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Zusammenfassung Hintergrund Komplikationen treten bei 3 – 16% der chirurgischen Eingriffe auf. Nach Expertenangaben sind ca. 50% dieser unerwünschten Ereignisse vermeidbar. Es ist empirisch belegt, dass Mortalitäts- und Komplikationsraten durch die Einführung von Checklisten gesenkt werden können. Material und Methode In dieser Studie wurde die Ausfüllqualität der bereits seit mehreren Jahren angewandten und einer durch die „Abteilung für Qualitäts- und Klinisches Risikomanagement“ optimierten, neuen Checkliste miteinander verglichen. Die Einführung der neuen OP-Sicherheits-Checkliste erfolgte Anfang Januar 2017 in einem Krankenhaus der Grund- und Regelversorgung. Zusätzlich wurden compliancefördernde Maßnahmen (Schulungen etc.) durchgeführt, mit denen die Nutzung der neuen Checkliste angeregt werden sollte. Ergebnis Insgesamt wurden jeweils 293 OP-Sicherheits-Checklisten (vorher und nachher) ausgewertet. Bei den aus insgesamt 11 Items bestehenden Checklisten verbesserte sich die Ausfüllqualität als Menge der eingetragenen Informationen mit Einführung der neuen OP-Sicherheits-Checkliste bei insgesamt 8 Items. Es gab im Zuge der Implementierung der neuen OP-Sicherheits-Checkliste kein Item, bei dem sich die Ausfüllqualität gegenüber der alten Liste verringerte. Schlussfolgerung Es wurde nachgewiesen, dass die Einführung dieser optimierten OP-Sicherheits-Checkliste in Zusammenhang mit compliancefördernden Maßnahmen eine wesentlich verbesserte Ausfüllqualität erbrachte. Unter Einbezug der analysierten Literatur zu diesem Thema lässt sich jedoch auch festhalten, dass die compliancefördernden Maßnahmen einen wichtigen Beitrag zu diesem Ergebnis leisteten.

Complications occur in 3 to 16% of surgical procedures. According to experts, about 50% of these adverse events are avoidable. It is empirically proven that mortality and complication rates can be reduced by introducing checklists.In this study, the quality of completion of the new checklist, which has already been used for several years, was compared with a checklist optimised by the Quality and Clinical Risk Management Department. The new surgical checklist was introduced at the beginning of January 2017 in a hospital providing primary and regular care. In addition, compliance-promoting measures (training, etc.) were carried out to encourage the use of the new checklist.A total of 293 surgical safety checklists each (pre and post) were evaluated. With the introduction of the new checklist for a total of 8 items, the quality of the surgical safety checklists consisting of 11 items improved. In the course of the implementation of the new surgical safety checklist, there was no item for which the quality of completion was reduced compared to the old list.It was proven that the introduction of these optimised surgical safety checklists in connection with compliance promoting measures resulted in a significantly improved quality of completion. However, in view of the literature on this topic, it can also be stated that the compliance-promoting measures made an important contribution to this result.Komplikationen treten bei 3 – 16% der chirurgischen Eingriffe auf. Nach Expertenangaben sind ca. 50% dieser unerwünschten Ereignisse vermeidbar. Es ist empirisch belegt, dass Mortalitäts- und Komplikationsraten durch die Einführung von Checklisten gesenkt werden können.In dieser Studie wurde die Ausfüllqualität der bereits seit mehreren Jahren angewandten und einer durch die „Abteilung für Qualitäts- und Klinisches Risikomanagement“ optimierten, neuen Checkliste miteinander verglichen. Die Einführung der neuen OP-Sicherheits-Checkliste erfolgte Anfang Januar 2017 in einem Krankenhaus der Grund- und Regelversorgung. Zusätzlich wurden compliancefördernde Maßnahmen (Schulungen etc.) durchgeführt, mit denen die Nutzung der neuen Checkliste angeregt werden sollte.Insgesamt wurden jeweils 293 OP-Sicherheits-Checklisten (vorher und nachher) ausgewertet. Bei den aus insgesamt 11 Items bestehenden Checklisten verbesserte sich die Ausfüllqualität als Menge der eingetragenen Informationen mit Einführung der neuen OP-Sicherheits-Checkliste bei insgesamt 8 Items. Es gab im Zuge der Implementierung der neuen OP-Sicherheits-Checkliste kein Item, bei dem sich die Ausfüllqualität gegenüber der alten Liste verringerte.Es wurde nachgewiesen, dass die Einführung dieser optimierten OP-Sicherheits-Checkliste in Zusammenhang mit compliancefördernden Maßnahmen eine wesentlich verbesserte Ausfüllqualität erbrachte. Unter Einbezug der analysierten Literatur zu diesem Thema lässt sich jedoch auch festhalten, dass die compliancefördernden Maßnahmen einen wichtigen Beitrag zu diesem Ergebnis leisteten.

Zusammenfassung Die Qualitat der medizinischen Behandlung unterliegt stetig zunehmenden internen und externen Anforderungen. Zur Qualitatssicherung und -steigerung ist insbesondere in der perioperativen Medizin eine Optimierung klinischer Prozesse unabdingbar. Ein fur diesen Zweck entwickeltes Instrument sind Klinische Pfade. Dies sind strukturierte Ablaufplane, in denen Kernprozesse der Behandlung zeitlich geordnet dargestellt werden. Die vorliegende Arbeit evaluiert mittels einer standardisierten Literaturrecherche sowie eigener Studien, ob Klinische Pfade die Qualitat der Behandlung in der perioperativen Medizin steigern konnen. Die Ergebnisse zeigen, dass Klinische Pfade einzelne Parameter der Prozessqualitat und des Outcomes signifikant verbessern. Allerdings ist der Evidenzgrad der meisten Studien gering, zudem existieren fur viele Settings, gerade im europaischen Raum, uberhaupt keine Studien. Somit besteht ein groser Bedarf an weiteren, nach Moglichkeit randomisierten, Studien, welche den Einfluss von Klinischen Pfaden auf die Qualitat der Behandlung untersuchen.

A 62-year-old patient treated for 9 years with hydroxyurea for chronic myeloproliferative disease developed multiple cutaneous neoplasms. Hydroxyurea minimizes DNA synthesis via inhibition of the enzyme ribonucleotide reductase and is used to treat hematological malignancies. The most important and severe side-effect is a dose-dependent myelodepression. An association with multiple skin tumors has been reported. The presented case emphasizes this potential risk of hydroxyurea therapy. Continuous dermatologic monitoring of patients treated with hydroxyurea is recommended.

Background Pityriasis lichenoides (PL) is a rare cutaneous lymphoproliferative disorder of unknown origin. Malignant transitions of PL have been described, but are very rare. We recently observed the fatal course of a 26-year-old patient who presented with a clinical picture resembling PL but had cytotoxic CD8+ T-cell lymphoma of the skin (CxCTL). This case prompted us to reinvestigate the role of cytotoxic T lymphocytes in PL and its relationship to antiviral immunity. Methods Skin biopsy specimens of 11 patients with PL and two biopsy specimens of CxCTL were included. In all, 5 biopsy specimens taken from healthy skin and 5 samples of varicella-zoster virus (VZV) skin lesions were analyzed for control purposes. The inflammatory infiltrate was characterized by immunohistochemistry using monoclonal antibodies against CD3, CD4, CD8, CD20, cutaneous lymphocyte-associated antigen (CLA), CCR4, CXCR3, Granzyme B, Tia-1, and MxA. Flow cytometry was used to analyze the expression of chemokine receptors on peripheral blood mononuclear cells in CxCTL. Results The CxCTL skin lesions were dominated by a dense infiltration of CD8+ cytotoxic lymphocytes with a skin-homing CLA+ CCR4+ phenotype. PL and VZV skin lesions were also characterized by a predominantly CD8+ T cellular infiltrate with strong expression of the cytotoxic molecules Granzyme B and Tia-1 and the skin-homing molecules CLA and CCR4. Coexpression analyses confirmed that skin CLA+ CD8+ cytotoxic T cells are present in CxCTL, VZV, and PL skin lesions. Strong lesional production of the antiviral protein MxA, which is specifically induced by type I interferons, could be found in all investigated disorders. The study was based on histologic, immunohistologic, and flow cytometric analyses in a limited number of patients, because of the rareness of the investigated diseases. Conclusion Our results revealed a striking similarity between the immunohistologic picture of malignant CxCTL, benign PL, and VZV skin lesions. Strong expression of the antiviral protein MxA in all disorders supports the view that a common antiviral immune response pattern leads to aberrant skin recruitment of CLA+ CCR4+ cytotoxic T lymphocytes in PL and CxCTL.

We studied 253 primary melanomas of the skin for histologic signs of regression. Detailed immunohistologic analyses, including expression of MxA (an antiviral protein specifically induced by type I interferons), the chemokine IP10/CXCL10, the chemokine receptor CXCR3, and the cytotoxic molecule granzyme B, were performed for 14 typical regressive tumors and 20 control samples (congenital nevi, halo nevi, unaffected skin). We found high expression of MxA, indicating local type I interferon production, in inflamed regressive melanocytic lesions, along with large numbers of natural interferon-producing plasmacytoid dendritic cells, CXCR3+ lymphocytes, and granzyme B+ lymphocytes. We also detected high expression of the interferon-induced chemokine IP10/CXCL10, linking type I interferon production and recruitment of CXCR3+ lymphocytes. Our results provide evidence that endogenous activation of type I interferons, infiltration of plasmacytoid dendritic cells, and recruitment of CXCR3+ and granzyme B+ lymphocytes are involved in spontaneous regression of melanoma and other melanocytic lesions. We believe this cytotoxic immune response represents an evolutionarily conserved pathway against intracellular pathogens.

Summary Background Leukopenia and lymphopenia are typical features of lupus erythematosus (LE) and correlate with elevated disease activity and higher grades of systemic involvement. Antilymphocyte antibodies are regarded as the most likely rationale for the decreased cell numbers; however, their relevance has not been confirmed so far. Objectives Previous investigations at our department have shown a significant correlation between diminished lymphocyte numbers and the presence of antinuclear antibodies (ANA). We wanted to achieve a better understanding of this phenomenon. Methods We performed a detailed analysis of autoantibodies and peripheral leucocyte subsets in 82 patients with different subtypes of LE. Leucocyte subsets were measured using flow cytometry (FACScanTM; Becton Dickinson, Franklin Lakes, NJ, U.S.A.); autoantibodies were detected by indirect immunofluorescence and by enzyme-linked immunosorbent assay. Results A significant association (P

Zusammenfassung Die Behandlung des kutanen Lupus erythematodes (CLE) stellt oft eine therapeutische Herausforderung dar, vor allem bei Patienten, die auf eine rein topische Therapie nicht ansprechen oder zusatzliche systemische Manifestationen zeigen. Hier mus vielfach auf eine systemische Therapie zuruckgegriffen werden. Zwar werden einige Substanzen erfolgreich in der systemischen Therapie des CLE eingesetzt, diese sind jedoch haufig nicht fur diese Indikation zugelassen. Wir geben im folgenden eine Ubersicht uber die eingesetzten Substanzen und stellen den Wirkmechanismus sowie mogliche Indikationen, Zulassung und wichtige Punkte fur das praktische Vorgehen dar. Berucksichtigt werden die Einsatzmoglichkeiten von Kortikosteroiden, Antimalariamedikamenten, Dapson, Azathioprin, Cyclophosphamid, Methotrexat, Retinoiden, Ciclosporin A, Mycophenolat Mofetil, Sulfasalazin, Thalidomid, Clofazimin, Tacrolimus, Immunglobulinen, monoklonalen Antikorper, Plasmapherese, Etanercept, Infliximab, Leflunomid, Gold und Interferon-α. Summary The treatment of cutaneous lupus erythematosus (CLE) remains a therapeutic challenge. In many cases, systemic treatment of the disease is necessary, especially in cases resistant to topical treatment or with internal organ involvement. Even though many different agents can be employed in this situation, most are not approved in Germany for the treatment of CLE. We give an overview of the agents used in the systemic treatment of CLE and review their mechanisms of action, indications and their practical use in cutaneous LE based on literature results and our own experience. We discuss corticosteroids, antimalarials, dapsone, azathioprine, cyclophosphamide, methotrexate, retinoids, cyclosporine A, mycophenolate mofetil, sulfasalazine, thalidomide, clofazimine, tacrolimus, immunoglobulins, monoclonal antibodies, plasmapheresis, etanercept, infliximab, feflunomid, gold and interferon-α.

The group of autoimmune cutaneous connective tissue diseases (CCTD) includes systemic sclerosis, dermatomyositis (DM), lupus erythematosus (LE), and subtypes. Most CCTD patients can be assigned to one of these phenotypes or mixed forms, and transitions among the subsets exist. We present the case of a 26-year-old woman with bullous LE and a background of pre-existing DM. Observations of transitions between DM and LE are extremely rare. Nevertheless, this case demonstrates the close relationship between these two disorders in the context of autoimmune connective tissue disease.

Chondroid syringoma belongs to the group of so-called mixed tumors, like pleomorphic adenomas of the lacrimal and salivary glands. The histogenesis of this tumour is still disputed, in particular with respect to its stromal component. The distribution of cytokeratins (CKs), CEA, EMA, vimentin, S-100 protein, desmin and actin [alpha-smooth muscle actin (alpha-SMA)] was investigated by immunohistological examination of paraffin sections from a chondroid syringoma of the apocrine type. The neoplastic formations have been classified into tubuloalveolar structures, solid nests/aggregations and stromal cells of varying morphology. The inner-most cells of tubuloalveolar structures were characterized by marked expression of CKs (KL1 and MNF116), CEA and EMA, while in the outer ones there was moderate expression of vimentin, S-100 was expressed to a lesser extent and KL1, weakly but there was marked and consistent expression of MNF116. Whereas the solid nests expressed vimentin, S-100 protein, MNF116 markedly and KL1 weakly, the stromal cells were consistently positive for vimentin, S-100 protein and, focally, CKs and alpha-SMA. Anti-alpha-SMA specifically detects myoepithelial cells. In addition, the partly overlapping immunoreactivity of the intermediate filaments, membrane proteins and proteins in the different structures may indicate a common clonal origin of all neoplastic cells in chondroid syringoma.

To determine whether specific T-cell activation pathways could produce nuclear contour irregularity in normal human lymphocytes, purified T cells were stimulated in vitro and subsequently analyzed by electron microscopy. The degree of nuclear contour irregularity was determined with the use of a computerized planimeter. Stimulation via the T-cell receptor (TCR)/CD3 complex using anti-CD3 monoclonal antibodies induced Sezary-like morphology (nuclear contour indices > 6.5) in a significant portion (9% to 28%) of T cells derived from different normal donors. T- cell activation via CD2 antigens showed induction of Sezary-like nuclear morphology in a lower percentage of cells in comparison with stimulation via the TCR/CD3 complex. In contrast, mitogenic stimulation in vitro did not induce alterations of nuclear morphology in T cells. Immunoelectron microscopy showed that nuclear contour irregularity induced in vitro did not correlate with surface-antigen expression of T- cell subpopulations. The results indicate that Sezary-like morphology is associated with cell activation in normal human T cells.

SummaryBackground Some patients suffering from cutaneous lupus erythematosus (CLE) develop extracutaneous manifestations during the course of the disease: up to 5% of patients with discoid LE (DLE) and up to 30% of subacute cutaneous LE (SCLE) patients show systemic involvement. Recent studies revealed some markers indicating systemic manifestations of CLE patients. However, the significance of diminished peripheral lymphocyte numbers as a marker of systemic involvement in CLE has not been investigated before. Objectives To determine the value of lymphocytopenia (

We present the case of a 71-year-old man with inclusion body myositis combined with subacute cutaneous lupus erythematosus and dysphagia. Although inclusion body myositis is usually resistant to immunosuppressive therapy, this patient improved under treatment with corticosteroids. The presented case is discussed in the context of earlier reports of inclusion body myositis and lupus erythematosus.

The treatment of cutaneous lupus erythematosus (CLE) remains a therapeutic challenge. In many cases, systemic treatment of the disease is necessary, especially in cases resistant to topical treatment or with internal organ involvement. Even though many different agents can be employed in this situation, most are not approved in Germany for the treatment of CLE. We give an overview of the agents used in the systemic treatment of CLE and review their mechanisms of action, indications and their practical use in cutaneous LE based on literature results and our own experience. We discuss corticosteroids, antimalarials, dapsone, azathioprine, cyclophosphamide, methotrexate, retinoids, cyclosporine A, mycophenolate mofetil, sulfasalazine, thalidomide, clofazimine, tacrolimus, immunoglobulins, monoclonal antibodies, plasmapheresis, etanercept, infliximab, feflunomid, gold and interferon-alpha.

Summary Background Infiltrating T lymphocytes are considered to play a major pathological role in skin lesions of cutaneous lupus erythematosus (CLE), a cutaneous autoimmune disease of unknown aetiology. Earlier histological studies revealed that the inflammatory infiltrate in CLE skin lesions is predominantly composed of T lymphocytes, with a slight predominance of CD4+ over CD8+ T cells, but failed to explain the development of scarring skin lesions, characteristic for chronic discoid lupus erythematosus (CDLE). Because recent investigations have highlighted the relevance of cytotoxic lymphocytes in autoimmune tissue destruction, we hypothesized that the scarring CDLE lesions might be caused by cytotoxic T lymphocytes. Objectives To analyse skin biopsies of 15 patients with CLE [10 female, five male; localized CDLE (lCDLE), n = 5; disseminated CDLE (dCDLE), n = 5, subacute CLE (SCLE), n = 5] and five control biopsies taken from healthy controls and to characterize the inflammatory infiltrate. Methods We used immunohistochemistry, including staining for the cytotoxic molecule granzyme B, the skin-homing molecule cutaneous lymphocyte antigen (CLA) and the protein MxA, which is specifically induced by type I interferons (IFNs). Results We found a strong coexpression of granzyme B and CLA on lesional lymphocytes of patients with scarring lCDLE and dCDLE, which was significantly enhanced when compared with nonscarring SCLE and healthy controls. The increased expression of granzyme B was closely associated with the lesional expression of the type I IFN-induced protein MxA. Conclusions Our results provide evidence that type I IFNs and potentially autoreactive cytotoxic lymphocytes targeting adnexal structures are highly associated with scarring lupus erythematosus lesions and might be responsible for their scarring character.

background. Dowling–Degos disease is a rare condition with a genetically determined disturbance of epidermal proliferation. The typical clinical picture is a reticulate pigmentation of the flexures, genital folds, and pectoral skin areas. Many different treatment options have been tried in recent years without a convincing therapeutic benefit. objective. To determine the effectiveness of Er:YAG laser in Dowling-Degos disease. methods. A 44-year-old woman suffering from Dowling-Degos disease was treated with the Er:YAG laser pulse energy between 1,000 and 1,200 mJ, three consecutive passes. results. The laser treatment led to a good clinical result. conclusion. Our case suggest that treatment with the Er:YAG laser might be a successful strategy in Dowling-Degos disease.

We present the case of a 38-year-old female patient with systemic lupus erythematosus and atypical urticarial skin lesions with an alteration in shape, but not complete disappearance, within 24 hours. Hematoxylin-eosin-stained sections revealed flame figures. We review urticarial lesions in lupus erythematosus and discuss the possible pathomechanisms.

We describe a cardiac transplant patient who had human cutaneous alternariosis with a sporotrichoid distribution of skin lesions. In this patient identification of the causative organism Alternaria infectoria was achieved by sequencing the rDNA internal transcribed spacer domain. Treatment with itraconazole led to clinical resolution within 4 months.

Das chemical peeling (Chemoexfoliation, chemical face lifting oder Chemochirurgie) mit Resorzin, Sa lizylsaure, Trichloressigsaure und Phenol wurde An fang dieses Jahrhunderts von dem deutschen Der matologen Unna [3] propagiert. Dem britischen Dermatologen MacKee wird die Anwendung des Phenols in der Behandlung der Aknenarben Anfang des 20. Jahrhunderts zugeschrieben [3]. Das chemi cal peeling wurde wahrend des ersten Weltkriegs in die Vereinigten Staaten eingefuhrt und uberwiegend zur kosmetischen Behandlung der aktinisch gescha digten Altershaut eingesetzt. Wahrend diese Be handlung in Europa zunachst keine weitere Bedeu tung erlangte, erwiesen sich in den Vereinigten Staa ten zunachst Kosmetikerinnen, spater auch Derma tologen als besonders aktiv und kreativ auf diesem Gebiet. Das chemical peeling mit Trichloressigsaure (TCA) zur Behandlung aktinischer Keratosen bzw. der Altershaut wurde durch Publikationen von Monash im Jahre 1945 [8] und Ayres im Jahre 1962 etab liert [1]. Baker [2] sowie Litton [7] haben Anfang der 60er Jahre eigene Rezepturen fur das Phenolpeeling entwickelt. Es handelt sich dabei um eine »dramati sche« Therapie der Altershaut, die aber in den Han den eines geubten Dermatologen besonders wir kungsvoll ist und eindrucksvolle Resultate mit lang anhaltendem Effekt bietet. In den letzten 15 Jahren sind zahlreiche Publikationen erschienen, die die Vielfalt der Methoden des chemical peeling in unter schiedlichen Rezepturen beschreiben. Daruber hin aus wurden Langzeitergebnisse auch mit histologischer Kontrolle diskutiert. An dieser Stelle sollen die histologischen Untersuchungen von Stegman [12] sowie Roenigk und Brodland [11] besonders er wahnt werden. In den 80er Jahren haben sich die α-Hydroxysauren in der Behandlung der Altershaut etabliert. Sie wurden auch in der Therapie der Acne vulgar is in Losung oder Cremeform eingesetzt [10, 13, 14].

A 59-year-old man presented at our department with a 4-week history of persisting and therapy-refractory infraorbital edema (Fig. 1). There was no previous history of eyelid edema, allergic reactions, autoimmune diseases, or new medications. Earlier therapy with corticosteroids and antihistamines was ineffective. Figure 1. Persistent swelling of both infraorbital folds The patient suffered from coronary heart disease and long-standing chronic bronchitis presenting with dyspnea on exertion. He had smoked 50 cigarettes per day since early youth. There was no history of worsening of his bronchogenic symptoms, weight loss, or night sweats over the last 3 months. Initial physical examination revealed marked infraorbital edema, enlarged liver, and decreased breath sounds in the left lung field. Moreover, there was a minor telangiectatic erythema localized to the periumbilical area and to the anterior chest. There was no suffusion of the neck and no remarkable peripheral edema. Laboratory parameters, including electrolytes, blood cell count, creatinine, transaminases, alkaline phosphatase, protein electrophoresis, C1-esterase inhibitor, C-reactive protein, immunoglobulin E, and thyroid parameters, were within normal limits. X-Ray of the chest detected a mediastinal widening. Computed tomography was performed and revealed a mediastinal tumor, 7 cm in diameter, reaching from the aortic arch to the heart. This tumor was compressing the superior vena cava, resulting in stasis of the leading vessels followed by infraorbital edema. Histopathologic examination of tumor biopsies led to the diagnosis of a bronchogenic small-cell carcinoma. Six cycles of polychemotherapy with doxorubicin, ifosfamide, and vincristine, radiation therapy (50 Gy), and intravascular stenting of the vena cava superior were performed. Following this treatment, regression of the tumor and a distinct decline in infraorbital edema were observed.

(2002). Periodic genital pruritus caused by syringoma of the vulva. Acta Obstetricia et Gynecologica Scandinavica: Vol. 81, No. 4, pp. 369-370.

This study presents the case of a 38-year-old patient from Pakistan with vitiligo, who developed multiple verrucous papules on the palms and soles several years after receiving ‘‘herbal treatment’’ from a travelling Indian doctor for a period of 12 months. Histopathological examination showed changes consistent with the diagnosis of arsenical keratosis. Molecular ‐ biological examination of a skin biopsy detected an atypical human papillomavirus. This observation supports the concept of human papillomavirus as a co-factor in the pathogenesis of premalignant arsenic-induced skin tumours. Key words: arsenical keratosis; Indian ethnic remedy; human papillomavirus.

Sir, Granuloma annulare (GA), a granulomatous disease of unknown aetiology, is characterized by small papules that are often fused into annular arrangements. Several variants are known: localized GA, generalized GA, subcutaneous GA, perforating GA and arcuate dermal erythema. Localized GA is the most common of the subtypes; 9 – 15% are afflicted with the generalized variant. The other subtypes are rare. Children and young adults are those predominantly affected – women twice as often as men. Human leucocyte antigen (HLA)-B8 has been reported to be increased in localized GA, while HLA-A31 and HLA-BW35 are reported to be increased in the generalized GA. Proposed pathogenic mechanisms of GA include cellmediated immunity (type IV), immune complex vasculitis and abnormalities of tissue monocytes, diabetes mellitus, thyroid disease, HIV and hepatitis C infection appear to be predisposing factors. Aside from these predisposing factors, trigger factors seem to play an important role in the development of the disease. GA may appear following other disease at the same site: mycobacterial and fungal infections, herpes simplex infection, herpes zoster, erythema multiforme minor and insect bites can lead to the manifestation of GA. An isomorphic phenomenon (Koebner reaction) is the assumed pathophysiologic mechanism for these observations. However, to the best of our knowledge a case of GA induced by scabies infection has not been described previously.