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Bossart S, Cazzaniga S, Heidemeyer K, Feldmeyer L, Simon D, Hunger RE, Seyed Jafari SM. Skin redness index: A new practical method for unbiased automated quantification of skin redness. J Eur Acad Dermatol Venereol 2024; 38:e397-e398. [PMID: 37909294 DOI: 10.1111/jdv.19619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Kulac M, Riggauer J, Ramelet AA, Bossart S. Hemorrhage of Varicose Veins: An Indication for Sclerotherapy. Dermatol Surg 2024; 50:311-312. [PMID: 38085041 DOI: 10.1097/dss.0000000000004051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Mustafa Kulac
- All authors are affiliated with the Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Seyed Jafari SM, Bossart S, Adatto M, Feldmeyer L, Yawalkar N, Heidemeyer K. Successful Removal of 17 Tattoos Self-Administered Using Black Eyeliner Ink with Quality-Switched Neodymium-Doped Yttrium Aluminum Garnet 1,064-nm Laser: A Case Report. Case Rep Dermatol 2024; 16:108-115. [PMID: 38650914 PMCID: PMC11034931 DOI: 10.1159/000538555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Tattooing has a rich historical presence in various human civilizations, with the earliest physical evidence dating back to around 3258 BC. While acceptance of tattoos is increasing in the Western world, negative associations remain. Short-pulsed lasers, such as Q-Switched (QS) or picosecond lasers, are the gold standard for tattoo removal. Case Presentation This case report discusses the successful removal of 17 amateur tattoos, which were self-administered by a 19-year-old female patient using black eyeliner ink and sewing needles. The tattoos, distributed across her body, including the face and hands, were partially or completely removed over 10 sessions using the QS Neodymium-doped Yttrium Aluminum Garnet 1,064-nm laser. Conclusion The factors that influence the efficacy of tattoo removal are highlighted, including tattoo type, location, and coexisting fibrosis. The psychological and social importance of effective tattoo removal is emphasized, particularly for young people seeking to disassociate from past experiences or affiliations.
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Affiliation(s)
- S. Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurice Adatto
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Skinpulse Dermatology and Laser Centre, Geneva, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Heidemeyer K, Cazzaniga S, Feldmeyer L, Imstepf V, Adatto M, Lehmann M, Rammlmair A, Pelloni L, Seyed Jafari SM, Bossart S. Skin hyperpigmentation index in melasma: A complementary method to classic scoring systems. J Cosmet Dermatol 2023; 22:3405-3412. [PMID: 37349912 DOI: 10.1111/jocd.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/19/2022] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Due to relapsing nature of melasma with significant impact on quality of life, an objective measurement score is warranted, especially to follow-up the patients with melasma and their therapy response in a quantitative and precise manner. AIMS To prove concordance of skin hyperpigmentation index (SHI) with well-established scores in melasma and demonstrate its superiority regarding inter-rater reliability. Development of SHI mapping for its integration in common scores. METHODS Calculation of SHI and common melasma scores by five dermatologists. Inter-rater reliability was assessed by intraclass correlation coefficient (ICC) and concordance by Kendall correlation coefficient. RESULTS Strong concordance of SHI with melasma area and severity index (MASI)-Darkness (0.48; 95% CI: 0.32, 0.63), melasma severity index (MSI)-Pigmentation (0.45; 95% CI: 0.26, 0.61), and melasma severity scale (MSS) (0.6; 95% CI: 0.42, 0.74). Using step function for mapping SHI into pigmentation scores showed an improvement of inter-rater reliability with a difference in (ICC of 0.22 for MASI-Darkness and 0.19 for MSI-Pigmentation), leading to an excellent agreement. CONCLUSION Skin hyperpigmentation index could be an important additional cost-and time-conserving assessment method, to follow-up the patients with melasma undergoing brightening therapies in clinical studies, as well as in routine clinical practice. It is in strong concordance with well-established scores but superior regarding inter-rater reliability.
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Affiliation(s)
- Kristine Heidemeyer
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Valentina Imstepf
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Maurice Adatto
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
- Skinpulse Dermatology & Laser Centre, Geneva, Switzerland
- Department of Dermatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Matthias Lehmann
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Anna Rammlmair
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lorenzo Pelloni
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Simon Bossart
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, Bern, Switzerland
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Ramelet AA, Bossart S. Transparietal diffusion of polidocanol: Potential complication of sclerotherapy? Phlebology 2023; 38:698-699. [PMID: 37644640 DOI: 10.1177/02683555231198405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
| | - Simon Bossart
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland
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Heidemeyer K, Seyed Jafari SM, Farnina L, Bossart S, Feldmeyer L, Yawalkar N. Case report: Area of focus of management of severe pityriasis rubra pilaris by dose optimization of adalimumab biosimilar in combination with acitretin and montelukast. Front Med (Lausanne) 2023; 10:1295777. [PMID: 38098840 PMCID: PMC10720432 DOI: 10.3389/fmed.2023.1295777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disorder characterized by hyperkeratotic follicular papules, orange-red scaling plaques with islands of sparing and palmoplantar keratoderma. While spontaneous resolution occurs in some cases, treatment can be challenging for others. The use of biologics in PRP management has gained attention in recent studies, although their high costs and potential side effects present limitations. We present a case of a 71-year-old patient with treatment-resistant PRP who showed significant improvement through optimized adalimumab treatment. Considering the emerging role of phospholipase A2 in PRP pathogenesis, montelukast was added, further enhancing the therapeutic response. By maintaining montelukast and prolonging the adalimumab interval to 3 and 4 weeks, effective dose optimization was achieved without PRP relapse. This case report highlights the potential for adalimumab dose optimization by shortening the initial treatment interval for increased effectiveness and lengthening the interval during the maintenance phase to conserve medication doses. Montelukast appears to assist in sustaining clinical outcomes during interval prolongation, necessitating further investigation through additional studies.
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Affiliation(s)
- Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bossart S, Daneluzzi C, Moor MB, Hirzel C, Heidemeyer K, Seyed Jafari SM, Hunger RE, Sidler D. HPV Vaccination in Immunosuppressed Patients with Established Skin Warts and Non-Melanoma Skin Cancer: A Single-Institutional Cohort Study. Vaccines (Basel) 2023; 11:1490. [PMID: 37766167 PMCID: PMC10535650 DOI: 10.3390/vaccines11091490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/04/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
cSCC (cutaneous squamous cell carcinoma) and its precursors are a major cause of morbidity, especially in immunosuppressed patients, and are frequently associated with human papillomavirus (HPV) infections. The purpose of this study is to investigate the therapeutic potential of alpha-HPV vaccination for immunosuppressed patients with established cSCC and its precursors. In this retrospective study, all patients who received Gardasil-9®, a nonavalent HPV vaccine, as secondary prophylaxis were examined. Dermatologic interventions in both the pre- and post-vaccination periods were analyzed with zero-inflated Poisson regression and a proportional intensity model for repeated events with consideration of the clinically relevant cofactors. The hazard ratio for major dermatologic interventions was 0.27 (CI 0.14-0.51, p < 0.001) between pre- and post-Gardasil-9® intervention. Gardasil-9® vaccination showed good efficacy in reducing major dermatologic interventions even after correction of relevant cofactors and national COVID-19 caseloads during the observational period. Alpha-HPV vaccination may potentially cause a significant decrease in dermatologic interventions and overall mortality as well as healthcare costs in immunosuppressed patients with high skin tumor burden.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Cloé Daneluzzi
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Matthias B Moor
- Department of Nephrology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Cédric Hirzel
- Department of Infectious Diseases, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Daniel Sidler
- Department of Nephrology, Inselspital University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
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Uthoff H, Teruzzi E, Boesch P, Hofer M, Spinedi L, Bossart S, Staub D, Keo HH. Safety and efficacy of endovenous thermal ablation for treatment of symptomatic varicose veins during summertime. VASA 2023; 52:332-341. [PMID: 37341558 DOI: 10.1024/0301-1526/a001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 06/22/2023]
Abstract
Background: Traditionally, varicose vein treatment is predominately performed during the colder seasons. However, data whether higher outdoor temperatures affect the outcome and/or complication rate of endovenous thermal ablation (ETA) for treatment of symptomatic varicose veins are missing. Patients and methods: In this observational study, the medical records of all patients who had ETA of the great saphenous vein (GSV), accessory saphenous vein (ASV), or small saphenous vein (SSV) between September 2017 and October 2020 were reviewed. Results: In total 846 ETA interventions in 679 patients with 1239 treated truncal veins and an average length of 69 cm phlebectomy were included. The highest temperature recorded on and within the first 14 days after treatment was on average 19.0°C (SD±7.2°C) with a minimum and maximum of -1°C and 35.9°C. Interventions were categorized according to the recorded temperature (<25°C n=584; 25-29.9°C n=191; and ≥30°C n=71). The occlusion rates were excellent (99-100%) across groups. Despite a significantly higher proportion of patients with obesity, personal history of superficial vein thrombosis and length of phlebectomies in the high temperature groups, no significant difference regarding days of work loss, patients' satisfaction or complications including bleeding or thromboembolic events was observed. Infections were rare (0.8%), but more frequently observed in the 25-29.9°C group (2.6%; p=0.058). No infection was observed in the ≥30°C group and pain 6 weeks after the intervention was even lower (VAS 0.5±1.0 and 0.5±1.2 vs. 0.0±0.1, p=0.008). Conclusions: Given the minimal invasive nature of ETA, our results can reassure clinicians and patients that ETA varicose vein treatment is possible and safe throughout the year, even on hot summer days. A non-significant trend to more infections was observed but was not associated with other adverse outcomes such as prolonged analgetics intake or inability to work.
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Affiliation(s)
- Heiko Uthoff
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Elisa Teruzzi
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Patricia Boesch
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Manuel Hofer
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | | | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, Switzerland
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
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Gabutti M, Heidemeyer K, Seyed Jafari SM, Bossart S, Hunger RE, Feldmeyer L, Yawalkar N. Dimethyl Fumarate Used as an Effective Treatment for Granuloma Annulare Disseminatum: An Immunohistochemical Case Study. Int J Mol Sci 2023; 24:13355. [PMID: 37686161 PMCID: PMC10487489 DOI: 10.3390/ijms241713355] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/25/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
This investigation demonstrates the use of dimethyl fumarate (DMF) for the treatment of disseminated granuloma annulare (GAD), a rare and chronic inflammatory skin disease. In this case, progressive GAD was treated with DMF, resulting in significant improvement of skin lesions within 5 weeks and complete healing within 7 months. Clinical response was associated with a reduction in inflammatory cells, including both T cell subsets (CD4+ > CD8+), CD183+/CXCR3+ cells, Langerhans cells (CD1a+), myeloid DCs, M1- and M2-like macrophages and the activation marker HLA-DR in immunohistochemical analysis. These findings support the use of DMF as a promising treatment option for this rare skin condition.
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Bossart S, Boesch PF, Keo HH, Staub D, Uthoff H. Endovenous Thermal Ablation for Treatment of Symptomatic Saphenous Veins-Does the Body Weight Matter? J Clin Med 2023; 12:5438. [PMID: 37685505 PMCID: PMC10487981 DOI: 10.3390/jcm12175438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/26/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE This study aimed to examine whether body weight may affect the effectiveness and safety of endovenous thermal ablation (ETA) for the treatment of symptomatic varicose veins. METHODS This retrospective single-center cohort study analyzed the outcomes and patient demographic data with a focus on the body weight of all patients who had ETA of symptomatic varicose veins between September 2017 and October 2020. RESULTS A total of 1178 treated truncal veins from 636 patients were analyzed. The mean ± standard deviation body mass index (BMI) was 25.5 ± 4.9. In 2.3% of cases, the patients were underweight (BMI < 18.5), 31.0% were overweight (BMI > 25), and 16.6% were obese (BMI > 30). Complete truncal occlusion was observed 1 year post intervention in 97.6-100% and patients were satisfied or very satisfied in 96.2-100% across BMI groups. Pain was low but significantly higher in the patients with obesity 6 weeks post intervention (visual analog scale 0.84 ± 1.49) and a higher infection rate was observed in the patients with obesity (n = 4/132; 3.0%). No significant association was observed between BMI and bleeding or thromboembolic events. CONCLUSIONS Patients with obesity experienced prolonged pain and more infections after ETA, but ETA for varicose vein treatment remains effective and safe, independent of the patient's BMI.
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Affiliation(s)
- Simon Bossart
- Gefässpraxis am See—Lakeside Vascular Center Lucerne, 6003 Lucerne, Switzerland; (P.F.B.); (H.U.)
- Department of Dermatology, Bern University Hospital Inselspital, University of Bern, 3012 Bern, Switzerland
| | - Patricia Fiona Boesch
- Gefässpraxis am See—Lakeside Vascular Center Lucerne, 6003 Lucerne, Switzerland; (P.F.B.); (H.U.)
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, 4001 Basel, Switzerland; (H.H.K.); (D.S.)
- Vascular Institute Central Switzerland, 5000 Aarau, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, 4001 Basel, Switzerland; (H.H.K.); (D.S.)
| | - Heiko Uthoff
- Gefässpraxis am See—Lakeside Vascular Center Lucerne, 6003 Lucerne, Switzerland; (P.F.B.); (H.U.)
- Department of Angiology, University Hospital, University of Basel, 4001 Basel, Switzerland; (H.H.K.); (D.S.)
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Bossart S, Kos S, Keo HH, Staub D, Uthoff H. Combining Proximal Foam Sclerotherapy and Distal Endovenous Laser Ablation for Recurrent Varicose Vein Treatment. Dermatol Surg 2023; 49:575-580. [PMID: 36989122 DOI: 10.1097/dss.0000000000003765] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Recurrent varicose veins with neovascularization are a common clinical problem. Although endovenous laser ablation (EVLA) has become the standard treatment modality to treat truncal veins, additional sclerotherapy is required to treat newly formed tortuous veins. A novel laser fiber with an injection channel (nLF) allows for such simultaneous proximal sclerotherapy and offers a potentially more effective treatment option. OBJECTIVE The aim of this study was to present our experience using the nLF for combined EVLA and sclerotherapy treatment of symptomatic recurrent varicose veins. MATERIALS AND METHODS A retrospective single-center cohort study analyzed the outcomes of all patients with symptomatic recurrent varicose veins, treated with an nLF between September 2020 and August 2022. RESULTS In total, 28 combined EVLA/sclerotherapy procedures performed with the nLF in 26 patients were analyzed. In all cases, neovascularizations were treated by sclerotherapy through the nLF catheter, followed by laser ablation of the remaining truncal veins. All follow-up ultrasound examinations showed persistent complete occlusion of the treated truncal veins and neovascularizations. No clinically relevant complications were observed. CONCLUSION Combining proximal foam sclerotherapy and distal EVLA using an nLF for the treatment of symptomatic recurrent varicose veins is safe and effective.
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Affiliation(s)
- Simon Bossart
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Lucerne, Switzerland
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Kos
- Institute for Radiology and Nuclear Medicine Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
| | - Heiko Uthoff
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
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Bossart S, Seyed Jafari SM, Heidemeyer K, Yan K, Feldmeyer L, Borradori L, Yawalkar N. Canakinumab leads to rapid reduction of neutrophilic inflammation and long-lasting response in Schnitzler syndrome. Front Med (Lausanne) 2023; 10:1050230. [PMID: 37007766 PMCID: PMC10050468 DOI: 10.3389/fmed.2023.1050230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/22/2023] [Indexed: 03/17/2023] Open
Abstract
Interleukin-1 (IL-1)-blocking therapies are effective in reducing disease severity and inflammation in Schnitzler syndrome. Here, we present a patient with Schnitzler syndrome treated successfully using canakinumab for over 10 years. Complete clinical response was associated with a decrease in dermal neutrophil number and expression of the pro-inflammatory cytokines IL-1β, IL-8, and IL-17 as assessed by immunohistochemical studies.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Simon Bossart,
| | - S. Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kexiang Yan
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikhil Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bossart S, Daneluzzi C, Cazzaniga S, Ramelet AA, Uthoff H, Seyed Jafari SM, Baumgartner M, Hunger RE, Heidemeyer K, Willenberg T. Skin hyperpigmentation after sclerotherapy with polidocanol: A systematic review. J Eur Acad Dermatol Venereol 2023; 37:274-283. [PMID: 36196455 DOI: 10.1111/jdv.18639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023]
Abstract
Skin hyperpigmentation after sclerotherapy with polidocanol-containing sclerosants is a common local side effect. Sclerotherapists should be familiar with factors that trigger hyperpigmentation after sclerotherapy with polidocanol-containing sclerosants. A systematic literature review of works reporting hyperpigmentation after sclerotherapy for telangiectasias, reticular veins, side branches and truncal varices with polidocanol-containing sclerosants was performed. Reported incidence rates, follow-up periods and potentially triggering factors were assessed and analysed. The search yielded 1687 results; of these, 27 reports met the inclusion criteria. The incidence of hyperpigmentation seemed to increase with higher concentrations of polidocanol and was more evident after sclerotherapy for epifascial veins than for intrafascial truncal veins when the polidocanol concentration was more than 0.25%. Regarding sclerotherapy for telangiectasias and reticular veins, the incidence of hyperpigmentation ranged between 2% and 25% for polidocanol 0.25% (liquid and foam), between 12.5% and 67.9% for polidocanol 0.5% (liquid and foam) and between 13% and 73% for polidocanol 1% (liquid and foam). Regarding truncal veins, the incidence ranged from 7% to 45.8% for polidocanol 1% (liquid and foam), from 16% to 17% for polidocanol 2% (foam) and from 7.4% to 32.5% for polidocanol 3% (liquid and foam). Regarding the treatment of side branches, the incidence of hyperpigmentation ranged from 5.6% to 53% for both foam and liquid sclerotherapy. Regarding the duration of hyperpigmentation, there are few data describing reticular veins and telangiectasias. Hyperpigmentation persisting for more than 6 months has been reported to have an incidence of up to 7.5%. Hyperpigmentation persisting for more than 1 year after foam polidocanol 1%-3% treatment for truncal veins has an incidence ranging from 8.1% to 17.5%. Other factors such as higher volumes and compression therapy after treatment seem to have a minor influence. Data regarding hyperpigmentation after polidocanol-related sclerotherapy are poor and should be improved by higher-quality research.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cloé Daneluzzi
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - Albert-Adrien Ramelet
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heiko Uthoff
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc Baumgartner
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Torsten Willenberg
- Gefässzentrum Bern, VASC Angiologie und Interventionen, Lindenhofspital Bern, Bern, Switzerland
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14
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Heidemeyer K, Bodle L, Böll S, Bossart S, Jafari SMS, Hunger RE, Cazzaniga S. Randomized Open-Label Trial Comparing Teledermatology vs. Face-to-Face Consultation in the Follow-Up of Patients with Mild-to-Moderate Acne. Acta Inform Med 2023; 31:31-36. [PMID: 37038496 PMCID: PMC10082660 DOI: 10.5455/aim.2023.31.31-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Background: Acne vulgaris is one of the most common dermatological diseases, especially in adolescents and young adults. Objective: The current study aimed to compare teledermatology versus face-to-face consultation in the follow-up of patients with mild-to-moderate acne. Methods: In this investigator-initiated, parallel arms, open-label, randomized clinical trial, after screening, participants were randomly assigned in a 1:1 ratio to be followed up through teledermatology or standard face-to-face consultations for a period of 6 months. The primary endpoint was the cumulative time spent by physician for consultations or online assessments. Results: 24 patients (21 females and 3 males; mean age 23.0 ± 3.3 years) underwent randomization in the two study groups. In intention-to-treat analysis, the cumulative time spent by physician was higher in the teledermatology group compared to face-to-face consultations with an average difference of 8:24 mm:ss (95% CI: 1:17-15:31). However, the cumulative time spent by the patient was significantly lower in the teledermatology group (mean difference 1:21:39 hh:mm:ss; 95% CI: 41:51-2:01:27). An optimal reduction of acne-severity was observed in both groups, without significant differences between them. The patient’s satisfaction did not change significantly over time and between groups, and was generally quite high. AEs were reported by one patient in the teledermatology group and four patients in the consultation group. Conclusion: Acne might be an optimal disease to be followed up using a teledermatology platform, to relieve the burden on patients and medical staff. However, it is necessary to implement more user-friendly platforms in order to achieve the best possible results in the treatment and follow-up of acne patients.
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Affiliation(s)
- Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Bodle
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Böll
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Centro Studi GISED, Bergamo, Italy
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15
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Mangana J, Zihler D, Bossart S, Brönnimann D, Zachariah R, Gérard CL. Treatment reality of patients with BRAF-mutant advanced/metastatic melanoma in Switzerland in the era of choice. Melanoma Res 2022; 32:366-372. [PMID: 35855650 PMCID: PMC9997623 DOI: 10.1097/cmr.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/08/2021] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
Cutaneous melanoma represents a major cause of cancer death in Europe. Without adequate therapy, the 5-year survival rate is 15-20% in distant metastatic disease. Evaluating the status quo of treatment standards in advanced melanoma and rationale for therapy decisions in Switzerland between January 2016 and September 2018. In this retrospective, anonymized registry, data of male and female patients with unresectable advanced/metastatic BRAF-positive cutaneous melanoma treated in first-, second- and third-line with registered substances were analyzed using descriptive statistics. Forty-one patients (56.1% male) were included providing a total of 70 treatment lines (first-line: n = 41; second-line: n = 18; and third-line: n = 11). Within the patients presenting with stage III or IV melanoma, immunotherapy with checkpoint inhibitors was more frequently administered as first-line treatment than targeted therapy (TT) (70.7% vs. 29.3%). Across all lines, patients received TT in 47.1% (predominantly combined BRAF-MEK-inhibition) and immunotherapy in 52.9% of the cases (anti-PD-1 monotherapy in 62.2% and anti-PD-1/anti-CTLA-4 combinations in 37.8%). Most commonly, the treatment type was switched from TT to immunotherapy or vice versa upon disease progression. The most frequent rationales for prescribing either TT or immunotherapy were physician's preference (40.0%) or remission pressure (28.6%), respectively. Disease progression led to treatment discontinuation more frequently than undesired events. Patients in Switzerland with unresectable advanced or metastatic BRAF-mutant melanoma predominantly receive guideline-recommended treatments. IO was used as predominant front-line therapy, with TT/immunotherapy switch being the predominant treatment principle. Sequencing studies are underway to identify the optimal treatment regimen for those patients. 32: 366-372 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Affiliation(s)
| | - Deborah Zihler
- Kantonsspital Aarau AG, Abteilung für Onkologie, Hämatologie und Transfusionsmedizin, Aarau
| | - Simon Bossart
- Universitätsspital Bern, Universitätsklinik für Dermatologie, Bern
| | - Daniel Brönnimann
- Incyte Biosciences International Sàrl, Medical Affairs Department, Morges
| | - Ralph Zachariah
- Kantonsspital Winterthur, Medizinische Onkologie und Hämatologie, Winterthur
| | - Camille Léa Gérard
- Precision Oncology Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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16
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Gschwend A, Helbling A, Feldmeyer L, Mani-Weber U, Meincke C, Heidemeyer K, Bossart S, Jörg L. Treatment with IL5-/IL-5 receptor antagonists in drug reaction with eosinophilia and systemic symptoms (DRESS). Allergo J Int 2022; 32:1-8. [PMID: 36035809 PMCID: PMC9396594 DOI: 10.1007/s40629-022-00224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/15/2022] [Indexed: 12/02/2022]
Abstract
Purpose Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe delayed drug hypersensitivity reaction with exanthema, eosinophilia, and organ manifestations. After culprit drug withdrawal, systemic corticosteroids (CS) are the most widely used treatment, often requiring high doses for months. Blocking the IL-5/IL‑5 receptor axis with mepolizumab, reslizumab, and benralizumab is a promising targeted treatment with a good safety profile and no immunosuppressive effect. The aim of this study is to summarize current experience with the anti-IL5/IL-5-receptor therapy in DRESS. Methods A retrospective analysis of all patients diagnosed with DRESS and treated with mepolizumab, reslizumab, or benralizumab in DRESS was performed. In addition, a PubMed-Medline search for publications on DRESS with anti-IL-5/IL‑5 receptor treatment was performed. Results Of the 14 cases identified, 6 patients were treated with mepolizumab, 6 with benralizumab, 1 patient with reslizumab, and 1 patient was switched from benralizumab to mepolizumab. The main indication for an IL‑5 blockade was a therapy-refractory course (7/14 [50.0%]), recurrent relapses (3/14 [21.4%]), and severe organ dysfunction (2/14 [14.3%]). In 13/14 (93%) cases, a rapid clinical improvement with suppression of eosinophilia and reduction of CS could be achieved. In all but two cases under mepolizumab (dose 100-600 mg) or reslizumab (dose according to body weight), two or more doses were necessary until resolution of DRESS. In 4/7 cases under benralizumab, a single 30 mg dose was sufficient. Conclusion Blockade of the IL-5/IL‑5 receptor axis appears to be a promising treatment in DRESS with fast clinical improvement, which may allow more rapid reduction of CS, and a good safety profile. In addition, a summary of recommendations on when to use blockade of the IL-5/IL‑5 receptor axis in DRESS treatment is provided.
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Affiliation(s)
- Anna Gschwend
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arthur Helbling
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Cordula Meincke
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Jörg
- Division of Allergology and Clinical Immunology, Department of Pneumology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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17
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Daneluzzi C, Seyed Jafari SM, Hunger R, Bossart S. The Immunohistochemical Assessment of Neoangiogenesis Factors in Squamous Cell Carcinomas and Their Precursors in the Skin. J Clin Med 2022; 11:jcm11154494. [PMID: 35956111 PMCID: PMC9370013 DOI: 10.3390/jcm11154494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer. Well-limited forms can be easily treated with excision, but locally advanced cancers can, unfortunately, progress to metastasis. However, it is difficult to establish the prognosis for cutaneous squamous cell carcinoma and its potential to metastasize. Therefore, this study aimed to evaluate neoangiogenesis in cSCC, as it plays a major role in the dissemination of neoplasia. A literature review was performed on selected neoangiogenic factors (VEGF, ANG1/2, Notch1, CD31/34/105, EGF, etc.). Most of them, including VEGF, EGFR, and CD105, had more elevated levels in the advanced stages of the lesion. The same is true for Notch1, p53, and TGFβ, which are the most frequently mutated tumor suppressors in this type of skin cancer. In addition, the inhibition of some of these markers, using Ang1 analogs, inhibitors of EGFR, TRAF6, or combined inhibitors of EGFR and IGF-IR, may lead to a decrease in tumor size. In conclusion, this literature review identified diagnostic and prognostic markers, as well as possible factors that can be used for the targeted therapy of spinaliomas.
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Affiliation(s)
| | | | | | - Simon Bossart
- Correspondence: ; Tel.: +41-31-63-2-08-81; Fax: +41-31-632-22-33
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18
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Bossart S, Cazzaniga S, Willenberg T, Ramelet AA, Heidemeyer K, Uthoff H, Baumgartner M, Hunger RE, Seyed Jafari SM. Reliability Assessment and Validation of the Skin Hyperpigmentation Index Compared to the Physician Global Assessment Score. Dermatology 2021; 238:688-691. [PMID: 34969031 DOI: 10.1159/000520753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/09/2021] [Accepted: 11/07/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The skin hyperpigmentation index (SHI), a new objective method for measuring skin hyperpigmentation, needs validation. OBJECTIVE To gain evidence of the reliability and validity of the SHI. METHODS Fifteen raters were divided into 3 groups (5 dermatologists, 5 nondermatologist physicians, and 5 nonphysician clinicians). Each rated 5 pigmented mole lesions with mild-to-severe hyperpigmentation to determine intra- and interrater reliability. All raters photographed the lesions and rated them using the subjective Physician Global Assessment (PGA) score. The same photographs were then assessed based on automatic computer measurement software using the online SHI tool (https://shi.skinimageanalysis.com). RESULTS The SHI reliability was excellent for all intra- and interrater assessments, while most PGA assessments showed good intra- and interrater agreement. Between-group reliability was excellent for SHI, while moderate-to-good for PGA evaluations. Concordance between the SHI and PGA assessments was strong across all groups of assessors. CONCLUSION There is evidence that the SHI is a reliable instrument for measuring skin hyperpigmentation, and can be used by nonexperienced clinicians.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | | | - Albert-Adrien Ramelet
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heiko Uthoff
- Department of Angiology, University Hospital Basel, Basel, Switzerland
| | - Marc Baumgartner
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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19
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Seyed Jafari SM, Cazzaniga S, Bossart S, Feldmeyer L, Pelloni L, van Rhyn M, Angermeier S, Adatto M, Hunger RE, Heidemeyer K. Efficacy Assessment of the High-Frequency High-Intensity Focused Ultrasound as a New Treatment for Actinic Keratosis. Dermatology 2021; 238:662-667. [PMID: 34933303 DOI: 10.1159/000520536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/10/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Actinic keratosis (AK) is the most common precancerous cutaneous lesion, with risk of progression to cutaneous squamous cell carcinoma. In the current study, we evaluated the efficacy of 20-MHz high-intensity focused ultrasound (HIFU), as a new treatment modality for AK. MATERIALS AND METHODS Patients with AK lesions (grades I-III) treated with HIFU were included in the study. The clinical assessment was performed 3 months after therapy. RESULTS Twenty-one patients (14 men, 7 women) with 108 AK lesions (grades I-III) were included in the current study. Ages ranged from 62 to 85 years (mean 72.6 years). Clinically complete resolution of the actinic damage in the treated area was detected in 72.2% of lesions. Furthermore, 28 lesions (26%) showed a reduction of the AK grade, or partial response, after the therapy. Most of the patients experienced annoying but short pain during the procedure. However, late adverse effects of the therapy, such as hypopigmentation, hyperpigmentation and erythema were reported only in a small portion of the lesions. CONCLUSIONS 20-MHz HIFU could be an effective and safe alternative treatment for AK.
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Affiliation(s)
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lorenzo Pelloni
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Maja van Rhyn
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sarina Angermeier
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Maurice Adatto
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
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20
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Bossart S, Seyed Jafari SM, Lehmann M, Jossi-Will A, Sane E, Heidemeyer K, Schorno P, Pelloni L, Rammlmair A, Schlapbach C. Effect of topical application of platelet-rich plasma on chronic venous leg ulcerations. Dermatol Ther 2021; 35:e15236. [PMID: 34845807 DOI: 10.1111/dth.15236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/27/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022]
Abstract
Wound products that reliably support healing of chronic leg ulcers remain a huge unmet need in clinical practice. Due to the lack of standardized comparable protocols and different systems for platelet-rich plasma (PRP) preparation, there is limited data on healing rates in chronic venous ulcers. In our case series with a total of seven chronic leg ulcers in four patients, we investigated the healing rates based on standardized digital photographs of chronic venous ulcers after application of topical PRP using a digital imaging software. In 5 out of 7 ulcers, the PRP-treated wound half showed faster healing as compared the control half of the wound. In this case series, PRP-treated sides of chronic venous leg ulcers showed a tendency for accelerated healing as compared to nontreated collateral wound side. Our data support the evaluation of topical PRP treatment in the management of chronic venous leg ulcers.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Mathias Lehmann
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andreas Jossi-Will
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Esther Sane
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Petra Schorno
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lorenzo Pelloni
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anna Rammlmair
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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21
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Heidemeyer K, Bossart S. Oral and genital suction purpura. J Eur Acad Dermatol Venereol 2021; 36:e106-e107. [PMID: 34487607 DOI: 10.1111/jdv.17644] [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] [Received: 07/05/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- K Heidemeyer
- Department of Dermatology, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Bossart
- Department of Dermatology, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland
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22
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Deinsberger J, Brugger J, Tschandl P, Meier-Schiesser B, Anzengruber F, Bossart S, Tzaneva S, Petzelbauer P, Böhler K, Beltraminelli H, Hafner J, Weber B. Differentiating Arteriolosclerotic Ulcers of Martorell from Other Types of Leg Ulcers Based on Vascular Histomorphology. Acta Derm Venereol 2021; 101:adv00449. [PMID: 33856037 PMCID: PMC9367051 DOI: 10.2340/00015555-3804] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinical differential diagnosis of arteriolosclerotic ulcers of Martorell is challenging due to the lack of clearly affirmative instrument-based diagnostic criteria. The aim of this study was to develop vascular histomorphological diagnostic criteria differentiating Martorell ulcers from other types of leg ulcers. The histomorphology of patients diagnosed with arteriolosclerotic ulcers of Martorell (n = 67) was compared with that of patients with venous leg ulcers, necrotizing leukocytoclastic vasculitis, pyoderma gangrenosum, and non-ulcerative controls (n = 15 each). In a multivariable logistic regression model, the rates of arteriolar calcification (odds ratio (OR) 42.71, 95% confidence interval (CI) 7.43–443.96, p < 0.001) and subendothelial hyalinosis (OR 29.28, 95% CI 4.88–278.21, p < 0.001) were significantly higher in arteriolosclerotic ulcers of Martorell. Arteriolar cellularity was significantly lower in Martorell ulcers than in controls (OR 0.003, 95 CI < 0.001–0.97, p = 0.05). However, the wall-to-lumen ratio was similar in all ulcers (OR 0.975, 95% CI 0.598–2.04, p = 0.929). Based on the Youden index, a wall cellularity of < 0.24 cells/100 μm2 was determined as the optimum cut-off point (sensitivity 0.955, specificity 0.944). Thus, arteriolar calcification, subendothelial hyalinosis, and arteriolar cellularity revealed high discriminatory power for arteriolosclerotic ulcers of Martorell.
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Affiliation(s)
- Julia Deinsberger
- Skin and Endothelium Research Division (SERD), Department of Dermatology, Medical University of Vienna, AT-1090 Vienna, Austria
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23
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Seyed Jafari SM, Feldmeyer L, Bossart S, Simon D, Schlapbach C, Borradori L. Case Report: Combination of Omalizumab and Dupilumab for Recalcitrant Bullous Pemphigoid. Front Immunol 2021; 11:611549. [PMID: 33584689 PMCID: PMC7879677 DOI: 10.3389/fimmu.2020.611549] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/14/2020] [Indexed: 12/16/2022] Open
Abstract
Bullous pemphigoid (BP) is a blistering autoimmune skin disease. Omalizumab, a monoclonal antibody directed to IgE, showed a beneficial effect in treatment of recalcitrant BP in case series. More recently, dupilumab, an interleukin (IL)-4-receptor alpha antagonist, also showed promising preliminary results. We describe a patient with refractory BP who showed a complete response to a combination therapy with omalizumab and dupilumab.
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Affiliation(s)
- S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bossart S, Ramelet AA, Willenberg T, Cazzaniga S, Baumgartner M, Heidemeyer K, Hunger RE, Seyed Jafari SM. Skin Hyperpigmentation Index Facilitating Quantification of Hyperpigmentation in Clinical Practice. Dermatology 2020; 237:486-488. [PMID: 32781447 DOI: 10.1159/000509160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,
| | - Albert-Adrien Ramelet
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - Marc Baumgartner
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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25
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Bossart S, Willenberg T, Ramelet AA, Cazzaniga S, Hunger RE, Seyed Jafari SM. The skin hyperpigmentation index: An objective method of measuring the intensity of hyperpigmentation after sclerotherapy. Phlebology 2020; 35:833-835. [PMID: 32715908 DOI: 10.1177/0268355520941359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Skin hyperpigmentation in chronic venous insufficiency and as a side effect in vein treatments are of great importance for the affected individuals. There are only a few qualitatively limited methods that allow its quantification. Previous techniques to develop a reliable scientific approach to quantification have failed due to the lack of standardized conditions including differences in lighting, distances and equipment. A newly developed measuring method, the "skin hyperpigmentation index", enables a fully automated and standardized quantification of skin hyperpigmentation with dermatoscopic images. The skin hyperpigmentation index defines the ratio of two scores, namely hyperpigmented skin of the affected area and normal sun protected skin from the same patient. This results in a range from 1 (no pigmentation) to 4 (maximum pigmentation). For a practical evaluation of the score, a free skin hyperpigmentation index calculator can be used online, which is accessible to all practitioners (https://shi.skinimageanalysis.com/). The skin hyperpigmentation index is a fully automated method for the quantitative assessment of skin pigmentation which can easily be applied to any skin type with any type of hyperpigmentation. This allows a simple, fast, and standardized quantification of skin hyperpigmentation and is useful for monitoring the progress and planning of whitening therapy.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Albert-Adrien Ramelet
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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26
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Bossart S, Gabutti MP, Seyed Jafari SM, Hunger RE. Nonavalent human papillomavirus vaccination as alternative treatment for genital warts. Dermatol Ther 2020; 33:e13771. [PMID: 32500585 DOI: 10.1111/dth.13771] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Abstract
Genital warts caused by the human papillomavirus (HPV) are the most common sexually transmitted disease and have a negative impact on quality of life. Of the more than 200 different types of HPV, low-risk types 6 and 11 are mainly responsible for the development of condyloma acuminata. Despite a large arsenal of local therapies such as numerous topical agents, CO2 laser ablation, and surgical removal, genital warts tend to be recalcitrant. HPV vaccination is mainly used as a preventive strategy to prevent genital warts, cervical cancer, and other anogenital cancers. However, in a few cases, HPV vaccination has been shown to be a good treatment alternative for patients with recalcitrant skin warts. Here we report five cases of recalcitrant genital warts that responded well to treatment with the nonavalent HPV vaccine. HPV vaccines could be beneficial as a noninvasive treatment alternative for recalcitrant genital warts.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Max Philip Gabutti
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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27
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Bossart S, Amsler F, Romer-Schenk G, Duchini S, Willenberg T. Pain in the aftermath of minimal invasive treatment for unilateral incompetence of the great saphenous vein. Phlebology 2020; 35:693-700. [PMID: 32539560 DOI: 10.1177/0268355520930639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Assessment of postprocedural pain after minimal invasive treatment of unilateral incompetence of the great saphenous vein. METHODS A total of 85 patients treated with endovenous laser ablation (1470 nm) in combination with foam sclerotherapy and evulsions reported postprocedural pain on a visual analogue scale (0-10) during 28 days after treatment. RESULTS A mean pain reduction from 3.9 on the first postinterventional day to 0.3 was noted during the observation time. After 28 days, 7% of patients had a visual analogue scale >1. Higher body mass index was strongly associated with more pain during the whole follow-up period (p < 0.01). Higher energy application per cm vein and greater great saphenous vein diameter showed more pain in the first week. Other factors like clinical stage CEAP classification, combination of laser with avulsions and/or sclerotherapy, season of treatment timepoint, and age or sex did not influence postinterventional pain course. CONCLUSION Higher body mass index and higher energy application per cm are associated with more postprocedural pain after endovenous laser ablation.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, University of Bern, Bern, Switzerland
| | | | | | - Sarah Duchini
- Gefässzentrum Bern, Lindenhofspital Bern, Bern, Switzerland
| | - Torsten Willenberg
- Gefässzentrum Bern, Lindenhofspital Bern, Bern, Switzerland.,Berner VenenZentrum, Bern, Switzerland
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28
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Bossart S, Mühlethaler K, Garzoni C, Furrer H. Is real time PCR preferable to the direct immunofluorescence in the diagnosis of Pneumocystis jirovecii pneumonia in HIV-infected patients? BMC Res Notes 2020; 13:235. [PMID: 32357915 PMCID: PMC7195742 DOI: 10.1186/s13104-020-05075-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives In this study, we compared IFA and real-time PCR in bronchoalveolar lavage specimens of HIV infected patients. A total of 66 BALs from 62 HIV patients were included in the study. 30 IFA positive and 36 IFA negative specimens were tested with real-time PCR, targeting the major surface glycoprotein. We performed a retrospective analysis of the patient’s medical records, compared the results of the IFA and PCR tests and analyzed costs, expenditure of time and personal expenses. Results All of the 30 IFA positive samples were PCR positive. 35 of 36 IFA negative probes were also negative in the PCR assay. Considering the PCR results as a binary outcome (positive/negative) sensitivity was 100%, specificity 97.2%. The patient with negative IFA and positive PCR had a clear clinical picture of PCP and responded to PCP treatment. PCR was more than twice as expensive and time-consuming as IFA. Diagnostic accuracy for PCP of PCR and IFA was comparable in HIV-infected patients, but IFA was significantly less expensive and less time-consuming. Therefore, IFA testing can continue to be used as gold standard in the diagnosis of PCP in HIV patients. However, in special cases, IFA may lack sensitivity and PCR should be added to the diagnostic armamentarium.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, University Hospital Inselspital, 3010, Bern, Switzerland. .,Institute for Infectious Diseases, Clinical Microbiology, University of Bern, Bern, Switzerland.
| | - Konrad Mühlethaler
- Institute for Infectious Diseases, Clinical Microbiology, University of Bern, Bern, Switzerland
| | - Christian Garzoni
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Internal Medicine and Infectious Disease, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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29
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Bossart S, Cazzaniga S, Willenberg T, Ramelet AA, Baumgartner M, Hunger RE, Seyed Jafari SM. Skin hyperpigmentation index: a new practical method for unbiased automated quantification of skin hyperpigmentation. J Eur Acad Dermatol Venereol 2020; 34:e334-e336. [PMID: 32103550 PMCID: PMC7496784 DOI: 10.1111/jdv.16312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Bossart
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - T Willenberg
- Gefässzentrum Bern, VASC, Lindehofspital Bern, Bern, Switzerland
| | - A-A Ramelet
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Baumgartner
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S M Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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30
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Bossart S, Imstepf V, Hunger RE, Seyed Jafari SM. Nonavalent Human Papillomavirus Vaccination as a Treatment for Skin Warts in Immunosuppressed Adults: A Case Series. Acta Derm Venereol 2020; 100:adv00078. [PMID: 32115668 PMCID: PMC9128913 DOI: 10.2340/00015555-3437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Simon Bossart
- Department of Dermatology, University Hospital, Inselspital Bern, CH-3010 Bern, Switzerland.
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Abstract
Skin cancer - prevention and therapy Abstract. Skin cancers are increasing in western countries. Prevention consists mainly of primary (UV- protection) and secondary (early detection) prevention. Family physicians are often the first contact persons to evaluate the dignity of skin lesions of high-risk patients and help to perform the diagnosis. If skin cancer is detected early, surgical removal is highly likely to achieve complete cure and reduce the financial burden due to malignant skin tumors. Great progress has been made in the local and systemic therapy of skin tumors in recent years.
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Affiliation(s)
| | - Simon Bossart
- 1 Universitätsklinik für Dermatologie, Inselspital, Bern
| | - Carine Houriet
- 1 Universitätsklinik für Dermatologie, Inselspital, Bern
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32
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Bossart S, Rammlmair A, Haneke E. Reversible Schamroth Sign after Pleural Tumor Resection. Skin Appendage Disord 2019; 5:327-328. [PMID: 31559259 DOI: 10.1159/000497463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/24/2018] [Accepted: 02/03/2019] [Indexed: 11/19/2022] Open
Abstract
The Schamroth sign can be used for the detection of nail clubbing and is associated with pulmonary and cardiovascular diseases. This case illustrates a patient with sudden nail clubbing and positive Schamroth sign without any other abnormal clinical or laboratory findings. Radiological workup revealed a pleural tumor, histologically confirmed as a solitary fibrous tumor. After thoracoscopic tumor resection, normalization of the nail clubbing with complete resolution of the Schamroth sign was observed. Our case demonstrates that sudden nail changes with positive Schamroth sign may indicate a new neoplastic pulmonary disease. It is of great importance to increase the awareness of this feature in order to obtain a timely diagnosis, specific treatment, and improved patient care.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Anna Rammlmair
- Department of Dermatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Eckart Haneke
- Department of Dermatology, Inselspital, University Hospital of Bern, Bern, Switzerland
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33
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Bossart S, Sidler D, Blum R, Hunger RE. Gout tophi on the soles resembling viral warts. Clin Case Rep 2018; 6:1121-1123. [PMID: 29881579 PMCID: PMC5986059 DOI: 10.1002/ccr3.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 11/10/2022] Open
Abstract
This case highlights the need to consider tophaceous gout in patients with post-transplant renal insufficiency, chronic immunosuppression, and hypertension, who develop atypical papules or nodules on the soles, which can cause problems in differentiation from other skin diseases.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Daniel Sidler
- Department of Nephrology, Hypertension, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Roland Blum
- Department of Dermatology, InselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Robert E. Hunger
- Department of Dermatology, InselspitalBern University HospitalUniversity of BernBernSwitzerland
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34
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Bossart S, Thurneysen S, Rushing E, Frontzek K, Leske H, Mihic-Probst D, Nagel HW, Mangana J, Goldinger SM, Dummer R. Case Report: Encephalitis, with Brainstem Involvement, Following Checkpoint Inhibitor Therapy in Metastatic Melanoma. Oncologist 2017; 22:749-753. [PMID: 28559410 DOI: 10.1634/theoncologist.2016-0366] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/16/2017] [Indexed: 11/17/2022] Open
Abstract
Checkpoint inhibitors are increasingly being used in the treatment of malignant melanoma and other cancers. With the use of such therapies, autoimmune-mediated adverse events in the central and peripheral nervous system are likely to occur more frequently. We report a unique case of brainstem encephalitis with a sudden lethal outcome following ipilimumab and pembrolizumab therapy in a patient with malignant melanoma. The autopsy showed a diffuse nodular activation of microglia in the whole encephalon with prominent intraparenchymal and perivascular lymphocytic infiltration of the brainstem. Non-infectious brainstem encephalitis is a well-recognized subset of paraneoplastic encephalitis. Brainstem involvement is usually accompanied by a wide spectrum of signs and symptoms, which were not observed in this case. The timing of the clinical symptoms as well as the histopathological findings suggest an autoimmune-adverse event of ipilimumab and pembrolizumab administration rather than a paraneoplastic disorder. In the presence of neurological symptoms, immediate cessation of the immunotherapy and immunosuppressive therapy may lead to successful therapeutic intervention, as described in previous reports. Therefore, it is crucial that physicians are aware of the possible side effects of immunotherapies on the nervous system. IMPLICATIONS FOR PRACTICE Metastatic melanoma patients treated with the anti-CTLA-4 inhibitor ipilimumab have a high utilization of various types of health care services, such as inpatient hospital stays or doctor visits. There are differences across countries regarding patterns of health care utilization and economic burden of the disease. Health care services are used more frequently after patients experience progression of their disease. The study highlights that better therapies leading to durable response in patients with metastatic melanoma have the potential to decrease health care costs and patient burden in terms of hospitalizations and other health care services.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Inselspital, Bern, Switzerland
| | - Selina Thurneysen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Elisabeth Rushing
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Karl Frontzek
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Henning Leske
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Daniela Mihic-Probst
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Hannes W Nagel
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Johanna Mangana
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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35
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Bossart S, Schnell B, Kerl K, Urosevic-Maiwald M. Ulcers as a Sign of Skin Infection with Mycobacterium wolinskyi: Report of a Case and Review of the Literature. Case Rep Dermatol 2016; 8:151-5. [PMID: 27462223 PMCID: PMC4943297 DOI: 10.1159/000446470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 12/21/2022] Open
Abstract
Infection with Mycobacterium wolinskyi, if not detected, may cause severe skin and soft tissue infection with prolonged healing process and is therefore associated with high morbidity. Only about 20 cases of M. wolinskyi infections in humans have been described in the literature until now, none of them in Switzerland. We report a case of an infection in a 72-year-old male patient with recurrent subcutaneous abdominal wall abscesses and ulcer formation after insulin injection in the underbelly. A culture of skin biopsy tissue showed rapid growth of non-tuberculous mycobacteria (NTM), which were identified by 16S rRNA gene sequencing as M. wolinskyi. Surgical excision and primary closure of all abdominal ulcers in combination with antibiotic therapy, based on the antimicrobiotic susceptibility test results, were performed and resulted in complete resolution of the clinical symptoms and no recurrence of infection at a 6-month follow-up. The present case emphasizes the importance of accurate diagnosis and treatment of chronic infection with ulcer formation. In such cases, it is crucial to consider the presence of NTM, such as M. wolinskyi, in order to obtain rapid diagnosis, specific treatment and improved patient care.
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Affiliation(s)
- Simon Bossart
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Schnell
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Katrin Kerl
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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