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Background: Teledermatology addresses the problems associated with the lack of specialists and the often long waiting time for an appointment with a dermatologist. The research project Online Dermatologist-AppDoc enables a fast anonymous expert opinion and was approved on 22 October 2018 by the Landesärztekammer Baden-Württemberg for 2 years as a model project., Objectives: The aim of the present work is the presentation of the first real healthcare data for German teledematology within the framework of the external quality assurance of the model project Online Dermatologist-AppDoc., Materials and Methods: Anonymous data records submitted to Online Dermatologist-AppDoc between 21 November 2018 and 1 August 2019 were analyzed qualitatively and quantitatively at the Department of Dermatology of the University Hospital Essen. In addition to the evaluation of the data records submitted so far, 100 cases submitted underwent a second assessment by a board-certified dermatologist to assess concordance., Results: A total of 1364 cases (60.4% men, 39.6% women) were included in the current first external scientific evaluation. In 90.3% of the cases, remote diagnosis was possible. The two most frequent diagnoses were different forms of eczema (n = 270) and nevi (n = 163). Almost two thirds of the patients (64.3%) could be treated teledermatologically only. The random second examination of 100 cases resulted in an agreement of the diagnosis including the differential diagnosis/diagnoses in 97% of the cases., Conclusions: The first external scientific evaluation of the teledermatological model project Online Dermatologist-AppDoc indicates that the reduction of spatial and temporal barriers of a dermatological examination as well as the teledermatological triage have been so far successful.

Background: Sexually transmitted infections (STIs) in the anorectal region are disproportionally detected in risk populations such as men who have sex with men (MSM). However, due to changes in sexual behaviour they are increasingly diagnosed in heterosexual individuals. Due to the recent implementation of oral HIV pre-exposure prophylaxis together with lack of condom use, a further rise in STIs is expected., Objectives: This review addresses epidemiology, clinical picture, diagnostic pitfalls and current therapy guidelines of "classical" bacterial STIs involving the anorectum., Conclusions: STI manifestations in the anal region are frequently nonspecific or asymptomatic so that the diagnosis may be missed. In an endoscopic examination of the rectum, they can even mimic inflammatory bowel disease or malignancy. Therefore, knowledge of possible symptoms of bacterial STIs in this area is helpful for early diagnosis. Coinfections with other STIs are common and should prompt a search of other pathogens including HIV and hepatitis B/C.

Background: Kaposi's sarcoma (KS) represents the most common AIDS-defining neoplasm. Only very few studies regarding the course and treatment of human immunodeficiency virus (HIV)-associated KS have been carried out in Germany., Objective: In this study the course of HIV-associated KS was observed in patients from the cohort database of the competence network for HIV/AIDS., Material and Methods: Data from HIV-associated KS patients from 9 German core centers from 1987 to 2011 were retrospectively collected. Kaplan-Meier curves for the recurrence and survival probability were calculated., Results: In 222 patients KS was diagnosed at a median age of 38.5 ± 10.1 years. Men were almost exclusively affected (97.7%). The HIV viral load at the time of diagnosis was in 7.4% <50 copies/ml. Of the patients 55.5% developed KS with a CD4 cell count of <200 cells/μl and 9.5% with >500 cells/μl. In 68 patients KS therapy consisted exclusively of the optimization or initiation of antiretroviral therapy (ART). In addition, 71 patients were treated with pegylated liposomal doxorubicin. During the median follow-up period of 8.9 ± 4.9 years, 80.2% of the patients were free of KS recurrence. Survival rates after 5 and 10 years were 96.8% and 91.3%, respectively., Conclusion: Even with a good immune status HIV-associated KS occurred. An effective ART was the most important mainstay of therapy. With appropriate therapy, HIV-positive patients with KS showed a good survival rate.

Background: Sexually transmitted infections (STIs) are increasingly observed in men who have sex with men (MSM), which is associated with the success in the antiretroviral treatment of HIV infection. Additionally, in heterosexuals, anal intercourse is more prevalent than previously assumed. Thus, anorectal manifestations of STIs are not a rare condition., Objectives: This review will focus on the clinical picture, diagnosis and therapy of frequent STIs involving the anorectal region., Conclusions: Due to localisation and frequent asymptomatic course, STIs in this region often pose diagnostic problems. Anorectal manifestations of STIs consist of tumorous masses, ulcers or proctitis and may be misdiagnosed as malignancy or inflammatory bowel disease. Herpes simplex and syphilis primarily show ulcerations and may involve the perianal region, whereas gonorrhoea and lymphogranuloma venereum mainly cause proctitic symptoms with exsudation. Because of commonly occurring coinfections a complete diagnostic workup concerning other STIs should be performed.

Disseminated infections with non-tuberculous mycobacteria (NTM) are a life-threatening AIDS-defining illness. Localized infections include pulmonary and extra-pulmonary disease as well as the immune reconstitution inflammatory syndrome (IRIS). Furthermore cutaneous and subcutaneous manifestations of systemic NTM-Infections have been reported. Skin infections without involvement of other anatomical regions are predominantly caused by M. marinum and M. ulcerans. No association with HIV is proven for these two species. This article summarizes the diseases caused by this heterogeneous group of bacteria. The focus is on disseminated disease, dermatological manifestations and extra-pulmonary localized infections. Diagnostic challenges, therapeutic strategies and prognosis of NTM-infections are discussed.

The availability and use of effective antiretroviral combination therapies has dramatically decreased the morbidity and mortality of HIV infection. Almost complete suppression of viral replication by antiretroviral therapy prevents disease progression and development of resistance, as well as leading to both regression of HIV-associated symptoms and clinically relevant immune reconstitution. More than 20 antiretroviral substances in four classes have been approved. As a result of the broad therapeutic options, HIV infection can be better treated. Although a high number of combinations can be conceived, only a small number is actually applicable. The decisions to start, monitor and change therapy have become even more difficult. The indication for treatment, the selection of the most suitable therapy for an individual, the counseling of the patient, and the monitoring of the success of treatment demand a high level of knowledge and experience. Virologic failures of modern antiretroviral therapy regimens are rare in adherent patients.

In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA.

Colonization with methicillin-resistant Staphylococcus aureus (MRSA) strains is an increasing problem in the treatment of wounds. Only a very limited repertoire of effective treatment strategies is available, especially for outpatient care. We successfully treated a chronic leg ulcer colonized with MRSA on an ambulatory basis, using larvae of the common greenbottle fly Lucilia sericata. Whereas the proteases secreted by Lucilia sericata may lead to efficient selective necrolysis, the phenylacetate and phenylacetataldehyde may exert antimicrobial effects. Treatment with Lucilia sericata represents an effective and inexpensive treatment strategy of chronic wounds, especially when colonized with MRSA Due to the low acceptance by patients and medical stuff, it is not often employed.