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Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease that negatively impacts overall health, quality of life (QoL), and work productivity. Prior studies on AD burden by severity have focused on moderate-to-severe disease. Here, we describe the clinical and humanistic burden of AD in Europe across all severity levels, including milder disease.Data were analyzed from the 2017 National Health and Wellness Survey from adult respondents with AD in the EU-5 (France, Germany, Italy, Spain, and the UK). AD disease severity was defined based on self-reported assessments as "mild," "moderate," or "severe" and by Dermatology Life Quality Index (DLQI) severity bands. Self-reported outcomes for AD respondents by severity were assessed using propensity score matching. These outcomes included a wide range of selected medical/psychological comorbidities, overall QoL and functional status (EuroQol 5-Dimensions 5-Level and Short Form-36 version 2 questionnaires), and work productivity and activity impairment (Work Productivity and Activity Impairment questionnaire).In total, 4208 respondents with AD (mild AD, 2862; moderate AD, 1177; severe AD, 169) and 4208 respondents without AD were included in this analysis. Results showed greater burden across severity levels compared with matched non-AD controls. A higher proportion of respondents with mild-to-moderate AD, defined by DLQI severity bands, reported atopic comorbidities (P 0.05) and a wide range of cardiac, vascular, and metabolic comorbidities, including hypertension, high cholesterol, angina, and peripheral vascular disease (P 0.005), compared with non-AD controls. Relative to potential impacts of various medical and psychological burdens, respondents with mild-to-moderate AD reported higher activity impairment than controls (P 0.0001).Clinical and humanistic burden was observed in European respondents with AD compared with matched non-AD controls across severity levels, with burden evident even in milder disease, highlighting the importance of improving disease management in early stages of AD.

Emollients are the mainstay maintenance treatment for atopic dermatitis (AD). A novel generation of emollients, 'emollients plus', containing active, non-medicated substances, has softened the distinction between emollients and topical drugs. A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Whilst the inclusion of five components of an ideal emollient has been proposed, no such consensus exists for emollients plus and they can vary markedly in their composition and modes of action for AD treatment. This could have a profound effect on their clinical efficacy. The efficacy of emollients plus in restoring and maintaining skin barrier function has been demonstrated on multiple levels, with evidence reported for their effects on the physical and biochemical, microbial, immunological, and neurosensory barriers. When selecting an appropriate AD treatment approach, the safety profiles of the available topical therapies must be carefully considered. There are several proposed treatment approaches for AD, including preventive, proactive, intermittent, and synergistic approaches. Emollients plus may be effective not only as maintenance therapy for AD, but also when used synergistically with anti-inflammatory pharmacological therapies.

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease with rising prevalence. Topical corticosteroids (TCS) are recommended as first-line therapy for patients with AD in China; however, corticophobia is a widespread concern, which can manifest as noncompliance: in a previous Chinese study, almost all parents whose children had AD were very concerned about the side effects of TCS and, as a result, nearly half did not use it in the event of recurrence. We propose a TCS-sparing treatment algorithm for the management of infants, children, adolescents, and adults with mild-to-moderate AD, to guide clinical practice in China.A panel of eight experts in AD from China and one expert from Germany formed to develop a practical algorithm for the management of mild-to-moderate AD, focusing on pimecrolimus.Irrespective of body location, all patients with mild AD (including acute flares) and infants with moderate AD should apply the topical calcineurin inhibitor (TCI) pimecrolimus twice daily to the affected area until symptoms disappear. For children, adolescents, and adults with moderate AD, pimecrolimus should be applied twice daily to sensitive skin areas, and a TCI (either pimecrolimus or tacrolimus) should be applied twice daily to other body locations. Short-term administration of TCS, followed by TCI twice daily, is recommended for most patients with moderate AD experiencing acute flares, regardless of lesion site. Emollients should be used regularly.The algorithm presented intends to simplify treatment of AD in China and guide clinical decision-making.

Approval of the new topical phosphodiesterase 4 inhibitor crisaborole ointment, 2%, to treat mild-to-moderate atopic dermatitis (AD) warrants careful consideration of available efficacy and safety data for topical therapies to contribute to a better understanding of the role of crisaborole in the treatment of mild-to-moderate AD. A literature review was conducted to identify results of randomized, blinded, vehicle-controlled trials of topical agents for the treatment of AD published from January 1, 1997 to April 30, 2018. This review summarizes the efficacy and safety data of topical therapies including corticosteroids, calcineurin inhibitors, and crisaborole and it shows that comparison among available agents is difficult because of differing methodologies used across clinical trials and that there is considerable variability in safety reporting among AD trials. Published clinical studies for crisaborole demonstrate its efficacy and manageable safety profile. J Drugs Dermatol. 2020;19(1):50-64. doi:10.36849/JDD.2020.4508

Basic therapy plays an important role in the management of psoriasis, regardless of disease severity or the therapeutic concept used. It helps reduce symptoms such as pruritus and scaling, decreases exacerbations, and may therefore prolong the remission period after successful antipsoriatic treatment. Accordingly, adequate basic therapy can also have a positive effect on patients' severely impaired quality of life. Unfortunately, the importance of basic therapy in psoriasis is still underestimated. Based on clinical trial data, the present review highlights the efficacy and potential of basic therapy, and focuses on new data and developments in this field.

T-shape, LPCVD silicon nitride cantilevers are fabricated to determine Young's modulus and fracture strength of silicon nitride thin films at room and cryogenic temperatures. A helium-cooled measurement setup is developed and installed inside a focused-ion-beam (FIB) system. A lead-zirconate-titanate (PZT) translator powered by a function generator and a dc voltage is utilized as an actuator, and a silicon diode is used as a temperature sensor in this setup. Resonant frequencies of identical cantilevers with different "milling masses" are measured to obtain thickness and Young's modulus of the silicon nitride thin films, while a bending test is performed to obtain fracture strength. From the experiment, the average Young's modulus of low-pressure chemical-vapor deposition (LPCVD) silicon nitride thin films varies from 260.5 GPa at room temperature (298 K) to 266.6 GPa at 30 K, and the average fracture strength ranges from 6.9 GPa at room temperature to 7.9 GPa at 30 K. The measurement setup and technique presented here can be used to characterize the mechanical properties of different MEMS materials at cryogenic temperatures.

Atopic dermatitis (AD) can be extremely disabling and may cause psychological problems for affected children and their families. Moisturizers and emollients are important in the baseline daily skin care of patients with AD. To assess the effect of a 3-month, twice-daily treatment with an emollient on the quality of life (QoL) of parents with a child with mild to moderate AD (SCORing Atopic Dermatitis [SCORAD] ≤ 30, a multicenter open trial was performed by eight dermatologists on 191 volunteers. Evaluation by the dermatologist of the child's clinical condition (SCORAD) and of the efficacy and overall safety of the treatment was associated with a QoL questionnaire completed by one parent of the atopic child. A self-assessment of the global QoL and of the efficacy and overall safety was also performed. During the study, mean SCORAD dropped from 28 to 12 (p0.001), with good improvement in skin dryness and pruritus criteria. At the same time, the self-assessment of the global parent QoL scores dropped from 4.4 to 2.1 (p0.001) with 60%, 48% and 79% favorable parent opinions regarding wellbeing or improvement of the health condition, quality of sleep, and efficacy of the emollient, respectively. This trial revealed the efficacy of the product in improving parent QoL (85% of parents noted improvement in QoL), and its global safety was considered to be very good or good, with 80% favorable opinions in parents' declarative judgements and dermatologists' assessments. The emollient evaluated improves the course of AD and can improve the QoL of patients and their families.

In 2008, community skin cancer screening (cSCS) was introduced into routine care of the German statutory health insurances (SHI). In the meantime, more than 13 million individuals have been screened. To date, no data are available on the perception of cSCS by the general public.Evaluation of public perception of cSCS in Germany.From 10 to 17th March 2011, a phone survey on a population-based sample of n = 1 014 German adults with SHI status was conducted by the Forsa Institute, including 12 questions on the use, knowledge and attitude regarding cSCS.Of the interviewees 48 % were concerned about skin cancer, 29 % of all persons and 31 % of those eligible had already undergone cSCS. Of these, a major proportion (80 %) had been screened by dermatologists. Of the interviewees 75 % would (again) consult a dermatologist for the next cSCS, and less than 10 % would consult the general practitioner. Although about 93 % considered health screenings useful, only 44 % were informed about the legal right to undergo free cSCS after the age of 35.In Germany cSCS is highly accepted in the community. Leading care providers are the dermatologists. Knowledge about the right to free cSCS needs better public propagation.

The aim of the CARPE (German acronym: Chronisches Handekzem-Register zum Patienten-Langzeitmanagement; meaning: chronic hand eczema registry on long-term patient management) registry is to investigate characteristics and treatment modalities in patients affected by chronic hand eczema in Germany.The registry was built up under the auspices of the German Dermatological Society (Deutsche Dermatologische Gesellschaft, DDG). Patients with chronic hand eczema are prospectively assessed by dermatological examination and patient questionnaire. Socio-economic data and data on diagnostics, skin status, severity and treatment of chronic hand eczema and atopy criteria are repeatedly assessed. Here, we present baseline characteristics of the first 515 patients.53.8 % of the patients were female, mean age was 47.3 years. The average duration of CHE was 7.7 years. 30.4 % had already received inpatient care, 31.2 % had been on sick leave in the past 12 months. 94.5 % had received topical corticosteroids prior to inclusion in the registry, 31.9 % topical calcineurin inhibitors, 38.3 % UV therapy, 28.6 % systemic antihistamines, 36.5 % systemic treatments, 14.9 % systemic corticosteroids, 25.8 % systemic retinoids.The CARPE project demonstrates the high medical burden and therapeutic challenge of chronic hand eczema and presents first data for health care research. Furthermore, the designed follow-up study will present important data about the natural history and prognosis of this chronic skin disease.

Retinoids and vitamin A derivatives have been widely used topically and systemically in the treatment of hyper- and parakeratotic skin diseases, genodermatoses, severe acne, autoimmune diseases (i. e. lupus erythematosus) or cutaneous T-cell lymphoma for more than 30 years. In addition to the desired proliferation-inhibiting, differentiation-inducing and antiinflammatory or sebo-suppressive effects, vitamin A derivatives also affect lipid metabolism. This is shown primarily by an increase of transaminases, triglycerides or cholesterol levels which vary in intensity from patient to patient. The degree of impact on the different parameters of lipid metabolism depends on the nature of the vitamin A derivative on the one hand due to different receptor specific binding interactions (RAR/RXR), while on the other hand posttranslational processes also play a major role. This review paper gives a brief, concise overview of the vitamin A derivatives and possible effects on lipid metabolism that can be expected. Additionally it contains a recommendation for secure handling of abnormal laboratory values before, during and after oral therapy with vitamin A derivatives. The aim of this article is to provide practical help and confidence in dealing with vitamin A derivatives in daily clinical practice. The publication was created in cooperation with the Deutsche Dermatologische Gesellschaft (DDG) and Deutsche Gesellschaft zur Bekämpfung von Fettstoffwechselstörungen und ihren Folgeerkrankungen (DGFF [Lipid-Liga] e. V.).

Hospitals in the German health care system are confronted with increasing economic competition due to paradigm shifts in funding inpatient treatment. Major hospitals, such as university hospitals, will be under significantly greater pressure to keep up the ability to compete by uniform per case payment. The new hospital funding system based on a Diagnosis Related Group (DRG) system and the economic competition involved require analyses of organisational and locational factors. Cooperativeness and efficient utilisation of resources, properties and staff will be determining factors to secure existence. Adequate responses and strategies are essential to cope with the growing operating requirements. Carrying out an analysis identifying one's own strengths and weaknesses, opportunities and threats will help to focus activities and sustainable strategies into areas where the strengths and the greatest opportunities lie. An example of the process of strategic planning and positioning is shown for a university department of dermatology.

Papuloerythroderma of Ofuji is a rare disease that mainly affects older men of Asiatic origin. Clinically, it is marked by highly pruritic papules which form larger plaques or may give rise to erythroderma. Larger body folds of the abdomen are typically spared (deckchair sign). There is a dispute whether papuloerythroderma of Ofuji represents an own entity or should be regarded as a variant of other inflammatory, neoplastic, or paraneoplastic dermatoses. We present a case of papuloerythroderma of Ofuji in a European patient in which the clinical course as well as the laboratory and histology suggested a relation to mycosis fungoides. Our patient developed pruritic urticarial plaques when systemic corticosteroids were tapered, but cleared complete with cyclosporin A.

Pimecrolimus (Elidel, SDZ ASM 981), a new macrolactam ascomycin derivative, was highly effective in treating plaque-type psoriasis when applied under Finn-chamber occlusion. A two-centre, randomized, double-blind, vehicle- and positive-controlled within-patient study was therefore conducted in 23 adult psoriasis patients. Pimecrolimus 1% was applied, twice daily, in an experimental ointment formulation, along with the corresponding vehicle, 0.005% calcipotriol ointment and 0.05% clobetasol-17-propionate ointment to test sites without occlusion for 21 days. Erythema, induration and scaling (score: 0 [absent] to 4 [severe]) were evaluated. The total sign score was defined as the sum of the erythema, induration and scaling scores (range 0-12). Pimecrolimus 1% ointment was significantly (p = 0.03) more effective than the corresponding vehicle, with an improvement in total sign score of 51.4% compared with 36.7% for the corresponding vehicle. Improvements with calcipotriol and clobetasol-17-propionate were 71.5% and 88.3%, respectively. No local or systemic drug-related side effects were observed in the study. We conclude that pimecrolimus 1% in the experimental ointment formulation was significantly more effective than its corresponding vehicle, but less effective than calcipotriol and clobetasol ointment. This is the first study reporting a significant therapeutic effect of pimecrolimus in an ointment formulation applied without occlusion to psoriatic plaques.

Mechanical properties of micro-electro-mechanical systems (MEMS) materials at cryogenic temperatures are investigated to extend MEMS devices into space applications. A helium-cooled measurement setup mimicking the outer space environment is developed and installed inside a focused-ion-beam (FIB) system. T-shape, low-stress LPCVD silicon nitride cantilevers suspended on a silicon substrate are fabricated as the test structures using bulk micromachining technique. A lead-zirconate-titanate (PZT) translator and a silicon diode are utilized as an actuator and a temperature sensor in the measurement setup, respectively. The resonant frequencies of an identical cantilever with different “milling masses” are measured to obtain the thickness and the Young's modulus. Additionally, a bending test is performed to determine the fracture strength. From the experiments, the Young's modulus of LPCVD silicon nitride thin films varies from 260.5 GPa ± 5.4 GPa at room temperature (298 K) to 266.6 GPa ± 4.1 GPa at 30 K, while the fracture strength ranges from 6.9 GPa ± 0.6 GPa at room temperature to 7.9 GPa ± 0.7 GPa at 30 K.

Melanocortin receptors (MC-Rs) are G-protein coupled receptors that mediate pleiotropic actions of melanocyte-stimulating hormones and adrenocorticotropin. There is increasing evidence that one of the five so far identified melanocortin receptors, i.e. melanocortin-1 receptor (MC-1R), has a more ubiquitous distribution in the skin than originally expected. In the present study, the expression of MC-1R in normal skin glands and hair follicles, various malformations and neoplasms with adnexal differentiation is described. Using an anti-MC-1R antibody directed against the amino acids 2-18 of the human MC-1R, specimens of normal healthy skin (n = 10) as well as hamartomas, cysts, hyperplasias, and benign or malignant neoplasms with eccrine, apocrine, sebaceous gland, and hair follicle differentiation (n = 98) were immunostained. MC-1R expression was widely preserved in various adnexal malformations and neoplasms as compared with normal skin and did not show major differences with regard to maturation of the neoplasms. The majority of adnexal epithelia showed an intracytoplasmically granular staining and, to a lesser extent, an intercellular staining pattern. Immunoelectron microscopical investigations revealed expression of MC-1R both along the cell surface and intracytoplasmically within tubular endosomes, the latter suggesting internalisation of the receptor. In conclusion, preserved MC-1R expression in adnexal epithelia suggests a functional role of proopiomelanocortin (POMC) in various malformations and neoplasms of the skin.

In the present study, we have investigated the pro-opiomelanocortin (POMC)-derived neuropeptide alpha-MSH for its ability to modulate activation of human mast cells. The in vitro ability of purified human skin mast cells to secrete various types of mast cell mediators was monitored in response to alpha-MSH at the mRNA and at the protein level. Picomolar concentrations of alpha-MSH induced a dose-dependent release of histamine from isolated human skin mast cells and from skin punch biopsies. However, no effect of alpha-MSH was seen regarding the expression of IL-1, IL-6, IL-8, TGF-beta, and TNF-alpha. Melanocortin receptor MC-1 was identified at the transcriptional level by RT-PCR analysis but not at the protein level, whereas, in leukemic human mast cells (HMC-1), the mRNAs and the proteins for the MC-1 and MC-5 receptor were identified. These results suggest that alpha-MSH may selectively induce acute inflammatory effects via secretion of histamine.

We present a cryogenic measurement setup installed inside a focused-ion-beam (FIB) system to characterize and microrepair microelectromechanical systems (MEMS) for space applications. The setup allows testing of MEMS devices under vacuum condition of 10−6Torr at variable temperatures ranging from 298to20K. In the experiment, a lead-zirconate-titanate translator powered by a function generator and a dc voltage is utilized as an actuator, and a thin-film thermo-resistor fabricated with test devices is used as an integrated temperature sensor. Additionally, a motorized x-y-z stage is installed to achieve highly accurate positioning function. Resonant techniques and bending tests based on the designed setup are developed to measure the mechanical properties of silicon nitride thin films at cryogenic temperatures. Combined with the functions of the FIB system, this setup also demonstrates the capability to microrepair microshutter arrays, programmable field selectors in the NASA James Webb Space Telescopes. Th...

Serum lysozyme has been demonstrated to be an indicator for macrophage activity in the tumor-bearing host. Therefore, we investigated lysozyme levels in the sera of 336 untreated tumor patients (121 malignant melanoma, 61 lung cancers, 70 cervical cancers, 49 breast cancers and 35 benign breast tumors, and 36 healthy controls). Patients with malignant melanoma and lung cancer had significantly higher lysozyme levels than the healthy controls. Within the clinical stages in melanoma, there was a decrease of lysozyme in stages II and III in comparison to stage I, but still above that of the control values. Patients with benign breast tumors had normal levels, whereas in breast cancer patients of stages I and II there was a significant reduction in the lysozyme levels. In stages III and IV no differences to the control group could be detected. In patients with cervical cancer (FIGO II and III) serum lysozyme levels were found to be within the normal range. From this study it can not be concluded that serum lysozyme reflects the immunological reactivity of the tumor bearer. Nevertheless, the reduced levels in stages I and II of breast cancer might point to an immunological defect.