Human Papillomavirus-type distribution in anogenital lesions of prepubertal children.

BACKGROUND: In contrast to adults, only limited data are available on the human papillomavirus (HPV)-type spectrum in anogenital warts (AGW) of children. OBJECTIVE: This study aimed to evaluate the HPV-type spectrum in AGW of prepubertal children. MATERIALS & METHODS: In a retrospective German multicentre study, HPV genotyping was performed in AGW biopsies of 55 1- to 12-year-old children using HPV group-specific PCRs followed by hybridization with type-specific probes or sequence analysis. RESULTS: Human papillomavirus-DNA was found in 53 of the 55 AGW. In 58.5% (31/53) of the HPV-positive AGW, mucosal HPV types were detected. HPV6 (27/53, 50.9%) was the predominant type. 43.4% (23/53) of the lesions were induced by cutaneous HPV types (HPV2, HPV27, HPV57). Mucosal HPV types were significantly more common in children under 5 years of age than in children 5 years of age and older (22/25, 88.0% [95% CI: 70.0-95.8] vs. 9/28, 32.1% [95% CI: 17.9-50.7], P < 0.001). In contrast, cutaneous HPV types were significantly more prevalent in the 5- to 12-year age group (4/25, 16.0% [95% CI 6.4-34.7] vs. 19/28, 67.9% [95% CI 49.3-82.1], P < 0.001). CONCLUSION: Anogenital warts in 5- to 12-year-old children are frequently associated with cutaneous HPV types, possibly due to horizontal transmission. HPV typing, in addition to comprehensive clinical and psychosocial evaluation, can potentially help in the assessment of these cases.

[Rheumatoid arthritis : These dermatoses lead you to the diagnosis]. / Rheumatoide Arthritis : Bei welchen Hautveränderungen sollte man daran denken?

BACKGROUND: Rheumatoid arthritis is one of the most common autoimmune disorders. In addition to chronic arthritis, rheumatoid arthritis may present a variety of extra-articular manifestations, most commonly of the skin. OBJECTIVES: Cutaneous manifestations associated with rheumatoid arthritis can be diverse, both specific and nonspecific. Which dermatoses should lead you to the diagnosis of an underlying rheumatoid arthritis? METHODS: Evaluation of exemplary overviews, case presentations and relevant textbook articles. RESULTS: Rheumatoid arthritis presents various specific and nonspecific skin manifestations. Besides visual diagnosis like classic rheumatoid nodules a histopathologic correlation or an interdisciplinary approach is often needed, such as for diagnosis of pyoderma gangrenosum. CONCLUSIONS: The early detection and correct classification of cutaneous manifestations associated with rheumatoid arthritis can be groundbreaking for a successful therapy and a consequently better prognosis for patients with rheumatoid arthritis. Therefore dermatologists bear responsibility in the patient-centered care.

[Successful therapy of condylomata acuminata with ingenol mebutate]. / Erfolgreiche Therapie von Condylomata acuminata mit Ingenolmebutat.

Condylomata acuminata (CA) are one of the most common sexually transmitted infections in the sexually active population. Due to the stigmatizing character of the disease and the high rate of relapse after therapy, CA may significantly affect patients' quality of life. Here, we report the case of successful treatment of multiple CA of the penis and scrotum in a 53-year-old man with ingenol mebutate gel.

[Acquired angioedema with C1-INH deficiency and accompanying chronic spontaneous urticaria in a patient with chronic lymphatic B cell leukemia]. / Erworbenes Angioödem mit C1-INH-Defizienz und begleitender chronisch spontaner Urtikaria bei chronisch lymphatischer B-Zell-Leukämie.

Acquired angioedema due to C1 inhibitor deficiency (C1-INH-AAE) is characterized by recurrent edema of the subcutaneous and/or submucosal tissue without wheals and negative family history of angioedema. Here, we present the case of a patient with a chronic lymphatic B cell leukemia who suffered from both C1-INH-AAE and chronic spontaneous urticaria. Oral corticosteroids, antihistamines, and the anti-IgE antibody omalizumab were applied to treat the chronic urticaria in combination with the plasma-derived C1 esterase inhibitor concentrate Berinert® and the bradykinin B2 receptor antagonist icatibant, but the symptoms did not improved significantly. Thus, polychemotherapy targeting the slow-growing lymphoproliferative disease including rituximab was initiated, which resulted in remission of both the urticaria and the angioedema.

[Successful treatment of Bowen disease with ingenol mebutate]. / Erfolgreiche Behandlung eines Morbus Bowen mit Ingenolmebutat.

Ingenol mebutate is a novel cytotoxic drug extracted from the plant Euphorbia peplus. Since November 2012 it is approved in Germany for the treatment of superficial actinic keratoses. We report the successful treatment of Bowen disease with ingenol mebutate in a patient being treated with the multikinase inhibitor sunitinib for to metastatic clear cell renal carcinoma.

[Current status of oral immunomodulatory and immunosuppressive agents]. / Aktueller Stand der oralen Therapie mit immunmodulatorischen und immunsuppressiven Medikamenten.

Various dermatological disorders require treatments with immunosuppressive or immunomodulatory agents. Nevertheless, several studies demonstrate low prescription rates for systemic treatments. This low usage may be a result of physicians' low levels of confidence in administering systemic treatments. However, immunosuppressive treatments represent safe options when potential side effects as well as pharmacological interactions are considered. This review overviews the most important oral immunosuppressive or immunomodulatory agents and summarizes their mode of actions, indications, and adverse effects. Biologics that require intravenous or subcutaneous application are not included, but novel and new agents likely to be released soon are considered.

[Multiple erythema migrans and facial nerve paralysis: clinical manifestations of early disseminated Lyme borreliosis]. / Multilokuläre Erythemata migrantia und Fazialisparese : Klinische Manifestationsformen der disseminierten Frühinfektion der Lyme-Borreliose.

Lyme borreliosis is a common vector-borne disease in Europe. The infection follows different stages with a broad variability of clinical symptoms and manifestations in different organs. A 49-year-old man presented with flu-like symptoms, facial nerve paralysis and multiple erythematous macular on his trunk and extremities. We diagnosed Lyme disease (stage II) with facial nerve paralysis and multiple erythema migrans. Intravenous ceftriaxone led to complete healing of hissymptoms within 2 weeks.

[Eosinophilic granulomatosis with polyangiitis presenting as livedo racemosa]. / Livedo racemosa als kutane Manifestation bei eosinophiler Granulomatose mit Polyangiitis.

As a rare antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome) is characterized by asthma, severe peripheral eosinophilia and the presence of extravascular granulomas. Cutaneous involvement usually includes palpable purpura or cutaneous to subcutaneous nodes. We present the case of a 43-year-old woman with EPGA and the unusual cutaneous manifestation of livedo racemosa.

[Pseudoxanthoma elasticum. More than a skin problem]. / Pseudoxanthoma elasticum. Mehr als ein Hautproblem.

Pseudoxanthoma elasticum (PXE) is a rare genetic systemic disease with ectopic mineralization of the connective tissue leading to clinical manifestations in the skin, eyes and cardiovascular system. PXE is caused by mutations in the ABCC6 gene and is transmitted in an autosomal recessive manner. A 9-year-old boy presented with periumbilical skin findings since birth. The detection of typical retinal manifestations ("peau d'orange"-phenomenon) made possible a definite diagnosis, following the new diagnostic criteria for PXE from 2010. Curative treatment options are still unavailable so the interdisciplinary care of PXE patients by dermatologists, ophthalmologists and cardiologists appears to be pivotal to prevent severe ophthalmologic and cardiovascular complications.

[Tinea barbae profunda by Arthroderma benhamiae. A diagnostic challenge]. / Tinea barbae profunda durch Arthroderma benhamiae. Eine diagnostische Herausforderung.

Dermatomycoses due to pets and farm animals are often a clinical and diagnostic challenge for dermatologists. A 24-year-old man presented with inflammatory skin changes on his cheeks and chin. Because of negative fungal culture and the clinical appearance of a highly inflammatory process, our first diagnosis was a bacterial pyoderma. Polymerase chain reaction (PCR) identified Arthroderma benhamiae in both the patient and his guinea pig. A. benhamiae is a zoophilic dermatophyte which belongs to the Trichophyton mentagrophytes-complex. The fungus is acquired from guinea pigs and causes highly inflammatory forms of tinea. PCR-based diagnostics are quick and simple tools to identify this pathogen, so that suitable antimycotic therapy can be initiated quickly.

[Eruptive melanocytic nevi during azathioprine therapy in myasthenia gravis]. / Eruptive melanozytäre Nävi unter Behandlung einer Myasthenia gravis mit Azathioprin.

While being treated with azathioprine and dexamethasone, a 21-year old man with myasthenia gravis suddenly developed rapidly progressing brown macules, predominantly on the trunk, palms and soles. We made a diagnosis of eruptive melanocytic nevi (EMN). This rare entity can appear after blistering skin diseases, in immunocompromised patients, and, in particular, during immunosuppressive therapy for autoimmune diseases. Since therapeutic regimens including azathioprine have been frequently reported in association with EMN, we recommended to our patient a treatment switch to mycophenolic acid to prevent the development of more nevi.

[Hereditary cutaneous leiomyomatosis]. / Hereditäre kutane Leiomyomatose.

The occurrence of multiple cutaneous leiomyomas can be indicative of hereditary cutaneous leiomyomatosis. This autosomal dominant disorder is due to germline mutations in the fumarate hydratase (FH) gene. Associations with uterine myomas and renal cell carcinomas have been described and are referred to as Multiple Cutaneous and Uterine Leiomyomas (MCUL) or Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC), respectively. A 34-year-old man presented with multiple red-brown papules and nodules. After histopathologic confirmation of piloleiomyomas, we made the diagnosis of hereditary cutaneous leiomyomatosis. Taking into consideration the aforementioned complications, close interdisciplinary management of these patients and regular screening examinations within affected families are mandatory.

[POEMS syndrome. An interdisciplinary clinical challenge]. / POEMS-Syndrom. Eine interdisziplinäre klinische Herausforderung.

POEMS syndrome is a rare paraneoplastic syndrome due to a plasma cell dyscrasia, which includes peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma cell proliferation and skin changes. Elevated levels of VEGF (vascular endothelial growth factor) in the serum of patients are suggested to play a pivotal role in the pathophysiology. A 60-year-old male presented with POEMS syndrome and painful edema, skin thickening of the distal extremities and livid-erythematous discoloration. The sclerotic changes resulted in a severe limitation of joint flexibility. Furthermore, the patient showed clubbing, white nails and a facial lipoatrophy. In addition to the skin changes, the patient was diagnosed with polyneuropathy, monoclonal gammopathy (type lambda), high elevated VEGF-levels, hepatomegaly, lymphadenopathy, hypothyreosis, hypogonadism and thrombocytosis in the course of POEMS syndrome. Treatment with 4 cycles of bortezomib and dexamethasone resulted in improvement of symptoms.

Dust Impacts on the 2012 Hurricane Nadine Track during the NASA HS3 Field Campaign.

During the 2012 deployment of the NASA Hurricane and Severe Storm Sentinel (HS3) field campaign, several flights were dedicated to investigating Hurricane Nadine. Hurricane Nadine developed in close proximity to the dust-laden Saharan Air Layer, and is the fourth longest-lived Atlantic hurricane on record, experiencing two strengthening and weakening periods during its 22-day total lifecycle as a tropical cyclone. In this study, the NASA GEOS-5 atmospheric general circulation model and data assimilation system was used to simulate the impacts of dust during the first intensification and weakening phases of Hurricane Nadine using a series of GEOS-5 forecasts initialized during Nadine's intensification phase (12 September 2012). The forecasts explore a hierarchy of aerosol interactions within the model: no aerosol interaction, aerosol-radiation interactions, and aerosol-radiation and aerosol-cloud interactions simultaneously, as well as variations in assumed dust optical properties. When only aerosolradiation interactions are included, Nadine's track exhibits sensitivity to dust shortwave absorption, as a more absorbing dust introduces a shortwave temperature perturbation that impacts Nadine's structure and steering flow, leading to a northward track divergence after 5 days of simulation time. When aerosol-cloud interactions are added, the track exhibits little sensitivity to dust optical properties. This result is attributed to enhanced longwave atmospheric cooling from clouds that counters shortwave atmospheric warming by dust surrounding Nadine, suggesting that aerosol-cloud interactions are a more significant influence on Nadine's track than aerosol-radiation interactions. These findings demonstrate that tropical systems, specifically their track, can be impacted by dust interaction with the atmosphere.

Post-laser hypersensitivity and the atopic patient.

Laser resurfacing has become an extremely popular modality in the treatment of the aging face. Reported complications associated with carbon dioxide laser resurfacing are on the increase. One such complication involves the occurrence of significant hypersensitivity in laser and non-laser-treated areas, often occurring for weeks or months after the original treatment and necessitating topical or systemic steroid therapy. In an effort to identify patients at risk, those with significant hypersensitivity reactions were interviewed retrospectively. Questions regarding their background atopic characteristics were posed. Their responses to certain questions were then compared with those of a control group of 50 patients from the same pool who suffered no ill effects after laser therapy. A total of 151 patients were included in the study (pool). Of these, 14 patients (9.3 percent) suffered significant hypersensitivity. Detailed history in these patients revealed possible prior "allergic sensitivity" in 78.6 percent of patients. In contrast, only 30 percent of 50 nonsymptomatic laser-treated patients admitted to any positive allergic tendencies. It is likely that carbon dioxide laser resurfacing may trigger a sensitivity reaction in susceptible individuals.

Early passive mobilization after digital nerve repair and grafting in a fresh cadaver.

In the clinical management of combined tendon and nerve injuries, there are competing treatment strategies. Isolated tendon injuries should be rapidly mobilized after repair to prevent adhesion formation, whereas isolated nerve repairs are usually immobilized to prevent disruption and to allow axon regrowth. Recommendations in the published literature for the management of combined tendon and nerve injuries are vague and advise up to 3 weeks of immobilization. The goals of this study were to determine which length of nerve gap resulted in rupture of a repair following postoperative mobilization with the modified Duran protocol and with unrestricted motion and to determine whether nerve grafts are at risk of rupture after mobilization. A total of 100 digital nerves from 10 cadaver hands were tested with the modified Duran and the unsplinted protocols. Each digital nerve on each hand was sequentially resected and repaired at five progressively larger gap lengths after testing with both protocols. The mean nerve gaps at which disruption occurred were significantly different between the splinted (9.7 +/- 0.8 mm, n = 100) and unsplinted (7.3 +/- 1.9 mm, n = 100) protocols (t test, p < 0.001). One hundred percent of repairs remained intact, with up to 5 mm of resection with the modified Duran protocol (n = 100) and with up to 2.5 mm of resection with the unsplinted protocol (n = 100). All nerve grafts remained intact after mobilization within a dorsal-blocking splint (n = 100). Considering mechanical integrity of the nerve repair only, these data suggest that early mobilization with tendon protocols may be considered after a nerve injury to avoid the detrimental tendon sequelae that result from immobilization. The adequacy of functional recovery of mobilized nerves is yet to be determined.

Identification of focal adenomyosis as a uterine lesion in two dogs.

A focal uterine adenomyosis is described in two bitches. In both cases, the uterus showed knobbly enlargements of 4 to 8 cm in diameter, which resulted in distinct clinical symptoms. Other pathological changes of the uterus were not present. One bitch was presented because of a history of vaginal discharge of several months' duration. Radiographs, as well as ultrasonography, revealed a soft tissue lesion at the cervix. The other bitch showed a marked reduction in its general condition and a sudden onset of a tense abdomen. Radiologically, a lesion of soft tissue opacity was observed in the mid-abdomen and was seen to originate from the left uterine horn during exploratory laparotomy. A torsion of the lesion was present, which explained the clinical signs in this second case.