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Heratizadeh A, Werfel T, Gieler U, Kupfer J. Neurodermitis-Erwachsenenschulung nach dem Konzept der „Arbeitsgemeinschaft Neurodermitisschulung für Erwachsene“ (ARNE). Hautarzt 2018; 69:225-231. [DOI: 10.1007/s00105-018-4125-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pereira M, Steinke S, Zeidler C, Forner C, Riepe C, Augustin M, Bobko S, Dalgard F, Elberling J, Garcovich S, Gieler U, Gonçalo M, Halvorsen JA, Leslie T, Metz M, Reich A, Şavk E, Schneider G, Serra-Baldrich E, Ständer H, Streit M, Wallengren J, Weller K, Wollenberg A, Bruland P, Soto-Rey I, Storck M, Dugas M, Weisshaar E, Szepietowski J, Legat F, Ständer S. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. J Eur Acad Dermatol Venereol 2017; 32:1059-1065. [DOI: 10.1111/jdv.14570] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
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Schaller M, Schöfer H, Homey B, Hofmann M, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Rosacea Management: Update on general measures and topical treatment options. J Dtsch Dermatol Ges 2017; 14 Suppl 6:17-27. [PMID: 27869379 DOI: 10.1111/ddg.13143] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 02/02/2023]
Abstract
Although there is presently no cure for rosacea, there are several recommended treatment options available to control many of the symptoms and to prevent them from getting worse. In addition to self-help measures like avoidance of trigger factors and proper skin care, rosacea management should include topical medications as one of the first-line choices for patients with erythematous and mild to severe papulopustular rosacea. Since mixed forms of characteristic rosacea symptoms are more common, medical treatment must be symptom-tailored for each individual case and will often involve a combination therapy. Approved topical agents for the major symptoms of rosacea encompass brimonidine for erythema and ivermectin, metronidazole or azelaic acid for inflammatory lesions, all of which have shown their efficacy in numerous valid, well-controlled trials. In addition, there are several other, not approved topical treatments which are possible options that require further validation in larger well-controlled studies.
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Reinholz M, Ruzicka T, Steinhoff M, Schaller M, Gieler U, Schöfer H, Homey B, Lehmann P, Luger TA. Pathogenesis and clinical presentation of rosacea as a key for a symptom-oriented therapy. J Dtsch Dermatol Ges 2017; 14 Suppl 6:4-15. [PMID: 27869372 DOI: 10.1111/ddg.13139] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
Rosacea is a common chronic inflammatory skin disorder that typically occurs in adults and affects the face. Synonyms of rosacea include "acne rosacea", "couperose" and "facial erythrosis", in German also "Kupferfinne" and "Rotfinne". The disorder is characterised by a chronic and flaring course and is caused by a genetically predisposed, multifactorial process. A higher incidence is seen in people with fair skin and a positive family history. The characteristic rosacea symptoms manifest primarily, but not exclusively centrofacially, with forehead, nose, chin and cheeks significantly affected. Based on the various main symptoms a classification of the individual clinical pictures can be performed. However, a classification often does not reflect the clinical reality, since the various symptoms commonly coexist. The present review provides an introduction on pathogenesis and clinical manifestations of rosacea and prefers a symptom-oriented therapy approach.
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Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. State of the art: systemic rosacea management. J Dtsch Dermatol Ges 2017; 14 Suppl 6:29-37. [PMID: 27869374 DOI: 10.1111/ddg.13141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 12/30/2022]
Abstract
Based on numerous trials, oral tetracyclines and most commonly their second-generation derivative doxycycline have become the main pillar in systemic rosacea treatment. However, the only preparation that has been approved so far in this setting is 40 mg doxycycline in an anti-inflammatory dosage and with a modified release formulation. With the introduction of this once-daily, non-antibiotic dosing of doxycycline, oral therapy is more commonly prescribed as first-line treatment in moderate to severe papulopustular rosacea. In addition, topical and oral strategies are often used in combination due to the more substantial improvements compared to monotherapy. Although several other non-approved oral agents like macrolides, isotretinoin, and carvedilol have been evaluated for systemic treatment and showed promising results, yet the experience with these drugs in rosacea is limited, and thus they should be reserved for special situations.
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Reinholz M, Ruzicka T, Steinhoff M, Schaller M, Gieler U, Schöfer H, Homey B, Lehmann P, Luger TA. Pathogenese und Klinik der Rosazea als Schlüssel für eine symptomorientierte Therapie. J Dtsch Dermatol Ges 2017; 14 Suppl 6:4-16. [PMID: 27869378 DOI: 10.1111/ddg.13139_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 01/06/2023]
Abstract
Rosazea ist eine häufige chronisch-entzündliche Hauterkrankung, die typischerweise bei Erwachsenen vorkommt und das Gesicht betrifft. Synonyme der Rosazea sind Acne rosacea, Kupferfinne, Rotfinne, Couperose und Rosacea. Die Erkrankung ist durch einen chronischen und schubartigen Verlauf gekennzeichnet und wird durch ein genetisch prädisponiertes, multifaktorielles Geschehen bedingt. Ein vermehrtes Auftreten wird bei hellem Hauttyp und positiver Familienanamnese verzeichnet. Die charakteristischen Rosazea-Symptome manifestieren sich vorwiegend, aber nicht ausschließlich zentrofazial, wobei Stirn, Nase, Kinn und die Wangen maßgeblich betroffen sind. Dabei werden unterschiedliche Hauptsymptome voneinander unterschieden, anhand derer eine Klassifikation der verschiedenen klinischen Bilder vorgenommen werden kann. Eine Klassifizierung wird oftmals jedoch nicht der klinischen Realität gerecht, da die verschiedenen Symptome häufig gemeinsam auftreten. Diese Übersichtarbeit führt in die Pathogenese und Klinik der Rosazea ein und plädiert für einen symptomorientierten Therapieansatz.
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Balieva F, Kupfer J, Lien L, Gieler U, Finlay AY, Tomás-Aragonés L, Poot F, Misery L, Sampogna F, van Middendorp H, Halvorsen JA, Szepietowski JC, Lvov A, Marrón SE, Salek MS, Dalgard FJ. The burden of common skin diseases assessed with the EQ5D™: a European multicentre study in 13 countries. Br J Dermatol 2017; 176:1170-1178. [PMID: 28032340 DOI: 10.1111/bjd.15280] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Generic instruments measuring health-related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical conditions, as well as calculation of utility data. OBJECTIVES To measure HRQoL in patients with common skin diseases and healthy controls across Europe using the EQ5D. METHODS This multicentre observational cross-sectional study was conducted in 13 European countries. Each dermatology clinic recruited at least 250 consecutive adult outpatients to complete questionnaires, including the EQ5D. RESULTS There were 5369 participants (4010 patients and 1359 controls). Mean ± SD self-rated health state reported by patients was 69·9 ± 19·7; for controls it was 82·2 ± 15·5. When adjusted for confounding factors, including comorbidity, mean patient EQ visual analogue scores were 10·5 points lower than for controls (standardized β = -0·23). Odds ratio with 95% confidence interval for impairment in all five dimensions of EQ5D adjusted for confounders was doubled for patients compared with controls. Patients with hidradenitis suppurativa (HS), blistering conditions, leg ulcers, psoriasis and eczemas had the highest risk for reduction in HRQoL in most dimensions (2-10-fold). Data on differences of impairment by dimensions offer new insights. CONCLUSIONS This study confirms the large impact skin conditions have on patients' well-being, differentiating between aspects of HRQoL. Patients with HS, blistering diseases, leg ulcers, infections and most chronic skin diseases reported reduced HRQoL compared with patients with chronic obstructive lung disease, diabetes mellitus, cardiovascular disease and cancers. These findings are important in the prioritization of resource allocation between medical fields and within dermatological subspecialities.
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Schaller M, Schöfer H, Homey B, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Aktueller Stand der systemischen Rosazea-Therapie. J Dtsch Dermatol Ges 2016; 14 Suppl 6:29-37. [DOI: 10.1111/ddg.13141_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
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Schaller M, Schöfer H, Homey B, Hofmann M, Gieler U, Lehmann P, Luger TA, Ruzicka T, Steinhoff M. Rosazea-Management: Update über allgemeine Maßnahmen und topische Therapieoptionen. J Dtsch Dermatol Ges 2016; 14 Suppl 6:17-28. [PMID: 27869373 DOI: 10.1111/ddg.13143_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Abstract
Obwohl bislang für die Rosazea keine kurative Therapie besteht, können verschiedene Optionen zur Behandlung der Symptome und zur Vorbeugung von Exazerbationen empfohlen werden. Neben Selbsthilfemaßnahme wie der Vermeidung von Triggerfaktoren und einer geeigneten Hautpflege sollte das Rosazea-Management bei Patienten mit erythematöser und leichter bis schwerer papulopustulöser Rosazea die Anwendung topischer Präparate als First-Line-Therapie umfassen. Da Überlappungen der charakteristischen Rosazea-Symptome im klinischen Alltag die Regel sind, sollte die medikamentöse Therapie auf die individuellen Symptome zugeschnitten werden; auch eine Kombinationstherapie kann erforderlich sein. Zu den für die Behandlung der Hauptsymptome der Rosazea zugelassenen Wirkstoffen gehören Brimonidin gegen das Erythem sowie Ivermectin, Metronidazol oder Azelainsäure gegen entzündliche Läsionen. Ihre Wirksamkeit wurde in zahlreichen validen, gut kontrollierten Studien belegt. Darüber hinaus existieren verschiedene nicht zugelassene topische Behandlungsmöglichkeiten, deren Wirksamkeit und Sicherheit noch in größeren, kontrollierten Studien zu untersuchen ist.
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Bieber T, Akdis C, Lauener R, Traidl-Hoffmann C, Schmid-Grendelmeier P, Schäppi G, Allam JP, Apfelbacher C, Augustin M, Beck L, Biedermann T, Braun-Fahrländer C, Chew FT, Clavel T, Crameri R, Darsow U, Deleuran M, Dittlein D, Duchna HW, Eichenfeld L, Eyerich K, Frei R, Gelmetti C, Gieler U, Gilles S, Glatz M, Grando K, Green J, Gutermuth J, Guttman-Yassky E, Hanifin J, Hijnen D, Hoetzenecker W, Irvine A, Kalweit A, Katoh N, Knol E, Koren H, Möhrenschlager M, Münch D, Novak N, O'Mahony L, Paller AS, Rhyner C, Roduit C, Schiesser K, Schröder J, Simon D, Simon HU, Sokolowska M, Spuls P, Stalder JF, Straub D, Szalai Z, Taieb A, Takaoka R, Todd G, Todorova A, Vestergaard C, Werfel T, Wollenberg A, Ring J. Global Allergy Forum and 3rd Davos Declaration 2015: Atopic dermatitis/Eczema: challenges and opportunities toward precision medicine. Allergy 2016; 71:588-92. [PMID: 27023268 DOI: 10.1111/all.12857] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gieler U, Gieler T, Kupfer JP. Acne and quality of life - impact and management. J Eur Acad Dermatol Venereol 2016; 29 Suppl 4:12-4. [PMID: 26059729 DOI: 10.1111/jdv.13191] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
Abstract
Acne is a common skin disease with a high prevalence in adolescents and young adults. In addition to physical effects such as permanent scarring and disfigurement, acne has long-lasting psychosocial effects that affect the patient's quality of life. Depression, social isolation and suicidal ideation are frequent comorbidities of acne that should not be neglected in the therapy of acne patients. Research evidence suggests that the impairment of quality of life can be alleviated by appropriate topical acne treatment.
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Schut C, Rädel A, Frey L, Gieler U, Kupfer J. Role of personality and expectations for itch and scratching induced by audiovisual itch stimuli. Eur J Pain 2015; 20:14-8. [DOI: 10.1002/ejp.751] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/09/2022]
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Schut C, Muhl S, Reinisch K, Claßen A, Jäger R, Gieler U, Kupfer J. Agreeableness and Self-Consciousness as Predictors of Induced Scratching and Itch in Patients with Psoriasis. Int J Behav Med 2015; 22:726-34. [DOI: 10.1007/s12529-015-9471-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schut C, Grossman S, Gieler U, Kupfer J, Yosipovitch G. Contagious itch: what we know and what we would like to know. Front Hum Neurosci 2015; 9:57. [PMID: 25717300 PMCID: PMC4324061 DOI: 10.3389/fnhum.2015.00057] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
All humans experience itch in the course of their life. Even a discussion on the topic of itch or seeing people scratch can evoke the desire to scratch. These events are coined “contagious itch” and are very common. We and others have shown that videos showing people scratching and pictures of affected skin or insects can induce itch in healthy persons and chronic itch patients. In our studies, patients with atopic dermatitis (AD) were more susceptible to visual itch cues than healthy. Also, personality traits like agreeableness and public self-consciousness were associated with induced scratching in skin patients, while neuroticism correlated with induced itch in healthy subjects. The underlying course of contagious itch is not yet fully understood. It is hypothesized that there are human mirror neurons that are active when we imitate actions and/or negative affect. Until now, there has been only limited data on the mechanisms of brain activation in contagious itch though. We have barely begun to understand the underlying physiological reactions and the triggering factors of this phenomenon. We summarize what we currently know about contagious itch and provide some suggestions what future research should focus on.
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Brockow K, Schallmayer S, Beyer K, Biedermann T, Fischer J, Gebert N, Grosber M, Jakob T, Klimek L, Kugler C, Lange L, Pfaar O, Przybilla B, Rietschel E, Rueff F, Schnadt S, Szczepanski R, Worm M, Kupfer J, Gieler U, Ring J. Effects of a structured educational intervention on knowledge and emergency management in patients at risk for anaphylaxis. Allergy 2015; 70:227-35. [PMID: 25407693 DOI: 10.1111/all.12548] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Structured educational programmes for patients at risk for anaphylaxis have not yet been established. Patients and caregivers often lack adequate skills in managing the disease. METHODS To investigate effects of structured patient education intervention on knowledge, emergency management skills and psychological parameters in patients with previous episodes of anaphylaxis and caregivers of affected children 95 caregivers (11 male, 84 female, mean age 37 years) of affected children and 98 patients (32 male, 66 female, mean age 47.5 years) were randomly assigned to an intervention (IG) or control group (CG) in a multicentre randomized controlled trial. The IG received two 3-h schooling modules of group education; the CG received standard auto-injector training only. Knowledge of anaphylaxis and emergency management competence in a validated training anaphylaxis situation as main outcome measures as well as secondary psychological parameters were assessed at baseline and 3 months after intervention. RESULTS In comparison with controls, the intervention led to significant improvement of knowledge from baseline to 3-month follow-up (caregivers: IG 3.2/13.2 improvement/baseline vs CG 0.7/12.6; P < 0.001; patients: IG 3.9/10.8 vs 1.3/12.6; P < 0.001). Moreover, emergency management competence was increased after intervention as compared to controls (caregivers: IG 8.6/11.2 vs CG 1.2/10.8; P < 0.001; patients: 7.1/11.0 vs 1.1/11.1; P < 0.001). Intervention showed significant reduction of caregiver anxiety (-1.9/8.4 vs -0.7/7.5; P < 0.05). There were no significant changes in the depression scores. CONCLUSION Structured patient education programmes may be beneficial in the management of anaphylaxis by increasing patients' empowerment to prevent and treat the disease.
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Schaaf H, Flohre S, Hesse G, Gieler U. [Chronic stress as an influencing factor in tinnitus patients]. HNO 2014; 62:108-14. [PMID: 24549511 DOI: 10.1007/s00106-013-2798-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Using the Trier Stress Inventory and based on a comparison between tinnitus and psoriasis patients, it is evaluated to what extent chronic stress is a definable influencing factor among tinnitus sufferers PATIENTS AND METHODS Psychological assessment of 114 tinnitus and 103 psoriasis inpatients was conducted using a test battery consisting of the tinnitus questionnaire (Tinnitus-Fragebogen, TF), the Trier Stress Inventory (Trierer Inventar zum chronischen Stress, TICS), a questionnaire about social support (Fragebogen zur sozialen Unterstützung, F-SozU) and the Patient Health Questionnaire (PHQ). RESULTS On average, hospitalized tinnitus patients have significantly higher values than the normative group on the following scales: social tensions, excessive work demands, chronic anxiety, professional strain, professional discontent, lack of social acceptance and social isolation, as well as on the overall screening scale. The measured stress values of tinnitus patients did not significantly differ from those of the comparison group, i.e. the hospitalized psoriasis patients. Although both groups show increased stress levels as measured by TICS, the hospitalized tinnitus patients had significantly more psychological comorbidities. No relationship exists between the raised stress values and hearing status. CONCLUSION Stress also has an influence on tinnitus suffering and is therefore certain to be of therapeutic relevance. In this respect, there is no significant difference between tinnitus and psoriasis patients; stress alone cannot explain the psychological comorbidity.
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Kurth RA, Leweke F, Brosig B, Herr C, Eikmann T, Gieler U. Stationäre integrative Psychotherapie bei Multiple Chemical Sensitivity Syndrom. PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-002-0238-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schut C, Felsch A, Zick C, Hinsch KD, Gieler U, Kupfer J. Role of illness representations and coping in patients with atopic dermatitis: a cross-sectional study. J Eur Acad Dermatol Venereol 2013; 28:1566-71. [DOI: 10.1111/jdv.12301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/19/2013] [Indexed: 11/30/2022]
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Reich-Schupke S, Alm J, Altmeyer P, Bachter D, Bayerl C, Beissert S, Bieber T, Böhmer J, Dill D, Dippel E, Dücker P, Effendy I, El Gammal S, Elsner P, Enk A, Feldmann-Böddeker I, Frank H, Gehring W, Gieler U, Goebeler M, Görge T, Gollnick H, Grabbe S, Gross G, Gudat W, Happ A, Herbst R, Hermes B, Hoff NP, John SM, Jungelhülsing M, Jünger M, Kaatz M, Kapp A, Kaufmann R, Klode J, Knaber K, König A, Krieg T, Kohl P, Kowalzick L, Lehmann P, Löffler H, Maschke J, Marsch W, Mechtel D, Mohr P, Moll I, Müller M, Nashan D, Ockenfels HM, Peter RU, Pillekamp H, Rompel R, Ruzicka T, Salfeld K, Sander C, Schaller J, Scharffetter-Kochanek K, Schuler G, Schulze HJ, Schwarz T, Splieth B, Stege H, Stolz W, Strölin A, Tran H, Tronnier M, Ulrich J, Vogt T, Wagner G, Welzel J, Willgeroth T, Wollina U, Zillikens D, Zouboulis CC, Zuberbier T, Zutt M, Stücker M. [Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]. Hautarzt 2013; 64:685-94. [PMID: 24022632 DOI: 10.1007/s00105-013-2623-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.
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Gieler U, Harth W. Psychodermatologie. Hautarzt 2013; 64:400-1. [DOI: 10.1007/s00105-012-2491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, Gieler U, Lipozencic J, Luger T, Oranje AP, Schäfer T, Schwennesen T, Seidenari S, Simon D, Ständer S, Stingl G, Szalai S, Szepietowski JC, Taïeb A, Werfel T, Wollenberg A, Darsow U. Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol 2012; 26:1045-60. [PMID: 22805051 DOI: 10.1111/j.1468-3083.2012.04635.x] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.
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Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, Gieler U, Lipozencic J, Luger T, Oranje AP, Schäfer T, Schwennesen T, Seidenari S, Simon D, Ständer S, Stingl G, Szalai S, Szepietowski JC, Taïeb A, Werfel T, Wollenberg A, Darsow U. Guidelines for treatment of atopic eczema (atopic dermatitis) Part II. J Eur Acad Dermatol Venereol 2012; 26:1176-93. [PMID: 22813359 DOI: 10.1111/j.1468-3083.2012.04636.x] [Citation(s) in RCA: 254] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.
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