[Children and adolescents with psoriasis. What therapy is recommended?]. / Kinder und Jugendliche mit Psoriasis. Welche Maßnahmen werden empfohlen?

Juvenile psoriasis shows a cumulative incidence of 1.76% until the 18th year of life and thus is important for both pediatricians and dermatologists. In contrast to psoriasis in adults, the main trigger factors are infections, mechanical trauma and stress factors and to a much lesser extent medical and recreational drugs. Apart from the classical predilection sites, the diaper area, scalp and face are mainly involved. Guttate psoriasis following streptococcal infections is a specific clinical manifestation in childhood and adolescence. Psoriasis arthritis of childhood falls into the group of juvenile idiopathic arthritis and typically presents before or simultaneously with skin symptoms. All recommended childhood vaccinations should be administered, ideally when the disease is under remission. Therapy relies heavily on topical agents like dithranol, corticosteroids, and alternatively topical calcineurin inhibitors in addition to individually adapted skin moisturizing measures. In severe cases which do not adequately respond to topical therapy, systemic treatment with classical immunomodulatory agents like methotrexate, cyclosporin, retinoids and fumarates may be initiated but all usage is off-label. The only agent licensed for the treatment of psoriasis in patients above the age of 8 years is etanercept if classical treatment has failed. Rehabilitative measures in mountain and seaside areas are reasonable for maintaining improvement and helping patient learn to deal with disease.

Nodular morphea.

Scleroderma may present as being strictly limited to the skin, as in morphea, or within a multiorgan disease, as in systemic sclerosis. Accordingly, cutaneous manifestations vary clinically. In nodular or keloidal scleroderma, patients develop lesions that are clinically indistinguishable from a keloid; however, the histopathological findings are more variable. We describe a 16-year-old girl with morpheic lesions for 3-4 years and additional development of keloidal nodules within these lesions. The histological examination revealed a hypertrophic scar besides morphea.

Medium dose long-wavelength ultraviolet A (UVA1) phototherapy for the treatment of acute and chronic graft-versus-host disease of the skin.

Long-wavelength ultraviolet A (340-400 nm UVA1) phototherapy has been reported to be effective in atopic dermatitis, localized scleroderma and other T-cell-derived skin diseases. UVA1 as an adjunct to systemic immunosuppressive treatment was found to be safe, and effective in 10 patients with chronic cutaneous (seven lichenoid and three sclerodermoid) graft-versus-host disease (GVHD) after stem cell transplantation. Complete and partial responses were achieved in six (60%), and in three (30%) patients, respectively. One patient had improvement of sclerotic skin lesions. At a median follow-up of 14 months, two patients with lichenoid lesions relapsed. Both responded to another treatment cycle. Furthermore, we treated seven patients with UVA1 as primary therapy for acute cutaneous GVHD grades II and III in a pilot experience. Five patients had a complete response with no relapse at a median follow-up of 9 months after UVA1. Two patients showed no response and systemic steroids had to be started. UVA1 therapy is feasible, well tolerated and can be effective in treating chronic as well as acute GVHD confined to the skin thereby avoiding systemic steroids. Our results should be confirmed in larger studies and the effectiveness of UVA1 compared to other established treatment modalities.

[The death of moulages - wax figures in dermatology]. / Das "Sterben" der Moulagen - Wachsabbildungen in der Dermatologie.

Wax has been used for illustration purposes back to antiquity. Since the renaissance period human anatomy and different diseases have often been depicted in wax. During the last century the art of moulage preparation evolved to three-dimensional, realistic representations of diseased parts of the human body. Its heyday and wide spread distribution paralleled the growing independence of dermatology. Apart from few exceptions, most mouleurs did not permit access to their technique either to successors or the public. Just like other European hospitals, the Department of Dermatology at Kiel University houses a comprehensive collection of moulages dating back to a century. The 455 objects left today were collected by Professor Viktor Felix Karl Klingmüller (1870-1942) who was head of the department from 1906 to 1937. The mouleur Alfons Kröner from Breslau who died 1937 supplied most (354) of the wax models. Highly esteemed at his time, Kröner was quite secretive about his art of moulagig. 35 of his moulages bear the abbreviation "DRP" standing for Deutsches Reichspatent (German patent); Kröner was granted a patent in 1902. In his patent application both wax mixtures and technical procedure of moulaging are described in great detail. Kröner, similarly to Jules Baretta (Paris), coloured his moulages at the back of the wax layers. Applying for a patent demonstrates his effort to meet increasing commercial pressure among suppliers of teaching aids at that time. Knowledge of individual technical procedures is essential for medical history as well as proper restauration of moulages as they continually deteriorate with time. Because of their three-dimensional and realistic disease representations, moulages still compare well to modern media used today. Consequently, the "dying of moulages" concerning the wax objects themselves as well as public or medical interest has to be stopped to preserve moulages for future generations.