S2k-Leitlinie - Kutane Lymphome Update 2016 - Teil 2: Therapie und Nachsorge (ICD10 C82 - C86)

[Approved systemic therapies in dermatology]

BACKGROUND

In recent years, an increasing spectrum of systemic therapies has become available in the field of dermatology. Some of these drugs are used off-label, which for example can lead to problems with reimbursement. This article is therefore intended to provide an overview of the currently approved systemic therapies in dermatology and to point out further alternatives such as Compassionate Use and Early Access Programs.

MATERIALS AND METHODS

The search for approved drugs in Germany was conducted online in the database for drugs of the Federal Institute for Drugs and Medical Devices. In addition, a comparison was made with the information provided from the Rote Liste.

RESULTS

For a total of 50 dermatologically relevant diseases, the respective approved system therapies are presented in tabular form.

CONCLUSIONS

It can be stated that the enormous developments over the last few years and the increasingly good evidence offer in many cases very promising systemic treatment concepts despite the frequent lack of clinical studies in the field of dermatology. However, the often necessary off-label use can cause difficulties in everyday clinical practice. The attending physician should therefore always be informed if a planned therapy involves off-label use. Previously approved alternatives should be considered and patients should be adequately informed.

Management of primary cutaneous lymphomas during the COVID-19 pandemic

Primary cutaneous lymphomas are defined as a heterogenic group of T- and B-cell non-Hodgkin lymphomas that present initially in the skin. Patients with primary cutaneous lymphomas are at a higher risk for developing complications in case of infection with the novel coronavirus severe acute respiratory syndrome coronavirus 2. The coronavirus disease 2019 (COVID-19) pandemic has affected the established diagnostic approach, staging, and therapeutic guidelines in patients with primary cutaneous lymphomas. In the light of the current global health crisis, management of primary cutaneous lymphomas needs to be adjusted. The key to achieving this is to balance the optimal control of the lymphoma, with a minimal increase of the personal risk for COVID-19 exposure and complications.

[Andrology in oncological diseases]

In dermato-oncological treatment there are many gonadotoxic interventions. Alkylating and hormonally active substances as well as gonadal irradiation, in particular, are known to have a fertilization-limiting effect in men. Since 2017 certified skin cancer centers in Germany therefore have the task to implement counselling on preservation of fertility. This is supported by the S2k guidelines on preservation of fertility in oncological treatment. Because recommendation of the various interventions from the dermato-oncological guidelines are dependent on the stage, the authors advocate at least the question "Is the desire to have children of interest to you?" when patients reach the appropriate stage. Fertility protection of men via cryopreservation of ejaculates or testicular tissue is then a simple and safe option. The procedure is standardized and usually available. In addition, the possibility of cryopreservation of testicular tissue from prepubertal male children and infants is now available via the new Androprotect project. If signs of hypogonadism occur during therapy, a treatment can be considered by weighing up the effects of testosterone but in this case it is important to take the anabolic and immunomodulating effects into account.