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Background In recent years, the introduction of the E‑Health Act and the relaxation of the ban on remote treatment has improved the framework for telemedicine in Germany. Objectives The aim of this article is to present an overview of the evidence of different areas of application for teledermatology. Materials and methods A narrative review of national and international studies and projects on the use of teledermatology for diagnosis, monitoring of diseases, triage between primary care physicians (PCPs) and dermatologists, and its use in facilities with reduced organizational and/or geographical access to specialist care was conducted. Results Diagnostic applications allow teledermatological assessment in a large proportion of cases, with high concordance of diagnosis and patient satisfaction. For the monitoring of patients, the majority of studies demonstrated no difference in effectiveness between on-site and remote consultation, while patients are spared travel distance and waiting time. For programs enabling triage most of the patients with dermatologic conditions were able to remain with the PCP, while acute patients requiring direct referral to a dermatologist were identified. In special facilities, such as prisons, dermatological teleconsultations are successfully utilized. Conclusion An adequate framework and promising evidence for the use of teledermatology exist. The areas of application are described in detail within the German S2k guideline for teledermatology. However, there is a potential risk for decreased access to telemedicine services for certain population groups.

Scabies is one of the most common and, in terms of burden of disease, one of the most significant skin diseases worldwide. In Germany, an increase in cases is currently being discussed, for which reliable data have been lacking until now.The goal is to clarify the prevalence and treatment of scabies in Germany.Multisource analyses of treatment data from a nationwide statutory health insurance company, the Federal Statistical Office and company skin screenings.In Germany, the number of cases of scabies has been rising since 2009 and especially since 2014. In the outpatient setting, there was an increase of 52.8% to around 128,000 treatment cases between 2010 and 2015. Currently, more than 11,000 inpatient cases are documented annually in Germany with scabies as the main diagnosis (ICD-10 B86). The increase between 2010 and 2016 was about 306%. The main outpatient specialist groups providing care are dermatologists and general practitioners, while in the inpatient sector treatment is provided by departments of dermatology, paediatrics and internal medicine.Due to the aforementioned development of prevalence and incidence, the need for care will remain at a high level in the future, which suggests an increased need for education and early detection.HINTERGRUND: Skabies stellt weltweit eine der häufigsten und hinsichtlich der Krankheitslast bedeutendsten Hautkrankheiten dar. In Deutschland wird derzeit eine Zunahme von Fällen diskutiert, wofür bisher belastbare Zahlen fehlten.Häufigkeit und Versorgungsmerkmale der Skabies in Deutschland.Multi-Source-Analysen aus Versorgungsdaten einer bundesweiten gesetzlichen Krankenversicherung, des Statistischen Bundesamtes und von betrieblichen Hautscreenings.In Deutschland weist Skabies seit 2009 und insbesondere seit 2014 eine steigende Versorgungsprävalenz auf. Im ambulanten Bereich findet sich ein Anstieg zwischen 2010 und 2015 von 52,8 % auf etwa 128.000 Behandlungsfälle. Stationär werden in Deutschland derzeit jährlich über 11.000 Fälle mit Skabies als Hauptdiagnose (ICD-10 B86) dokumentiert. Der Anstieg zwischen 2010 und 2016 betrug etwa 306 %. Hauptversorgende ambulante Fachgruppen sind Dermatologen und Hausärzte, im stationären Bereich Fachabteilungen für Dermatologie, Pädiatrie und Innere Medizin.Der Versorgungsbedarf wird zukünftig aufgrund der vorgenannten Entwicklung von Prävalenz und Inzidenz weiter auf einem hohen Niveau bleiben, was einen erhöhten Aufklärungs- und Früherkennungsbedarf nahelegt.

Natalia Kirsten, Nicole Mohr, Matthias Augustin Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyCorrespondence: Natalia KirstenInstitute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, 20246, GermanyTel +49-40-7410-55428Fax +49-40-7410-5348Email n.kirsten@uke.dePurpose: Although acne vulgaris (AV) is a common disease and can persist into adulthood, there are few large-scale epidemiological studies on the prevalence of acne vulgaris in adults. The aim of our study was to characterise the epidemiology and comorbidity of acne vulgaris in working adults in Germany.Patients and Methods: Within the framework of a cross-sectional study, a total of 161,269 employees underwent dermatological whole-body examinations in more than 500 German companies between 2001 and 2016. Point prevalence rates for acne vulgaris and further skin diseases and their 95% confidence intervals were calculated and differences between participants with and without acne vulgaris were tested with chi-squared tests.Results: Mean age was 43.2 years ± 10.9, 55.5% were male. In total, n = 5311 people (3.3%) with acne vulgaris were identified. Prevalence decreased by age. Controlling for age and gender, acne was significantly associated with folliculitis (OR = 1.91; CI: 1.76– 2.07), contact dermatitis (OR = 1.74; CI: 1.08– 2.81), rosacea (OR = 1.74; CI: 1.40– 2.15), pyoderma (OR = 1.58; 1.22– 2.06), seborrheic dermatitis (OR = 1.47; CI: 1.27– 1.71), hand eczema (OR = 1.34; CI: 1.00– 1.76), verruca vulgaris plantaris (OR = 1.29; CI: 1.09– 1.51), tinea pedis (OR = 1.27; CI: 1.10– 1.47), spider veins (OR = 1.26; CI: 1.16– 1.38) and telangiectasia (OR = 1.15; CI: 1.02– 1.30).Conclusion: These data underline the importance of acne vulgaris in the adult population. Further studies to better understand the pathophysiology of AV and its comorbidity in different phases of adulthood would be desirable to develop appropriate guidelines and therapy concepts.Keywords: acne vulgaris, comorbidities, epidemiology, inflammation

Natalia Kirsten,1 Nicole Mohr,1 Franziska Gensel,1 Aminah Alhumam,1,2 Guido Bruning,3 Matthias Augustin1 1Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; 2Department of Dermatology, College of Medicine, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia; 3Department of Vein and Dermatosurgery, Tabea Hospital GmbH and Co KG, Hamburg, GermanyCorrespondence: Natalia KirstenInstitute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, Hamburg, D-20246, GermanyTel +49-40-7410-55428Fax +49-40-7410-55348Email n.kirsten@uke.deIntroduction: Data on the prevalence of chronic venous disorders (CVD) at the national level in Germany are scarce.Methods: We performed a population-based observational study based on clinical examinations, personal history, and technical examinations. Data were collected from 2006 to 2015. Descriptive data analysis was done to determine CVD and chronic venous insufficiency (CVI) prevalence and occurrence of potential risk factors. Chi-squared tests were performed to estimate the influence of risk factors on the prevalence of CVD.Results: In total, 19,104 employees from different branches were included. The majority of the examined people were doing office work (n = 8157; 80.2%). A total of 4038 persons (21.1%) show at least one sign of CVD. At least one sign of CVI could be found in 679 persons (3.6%). Being female was found to be protective with an odds ratio of 0.66 (95% CI 0.59– 0.73).Conclusion: There is clear indication for active venous treatment in 22.3% of the adult working population in Germany.Keywords: venous insufficiency, epidemiology, prevalence

Natalia Kirsten,1 Nicole Mohr,1 Aminah Alhumam,1,2 Matthias Augustin1 1Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; 2Department of Dermatology, College of Medicine, King Faisal University, Hofuf, Al Ahsa, Saudi ArabiaCorrespondence: Natalia KirstenInstitute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, GermanyTel +49-40-7410-55428Fax +49-40-7410-5348Email n.kirsten@uke.deBackground: Seborrhea is a skin condition characterized by abundant production of sebum associated with typical dermatological conditions such as rosacea and acne. Little is known about the prevalence of seborrhea and the frequency of concurrent skin diseases in the general population.Objective: To investigate the epidemiology and comorbidity of seborrhea in the adolescent and adult working population.Methods: In large-scale examinations by dermatologists in 343 German companies, the seborrheic skin type and the occurrence of skin findings were documented electronically. Odds ratios (OR) and their 95% confidence intervals (95% CI) of further skin diseases were computed. Logistic regression analyses were conducted for each disease using seborrhea as dependent variable.Results: A total of 48,630 employees were examined. About 6.0% showed seborrhea (6.6% in men, 5.4% in women). Seborrhea strongly predicted acne (OR 3.59; CI 3.18– 4.05), trichilemmal cysts (OR 1.99; CI 1.25– 3.18) and rosacea (OR 1.45; CI 1.17– 1.81). Regression analyses controlling for age, gender and phototype confirmed significant associations of seborrhea with acne and rosacea.Conclusion: Only a minor proportion of the working population shows meaningful seborrheic skin. However, this condition predicts distinct skin diseases and thus needs attention, in particular, with respect to consulting and secondary prevention.Keywords: seborrhea, seborrheic skin, epidemiology, comorbidities

Background Large variations in the quality of psoriasis care lead to patients being willing to bypass the nearest physician to receive higher quality of care. However, it remains unknown whether actual travel time is associated with quality of care. This study aimed to identify perceived quality of care determinants for travel time to the physician among patients with psoriasis in Germany. Furthermore, differences in access and perceived quality of care between urban and rural areas in Germany were analyzed. Methods This cross-sectional observational study based on patient-level healthcare data. Perceived quality of care and treatment satisfaction were assessed from the patients’ perspective. Travel time was estimated by the patients. Multiple regression analysis with the predictors patient characteristics, system-related variables, urbanity, and patient satisfaction with treatment, was applied to identify determinants of travel time with subgroup analyses for rural and urban areas. Results We included 497 patients from 29 dermatological practices in Germany. There were significant differences in psoriasis care between urban and rural areas. Longer travel time was associated with lower age, higher income, higher number of consulted dermatologists since diagnosis, rural residence, more waiting time for the first appointment, lower dermatologist density, and higher patient reported treatment satisfaction. Discussion The results indicate an association between actual travel time and treatment satisfaction. Patients with higher perceived quality of care travel longer for their dermatological treatment. The results are also relevant to needs related planning.

Fumaric acid esters (FAEs) are a well-established treatment option for long-term therapy of moderate to severe plaque psoriasis. This study examines effectiveness of FAEs for the treatment of plaque psoriasis in real-world practice at 12 months and if patient characteristics affect the odds of clinical response.A descriptive, multivariable logistic regression analysis was conducted in a cohort drawn from the German registry PsoBest. Baseline patient characteristics were assessed as potential treatment effect modifiers.444 patients (mean age 47.0 years, 39.0% female) were eligible for response analysis using nonresponder imputation at month 12. Of these, 39.6% achieved clinical response, i.e. Psoriasis Area and Severity Index (PASI) ≤ 3 or skin clearance. In logistic regression analysis (FAEs showed a favorable response at 12 months, largely independent of patient characteristics.

Hidradenitis suppurativa (HS)/Acne inversa (AI) geht mit zahlreichen und relevanten Einschrankungen der Lebensqualitat fur die Betroffenen und ihre Angehorigen einher. Literaturangaben zur Pravalenz der HS variieren erheblich, sie ist jedoch wahrscheinlich hoher als in fruheren Publikationen angenommen. Die Versorgung der HS geht mit hohen Kosten fur das Gesundheitssystem und die Betroffenen einher. Die Einfuhrung der Biologikatherapie hat zu weiteren Kosten, jedoch auch erheblichem Mehrnutzen in der Versorgung gefuhrt. Angesichts der Komplexitat von Diagnostik und Therapie besteht ein besonderer Bedarf an optimierten Versorgungskonzepten, um die Last fur die Betroffenen, ihre Angehorigen und das Gesundheitssystem zu reduzieren.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with comorbidities and quality of life losses. The implementation of evidence-based preventive measures strengthens patient participation and offers the potential to improve quality of care for AD. Objectives: To assess adherence to guideline-oriented preventive measures in adult patients with AD in dermatological routine care in Germany. Methods: The self-responsible application of preventive measures, clinical features, pruritus, disease severity, and duration of disease as well as skin disease-related quality of life were assessed in two independent cross-sectional studies in 2010 and 2017–2019. Results: Between 2017 and 2019, 706 patients (55.8% female, mean age 41 years) were recruited in a comparable way to the survey in 2010 with 1,678 patients (60.5% female, mean age 38 years). Regular skin care was applied by 99.5% (2010: 94.9%), 90.9% avoided skin irritants (2010: 84.6%), and 80.2% (2010: 61.6%) did not smoke at home. Relaxation techniques were applied by 44.4% (2010: 29.9%). Advice on self-help measures was taken by 36.4% (2010: 27.1%) and 29.2% (2010: 15.4%) attended AD patient education courses. All six preventive measures categorized as obligatory were performed by 13.9% of the patients (2010: 6.7%). Predictors for the number of obligatory preventive measures applied were a high level of education, a longer disease duration, and a lower quality of life. Conclusions: Although the self-reported use of evidence-based preventive measures in the 2017–2019 study appears to be more frequent than in 2010, important measures are still insufficiently established. Hence, more implementation, including education, is needed to increase the use of guideline-oriented preventive measures.

In psoriasis treatment, there is a high need to define meaningful endpoints and differences from the patient perspective to analyze patient-relevant differences of frequently used outcome methods for psoriasis under real-world conditions. A sample of 3116 patients from the German Psoriasis-Registry PsoBest was analyzed for clinical as well as patient-reported outcomes (PRO) after 3- and 6-month treatment. The parameters PASI, DLQI, and PBI were intercorrelated and related to two anchoring variables: (1) patient satisfaction with treatment and (2) perceived complete clearance. Baseline data were as follows: PASI 10.5 ± 9.1, DLQI 12.4 ± 3.4, and PBI 2.7 ± 0.3. There was an almost linear relationship between “complete patient satisfaction” and the relative differences in PASI in the range from PASI 25 to PASI 90. However, there was no additional benefit between PASI 90 and PASI 100. The same finding resulted from the anchoring variable “perception of complete healing”. When related to DLQI outcomes, relative PASI changes as well as absolute changes and PASI at 3 and 6 months showed relevant differences between the PASI classes 25 to 90 but not between PASI 90 and PASI 100. Under real-world conditions, changes in PASI and DLQI reflect patient-relevant benefits.

Rosacea is a common chronic skin condition, but data on its epidemiology and related comorbidities are scarce.To analyze the prevalence and associated cutaneous comorbidities of rosacea in Germany.Voluntary dermatological full-body examinations were conducted between 2001 and 2016 in more than 500 German companies by experienced dermatologists and documented electronically. Point-prevalence rates were calculated, and associations were tested with chi-squared tests and logistic regression analysis.A total of 161,269 participants (mean age was 43.2 ± 10.9 years; 55.5% male) were included; 2.1% had rosacea (men: 2.1%, women 2.1%, mean age 50.7 ± 9.3 years). The prevalence of rosacea increased significantly with age (16-29 years: 0.3%; 30-39 years: 0.9%; 40-49 years: 2.0%; 50-59 years: 3.5%; 60-70 years: 5.7%). Furthermore, there was a significant decreasing prevalence from skin type I toward type IV (skin type I: 3.2%; II: 2.2%; III: 1.5%; IV: 0.4%). The most frequent dermatological comorbidities were: telangiectasia (OR = 2.5), folliculitis (OR = 1.8), seborrheic dermatitis (OR = 1.6), acne (OR = 1.6), tinea pedis (OR = 1.4), psoriasis (OR = 1.4), spider veins (OR = 1.1), and hemangioma (OR = 1.1).Rosacea is a common skin condition that is most prevalent above the age of 65 years. Rosacea patients have an increased risk for associated comorbidities. Therefore, the diagnostic and therapeutic process for rosacea patients must ensure an integrated, complete dermatological approach in terms of medical care.

Nicole Mohr, Jana Petersen, Natalia Kirsten, Matthias Augustin Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyCorrespondence: Nicole MohrInstitute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, D-20246, GermanyTel +49-40-7410-55428Fax +49-40-7410-5348Email n.mohr.ivdp@gmail.comBackground: Most epidemiological data on vitiligo refer to selected environments or focus on the prevalence of comorbidity unrelated to the population.Objective: Aim of the study was to gain robust representative prevalence data on vitiligo and on associated dermatologic comorbidity in the German adult population.Methods: A dual population-based approach was applied with 1) primary data obtained between 2004 and 2014 from dermatological exams in the general working population; 2) claims data from a large German statutory health insurance, reference year 2010.Results: In the working cohort (N = 121,783; 57% male; mean age 43 years), the prevalence of vitiligo was 0.77% (0.84% in men; 0.67% in women). In the claims data (N = 1,619,678; 38% male; mean age 46 years), prevalence was 0.17% (0.14% in men; 0.18% in women). In the working cohort, vitiligo was significantly more common in people with fair skin type, ephelides and port-wine stains and less common in people with acne and solar lentigines. In the claims data, vitiligo was associated with a variety of skin conditions, eg, atopic dermatitis, psoriasis and alopecia areata.Conclusion: The resulting discrepancy of claims vs primary data between 0.17% and 0.77% indicates the most probable spectrum of vitiligo prevalence in Germany. It is more frequently observed in clinical exams than recorded in claims data, indicating a marked proportion of people seeking no medical help. Such nonattendance may result from the fact that many treatment options do not provide satisfying benefits to the patients.Keywords: pigmentation, health services research, public health research, prevalence, comorbidity

Background: Travel to clinics for chronic wound management is burdensome to patients. Remote assessment and management of wounds using mobile and telehealth approaches can reduce this burden and improve patient outcomes. An essential step in wound documentation is the capture of wound images, but poor image quality can have a negative influence on the reliability of the assessment. To date, no study has investigated the quality of remotely acquired wound images and whether these are suitable for wound self-management and telemedical interpretation of wound status. Objective: Our goal was to develop a mobile health (mHealth) tool for the remote self-assessment of digital ulcers (DUs) in patients with systemic sclerosis (SSc). We aimed to define and validate objective measures for assessing the image quality, evaluate whether an automated feedback feature based on real-time assessment of image quality improves the overall quality of acquired wound images, and evaluate the feasibility of deploying the mHealth tool for home-based chronic wound self-monitoring by patients with SSc. Methods: We developed an mHealth tool composed of a wound imaging and management app, a custom color reference sticker, and a smartphone holder. We introduced 2 objective image quality parameters based on the sharpness and presence of the color checker to assess the quality of the image during acquisition and enable a quality feedback mechanism in an advanced version of the app. We randomly assigned patients with SSc and DU to the 2 device groups (basic and feedback) to self-document their DU at home over 8 weeks. The color checker detection ratio (CCDR) and color checker sharpness (CCS) were compared between the 2 groups. We evaluated the feasibility of the mHealth tool by analyzing the usability feedback from questionnaires, user behavior and timings, and the overall quality of the wound images. Results: A total of 21 patients were enrolled, of which 15 patients were included in the image quality analysis. The average CCDR was 0.96 (191/199) in the feedback group and 0.86 (158/183) in the basic group. The feedback group showed significantly higher (P

Background Hidradenitis suppurativa (HS) is a chronic, debilitating inflammatory skin disease. In Germany, there are no population-based data on the epidemiology of HS. Objectives The objective of this study was to examine the occurrence of HS in inpatient as well as in outpatient settings. Methods We used three data sources for analysing the prevalence, incidence and case-related occurrence of HS in different settings: data of two German statutory health insurance (SHI) companies and hospital discharge data provided by the Federal Statistical Office. The studied period was from 2010 to 2015. Results In a representative sample of about 2.3 million insurees (out of 5.9 million total persons) of the SHI DAK-Gesundheit, 791 were diagnosed with HS in 2010. This coding prevalence of 0.03% is in accordance with the data of another SHI (Barmer) on about 9 million total insurees. In 2015, at least 34.7% of incident persons with HS had one potential misdiagnosis in 2014. Conclusion This population-based study analyses the prevalence and incidence of HS in Germany. The coding prevalence of 0.03% observed in two independent SHI data sets is lower than expected. The findings of considerable potential misdiagnosis add to the underdiagnosis of HS in general and underline the need for future strategies to early detection and valid diagnosis of HS.

Living with chronic ulcers can be burdensome and restrictive, with regard to not only physical and psychological but also social well‐being. This review aims to analyse social participation in patients with chronic wounds and to compare results across different wound types. A search string was applied in several electronic databases. Results were screened according to predefined inclusion and exclusion criteria. Data of eligible articles were extracted and synthesised narratively. The search revealed 42 eligible publications. Only minor differences across different ulcer types could be detected. Overall, family members were the main social contacts for patients; they often provided wound care and emotional support. Patients had few non‐family relations, but those existing were often very close. Patients felt guilty as their condition imposed burden on family and friends, as well. A close relationship with nurses was described. Restrictions were caused by direct and indirect consequences of the wound. Overall, social support and social connections were reduced in wound patients. Inconsistent results were found regarding social isolation. In summary, people with chronic wounds experience impairments in all aspects of social participation. Therefore, social participation deserves increased attention in routine care both as a trigger of burden and as an outcome of therapy.

Psoriasis may cause considerable disease burden. The involvement of sexually-sensitive/visible body areas has been associated with decreased quality of life (QoL), more depressive symptoms and stigmatisation experiences. To characterise the topical distribution of psoriasis in sexually-sensitive and visible areas, to examine its impact on QoL and to determine which specific patient needs should be addressed in routine care. Patients with psoriasis vulgaris were recruited within a cross-sectional nationwide survey, involving 157 randomly assigned German dermatology practices/clinics. The main outcome measures were the EuroQoL visual analogue scale (EQ VAS), the Dermatology Life Quality Index (DLQI), the Patient Needs Questionnaire (PNQ) and a grid scheme for topical distribution of psoriasis. The sample included 2,009 patients (43.7% female; 21.8% ≥ 65 years; 64.2% with lesions in sexually-sensitive areas and 86.2% with lesions in visible areas). Patients with concomitant involvement of sexually-sensitive and visible areas presented increased DLQI impairments relative to patients with no involvement of sexually-sensitive or visible areas (F(3,1723) = 4.091, p = 0.007). Significant differences were also found for patient needs dimensions (PNQ) depending on the body areas affected (F(15, 4602) = 2.936, p

Background In the study series PsoHealth first data from 2004/05 showed a poor quality of health care for psoriasis in Germany. Most patients lacked sufficient care and only a minor proportion received systemic drugs. Since 2007, a national psoriasis program has been conducted. Objectives (1) To analyse the quality of health care for psoriasis in the most recent PsoHealth4 survey 2016/2017 (2) to compare health care quality indicators with prior assessments since 2004/05. Materials and methods The recent cross-sectional PsoHealth4 survey was conducted 2016/17 and three preceding studies were performed in 2004/05, 2007 and 2013/14, each including at least 1,500 patients. The common set of quality indicators included disease severity (PASI and proportion of patients with PASI >20, indicating high severity), quality of life (DLQI and proportion of patients with DLQI >10, indicating strong impairments in quality of life), systemic therapy and inpatient treatment of the last five years. Results Between December 2015 and December 2017, N = 1,827 patients from 93 dermatological centres were included in the most recent survey (mean age: 50.8±14.6 years, 45.2% female). 7.3% showed a PASI >20, compared to 17.8% in 2004/05. 21.4% reported a DLQI >10, compared to 34.0% in 2004/05. 57.6% of all participants stated to have received a systemic therapy at least once within the last five years, compared to 32.9% in 2004/05. 18.0% received inpatient hospital treatment at least once within the last five years, compared to 26.9% in 2004/05. Conclusion A remarkable improvement of the health care quality for psoriasis patients in Germany within the past 12 years can be assumed. Major determinants could be the innovation shift which included programmes such as the S3 guideline, a consensus on treatment goals, national health care goals for psoriasis and higher utilisation of innovative drugs.

ZusammenfassungHintergrund: Venenkrankheiten haben in Deutschland eine hohe sozioökonomische Bedeutung. Fragestellungen: Welchen Umfang und welche Bedeutung hat die phlebologische Versorgung durch niedergelassene Dermatologen? Methoden: Strukturierte Onlineumfrage im Mai 2018 in bundesweit n = 1.500 Hautarztpraxen. Ergebnisse: Von den 704 (46,9%) rückmeldenden Praxen weist 49,7% die Zusatzweiterbildung „Phlebologie“ auf. 87% der Dermatologen führen in ihrer Praxis phlebologische Behandlungen durch, davon 74% vertragsärztlich. Im Durchschnitt versorgen sie 18 phlebologische Patienten pro Woche, entsprechend 880 pro Jahr. Häufigste Leistungen: Venendiagnostik (Doppler/Duplex) und Verödungen von Besenreisern oder Seitenästen (jeweils > 50%). 43% zeigten sich mit ihren phlebologischen Behandlungsmöglichkeiten eher oder sehr zufrieden, 35% schätzten die Versorgungssituation in der Phlebologie schlechter als vor 10 Jahren ein. Der Zusatzweiterbildung wird von 82% eine hohe Bedeutung für das Fach zugesprochen. Fazit: Die phlebologische Versorgung, wie auch die Zusatzbezeichnung „Phlebologie“, ist für die Dermatologie von großer Bedeutung.

The association of hidradenitis suppurativa with other skin diseases has not yet been investigated in larger studies based on dermatological exams. The objectives of this study are to determine the prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population. Between 2014 and 2017, 20,112 people in 343 German companies were examined for the presence of clinical features of hidradenitis suppurativa within the framework of a cross-sectional epidemiological study based on whole-body examinations. In addition, all cutaneous comorbidities were recorded. Point prevalence was calculated and the differences between individuals with and without hidradenitis suppurativa were determined by bivariate analysis. All statistical procedures were performed using SPSS 23.0 for Windows. Of 20,112 people examined, mean age was 43.6 ± 10.5 years; 52.3% were male. In total, n = 57 people (0.3%) with hidradenitis suppurativa were identified; 61.4% (n = 35) being male. In addition, non-inflammatory hidradenitis suppurativa-related lesions were found in 674 other individuals. In a bivariate comparison, patients with hidradenitis suppurativa showed significantly more frequently the following cutaneous comorbidities: acne vulgaris, psoriasis, seborrhoeic dermatitis, excoriations, and folliculitis. We determined a point prevalence of hidradenitis suppurativa of 0.3%. Since we have examined the working population, the healthy worker effect, which could have led to underestimation of prevalence, cannot be ruled out. The point prevalence of 0.3% for employed people in Germany and a prevalence of 3.0% for inflammatory and non-inflammatory hidradenitis suppurativa-related lesions show that hidradenitis suppurativa is an important disease for the whole health system.

Background Dry skin is a frequent and multifaceted condition which can be associated with skin irritation, itch, patient discomfort and manifest skin disease. In spite of being frequent, little is known about the epidemiology of dry skin in the population. Objective To determine the prevalence of dry skin in the German adult population. Methods Data of 48 630 employed persons were assessed on a cross-sectional level in whole-body examinations by experienced dermatologists during company-based skin screenings conducted in 343 German companies. Next to the current dermatologic findings, age, gender, allergies, atopic diseases and the skin type were assessed. Results In total, n = 14 300 persons (29.4%) were rated as having xerotic skin. Older age but not gender was associated with xerosis. In the regression analyses controlling for age and gender, dry skin was a significant predictor for: axillary dermatitis (OR: 4.51; CI 2.70-7.54), atopic eczema (OR: 3.99; CI 3.42-4.65), exsiccation eczema (OR: 2.96; CI 2.40-3.65), psoriasis (OR: 1.57; CI 1.38-1.78), plantar warts (OR: 1.42; CI 1.26-1.60), seborrhoeic dermatitis (OR: 1.28; CI 1.16-1.42) and atopic disposition (OR: 1.17; CI 1.12-1.22). Conclusion Dry skin is a frequent condition in the adult general population and needs special attention. Known risk factors may facilitate identifying patients at risk for deterioration.

Psoriatic arthritis is a frequent manifestation of psoriasis, and has a high level of impact on physical func­tioning, work ability and quality of life. However, there have been few studies of the epidemiology, development of and risk factors for concomitant psoriatic arthritis in patients with psoriasis. This study analysed data from a German public health insurance database of > 2 million individuals. Factors influencing the development of psoriatic arthritis were determined by descriptively analysing comorbidities and Cox regression modelling. The prevalences of psoriasis and psoriatic arthritis were 2.63% and 0.29% in adults (18+ years) and, respectively, 0.30% and 0.01% in children (0–17 years). The proportion of adult patients with incident psoriasis who developed concomitant psoriatic arthritis within five years after diagnosis of psoriasis (mean 2.3 years) was 2.6%. Cardiovascular diseases are the most frequent comorbidity in patients with psoriasis with or without concomitant psoriatic arthritis. Depression and neurosis/stress disorder were identified as indicators for the development of psoriatic arthritis.

Voraussetzung fur eine erfolgreiche Wundversorgung ist ein Verstandnis fur die Physiologie des Wundheilungsprozesses. Eine Storung des phasenhaften Ablaufs kann zu Verzogerungen, Komplikationen oder einem Sistieren der Wundheilung fuhren. Die Grunde fur eine pathologische Wundheilung sind vielfaltig, dazu zahlen unter anderem Sauerstoffmangel, Entzundungen, Infektionen, aber auch eine nicht an die Wundphase adaptierte Versorgung der Wunde. Der folgende Artikel gibt eine Ubersicht uber die Phasen der Wundheilung, die stadienadaptierte, moderne Wundversorgung, die Narbenpravention und -behandlung.

Alterations in the innate and adaptive immunity underpin psoriasis pathophysiology, with the Th17 cells subset now recognized as the fundamental cells in the key controlling pathway involved in its pathogenesis. Since psoriasis is a systemic disease with important comorbidity, further knowledge on the interleukin (IL)-23/Th17 axis led to the hypothesis that there may be shared pathogenic pathways between primary skin disease and comorbidity. Psoriasis has been identified as a risk factor for cardiovascular and metabolic disease, and increasing evidence gives support to this epidemiological observation from the clinical-pathologically field. As an example, increased levels of IL-23 and IL-23R have been found in human atherosclerotic plaque, and levels correlated with symptom duration and mortality. Also, upregulation of IL-23/IL-17 seems to play an important role in both myocardial damage and stroke, with interesting reports on deleterious effect neutralization after administration of related anti-bodies in both associated conditions. In diabetic patients, increased levels of IL-23/IL-17 have also been observed and available data support a synergistic role of IL-23/IL-17 in β-cells damage. In obesity, signs of an expansion of Th17 subset in adipose tissue have been reported, as well as elevated concentrations of IL-23 in obese patients. In non-alcoholic fatty liver disease, closely related to metabolic syndrome, but also in other mentioned cardiometabolic disorders, a predominance of IL-23 and other related pro-inflammatory factors has been identified as participating in their pathogenesis. Thus, the involvement of the IL-23/Th17 axis in these shared psoriasis-cardiometabolic pathogenic mechanisms is reviewed and discussed in the light of the existing preclinical and clinical evidence, including that from comorbid psoriasis patients.

Background: Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has been shown to have significant efficacy and a favourable safety profile in the treatment of moderate-to-severe psoriasis and psoriatic arthritis. Objective: To assess the efficacy and safety of secukinumab through 5 years of treatment in moderate-to-severe psoriasis. Methods: In the core SCULPTURE study, Psoriasis Area and Severity Index (PASI) 75 responders at Week 12 continued receiving subcutaneous secukinumab until Year 1. Thereafter, patients entered the extension phase and continued treatment as per the core trial. Treatment was double-blinded until the end of Year 3 and open-label from Year 4. Here, we focus on the 300 mg fixed-interval (every 4 weeks) treatment, the recommended per label dose. Efficacy data are primarily reported as observed, but multiple imputation (MI) and last observation carried forward (LOCF) techniques were also undertaken as supportive analyses. Results: At Year 1, 168 patients entered the extension study and at the end of Year 5, 126 patients completed 300 mg (every 4 weeks) treatment. PASI 75/90/100 responses at Year 1 (88.9%, 68.5% and 43.8%, respectively) were sustained to Year 5 (88.5%, 66.4% and 41%). PASI responses were consistent regardless of the analysis undertaken (as observed, MI, or LOCF). The average improvement in mean PASI was approximately 90% through 5 years compared with core study baseline. DLQI (dermatology life quality index) 0/1 response also sustained through 5 years (72.7% at Year 1 and 65.5% at Year 5). The safety profile of secukinumab remained favourable, with no cumulative or unexpected safety concerns identified. Conclusion: Secukinumab 300 mg treatment delivered high and sustained levels of skin clearance and improved quality of life through 5 years in patients with moderate-to-severe psoriasis. Favourable safety established in the secukinumab phase 2/3 programme was maintained through 5 years.

BACKGROUND: Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. OBJECTIVES: To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. METHODS: In the course of voluntary company skin checks, full-body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. RESULTS: In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35-64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9-18·1], onychomycosis (9·1%, 95% CI 8·3-10·0), tinea pedis (7·1%, 95% CI 6·3-7·8), rosacea (4·1%, 95% CI 3·6-4·7), acne (4·0%, 95% CI 3·4-4·5) and psoriasis (2·7%, 95% CI 2·3-3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0-2·3], contact dermatitis (OR 1·8, 95% CI 1·1-2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4-2·2), rosacea (OR 1·6, 95% CI 1·4-1·8), acne (OR 1·4, 95% CI 1·2-1·7), pyoderma (OR 1·4, 95% CI 1·1-1·8), tinea corporis (OR 1·4, 95% CI 1·0-2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0-1·7) and psoriasis (OR 1·2, 95% CI 1·0-1·5). CONCLUSIONS: Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

IL-17 blockers are among the newer anti-psoriatic treatment options and little is known about the interclass switching. We have thus initiated a multi-center, multi-national, retrospective study to assess the treatment response of patients who were switched from one IL-17 blocker to another. Analysis consisted of data from patients with moderate-to-severe psoriasis who did not respond satisfactorily to one of the available IL-17 blockers (secukinumab, ixekizumab, brodalumab) and were subsequently switched to another drug of this class. After 12 weeks of treatment, patients' PASIs were evaluated. Treatment success was defined as reaching PASI 75 after 12 weeks. Topical treatment was allowed and used in all patients. 26 patients were included (13 male, 13 female) and 29 switches were evaluated. Overall, 29 switches in 21 patients were evaluated. 18 patients changed their therapy from secukinumab to ixekizumab, or in 7 cases to brodalumab. Brodalumab was used in 3 cases after failure of treatment with ixekizumab. Only in one case, non-response of brodalumab resulted in a therapy switch to secukinumab. In 15 (52%) cases, PASI 75 was reached. In 6 (20%) patients, the switch led to a PASI 50 response. No success of treatment was seen among 8 (28%) participants. When patients fail to respond or do not tolerate an IL-17 blocker, switching to another anti-IL-17A/RA is a promising viable option. Larger studies are needed to confirm our results.

Background Atopic eczema (AE) is a common and burdensome chronic skin disease. Clinical guidelines suggest an evidence-based, personalized and stepwise treatment approach. Only few studies have so far focused on the specific patient needs in treatment. Objectives To characterize therapeutic needs of patients with AE in routine care. Methods Nationwide cross-sectional study in 91 dermatology practices and outpatient clinics. Descriptive statistics were used for valuation. Comparisons of HRQoL and general health status were performed including subgroups (age, gender and disease duration). Group comparisons of patient needs were performed for age groups, gender and disease duration. Correlations between patients' needs (PNQ) and HRQoL, generic health status and severity were tested. In addition, a hierarchical regression analysis was performed to determine which variables contribute to explain the variance in patient needs. Results Analysis of 1678 patients (60.5% female, mean age 38.35 ± 15.92 years) revealed a high disease burden with mean SCORAD of 42.26 ± 18.63, mean DLQI of 8.49 ± 6.45 and mean EQ VAS of 63.62 ± 21.98. Among the patient needs that were most frequently rated as 'quite important'/'very important' were as follows: 'to be free of itching' (96.0%), 'to get better skin quickly' (87.7%) and 'to be healed of all skin defects' (85.7%). In general, older people, women and patients who had been diagnosed with AE for 1 year or less rated the treatment needs as more important than younger patients, men and patients who had been diagnosed with AE for more than 1 year. Major determinants of higher needs were skin-related quality of life impairments, higher disease severity and higher age. Conclusions Patients with AE show a high number and variety of therapeutic needs related to disease signs and symptoms, which are associated with individual disease burden. The patient needs vary substantially according to patient characteristics. Identification of patient-specific needs may support personalized, patient-centred care and shared decision-making.

ObjectivesTo validate the newly developed Daily Experience Sampling Questionnaire (DESQ) that measures affective subjective well-being (SWB). The DESQ is an end-of-day diary in which respondents retrospectively rate their SWB at six different, randomly determined moments; it is completed over 1 week. The DESQ shall provide an alternative or complementary approach to existing methods of near-time SWB measurement (experience sampling, Day Reconstruction Method). The primary research objective was to determine criterion validity of the DESQ.DesignProspective, non-interventional study.SettingParticipants were recruited in Hamburg, Germany, at a specialised outpatient clinic (patients) and via different channels (healthy participants).Participants101 adults with diagnosed and stable psoriasis (46 women, 55 men); 105 adults without psoriasis (49 women, 56 men).Primary and secondary outcome measuresParticipants completed the DESQ for 3 weeks. In weeks 2 and 3, they also performed experience sampling. Criterion validity was determined by weekwise intraclass correlations (ICC) between both methods. Sensitivity to change was determined by the correlation between changes in both methods from weeks 2 to 3. For convergent validity, related concepts such as life satisfaction were measured. Retest reliability was determined using DESQ values of weeks 2 and 3.ResultsCriterion validity was excellent (ICC: patients=0.86, 95% CI 0.81 to 0.91; healthy participants=0.86, 95% CI 0.79 to 0.91). Sensitivity to change was r=0.57 and r=0.56, respectively. Correlations with convergent criteria were mostly significant and higher in constructs more proximal to SWB. The ICC indicating retest reliability was 0.77 in patients (95% CI 0.68 to 0.84) and 0.81 in healthy participants (95% CI 0.73 to 0.86).ConclusionsThe DESQ is a valid, reliable and feasible instrument for SWB measurement in people with psoriasis and healthy people. Its approach of end-of-day evaluations of single moments may also lend itself to the measurement of other highly time-variant constructs such as pain, fatigue or depression.

Genital psoriasis affects 2-5% of psoriasis patients; generalised plaque or intertriginous psoriasis also affects the genital area in 29-40% of cases. Anogenital psoriasis has been associated with significant quality of life impairments, but little is known about specific patient needs/treatment goals. This study aimed to examine the overall and sex-related disease burden, patient needs and treatment benefits in patients with anogenital psoriasis, compared to patients with psoriasis not affecting the anal/genital areas. Within the cross-sectional nationwide survey, 2,009 participants were consecutively recruited in 157 randomly assigned German dermatology practices and clinics, according to the following inclusion criteria aged 18 years or over; diagnosis of psoriasis vulgaris; ability to answer the questionnaires; and written informed consent. Based on a high-resolution grid on the topical distribution of psoriasis, two groups were formed: anogenital psoriasis (n = 622) and comparison group (n = 1,303). Clinical severity was assessed by the Psoriasis Area and Severity Index (PASI). Patients completed the EuroQoL visual analogue scale (EQ VAS), the Dermatology Life Quality Index (DLQI), and the Patient Benefit Index (PBI). Patients with anogenital psoriasis had higher PASI (13.0±10.6 vs. 8.9±7.6, P < 0.001) and more DLQI impairments (8.9±6.9 vs. 7.0±6.2, P = 0.002) than controls. At the item-level, they also reported more sex-related DLQI impairments (DLQI-i9: 0.5±0.8 vs. 0.3±0.7, P < 0.001) and treatment needs (PBI-i17: 2.2±1.8 vs. 1.9±1.8, P = 0.001). A great percentage of missing/not-relevant responses was found for sex-related items (23.3-41.9%). These results suggest that the assessment of sex-related impairments and treatment needs should be prioritised in patients with anogenital psoriasis. Questionnaires may be used as a less uncomfortable way for patients to discuss their genital lesions and sexual function during healthcare visits. However, the great percentage of missing/not-relevant responses to sex-related items calls for in-depth assessments and effective patient-physician communication regarding these sensitive topics.

Background Different phenotypes have been described in psoriasis. Few details are known about the topology of patients in routine care. Objectives To characterize the frequency and distribution of body sites affected by psoriasis in Germany. Methods Data from a national cross-sectional study (PsoHealth2) were analysed. Each practice consecutively recruited 20 patients independently of treatment. Topical distribution was identified with a detailed grid scheme of 1424 squares filled by the patient. Psoriasis history, clinical findings, comorbidity and patient-reported outcomes were obtained. Results In total, 2009 patients with psoriasis were observed. Nineteen per cent of patients had psoriatic arthritis, 65·4% had scalp involvement and 35·6% had nail involvement; in 40·5% of patients, their first-degree relatives also had psoriasis. In total, 1927 (95·9%) provided complete grid data. The mean number of grids marked was 152·4 ± 193·2, corresponding to 10·7% of body surface area. The most frequently affected body areas were the elbows, knees, lower legs and scalp (65-78%). In a linear regression analysis (corrected R² = 0·093), the strongest predictors of reductions in health-related quality of life (HRQoL), measured by the Dermatology Life Quality Index, were having the hands (β = 0·147; P = 0·000), arms (β = 0·097; P = 0·008), genitals (β = 0·080; P = 0·010), neck (β = -0·072; P = 0·043), scalp (β = 0·068; P = 0·010) and nails affected (β = 0·064; P = 0·005). Conclusions Typical psoriatic lesions are found in real-world care. However, smaller areas are important determinants of reductions in HRQoL.

International audience; Mast cell activation syndrome (MCAS), is associated with mast cell activation-related symptoms involving two or more organs. The disease in patients with MCAS does not fulfill the diagnostic criteria for systemic (SM) or cutaneous mastocytosis. There is limited information about the clinical and biological characteris-tics of MCAS in clinical practice.1,2,4 The performance of the proposed diagnostic criteria for MCAS has not been prospectively assessed. Bone marrow tryptase has been shown to be a sensitive diagnostic tool for SM even in patients with normal serum tryptase (ST).The primary objective of this study was to describe the clinicaland paraclinical characteristics of a cohort of patients with primary MCAS. The secondary objective was to describe the usability of the two available sets of diagnostic criteria for MCAS. We included all consecutive adult patients with a diagnosis of primary MCAS evaluated between April 2011 and May 2015. The diagnostic of MCAS was established using the diagnostic criteria defined by Valent et al. and/or those defined by Molderings et al. The presence/absence of a monoclonal mast cell carrying the D816V KIT mutation and/or expression of CD25 in bone marrow determined the classification of patients as monoclonal MCAS (MMCAS)/idiopathic MCAS (IMCAS) respectively.