[Eumycetoma due to Fusarium chlamydosporum : Case report und review of the literature]. / Eumyzetom durch Fusarium chlamydosporum : Fallbericht und Literaturübersicht.

Eumycetomas are chronic purulent infections by (mold) fungi that affect the skin and subcutaneous tissue and are associated with a granulomatous inflammatory reaction. An affection of deeper structures is possible and can lead to amputation. In most cases, the distal lower limbs are affected. The clinically similar actinomycetoma is caused by gram-positive, filamentous bacteria. Both diseases are subsumed as mycetomas and have been classified by the World Health Organization as "neglected tropical diseases". Eumycetomas are endemic in the "Trans-African Belt". Pathophysiologically, there is an inoculation of the respective, partially ubiquitous pathogens into the skin through microtrauma during barefoot walking. Characteristic criteria in histology are grains which correspond to microcolonies of the pathogen in vivo. In addition to culturing the pathogen, further molecular diagnostics should be pursued. Imaging procedures are usually necessary before major surgery. The treatment is difficult and lengthy and the use of systemic antifungals in combination with an operative approach is the first-line treatment. Itraconazole continues to be the gold standard. In refractory cases terbinafine can be used as a second-line therapy. Wearing sturdy footwear is an effective prophylaxis. Although preventable and treatable, eumycetoma, as a disease of the poor, remains endemic and is associated with considerable morbidity and socioeconomic burden. This is the first report on a eumycetoma in a patient from Sudan due to Fusarium chlamydosporum. Treatment with oral terbinafine for 1.5 years was successful.

[Physical and chemical emergencies in dermatology]. / Physikalische und chemische Notfälle in der Dermatologie.

Physical and chemical emergencies are often caused by household or work accidents. Regardless of the medical field and outside specialized clinics, the physician may be confronted with the situation for first or secondary care. The identification of the causing agent and a rapid assessment of the extent and severity of the tissue damage are essential to initiate early transfer to a specialized burn clinic. Grade 2b tissue damage is usually surgically treated. Smaller and superficial injuries can often be conservatively treated. Even supposedly safe and over-the-counter medicines can also lead to serious tissue damage.

[Diagnosis and therapy of genitoanal ulcers of infectious etiology]. / Diagnostik und Behandlung genitoanaler Ulzera infektiöser Genese.

BACKGROUND/OBJECTIVES: In this review article the diagnostic and therapeutic principles of genital ulcers of infectious etiology are highlighted. Besides frequent causative infections rare but relevant diseases in the differential diagnosis are discussed in detail. MATERIAL AND METHODS: A Pubmed literature search was carried out, guidelines from different task groups and clinical experiences are presented. RESULTS: Infections with herpes simplex virus (first) and syphilis (second) are still the most common causes of infectious genital ulcers. An endemic occurrence, previously rare in Europe, has been observed in recent years. Particular risk groups, such as men who have sex with men (MSM), sex workers or sex tourists are affected. Even less common locations, such as the mouth or the rectum, lymphogranuloma venereum (LGV) and atypical clinical symptoms (e.g. pelvic pain in pelvic lymphadenopathy with LGV) must be considered in the differential diagnosis. CONCLUSION: In recent years sexually transmitted infections (STI) have shown a significant increase in western industrialized nations. In all cases with unclear findings in the genital and anal areas (and also in the oral cavity) STI diseases must be reconsidered in the differential diagnosis.

Mammalian target of rapamycin and its downstream signalling components are activated in psoriatic skin.

BACKGROUND: Mammalian target of rapamycin (mTOR) signalling integrates signals leading to cellular growth, proliferation and differentiation. Disturbance of this tightly regulated interplay leads to malignancies, as reflected by altered mTOR signalling in epidermal tumours. As psoriatic keratinocytes also show features of perturbed cell growth and differentiation, the question arises as to whether mTOR signalling also plays a role in the pathogenesis of psoriasis. OBJECTIVES: To investigate the activation status of mTOR signalling components in psoriasis. METHODS: Biopsies from lesional and nonlesional skin of patients with psoriasis (n = 10), as well as samples from healthy donors (n = 3), were analysed by immunohistochemistry and Western blot, utilizing antibodies detecting phosphorylated mTOR, phospho-S6 kinase and phospho-S6 ribosomal protein. RESULTS: We found mTOR and its downstream signalling molecule, the ribosomal protein S6, to be activated in lesional psoriatic skin. While mTOR is activated throughout the whole epidermis, with particularly strong activation in the basal layer, S6 is active in suprabasal layers of differentiating keratinocytes. CONCLUSIONS: Altogether these results suggest a role for mTOR signalling in the epidermal changes leading to the psoriatic phenotype. mTOR inhibition might be a mode of action to explore in developing innovative antipsoriatic drugs.