[Quality of care for patients with atopic dermatitis in Germany-no improvements in indicators after ten years]. / Qualität der dermatologischen Versorgung von Neurodermitis in Deutschland ­ keine Verbesserung der Indikatoren nach 10 Jahren.

BACKGROUND: With AtopicHealth1, the first national care study on atopic dermatitis (AD) was conducted in 2010. At that time, about one third of the patients undergoing treatment by dermatologists showed severe limitations in quality of life, which indicated an insufficient quality of care. The aim of the present study was to characterise the current care of patients with AD undergoing dermatological treatment in comparison between different severity grades, as well as in comparison to 2010 and to psoriasis. METHODS: The Germany-wide multicentre cross-sectional study "AtopicHealth2" recorded clinical data, quality of life (DLQI), therapies, preventive behaviour and patient-defined treatment benefit (PBI). Patients with an indication for systemic therapy were considered moderately to severely affected for subgroup analyses, the others mildly affected. RESULTS: Between 2017 and 2019, 1291 patients (median age 41 years, 56.5% female) were enrolled by 111 centres. Compared with 2010, there were no improvements in quality of life (DLQI 8.5 in both studies), severity (SCORAD 45.4 vs. 42.3 in 2010) or treatment benefit (PBI 2.2 vs. 2.4 in 2010). Moderately to severely affected patients were more likely to show impaired quality of life (45.4% vs. 23.6%) and less likely to have relevant treatment benefits (PBI < 1: 21.3% vs. 13.2%) than mildly affected patients. In contrast to psoriasis, patients with AD revealed higher quality of life limitations (DLQI 8.5 vs. 6.1) and lower treatment benefit (PBI 2.2 vs. 2.8). DISCUSSION: Compared to 2010, there is no improvement in the quality of care for AD in Germany. Compared to psoriasis, patients with AD show higher burden and lower treatment benefit, which underlines the need for therapeutic innovations.

[Rapid resolution of severe psoriasis vulgaris in an HIV-positive patient treated with antiretroviral therapy]. / Schnelle Abheilung einer schweren Psoriasis vulgaris bei einem HIV-positiven Patienten unter antiretroviraler Therapie.

Psoriasis exacerbation may occur in patients with human immunodeficiency virus (HIV). We present the case of a patient with severe psoriasis vulgaris (PASI 34.2) and an initial HIV diagnosis who showed rapid resolution of psoriasis upon initiation of antiretroviral therapy. Antiretroviral therapy is an effective treatment option for HIV-associated psoriasis. Especially in patients with a sudden psoriasis flare-up or resistance to therapy, HIV testing should be considered as knowledge of an underlying infection is elementary to treatment decision-making.

[Inappropriate systemic therapy in severe atopic dermatitis-severe long-term damage]. / Unsachgemäße Systemtherapie bei schwerer atopischer Dermatitis ­ fatale Langzeitschäden.

The therapeutic options for treatment of severe cases of atopic dermatitis have been limited until recently, but fundamentally improved with the approval of the first biological dupilumab at the end of 2017. With the biological tralokinumab and the Janus kinase inhibitors baricitinib and upadacitinib, further new systemic drugs have recently been approved. Nevertheless, there are cases in which modern treatment options are not taken into account, as shown by a 28-year-old patient with serious side effects from long-term treatment with systemic glucocorticoids. In addition to the extensive clarification of the consequential damage, guideline-based therapy with dupilumab was initiated as well as interdisciplinary cooperation with endocrinologists, ophthalmologists, osteologists and nutritionists.