German S3-guidelines on the treatment of psoriasis vulgaris (short version).

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance (Richards et al. in J Am Acad Dermatol 41(4):581-583, 1999). To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis first published in 2006 and now updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. This short version of the guidelines presents the resulting series of therapeutic recommendations, which were based on a systematic literature search and discussed and approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs, as well as detailed information on how best to apply the treatments described (for full version please see Nast et al. in JDDG Suppl 2:S1-S104, 2011 or http://www.psoriasis-leitlinie.de ).

European S3-guidelines on the systemic treatment of psoriasis vulgaris.

Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.

[Fairy tale drama--an inpatient group psychotherapeutic method for patients with ego disorders]. / Märchendrama--eine psychotherapeutische Stationsgruppenmethode für Ich-gestörte Patienten.

Patients with "early disturbances" partly display considerable resistance to treatment methods that promote regression or aim at uncovering inhibitions, since they themselves lack emotional differentiation. In an inpatient setting such patients are able to transfer their non-experienced share of feelings and references to the treating personnel. If these transferred feelings are not properly processed and managed, therapy blockades and communication blockades arise, resulting in considerable frustrations of all concerned within the therapeutic community. Against the background of these experiences we developed a ward group method inviting both patients and staff to join hands in creative playing (e.g. by acting a fairy tale on the stage); within this framework it is possible to shape latent group, ward and team conflicts on a metaphorical level. As a result we achieve a reduction of the emotional tension level within the ward, a reduction of team conflicts, and hence an improved therapeutical climate and better possibilities to translate into reality appropriate strategies for a fair solution of problems. The overall framework, the therapeutic concept, as well as the individual stages of work-in-progress in the realisation of the fairy-tale drama are described in detail (e.g. phase of birth of the fairy tale, phase of fairy-tale recital, phase of casting, actual performance phase and subsequent discussion phase). These steps are described both as regards their form and their contents; they are compared with other group techniques of a similar nature.