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Zusammenfassung Ziel Darstellung der aktuellen Literatur und neuer Erkenntnisse zum Zusammenhang der chronisch spontanen Urtikaria (CSU) mit Adipositas-assoziierter Inflammation und metabolischen Erkrankungen. Methodik Eine englischsprachige, Pubmed-basierte Literaturrecherche mit den Stichwörtern „chronic urticaria“ und „hypertension“, „hyperlipidemia“, „metabolic syndrome“, „metabolic diseases“, „obesity“, „overweight“, „glucose intolerance“, „diabetes“ sowie zu „cytokines“, „pro-inflammatory“, „adipokines“, „immunological dysregulation“. Ergebnisse In der aktuellen Literatur zeigen sich erhöhte Prävalenzen für Adipositas, Diabetes mellitus, Hyperlipidämie und Hypertonie bei CSU-Patienten. Zudem zeigen sich signifikante Assoziationen zwischen metabolischen Komorbiditäten und der klinischen Ausprägung, Krankheitsdauer oder dem therapeutischen Ansprechen bei der CSU. Darüber hinaus lassen sich gemeinsame immunologische Merkmale zwischen der CSU und Adipositas erkennen, da eine Dysbalance pro- und anti-inflammatorisch wirksamer Zytokine sowie Adipokine zugunsten eines pro-inflammatorischen Zustandes bei beiden Erkrankungen vorliegt. Die Ableitung klinischer Implikationen in Hinblick auf Screening-, Präventions- oder Interventionsmaßnahmen metabolischer Erkrankungen bei der CSU sollte diskutiert werden.

The IMMUNED trial previously showed significant improvements in recurrence-free survival for adjuvant nivolumab plus ipilimumab as well as for adjuvant nivolumab alone in patients with stage IV melanoma with no evidence of disease after resection or radiotherapy. Here, we report the final analysis, including overall survival data.IMMUNED was an investigator-sponsored, double-blind, placebo-controlled, three-arm, phase 2 trial conducted in 20 academic medical centres in Germany. Eligible patients were aged 18-80 years with stage IV melanoma with no evidence of disease after surgery or radiotherapy. Patients were randomly assigned (1:1:1) to either nivolumab plus ipilimumab (nivolumab 1 mg/kg plus ipilimumab 3 mg/kg every 3 weeks for four doses followed by nivolumab 3 mg/kg every 2 weeks), nivolumab monotherapy (nivolumab 3 mg/kg every 2 weeks), or matching placebo, for up to 1 year. The primary endpoint was recurrence-free survival in the intention-to-treat population. Secondary endpoints were time-to-recurrence, overall survival, progression-free survival or recurrence-free survival 2 (in patients in the placebo group who crossed over to nivolumab monotherapy after experiencing disease recurrence), and safety endpoints. This trial is registered on ClinicalTrials.gov (NCT02523313), and is complete.Between Sept 2, 2015, and Nov 20, 2018, 175 patients were enrolled in the study, and 167 were randomly assigned to receive either nivolumab plus ipilimumab (n=56), nivolumab plus ipilimumab-matching placebo (n=59), or double placebo control (n=52). At a median follow-up of 49·2 months (IQR 34·9-58·1), 4-year recurrence-free survival was 64·2% (95% CI 49·2-75·9) in the nivolumab plus ipilimumab group, 31·4% (19·7-43·8) in the nivolumab alone group, and 15·0% (6·7-26·6) in the placebo group. The hazard ratio (HR) for recurrence for the nivolumab plus ipilimumab group versus placebo was 0·25 (97·5% CI 0·13-0·48; p0·0001), and for the nivolumab group versus placebo was 0·60 (0·36-1·00; p=0·024). Median overall survival was not reached in any treatment group. The HR for overall survival was significantly in favour of the nivolumab plus ipilimumab group versus placebo (HR 0·41; 95% CI 0·17-0·99; p=0·040), but not for the nivolumab group versus placebo (HR 0·75; 0·36-1·56; p=0·44). 4-year overall survival was 83·8% (95% CI 68·8-91·9) in the nivolumab plus ipilimumab group, 72·6% (57·4-83·2) in the nivolumab alone group, and 63·1% (46·9-75·6) in the placebo group. The median progression-free survival or recurrence-free survival 2 of patients in the placebo group who crossed over to nivolumab monotherapy after experiencing disease recurrence was not reached (95% CI 21·2 months to not reached). Rates of grade 3-4 treatment-related adverse events remained largely unchanged compared with our previous report, occurring in 71% (95% CI 57-82) of the nivolumab plus ipilimumab group, and 29% (95% CI 17-42) of patients receiving nivolumab alone. There were no treatment-related deaths.Both active regimens continued to show significantly improved recurrence-free survival compared with placebo in patients with stage IV melanoma with no evidence of disease who were at high risk of recurrence. Overall survival was significantly improved for patients receiving nivolumab plus ipilimumab compared with placebo. Use of subsequent anti-PD-1-based therapy was high in patients in the placebo group after recurrence and most likely impacted the overall survival comparison of nivolumab alone versus placebo. The recurrence-free and overall survival benefit of nivolumab plus ipilimumab over placebo reinforces the change of practice already initiated for the treatment of patients with stage IV melanoma with no evidence of disease.Bristol-Myers Squibb.

Freerk Prenzel1,2 *, Regina Treudler1,3 *, Tobias Lipek,1,2 Maike vom Hove,1,2 Paula Kage,1,3 Simone Kuhs,1,4 Thorsten Kaiser,1,4 Maximilian Bastl,5 Jan Bumberger,6– 8 Jon Genuneit,9,10 Thomas Hornick,8,11 Stefan Klotz,8,12 Julia Zarnowski,1,3 Maren Boege,1,13 Veit Zebralla,1,13 Jan-Christoph Simon,1,3 Susanne Dunker8,11 1Leipziger Interdisciplinary Center for Allergy (LICA), Comprehensive Allergy Center, Leipzig, Germany; 2University of Leipzig, Medical Center, Department of Pediatrics, Leipzig, Germany; 3University of Leipzig, Medical Center, Department of Dermatology, Venerology and Allergy, Leipzig, Germany; 4University of Leipzig, Medical Center, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig, Germany; 5Medical University of Vienna, Department of Otorhinolaryngology, Vienna, Austria; 6Helmholtz-Centre for Environmental Research (UFZ), Department Monitoring and Exploration Technologies, Leipzig, Germany; 7Helmholtz-Centre for Environmental Research (UFZ), Research Data Management, Leipzig, Germany; 8German Centre for Integrative Biodiversity Research (iDiv) Halle, Jena, Leipzig, Germany; 9Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany; 10German Center for Child and Youth Health, Leipzig/ Dresden, Dresden, Germany; 11Helmholtz-Centre for Environmental Research (UFZ), Department Physiological Diversity, Leipzig, Germany; 12Helmholtz-Centre for Environmental Research (UFZ), Department Community Ecology, Halle, Germany; 13University of Leipzig, Medical Center, Department of Otorhinolaryngology, Head and Neck Surgery, Leipzig, Germany*These authors contributed equally to this workCorrespondence: Susanne Dunker, Helmholtz Centre for Environmental Research – UFZ, Leipzig, Germany, Tel +49 341 9733170, Email susanne.dunker@ufz.dePurpose: Ailanthus altissima is one of the world’s most invasive species with a globally problematic spread. Pollen is dispersed locally and partially airborne. We aimed at investigating if (i) A. altissima pollen can be detected in relevant quantity in the air and if (ii) sensitization to A. altissima can be detected in patients with seasonal exacerbation of atopic diseases.Patients and Methods: We recorded distribution of A. altissima in Leipzig, Germany. In 2019 and 2020, pollen was collected with a Hirst-type pollen trap placed on the roof of the University Hospital. Specific IgE investigations were performed in children and adults with history of atopic diseases with deterioration between May and July. We analysed specific IgE for A. altissima, Alternaria sp., birch, grasses, profilins, polcalcins and crossreacting carbohydrates.Results: We found abundant growth of A. altissima and pollen was detected from early June to mid-July with a maximum pollen concentration of 31 pollen/m3. Out of 138 patients (63 female, 69 children/adolescents), 95 (69%) had seasonal allergic rhinitis, 84 (61%) asthma, and 43 (31%) atopic dermatitis. Sensitization to A. altissima was shown in 59 (42%). There were no significant differences between age groups. In 59% of patients sensitized (35/59), there was no sensitization to possibly cross-reacting structures.Conclusion: Sensitization to A. altissima pollen could be detected in 42% of our patients with atopic diseases, suggesting allergenic potential of this neophyte. In the context of further spread with climate change, eradication strategies and population-based sensitization studies are needed.Keywords: allergy, invasive species, neophyte, pollinosis, pollen count

After R0 resection of extensive cutaneous squamous cell carcinoma of the scalp with indication for postoperative radiotherapy, closure techniques should be chosen that allow rapid initiation of radiotherapy. The aim of this retrospective analysis is to evaluate defect coverage by transverse transposition flap and split skin grafting of the donor site in such a scenario with regard to oncologic safety (recurrence rate) and permanence of wound closure.Eleven patients were identified who had histologic cutaneous squamous cell carcinoma treated by microscopically controlled excision and defect coverage using a transverse transposition flap and split skin grafting of the donor site and who received postoperative radiotherapy. Patients were evaluated for recurrence, wound healing disorders and side effects of radiotherapy.The mean age was 81 years. Follow-up time averaged 1.4 years after the last radiotherapy session. Wound healing disorders of the transposition flap or graft necrosis were not detected. All therapy-associated side effects had resolved at follow-up. Local recurrence or metastasis did not occur.Combined transverse transposition flap plasty with split-skin grafting of the donor site is a safe treatment concept with few side effects for large scalp defects with exposed calvaria requiring postoperative radiotherapy.

A variety of additives found in foodstuffs have been associated with triggering of a number of clinical pictures. Hypersensitivity reactions of allergic and non-allergic etiology have been widely described, but are reported to be rare overall. This review presents a selection of food additives for which anaphylactic reactions have been described. These include colorants (e.g., tartrazine, carmine, patent blue), preservatives (e.g., sulfites, sodium benzoate), and thickeners/gelling agents (e.g., carboxymethylcellulose, guar, gum arabic). Possible diagnostic procedures (skin test, specific IgE, cellular antigen stimulation test, oral provocation) are presented. For those affected, avoidance of consumption is facilitated by the mandatory declaration (class name, E‑number/designation) required in the European Union. Only sulfur dioxide and sulfites have to be highlighted as food allergens, depending on the concentration. Due to the limited diagnostic procedures available, it cannot be excluded that the frequency of hypersensitivity to food additives is underestimated.

Wound healing of acute full-thickness injuries and chronic non-healing ulcers leads to delayed wound closure, prolonged recovery period and hypertrophic scarring, generating a demand for an autologous cell therapy and a relevant pre-clinical research models for wound healing. In this study, an immunocompetent model for wound healing was employed using a syngeneic murine cell line of mesenchymal stem cells cultured from the mouse whisker hair follicle outer root sheath (named moMSCORS). moMSCORS were isolated using an air-liquid interface method, expanded in vitro and characterized according to the MSC definition criteria - cell viability, in vitro proliferation, MSC phenotype and multi-lineage differentiations. Moreover, upon applying moMSCORS in an in vivo full-thickness wound model in the syngeneic C57BL/6 mice, the treated wounds displayed different morphology to that of the untreated wound beds. Quantitative evaluation of angiogenesis, granulation and wound closure involving clinical scoring and software-based quantification indicated a lower degree of inflammation in the treated wounds. Histological staining of treated wounds by the means of H&E, Alcian Blue, PicroSirius Red and αSMA immune labelling showed lower cellularity, less collagen filaments as well as thinner dermal and epidermal layers compared with the untreated wounds, indicating a general reduction of hypertrophic scars. The decreased inflammation, accelerated wound closure and non-hypertrophic scarring, which were facilitated by moMSCORS, hereby address a common problem of hypertrophic scars and non-physiological tissue properties upon wound closure, and additionally offer an in vivo model for the autologous cell-based wound healing. Graphic Abstract

The green-lipped mussel (Perna canaliculus) originates from New Zealand. To preserve the health benefits of green-lipped mussel meat, it is freeze-dried to make a long-lasting powder. The powder is used to treat arthritis because of its potential anti-inflammatory properties. The report describes a 54-year-old woman who developed immediate rhinoconjunctival and respiratory symptoms after inhaling green-lipped mussel powder she gave to her dog for arthritis. A skin prick test with green-lipped mussel powder was performed. Protein extracts from P canaliculus were separated by sodium dodecyl–sulfate polyacrylamide (SDS) gel electrophoresis and probed with serum from patients and serum preincubated with green-lipped mussel extract. Bound immunoglobulin E (IgE) was detected by specific anti-human-IgE antibodies, and IgE-binding proteins were subsequently identified by liquid chromatography and mass spectrometry. The skin prick test was positive for green-lipped mussel. Specific IgE against green-lipped mussel extract was detected using Western immunoblotting. These potential allergenic proteins were identified by mass spectrometry as actin, tropomyosin, and paramyosin. All three allergens are reported for the first time for P canaliculus. Actin is a major allergen in Paphia textile, paramyosin in Sarcoptes scarbiei, and tropomyosin in Haliotis discus. For all IgE-binding proteins, the software AllCatPro predicted high allergenicity, supporting our conclusion that these proteins from P canaliculus may also be allergenic. The identification of allergens from P canaliculus provides the opportunity for specific tests to assess the frequency of allergic reactions to P canaliculus.

Background: Atopic eczema (AE) is known to be associated with depression and anxiety. We aimed at investigating the occurrence of selected psychological comorbidities in patients with AE under treatment in our university dermatological department. Methods: Monocentric prospective examination of adult AE patients using PO-SCORAD (Patient-Oriented Severity Scoring of AD), EASI (Eczema Area and Severity Index), POEM (Patient-Oriented Eczema Measure), DLQI (Dermatologic Life Quality Index), LSNS-6 (Lubben Social Network Scale 6), CES-D (Center for Epidemiologic Studies Depression Scale), HADS-D and -A (Hospital Anxiety and Depression Scale), and GAD-7 (Generalized Anxiety Disorder Scale-7) was carried out. We looked for correlations between AE severity and psychosocial comorbidities. Data were compared with age- and sex-matched controls from nonatopic subjects. Statistics: Mann-Whitney U test and Spearman’s rank correlation were used. Results: Eighty-four patients (44 women, median age 35.0 years, range: 19.4–92.8 years) were included. PO-SCORAD was 40.4 [23.4–55.4] (median [interquartile range]), EASI 9.3 [3.4–18.9], POEM 16 [8–24], and DLQI 10 [4–18]. Compared with 161 from the healthy LIFE-Adult cohort controls, our patients with AE had significantly higher scores for HADS, GAD-7, and CES-D (p < 0.001, respectively), but there was no increase in the LSNS score (18 vs. 19; p = 0.067). Within the group of AE patients, there was a significant correlation of the subjective skin severity and the depression and anxiety values: POEM significantly correlated with GAD-7, CES-D, and HADS-A and -D (p < 0.001). PO-SCORAD significantly correlated with GAD-7 and CES-D (p < 0.05). EASI correlated neither with HADS-A or -D nor with CES-D. Patients with suicidal thoughts, plans, or attempts in the last 12 months had significantly more severe AE than those without (POEM 25 [15.3–26] vs. 15 [7–23]; p = 0.013, and PO-SCORAD 51.6 [40.2–63] vs. 20.5 [20.7–52]; p = 0.014). Conclusion: Patients with AE being currently under treatment in our department had significantly increased scores indicating depression and anxiety. Suicidal tendency was increased in patients with severe AE. Key Message: AE patients may develop depression, anxiety, and suicidal ideation. Patient-oriented scores may help identifying high-risk patients.

Hautkrankheiten werden in Deutschland stationär vorwiegend in den 115 Hautkliniken versorgt.Versorgungswissenschaftliche und gesundheitsökonomische Analyse der dermatologischen stationären Versorgung und Prädiktion des zukünftigen Versorgungsbedarfes auf der Basis von Primär- und Sekundärdaten.Die ambulante und stationäre Versorgung der dermatologischen Behandlungsindikationen wird überwiegend durch Fachärzte für Dermatologie getragen. Stationär wurden 2018 833 491 Fälle behandelt, entsprechend 4,21 % aller stationären Fälle (19 808 687). Häufigste Behandlungsfälle waren: epithelialer Hautkrebs (gesamt 87 386, davon dermatologische Kliniken 52 608), gefolgt von Melanom (23 917/17 774), Psoriasis (19 291/13 352), Erysipel (73 337/11 260), sonstige Dermatitis (12 671/10 842), atopisches Ekzem (11 421/9734) und Herpes zoster (26 249/9652). Mit einer durchschnittlichen Verweildauer von 5,69 Tagen befanden sich die dermatologischen Kliniken im unteren Drittel. Der Anteil der in Hautkliniken versorgten stationären Indikationen war am höchsten bei Prurigo (95,2 %), Pemphigus (94,9 %), Parapsoriasis (94,6 %), Pemphigoid (90,3 %), Dermatitiden (85,6 %) und atopischem Ekzem (85,2 %). Während die Gesamtzahl der stationären Behandlungsfälle in Deutschland zwischen 2000 und 2018 um durchschnittlich 17,5 % gestiegen ist, ist dies bei Hautkrankheiten zu 26,6 % der Fall, bei einzelnen zu über 150 %. Die Projektion der heutigen auf die zukünftige stationäre Versorgung lässt einen weiterhin hohen Bedarf an stationärer Versorgung durch die Hautkliniken erwarten.Die stationäre dermatologische Versorgung ist auch zukünftig ein unerlässlicher Bestandteil der qualifizierten, sozialrechtlich notwendigen Versorgung in Deutschland.

Background In Germany, skin diseases are mainly treated in the 115 dermatological hospitals. Methods Health care and health economic analysis of dermatological inpatient care and prediction of future care needs based on primary and secondary data. Results Outpatient and inpatient care for dermatologic treatment indications is predominantly provided by dermatology specialists. Inpatient treatment was provided for 833,491 cases in 2018, corresponding to 4.21 % of all inpatient cases (19,808,687). Most common treatment cases were: epithelial skin cancer (total 87,386, of which dermatology clinics 52,608), followed by melanoma (23,917/17,774), psoriasis (19,291/13,352), erysipelas (73,337/11,260), other dermatitis (12,671/10,842), atopic dermatitis (AD) (11,421/9,734), and herpes zoster (26,249/9,652). With an average length of stay of 5.69 days, dermatology hospitals were in the bottom third. The proportion of inpatient indications cared for in dermatology hospitals was highest for prurigo (95.2 %), pemphigus (94.9 %), parapsoriasis (94.6 %), pemphigoid (90.3 %), eczema other than AD (85.6 %), and AD (85.2 %). While the total number of inpatient treatment cases in Germany has increased by an average of 17.5 % between 2000 and 2018, this is the case for 26.6 % of skin diseases and over 150 % for individual ones. The projection of current to future inpatient care suggests a continued high demand for inpatient care by dermatology hospitals. Conclusion Inpatient dermatological care will continue to be an indispensable component of qualified, socially necessary care in Germany.

Zusammenfassung Hintergrund Die mittelschwere bis schwere Psoriasis vulgaris kann wirksam mit immunmodulierenden Biologika wie dem Interleukin-17A-Inhibitor Secukinumab behandelt werden. In der Praxis stellt sich jedoch oft die Frage nach dem Vorgehen in besonderen Situationen, beispielsweise bei Infektionen, Komorbidität, Schwangerschaft oder operativen Eingriffen. Ziel der Arbeit In diesem Konsensdokument deutscher Psoriasisexperten sollen in Ergänzung zu den aktuellen Leitlinien häufige Fragen aus dem Therapiealltag zur Behandlung der Psoriasis mit Secukinumab beantwortet werden. Methoden In einem virtuellen Expertentreffen im Mai 2020 wurden auf Grundlage von Erfahrungen der Teilnehmer und aktueller Literatur praxisrelevante Aspekte der Behandlung der Psoriasis erörtert. Darauf basierend wurde ein Konsensdokument verfasst. Ergebnisse Die vorliegende Arbeit bietet praktische Hinweise zur Anamnese einschließlich der Erfassung von Vortherapien, Schweregrad der Psoriasis und Begleiterkrankungen vor Beginn einer Therapie mit Secukinumab. Ferner wird auf das Vorgehen bei Impfungen, Infektionen, operativen Eingriffen, Sondermanifestationen der Psoriasis und Komorbiditäten einschließlich vorbestehenden Autoimmunerkrankungen und Tumorerkrankungen unter Therapie mit Secukinumab eingegangen. Auch Fragen zur Familienplanung und zu gesundheitspolitischen Regularien werden diskutiert. Diskussion Die in diesem Konsensdokument zusammengefassten unterstützenden Empfehlungen zur Behandlung der Psoriasis mit Secukinumab sollen dazu beitragen, für die Patienten eine optimale Therapie zu erreichen und ihre Lebensqualität zu verbessern.

Die Therapie der Nahrungsmittelallergie (NMA) besteht bisher in einer Allergenkarenz und dem Einsatz von Notfallmedikamenten. Die Moglichkeit einer allergenspezifischen Immuntherapie (AIT) auf unterschiedlichen Applikationswegen findet in den letzten Jahren zunehmend Beachtung. Bei der primaren NMA wird vorrangig die orale AIT eingesetzt. Wahrend dieses bisher nur in Studien moglich war, existiert seit Kurzem fur die Erdnussallergie auch ein kommerziell erhaltliches Extrakt in Europa. Bei der sekundaren NMA kommen sublinguale und subkutane AIT v. a. mit den kreuzreagierenden Pollenallergenen zum Einsatz. Eine Zulassung fur diese Indikation existiert nicht, sodass eine AIT nur bei gleichzeitig bestehender Atemwegssymptomatik erfolgen sollte.

We recorded distribution ofWe found abundant growth ofSensitization to

Atopic dermatitis (AD) is a chronic inflammatory disease. During the last years, researchers have focused on a variety of associated comorbidities, especially psychosocial disease. This article aims at giving an overview over recent data. A systematic literature research was performed in PubMed including data from the time period January 1, 2018 until March 1, 2020. Patients with AD frequently suffer from cocomitant depression, anxiety, and attention deficit hyperactivity disorder. There is less evidence about the relation between AD and schizophrenia, eating disorder, and obsessive compulsive disorder. There is still great need for research in the connection between AD and psychosocial disease, particularly about the pathogenesis and the influence of new therapies.

In food allergy, allergen avoidance and emergency treatment are still therapeutic hallmarks but, recently, allergen immunotherapy (AIT), with different application routes, has gained more attention. In primary food allergy, oral immunotherapy has been frequently used in clinical trials. This year, an oral immunotherapy preparation for treatment of peanut allergy was licensed in Europe. In secondary food allergy, sublingual and subcutaneous extracts have been used in clinical trials, mostly with cross-reactive pollen allergens. As there is no AIT preparation licensed for this indication, therapy should only be started when there also is a need for treating associated respiratory symptoms.Die Therapie der Nahrungsmittelallergie (NMA) besteht bisher in einer Allergenkarenz und dem Einsatz von Notfallmedikamenten. Die Möglichkeit einer allergenspezifischen Immuntherapie (AIT) auf unterschiedlichen Applikationswegen findet in den letzten Jahren zunehmend Beachtung. Bei der primären NMA wird vorrangig die orale AIT eingesetzt. Während dieses bisher nur in Studien möglich war, existiert seit Kurzem für die Erdnussallergie auch ein kommerziell erhältliches Extrakt in Europa. Bei der sekundären NMA kommen sublinguale und subkutane AIT v. a. mit den kreuzreagierenden Pollenallergenen zum Einsatz. Eine Zulassung für diese Indikation existiert nicht, sodass eine AIT nur bei gleichzeitig bestehender Atemwegssymptomatik erfolgen sollte.

Diagnostics in type-1 allergy rely on medical history and clinical examination. Extent and severity of signs and symptoms can be documented by standardized scores and questionnaires. Both skin prick test and intradermal test are useful for search of immunoglobulin E-mediated sensitizations but the availability of commercially available diagnostic extracts has been markedly reduced during the last years. Investigation of total and of specific serum IgE is the most important in vitro diagnostic analyte in type-1 allergy. Identification of the individual molecules to which patients are sensitized, known as molecular or component-resolved diagnostics (CRD), has recently markedly improved management of type-1 allergy to pollen, food and hymenoptera venoms. Main features of CRD are increased analytic sensitivity, detection of cross-reactivity and determination of individual sensitization profiles which allow for risk assessment and facilitate decisions for or against allergen immunotherapy. Basophil activation test as well as determination of selected biomarkers (e.g. tryptase) may also be helpful in some cases. If any allergy test is positive, one will have to distinguish reactions, which are clinically relevant, from those, which are not. In vivo provocation tests (e.g. nasal provocation, oral drug or food challenge) may help to clarify the relevance of a sensitization.

Nach Ro-Resektion ausgedehnter kutaner Plattenepithelkarzinome des Kapillitiums mit Indikation zur postoperativen Radiatio sollten Verschlusstechniken gewählt werden, die die zügige Einleitung einer Radiotherapie nicht behindern und diese auch aushalten. Ziel der vorliegenden retrospektiven Analyse ist es, die Defektdeckung mittels transversaler Transpositionslappenplastik und Spalthautdeckung des Hebedefektes in einem solchen Szenario hinsichtlich onkologischer Sicherheit (Rezidivrate) und Permanenz des Wundverschlusses zu untersuchen.Elf Patienten wurden ermittelt, die histologisch ein kutanes Plattenepithelkarzinom aufwiesen, das durch mikroskopisch kontrollierte Exzision und Defektdeckung mittels transversalem Transpositionslappen und Spalthautdeckung des Hebedefektes in der Universitätshautklinik Leipzig versorgt und postoperativ bestrahlt wurde. Bei allen Patienten handelte es sich um betagte multimorbide Patienten. Die operative Versorgung erfolgte in Tumeszenzlokalanästhesie. Die Patienten wurden auf Rezidive, Wundheilungsstörungen und Nebenwirkungen der Strahlentherapie untersucht.Das Durchschnittsalter betrug 81 Jahre. Die Nachbeobachtungszeit umfasste im Durchschnitt 1,4 Jahre nach der letzten Radiotherapiesitzung (minimal 72 Tage, maximal 3,7 Jahre). Wundheilungsstörungen des Transpositionslappens oder Transplantatnekrosen wurden nicht nachgewiesen. Alle therapieassoziierten Nebenwirkungen waren bei Kontrolle abgeklungen. Lokalrezidive oder Metastasen traten bei keinem Patienten auf.Die kombinierte transversale Transpositionslappenplastik mit Spalthautdeckung des Hebedefektes ist ein sicheres und nebenwirkungsarmes Behandlungskonzept für große Skalpdefekte mit freiliegender Kalotte, die einer postoperativen Radiatio bedürfen.

ZusammenfassungEs wird über den Fall einer 13-jährigen Patientin mit neu aufgetretenen, auf Druck schmerzhaften Hautveränderungen beidseits am Hals und im Gesicht berichtet. Auf Nachfrage traten die Effloreszenzen episodisch im Rahmen von Stresssituationen auf. Im Verlauf kam es zu einer Spontanheilung mit Narbenbildung und mehreren Rezidiven. Nach erfolgter Probebiopsie wurde ein Gardner-Diamond-Syndrom ausgeschlossen und der Verdacht auf selbstinduzierte Hautläsionen geäußert.

Recognizing and treating rare checkpoint inhibitor related adverse events may be a clinical challenge in melanoma therapy. One of rather rare affected organs is the pancreas. Immune-related pancreatitis is difficult to recognize due to its variable clinical characteristics. Asymptomatic elevations of serum lipase and/or amylase during therapy with immune-checkpoint blockade impede the diagnostic process. We present a patient who developed an immune-related pancreatitis within the first 4 months of immunotherapy. Treatment with high dose systemic glucocorticosteroids with very slow tapering over a total period of 6.5 months was necessary to keep the patient symptom free as well as to maintain long-term normalization of serum lipase. Checkpoint blockade related pancreatitis may occur as acute or chronic disease and may lack any radiographic signs. As in our case, very slow tapering of initially high dose systemic glucocorticosteroids seems to be a crucial requirement for lasting recovery. Even after successful treatment, late-onset secondary pancreatic insufficiency may occur and patients have to be followed up at regular intervals. Restarting immunotherapy after resolution of immune-related pancreatitis is possible but needs careful risk-benefit consideration.

We present the case of a woman in her eighties with a collision tumor composed of a malignant melanoma, a squamous cell carcinoma and a basal cell carcinoma. The simultaneous growth of histogenetically different, spatially not separate, malignant tumors of the skin is rare. The classification is difficult and sometimes confusing, especially regarding the terminology used in the literature. The correct classification of such tumors has a high significance for the clinical daily routine.

Bei der Tinea barbae handelt es sich um eine seltene Dermatomykose, die per definitionem follikular gebunden im Bartbereich erwachsener Manner auftritt. Der Hautbefund beginnt meist mit Erythemen mit Schuppung. Bei Progredienz oder Ausbreitung an Terminalhaaren in die Tiefe kommt es zu Follikulitiden mit Pustel- und Knotenbildung sowie Abszedierungen mit fest anhaftenden gelblichen Krusten, begleitet von einer lokoregionaren Lymphknotenschwellung und gelegentlich vermindertem Allgemeinzustand oder (sub)febrilen Temperaturen. Dies fuhrt haufig zunachst zur Verdachtsdiagnose einer bakteriellen Folliculitis barbae oder Impetigo contagiosa. Die Tinea barbae wird meist durch Spezies der Gattung Trichophyton (T.) ausgelost. Die Erreger sind vielfaltig und gehoren uberwiegend zu den zoophilen, nur gelegentlich zu anthropophilen und selten zu den geophilen Dermatophyten. Mithilfe der gezielten Anamnese und Diagnostik in Form von mykologischen Untersuchungen, Histologie und molekularbiologischem Dermatophytennachweis mittels Polymerasekettenreaktion kann heute schnell die Diagnose einer Tinea barbae, bei unserem Patienten ausgelost durch T. mentagrophytes, gestellt werden. Bei zeitnaher und ausreichend langer Therapie kommt es zur vollstandigen Restitutio ad integrum.