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Campana LG, Farronato S, Hodgetts J, Odili J, Vecchiato A, Bracken A, Baier S, Bechara FG, Borgognoni L, Caracò C, Carvalhal S, Covarelli P, Clover J, Eisendle K, Fantini F, Fierro MT, Farricha V, Gregorelli C, Hafner J, Kunte C, Gerlini G, Hessam S, Mandalà M, Piazzalunga D, Quaglino P, Snoj M, Ross AM, Trigona B, Moreno-Ramirez D, Tauceri F, Peach H, Rutkowski P, Muir T, de Terlizzi F, Patuzzo R, Mühlstädt M, Dietrich KA, Mussack T, Matteucci P, Kis E, Ascierto P, Sersa G, Valpione S. European e-Delphi process to define expert consensus on electrochemotherapy treatment indications, procedural aspects, and quality indicators in melanoma. Br J Surg 2023:7148599. [PMID: 37131298 DOI: 10.1093/bjs/znad105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/23/2022] [Accepted: 04/02/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Skin metastases are an important co-morbidity in melanoma. Despite broad adoption, electrochemotherapy implementation is hindered by a lack of treatment indications, uncertainty regarding procedural aspects, and the absence of quality indicators. An expert consensus may harmonize the approach among centres and facilitate comparison with other therapies. METHODS An interdisciplinary panel was recruited for a three-round e-Delphi survey. A literature-based 113-item questionnaire was proposed to 160 professionals from 53 European centres. Participants rated each item for relevance and degree of agreement on a five-point Likert scale, and received anonymous controlled feedback to allow revision. The items that reached concordant agreement in two successive iterations were included in the final consensus list. In the third round, quality indicator benchmarks were defined using a real-time Delphi method. RESULTS The initial working group included 122 respondents, of whom 100 (82 per cent) completed the first round, thus qualifying for inclusion in the expert panel (49 surgeons, 29 dermatologists, 15 medical oncologists, three radiotherapists, two nurse specialists, two clinician scientists). The completion rate was 97 per cent (97 of 100) and 93 per cent (90 of 97) in the second and third rounds respectively. The final consensus list included 54 statements with benchmarks (treatment indications, (37); procedural aspects, (1); quality indicators, (16)). CONCLUSION An expert panel achieved consensus on the use of electrochemotherapy in melanoma, with a core set of statements providing general direction to electrochemotherapy users to refine indications, align clinical practices, and promote quality assurance programmes and local audits. The residual controversial topics set future research priorities to improve patient care.
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Affiliation(s)
- Luca G Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sofia Farronato
- Institute of General Practice, College of Health Care Professions Claudiana, Bolzano/Bozen, Italy
| | - Jackie Hodgetts
- Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Joy Odili
- Department of Plastic Surgery, St George's Hospital, London, UK
| | | | | | - Susanne Baier
- Medical Oncology Unit, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Falk G Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr University, Bochum, Germany
| | - Lorenzo Borgognoni
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Santa Maria Annunziata Hospital, Florence, Italy
| | - Corrado Caracò
- Division of Surgery of Melanoma and Skin Cancer, Istituto Nazionale Tumori-IRCCS Fondazione 'G. Pascale', Naples, Italy
| | - Sara Carvalhal
- Melanoma and Sarcoma Unit, Department of Surgery, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Piero Covarelli
- Department of Surgery and Medicine, University of Perugia, Perugia, Italy
| | | | - Klaus Eisendle
- Teaching Department of Dermatology, Central Hospital Bolzano, Bozen/Bolzano, Italy
| | - Fabrizio Fantini
- Dermatology Unit, Azienda Ospedaliera 'A. Manzoni', Lecco, Italy
| | | | - Victor Farricha
- Melanoma and Sarcoma Unit, Department of Surgery, Portuguese Institute of Oncology, Lisbon, Portugal
| | | | - Jürg Hafner
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Christian Kunte
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
- Department of Dermatosurgery and Dermatology, Artemed Hospital, Munich, Germany
| | - Gianni Gerlini
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Santa Maria Annunziata Hospital, Florence, Italy
| | - Schapoor Hessam
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr University, Bochum, Germany
| | - Mario Mandalà
- Unit of Medical Oncology, Department of Surgery and Medicine, University of Perugia, Perugia, Italy
| | | | - Pietro Quaglino
- Department of Dermatology, University of Turin, Turin, Italy
| | - Marko Snoj
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Béatrice Trigona
- Dermatosurgery Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Francesca Tauceri
- General and Oncological Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Howard Peach
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Centre, Warsaw, Poland
| | - Tobian Muir
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Roberto Patuzzo
- Melanoma Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michael Mühlstädt
- Dermatosurgery Unit, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Karin-Almut Dietrich
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - Thomas Mussack
- Department of General and Abdominal Surgery, Munich South Surgical Hospital, Munich, Germany
| | - Paolo Matteucci
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Paolo Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, INT IRCCS Fondazione 'G. Pascale', Naples, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sara Valpione
- Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
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2
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Pastor D, Alvarez Martinez D, Andenmatten-Trigona B, Mühlstädt M. [Surgical treatment of hidradenitis suppurativa]. Rev Med Suisse 2023; 19:624-629. [PMID: 36988170 DOI: 10.53738/revmed.2023.19.820.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease that primarily affects the apocrine skin glands. Management options include risk factor modification, pharmacologic agents, and surgery. Many surgical management techniques exist, including incision and drainage, laser hair removal, deroofing, limited or wide local excision. Deroofing is an interesting alternative for simple superficial fistulas and potentially even for more complex lesions. Surgical treatment can be combined with drug treatment. The indication depends on a comprehensive and multidisciplinary assessment considering the severity and number of target lesions.
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Affiliation(s)
- Damien Pastor
- Service de dermatologie et vénéréologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - David Alvarez Martinez
- Service de dermatologie et vénéréologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Béatrice Andenmatten-Trigona
- Service de dermatologie et vénéréologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Michael Mühlstädt
- Service de dermatologie et vénéréologie, Département de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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3
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Piletta-Zanin A, Hsieh A, Mühlstädt M, Andenmatten-Trigona B. [Dermatology - Latest developments in targeted therapies for atopic dermatitis, alopecia areata and chronic spontaneous urticaria]. Rev Med Suisse 2022; 18:156-160. [PMID: 35107888 DOI: 10.53738/revmed.2022.18.767.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In recent years, a lot of targeted therapies have appeared on the market. The huge choice and rapid development make it sometimes difficult to stay up to date. This article reviews the latest therapies in the field of atopic dermatitis, alopecia areata and chronic spontaneous urticaria. Anti-IL-4 and anti-IL-13 antibodies and, more recently, JAK inhibitors have been proven to be effective for moderate to severe atopic dermatitis. JAK inhibitors seem promising for the treatment of severe alopecia areata. Ligelizumab and nemoli zumab will provide therapeutical options for chronic spontaneous urticaria and prurigo respectively. These breakthroughs will improve the quality of life of people suffering from invalidating dermatitis, at a certain price.
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Affiliation(s)
| | - Aurélie Hsieh
- Service de dermatologie et vénéréologie, Département des spécialités de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Michael Mühlstädt
- Service de dermatologie et vénéréologie, Département des spécialités de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Béatrice Andenmatten-Trigona
- Service de dermatologie et vénéréologie, Département des spécialités de médecine, Hôpitaux universitaires de Genève, 1211 Genève 14
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Holtkamp SJ, Ince LM, Barnoud C, Schmitt MT, Sinturel F, Pilorz V, Pick R, Jemelin S, Mühlstädt M, Boehncke WH, Weber J, Laubender D, Philippou-Massier J, Chen CS, Holtermann L, Vestweber D, Sperandio M, Schraml BU, Halin C, Dibner C, Oster H, Renkawitz J, Scheiermann C. Circadian clocks guide dendritic cells into skin lymphatics. Nat Immunol 2021; 22:1375-1381. [PMID: 34663979 PMCID: PMC8553624 DOI: 10.1038/s41590-021-01040-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022]
Abstract
Migration of leukocytes from the skin to lymph nodes (LNs) via afferent lymphatic vessels (LVs) is pivotal for adaptive immune responses1,2. Circadian rhythms have emerged as important regulators of leukocyte trafficking to LNs via the blood3,4. Here, we demonstrate that dendritic cells (DCs) have a circadian migration pattern into LVs, which peaks during the rest phase in mice. This migration pattern is determined by rhythmic gradients in the expression of the chemokine CCL21 and of adhesion molecules in both mice and humans. Chronopharmacological targeting of the involved factors abrogates circadian migration of DCs. We identify cell-intrinsic circadian oscillations in skin lymphatic endothelial cells (LECs) and DCs that cogovern these rhythms, as their genetic disruption in either cell type ablates circadian trafficking. These observations indicate that circadian clocks control the infiltration of DCs into skin lymphatics, a process that is essential for many adaptive immune responses and relevant for vaccination and immunotherapies.
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Affiliation(s)
- Stephan J Holtkamp
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | - Louise M Ince
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Coline Barnoud
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Madeleine T Schmitt
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
- Laboratory 'Cell Biology of the Immune System', Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | - Flore Sinturel
- Department of Medicine, Division of Endocrinology, Diabetes, Nutrition and Patient Education, University Hospitals of Geneva, Geneva, Switzerland
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
- Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Genetics and Genomics of Geneva (iGE3), University of Geneva, Geneva, Switzerland
| | - Violetta Pilorz
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | - Robert Pick
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Jemelin
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michael Mühlstädt
- Division of Dermatology and Venereology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Wolf-Henning Boehncke
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Dermatology and Venereology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Jasmin Weber
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | | | - Julia Philippou-Massier
- Laboratory for Functional Genome Analysis, Gene Center Munich, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Chien-Sin Chen
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | - Leonie Holtermann
- Department of Vascular Cell Biology, Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - Dietmar Vestweber
- Department of Vascular Cell Biology, Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - Markus Sperandio
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | - Barbara U Schraml
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | - Cornelia Halin
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Charna Dibner
- Department of Medicine, Division of Endocrinology, Diabetes, Nutrition and Patient Education, University Hospitals of Geneva, Geneva, Switzerland
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
- Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Genetics and Genomics of Geneva (iGE3), University of Geneva, Geneva, Switzerland
| | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | - Jörg Renkawitz
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
- Laboratory 'Cell Biology of the Immune System', Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany
| | - Christoph Scheiermann
- Biomedical Center (BMC), Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine (WBex), Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Planegg-Martinsried, Germany.
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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5
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Hsieh A, Andenmatten-Trigona B, Mühlstädt M. [Micrographic surgery and its variants]. Rev Med Suisse 2021; 17:630-634. [PMID: 33793100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cutaneous tumours can be ill-delineated and subclinical tumour can be missed when using the usual methods of pathology processing because only less than 1 % of the margin is examined. Micrographic surgery was developed to allow for examination of 100 % of the margin. It reduces the recurrence rate and spares healthy tissue thus reducing lesion size and facilitating reconstruction. This method is particularly suitable for peri-orificial cutaneous tumours of the face with high rates of local recurrence. Mohs micrographic surgery is the main technique for frozen tissue and there are other often under-recognized variations using permanent paraffin sections known as the « collerette » ( spaghetti), « muffin » or the « Tübinger Torte » method.
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Affiliation(s)
- Aurélie Hsieh
- Unité de dermatochirurgie, Service de dermatologie et vénéréologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Béatrice Andenmatten-Trigona
- Unité de dermatochirurgie, Service de dermatologie et vénéréologie, Département des spécialités de médecine, HUG, 1211 Genève 14
| | - Michael Mühlstädt
- Unité de dermatochirurgie, Service de dermatologie et vénéréologie, Département des spécialités de médecine, HUG, 1211 Genève 14
- Certified Micrographic Surgeon and Trainer, European Society for Micrographic Surgery
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Stenz NA, Stampf S, Arnold AW, Cozzio A, Dickenmann M, Gaide O, Harms M, Hunger RE, Laffitte E, Mühlstädt M, Nägeli M, Hofbauer GFL. Skin Cancer Development in Solid Organ Transplant Recipients in Switzerland (Swiss Transplant Cohort Study). Dermatology 2020; 237:970-980. [PMID: 33227788 PMCID: PMC8619732 DOI: 10.1159/000510685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/27/2020] [Indexed: 08/15/2023] Open
Abstract
IMPORTANCE Skin cancer, in particular squamous cell carcinoma, is the most frequent malignancy among solid organ transplant recipients with a higher incidence compared to the general population. OBJECTIVE To determine the skin cancer incidence in organ transplant recipients in Switzerland and to assess the impact of immunosuppressants and other risk factors. DESIGN Prospective cohort study of solid organ transplant recipients in Switzerland enrolled in the Swiss Transplant Cohort Study from 2008 to 2013. PARTICIPANTS 2,192 solid organ transplant recipients. MATERIALS AND METHODS Occurrence of first and subsequent squamous cell carcinoma, basal cell carcinoma, melanoma and other skin cancers after transplantation extracted from the Swiss Transplant Cohort Study database and validated by medical record review. Incidence rates were calculated for skin cancer overall and subgroups. The effect of risk factors on the occurrence of first skin cancer and recurrent skin cancer was calculated by the Cox proportional hazard model. RESULTS In 2,192 organ transplant recipients, 136 (6.2%) developed 335 cases of skin cancer during a median follow-up of 32.4 months, with squamous cell carcinoma as the most frequent one. 79.4% of skin cancer patients were male. Risk factors for first and recurrent skin cancer were age at transplantation, male sex, skin cancer before transplantation and previous transplantation. For a first skin cancer, the number of immunosuppressive drugs was a risk factor as well. CONCLUSIONS AND RELEVANCE Skin cancer following solid organ transplantation in Switzerland is greatly increased with risk factors: age at transplantation, male sex, skin cancer before transplantation, previous transplantation and number of immunosuppressive drugs.
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Affiliation(s)
- Nadja Angela Stenz
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Susanne Stampf
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Andreas W Arnold
- Department of Dermatology, University Basel and Dermatologie am Rhein, Basel, Switzerland
| | - Antonio Cozzio
- Department of Dermatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michael Dickenmann
- Division of Transplant Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Olivier Gaide
- Department of Dermatology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Mirjam Harms
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, University Hospital Berne, Berne, Switzerland
| | - Emmanuel Laffitte
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Michael Mühlstädt
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Mirjam Nägeli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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7
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Mühlstädt M, Tzika E, Boehncke WH. [A plethora of choices: treating actinic keratoses]. Rev Med Suisse 2020; 16:646-650. [PMID: 32239839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Actinic keratoses are the most frequent precancerous lesions on Caucasian skin, often giving rise to squamous cell carcinomas. Appropriate prophylaxis, screening, and early intervention can substantially reduce the incidence of the latter. While isolated actinic keratoses can easily be treated by means of cryotherapy or curettage, multiple lesions often occurring on chronically sun-damaged skin demand more potent therapeutic strategies, such as topical cytostatic or immunomodulatory drugs, or photodynamic therapy. In this review, we give a practice-oriented overview on clinical manifestations, prevention, and treatment of actinic keratoses, and we emphasise the role of general practitioners in the management of this important pathology.
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Affiliation(s)
- Michael Mühlstädt
- Service de dermatologie et vénéréologie, Département de médecine, HUG, 1211 Genève 14
| | - Evangelia Tzika
- Service de dermatologie et vénéréologie, Département de médecine, HUG, 1211 Genève 14
| | - Wolf-Henning Boehncke
- Service de dermatologie et vénéréologie, Département de médecine, HUG, 1211 Genève 14
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8
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Trigona B, Lang C, Mühlstädt M. [Phenolisation: treatment of choice for ingrown nails]. Rev Med Suisse 2019; 15:678-681. [PMID: 30916906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ingrown nails are a common and painful pathology not always responding to local treatment. Destroying the matrix by application of phenol (phenolisation) has proven its superiority over the so called classic surgical methods. This is partially due to the exceptional properties of phenol: demyelinisation of the terminal nerve fibres provides long-term pain relief, the coagulation of proteins stops bleeding and the molecule has antiseptic properties. Phenolisation requires only few resources and can be widely used. Recurrence rates are particularly low at 2 %. We present this technique as the treatment of choice for ingrown nails.
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Affiliation(s)
- Béatrice Trigona
- Unité de dermatochirurgie, Service de dermatologie et vénéréologie, Département de médecine, HUG, 1211 Genève 14
| | - Caroline Lang
- Unité de dermatochirurgie, Service de dermatologie et vénéréologie, Département de médecine, HUG, 1211 Genève 14
| | - Michael Mühlstädt
- Unité de dermatochirurgie, Service de dermatologie et vénéréologie, Département de médecine, HUG, 1211 Genève 14
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9
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Campana L, Quaglino P, Bechara F, Marconato R, Ascierto P, Caracò C, Brizio M, Clover J, Bourke M, Valpione S, Sersa G, Kunte C, Mühlstädt M, Gerlini G, Hafner J, Patuzzo R, Farronato S, Orlando A, Eisendle K, Kis E. Electrochemotherapy in melanoma: a European e-Delphi survey to define a consensus on indications, treatment modalities and quality indicators. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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10
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Hunger RE, Laffitte E, Läuchli S, Mainetti C, Mühlstädt M, Schiller P, Lapointe AK, Meschberger P, Navarini AA. Swiss Practice Recommendations for the Management of Hidradenitis Suppurativa/Acne Inversa. Dermatology 2017; 233:113-119. [PMID: 28683447 DOI: 10.1159/000477459] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/11/2017] [Indexed: 12/26/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a painful, inflammatory, debilitating skin disease with a chronic intermittent course. The central pathogenetic event seems to be the occlusion of the hair follicle. HS has a 1-year prevalence of about 1%. It typically presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body: most commonly the axillae, inguinal, and anogenital regions. HS has a high negative impact on patients' quality of life even in patients with only limited disease burden, and the diagnosis of HS is often made with a long diagnostic delay. In this practical short version we present diagnostic and therapeutic recommendations which are based on a systematic literature search as well as an informal expert consensus of Swiss dermatologists and dermatosurgeons.
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Affiliation(s)
- Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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11
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Lang C, Masouyé I, Mühlstädt M, Quenan S, Kaya G, Laffitte E. Borrelia-associated Fasciitis: Two Cases. Acta Derm Venereol 2017; 97:660-662. [PMID: 28175927 DOI: 10.2340/00015555-2627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Caroline Lang
- Department of Dermatology, University hospital of Geneva, 1205 Genève, Switzerland.
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Abstract
We present the case of a healthy 76-year-old man with a whitish, hyperkeratotic lesion of the lower lip diagnosed as actinic cheilitis (AC) previously treated with classic red light photodynamic therapy 5 years ago. Initial treatment with 5% imiquimod cream - also with intensified application - failed. After 2 cycles thrice daily, consecutive applications of 150 μg/g ingenol mebutate gel at 3 weeks' interval, the lesions cleared completely. Surprisingly, no pustular or crusting reaction or other side effect occurred contrary to expectation. Remission was stable for 10 months, when recurrence occurred. Ingenol mebutate proved to be a feasible and safe treatment in this otherwise refractory case of AC.
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Affiliation(s)
- Evangelia Tzika
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
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Abstract
We present the case of a 73-year-old male patient who had received a first renal transplant at 36 years and a second one at the age of 55 years. He is currently under immunosuppression with everolimus 2.5 mg/day and prednisone 5 mg/day. The patient presented with multiple actinic keratoses on both cheeks and the forehead and received treatment by ingenol mebutate 150 µg/g gel daily on 3 consecutive days on his right cheek and methyl aminolevulinate (MAL) photodynamic therapy activated by daylight (MAL-dPDT) on the forehead and the left cheek. MAL-dPDT treatment proved a feasible, repeatable, physician-directed method of treating field cancerization with limited morbidity for a period of 6 days. Treatment with ingenol mebutate gel was a feasible, possibly self-directed method of treating field cancerization with limited morbidity for 10 days in this immunosuppressed patient. Both treatments showed similar efficacy. At the time of treatment, the MAL daylight PDT ran at 3 times the cost of ingenol mebutate gel.
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Affiliation(s)
- Michael Mühlstädt
- Division of Dermatology and Venerology, Geneva University Hospitals, Geneva, Switzerland
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Fuhrmann P, Mühlstädt M, Schwope I. Crystal structure of bis-(1-phenoxy-propen-2-yl)- sulfane, (C6H5OC3H4)2S. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1992.202.14.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Mulaj RR, Mühlstädt M, Barouti N. [Antisepsis of wounds: when and what?]. Rev Med Suisse 2015; 11:773-778. [PMID: 26021139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bacterial colonisation of a wound is a normal process and usually not dangerous. The role of micro-organisms in the healing process is not fully elucidated, however it is well known that infection interrupts healing and even worse can severely threaten the organism. We present the different types of antiseptics that are used in treating wounds as well as their interactions. We would like to remind the reader that antiseptics are more effective than antibiotics with much fewer resistances. Finally, we provide a flow chart for a reasonable treatment of chronic wounds.
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Verburg M, Lang M, Mühlstädt M, Klein A, Schauber J, Sattler EC, Kunte C. Cutaneous Squamous Cell Carcinoma with Perineural Invasion: Report on Eight Cases and Review of the Literature. Dermatology 2014; 230:135-42. [DOI: 10.1159/000368771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/01/2014] [Indexed: 11/19/2022] Open
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17
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Kulichová D, Geimer T, Mühlstädt M, Ruzicka T, Kunte C. Surgical site infections in skin surgery: a single center experience. J Dermatol 2013; 40:779-85. [PMID: 23961937 DOI: 10.1111/1346-8138.12255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 07/01/2013] [Indexed: 11/29/2022]
Abstract
The main interests covered in this article are the determination of risk factors and incidence of surgical site infections in dermatosurgery and suggestions for rational use of antibiotic prophylaxis. A total of 3284 consecutive dermatosurgical interventions in 1088 patients were performed in our dermatosurgery department. Data regarding patient characteristics and perioperative course were prospectively collected and retrospective analysis of this data was performed. Association of perioperative parameters and postoperative surgical site infections was assessed by χ(2) -test. Rate of postoperative infections in our study was low (1.9%). Purulent surgical sites showed the highest incidence of severe postoperative infections (4.7%; P < 0.001). The lowest incidence of mild infections was seen in preoperatively clean surgical sites (0.8%; P < 0.001). All patients with severe infections and 68% patients with mild infections were older than 70 years. The head and neck and acral regions were the groups mostly affected by mild postoperative conditions (2.4% and 1.7%, respectively; P = 0.006). The frequency of mild and severe infections in procedures performed by experienced surgeons was lower than in procedures performed by less experienced surgeons (0.6% vs 3.1% in mild infections, 0.1 vs 0.8 in severe infections; P < 0.001). The main risk factors for postoperative infections were wounds in the head and neck region, lips and oral mucosa or acral regions, older age of patients, worse preoperative state of surgical sites and less experienced surgeons. In the majority of cases where risk factors were missing there was no need of antibiotic prophylaxis.
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Affiliation(s)
- Daniela Kulichová
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
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Affiliation(s)
- Daniel Heinrich
- Department of Neurology, Ludwig-Maximilians-University, Marchioninistr 15, 81377 Munich, Germany
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Vogel S, Mühlstädt M, Molin S, Ruzicka T, Schneider J, Herzinger T. Unilateral favre-racouchot disease: evidence for the etiological role of chronic solar damage. Dermatology 2013; 226:32-4. [PMID: 23446228 DOI: 10.1159/000346576] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 12/14/2012] [Indexed: 11/19/2022] Open
Abstract
Favre-Racouchot disease commonly presents as comedones, cysts and elastosis in the periocular region of older men. Its etiology has been linked to several exogenous factors. Here we present 2 patients with strictly unilateral manifestation of the disease and a corresponding history of predominantly one-sided chronic occupational sun exposure and smoking, making the case for the causative role of these two factors.
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Affiliation(s)
- Sandra Vogel
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, DE–80337 Munich, Germany
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Abstract
An estimated 1% of the population suffers from hidradenitis suppurativa/acne inversa, a chronic inflammatory disease that is a burden for patients and doctors alike. The progressive disease often isolates the patients socially and causes constant pain. It can take years until the diagnosis is finally made. Dermatologists are often confronted with a relapsing condition and a frustrated patient. This article summarizes our understanding of the disease and outlines therapeutic options.
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Affiliation(s)
- M Mühlstädt
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland.
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Mühlstädt M, Thomé C, Kunte C. Rapid wound healing of scalp wounds devoid of periosteum with milling of the outer table and split-thickness skin grafting. Br J Dermatol 2012; 167:343-7. [PMID: 22512740 DOI: 10.1111/j.1365-2133.2012.10999.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Excision of large scalp tumours may result in exposed bone devoid of periosteum. The resultant surgical defects may be too large to close by either primary closure or local cutaneous flap. The denuded bone usually precludes the immediate placement of a skin graft. OBJECTIVES To describe our experience with milling the outer cortical table of the skull in order to promote granulation and hasten wound healing. METHODS In 11 patients, we expanded existing techniques of exposing diploic veins in the cancellous bone by completely milling the exposed outer table of the scalp bone with a rose head burr driven by a pneumatic power drill. After induction of punctate bleeding a split-skin graft was placed in the same session and secured with a tie-over foam dressing. Dressing was removed 7 days after surgery. All patients received perioperative antibiotics. Informed consent was obtained prior to the procedure. RESULTS In all 11 patients a healing of the split-thickness skin graft was observed within 1 week. CONCLUSIONS The combination of extensive exposure of cancellous bone and an immediate split-thickness skin graft reduces convalescence time from multiple weeks to 7 days. This is beneficial in older patients sparing them from frequent visits to the doctor. Furthermore, early closure may reduce the risk of infection.
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Affiliation(s)
- M Mühlstädt
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstr. 9-11, D-80337 Munich, Germany
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Sattler E, Räwer HC, Mühlstädt M, Ruzicka T, Burgdorf W, Kunte C. Basalzellkarzinome auf mit Radiotherapie vorbehandelten vaskulären Malformationen. Hautarzt 2011; 62:534-8. [DOI: 10.1007/s00105-011-2188-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mühlstädt M, Graefe J. Synthesen cycloaliphatischer Ketone aus Cyclododecatrien-(1,5,9); Herstellung von Cyclanonen aus cyclischen Allenen-Ringerweiterungen an cyclischen Allenen. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/zfch.19660060206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Schöllner R, Herzschuh R, Mühlstädt M. Die Autoxydation ungesättigter Fettsäureester in Gegenwart von Protonen und Methanol. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/zfch.19630030110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mühlstädt M, Thomas P. Neue Wege in der dermatologischen Lehre. J Dtsch Dermatol Ges 2010. [DOI: 10.1111/j.1610-0387.2010.07434_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mühlstädt M, Thomas P. A new pathway in teaching dermatology. J Dtsch Dermatol Ges 2010; 8:490-4. [DOI: 10.1111/j.1610-0387.2010.07434.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sick I, Mühlstädt M, Flaig MJ, Kunte C. [Subcutaneus nodule at the index finger of a 56-years-old female patient. Giant cell tumor of the tendon sheath]. J Dtsch Dermatol Ges 2010; 8:133-5. [PMID: 20151949 DOI: 10.1111/j.1610-0387.2009.07255.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Engewald W, Weiss C, Mühlstädt M. IV. Mitteilung: Über den elekrophilen H-D-Austausch der Wasserstoffatome 1 und 3 des Indolizins. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/10256016808552013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- Michael Mühlstädt
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München.
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Affiliation(s)
- Theda Schuh
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum Innenstadt der Ludwig-Maximilians-Universität München, Germany
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Sick I, Schuh T, Mühlstädt M, Betke M, Kunte C. [The paramedian forehead flap with and without transplantation of earcartilage]. J Dtsch Dermatol Ges 2008; 6:65-6. [PMID: 18190435 DOI: 10.1111/j.1610-0387.2007.06614.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Isabell Sick
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität Städtisches Klinikum München GmbH, Krankenhaus München-Thalkirchner Strasse, Germany.
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Abstract
A 6 year old girl presented with flat-topped, skin-colored, partly grouped papules with slightly roughened surface on the left side of the forehead and around the left orbit. In an off-label use imiquimod 5% cream was applied twice a week before bedtime and was rinsed off in the morning. After four weeks of treatment the lesions had vanished completely. We suggest imiquimod 5% cream as a treatment option for juvenile plane warts even in children and in the face.
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Affiliation(s)
- M Mühlstädt
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Frauenlobstrasse 9-11, 80337, München, Germany.
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Mühlstädt M, Kuhl P. Zur Molekülverknüpfung mit Schwefelchloriden. VII. Reaktion von Dichlorsulfan mit seitenkettensubstituierten Allyl-phenyl-ethern. Weitere Synthesen von 2,3-Dihydro-1,4-benzoxathiinen. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19783200521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mühlstädt M, Schulze B. Nitrovinylverbindungen. II. Aminomethylierung von ω-Nitrocarbonsäureestern zur Darstellung von Nitrovinylcarbonsäureestern. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19713130423] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Schulze B, Herre S, Brämer R, Laux C, Mühlstädt M. β-Thiocyanatovinylcarbonylverbindungen. IV. Darstellung und Reaktionen der 2-Thiocyanatomethylen-cycloalkanone-(1). ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19773190218] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mühlstädt M, Widera R. Zur Molekülverknüpfung mit Schwefelchloriden. VI. Die Reaktion von Dichlorsulfan mit Thiocarbamidsäureestern. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19783200115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mühlstädt M, Schneider P, Martinetz D. Zur Molekülverknüpfung mit Schwefelchloriden. I. Die Reaktion von Dichlorsulfan mit Isobuten, Isobutenderivaten und Allen. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19733150516] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Engewald W, Mai H, Mühlstädt M. Molekülstruktur und Retentionsverhalten. IV. Gaschromatographische Charakterisierung von Chlorierungsprodukten des Isobutens. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19763180405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kleinpeter E, Duschek C, Mühlstädt M. Konformationsuntersuchungen mit Hilfe der13C-NMR-Spektroskopie. I. Vorzugskonformation von alkylsubstituierten Di- bzw. Tetrahydropyranen (Rosenoxide und Analoga). ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19783200218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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