[Dermatosurgery in the age of novel oral anticoagulants/direct oral anticoagulants]. / Dermatochirurgie im Zeitalter der neuen oralen Antikoagulanzien/direkten oralen Antikoagulanzien.

Current guidelines generally recommend continuation of blood thinning drugs in dermatologic surgery and the previously used "bridging" with subcutaneous or intravenous heparin is obsolete. While the guidelines are increasingly implemented in daily practice, there is still uncertainty concerning the use of the novel direct oral anticoagulants (NOAC = DOAC). In this review, we analyze current developments and formulate concise recommendations for continuation during skin surgery under consideration of individual risk.

[Cylindromas-rare but striking]. / Zylindrome ­ selten aber eindrucksvoll.

Cylindromas are rare tumors of adnexal structures in adults. They are predominantly found on the scalp and face. More impressive than incidentally diagnosed solitary cylindromas are multiple tumors in patients with familial Brooke-Spiegler syndrome. If many large cylindromas appear on the head, they are termed turban tumor. Sudden growth or ulceration should raise suspicion for malignant transformation.

[Paraneoplastic skin diseases]. / Paraneoplastische Hauterkrankungen.

Various specific skin alterations can occur in patients with malignant diseases. If these skin diseases occur as associated symptoms of a malignant process, they are called paraneoplastic. In this overview, obligate and frequent facultative paraneoplastic skin diseases are assigned according to the triggering type of malignancy. Some of the processes predominantly show a link with malignant diseases of the digestive tract, e.g. acanthosis nigricans, florid cutaneous papillomatosis, necrolytic migratory erythema, Leser-Trélat syndrome, palmoplantar keratoderma, panniculitis and pityriasis rubra pilaris. Others are predominantly associated with a hematolymphoid malignoma, e.g. acquired ichthyosis, exfoliative erythroderma, necrobiotic xanthogranuloma, paraneoplastic pemphigus, plane xanthoma, pyoderma gangrenosum, scleromyxedema, Sweet syndrome and leukocytoclastic vasculitis. In a third group paraneoplastic skin diseases are pooled in association with other malignancies, e.g. Trousseau's syndrome, dermatomyositis, erythema gyratum repens, hypertrichosis lanuginosa acquisita and papuloerythroderma of Ofuji. In order to initiate targeted diagnostics for detection of an underlying malignant disease, it is essential that accomplished physicians recognize the skin diseases that represent obligate or potential paraneoplasms as such.

[Ingrown toenails-options for daily practice]. / Eingewachsene Zehennägel ­ Optionen für die tägliche Praxis.

The ingrown toenail is a common, painful and inflammatory clinical presentation, especially, but not exclusively, in adolescent patients. Numerous conservative treatment methods are available. Usually, however, the surgical treatment is at the end of a chain of suffering. While classified as obsolete, the so-called Emmert plasty is still used for surgical treatment. As a gentle alternative, selective treatment of the lateral matrix horn by resection or phenol caustics is increasingly used. The latter methods offer numerous benefits with little postoperative pain and faster recovery to normal quality of life.

[Mucous pseudocysts-when and how to treat?] / Mukoide Pseudozysten ­ wann wie therapieren?

The treatment of mucous pseudocysts must consider their tendency for recurrence. There are numerous established treatment options available. The decision on the optimal therapy, however, depends on the clinical presentation and symptoms as well as on possible side effects. This review presents surgical as well as nonsurgical treatment options for digital mucous pseudocysts and an algorithm is suggested. For recurrent and symptomatic lesions with pain or deformation of the nail plate, surgical excision of the pseudocyst and closure with a flap can be considered.

Prospective multicentre cohort study on 9154 surgical procedures to assess the risk of postoperative bleeding - a DESSI study.

BACKGROUND: To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin. OBJECTIVE: To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy. METHODS: Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions. RESULTS: Bleeding complications were observed in 7.14% of cases (654/9154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis, INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa/acne inversa (HS/AI) were significant parameters independently influencing the risk of bleeding. Discontinuation of phenprocoumon therapy and subsequent switching to low molecular weight heparin was associated with the highest risk of bleeding (9.26%). CONCLUSION: Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy. Discontinuation of DOACs is recommended 24 h prior to surgery. Bridging of phenprocoumon should be terminated. In patients with a bleeding history, the INR value should be within the therapeutic range.

[Nihil certum: historical development of the term prurigo]. / Nihil certum: Historische Entwicklung des Begriffs Prurigo.

The term prurigo is still used to designate primary dermatoses and secondary reaction patterns. A clear definition of the term is not available nor a clear clinical classification of diseases categorized under the term. Furthermore, there is no certainty about the entity it was primarily used to refer to, and whether it should always be considered in relation to pruritus. The concept appears already in very early medical treatises. From the very beginning, it was used in dermatology in a non-uniform way, and was alternately accorded and denied the status of an independent disease entity. Moreover, prurigo was subdivided into many different forms, but their descriptions are partly very similar, so that, for instance, it is quite difficult today to draw any conclusions about the clinical entities the frequently used terms prurigo mitis and prurigo formicans referred to. In contrast, the term prurigo nodularis is still commonly used. This article traces exemplarily the use of the term prurigo in the standard medical textbooks up to the definition of prurigo nodularis.

[Nail diseases in routine practice]. / Nageldermatosen in der Praxis.

BACKGROUND: Nail problems are common reasons for patients presenting to dermatological and general practitioners practices. PROBLEM: Which nail diseases should be known and recognized in routine daily practice? MATERIAL AND METHODS: This article presents the most common nail alterations experienced by the authors from clinics and routine practices with guidelines on the diagnostics, therapy and additional literature. RESULTS: Nail alterations can be designated as inflammatory nail dermatoses or neoplasms. Depending on the local nail findings, clinical investigations, patient history, histology if necessary and additional procedures, concrete indications can be derived for the correct diagnosis and therapy. CONCLUSION: Knowledge of the most commonly occurring nail diseases allows a targeted classification and additional diagnostics which can help to alleviate pain, improve aesthetics and adequately treat malignant alterations.

[Pediatric nail surgery]. / Nagelchirurgie bei Kindern.

BACKGROUND: Although interventions on the skin of children and adolescents often heal better than in adults, inappropriate interventions on nails can lead to avoidable trauma and irreparable damage to fingers and toes. PROBLEMS: When are interventions on nails indicated in children? What age-related characteristics are important? MATERIAL AND METHODS: With reference to the literature and experience from own clinical cases, the most commonly occurring constellations in children are discussed and approaches to protective treatment are demonstrated. RESULTS: Ingrown toenails are one of the most common reasons for presentation due to nail problems in childhood. Conservative measures or protective interventions on the nail matrix avoid unnecessary trauma caused by currently obsolete techniques. Additional nail problems in children which could be treated operatively included nail pigmentation, exostosis and onychodystrophy. CONCLUSION: A thorough evaluation of the indications and cautious implementation allows a targeted nail surgery or its avoidance even in childhood.

[Dark nail: clinical findings, diagnostics and therapy of melanonychia]. / Dunkler Nagel : Klinik, Diagnostik und Therapie der Melanonychie.

BACKGROUND: A dark colored pigmentation of nails can be due to a subungual malignant melanoma. There are, however, many other benign causes and this differentiation is an important challenge in dermatological practice. PROBLEM: When should nail pigmentation be clarified by histological investigations? MATERIAL AND METHODS: This article gives a survey of the literature on this topic and a review of own experiences with clinical case examples. The various causes of melanonychia are presented and criteria for the early recognition of melanoma of the nail matrix are formulated. RESULTS: The width and depth of color of longitudinal melanonychia do not allow any conclusions on the dignity. If the nail striation is proximally broader than distally, this is evidence of a proliferative event. Confirmation of a subungual hemorrhage does not exclude a malignancy per se. Also detection of pigmentation due to fungi does not exclude the additional presence of a subungual melanoma. A systematic clinical analysis using clear criteria leads to a working diagnosis and suitable treatment. CONCLUSION: An early and correct designation of nail pigmentation can avoid unnecessary nail interventions but can also be life saving.

[Platelet inhibitors and anticoagulants: managing blood thinners in dermatosurgery]. / Thrombozytenaggregationshemmer und Antikoagulanzien : Umgang mit Blutverdünnern in der Dermatochirurgie.

Many patients requiring dermatologic surgery are taking anticoagulants or antiplatelet agents. The perioperative management of these drugs is not standardized and affected by fear of bleeding complications. Studies show only moderate increase in bleeding complications while taking these drugs. Our clinical experience shows no significant peri- or postoperative bleeding. As part of a risk assessment, thromboembolic complications outweigh any bleeding risk of surgery. Therefore, in the experience of the authors, blood thinning drugs should be continued before and during dermatosurgical procedures. General assessment of laboratory parameters concerning coagulation or platelet function is not necessary and can be restricted to selected subgroups of patients.

[How useful are diets against cancer?]. / Wie sinnvoll sind "Krebsdiäten"?

BACKGROUND: Diets against cancer are attractive for patients who try to influence disease progression. METHODS: In order to determine the most influential cancer diets in Germany, we analyzed the chatroom for cancer patients "Krebs-Kompass", the search machines Google and Bing and our own counseling experience as experts. We conducted a systematic literature review of clinical data in Medline also considering preclinical data on safety. RESULTS: The most often mentioned "cancer diets" are Budwig diet, Gerson's regimen, lowcarb diet, cancer cure of Breuß and macrobiotic diet. These diets can be classified according to the principle idea of carcinogenesis as follows: cancer as a lack or abundance of a substance or as a consequence of pathological metabolism of cancer cells. Staying in line with a specific diet the patients are thought to be able to cure themselves or at least substantially contribute to cure. However, we did not find any scientific publication of a clinical study which describes positive results regarding survival. On the contrary, data show malnutrition and side effects. CONCLUSION: There is no indication to consume a "cancer diet". In some cases adverse effects can occur. Cancer patients who are discussing nutrition should be warned about taking up a "cancer diet".

[Special aspects of dermatologic surgery in children]. / Besonderheiten der Dermatochirurgie im Kindesalter.

This reviews gives suggestions how to meet the needs of our young patients, especially with reference to dermatologic surgery. With the right attitude, specific knowledge and appropriate preparation, a potential disruption can be transformed into a low-conflict routine or even a rewarding experience for all persons involved.

Reduced expression of nicotinic alpha subunits 3, 7, 9 and 10 in lesional and nonlesional atopic dermatitis skin but enhanced expression of alpha subunits 3 and 5 in mast cells.

BACKGROUND: The skin cholinergic signalling system is modulated in atopic dermatitis (AD). OBJECTIVES: To investigate of the role of nicotinic acetylcholine receptors (nAChRs) in the pathogenesis of AD. METHODS: We investigated the expression and localization of nAChR alpha subunits in AD by quantitative reverse transcription-polymerase chain reaction and immunohistochemistry of biopsies from lesional and nonlesional areas of AD skin and of skin biopsies from healthy control persons. RESULTS: Our data demonstrate the presence of mRNA and protein of the nAChR alpha subunits 3, 5, 7, 9 and 10 in keratinocytes and mast cells in healthy and AD skin. Expression of the alpha subunits 3, 7, 9 and 10 was generally reduced in the skin of patients with AD whereas mast cells in AD but not in healthy skin showed alpha3 and alpha5 subunit immunoreactivity. Differences in the subunit mRNA levels between lesional and nonlesional skin were obtained for the alpha subunits 3, 9 and 10 with higher levels of alpha3 but lower levels of alpha10 subunit mRNA in lesional areas. No differences in the expression of the alpha subunits was found between the groups of extrinsic, intrinsic or mixed AD types, between genders and between smokers and nonsmokers. CONCLUSIONS: This supports the idea that the cholinergic system is dysregulated independently from inflammation in AD and that inflammation further modulates individual nAChR subunits.