Comparison of a novel aluminum lactate-based with an aluminum chloride-based antiperspirant in excessive axillary and inguinal perspiration: first randomized controlled trial.

BACKGROUND: Topical aluminum salts are a commonly used remedy for excessive axillary perspiration. To the contrary, less is known about their anhidrotic potential in the groin. This study sought to compare the anhidrotic efficacy and tolerability of an aluminum chloride-based antiperspirant to an innovative aluminum lactate-based antiperspirant in healthy study participants presenting with excessive axillary and inguinal perspiration. PARTICIPANTS AND METHODS: Fifty participants were enrolled in this open open-labeled, randomized, controlled trial. Following a baseline assessment, efficacy was analyzed at two time points throughout the study period by means of four physiological parameters (pH value, transepidermal water loss, gravimetric analysis, Minor test) and two questionnaires (Dermatology Life Quality Index, Hyperhidrosis Disease Severity Scale). Tolerability was evaluated via symptom diaries. RESULTS: Both study preparations were comparably effective in reducing axillary and inguinal perspiration and exhibited increasing effectiveness over time. In both treatment regions, the aluminum lactate-based antiperspirant had a more favorable tolerability profile than the aluminum chloride-based antiperspirant. CONCLUSIONS: Due to its comparable efficacy and - most noticeably in the groin - superior tolerability, this study supports the use of topical aluminum lactate as a first-line option to control excessive axillary and inguinal perspiration.

Disseminierte papulöse Variante des Morbus Dowling-Degos: Histopathologische Merkmale bei POGLUT1-Mutation.

Der Morbus Dowling-Degos ist eine seltene, benigne Genodermatose. Charakteristisch sind lentiginöse Hyperpigmentierungen sowie rotbraune Papeln und Plaques. Häufig sind die Beugeseiten und Intertrigines betroffen, das klinische Bild kann jedoch variieren. Verantwortlich für die klinische Ausprägung sind Mutationen in unterschiedlichen Genen. Während Mutationen im Keratin 5 (KRT5)-Gen ein retikuläres Verteilungsmuster begünstigen, führen Mutationen im POGLUT1-Gen zu einem disseminierten, papulösen klinischen Bild. Die akantholytische Variante des Morbus Dowling-Degos wird historisch als Morbus Galli-Galli bezeichnet, unsere Falluntersuchung zeigt jedoch, dass die histopathologischen Veränderungen auch innerhalb eines Patienten variieren können. Bisher gibt es kein einheitliches Therapiekonzept. Keratolytische Maßnahmen stehen im Vordergrund, mit unterschiedlich gutem Ansprechen. Neue Therapieansätze mit Hilfe der Lasertechnologie scheinen eine vielversprechende Behandlungsoption zu sein.

Disseminated papular variant of Dowling-Degos disease: Histopathological features in POGLUT1 mutation.

Dowling-Degos disease is a rare benign genodermatosis. It is characterized by lentiginous hyperpigmentation and reddish-brown papules and plaques. The flexor sides and intertrigines are often affected, but the clinical appearance may vary. Mutations in different genes are responsible for the clinical manifestation. While mutations in the keratin 5 (KRT5) gene favor a reticular distribution pattern, mutations in the POGLUT1 gene lead to a disseminated, papular clinical picture. Acantholytic variants of Dowling-Degos disease have historically been referred to as Galli-Galli disease, but our case study shows that the histopathological changes can vary even within a single patient. To date, no standardized therapy concept exists. The main focus is on keratolytic measures, with varying response. New therapeutic approaches using laser technology appear to be a promising treatment option.

S2k guideline: Laser therapy of the skin.

This guideline aims to improve the efficiency and safety of lasers and optical radiation sources with similar effects (especially IPL). Laser therapy of skin lesions with an increased amount of melanocytes should be performed with caution. Laser treatment of pigmented melanocytic nevi is not recommended. The guideline contains recommendations regarding the treatment of lentigines and café-au-lait spots, non-pigmented dermal nevi, Becker nevus, nevus of Ota/Hori/Ito and melasma. Further recommendations focus on the treatment of skin lesions without an increased amount of melanocytes (ephelides, postinflammatory hyperpigmentation including berloque dermatitis, seborrheic keratoses, traumatic/decorative tattoos and metallic deposits), hypopigmentation (vitiligo), benign non-pigmented neoplasms (fibrous papule of the nose, nevus sebaceus, epidermal nevus, neurofibroma, sebaceous gland hyperplasia, syringoma, xanthelasma palpebrarum), inflammatory dermatoses (acne papulopustulosa/conglobata, acne inversa, granuloma faciale, lichen sclerosus, lupus erythematosus, psoriasis vulgaris, rosacea, rhinophyma), wrinkles/dermatochalasis/striae, hypertrichosis, scars (atrophic, hypertrophic; keloids, burn/scald scars), laser-assisted skin healing, onychomycosis, precancerous lesions and malignant tumors (actinic keratoses/field cancerization, cheilitis actinica, basal cell carcinoma), vascular skin lesions (angiokeratoma, angioma, hemangioma, malformation, spider veins, granuloma telangiectaticum (pyogenic granuloma), rubeosis (erythrosis interfollicularis colli, ulerythema ophryogenes), nevus flammeus, telangiectasias and Osler's disease (hereditary hemorrhagic telangiectasia) and viral skin lesions (condylomata acuminata, mollusca contagiosa, verrucae planae juveniles/vulgares/ verrucae palmares et plantares).

Comparison of novel aluminium lactate versus aluminium chloride-based antiperspirant in excessive axillary perspiration: First prospective cohort study.

Aluminium chloride-based antiperspirants are an effective topical therapeutic option for mild to moderate states of excessive perspiration. Its use is primarily limited by the occurrence of skin irritation, especially in sensitive skin types. The objective of this study was to compare the antiperspirant efficacy and tolerability of a novel antiperspirant with 12.5% aluminium lactate, and a 12.5% aluminium chloride-based antiperspirant. This cohort study was conducted as a two-sided self-assessment comparison between both preparations in healthy volunteers to generate selfcare-related data. Almost half of the participants stated that aluminium chloride was more efficacious than aluminium lactate; 22% stated aluminium lactate was more efficacious than aluminium chloride; 28% observed no difference in the efficacy of both preparations (p = 0.04). However, 88% described greater tolerability with aluminium lactate (p < 0.0001). In this study, aluminium lactate showed significantly greater tolerability than aluminium chloride, although the latter tended to show slightly greater efficacy.

Superiority of occipital donor sites for split-thickness skin grafting in dermatosurgery: Results of a prospective randomized controlled study.

BACKGROUND: Split-thickness skin grafts are commonly used in dermatosurgery. For occipital donor sites, retrospective studies have shown good results with respect to graft take and healing rates. Nevertheless, the majority of grafts in dermatosurgery are harvested from the thigh. To date, there has been no prospective randomized controlled study comparing occipital versus femoral donor sites. PATIENTS AND METHODS: Following micrographically controlled R0 tumor resection, 108 patients were randomized prior to undergoing split-thickness skin grafting (donor site: occiput vs. thigh). Follow-up examinations were carried out on day 3, 5, 7, and 14, as well as one month and three months after surgery. Documented data included graft take rates, re-epithelialization rates at the donor site, pain, cosmetic outcome, Vancouver Scar Scale (VSS), and complications. RESULTS: Occipital donor sites showed significantly faster reepithelization, less pain, fewer complications, a better cosmetic outcome, and better results on the VSS. With regard to graft take rates, grafts harvested from the occiput were significantly superior on days 3 and 5. CONCLUSIONS: This is the first randomized controlled trial showing a significant superiority of occipital compared to femoral donor sites regarding re-epithelialization, pain, cosmetic outcome and the Vancouver Scar Scale.

Removal of Tattoos by Q-Switched Nanosecond Lasers.

Tattoo removal by Q-switched nanosecond laser devices is generally a safe and effective method, albeit a time-consuming one. Despite the newest developments in laser treatment, it is still not possible to remove every tattoo completely and without complications. Incomplete removal remains one of the most common challenges. As a consequence, particular restraint should be exercised when treating multicoloured tattoos, and patients need to be thoroughly informed about remaining pigment. Other frequent adverse effects include hyper- and hypopigmentation as well as ink darkening; the latter is particularly frequent in permanent make-up. Scarring is also possible, although it is rare when treatment is performed correctly. It is becoming more widespread for laser operators to encounter allergic reactions and even malignant tumours in tattoos, and treating these conditions requires a nuanced approach.

Treatment errors resulting from use of lasers and IPL by medical laypersons: results of a nationwide survey.

BACKGROUND: The demand for hair and tattoo removal with laser and IPL technology (intense pulsed light technology) is continually increasing. Nowadays these treatments are often carried out by medical laypersons without medical supervision in franchise companies, wellness facilities, cosmetic institutes and hair or tattoo studios. This is the first survey is to document and discuss this issue and its effects on public health. PATIENTS AND METHODS: Fifty patients affected by treatment errors caused by medical laypersons with laser and IPL applications were evaluated in this retrospective study. We used a standardized questionnaire with accompanying photographic documentation. Among the reports there were some missing or no longer traceable parameters, which is why 7 cases could not be evaluated. RESULTS: The following complications occurred, with possible multiple answers: 81.4% pigmentation changes, 25.6% scars, 14% textural changes and 4.6% incorrect information. The sources of error (multiple answers possible) were the following: 62.8% excessively high energy, 39.5% wrong device for the indication, 20.9% treatment of patients with darker skin or marked tanning, 7% no cooling, and 4.6% incorrect information. CONCLUSIONS: The causes of malpractice suggest insufficient training, inadequate diagnostic abilities, and promising unrealistic results. Direct supervision by a medical specialist, comprehensive experience in laser therapy, and compliance with quality guidelines are prerequisites for safe laser and IPL treatments. Legal measures to make such changes mandatory are urgently needed.

Triple swabbing allows sensitive MRSA detection in dermatologic patients of a university tertiary care hospital.

BACKGROUND: To optimize preventive measures to control MRSA, we investigated retrospectively the suitability of a multiple site screening model and the optimal sampling technique to detect MRSA in a university-based phlebology and skin cancer center in Germany. PATIENTS AND METHODS: During 4.5 years samples of 3 712 inpatients in a dermatologic department were analyzed for MRSA by conventional microbiologic cultures and in parallel by PCR. Samples were taken from nares, wounds and skin lesions. RESULTS: MRSA was detected in 60 inpatients (1.6%). 268 of 7 269 (3.7%) samples at admission and during hospital stay were found positive ñ 96 (35.8%) of these were swabs of nares, 59 (22.0%) surveillance swabs, 53 (19.8%) wound swabs and 42 (15.7%) from other dermatologic lesions. Twenty-five of 60 patients (41.7%) were found positive only in the nares, 10 (16.7%) patients only in wounds and 4 (6.7%) patients only in lesions. 166 (61.9%) of all positive culture samples became positive 24 hours after cultivation, 86 (32.1%) after 48 hours, and 16 (6.0%) after 72 hours. CONCLUSIONS: Highest sensitivity to detect MRSA can be reached by combining three swabs: nares, wounds and skin lesions (ìtriple-testî). Culture of screening specimens for 72 hours is recommended.

"Smoking guns": hazards generated by laser and electrocautery smoke.

The smoke generated by laser surgery and electrocautery may contain significant amounts of toxic, carcinogenic, and infectious gases and particles. Although there is little scientific data on the actual type and extent of the hazards related to exposure, considering the potential for irreversible health damage, safety measures should not be delayed. All potentially exposed persons (including patients, medical, and cleaning staff) should be acquainted with the possible health and occupational hazards related to smoke from electrocautery and laser surgery procedures.

Liposuction - a surgical procedure in dermatology.

Liposuction is an integral part of the wide range of surgical procedures in dermatology. Dermatologists established tumescent local anesthesia in combination with the use of micro-cannulas; especially dermatologists from Germany and Austria actively designed and developed these new techniques. In this position paper, we discuss the history, various interdisciplinary aspects, the significance, and the treatment indications for this procedure as well as its role within dermatologic training programs and research. For quality reasons, members of the Germany Society of Dermatologic Surgery and the Austrian Society of Dermatologic Surgery discuss several fundamental professional aspects as well as the historical development of liposuction.

Treatment of xanthelasma palpebrarum using a pulsed dye laser: a prospective clinical trial in 38 cases.

BACKGROUND: Several studies have reported positive results of nonablative laser treatment of xanthelasma palpebrarum, but the published evidence is weak and inconclusive. OBJECTIVE: To systematically evaluate the effect of pulsed dye laser (PDL) treatment of xanthelasmas. MATERIALS AND METHODS: Twenty female Caucasian patients with 38 lesions (< or =1 mm above skin level) were enrolled. They received up to five treatment sessions with a PDL (wavelength, 585 nm; energy fluence, 7 J/cm(2); pulse duration, 0.5 ms; spot size, 10 mm; number of passes, 2) at 2- to 3-week intervals. Photographs were taken before each treatment session and 4 weeks after the last treatment. Two independent examiners categorized clearance into four groups (no clearance [<25% xanthelasma area(s) cleared], moderate [25-50%], good [51-75%], and excellent [>75%]). Patient satisfaction was assessed on a verbal rating scale. RESULTS: Approximately two-thirds of the lesions showed clearance greater than 50%, and one-quarter had clearance greater than 75%. Interrater reliability was excellent (contingency coefficient >0.7 at all visits). Treatments were well tolerated and had no major side effects. Patient satisfaction was generally high. CONCLUSION: PDL is a promising approach for treating xanthelasmas, especially when multiple sessions are performed.