[Treatment of actinic keratoses in older adults]. / Therapie aktinischer Keratosen beim älteren Menschen.

Actinic keratoses (AKs) are common precancerous skin lesions that primarily affect older adults due to cumulative sun exposure. Given the increased vulnerability of older adults to developing AKs, appropriate therapeutic strategies are crucial to prevent their progression to invasive squamous cell carcinoma. This comprehensive review aims to explore the various treatment modalities available for AKs in the elderly population, focusing on their efficacy, safety, and suitability for this specific age group. The article discusses topical treatments, cryotherapy, photodynamic therapy, chemical peels, and surgical interventions, providing a detailed analysis of their mechanisms of action, benefits, limitations, and considerations in geriatric patients. Furthermore, the importance of individualized treatment plans, considering factors such as comorbidities, medication interactions, and patient preferences, are highlighted.

Response durability after cessation of immune checkpoint inhibitors in patients with metastatic Merkel cell carcinoma: a retrospective multicenter DeCOG study.

BACKGROUND: Immune checkpoint inhibitors (ICI) have led to a prolongation of progression-free and overall survival in patients with metastatic Merkel cell carcinoma (MCC). However, immune-mediated adverse events due to ICI therapy are common and often lead to treatment discontinuation. The response duration after cessation of ICI treatment is unknown. Hence, this study aimed to investigate the time to relapse after discontinuation of ICI in MCC patients. METHODS: We analyzed 20 patients with metastatic MCC who have been retrospectively enrolled at eleven skin cancer centers in Germany. These patients have received ICI therapy and showed as best overall response (BOR) at least a stable disease (SD) upon ICI therapy. All patients have discontinued ICI therapy for other reasons than disease progression. Data on treatment duration, tumor response, treatment cessation, response durability, and tumor relapse were recorded. RESULTS: Overall, 12 of 20 patients (60%) with MCC relapsed after discontinuation of ICI. The median response durability was 10.0 months. Complete response (CR) as BOR to ICI-treatment was observed in six patients, partial response (PR) in eleven, and SD in three patients. Disease progression was less frequent in patients with CR (2/6 patients relapsed) as compared to patients with PR (7/11) and SD (3/3), albeit the effect of initial BOR on the response durability was below statistical significance. The median duration of ICI therapy was 10.0 months. Our results did not show a correlation between treatment duration and the risk of relapse after treatment withdrawal. Major reasons for discontinuation of ICI therapy were CR (20%), adverse events (35%), fatigue (20%), or patient decision (25%). Discontinuation of ICI due to adverse events resulted in progressive disease (PD) in 71% of patients regardless of the initial response. A re-induction of ICI was initiated in 8 patients upon tumor progression. We observed a renewed tumor response in 4 of these 8 patients. Notably, all 4 patients showed an initial BOR of at least PR. CONCLUSION: Our results from this contemporary cohort of patients with metastatic MCC indicate that MCC patients are at higher risk of relapse after discontinuation of ICI as compared to melanoma patients. Notably, the risk of disease progression after discontinuation of ICI treatment is lower in patients with initial CR (33%) as compared to patients with initial PR (66%) or SD (100%). Upon tumor progression, re-induction of ICI is a feasible option. Our data suggest that the BOR to initial ICI therapy might be a potential predictive clinical marker for a successful re-induction.

[UV phototherapy : UV phototherapy and photodiagnostics-a practical overview]. / UV-Phototherapie : UV-Phototherapie und Photodiagnostik ­ eine praktische Übersicht.

UV phototherapy is an essential and efficient therapeutic option in the treatment of dermatological diseases. It is an integral part of multiple guidelines and maintains its high clinical significance despite the development of new therapeutic options for systemic treatment. Due to the difficult revenue situation, the market for ready-to-use products of psoralen and UV therapy devices is constantly changing.

[Wound treatment in diabetes patients and diabetic foot ulcers]. / Wundbehandlung bei Diabetes und diabetischem Fußulkus.

Diabetes mellitus (DM) is a paramount and rising medical challenge in both industrial and emerging nations. For Germany, 6.9 million out of 64.9 million insured persons in 2010 were reported to suffer from DM and approximately 5.8 million suffered from type 2 DM. The prevalence of diabetic foot ulcer (DFU) or diabetic foot syndrome (DFS) is 2-10% and the incidence is 2-6%. In addition, patients with DM present associated skin disorders with chronic wound healing, e.g., pyoderma gangrenosum or lecrobiosis lipoidica. Knowledge of the pathogenesis and skills for treatment of chronic wounds in diabetic patients are important for dermatologists. Patients with diabetes and wound healing disorders and accompanied unspecific skin disorders like eczema, cellulitis or contact dermatitis are often primarily or secondarily treated by dermatologists. In this article, practical hints for the treatment of DFS and other chronic wound in patients with DM are presented.

A randomized, multinational, noninferiority, phase III trial to evaluate the safety and efficacy of BF-200 aminolaevulinic acid gel vs. methyl aminolaevulinate cream in the treatment of nonaggressive basal cell carcinoma with photodynamic therapy.

BACKGROUND: Basal cell carcinoma (BCC) represents the most common nonmelanoma skin cancer worldwide, affecting mainly adult, fair-skinned individuals. The World Health Organization distinguishes aggressive and nonaggressive forms, of which prototypical variants of the latter are primary nodular and superficial BCC. OBJECTIVES: To demonstrate noninferiority of BF-200 ALA (a nanoemulsion gel containing 5-aminolaevulinic acid) compared with MAL (a cream containing methyl aminolaevulinate) in the treatment of nonaggressive BCC with photodynamic therapy (PDT). Noninferiority of the primary efficacy variable (overall patient complete response 12 weeks after last PDT) would be declared if the mean response for BF-200 ALA was no worse than that for MAL, within a statistical margin of Δ = -15%. METHODS: The study was a randomized, phase III trial performed in Germany and the U.K. with ongoing 5-year follow-up. Of 281 randomized patients, 138 were treated with BF-200 ALA and 143 with MAL. Patients received two PDT sessions 1 week apart. Remaining lesions 12 weeks after the second PDT were retreated. Illumination was performed with a red light source (635 nm, 37 J cm-2 ). The results shown include clinical end points and patients' reassessment 12 months after the last PDT. The study was registered with EudraCT (number 2013-003241-42). RESULTS: Of the BF-200 ALA-treated patients, 93·4% were complete responders compared with 91·8% in the MAL group. The difference of means was 1·6, with a one-sided 97·5% confidence interval of -6·5, establishing noninferiority (P < 0·0001). The results for secondary efficacy parameters were in line with the primary outcome. Recurrence rates 12 months after the last treatment were ≤ 10%. CONCLUSIONS: Treatment of nonaggressive BCC with BF-200 ALA-PDT is highly effective and well tolerated with proven noninferiority to MAL-PDT. It demonstrates low recurrence rates after 1 year of follow-up.

[Evidence of compression therapy]. / Evidenz der Kompressionstherapie.

BACKGROUND: Medical compression therapy is widely used to treat phlebologic diseases. Compression bandages as well as compression stockings are used. Compression has been identified to be an effective conservative therapy for the healing of venous ulcers and other indications. Thus, the evidence for the use of medical compression therapy and for which indications is presented. MATERIALS AND METHODS: Review and systematic presentation of the evidence-based use of compression. The current literature, guidelines, and consensus statements were searched and the indications for compression therapy are presented. RESULTS: There is a high level of evidence that compression therapy is effective to heal venous ulcers and to prevent recurrent ulcers. The use of compression bandages and hosiery after interventional and surgical procedures for varicose veins is based on experience but not on randomized controlled trials. According to clinical experience, the healing of inflammatory skin diseases (e.g., erythema nodosum, pyoderma gangrenosum, necrobiosis lipoidica, cutaneous leukocytoclastic vasculitis, and psoriasis of the extremities) is supported by compression therapy. Compression therapy in patients suffering from venous ulcers is highly recommended.

[New approaches for the prevention of actinic keratosis]. / Neue Ansätze zur Prävention aktinischer Keratosen.

Actinic keratosis is one of the most common skin diseases. Because of the ongoing demographic changes, it is anticipated that the incidence will further increase. Prevention of actinic keratoses is thus of great importance. By far the most important cause of actinic keratoses is the chronic cumulative irradiation of human skin with ultraviolet B and A radiation from natural sunlight. There is no doubt that use of sunscreens is effective in preventing actinic keratoses. Recent studies indicate that in high-risk groups the regular use of medical devices which are characterized by a very high SPF and which contain liposomally encapsulated DNA repair enzymes are effective in preventing the development of new actinic keratoses even when field cancerization is already present in human skin. There is also evidence that oral photoprotective strategies based on the regular intake of vitamin B3 may be used to prevent actinic keratoses.

[Vitamin D and UV protection]. / Vitamin D und UV-Schutz.

A high percentage of people present with reduced vitamin D3 levels. Reduced vitamin D3 levels have to be supplemented. Oral supplementation can be performed easily and without significant side effects. Because vitamin D3 can be produced in the skin via ultraviolet B (UVB) irradiation, it is possible to elevate reduced vitamin D3 levels by UVB exposure. However, UVB, which is classified as a complete carcinogen, induces skin cancer. Therefore, UVB irradiation should not be utilized to stimulate vitamin D3 synthesis. Sun protection, especially wearing of clothes and seeking shade and appropriate use of sunscreens, correlates with reduced D3 levels. A risk-benefit calculation shows that oral supplementation of vitamin D3 is preferred to UVB/sun expsure to increase serum vitamin D3 levels.

[Segmental type 1 manifestation of Darier disease. An example of cutaneous mosaicism]. / Segmentale Typ-1-Manifestation des Morbus Darier. Ein kutanes Mosaik.

A 45-year old man presented with red-brown hyperkeratotic papules that were distributed in an unilateral segmental fashion on the right thorax. Histopathological examination revealed acanthosis and, in particular, acantholysis and dyskeratosis in the basal and suprabasal epidermal layers. Based on the clinical and histopathologic findings we diagnosed a type 1 segmental Darier disease. Darier disease is an autosomal dominant disorder that is caused by mutations in the ATP2A2 gene and is characterized by dysfunctional adhesion between neighboring keratinocytes. The type 1 segmental manifestation reflects a de novo postzygotic somatic mutation in the heterozygous state and as a rule can be found in all autosomal dominantly inherited genodermatoses.

Effect of breeding strategy and feeding system on the within-herd variation of lean meat percents in Danish slaughter pigs.

In several countries slaughter pigs are paid for individually, according to slaughter weight and lean meat percent (LMP). Production of uniform batches of pigs within the optimal weight and LMP limits will obtain the best price. Therefore, all pigs should have a similar growth rate (average daily gain, ADG) and reach an appropriate slaughter weight within the same time period. LMP may serve as a proxy for ADG since pigs with low LMP have significantly higher ADG than pigs with high LMP and vice versa. Both breeding strategy and feeding system may influence the range of variation among pigs. The aim of this study was to test the two following hypotheses: (1) Herds purchasing breeding gilts have a higher mean value and a lower variation (standard deviation) in LMP than herds producing their own breeding gilts and (2) Herds using restricted feeding of finishers have a higher mean value and a lower variation (standard deviation) in LMP than herds with ad libitum feeding of finishers. The study included 72 herds and a total of 345,132 pigs slaughtered during one year. Among the 72 herds, 40 were home-breeders and 32 purchased breeding gilts from a breeding company. Nineteen herds used restricted feeding, of which 8 (42%) were home-breeders. Fifty-three herds used ad libitum feeding, of which 32 (60%) were home-breeders. Breeding strategy had a significant effect on SDLMP (p=0.003), where purchase of breeding gilts resulted in a significantly lower standard deviation of the monthly LMP compared to home-bred gilts (a difference in median SDLMP of 0.2 percentage points or 8% difference between groups). Feeding system had a significant effect on the meanLMP (p<0.001), with a significantly higher meanLMP in herds using restrictive feeding compared to ad libitum feeding (60.7% versus 60.0%). Restrictive feeding also resulted in a significantly lower SDLMP (p<0.001) compared to ad libitum feeding (2.2% versus 2.5% or a 12% difference between groups).

Association between lean meat percentage and average daily weight gain in Danish slaughter pigs.

Danish pigs that are within optimal weight limits and have a high lean meat percentage (LMP) obtain the best prices at slaughter. Another reason to consider the variation in LMP is the assumed association between LMP and average daily weight gain (ADG) at the individual level. The aim of this study was to test whether high ADG was associated with low LMP and vice versa. A cohort of 99 pigs from a conventional Danish herd was followed from 30kg to slaughter. The data included days in the herd, start- and end-weights, calculated ADG and LMP, reported from the abattoir. The study also included existing data from 13,057 boars from a Danish boar test station. The results of the study demonstrated a significant negative association between LMP and ADG: Pearson's correlation coefficient (r)=-0.42 (95% CI: -0.57; -0.24) (p<0.0001) for the cohort and r=-0.42 (95% CI: -0.48; -0.36) (p<0.0001) for the boars.

Characterization of commercial synthetic resins by pyrolysis-gas chromatography/mass spectrometry: application to modern art and conservation.

To characterize a set of synthetic resins, a methodology by pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) has been developed. The studied reference materials were commercial versions of a wide range of synthetic resins. For each polymer, the pyrolytic and chromatographic conditions were optimized to adequately resolve the fragment mixture in a short time. The proposed analytical method does not require previous treatment of the sample, and due to its high sensitivity, only a small sample quantity in the microgram range can be used. The pyrolysis temperature was found to have little effect on the obtained pyrograms. The summarized data set for the individual polymer materials, especially the characteristic fragments with a structure close to the monomeric unit, was useful to identify commercial synthetic resins. These materials were used in the art and conservation field, as binding media, paint additives, painting varnishes, coatings, or consolidants. Two case studies are introduced where direct Py-GC/MS and thermally assisted hydrolysis and methylation GC/MS were applied on art objects: first, a modern gluing material of a medieval reverse glass painting, and the second example, the binding medium of a painting by Georg Baselitz ("Senta", 1992/1993) from the Sammlung Moderne Kunst at the Pinakothek der Moderne, Munich.

[Trombiculiasis in humans]. / Trombidiose des Menschen.

Trombiculiasis is an epizoonosis that occurs worldwide and is caused by various types of chiggers. Clinical findings after accidental contact with the parasitic mite larvae include erythematous papules and urticarial plaques, to some extent with vesicular transformation, which can lead to excoriations due to the intense pruritus. Prophylaxis against exposure is recommended when visiting areas known to be colonized by mites. Reactions to bites can be treated by local application of alcohol compresses or zinc lotions and external application of agents containing polidocanol or glucocorticosteroid. Systemic antihistamines are indicated to control itching.

[Ultraviolet therapy in patients with chronic hand eczema]. / Ultravioletttherapie des chronischen Handekzems.

Treatment of hand eczema is dominated by the administration of topical glucocorticosteriods. If topical treatment fails, the best second-line option is ultraviolet (UV) therapy alone or as combination therapy. UVB and PUVA (psoralen plus UVA) therapy is effective and has relatively few side effects. Due to the localized nature of the disease, topical PUVA therapy is preferable to systemic PUVA treatment. Among the topical methods, cream PUVA therapy is simple, safe and highly effective. Recent clinical studies have demonstrated the therapeutic efficacy of a new retinoid called alitretinoin, a 9-cis-retinoic acid. However, even this form of treatment does not lead to a complete cure in all patients. Under the primacy of multimodal treatment, UV therapy should be administered as combination therapy if oral retinoids are not sufficiently effective.

Effect of amelogenin extracellular matrix protein and compression on hard-to-heal venous leg ulcers: follow-up data.

OBJECTIVE: To undertake a follow-up of patients with hard-to-heal venous leg ulcers (VLUs) who had participated in a randomised controlled trial in which they had been treated with either compression therapy in combination with amelogenin extracellular matrix protein or compression therapy alone for 12 weeks or until their ulcers had healed, whichever occurred first. METHOD: Patients were randomised to receive either high compression therapy plus amelogenin (n=42) or high compression therapy alone (n=41) for a period up to and including 12 weeks. The method and initial findings are detailed in an earlier paper. Twelve weeks after the final visit, the patients were followed up and the wounds were re-evaluated. RESULTS: The initial results demonstrated clinically and statistically significant benefits for the patients in the amelogenin group. The results of the follow-up showed that the successful healing response had been maintained. Significantly more patients continued to show a reduction in ulcer size from baseline in the amelogenin-treated group versus the control group (p=0.02), and there was a statistically significant (p=0.01) larger reduction in the amelogenin-treated group. This group also had a significantly (p=0.02) higher percentage of patients with decreases in wound size. The overall number of patients with healed wounds was greater (n=9) in the amelogenin-treated group than in the control group (n=3). Pain continued to be significantly reduced in the amelogenin-treated group compared with the control group (p=0.001). CONCLUSION: Amelogenin therapy in conjunction with high compression therapy was beneficial in the treatment of hard-to-heal VLUs when compared with treatment with high compression alone. These beneficial effects were maintained post-treatment and were identified at follow-up.