalence. Furthermore, using the example of allergic rhinitis, a close correlation of search engine query data with actual pollen count can be demonstrated., Discussion: In many cases, search engine query data are appropriate to estimate seasonal variability in prevalence of common dermatoses. This finding may be useful for real-time analysis and formation of hypotheses concerning pathogenetic or symptom aggravating mechanisms and may thus contribute to improvement of diagnostics and prevention of skin diseases.

While the impact of obesity on diabetes, cardiovascular disease and carcinoma development has been studied extensively, only little attention has been paid to its influence on the skin. Obesity alters the skin barrier, can induce skin manifestations, and worsens existing skin diseases like psoriasis. Cutaneous manifestations of obesity may be pseudoacanthosis nigricans, fibroma pendulans (skin tags, fibroepithelial polyps) and striae distensae. Obesity is also associated with hyperandrogenism in women and girls, promoting acne vulgaris, hirsutism, and androgenetic alopecia. In addition, there is a pathogenic association between obesity and psoriasis: the release of pro-inflammatory factors from fat tissue results in the worsening of psoriasis; an association between the severity of psoriasis and the body mass index has been shown. Obesity promotes skin infections like erysipelas and intertrigo.

20% of the population suffers from a dermatologic disease. Most patients with skin problems first try a self-medication or seek the general practitioner.That is the reason why general practitioners should have some knowledge in dermatology. Most patients with skin problems attending the family physician have eczema, infections of the skin or benign skin tumors. Most common prescribed dermatologic medications are antihistaminics, anti-microbial agents and topical steroids.The skin is a boundary to the inside and to the outside. Skin diseases can lead to secondary problems in internal organs and on the other side disorders of internal organs can produce typical skin lesions which can be a clue for diagnosis.

The incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.

Rheumatoid arthritis (RA) represents an autoimmune disease affecting mostly joints, in particular small finger and toe joints. In addition RA can show extra-articular manifestations in many organs. Information on the frequency of extra-articular manifestations (EAMs) in RA varies greatly in different publications from 17.8% to 40.9% and EAMs tend to become higher with increasing duration and severity of the disease. The exact etiology and pathogenesis are still unclear but vasculitic alterations together with deposition of immune complexes can often be found histopathologically in affected organs. It must also be taken into consideration that EAMs can also be a result of the pharmaceutical therapy. The organ findings can vary greatly which is also reflected in the multitude of clinical symptoms. Possible target organs are the blood vessels, kidneys, central nervous system, cardiovascular system, the lungs, eyes, skin, nails as well as blood and the hemopoetic system. The prognosis for RA becomes progressively worse in the presence of EAMs. Regular and continuous control investigations are necessary in order to be able to diagnose EAMs early and to begin therapy. Therapy includes the administration of non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) and especially in advanced stages cyclophosphamide or biologicals. Therapy is still very empirical due to the lack of appropriate studies.

In 2007, the German Federal Government introduced a general health insurance obligation, but there are still vulnerable groups such as poor and homeless people without access to medical care. Especially for social fringe groups, a visit to the doctor involves many obstacles. Ten years ago the project "Outreach medical care for homeless people and people threatened by homelessness in Hanover" was established in order to reduce those gaps in healthcare provision. A continuously conducted evaluation of the project shows that low-threshold consulting hours are accepted and the transition to medical specialists is becoming increasingly easy. So the evaluation plays an important part in the development of the project. Since the healthcare reform in 2004, however, the number of cases has increased by 30 % while the actual homeless target group has remained the same. In order to guarantee access to the healthcare system for patients who cannot afford additional payments, the abolition of the quarterly practice fee and other additional payments for people on a low income is an important step. The growing requirements, resulting from a changing clientele and changes in the general conditions, are raising questions as to the nature of such projects and its future funding. In the long run it isn't the aim of this non-profit project to take on central tasks of a mutually supportive community. Therefore the data and results collected on the evaluation not only serve to improve the projects management, but also provide important information to other initiatives outside Hanover whether and how to support the respective groups of patients., (Copyright © 2012. Published by Elsevier GmbH.)

Dermato-epidemiology is an important scientific discipline which investigates skin diseases using epidemiological methods. Epidemiology is the science of the distribution and determinants of disease in specified populations. We describe fundamental terms of dermato-epidemiology (measures of disease occurrence, measures of risk), different study types (observational studies, interventional studies), the selection of statistical tests, bias and confounding as well as the principles of evidence-based dermatology, and give illustrative examples.

Assessment of benefits and quality of medical healthcare treatment is becoming more and more important. In order to accurately carry out this assessment and to assure a reliable planning of health care, valid data are needed. Health services research is an interdisciplinary field of research, which provides information on disease and health care and to uncover suboptimal and incorrect services. This information can be used to improve the quality of treatment and to increase efficiency. In order to obtain information on the health care for skin and allergic diseases the German Center for Health Services in Dermatology (CVderm) was founded in 2005. It is actively involved in the coordination and conducation of health care, collaborating with other university groups.

Patient registries are prospective, systematic data collections, which are non-interventional (observational) in nature and reflect care practices under routine conditions. As a result, they include the most common disease characteristics (e.g. in cancer registries) and/or medical interventions (e.g. in therapy registries). The importance of registries in health services research and in clinical medicine is rapidly increasing. This is due to increasingly scarce resources in the health system and the growing need for data on benefits and efficiency. Registries permit evaluation long-term outcomes on e.g. quality of life, effectiveness as well as treatment quality. An overview of registry methodology from definitions to data analysis is given, existing registries in dermatology in Germany are summarized.

Aim of the Study: For public health promotion purposes it is important to know how the general public perceives the risk factor "UV exposure" and how UV risk perception is connected to health-related attitudes and beliefs. The aim of the study was to collect representative data about UV risk perception in Germany., Methods: A representative telephone survey using the ADM design was carried out among 1 501 German residents between May and July 2007. Variables related to UV risk knowledge, relevance of risk topics in every-day thinking and risk estimates were investigated. Data regarding a subjective benefit evaluation of UV exposition was also collected., Results: The results suggest no essential gaps in the general knowledge about UV risks, except for the underestimation of UV-related cataracts. The respondents thought it extremely likely that UV exposure would cause health damage such as skin cancer, photoaging or sun burns. People were asked to report how often they had thought about a number of health risks including UV risks in the last two weeks. It was established that UV risks are present but not dominant in people's every-day thinking. Along with it, the risk evaluation proves to be rather moderate. The mean value for respondents' perceived personal risk is M=5.1, in the midsection of the given 10-point scale. The results show that perceived personal risk is not influenced by the serious UV health risks such as cancer or cataracts. The results also indicate that UV benefit and UV risk perception are not strongly related to one another., Conclusions: In summary, participants' perception and assessment of the various health risks of UV exposure seem to be realistic, but the UV risk assessment it is not related to the perception of personal risk. One must therefore assume that UV health risk information and education campaigns do not necessarily lead to a change in the perception of personal UV risk. Rather than addressing primarily risk knowledge, UV risk communication should focus more on motivational aspects and consider the role of UV benefit perception., (© Georg Thieme Verlag KG Stuttgart · New York.)

During recent decades the industrial use of isocyanates has expanded enormously due to the huge product palette with a variety of different properties. As opposed to the fast technical development, there is a delay in the formulation of respective occupational health and safety regulations. Adverse health effects of isocyanates are mainly due to inhalative exposure. In addition, cutaneous contact causes toxic as well as allergic reactions. Oligomeric and polymeric isocyanates that are mostly used in the industry are only regulated in the Technical Rules for Hazardous Substances 430 (TRGS 430), but not by the mandatory occupational medical surveillance directive (Arbeitsmedizinische Vorsorgeverordnung). Although the TRGS 430 facilitates risk assessment (e. g., the aerosol penetration factor is related to the size of aerosols; only the acute irritative effect of oligomeric and polymeric isocyanates as shown in animal studies is taken into consideration in the case of defining a so-called evaluation factor), so far this new regulation has not yet been implemented in practice according to our own findings.

Scientifically based prevention and patient management concepts in occupational dermatology have substantially improved during recent years. Currently the public statutory employers' liability insurance bodies fund a multi-step intervention approach designed to provide quick preventive help for all levels of severity of occupational dermatoses. An administrative guideline (hierarchical multi-step intervention procedure for occupational skin diseases--"Stufenverfahren Haut") insures professional support and optimal patient orientation by the statutory insurers' representatives. For secondary prevention, the so-called dermatologist's procedure ("Hautarztverfahren") was recently updated in order to provide more rapid dermatologic consultations which are covered for by the public statutory employers' liability insurance bodies. Additionally, combined outpatient dermatologic and health-educational intervention seminars ("secondary individual prevention"[SIP]) are offered to affected employees in a nationwide scheme. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed ("tertiary individual prevention"[TIP]). TIP requires 3 weeks inpatient treatment including intensive health care instruction and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study ("Medical-Occupational Rehabilitation Procedure Skin--optimizing and quality assurance of inpatient-management"-"Medizinisch-Berufliches Rehabilitationsverfahren Haut--Optimierung und Qualitätssicherung des Heilverfahrens"[ROQ]) started which will further standardize TIP and evaluate scientific sustainability in depth (3-year dermatological follow-up of 1,000 patients). The study is being funded by the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]).

Background: Skin diseases have great socio-economic importance in Germany due to their high and in some cases still-increasing prevalence. Little attention has yet been paid to the influence of the change in climate on these diseases., Objective: Clarify the evidence of the effects of climate change on the prevalence of skin diseases and allergies in Germany., Methods: First, a theoretical model of the possible mechanisms and influence factors of climate and weather was created for different disease groups (skin malignancies, allergies, skin infections). Then, a systematic online and manual literature search was made for model-derived key words.The relevant publications were selected and evaluated according to a priori criteria., Results: From a total of n = 31,221 hits, n = 320 publications remained for evaluation.Changes in the following parameters can be regarded as essential climatologic factors influencing the prevalence of skin and allergic diseases: temperature, UV radiation, precipitation/humidity, cloudiness, and general weather conditions.There were only a few original articles addressed to this topic. Most of them address recurring phenomena (especially levels of airborne pollen), UV radiation or ozone (and the ozone hole). Quantitative statements, prognosis models and climate scenarios have not yet been published for Germany with respect to skin diseases., Conclusion: Only few scientific articles on the relationship between climate changes and the prevalence of skin diseases have been published. They do not allow a reliable statement on future developments. The outlook for changes in prevalence requires further clarification using published climate models.

Study Objective: As a consequence of the demographic transition, the proportion of geriatric nurses aged over 50 is increasing. The present study examines whether the prevalence of skin and back diseases and preventive behaviour differ between this group and younger employees. An additional objective was to record the proportion of older employees with a health- and occupation-related impairment., Methods: 2 149 nurses working in home care settings and nursing homes were questioned in written form about their working ability, their preventive behaviour and their health situation. They were also subjected to dermatological investigation (with the Osnabrück Hand Eczema Severity Index - OHSI) and orthopaedic investigation (based on the multiple-step inventory of examinations)., Results: Older nurses more often rated their working ability as "(fairly) poor" than did younger nurses. This applied both to physical demands (11 vs. 4%) and to psychological demands (10 vs. 5%). They were also more affected by symptoms in the cervical spine (28 vs. 13%) and the lumbar spine (56 vs. 37%). Hand eczema was not more prevalent in older nurses. The state of health of 10% of the nurses aged over 50 indicated a health- and occupation-related impairment in regard to work ability and back complaints. Roughly equal proportions of the younger and older groups participated in measures for the primary prevention of back symptoms. The older nurses participated more often in advisory sessions on skin protection and more frequently applied cream to their hands. The younger nurses were in skin contact with water or fluids for shorter periods and more often exclusively used disinfectants after patient contact., Conclusion: Geriatric nurses with a health- and occupation-related impairment require intensive measures to support their health and to prevent health damage and to stop them from leaving work prematurely. If at all possible, these measures should not be restricted to a single social insurance agency. The individual preventive behaviour to avoid occupational back symptoms is not dependent on age. An age effect was observed for individual measures to protect the skin. Nevertheless, these had no effect on the risk of disease. The results indicate that more attention should be given to older employees during occupational training.

History: A 60-year-old man with diabetes mellitus and chronic renal insufficiency needing hemodialysis was admitted with a 3 months history of multiple hyperkeratotic papules on the trunk and extremities partly ulcerated with a keratotic central plug., Investigations: Laboratory tests revealed elevated levels of blood urea nitrogen, creatinine, and HbA (1c). Histopathology showed vertical strands of collagen perforating from the ulcerated lesions. COURSE, DIAGNOSIS AND TREATMENT: The biopsy specimen was consistent with acquired reactive perforating collagenosis. The progression was stopped and secondary wound healing was initiated after two weeks of therapy with allopurinol and PUVA., Conclusion: Acquired reactive perforating collagenosis should be considered when ulcera with oystershell-like keratotic plugs are found especially in patients with predisposing diseases like diabetes and renal insufficiency. A good interdisciplinary cooperation between internist and dermatologist is crucial for the early recognition by histopathology and the immediate treatment.

Background: Acquisition of patient's quality perception is an essential element for quality management in a clinic. Determinants important for patient satisfaction at a dermatological university clinic were investigated., Patients and Methods: 650 in-patients of a dermatological university clinic were approached in written form at discharge. The questionnaire contained questions to importance and satisfaction, to structures and processes of the clinic orientated at the requirements of KTQ (Cooperation for transparency and quality in the hospital)., Results: The response rate was 51 %. 98 % of the patients stated that they would like to be treated in the clinic again. High satisfaction was shown to important items for patients as medical and nursing care and the healing process. In general patient's needs differ little to those derived from other patient questionnaires but they show specialty specific features. Important suggestions can be derived from the attached free text answer., Conclusions: From the results a lot of steps to improve patient's care could be derived and implemented. Since the results of patient questionnaires are subjected to multiple partially subjective factors, the comparison with other hospitals/disciplines (benchmarking) or the exact scientific acquisition is only restrictedly possible. Repetitive investigations in combination with further steps are a valuable instrument on the way to a continuous improvement process.

Background: Anogenital dermatoses (AGD) are common and often very distressing. Clinically it is often unclear if allergic contact dermatitis or irritant dermatitis is involved. In order to optimize therapy and prophylaxis, it is essential to identify relevant allergens or irritants., Patients and Methods: Data of the Information Network of Departments of Dermatology (IVDK, data center in Göttingen) collected between 1999 and 2003 were analyzed. The anogenital area was involved in 1 168 patients with suspected allergic contact dermatitis. Clinical variables and patch test results were statistically compared with the remaining IVDK patch test population, the latter standardized for age and sex., Results: Allergic contact dermatitis had been suspected prior to patch testing in 39.5 %, while in 24.6 % this diagnosis was eventually confirmed. Irritant contact dermatitis was diagnosed in 11.8 %. Other diagnoses, included balanitis, lichen sclerosus et atrophicus and herpes genitalis. Positive reactions to cinchocaine (6.6 %), bufexamac (3.5 %) and benzocaine (2.4 %) were observed significantly more often among patients with anogenital dermatitis. Among those in whom co-factors were considered important (n = 422), wetness (38.4 %), occlusion (30.3 %), mechanical strain (4.7 %) and heat (3.6 %) were mentioned as irritation factors., Conclusion: Because of the significantly higher frequency of sensitization to cinchocaine, benzocaine and bufexamac in patients with anogenital dermatitis, these ingredients should be used only with caution. According to the literature, ingredients of toiletries, cosmetics and contraceptives of any kind seem to cause allergic contact dermatitis rarely although there are several case reports. Comprehensive patch test including the standard series plus major sensitizers such as cinchocaine, benzocaine and bufexamac, and in particular patients' own skin care products, is recommended.

Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations. In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes. Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients' history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients' history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes. It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.

During the last century the median life expectation age was lengthened about 30 years in Germany. According to recent prognoses this trend will continue over the next decades. Not only the number of people older than 60 years but also its percentage within the population was and will be increasing dramatically. This has important socio-economic, political and health-economic consequences. The increasing older population has an important impact on Dermatology. The incidence of many skin diseases is increasing with age due to life long exposure (e. g. UV-light), and aging processes are affecting the skin, its functions and immunology. Last not least, the distinction between skin disease and "cosmetic" skin problems has changed in the past decades in our society. Even a small reduction in the threshold of what the public and health professionals regard as a skin complaint worthy of medical attention could lead to a large increase in future dermatology service requirements. The demographic changes in our society are becoming an important issue in dermatological health care research.

The high incidence rates of occupational contact dermatitis, its poor prognosis, and the high social and economic impact of the disease for the affected individuals as well as for the medical insurance companies indicates a need to strive for the target of "rehabilitation instead of retirement". Here, we highlight the need and effectiveness of rehabilitation measures in individuals with work related skin diseases (mainly contact dermatitis and hand eczema). We discuss the measures for secondary individual prevention as well as tertiary prevention, which have been established in our department together with the state medical insurance companies, mainly the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BWG: Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Service). The results of the multicentre study "Optimisation and Quality Assessment of Tertiary Prevention of Occupational Dermatoses" are presented and discussed. Both, the secondary as well as tertiary prevention measures have been successful, which has resulted in a decrease in the total annual rehabilitation costs to the BGW. A reason for this success story is the fact that in Germany these organisations are, in contrast to the health insurance companies, responsible for both acute treatment and the rehabilitation.

Particles in the air influence mortality and morbidity even in concentrations which were considered harmless. This report examines their role in allergies. Studies on children from areas with different degrees of pollution show that the "classical" type of air pollution with high amounts of coarse particles apparently does not induce allergies. Nearly all studies, which characterized exposure on a smaller spatial scale, found that symptoms of asthma and allergic rhinitis were more common in children exposed to traffic-related pollution. Time series and panel studies demonstrate that particle pollution contributes to asthma aggravation. Whether this applies to eczema or allergic rhinitis has hardly been investigated. Overall the studies suggest a special role for traffic-related particles.

Background and Objective: With the advent of the DRG system, German hospitals are being forced to improve cost transparency and to uncover inefficient structures., Methods: Diagnosis-based costs were calculated in the Department of Dermatology in the University Hospital of Freiburg for ten samples, each containing 20 cases. By using in-patient files, cost and productivity information for the fiscal year 2000 was attributed to each single case in a bottom-up-approach. The resulting total costs per case were contrasted to their remuneration under the DRG system., Results: Average case costs were determined between EUR 1,339.83 and EUR 5,714.73. With 19.3% to 28.4% of total costs, nursing costs were the biggest single cost factor. Prolonging the length of stay incurred average extra costs of EUR 144.26 to EUR 199.98 per case and day. The correlation of case costs and their corresponding DRG cost weights was modest with r=0,48. There was considerable cost variance within individual DRGs., Conclusions: The diagnosis-related cost calculation reveals striking cost differences relating to specific diagnoses. This method is more suitable for cost calculations in the hospital than more general approaches.

Background: Since January 2004, all German hospitals have been obliged to operate with a new hospital funding system based on DRGs. For the DRG system to serve as a fair basis for reimbursement requires that the dermatologic services be adequately covered in the classification system. The German Dermatologic Society (DDG) in cooperation with the DRG-Research Group of the University Hospital Muenster carried out a DRG evaluation study. Based on these results, suggestions for the adjustment of the G-DRG system were proposed by the DDG in the G-DRG adaptation round for 2004., Methods: Based on data of the DRG evaluation project (14,555 dermatological cases from 19 hospitals) the homogeneity in the G-DRG system 2004 was examined and compared with the quality of depiction in the G-DRG version 1.0., Results: The correlation between expenditure and case mix index in the hospitals improved in the G-DRG system 2004. Most proposals submitted by the German Dermatologic Society for the adaptation into the G-DRG system 2004 were accepted. Some fundamental problems such as reimbursement of high cost drugs and special services, as well as the reimbursement of high and low outliers, were only marginally addressed., Conclusions: The G-DRG system 2004 will need to be continuously adapted in the field of dermatology. Based on this work, the German Dermatologic Society has made suggestions to be adapted in the G-DRG system 2005 and submitted them to the German DRG Institute.

Background: Expert dermatologic evaluation is the most relevant tool for secondary prevention in occupational dermatology in Germany. If there is a possibility of a work-related skin disorder in an employee, dermatologists may conduct the relevant diagnostic procedures (e.g. patch-and prick-tests, serology) at the expenses of the public employers' liability insurance fund (UVT). Most dermatologists make careful use of this unparalleled privilege, which is also an obligation. However, recently, with an increasing number of dermatologist's reports submitted, there have been occasional complaints by the UVT concerning overly extensive testing. In 1999 the Task Force on Occupational and Environmental Dermatology (ABD) of the German Dermatological Society established a clearing procedure. Two experienced occupational dermatologists will--separately--give their expert opinion on dermatologist's reports which have been forwarded anonymously by the UVT for expert review., Results: Thus far, from May 1999 to May 2003 155 dermatologist's reports have been submitted to the clearing procedure. The complaints were in > 95% of cases considered justified by the experts. Their criticism was primarily directed towards excessive testing procedures and failure to provide sufficient clinical information., Conclusions: The UVT does not undertake such extensive preventive efforts for any other occupational disease. Therefore, quality management of the dermatologist's procedure--conducted by dermatologists and providing transparency--is essential to maintain and develop this effective tool of secondary prevention for the benefit of workers and employers.

Within the scientific establishment of dermatology, it is difficult to initiate or to support basic dermatology services in Third World countries. The author describes his experiences over 10 years in backing a community-based health care project in western Kenya. The problems with supporting tropical dermatology in Germany are also discussed.

Background: Dermatology and venereology, as a cross-sectional discipline, plays an important role in the interdisciplinary care of inpatients. Nonetheless, only a few studies on dermatological consultations have been performed. We reviewed the dermatological consulting service at the University Hospital of the Martin-Luther-University, Halle, Germany., Patients and Methods: All consultations performed in 2001 and 2002 were retrospectively assessed. In addition, the time spent in consulting activities was prospectively recorded over a period of six months (January-June 2003)., Results: A total of 2390 consultations were evaluated. Most of the consultations (42.8%) were made on internal medicine wards, followed by pediatrics (11.7%), neurology (9.9%) and cardiothoracic surgery (5.7%). Infectious skin diseases accounted for the most frequent diagnosis at 24.4%. The time lapse between request and performance of the consultation averaged 1.1 days. Patients older than 40 years needed dermatological consultation more frequently than younger patients. The duration of consultation averaged 23 minutes (time to site, patient examination, documentation). Thus, the man-hours required for the consulting service is 33.6 per month., Conclusion: The study emphasizes that dermatological consultation services make an important contribution to the care of inpatients. In light of increasing specialization in medicine, the consulting service guarantees interdisciplinary treatment of the patients and is thus an important quality parameter for inpatient care.

Objective: The aim of this cross-sectional study was to establish the prevalence of physical diseases, the subjective evaluation of their own health and health care utilization in the actually homeless and a comparison group of formerly homeless., Methods: A representative sample of 82 homeless and 37 formerly homeless was studied. Instruments were a physical examination and a standardized interview. The latter included parts of the assessment of the German cardiovascular disease prevention study and the questionnaire "Funktionseinschränkungen" (functional impairments) by Potthoff (1982)., Results: Disease prevalence was high. The main diagnoses fell within the categories of defective dental status (over 80%), ophthalmologic diseases (over 60%) and diseases of the liver and musculoskeletal system (over 40% each). Morbidity in the formerly homeless was even higher. In both groups the subjective evaluation of their own health was unrealistically positive. Risk factors for cardiovascular diseases were high. Health care utilization was mainly acute., Conclusions: The medical care of the homeless in standard medical services is insufficient and could be improved by especially tailored projects which should include education about risk factors. Formerly homeless continue to show high disease prevalence.

The demand for non-surgical cosmetic treatments has grown considerably in recent years. It appears German dermatology departments now also increasingly seem to offer many of these methods. In 2001 we evaluated the use of different non-surgical cosmetic techniques in German dermatology departments through means of a national questionnaire. Information was requested from 85 departments, of which 63.5% responded. The outcome revealed that 96.3% of the participating departments have lasers at their disposal to treat cosmetic skin lesions, 79.6% carry out injections with botulinum toxin, 59.3% perform chemical peels and 37% perform tissue augmentation with injectable fillers. Overall, the ratio between desired and adverse effects as well as the economic benefit of all evaluated methods was judged as positive by the interviewees. In a comparison of all evaluated modalities, the therapeutic index was considered most favourable with botulinum toxin and most unfavourable with injectable filling agents. With regard to cost-effectiveness, soft tissue augmentation was judged best, while chemical peels alongside lasers were regarded as least advantageous in this respect. Further evaluated topics were indications, substances, organisation and other issues. In summary the survey confirmed that a large number of German dermatology departments employ non-surgical cosmetic procedures matching the international upward trend of cosmetic dermatology.

During the last century the median life expectancy increased by about 30 years in Germany. According to recent prognoses, this trend will continue over the next decades. Not only the number of people older than 60 years but also its percentage within the population has and will continue to increase dramatically. This has important socio-economic, political and health-economic consequences. The increasingly older population has an important impact on dermatology. The incidence of many skin diseases increases with age because of long-term exposure to exogenous factors such as UV irradiation. Aging processes especially affect the skin. Last not least, the distinction between skin disease and "cosmetic" skin problems has changed in the last decades in our society. Even a small reduction in the threshold of what the public and health professionals regard as a skin complaint worthy of medical attention could lead to a large increase in future dermatology service requirements. The demographic changes in our society are becoming an important issue in dermatological health care research.

Background and Aim: Tea tree oil, a distillation product of the Australian tea tree (Melalence alternitolia) is increasingly used as an alternative remedy for various dermatological diseases. Tea tree oil contains several allergenic monoterpenes and sesquiterpenes. In this multicenter study it was evaluated, whether the increasing use of tea tree oil has lead to an increased frequency of sensitization in Germany and Austria which would justify its inclusion into the standard series., Patients and Method: For patch testing a standardized tea tree oil was used, dissolved 5% in diethylphtalate (DEP). Consecutive patients of 11 dermatological departments in Germany and Austria were tested. Readings were taken on day 2 and 3 according to the guidelines of the German Contact Dermatitis Research Group (DKG)., Results: 5% tea tree oil was positive in 36/3375 patients (1.1%). Sensitization frequencies showed great regional variations and ranged from 2.3% (Dortmund), 1.7% (Buxtehude), 1.1% (Essen), 0.7% (Graz), to 0% (Berlin, Vienna). 14/36 patients (38.9%) also showed a positive patch test reaction to oil of turpentine., Conclusion: Our results show that tea tree oil is an important contact allergen for some centers. It should be tested, if medical history suggests its previous use. Considering the great regional differences in frequencies of sensitization its inclusion into the standard series is not recommended yet.