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ZusammenfassungWir berichten über eine 61-jährige Patientin, die seit 1 Jahr an plötzlich aufgetretenem, starkem Pruritus und Knoten auf der Haut des gesamten Integuments litt. Es wurde die Diagnose einer chronischen Prurigo (CPG) gestellt. Im Rahmen einer umfassenden und interdisziplinären Durchuntersuchung wurde ein metastasiertes Ovarialkarzinom festgestellt. Nach radikaler operativer Therapie und Chemotherapie heilte die CPG ab und ist bis heute nicht rezidiviert. Es ist nicht auszuschließen, dass es sich hier um eine paraneoplastische CPG handelt. Dieser Fall demonstriert auch, dass bei CPG eine Ursache gefunden werden kann und daher eine gründliche Abklärung einer CPG sehr wichtig ist und auch lebensrettend sein kann.

Massage therapists are particularly exposed to constituents of massage preparations, wet work and mechanical strain and therefore, at high risk to develop occupational dermatitis (OD).To describe the sensitization spectrum of massage therapists with OD.In a retrospective study, patch test data of patients with OD (128 massage therapists and 24 374 patients working in other professions) collected by the Network of Departments of Dermatology (IVDK, 2008-2020) were analysed.Hand dermatitis (91.4%) and allergic contact dermatitis (34.4%) were common in massage therapists with OD. Most frequent were sensitizations to fragrances/essential oils which were found in 54 (42.2%) massage therapists and thus, more often than in other patients with OD. Concomitant positivity to several fragrances/essential oils was frequent. In 8 (14.8%) of the 54 massage therapists, sensitizations to fragrances/essential oils were not detected with the baseline series, but only with special fragrance series.Allergic contact dermatitis is common in massage therapists with OD and is mainly caused by fragrances and essential oils. Hence, massage therapists should be aware of this risk. When OD is suspected, not only the baseline series, but also special fragrance series should be patch tested in this occupational group.

Background: Hand eczema (HE) is a common skin disease characterized by itch, pain and visible skin changes such as fissures, erythema and vesicles. It is not yet clear which outcome domains are most important for patients. The Hand Eczema Core Outcome Set (HECOS) initiative is developing a consented set of core domains and suitable measurement instruments for the future application in all HE trials. This includes an online Delphi survey about core domains, which requires a ‘Long List’ of all domains that might be important to measure. Objectives: To compile a ‘Long List’ of candidate outcome domains for therapeutic HE trials with suggestions from patients and experts. Methods: First, 60 patients with chronic HE were interviewed at seven study sites in Croatia, Denmark, Germany, the Netherlands and Spain. Patients were asked about domains that were important from their perspectives. Second, 185 HE experts were invited by email to complete an online survey. With an open question, they were asked to suggest up to six domains. Results: Suggestions were provided by 58 patients and 82 experts. Most patients and experts suggested to measure the domains ‘signs’, ‘symptoms’ and ‘HE-related quality of life’. Specifically, >25% of patients said that less itch, pain or fissures indicated a successful treatment. Among experts, >25% suggested ‘itch’ and ‘ability to work’ as core sub-domains. Further outcomes from the domains ‘HE control over time’, ‘patient-reported treatment experience’ and ‘skin barrier function’ were mentioned. Conclusion: ‘Itch’ was rated high among patients with HE and professional HE experts. While patients emphasized fissures as important, experts underlined the ability to work. This investigation allowed us to define a ‘Long List’ of 7 candidate outcome domains with 58 sub-domains. From this list, a panel of stakeholders will select core domains during an online Delphi survey.

Background: Atopic dermatitis (AD) patients display an altered skin microbiome which may not only be an indicator but also a driver of inflammation. We aimed to investi- gate associations among AD patients' skin microbiome, clinical data, and response to systemic therapy in patients of the TREATgermany registry. Methods: Skin swabs of 157 patients were profiled with 16S rRNA gene amplicon sequencing before and after 3 months of treatment with dupilumab or cyclosporine. For comparison, 16s microbiome data from 258 population-­based healthy controls were used. Disease severity was assessed using established instruments such as the Eczema Area and Severity Index (EASI). Results: We confirmed the previously shown correlation of Staphylococcus aureus abundance and bacterial alpha diversity with AD severity as measured by EASI. Therapy with Dupilumab shifted the bacterial community toward the pattern seen in healthy controls. The relative abundance of Staphylococci and in particular S. aureus significantly decreased on both lesional and non-­lesional skin, whereas the abundance of Staphylococcus hominis increased. These changes were largely independent from the degree of clinical improvement and were not observed for cyclosporine. Conclusions: Systemic treatment with dupilumab but not cyclosporine tends to re- store a healthy skin microbiome largely independent of the clinical response indicat- ing potential effects of IL-­4RA blockade on the microbiome.

BACKGROUND Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. OBJECTIVES To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. METHOD The Guideline Development Group (GDG) was established on behalf of the ESCD. A call for interest was launched via the ESCD website and via the ESCD members' mailing list. Appraisal of the evidence for therapeutic and preventive interventions was applied and a structured method of developing consensus was used and moderated by an external methodologist. The final guideline was approved by the ESCD executive committee and was in external review on the ESCD webpage for 1 month. RESULTS Consensus was achieved for several statements and management strategies. CONCLUSION The updated guideline should improve management of hand eczema.

Background: Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with a poor prognosis and low healing rates leading to an enormous burden for the affected individual and for society. Objectives: To present the sensitization frequencies to the most relevant allergens of the European baseline series in patients with occupational contact dermatitis (OCD) and to compare sensitization profiles of different occupations. Methods: The data of 16 022 patients considered having OCD after patch testing within the European Surveillance System on Contact Allergies (ESSCA) network between January 2011 and December 2020 were evaluated. Patients (n = 46 652) in whom an occupational causation was refuted served as comparison group. Results: The highest percentages of OCD were found among patients working in agriculture, fishery and related workers, metal industry, chemical industry, followed by building and construction industry, health care, food and service industry. Sensitizations to rubber chemicals (thiurams, carbamates, benzothiazoles) and epoxy resins were associated with at least a doubled risk of OCD. After a decline from 2014 onwards, the risks to acquire an occupation-related sensitization to methyl(chloro)isothiazolinone (MCI/MI) and especially to methylisothiazolinone (MI) seem to increase again. Sensitization rates to formaldehyde were stable, and to methyldibromo glutaronitrile (MDBGN) slightly decreasing over time. Conclusions: Among allergens in the European Baseline Series, occupational relevance is most frequently attributed to rubber accelerators, epoxy resins and preservatives.

BACKGROUND Treatment of prurigo nodularis (PN) is challenging and new treatment options are needed. OBJECTIVE To evaluate the efficacy and safety of two oral doses of the kappa opioid agonist and mu opioid antagonist nalbuphine extended release (NAL-ER) tablets in a phase 2, multicentre, randomized, double-blind, placebo-controlled trial with an open-label, 50-week extension phase. METHODS Subjects with moderate-to-severe PN were randomized to NAL-ER 81 mg (NAL-ER81) or 162 mg (NAL-ER162) tablets twice-daily or placebo for 8 weeks of stable dosing following a 2-week titration period. Subjects completing Week 10 with a Worst Itch Numerical Rating Scale (WI-NRS) score ≥5 at the time of rollover (or during the observation period) were eligible for open-label treatment. RESULTS Of 63 randomized subjects, 62 were treated and comprised the modified intent-to-treat population (MITT), 50 completed 10 weeks of treatment. In the MITT analysis, 8 subjects (44.4%) treated with NAL-ER162 (P = 0.32) and 6 (27.3%) treated with NAL-ER81 (P = 0.78) achieved ≥30% reduction from baseline in 7-day WI-NRS at Week 10 (primary efficacy endpoint) vs. 8 (36.4%) in the placebo group. Itch reduction was significant among 8/12 (66.7%) subjects completing Week 10 treated with NAL-ER162 vs. placebo (8/20, 40.0%; P = 0.03). Additionally, 6 subjects (33.3%) treated with NAL-ER162 and 3 (13.6%) treated with NAL-ER81 achieved ≥50% reduction from baseline in 7-day WI-NRS at Week 10 (coprimary endpoint). Extended open-label treatment was associated with further improvements in itch reduction and favourable changes in PN lesion activity as assessed by Prurigo Activity Score. Adverse events occurred predominantly during dose titration and were of mild-to-moderate severity. The safety profile did not change with extended open-label treatment. CONCLUSION In adult subjects with PN, oral treatment with NAL-ER 162 mg twice daily provided measurable anti-pruritic efficacy in subjects completing ≥10 weeks of treatment and was well tolerated (ClinicalTrials.gov: NCT02174419).

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. Objectives In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients. Methods TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers. Results Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet. Conclusions German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

Die Berufsdermatologie hat sich, insbesondere in den letzten Jahren, zu einem lebendigen und interessanten Spezialgebiet mit interdisziplinarem Charakter entwickelt. Sie umfasst mehr als Handekzeme. Insbesondere in den letzten Jahren hat die immer starker ansteigende Pravalenz der atopischen Dermatitis (AD) auch zu einer Zunahme von atopischen Handekzemen gefuhrt, die beruflich verschlimmert sein konnen. Auch kann anhand von neueren Systemtherapien das Handekzem deutlich besser behandelt werden. Die aktuelle Leitlinie zum Handekzem umfasst eine Palette von verschiedenen topischen und systemischen Therapien. Dennoch zeigen sich in der taglichen berufsdermatologischen Praxis immer noch sehr hartnackige Falle, insbesondere bei den vesikularen Handekzemen. Letztgenannte konnen des Ofteren keiner eindeutigen Ursache zugeordnet werden, was haufig fur die Betroffenen ein groses Problem darstellt. Zudem sollten auch Kofaktoren, wie z. B. chronische Infektionsgeschehen und psychische Erkrankungen, besonders berucksichtigt werden. In diesem Beitrag werden anhand mehrerer berufsdermatologischer Falle besondere Herausforderungen der Berufsdermatologie dargestellt.

Es ist der Aufbau einer berufsdermatologischen Kohorte am Universitatsklinikum Heidelberg vorgesehen. In einer 3‑jahrigen prospektiven multizentrischen Kohortenstudie wird ein neues Diagnostikum, der sog. molekulare Klassifikator, bei mindestens 262 berufsdermatologischen Patienten eingesetzt, um Psoriasis und Ekzem zu differenzieren. Als Kontrollgruppe dient eine Kohorte von 282 berufsdermatologischen Patienten, bei denen die gleiche Verdachtsdiagnose gestellt, aber nicht der molekulare Klassifikator eingesetzt worden war. In 5 Nachbefragungen uber 3 Jahre werden insbesondere Daten zu Diagnosen, Krankheitsverlauf und -schwere, Zeiten der Arbeitsunfahigkeit, Berufsverbleib und Lebensqualitat erhoben. Es soll gezeigt werden, dass eine fruhzeitige Diagnosestellung insbesondere die Auswahl der Therapie, den Krankheitsverlauf, die Anzahl der Fehltage beeinflusst. Die Studie wird von der Deutschen Gesetzlichen Unfallversicherung (DGUV) gefordert.

Hintergrund Der Zusammenhang zwischen atopischer Dermatitis (AD) und allergischer Kontaktdermatitis ist nach wie vor nicht abschliesend geklart. Studien ergeben sehr unterschiedliche Resultate; sie reichen vom Fehlen jeglichen Zusammenhangs bis hin zu einer vermehrten Sensibilisierung auf multiple Allergene. Konsistente Assoziationen mit bestimmten Allergenen wurden jedoch bisher nicht gefunden. ZIEL: Wir haben eine grose Kohorte von Patienten, stratifiziert nach atopischer Hautdiathese gemas dem Erlanger Atopiescore (EAS), unabhangig von einer aktiven Hauterkrankung, durch Epikutantests untersucht. Methoden Retrospektive Multicenter-Datenanalyse aus funf dermatologischen Zentren in Deutschland mit 4.509 Patienten. Die Patienten wurden nach dem EAS eingeteilt in eine Gruppe ohne atopische Hautdiathese (n = 2.165) und eine mit atopischer Hautdiathese (n = 1.743). Ergebnisse In der Gruppe mit atopischer Hautdiathese zeigten signifikant mehr Personen mindestens eine positive Epikutantest-Reaktion in der Standardreihe als in der Gruppe ohne atopische Hautdiathese (49,1 % vs. 38,3 %). In der logistischen Regressionsanalyse war die atopische Hautdiathese mit einem signifikant erhohten Sensibilisierungsrisiko gegen Methylchloroisothiazolinon/Methylisothiazolinon (OR 2.383) und Methylisothiazolinon (OR 1.891), Thiuram-Mix (OR 1.614) sowie Nickel (OR 1.530), Kobalt (OR 1.683) und Chrom (OR 2.089) assoziiert. Schlussfolgerungen Die atopische Hautdiathese zeigte sich als der wichtigste intrinsische Risikofaktor fur eine Kontaktsensibilisierung gegen einige spezifische Antigene. Eine fruhere oder derzeit bestehende AD erwies sich als weniger relevante Grose.

Background and Objective: Self-assessment of general health status includes a variety of verifiable objective and subjective criteria and shows a significant influence on patient-related outcomes such as quality of life. The objective of this study was to investigate how patients assess the severity of their chronic hand eczema compared to physicians.Patients and method: Data for 1281 patients and their physicians from the German registry “CARPE” was available at baseline. At a 2-year follow-up, the remaining 788 cases served as a comparison. Concordance analysis was performed using Bangdiwala's B.Results:Only 16.62% (baseline) and 11.47% (follow-up) of the severity ratings showed complete concordance. The baseline shows a more pessimistic, the follow-up a more optimistic assessment from the patients compared to the physicians. Women and older patients had lower agreement. Bangdiwala's B value lies at the lower border of a substantial agreement ( B̂ω(baseline)=0.573, B̂ω(follow-up)=0.498).Conclusion:The assessment of the severity of hand eczema often differs between physician and patient. To ensure successful therapy and adherence, dermatologists should inquire about their patients' individual perception of the severity of the hand eczema, especially in older patients and women.

Background Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials, and so on. Most large‐scale reports on contact allergy due to MWFs are more than 10‐years‐old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to MWFs. Objectives To describe a current spectrum of contact sensitization in metalworkers with occupational dermatitis (OD). Patients and Methods Retrospective analysis of patch test data collected by the Information Network of Departments of Dermatology (IVDK; 2010–2018), stratifying for 804 cutting metalworkers, 2197 mechanics, and 355 other metalworkers. Results Cutting metalworkers were most frequently sensitized to monoethanolamine (12.6%), colophonium/abietic acid (11.4%) and formaldehyde releasers (up to 8.5%) from the MWF series, and formaldehyde (4.6%) and iodopropynyl butylcarbamate (4.6%) from the baseline series. Sensitization among mechanics and other metalworkers indicates possible occupational exposure to MWFs, glues, and resins, although this may not be expected from their job titles. Conclusions The spectrum of MWF contact allergens remained largely unchanged during the last years. Taking a comprehensive occupational history is indispensable in order to not miss relevant allergen exposures.

Background There is considerable variability across European patch test centres as to which allergens are included in local and national cosmetics series. Objectives To propose a standardised, evidence-based cosmetic series for Europe based on up-to-date analysis of relevant contact allergens. Methods We collated data from the European Surveillance System on Contact Allergies (ESSCA) from 2009-2018 to determine which cosmetic allergens produce a high yield of contact allergy. Contact allergens with a prevalence of >0.3% that were considered relevant were included. Rare contact allergens were excluded if deemed no longer relevant or added to a supplemental cosmetic series for further analysis. Results Sensitisation prevalence rates of 39 cosmetic contact allergens are tabulated. Thirty of these allergens yield >0.3% positive reactions and are therefore included in our proposed European Cosmetic Series. Six are considered no longer relevant and therefore excluded. Three are included in a supplementary European cosmetic series. An additional 9 allergens are included in either the core or supplemental European cosmetic series following literature review. Conclusion We have derived a potential European cosmetic series based upon the above methods. This will require ongoing investigation based upon the changing exposure profiles of cosmetic allergens as well as new and evolving substances. This article is protected by copyright. All rights reserved.

Introduction Chronic hand eczema (CHE) is a relapsing inflammatory dermatologic disease. Signs and symptoms can have a significant impact on patients’ health-related quality of life (HRQoL). The aim of this study is to characterize the core signs, symptoms and impacts of CHE to develop a conceptual model. Methods A structured literature search and qualitative interviews with 20 adult CHE patients in the US and 5 expert dermatologists were conducted to explore the patient experience of CHE signs, symptoms and impacts. Findings were used to support the development of a conceptual model. Results There was a paucity of CHE qualitative research in the literature, supporting the need for the prospective qualitative research. The primary signs and symptoms identified from the literature review and interviews included itch, dryness, cracking, pain, thickened skin and bleeding. The most salient impacts included embarrassment and appearance concerns, frustration, impacts on work and sleep disturbance. Saturation was achieved for all signs, symptoms and impact concepts. Conclusions Findings from this literature review and in-depth qualitative interviews supported the development of a comprehensive conceptual model documenting the signs, symptoms and impacts relevant to CHE patients. Such a model is of considerable value given the lack of existing studies in the literature focused on the qualitative exploration of the CHE patient experience. Limitations included the patient sample being only from the US and not including some CHE subtypes.

In 2019, a number of allergens (haptens), henceforth, "the audit allergens," were considered as potential additions to the European Baseline Series (EBS), namely, sodium metabisulfite, 2-bromo-2-nitropropane-1,3-diol, diazolidinyl urea, imidazolidinyl urea, Compositae mix II (2.5% or 5% pet), linalool hydroperoxides (lin-OOH), limonene hydroperoxides (lim-OOH), benzisothiazolinone (BIT), octylisothiazolinone (OIT), decyl glucoside, and lauryl glucoside; Evernia furfuracea (tree moss), was additionally tested by some departments as well.To collect further data on patch test reactivity and clinical relevance of the audit allergens in consecutive patients across Europe.Patch test data covering the audit allergens in 2019 and 2020 were collected by those departments of the European Surveillance System on Contact Allergies testing these, as well as further collaborators from the EBS working group of the European Society of Contact Dermatitis (ESCD), and the Spanish Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea. As patch test outcome, reactions between day (D) 3 and D5 were considered.Altogether n = 12 403 patients were tested with any of the audit allergen. Positive reactions were most common to lin-OOH 1% pet. (8.74% [95%CI: 8.14-9.37%]), followed by lin-OOH 0.5% pet., and lim-OOH 0.3% pet (5.41% [95% CI: 4.95-5.89%]). Beyond these terpene hydroperoxides, BIT 0.1% pet. was the second most common allergen with 4.72% (95% CI: 4.2-5.28%), followed by sodium metabisulfite 1% pet. (3.75% [95%CI: 3.32-4.23%]) and Compositae mix 5% pet. (2.31% [95% CI: 1.84-2.87%]). For some allergens, clinical relevance was frequently difficult to ascertain.Despite many positive patch test reactions, it remains controversial whether lin- and lim-OOH should be tested routinely, while at least the two preservatives BIT and sodium metabisulfite appear suitable. The present results are a basis for further discussion and ultimately decision on their implementation into routine testing among the ESCD members.

Journal der Deutschen Dermatologischen Gesellschaft : JDDG 20(10), 1387-1402 (2022). doi:10.1111/ddg.14830, Published by Wiley-Blackwell, Berlin

Pruritus ist ein fachübergreifendes Leitsymptom zahlreicher Erkrankungen und stellt eine interdisziplinäre diagnostische und therapeutische Herausforderung dar. Im Gegensatz zu akutem Pruritus ist chronischer Pruritus (CP) ein zumeist schwer behandelbares Symptom verschiedener Erkrankungen. Durch Kratzen und Ausbildung Kratz-assoziierter Hautveränderungen kann der ursprüngliche Hautstatus verändert werden. Bei Vorliegen eines Juck-Kratz-Zirkels können sich sogar sekundäre Krankheitsbilder wie die chronische Prurigo entwickeln. Chronischer Pruritus führt zu erheblichem subjektivem Leiden der Betroffenen, was sich in Einschränkungen der gesundheits-bezogenen Lebensqualität wie Schlafstörungen, Angst, Depressivität, Erleben von Stigmatisierung und/oder sozialem Rückzug bis hin zu klinisch relevanten psychischen Komorbiditäten führen kann. Die Versorgung der Patienten soll somit die (a) interdisziplinäre Diagnostik und Therapie der auslösenden Grunderkrankung, (b) Therapie der sekundären Folgesymptome des Pruritus (dermatologische Therapie, Schlafförderung, bei einer begleitenden oder zugrundeliegenden psychischen oder psychosomatischen Erkrankung eine entsprechende psychologisch-psychotherapeutische Behandlung) und (c) symptomatische antipruritische Therapie umfassen. Das Ziel dieser interdisziplinär erstellten Leitlinie ist es, das therapeutische Vorgehen, aber auch die interdisziplinäre Diagnostik bei CP zu definieren und zu standardisieren. Dies ist die Kurzversion der aktualisierten S2k-Leitlinie zu chronischem Pruritus. Die Langversion findet sich unter www.awmf.org.

Einleitung: TREATgermany ist ein Forschungsregister, das deutschlandweit Informationen zu Erkrankungsschwere, Therapieverlauf und Patient Reported Outcomes bei erwachsenen Patienten mit moderater bis schwerer Neurodermitis (AD) dokumentiert. Im Beitrag wird der Zusammenhang der globalen Einschätzung der Erkrankungsschwere der AD durch Ärzte und Patienten zur Baselinevisite und deren Abhängigkeit von Erkrankungssymptomen untersucht. Methoden: Skalen: Globale Einschätzung der Schwere der AD (0 (abgeheilt) - 5 (sehr schwer)) durch Patienten (PGA) und Ärzte (IGA). Symptome: NRS für Schmerzen, Juckreiz und Schlafstörungen der letzten 3 Tage (0 (kein Auftreten des Symptoms) - 10 (schwerst-vorstellbares Auftreten)). Statistik: Stata 15, Wilcoxon-Vorzeichen-Rang-Test. + TREATgermany wird durch Sanofi, LEO, Galderma und Lilly finanziell unterstützt. Ergebnisse: 2016-2020 wurden 1.025 Patienten (Alter 42±15 Jahre; 42% Frauen) in 38 Zentren eingeschlossen. PGA und IGA lagen im Median bei beiden Geschlechtern bei 3 (moderat). Frauen (F) litten stärker unter den erfragten Symptomen als Männer (M) (Mediane: Schmerzen: 4 vs 3, Juckreiz: 7 vs 6, Schlafstörungen: 5 vs 4). PGA und IGA stimmten bei 38,4% der Patienten überein. 30,2 bzw. 31,4% der Frauen sowie 35,1 bzw. 26,5% der Männer schätzten ihre AD leichter bzw. schwerer ein als der Arzt (F: p = 0,9; M: p = 0,002). 50,3% der Patienten litten stark unter Schmerzen, Juckreiz oder Schlafstörungen (mind. 1 Wert ≥7), 14,2% unter allen 3 Symptomen. Je 38,0 bzw. 46,2% dieser Patienten schätzten ihre AD schwerer ein als der Arzt (M 33,8 vs 39,7%; F 42,5 vs 52,0%). Fazit: Arzt- und Patientenbeurteilung der AD stimmen geschlechtsspezifisch insbesondere bei schwerem Symptomerleben nicht immer überein. Dies zeigt den Bedarf an individualisierter Behandlung der AD, die Patientenpräferenzen im Fokus hat.

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Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens.

Der diagnostische Standard zum Nachweis einer bestehenden allergischen Kontaktdermatitis ist der Epikutantest. Die vorliegende Leitlinie richtet sich an Assistenz- und Facharzte der Dermatologie, Allergologie und Arzte weiterer Fachgruppen in Klinik und Praxis, die an der Indikationsstellung oder Durchfuhrung von Epikutantests bei Patienten mit Kontaktekzemen und weiteren Spattypallergien beteiligt sind, sowie Kooperationspartner der Arzteschaft (Fachberufe im Gesundheitswesen, Kostentrager). Die Leitlinie zur Durchfuhrung des Epikutantests mit Kontaktallergenen wurde auf der Basis einer systematischen Literatursuche zu definierten Schlusselfragen evidenzbasiert und im formellen Konsensusverfahren (S3) von Dermatologen unter Einbindung von Padiatern, Arbeitsmedizinern, Assistenzpersonal und Patientenvertretern erstellt. Bezuglich der methodischen und inhaltlichen Arbeit, auf denen die Empfehlungen basieren, wird auf Methodenbericht und Evidenztabellen verwiesen. Die Leitlinie stellt allgemeine Aspekte der Epikutantestung sowie medizinrechtliche Aspekte dar. Es werden Empfehlungen gegeben zur Indikationsstellung, Patientenaufklarung, Auswahl von Testsubstanzen und Kammersystemen, Expositionsort, -dauer und Ablesezeitpunkten, Interpretation von Testreaktionen, endogenen und exogenen Einflussfaktoren, Testung besonderer Personengruppen (Kinder, Schwangere, Immunsupprimierte) sowie Risiken und unerwunschten Nebenwirkungen bei der Durchfuhrung des Epikutantests mit Kontaktallergenen.

Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens. Note: This publication is part 1 of the short version of the S3 guidelines for "Epicutaneous patch testing using contact allergens and drugs" (registry no. 013 - 018; date: March 20, 2019; valid until December 31, 2021). Part 2 of the short version will be published in the next issue. The long version of these guidelines can be accessed at www.awmf.org. The method report is available as online publication (https://www.awmf.org/leitlinien/detail/ll/013-018.html) and contains the evidence tables in its appendix.

Der diagnostische Standard zum Nachweis einer bestehenden allergischen Kontaktdermatitis ist der Epikutantest. Die vorliegende Leitlinie richtet sich an Assistenz- und Facharzte der Dermatologie, Allergologie und Arzte weiterer Fachgruppen in Klinik und Praxis, die an der Indikationsstellung oder Durchfuhrung von Epikutantests bei Patienten mit Kontaktekzemen und weiteren Spattypallergien beteiligt sind, sowie Kooperationspartner der Arzteschaft (Fachberufe im Gesundheitswesen, Kostentrager). Die Leitlinie zur Durchfuhrung des Epikutantests mit Kontaktallergenen wurde auf der Basis einer systematischen Literatursuche zu definierten Schlusselfragen evidenzbasiert und im formellen Konsensusverfahren (S3) von Dermatologen unter Einbindung von Padiatern, Arbeitsmedizinern, Assistenzpersonal und Patientenvertretern erstellt. Bezuglich der methodischen und inhaltlichen Arbeit, auf denen die Empfehlungen basieren, wird auf Methodenbericht und Evidenztabellen verwiesen. Die Leitlinie stellt allgemeine Aspekte der Epikutantestung sowie medizinrechtlicher Aspekte dar. Es werden Empfehlungen gegeben zur Indikationsstellung, Patientenaufklarung, Auswahl von Testsubstanzen und Kammersystemen, Expositionsort, -dauer und Ablesezeitpunkten, Interpretation von Testreaktionen, endogenen und exogenen Einflussfaktoren, Testung besonderer Personengruppen (Kinder, Schwangere, Immunsupprimierte) sowie Risiken und unerwunschten Nebenwirkungen bei der Durchfuhrung des Epikutantests mit Kontaktallergenen.

Die Therapie des Handekzems stellt in der taglichen dermatologischen Praxis eine grose Herausforderung dar. Es gibt verschiedene Lokaltherapeutika, physikalische Therapien und Systemtherapeutika, die seit Einfuhrung von Alitretinoin eine grose Bereicherung erfahren haben. Das seit 2017 zur Behandlung der atopischen Dermatitis zugelassene Dupilimab kann theoretisch auch zur Therapie des atopischen Handekzems eingesetzt werden. Der wichtigste und erste Schritt der Therapie ist die Abklarung der Ursache des Handekzems mit den entsprechenden diagnostischen Masnahmen, von der Hautbiopsie bis zu den Allergietestungen reichend. Eine wichtige Saule der Therapie stellt die Basistherapie in Form einer konsequenten und stadienadaptierten Hautpflege dar. Bei der Behandlung des Handekzems sollte die Therapie gemas einem Stufenschema erfolgen, wobei die Basistherapie stets beizubehalten ist und topische, systemische und physikalische Therapieformen erganzend, oft auch parallel, der Atiologie und der Klinik des Handekzems entsprechend, ausgewahlt und eingesetzt werden. Bei einem leichten bis mittelschweren Handekzem stellen Basistherapie und topische Glukokortikosteroide gemas verschiedenen Leitlinien die Standardtherapie dar, wahrend UV-Phototherapie und Systemtherapie bei den mittelschweren bis schweren Handekzemen eingesetzt werden. In diesem Ubersichtsbeitrag werden anhand von Fallserien, klinischen Studien, Leitlinien und Expertenempfehlungen die wichtigsten Masnahmen und Therapeutika dargestellt.

ZusammenfassungBerufliche Hautkrankheiten zählen zu den häufigsten Berufskrankheiten, insbesondere in den Industrieländern. Das Gesundheitswesen, die Metallbearbeitung, das Friseurhandwerk, das Baugewerbe und die Lebensmittelindustrie sind dabei besonders betroffen. In diesen Berufen ist die Haut der Beschäftigten oft Wasser, arbeitsspezifischen Reizstoffen und Allergenen ausgesetzt und es besteht ein hohes Risiko, ein Kontaktekzem, am häufigsten an den Händen, zu entwickeln. Die Folgen auf individueller und gesellschaftlicher Ebene sind enorm. Berufliche Hauterkrankungen verursachen hohe Kosten. Fehlzeiten und mangelnde Produktivität belasten insbesondere kleine und mittlere Betriebe. Der Prävention berufsbedingter Hauterkrankungen kommt daher seit Jahren eine wichtige Bedeutung zu. Auf ambulanter Versorgungsebene spielt die sekundäre Individualprävention (SIP) eine wesentliche Rolle. Sie beinhaltet ein ambulantes dermatologisches Heilverfahren sowie das Angebot von interdisziplinären Hautschutzseminaren. Frühzeitig eingeleitete Präventions- und Therapiemaßnahmen können der Manifestation einer Berufserkrankung nach BK 5101 entgegenwirken und Kosten sparen.

Anecdotal evidence suggests that neurokinin 1 receptor antagonism reduces pruritus intensity in chronic pruritic conditions such as prurigo nodularis (PN).This study assessed safety and efficacy of the neurokinin 1 receptor antagonist serlopitant for treatment of pruritus in PN.In this randomized, double-blind, placebo-controlled study, 128 patients with chronic, treatment-refractory PN for more than 6 weeks received serlopitant, 5 mg, or placebo orally once daily for 8 weeks. The primary end point was change in average itch visual analog scale score at weeks 4 and 8.Average itch visual analog scale scores significantly improved with serlopitant versus with placebo at weeks 4 and 8: the least squares mean difference (serlopitant minus placebo) was -1.0 at week 4 (P = .02) and -1.7 at week 8 (P .001). The least squares mean difference between serlopitant and placebo reached statistical significance at week 2 (-0.9 [P = .011]). The most frequently reported treatment-emergent adverse events in the serlopitant group were nasopharyngitis, diarrhea, and fatigue.The 8-week duration may be insufficient to assess clinically relevant resolution of PN lesions.Serlopitant reduced pruritus in patients with treatment-refractory PN and was well tolerated.

The considerable heterogeneity of outcomes and measurement instruments in hand eczema trials substantially limits the evidence synthesis concerning therapeutic and preventive interventions. Therefore, the Hand Eczema Core Outcome Set (HECOS) initiative is developing a core outcome set for future trials. The first objective was to identify outcomes that were measured in previous trials, to group them in domains, and to identify their measurement instruments. We conducted a systematic review of controlled and randomized controlled hand eczema trials published since 2000. Sixty-one eligible studies were identified. Each assessed one or more of 47 outcomes in the "skin" domain. Eighteen trials (30%) additionally focused on preventive behaviour in risk occupations. Quality of life was measured in 13 studies (21%). Thirty-two distinct named instruments were applied, but 223 measurements (62%) were conducted with unnamed instruments. Only 32 studies (52%) defined a primary outcome. Twenty-nine trials (48%) provided some information on adverse events, but none gave any references concerning relevant methods. Our review confirms the need to harmonize outcome measurements in hand eczema trials. The findings form the basis for a consensus process to generate a core outcome set to improve the explanatory power and comparability of future hand eczema studies.