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Clinical picture, potassium hydroxide preparation and fungal culture are the principal diagnostic tools of tinea capitis. In Germany, griseofulvin is the only approved antifungal agent for the treatment of tinea capitis in children. The modern ergosterole biosynthesis inhibitors (terbinafine, itraconazole, and fluconazole) are namely tested and allowed for antifungal therapy in adults. They are not yet admitted for the treatment of children with tinea capitis. Thus, far few randomized double blind controlled studies concerning the effectiveness of these agents for the systemic therapy of tinea capitis have been published. Almost all open studies showed that the modern antifungals terbinafine, itraconazole, and fluconazole are superior to griseofulvin because of shorter duration of therapy and higher rates of cure.

Mastocytosis is a heterogeneous group of disorders characterised by an abnormal growth and accumulation of mast cells in skin, bone marrow, gastrointestinal tract, liver, spleen, and lymph nodes. Symptoms occur due to the release of histamine, prostaglandin D2, heparin and other mediators derived from mast cells. The clinical feature covers a broad spectrum from single mastocytoma to malignant mastocytosis and mast cell leukaemia. We report on two cases with adult benign systemic mastocytosis to show the variety of symptoms. Diagnostics oriented according to symptoms and options on therapy are presented as well as differential diagnosis and associated haematological disorders. The importance of advice and regular follow-ups of patients with systemic mastocytosis is emphasised.

Malassezia furfur und andere, neu beschriebene Malassezia-Arten werden aus taxonomischer, epidemiologischer und mikrobiologischer Sicht dargestellt. Im Mittelpunkt steht die Vermittlung der pathogenetischen bzw. auch atiologischen Bedeutung des lipophilen Spross- oder Hefepilzes fur eine Reihe dermatologischer Erkrankungen, u. a. der Pityriasis versicolor, aber auch der Malassezia-Follikulitis und des seborrhoischen Ekzems. Die In-vitro-Empfindlichkeit von Malassezia gegenuber Antimykotika und antiseborrhoischen Wirkstoffen erhalt klinische Relevanz, wenn es um die vielfaltigen lokalen und systemischen Behandlungsmoglichkeiten der genannten Hautkrankheiten geht. Nicht zuletzt soll auch der neuerdings diskutierte Zusammenhang zwischen Malassezia und atopischem Ekzem anhand mikrobiologisch-immunologischer Mechanismen beleuchtet werden. Malassezia ist als auslosendes Agens mit einer Reihe v. a. dermatologischer Erkrankungen assoziiert. So gilt der lipophile Sprosspilz als Ursache der Pityriasis versicolor, der Pityrosporum- bzw. Malassezia-Follikulitis, daneben wurde eine Malassezia-Blepharitis beschrieben. Zunehmend treten systemische Infektionen durch Malassezia ausschlieslich bei unreifen Sauglingen und immunsupprimierten Patienten auf. Von Bedeutung ist Malassezia auch in Bezug auf die Pathogenese des seborrhoischen Ekzems und der Kopfschuppen. Aktuelle experimentelle Arbeiten lassen vermuten, dass Malassezia-Allergene als Trigger auch den Verlauf des atopischen Ekzems – zumindest der sog. “head-neck”-Form – beeinflussen.

The heat-stable and soluble glycoprotein gp200 (molecular weight 200 kDa) is part of the cell wall of S. cerevisiae. Recently, an association was shown between IgA and IgG against gp200 and inflammation in Crohn's disease. Gp200 is able to induce a proliferation of human lymphocytes in vitro, together with a natural killer cell associated cytotoxicity. Specific IgE against Saccharomyces cerevisiae (baker's or brewer's yeast) may be detected in approximately 73%, against Candida albicans in 68% of those patients suffering from severe atopic dermatitis. The aim of this study was to elucidate the possible role of an anti-gp200 immune response for the pathogenesis of atopic dermatitis by immunoblot analysis. Anti-gp200 IgE was found in 55% of healthy individuals, in 67% of individuals with atopic predisposition without eczema, in 63% of the patients with mild atopic dermatitis, and in 86% of patients with severe atopic dermatitis, respectively. On the contrary, anti-gp200 IgG could be shown in 55% of healthy individuals, in 89% of individuals with atopic predisposition but without eczema, in 100% of patients with mild atopic dermatitis, and in 79% with severe atopic dermatitis, respectively. No immunoreactivity was found when an extract of Arxula adeninivorans was used as antigen. These results underline the specificity of the immunoblot results with gp200 from Saccharomyces cerevisiae. It can be concluded that occurrence of specific IgE against Saccharomyces cerevisiae cannot be explained by a cross reactivity, e.g., against Candida albicans allergens. Further investigations with the recombinant gp200 will give information on the role of this glycoprotein both in atopic dermatitis and Morbus Crohn.

A 19 year old woman presented with a 4 week history of scaly erythematous patches with pustules on the trunk and extremities. Additionally, a massive infection in the genital region was conspicuous. The mons pubis was swollen, indurated and very painful. The presence of follicular pustules and nodules with discharge led to the diagnosis of kerion celsi Trichophyton mentagrophytes var. asteroides was isolated as causative agent. Systemic treatment with itraconazole (Sempera®) was coupled with topical sertaconazolenitrat (Zalain® ). The lesions responded well. The source of human infections by zoophilic dermatophytes, e.g. Trichophyton mentagrophytes var. asteroides is rodents. Such infections typically involve the scalp and beard; kerion celsi of mons pubis area is a rarity.

SALMONELLA (S.) ARIZONAE is an emerging pathogen which has been described in the last years more frequently. It is a cause of enteritis, in rare cases this bacterium is responsible for extraintestinal infections, too. A 74 year old male patient suffered from a squamous cell carcinoma of the skin at the right lower leg. After excision and meshgraft transplantation for covering the defect a wound infection developed. Both STAPHYLOCOCCUS AUREUS and S. ARIZONAE could be detected. The patient was treated successfully by ciprofloxacin. A new meshgraft transplantation was performed, and wound healing was achieved without any further complications. The origin of the S. ARIZONAE strain could not be explained. However, this SALMONELLA subspecies occurs mainly in reptiles and amphibians. A transfer to pet holders and other contact persons is possible and is increasingly described.

From 1997 to 2009, 1,862 dermatology, gynaecology, and paediatrics (DGP) associated clinical yeast isolates were analysed for species occurrence, specimen origin and type, (multi-) resistance pattern, and testing period. The top seven of the isolated DGP-associated species remained the same as compared to total medical wards, withCandida albicans(45%) as most frequent pathogen. However, the DGP wards and DGP ICUs showed species-specific profiles; that is, the species distribution is clinic-specific similar and however differs in their percentage from ward to ward. By applying the “one fungus one name” principle, respectively, the appropriate current taxonomic species denominations, it has been shown that no trend to emerging species from 1998 to 2008 could be detected. In particular the frequently isolated non-Candida albicansspecies isolated in the DGP departments have already been detected in or before 1997. As yeasts are part of the cutaneous microbiota and play an important role as opportunistic pathogens for superficial infections, proper identification of the isolates according to the new nomenclature deems to be essential for specific and calculated antifungal therapy for yeast-like DGP-related infectious agents.

Hintergrund und Fragestellung. Die klinische Differenzierung der hereditaren Ichthyosen ist ohne labordiagnostische Kenngrosen kaum moglich. Ein Verfahren zur Detektion einer X-chromosomal-rezessiven Ichthyose (XRI) ist die Serumlipoproteinelektrophorese. Diese zeigt im Vergleich zu gesunden Probanden bei XRI-Patienten erhohte elektrophoretische Mobilitoten der LDL und VLDL (Low Density und Very Low Density Lipoproteine). Die Ursachen hierfur sind nur teilweise bekannt (erhohte Cholesterinsulfatkonzentration der LDL) und deshalb Gegenstand vorliegender Studie. Patienten/Methodik. Untersucht wurden XRI-Patienten, Patienten mit Ichthyosis vulgaris, Probanden. Als Methoden kamen zur Anwendung SDS-PAGE-Elektrophorese und Isoelektrische Fokussierung zur Detektion XRI-assoziierter Variationen der Apolipoproteine Apo B-100, Apo C-III und Apo E. Ergebnisse. XRI-assoziierte Apolipoproteinvarianten wurden nicht detektiert. Im Unterschied zur Literatur wurde auch fur die HDL (High Density Lipoproteine) von XRI-Patienten eine geringfugig verlangerte Elektrophoresestrecke beobachtet. Schlussfolgerungen. Die Ursache fur die erhohte elektrophoretische Mobilitat der VLDL und HDL von XRI-Patienten bleibt unklar. Nachfolgende Studien sollten deshalb weitere Apolipoproteine untersuchen sowie die Literaturdaten zum HDL- und VLDL-Cholesterinsulfatgehalt von XRI-Patienten verifizieren.

A 15-year-old HIV-positive Ugandan boy suffered from several dry and hyperkeratotic lesions of his left hand and forearm with circinated, erythematous and scaly morphology. Microsporum gypseum could be isolated as causative agent of this ringworm. Species differentiation was confirmed and specified by sequence analysis of the internal transcribed spacer of the ribosomal DNA. Successful topical treatment of the tinea manus was started with clotrimazole-containing ointment.

Eine Studentin der Veterinarmedizin entwickelte 2 Monate nach einem geburtshilflichen Praktikum in einem Rinderstall eine tiefe Trichophytie am Mons pubis. Kulturell lies sich ein langsam wachsender, weiser Dermatophyt nachweisen, der zunachst als Trichophyton mentagrophytes identifiziert wurde. Die aufgrund der ungewohnlichen Lokalisation durchgefuhrte molekularbiologische Differenzierung mittels Sequenzierung variabler ribosomaler Genabschnitte ergab die Spezies Trichophyton verrucosum. Unter systemischer antimykotischer Therapie heilten die entzundlichen Hautveranderungen unter Zurucklassen einer vernarbenden Alopezie ab.

Bei insgesamt 19 Patienten mit Prurigo simplex subacuta, mikrobiellem, atopischem sowie postskabiosem Ekzem, Lichen ruber exanthematicus, Pityriasis lichenoides and Hautsarkoidose wurde die 1-Hydroxypyren-Konzentration im Urin vor, wahrend und nach einer externen Steinkohlenteerbehandlung mittels Hochleistungsflussigkeitschromatographie mit Fluoreszenzdetektion bestimmt, um so einen Ruckschlus auf die dermale Aufnahme und den zeitlichen Verlauf der renalen Exkretion der potentiell kanzerogenen polyzyklischen aromatischen Kohlenwasserstoffe aus dem Teer zu erhalten. Ausgehend von einem pratherapeutischen Wert von 6,04±2,06 µg 1-Hydroxypyren/g Kreatinin steigt die renale Ausscheidung wahrend der Teerbehandlung signifikant an (p

The basidiomycete Coprinus sp. was isolated repeatedly from bronchial secretions and bronchoalveolar lavage of a 40-year-old woman suffering from a relapse of acute lymphoblastic leukemia 5 years after she underwent autologous bone marrow transplantation. Post-mortem microbiological investigation of lung tissue revealed simultaneously growing Coprinus sp. and Aspergillus flavus. Histopathological examination of the lung demonstrated septate hyphae characteristic of both Aspergillus and Coprinus. The basidiomycete Coprinus sp. should be considered as a potential opportunistic pathogen because of its excellent growth at 37°C.

The in vitro antifungal activity of the new hydroxypyridone antimycotic rilopirox has been evaluated against 29 separate clinical isolates of Mαlαsseziα (M.) furfur obtained from patients with pityriasis versicolor, seborrhoeic dermatitis or dandruff. Minimum inhibitory concentrations (MICs) of rilopirox were measured by the agar dilution technique and, in comparison, by a recently described microdilution method with colorimetric detection of the MIC end points. Rilopirox was found to be able to inhibit growth of all clinical yeast isolates. For the investigated M. furfur strains MIC values from 12.5 to 50 µg ml-1 with a median of 25 µg ml-1 were determined by the agar dilution method. Using the microdilution technique, MIC values between 16 and 128 µg ml-1 (median 32 µg ml-1) were found for the M. furfur isolates. It has to be taken into account that with a 0.3% solution concentrations of 300,000 µg ml-1 are applied to the skin. Furthermore, due to its extreme low penetration rilopirox is long-term available in the skin in inhibiting concentrations. In comparison with rilopirox, the in vitro susceptibility of M. furfur against the systemically applicable triazole antimycotic itraconazole and clotrimazole, an established topical antifungal, was tested. As expected, low MIC values for these azoles were found by the agar dilution method. The median of the MIC of M. furfur was 0.1 µg ml-1 for itraconazole, and 6.25 µg ml-1 for clotrimazole. The inhibitory effectivity of rilopirox against clinical isolates of M. furfur seems to justify its therapeutic evaluation in clinical trials. This new antifungal may be a useful alternative not only in pityriasis versicolor but also in seborrhoeic dermatitis due to the growth inhibition of M. furfur.

Onychomycosis is a worldwide problem with no tendency for self-healing, and existing systemic treatments achieve disease-free nails in only 35 to 76% of cases. Recently, treatment of nail fungus with a near-infrared laser has been introduced. It is assumed that fungal eradication is mediated by local heat. To investigate if laser treatment has the potential to eradicate fungal hyphae and arthrospores, laser heat application and propagation needs to be studied in detail. This study aimed to measure nail temperatures using real-time videothermography during laser irradiation. Treatment was performed using 808- and 980-nm linear scanning diode lasers developed for hair removal, enabling contact-free homogeneous irradiation of a human nail plate in one pass. Average and peak temperatures increased pass by pass, while the laser beam moved along the nail plates. The achieved mean peak temperatures (808 nm: 74.1 to 112.4°C, 980 nm: 45.8 to 53.5°C), as well as the elevation of average temperatures (808 nm: 29.5 to 38.2°C, 980 nm: 27.1 to 32.6°C) were associated with pain that was equivalent to that of hair removal procedures and was not significantly different for various wavelengths. The linear scanning laser devices provide the benefits of contact-free homogeneous heating of the human nail while ensuring adequate temperature rises.

Since 2010 the FDA has approved laser systems as capable of producing a "temporary increase in clear nails" in patients with onychomycosis. Fungal eradication is probably mediated by heat in infrared laser systems; their efficacy has been confirmed thermographically, histologically and in electron microscopy. Another approach to decontaminate the nail organ is to disrupt fungi and spores by q-switched pulse applications. Recently specific combinations of wavelengths have been tested for their ability to disrupt the mitochondrial transmembrane potential at physiological temperatures by generating ATP and ROS. While clinically extremely high clearance rates of approximately 87.5-95.8 % have been reported, in-vitro investigations have failed to confirm the clearance. The variety of systems and advised parameters hampers a systematic evaluation. Recommendations for safe and practical treatment protocols, informed consent items, and combination with conventional treatment options are all areas of active work. Currently there is a lack of data concerning the long-term efficacy of laser therapy of onychomycosis; certified treatment protocols are needed.

Dermatomycoses are caused most commonly by dermatophytes. The anthropophilic dermatophyte Trichophyton rubrum is still the most frequent causative agent worldwide. Keratinolytic enzymes, e.g. hydrolases and keratinases, are important virulence factors of T. rubrum. Recently, the cysteine dioxygenase was found as new virulence factor. Predisposing host factors play a similarly important role for the development of dermatophytosis of the skin and nails. Chronic venous insufficiency, diabetes mellitus, disorders of cellular immunity, and genetic predisposition should be considered as risk factors for onychomycosis. A new alarming trend is the increasing number of cases of onychomycosis - mostly due to T. rubrum - in infancy. In Germany, tinea capitis is mostly caused by zoophilic dermatophytes, in particular Microsporum canis. New zoophilic fungi, primarily Trichophyton species of Arthroderma benhamiae, should be taken into differential diagnostic considerations of tinea capitis, tinea faciei, and tinea corporis. Source of infection are small household pets, particularly rodents, like guinea pigs. Anthropophilic dermatophytes may be introduced by families which immigrate from Africa or Asia to Europe. The anthropophilic dermatophytes T. violaceum, T. tonsurans (infections occurring in fighting sports clubs as "tinea gladiatorum capitis et corporis") and M. audouinii are causing outbreaks of small epidemics of tinea corporis and tinea capitis in kindergartens and schools. Superficial infections of the skin and mucous membranes due to yeasts are caused by Candida species. Also common are infections due to the lipophilic yeast fungus Malassezia. Today, within the genus Malassezia more than 10 different species are known. Malassezia globosa seems to play the crucial role in pityriasis versicolor. Molds (also designated non-dermatophyte molds, NDM) are increasingly found as causative agents in onychomycosis. Besides Scopulariopsis brevicaulis, several species of Fusarium and Aspergillus are found.

A case of fatal disseminated infection caused by the dematiaceous hyphomycete Scedosporium prolificans diagnosed post mortem is reported in a 60-year-old male patient with acquired immunodeficiency syndrome who additionally suffered from Burkitt's lymphoma. The patient was significantly granulocytopenic following aggressive chemotherapy and irradiation. He developed dyspnoea at rest and chest pain despite a normal chest radiograph. Fluconazole treatment was carried out empirically because no sign of a fungal infection was detected ante mortem, either by mycological cultivation or by serological investigation. First post-mortem examination revealed a disseminated fungal infection involving the central nervous system. Scedosporium prolificans was cultured from the kidney, spleen and myocardium. In vitro, the fungal isolate was found to be highly resistant to all available systemic antimycotics.

Zusammenfassung. In den letzten Jahren treten zunehmend Schimmelpilze - an erster Stelle Aspergillus-Arten - als Erreger systemischer Mykosen auf. Es sollte deshalb die Pravalenz invasver Schimmelpilzinfektionen (ISI) am Leipziger Universitatsklinikum im Zeitraum von 1992–1994 untersucht werden. Dazu wurden mykologisch-kulturelle Befunde - Nachweis von Aspergillus in relevanten Korpermaterialien - sowie mykologisch-serologische Befunde - Aspergillus-Antigen (Pastorex) in Serum, Bronchialsekret, BAL, Liquor) und Aspergillus-Antikorper (indirekte Hamagglutination, Immun-diffusion) - anhand der Krankenunterlagen und eventuell vorhandener Sektionsprotokolle bzw. histologischer Praparate hinsichtlich ihrer Relevanz in bezug auf das tatsachliche Vorliegen einer invasiven Aspergillose (IA) uberpruft. Auserdem wurden alle Sektionen, bei denen erst post mortem histologisch (teilweise auch kulturell) eine ISI gesichert wurde, ebenfalls berucksichtigt. Bei Zugrundelegung strenger Kriterien - entweder pathohistologischer Nachweis und/oder Aspergillus-Anzuchtung aus relevanten Materialien (Bronchialsekret, -lavage) gemeinsam mit dem Nachweis von Aspergillus-Antigen im Serum - wurden 21 ISI beobachtet. 14 Patienten mit malignen Hamoblastosen (11 Leukamien, 2 aplastische Anamien, 1 Non-Hodgkin-Lymphom) standen sieben Patienten mit anderen disponierenden Grunderkrankungen gegenuber. Sieben der 14 hamatologischen Patienten hatten eine Knochenmarktransplantation erhalten. Nichthamatologische Grunderkrankungen waren: Peritonitis nach Billroth II. Nierentransplantation, systemischer Lupus erythematodes. Polymyalgia rheumatica, Glioblastom, Subarachnoidalblutung sowie AIDS + Burkitt-Lymphom. Insgesamt 16 ISI wurden pathohistologisch (z. T. mit Erregeranzucht) bestatigt. Erreger war in der Regel Aspergillus fumigatus. Auserdem traten eine Aspergillus-terreus-Infektion und eine Mischinfektion von Aspergillus flavus und Coprinus spec. auf. Eine disseminierte Scedosporium-prolificans-Infektion, die neben Lunge, Myokard und Nieren auch das ZNS betraf, kam bei einem AIDS-Patienten vor. Wahrend der labordiagnostische Verdacht auf eine IA bei 13 Patienten bereits zu Lebzeiten geausert werden konnte (13 x kulturell, 6 x Aspergillus-Antigen), wurden 8 der 21 Schimmelpilzinfektionen erst durch die pathologische Untersuchung erkannt. Unabhangig davon war die Prognose mit nur zwei nicht letal verlaufenen invasiven Schimmelpilzinfektionen sehr schlecht. Summary. Invasive mould infection, e. g. aspergillosis in the first place, is a common infection in immunocompromised patients. The diagnosis of invasive mould infection is difficult in the absence of confirmation by tissue biopsy and histological studies. Therefore, prevalence of invasive mould infections at the School of Medicine of the Leipzig University between 1992 and 1994 was investigated. The diagnosis of invasive mould infection was suspected on clinical, mycological, and radiological findings. The definitive diagnosis was obtained by identification of characteristic mould hyphae on stained smears, and/or positive culture, and/or the detection of Aspergillus antigen (Pastorex) in serum, bronchial secretion, or bronchoalveolar fluid, and confirmed by histopathology. In altogether 2 1 patients the definitive diagnosis invasive mould infection was recorded, among them 20 invasive aspergilloses. Underlying diseases were Icukaemia (n=11), aplastic anaemia (n=2), non-Hodgkin-lymphoma (n=1), systemic lupus erythematosus (n=1), kidney transplant ation (n=1), peritonitis after Billroth I1 anastomosis (n=l), Polymyalgia rheumatica (n=1), AIDS plus Burkitt lymphoma (n=1), gliohlastonia (n=1), arid subarachnoid hacmorrhage (n=1). As causative fungi were isolated: Aspereigillus fumigates (n=13), Aspergillus terrtus (n=1), Aspergillus flauus as rare simultaneous infection with the basidiomycete coprinus spec. in a leukacmic patient (n=1), and the dematiaccous fungus Scedosporium prolificans in an AIDS patient with Burkitt lymphoma (n=1). In four patients the invasive mould infection was confirmed histopathologically without isolation and differentiation of the causative agent. Nineteen of the 21 patients with invasive mould infections died corresponding to a mortality rate of 90%.

The in vitro antifungal activity of tea oil, the essential oil of Melaleuca alternifolia, has been evaluated against 26 strains of various dermatophyte species, 54 yeasts, among them 32 strains of Candida albicans and other Candida sp. as well as 22 different Malassezia furfur strains. Minimum inhibitory concentrations (MIC) of tea tree oil were measured by agar dilution technique. Tea tree oil was found to be able to inhibit growth of all clinical fungal isolates. For the investigated dermatophytes MIC values from 1,112.5 to 4,450.0 μg/ml with a geometric mean of 1,431.5 μg/ml were demonstrated. Both C. albicans strains and the other strains belonging to the genus Candida and Trichosporon appeared to be slightly less susceptible to tea tree oil in vitro. However, their MIC values, which varied from 2,225.0 to 4,450.0 μg/ml (geometric mean 4,080 μg/ml), indicated moderate susceptibility to the essential oil of M. alternifolia. The lipophilic yeast M. furfur seemed to be most susceptible to tea tree oil. MIC values between 556.2 and 4,450.0 μg/ml (geometric mean 1,261.5 μg/ml) were found against the tested M. furfur strains. However, when calculated as percentage tea tree oil of the agar, the above-mentioned concentrations correspond to 0.5-0.44% tea tree oil content. These values are far below the usual relatively high therapeutic concentrations of the agent; approximately 5-10% solution or even the concentrated essential oil are used for external treatment. In comparison with tea tree oil, in vitro susceptibility against miconazole, an established topical antifungal, was tested. As expected, very low MIC values for miconazole were found for dermatophytes (geometric mean 0.2 μg/ml), yeasts (geometric mean 1.0 μg/ml), and M. furfur (geometric mean 2.34 μg/ml). It is suggested that the in vivo effect of tea tree oil ointment in the therapy of fungal infections of the skin and mucous membranes as well as in the treatment of dandruff, a mild form of seborrheic dermatitis, may be at least partly due to an antifungal activity of tea tree oil.

Thirty strains of the lipophilic yeast Pityrosporum ovale were isolated from patients suffering from seborrhoeic dermatitis and dandruff and tested for susceptibility both to some classic antifungal agents and to several primarily non-antimycotic drugs. Minimal inhibitory concentrations (MIC) of altogether eleven agents were measured by the agar dilution technique. As expected, the tested imidazoles showed a good inhibition of growth of Pityrosporum. The most effective agents were ketoconazole (MIC 0.1 microgram/ml) and itraconazole (MIC 0.05 microgram/ml for some strains). MIC for fluconazole, clotrimazole and tioconazole were also low, indicating a good inhibition of Pityrosporum. In contrast, the range of MIC for bifonazole was moderate to high (for some strains 12.5-25 micrograms/ml). For zinc pyrithion a very good in vitro efficacy (MIC 0.78-1.56 micrograms/ml) was dedicated. The MIC for selenium disulphide was 1.56-3.13 micrograms/ml. The antipsoriatic drugs dithranol and liquor carbonis detergens also inhibited growth of all Pityrosporum ovale strains investigated but only at higher concentrations.

Ein 36-jahriger Mann litt an einem therapierefraktaren, stark juckenden Analekzem. Eine Stuhluntersuchung auf Pilze erbrachte als zufalligen Nebenbefund massenhaft vegetative Formen des Darmparasiten Giardia lamblia sowie die hochinfektiosen Lamblienzysten. Eine Behandlung mit Metronidazol per os war - im Gegensatz zu allen vorausgehenden frustranen Lokaltherapien - erfolgreich. Lamblien (Giardia lamblia/Giardia intestinalis) verursachen in der Regel eine akute oder chronische Diarrho. Kutane Manifestationen sind extrem selten, wenn, dann treten sie als Folge eines infektallergischen oder allergologischen Geschehens im Sinne einer Urtikaria, von Pruritus und auch eines atopischen Ekzems auf. Bisher nicht beschrieben wurde die Verursachung eines therapierefraktaren chronischen Analekzems durch Lamblienbefall des Intestinums. Auf einen kausalen Zusammenhang zwischen intestinaler Parasitose und Analekzem muss hier aufgrund des mikroskopischen Nachweises von Lamblienzysten sowie von Giardia lamblia-Antigen im Stuhl mittels Elisa und ex juvantibus wegen des Therapieerfolges mit Metronidazol geschlossen werden. A 36-year-old man presented with a strongly pruritic anal eczema without any response to different ointment preparations. Examination of the faeces for yeast colonization surprisingly revealed the occurrence of Giardia cysts and Giardia trophozoite forms. Treatment was given in the form of metronidazole per os 250 mg three times daily for 7 days, and the cutaneous lesions of the anal eczema resolved in a few weeks. Giardia lamblia (Giardia intestinalis) are enteroparasites and produce gastrointestinal symptoms such as acute and chronic diarrhoea. Cutaneous manifestations which are associated with giardiasis occur extremely rarely. Hitherto, the following signs have been described: urticaria, angioedema, mouth ulcers, pruritus, and atopic dermatitis. Until now, there is no further report on anal eczema caused by intestinal giardiasis. We considered that the here described cutaneous manifestation of an anal eczema was secondary to the associated gastrointestinal infection due to Giardia lamblia cysts and trophozoite forms, as they cleared with specific treatment by metronidazole.

Non-tuberculous mycobacteria are rarely responsible for skin and soft tissue infections. These infections are caused by different mycobacterial species originating from the environment (water, soil, plants, and animals). Various factors influence the clinical manifestation of the cutaneous infection: the immunological situation of the patient, the degree of cutaneous impairment, and the extent of the contact with the contaminated environment. The clinical manifestation is non-specific and often the cause of extensive diagnostic activities. The diagnosis is based on the cultural detection of the causative pathogen. The management of these skin and subcutaneous infections is a challenge for each physician. The treatment comprises administration of several antibiotics and antituberculosis drugs for many months. Surgical procedures are necessary in some patients.

Apoptotic pathways are providing important saveguard mechanisms in protection from cancer by eliminating altered and often harmful cells. The disturbances of cell proliferation, differentiation and apoptosis are also found on specific signal-transduction pathways within the tumour cells and between these and the immune system. The article focuses attention on the evolution of the melanocytic naevi in the direction of a dysplastic or tumour cell. The determination of single molecules as prognostic parameters within cancer genesis seems to be problematic. New hopes are being placed on the treatment with TW-37, ABT-737 and TAT-Bim, which, to an extent, are able to support the programmed cell death. The clinical importance of these innovative therapies remains to be seen and should therefore, be viewed with considerable criticism. Caminhos apoptóticos estão fornecendo importantes mecanismos de salvaguarda na proteção contra o câncer através da eliminação de células alteradas e freqüentemente nocivas. Os distúrbios de proliferação, diferenciação e apoptose celular são também encontrados nos caminhos específicos sinal-transdução dentro das células tumor e entre essas células e o sistema imunitário. O artigo foca na evolução da verruga conhecida como melanocytic naevi em direção a uma célula displasica ou célula tumor. A determinação de moléculas isoladas como parâmetros de prognóstico dentro da gênesis do câncer parece problemática. Novas esperanças estão sendo colocadas no tratamento com TW-37, ABT-737 e TAT-Bim, os quais, até certo ponto, são aptos a apoiar a morte celular programada (PCD). A importância clínica dessas terapias inovadoras permanece ainda a ser vista e devem, por essa razão, serem olhadas com considerável juízo crítico.

During the last years an increasing number of patients suffering from therapy refractory chronic wounds which are frequently infected by multi-resistant bacteria - e.g. methicillin-resistant Staphylococcus aureus - have led to an increasing interest in the treatment using larvae or maggots of the blow fly species Lucilia sericata. Maggots are responsible for necrectomy and they have antimicrobial activity in particular against grampositive bacteria like a disinfectant of the wound. It is concluded that maggots debridement therapy (MDT) using larvae of the species Lucilia sericata in non-healing chronic ulcers of the lower legs successfully leads to cleaning, debridement, reduced bacterial load, and improved wound granulation. A review is given on the clinical use of maggots, their mechanism of action and clinical efficacy for wound healing.

Sarcoidosis of the skin may have an extremely heterogeneous clinical presentation, so that the definitions of 'great imitator' and 'clinical chameleon' have long been used. There is, in fact, a large group of skin diseases that can enter the differential diagnosis with cutaneous sarcoid manifestations, either clinically or/and pathologically. As the clinical consequences and the prognosis of these groups of diseases are often very different, it is important to correctly plan the diagnostic workup. The diagnostic process in this case often presents a challenge as no single test is sufficiently specific, so that a certain diagnosis can be only made in the presence of a compatible clinical and radiographic picture, along with histopathological evidence of non-necrotizing, epithelioid cell granulomas, and exclusion of other potential aetiologies. For practical reasons, four main groups of skin conditions capable of mimicking sarcoidosis can be identified: (i) transmissible, infectious diseases; (ii) allergic and immunological manifestations of various aetiologies; (iii) granulomatous diseases of various aetiologies; and (iv) lymphomas and pseudolymphomas. The aim of this article is to describe the main clinical and histopathological findings of such disease entities, and to discuss the role of those features (morphological, pathological and laboratory) that can help distinguish them from sarcoidosis of the skin.

Podoconiosis or mossy foot is a form of non-filarial lymphedema. This geochemical elephantiasis is a disabling condition caused by the passage of microparticles of silica and aluminum silicates through the skin of people walking barefoot in areas with a high content of soil of volcanic origin. Podoconiosis is widespread in tropical Africa, Central America and North India, yet it remains a neglected and under-researched condition. The disabling effects of podoconiosis cause great hardship to patients. It adversely affects the economic (reduced productivity and absenteeism), social (marriage, education, etc.) and psychological (social stigma) well-being of those affected. Podoconiosis can be prevented; the main primary preventive measure is protective footwear. Secondary measures include a strict hygiene regimen and compression therapy, which can reverse initial lesions. Tertiary approaches include surgical management, such as shaving operations to reduce hyperplastic and verrucous elephantiasis.

The uremic pruritus is a very painful symptom suffered by chronic haemodialysis patients and is observed in 22 to 74% of the subjects. The causes of uremic pruritus have not yet been clarified. During the last 20 to 30 years it has been focused on altogether 5 different pathophysiological hypotheses: stimulating influences (e.g. calcium phosphate deposits in the epidermis), stimuli (e.g. secondary hyperparathyroidism), neuropathic injuries (e.g. disturbance of the cutaneous innervation in patients with uremic peripheral neuropathy), and central nervous changes (e.g. accumulation of endorphins in uremic patients which is associated with increasing pruritus), and immunologic conditions. The last mentioned immunological hypothesis has increasing importance, not at least based on the fact that the application of a topical calcineurin inhibitor (tacrolimus) improves the uremic pruritus. However, this fact could not be confirmed in a recent prospective placebo-controlled study from the USA. Only after kidney transplantation with a functioning transplant the uremic pruritus is stopped. That is why no causal therapy exists so far. Actually, the uremic pruritus has to be treated by topical and systemic means in a symptomatic and polypragmatic way only. Urea represents one of the most important "natural moisturizing factors" which are responsible for the hydration of the skin. It has been demonstrated that older patients have decreased urea levels within the stratum corneum of the epidermis, whereas in patients with terminal kidney insufficiency - despite dryness of the skin - as a paradox finding elevated levels of urea have been assessed in the stratum corneum. Because of this reason, the meaning of urea as part of the "natural moisturizing factors" system is not understood, until now. However, there are very promising results of clinical phase II studies showing a significant effect of topical application of 2.5% L-arginine hydrochlorid ointment - a semi-essential amino acid - on improvement of dryness and, in particular, on improvement of pruritus in haemodialysis patients.

The localisation of a dermatophytosis on the face is rare. Differential diagnoses include a broad range of dermatological disorders, e. g. contact dermatitis, psoriasis vulgaris, seborrhoeic dermatitis, demodicosis, and polymorphic photo eruptions. Two patients suffering from tinea faciei incognito caused by Trichophyton rubrum are presented. Diagnosis was based on mycological diagnostics of skin scrapings using Calcofluor preparation and cultivation of the causative dermatophyte. Both patients were suffering from tinea pedis and tinea unguium caused by the same dermatophyte species. An infection caused by Trichophyton rubrum of the face always occurs following autoinoculation from a pre-existing tinea pedis and tinea unguium of feet and toenails, sometimes of the fingernails.

Background: Invasive pulmonary aspergillosis (IPA) remains a life-threatening condition despite systemic antifungal therapy. Objectives: This retrospective analysis investigated whether additional bronchoscopic instillation of amphotericin B (amB) would improve efficacy of antifungal treatment in patients with haematological malignancies suffering from IPA. Methods: Twenty patients (40.6 ± 14.2 years, 14 male) with preceding chemotherapy, bone marrow or stem cell transplantation complicated by severe IPA who did not respond sufficiently to systemic antifungal therapy were additionally treated by repeated bronchoscopic instillations of amB solution (91 instillations, on average 4.6 ± 2.2 instillations per patient over a period of 24.1 ± 21.0 days). Therapeutic response to this combined treatment regimen was monitored by chest X-ray and CT scan. Results: The mean infiltration sizes during systemic antifungal therapy alone (mean duration 11.9 ± 9.9 days) did not change significantly. However, after additional bronchoscopic instillation of amB solution infiltration sizes were reduced significantly (p < 0.05). A total resolution of infiltrates was seen in 3 and a partial reduction in 13 of 20 patients. Mean duration of total antifungal treatment was 50.1 ± 24.0 days. The mean follow-up period was 34.1 ± 31.2 months. The IPA-related mortality rate was 18.8% (3 of 16 patients). Conclusions: Additional bronchoscopic instillation of amB may improve the efficacy of systemic antifungal therapy in patients with haematological malignancies complicated by severe IPA. Bronchoscopic instillation of amB should be considered as an additional treatment option in cases with IPA unresponsive to systemic therapy.

Background: Dermatophytes, yeasts and moulds all are potential causative agents of onychomycosis.The aim of this study was to determine the percentage of cases of onychomycoses caused by each group. In addition, the responsible genus and species was identified for each nail infection. Patients and methods: In a retrospective study performed at the Department of Dermatology of the Leipzig University, 5 077 nail samples from 4 177 patients -2 240 women and 1 937 men - with a variety of nail changes-not just onychomycosis-were investigated. 75 % were toenails, 23 % fingernails, and 2 % from both sites. Results: Both microscopic and/or cultural detection of fungi (dermatophytes, yeasts and moulds) were successful in 54% of samples. Causative fungal agents were: 68 % dermatophytes, 29 % yeast, and 3 % moulds. The most frequently detected dermatophyte species were T. rubrum (91 %), and T. mentagrophytes (7.7 %). Among yeasts, C. parapsilosis (42 %) was most common, followed by C. guilliermondii (20.1 %), C. albicans (14.2 %), and Trichosporon spp. (10%). Scopulariopsis brevicaulis (43 %) was the most frequent mould.The percentage of mixed fungal infections was 22 %. Conclusions: Dermatophytes, in particular T. rubrum, but also T. mentagrophytes, are the most frequently isolated causative agents in onychomycosis. In addition, yeasts may be isolated relatively frequently, while moulds are uncommon.

Summary. Trichophyton tonsurans is an anthropophilic dermatophyte that is predominantly responsible in man for tinea capitis. Although this fungus has a world-wide distribution, most reports of the occurrence of Trichophyton tonsurans infections originate from the USA, Latin America and some European countries. A 31-year-old African woman, formerly a resident of Zaire, with tinea corporis caused by Trichophyton tonsurans infection is described here. Zusammenfassung. Trichophyton tonsurans ist ein anthropophiler Dermatophyt, der in erster Linie als Verursacher der Tinea capitis auftritt. Obwohl dieser Hautpilz weltweit vorkommt, stammen die meisten Beschreibungen von Trichophyton tonsurans-Infektionen aus den USA, Lateinamerika und einigen europaischen Landern. Es wird eine 31-jahrige afrikanische Frau beschrieben, die aus Zaire stammt und an einer Tinea corporis litt, verursacht durch Trichophyton tonsurans.

The aim of this double-blind, multinational, phase III study was to investigate the clinical and bacteriological efficacy of nadifloxacin 1% cream compared with erythromycin 2% cream in 474 European patients with predominantly inflamed slight-to-moderate acne vulgaris. During 12 weeks of treatment both nadifloxacin and erythromycin caused significant reduction in the number of inflamed papulo-pustular lesions (66.7% and 64.7%, respectively) and open and closed comedones. The microbiological evaluation showed a significant reduction of coagulase negative staphylococci (CNS) only in the nadifloxacin group, while Propionibacterium acnes was significantly reduced by both formulations. A significantly higher resistance and the extent of resistant of P. acnes and CNS against erythromycin compared to nadifloxacin were also evidenced. All adverse events reported were minor in both groups. This pivotal erythromycin-controlled study has demonstrated that nadifloxacin 1% cream was as efficacious and safe as erythromycin 2% and extremely low numbers of nadifloxacin-resistant microorganisms were detected in the treatment period.

Der 72-jahrige Patient stellte sich zur Begutachtung eines dunklen Flecks am Rucken vor, der sich binnen weniger Monate gebildet hatte. Er gab an, dass die Hautveranderung kurz nach seinem Sommerurlaub entstanden sei, in dem er sich ohne Schutz intensiv der Sonne ausgesetzt hatte. Die korperliche und die histologische Untersuchung erbrachten 5 auffallige Befunde.

Piercing, i.e. perforation of skin or mucous membranes in order to attach mostly metallic jewelery as well as multicolored skin tattooing have become more popular than ever before and a considerable number of (young) people practise these methods of body art which are supposed to increase the individuality. But there is a lot of side effects, among them especially infections. The most important bacteria cultivated from such patients are Staphylococcus aureus, group A streptococci and Pseudomonas aeruginosa. Viruses which can be transmitted by piercing or tattooing are especially hepatitis B virus and hepatitis C virus. Besides local bacterial infections also systemic infections (sepsis, endocarditis) occur. The main aspects of diagnostics, therapy and prevention are discussed.

Objective The in vitro antimicrobial susceptibility of Pityrosporum ovale strains isolated from patients with seborrheic dermatitis was determined. Method Minimum inhibitory concentrations of a total of 11 agents - including true antifungal, antiseborrheic, and antipsoriatic drugs - were measured. Results Ketoconazole was the most effective of the tested antifungal agents against Pityrosporum ovale in vitro (minimum inhibitory concentration 0.1 μg/ml). The antiseborrheic agents zinc pyrithione and selenium disulfide showed a good in vitro efficacy against Pityrosporum with similar minimum inhibitory concentrations. Liquor carbonis detergens and dithranol were also able to inhibit growth of Pityrosporum ovale in vitro, but much higher concentrations were necessary. Conclusion The tested agents commonly used against seborrheic dermatitis might exert their efficacy, at least in part, due to inhibition of Pityrosporum ovale.

A 21-year-old female presented at age 2 years with a chronic mucocutaneous candidiasis and at age 3 alopecia totalis. Later, chronic hypoparathyroidism and autoimmune adrenal insufficiency appeared. In addition, malabsorption syndrome and signs of pernicious anaemia occurred. The onychomycosis totally improved under systemic treatment with fluconazole (Diflucan), endocrine and organ failure with replacement therapy. The autoimmune polyglandular syndrome (APS 1) is a rare autosomal recessive inherited disease. Chronic mucocutaneous candidiasis (CMC) generally presents very early in life and is the most frequent of the three main diseases of APS type 1 (chronic hypoparathyroidism, autoimmune Addison's disease). It can be considered as a precocious marker of APS type 1. Consequently, all patients affected by isolated CMC, especially children, should be evaluated and carefully followed up by immunological, biochemical, and clinical tests to recognize signs and symptoms of imminent or ongoing endocrine glandular failure.

In a 64-year-old man suffering from hypoblastic myelodysplastic syndrome a secondary acute myeloid leukaemia developed. After induction chemotherapy with resulting partial remission he received an allogenic (related) peripheral blood stem cell transplantation conditioned with 2 Gy total body irradiation. After haematopoietic reconstitution chest pain and dyspnoea appeared. Computer tomography revealed diffuse bilateral infiltrates which were considered to be suspicious for an invasive pulmonary aspergillosis of the left upper lobe. Respiratory and circulatory insufficiency occurred. In bronchoalveolar lavage fluid Aspergillus antigen was detected. In addition, Aspergillus flavus was isolated on Sabouraud-dextrose agar. Ambisome (liposomal encapsulated amphotericin B) was applied in high dosages. On the skin of the sides and the back five livid red stained nodular lesions with haemorrhagic infarctions appeared. Pathohistologically, both in PAS (periodate acid Schiff) and Grocott-Gomori staining conglomerates of septated hyphae were detected in corium and subcutis. In addition, Aspergillus flavus grew from skin tissue. Despite antifungal treatment the patient died from Aspergillus pneumonia and generalized aspergillosis with dissemination to heart, brain, and skin.

Ein 15-jahriges Madchen kommt wegen seit Wochen juckender Kopfhaut sowie geroteter und aufgekratzter Haut im Nacken in die Sprechstunde. Unter glukokortikoidhaltiger Creme hat der Juckreiz nachgelassen. Die ekzematosen Hautveranderungen blieben aber unverandert. Die Anamnese ergibt „Milchschorf“ im Sauglings- und „Beugenekzem“ im Kleinkindalter.

The lectin-mediated agglutination kinetics of Candida albicans, Candida tropicalis, Candida glabrata, Candida krusei, Candida kefyr, and Candida parapsilosis strains isolated from immunocompromised patients was investigated. The rate of the lectin-induced cell agglutination depends on the physiological state of the yeast cell population. Therefore, the Candida strains have to be cultivated and investigated under identical conditions. Lentil lectin (prepared from Lens culinaris), castor lectin, and concanavalin A were used. Different yeast species showed different agglutination behaviour. Furthermore, the lectin-mediated rate of agglutination is a strain-specific property which makes it possible to distinguish between different yeast strains of the same species. It is concluded that the lectin-mediated agglutination kinetics allows reproducible differentiation of yeast strains of the same species.

In vitro susceptibilities were determined for a total of 159 clinical isolates and 12 reference strains of yeasts belonging to different Candida species including 94 Candida albicans strains, and further genera such as Cryptococcus, Trichosporon, Geotrichum and Saccharomyces. Minimum inhibitory concentration (MIC) values for fluconazole and itraconazole were assessed using a microdilution technique with the semisynthetic high resolution (HR) medium supplemented with glucose and asparagine but without sodium hydrogen carbonate (pH 7.0), according to a proposal of the working group 'Clinical Mycology' of the German Speaking Mycological Society. Fluconazole MIC values for C. albicans were between 0.125 and > or = 128 micrograms ml-1. Thus, the median of 1 microgram ml-1 showed that the overall fluconazole susceptibility was good. As expected, Candida krusei (seven strains) exhibited diminished in vitro susceptibility with MIC values for fluconazole of 8 to 128 micrograms ml-1 with a median of 64 micrograms ml-1. Some Candida kefyr strains seemed to be less susceptible against fluconazole which was indicated by a MIC90 of 64 micrograms ml-1. Surprisingly, no Candida glabrata isolate exhibited a MIC value greater than 16 micrograms ml-1. Other Candida species, Trichosporon cutaneum, Geotrichum candidum and Saccharomyces cerevisiae showed low MICs to fluconazole. In vitro susceptibility testing of itraconazole revealed that all Candida species except C. albicans, but also Trichosporon cutaneum, Geotrichum candidum, and Saccharomyces cerevisiae exhibited acceptable low MIC values against itraconazole (0.03-2 micrograms ml-1). Their MIC90 values for itraconazole were in the close range between 0.125 and 2 micrograms ml-1. MIC values between 0.125 and 2 micrograms ml-1 were obtained, even for C. krusei strains. On the other hand, the range of C. albicans MICs was between 0.0125 and > or = 16 micrograms ml-1 with MIC50 and MIC90 values of 0.125 and > or = 16 micrograms ml-1, respectively, indicating that a considerable number of yeast strains have high MICs. The comparative evaluation of different experimental conditions revealed that there exists a marked influence both of inoculum size and incubation time on the results of susceptibility testing. Therefore, for routine usage 10(2) CFU ml-1 and 18-24 h incubation time for this microdilution method with HR medium are recommended.