[Psychosomatic disorders of the scalp]. / Psychosomatik der Kopfhaut.

Psychosomatic disorders of the scalp have some special characteristics due to the visibility, possible stigmatization, and amount/patterns of hair. Of practical relevance is trichotillomania, which is now classified as an obsessive-compulsive disorder (OCD). Patients who are obsessed with normal physiological hair loss represent a further psychodermatological challenge. Psychosomatic therapy includes basic psychosomatic care, behavior therapy, or treatment with psychopharmaceuticals.

[Beauty complication unit]. / Beauty-Komplikationssprechstunde.

A growing market, high demand, and the increasing complexity of cosmetic interventions have led to greater challenges in aesthetic medicine. In the present paper, medical, psychological and sociocultural aspects of possible complications are presented. Difficult situations can occur before, during, or after aesthetic interventions and require specific medical measures. This makes it necessary to set up a special consultation unit for beauty complications that takes into account extended medical and emotional aspects.

[What is beauty? : Manifest for an aesthetic character medicine]. / Was ist Schönheit? : Manifest einer ästhetischen Charaktermedizin.

Aesthetic medicine has in recent decades attained a growing social significance and firm place in the medical profession image. In a short time, a variety of technical procedures and processes have been developed and applied by specialized physicians. A further leading medical discussion regarding the central question "What is beauty" is missing compared with the technologically innovative progress. Beauty is characterized by an individual and subjective pleasure. Social media and fashion trends exert a central influence on common beauty ideals and aesthetic medicine. In practice, the artificial intervention must accord to the individual personality. Therefore, the professional term Aesthetic Medicine is insufficient and should be replaced by "Aesthetic Character Medicine". The particular purpose is the aim of graceful aging and a sustained adequate result which outlasts the zeitgeist. This requires medical know how and clear aesthetic self-conception of the physician. "Aesthetic Character Medicine" can be realized in a discourse, with the 10-step plan presented in this article.

[Superbrown beauty : The surface of tanorexia and tanning dependence]. / Überbraune Ästhetik : Die Oberfläche von Tanorexie und Bräunungssucht.

Brown skin symbolizes fitness, health, youthfulness and beauty, combined with leisure, activity, and joy of life in the Central European culture. Tanorexia is a tanning dependence that describes the morbid excessive desire for constant skin tanning. Particularly young women are affected. This article shows the underlying psychodermatological disorders.

[Self injury in adolescence]. / Selbstverletzungen in der Adoleszenz.

Self-injury often occurs for the first time in adolescence. The current classification distinguishes several groups: (1) factitious disorder imposed on self and factitious disorder imposed on another, (2) nonsuicidal self-injury (NSSI) and (3) obsessive-compulsive (OCD) and related disorders. The differential diagnosis includes a wide spectrum of psychiatric diseases, including borderline personality disorder (BPD), inherited disorders like Lesch-Nyhan syndrome (LNS) and also body modifications. In all these cases, self-harm is a subphenomenon. This review focuses on typical dermatological pictures.

[Botulinum toxin: the misguided path]. / Botulinumtoxin als Irrweg.

Botulinum toxin is widely used and has become a popular mass phenomenon in aesthetic medicine. Considerable scientific data concerning the biopsychosocial impact of botulinum toxin use have become available. The bidirectional interaction of mimic and emotion, described as the facial feedback hypothesis, is particularly influenced, as is mimicry. Furthermore, botulinum toxin can cause dysfunction of face harmony including false laughing or the "frozen face". As a result, complex psychosocial disturbances can occur and may affect social interaction and cause flattening of affect. Thus one must ask whether in the future botulinum toxin will continue to be employed in aesthetic dermatology or perhaps be regarded as a misguided path.

Delusional infestation and the specimen sign: a European multicentre study in 148 consecutive cases.

BACKGROUND: Systematic studies of delusional infestation (DI), also known as delusional parasitosis, are scarce. They lack either dermatological or psychiatric detail. Little is known about the specimens that patients provide to prove their infestation. There is no study on the current presentation of DI in Europe. OBJECTIVES: To determine the number of true infestations, to assess with which pathogens patients believe themselves to be infested, and to gather details about the frequency and nature of the specimens and the containers used to store them, based on European study centres. METHODS: Retrospective study of consecutive cases with suspected DI from six centres (Dermatology, Psychiatry, Tropical Medicine) in four European countries (U.K., Germany, Italy, France). RESULTS: In total, 148 consecutive cases of suspected DI were included, i.e. the largest cohort reported. None of the patients had evidence of a genuine infestation, as shown by examinations by dermatologists and/or infectious disease specialists. Only 35% believed themselves to be infested by parasites; the majority reported a large number of other living or inanimate (17%) pathogens. Seventy-one patients (48%) presented with what they believed was proof of their infestation. These specimens were mostly skin particles or hair, and rarely insects (only very few of which were human pathogenic or anthropophilic, and none of these could be correlated with the clinical presentation), and only 4% were stored in matchboxes (three of 71). CONCLUSIONS: This first multicentre study of DI in Europe confirms that the term 'delusional infestation' better reflects current and future variations of this entity than 'delusional parasitosis'. The presentation of proofs of infestation, commonly referred to as 'the matchbox sign', is typical but not obligatory in DI and might better be called 'the specimen sign'.

[Topical tacrolimus in necrobiosis lipoidica]. / Topische Anwendung von Tacrolimus bei Necrobiosis lipoidica.

Necrobiosis lipoidica (NL) is a chronic inflammatory skin disease that is difficult to treat. The etiology is unknown, but vascular abnormalities and immunologic factors have been implicated. We treated a patient with long-standing NL with multiple vascular risk factors (diabetes mellitus, protein S-deficiency, and antiphospholipid syndrome) with topical tacrolimus, a non-steroidal immunomodulator that causes no skin atrophy. After 12 weeks of topical tacrolimus (0.1%) ointment, our patient already showed a good remission with a significant decrease in inflammatory signs.

[Mid-dermal elastolysis]. / Elastolyse der mittleren Dermis.

Mid-dermal elastolysis is a rare dermatosis of still unknown etiology with a characteristic mid-dermal loss of elastic tissue on histopatholoy. Papular and plaque-like wrinkling of the skin as well as inflammatory and non-inflammatory variants have been described. We present a 39-year-old patient with extended skin wrinkling of the trunk and upper extremities after extensive UV light exposure and describe the clinical and histopathological findings. Based on our case, differential diagnoses are discussed and the literature is reviewed.

Lifestyle drugs in old age--a mini-review.

Normal aging is no disease. The individual lifestyle may be responsible for a large fraction of the so-called 'age-related' changes. An increasing number of healthy individuals make use of 'lifestyle' drugs, such as nootropics, psychopharmaca, hormones and ecodrugs. In this respect, the fact that many people try to improve their outer appearance, to solve their 'cosmetic problems', to influence their rate of hair growth and to altogether delay, halt or even reverse the natural aging process has become a relevant matter for the practising doctor. Lifestyle drugs are taken in an attempt to increase personal life quality by means of attaining a certain psychosocially defined medical or beauty ideal, rather than to manage a medically identifiable, well-defined disease. Often, patients suffering from somatoform disorders such as hypochondriac disorders, body dysmorphic disorders, somatization disorders or persistent somatoform pain disorders may spontaneously ask physicians to prescribe them lifestyle drugs. Also, when 'healthy' people demand a lifestyle drug, possible side effects and contraindications must be taken into consideration and ruled out.

Identification of a 27 kDa protein in patients with anaphylactic reactions to mango.

Mango fruit has become increasingly popular in recent years. We report on 2 patients who developed anaphylactic reactions after the ingestion of fresh mango. Allergy to mango was confirmed by a positive skin prick test result and positive cellular allergen stimulation test results. Neither of the patients had detectable mango-specific immunoglobulin (Ig) E levels. Results were validated by sodium dodecyl sulfate polyacrylamide gel electrophoresis immunoblotting and analyzed using Quantiscan.We identified 2 major allergens with a molecular weight of 27 kDa in both patients, in addition to a 15 kDa allergen in 1 patient and a 32 kDa allergen in the other. Currently available IgE systems seem to be lacking these mango allergens and as such are probably unsuitable for diagnosing type 1 sensitization to mango. Skin prick testing with fresh mango fruit therefore seems to be a much more reliable test method for clinical practice.

New lifestyle drugs and somatoform disorders in dermatology.

An increasing number of healthy individuals make use of 'lifestyle' drugs, such as nootropics, psychopharmaca, hormones and eco-drugs. In this respect, the fact that many people try to improve their outer appearance, solve their 'cosmetic problems', influence their rate of hair growth and altogether delay, halt or even reverse the natural ageing process has become a relevant matter for the practising dermatologist. Lifestyle drugs in dermatology are taken in an attempt to increase personal life quality by means of attaining a certain, psychosocially defined beauty ideal. They are not taken to manage a medically identifiable, well-defined disease. Often, patients suffering from somatoform disorders, such as hypochondriac disorders, body dysmorphic disorders, somatization disorders or persistent somatoform pain disorders, may spontaneously ask physicians, in particular dermatologists and plastic surgeons, to prescribe them lifestyle drugs. Typically, patients repeatedly present with alleged 'physical symptoms' that turn out to be subjective complaints without any underlying identifiable medical disease. The use of lifestyle drugs without any proper medical indication may lead to a chronification of the emotional disorders that had ultimately been the cause of the patients' request for such drugs. Such disorders may need to be treated promptly with psychotherapy and/or appropriate psychopharmacotherapy, and the choice of the treatment requires an accurate differential diagnostic approach.

[Eruptive xanthomas with hypertriglyceridemia]. / Eruptive Xanthome bei Hypertriglyzeridämie.

Eruptive xanthomas are often associated with elevated plasma levels of triglyceride-rich lipoproteins and may be a marker for occult hyperlipidemia, diabetes mellitus or pancreatitis. A 42-year-old woman presented with the acute onset of disseminated eruptive xanthomas secondary to hyperlipidemia associated with diabetes and concomitant acute pancreatitis. She improved after optimized insulin therapy and intensified treatment of hyperlipidemia. Eruptive xanthomas should be diagnosed early and lead to further metabolic evaluations.

[Brownish plaques on both sides of the nose]. / Bräunliche Plaques an beiden Nasenseiten.

Granuloma fissuratum (Gf) is painful granular tissue caused by constant pressure exerted by glasses. The differential diagnosis includes further granulomatous dermatoses such as cutaneous sarcoidosis, mycobacterioses and autoimmune diseases. It is also important to rule out a basal cell carcinoma. The simplest and most effective treatment of Gf is to correct the glasses frame or, even better, to avoid wearing glasses to correct eyesight. Topical antiseptic/antibiotic treatment is recommended for superinfected lesions. The Gf usually heals within 1-6 months after correction of the glasses. If the lesion does not heal on its own, complete excision is recommended.

[Topical immunomodulation. A milestone for the treatment of therapy-resistant noninfectious chronic external otitis?]. / Topische Immunmodulation. Ein Meilenstein in der Behandlung der therapieresistenten nichtinfektiösen chronischen Otitis externa?

BACKGROUND: Recurrent exacerbation of chronic external otitis represents a special challenge for the attending physician. The goal of our study was to evaluate the effectiveness of novel topical immunomodulators acting through an anti-inflammatory, nonsteroidal mechanism. PATIENTS AND METHODS: In a prospective study, in 33 patients an ear wick containing tacrolimus ointment (Protopic 0.1%) was inserted every 2-3 days. Altogether, the wick was changed three times. Therapeutic outcomes were assessed by reexaminations, video-otoscopy, and a standardized findings sheet. RESULTS: Twenty-eight patients showed significant improvement of clinical symptoms, with 13 of them showing complete healing (follow-up 10-22 months). Relapses (15 cases) were associated with significantly extended symptom-free intervals and reduced numbers of further recurrent episodes. CONCLUSIONS: Because of the safe and successful anti-inflammatory effects, topical immunomodulators represent a new alternative in chronic inflammatory stages of otherwise therapy-resistant external otitis.

[Midlife crisis in men? Subjectively perceived physical and mental changes in men of advancing age]. / Midlife-crisis bei Männern? Subjektiv wahrgenommene körperliche und psychische Veränderungen bei Männern zunehmenden Alters.

OBJECTIVE: What changes physically and mentally in men with increasing age? Does satisfaction with life only decrease? The personal subjective perception of the situation plays a decisive role in this assessment. One compares oneself to the past and to others, notices the illnesses of others and monitors oneself. METHODS: To study this problem, 85 men between the ages of 40 and 65 years were anonymously questioned by letter. The men filled out two questionnaires: one on change of life and virility symptoms (KLV) and a second on satisfaction with life (FLZ). The respondents were divided into three age groups: 40-47 (n = 26), 48-55 (n = 33) and 56-65 (n = 26) years old. RESULTS: The most frequent mental changes were related to concentration disorders (72.9%), tiredness (70.6%), increased irritability (65.9%) and a failing memory (63.5%). For physical changes, joint and limb pain (77.6%) were named the most frequently, followed by back pain (68.2%), the diminishing interest in sex (62.6%) and weight gain (55.0%). Whereas the rating of many criteria in the 40 to 47-year olds did not differ from that of the 56 to 65-year olds, the satisfaction with life in the 48 to 55-year olds in regards to leisure time, partner relationship, personal sexuality, satisfaction with oneself and social integration was lower. CONCLUSIONS: In summary, many areas of a man's life become destabilized at around age 50. Nevertheless, men are able to adapt to their changed physical and mental abilities and qualitatively reorient themselves.

Clinical pictures and classification of somatoform disorders in dermatology.

Somatoform disorders in dermatology are a heterogeneous group from a biopsychosocial point of view. Among the clinical patterns we find, for example, pruritus, pain, paresthesia as well as feelings of disfiguration, eco-syndromes, erythrophobia or psychogenic pseudoeffluvium. The multiple clinical symptoms are usually accompanied by psychosocial disorders, these are subjective complaints by the patient which cannot be medically objectified. The relevant somatoform disorders in dermatology can be differentiated as somatisation disorders, hypochondriacal disorders, somatoform autonomous disorders, persistent somatoform pain disorders and "other somatoform disorders". A precise differential-diagnostic division is necessary in order to initiate adequate therapy strategies. With this overview article, we would like to make an updated classification recommendation for dermatology and present experiences in therapy.