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Philipp-Dormston WG, Aschoff R, von Braunmühl T, Eigentler T, Haalck T, Thoms KM. [Decision criteria and patient characteristics for patient-oriented treatment of field cancerization : Standardized algorithm for personalized treatment concepts]. Hautarzt 2021; 72:314-320. [PMID: 33263779 PMCID: PMC8016782 DOI: 10.1007/s00105-020-04731-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/30/2022]
Abstract
Hintergrund Aktinische Keratosen (AK) zeichnen sich durch einen chronischen Verlauf aus, und häufig ist ein ganzes Hautareal betroffen (Feldkanzerisierung). Die patientenindividuelle Abwägung therapiespezifischer Vor- und Nachteile einer feldgerichteten Therapie ist herausfordernd. Fragestellung Ziel der vorliegenden Arbeit war die Entwicklung und Evaluierung patientenorientierter Entscheidungskriterien, die sich für die pragmatische Einordnung einer AK-Feldtherapie im Behandlungsalltag bei Patienten mit besonderer Prädisposition zur Feldkanzerisierung eignen (Patiententyp 1 bis 3). Material und Methoden Die Entwicklung der Entscheidungskriterien und der Patiententypologie erfolgte im Rahmen eines nominalen bzw. strukturierten Multi-level-Gruppenprozesses. Anhand der patientenrelevanten Entscheidungskriterien, der verfügbaren Evidenz aus klinischen Studien und entlang der Patiententypologie wurde ein Bewertungsalgorithmus etabliert, und feldgerichtete AK-Therapieoptionen wurden systematisch evaluiert. Ergebnisse Als patientenrelevante Kriterien für die Therapieentscheidung wurden u. a. Effektivität, Sicherheit, Praktikabilität der Therapie, Adhärenz, Kosmetik, Patientenpräferenz und Komorbiditäten identifiziert und näher spezifiziert. In Bezug auf diese Entscheidungskriterien und Patiententypen, bei denen eine Feldtherapie vorrangig indiziert ist, erfüllte die photodynamische Therapie mit Tageslicht das therapiebezogene Anforderungsprofil in besonderem Maße. Schlussfolgerung Die Definition von patientenrelevanten und therapiebezogenen Entscheidungskriterien in der AK-Feldtherapie erlaubt eine strukturierte und gleichzeitig praxisorientierte Herangehensweise, um spezifische Therapieoptionen einzuordnen und individuelle Therapieentscheidungen herzuleiten.
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Affiliation(s)
- W G Philipp-Dormston
- Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland. .,Hautzentrum Köln, Klinik Links vom Rhein, Schillingsrotter Str. 39-41, 50996, Köln, Deutschland.
| | - R Aschoff
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - T von Braunmühl
- Praxis für Dermatologie und Allergologie im Isarklinikum München, München, Deutschland
| | - T Eigentler
- Zentrum für Dermatologische Onkologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - T Haalck
- Fachbereich Dermatologie, Ambulanzzentrum des UKE GmbH - Medizinisches Versorgungszentrum (MVZ) des Universitätsklinikums Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - K-M Thoms
- Hautkrebszentrum der UMG/Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen (UMG), Göttingen, Deutschland
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Ruini C, Wittmann D, Summer B, von Braunmühl T, French L, Thomas P. Nickel contact dermatitis evaluated by means of optical coherence tomography: first impressions. J Eur Acad Dermatol Venereol 2019; 33:e265-e267. [DOI: 10.1111/jdv.15536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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)
- C. Ruini
- Department of Dermatology and Allergology University Hospital of the Ludwig Maximilian University Frauenlobstr.9‐11, 80337 Munich Germany
- Department of Dermatology München Klinik GmbH – Munich Municipal Hospital Thalkirchnerstrasse 48, 80337 Munich Germany
| | - D. Wittmann
- Department of Dermatology and Allergology University Hospital of the Ludwig Maximilian University Frauenlobstr.9‐11, 80337 Munich Germany
| | - B. Summer
- Department of Dermatology and Allergology University Hospital of the Ludwig Maximilian University Frauenlobstr.9‐11, 80337 Munich Germany
| | - T. von Braunmühl
- Department of Dermatology and Allergology University Hospital of the Ludwig Maximilian University Frauenlobstr.9‐11, 80337 Munich Germany
| | - L.E. French
- Department of Dermatology and Allergology University Hospital of the Ludwig Maximilian University Frauenlobstr.9‐11, 80337 Munich Germany
| | - P. Thomas
- Department of Dermatology and Allergology University Hospital of the Ludwig Maximilian University Frauenlobstr.9‐11, 80337 Munich Germany
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Bac I, Ruini C, Niesert A, Horváth O, Berking C, Ruzicka T, von Braunmühl T. 640 Effects of short-term moisturizer application in different ethnic skin types - non-invasive assessment with optical coherence tomography and reflectance confocal microscopy. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.649] [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: 10/17/2022]
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance. Br J Dermatol 2018. [DOI: 10.1111/bjd.16612] [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: 11/29/2022]
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. 基底细胞癌光学相干断层成像:位置、亚型、观察者变化和图像质量对诊断性能的影响. Br J Dermatol 2018. [DOI: 10.1111/bjd.16631] [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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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance. Br J Dermatol 2018; 178:1102-1110. [DOI: 10.1111/bjd.16154] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Affiliation(s)
- J. Holmes
- Michelson Diagnostics Ltd; Maidstone Kent U.K
| | - T. von Braunmühl
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - C. Berking
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - E. Sattler
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - M. Ulrich
- Private Dermatology Office/CMB Collegium Medicum Berlin GmbH; Berlin Germany
| | - U. Reinhold
- Dermatology Center Bonn Friedensplatz; Bonn Germany
| | - H. Kurzen
- Private Dermatology Office; Freising Germany
| | - T. Dirschka
- Private Dermatology Office; Wuppertal Germany
| | - C. Kellner
- St Bernard-Hospital; Kamp Lintfort Germany
| | - S. Schuh
- General Hospital Augsburg; Department of Dermatology and Allergology; Augsburg Germany
| | - J. Welzel
- General Hospital Augsburg; Department of Dermatology and Allergology; Augsburg Germany
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Käser S, von Braunmühl T, Ruzicka T, Ruini C. Thumb necrotic ulcers caused by weeverfish: case report and review of the literature. J Eur Acad Dermatol Venereol 2018; 32:e333-e334. [PMID: 29485225 DOI: 10.1111/jdv.14893] [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)
- S Käser
- Department of Dermatology and Allergology, University Hospital of the Ludwig Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany.,Department of Dermatology, Municipal Hospital of Munich, Thalkirchnerstrasse 48, 80337, Munich, Germany
| | - T von Braunmühl
- Department of Dermatology and Allergology, University Hospital of the Ludwig Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, University Hospital of the Ludwig Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany.,Department of Dermatology, Municipal Hospital of Munich, Thalkirchnerstrasse 48, 80337, Munich, Germany
| | - C Ruini
- Department of Dermatology and Allergology, University Hospital of the Ludwig Maximilian University, Frauenlobstr. 9-11, 80337, Munich, Germany.,Department of Dermatology, Municipal Hospital of Munich, Thalkirchnerstrasse 48, 80337, Munich, Germany
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Bagci I, Ruini C, Niesert A, Horváth O, Berking C, Ruzicka T, von Braunmühl T. 175 Effects of short-term moisturizer application in different ethnic skin types - non-invasive assessment with optical coherence tomography and reflectance confocal microscopy. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.485] [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: 10/18/2022]
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Käser S, Ruini C, Ezmerli M, von Braunmühl T, Hartmann D, Ruzicka T, Reinholz M. EGFRI-induced papulopustular rosacea-like rash successfully treated with topical ivermectin. J Eur Acad Dermatol Venereol 2017; 31:e302-e304. [DOI: 10.1111/jdv.14089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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]
Affiliation(s)
- S. Käser
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - C. Ruini
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - M. Ezmerli
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - T. von Braunmühl
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - D. Hartmann
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - T. Ruzicka
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
| | - M. Reinholz
- Department of Dermatology and Allergology; Ludwig Maximilian University; Munich Germany
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Ruini C, Sattler E, Hartmann D, Reinholz M, Ruzicka T, von Braunmühl T. Monitoring structural changes in Demodex mites under topical Ivermectin in rosacea by means of reflectance confocal microscopy: a case series. J Eur Acad Dermatol Venereol 2017; 31:e299-e301. [PMID: 27976437 DOI: 10.1111/jdv.14084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C Ruini
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.,Fachklinik für Dermatologie und Allergologie, Städtisches Klinikum München, Munich, Germany
| | - E Sattler
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - D Hartmann
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.,Fachklinik für Dermatologie und Allergologie, Städtisches Klinikum München, Munich, Germany
| | - M Reinholz
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - T von Braunmühl
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.,Fachklinik für Dermatologie und Allergologie, Städtisches Klinikum München, Munich, Germany
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Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer in fair-skinned individuals. Although lymph node or visceral metastases are observed in less than 0.5 % of all cases, BCC can have a fatal course due to its highly invasive growth pattern. OBJECTIVES To provide a comprehensive update on diagnosis, treatment, and prevention of BCC. MATERIALS AND METHODS We review the current literature and recommendations of the German guidelines on treatment and prevention of skin cancer. The most pertinent developments are summarized in this review article. RESULTS The use of optical coherence tomography and reflectance confocal microscopy can significantly improve the diagnosis of BCC compared with clinical assessment and dermoscopy alone. Mohs micrographic surgery remains the therapeutic gold standard for tumors in the head and facial area and tumors with high-risk features. The application of imiquimod, 5‑fluorouracil, or photodynamic therapy should be restricted to low-risk superficial tumors. Topical inhibitors of the sonic hedgehog (SHH) pathway are currently being evaluated in early clinical trials. In contrast, vismodegib and sonidegib have been approved for the systemic treatment of locally advanced and metastatic BCC with good response rates. The most common adverse events of both agents are muscle cramps, dysgeusia, diffuse alopecia, weight loss, and fatigue. In an Australian phase III trial, oral nicotinamide (vitamin B3) reduced the occurrence of new BCC by 20 % in skin cancer patients. CONCLUSIONS Targeted therapy with SHH inhibitors has improved the prognosis of locally advanced and metastatic BCC, albeit at the cost of a significant number of adverse events.
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Affiliation(s)
- M Heppt
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München (LMU), Frauenlobstr. 9-11, 80337, München, Deutschland
| | - T von Braunmühl
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München (LMU), Frauenlobstr. 9-11, 80337, München, Deutschland
| | - C Berking
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München (LMU), Frauenlobstr. 9-11, 80337, München, Deutschland.
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12
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von Braunmühl T, Hartmann D, Tietze JK, Cekovic D, Kunte C, Ruzicka T, Berking C, Sattler EC. Morphologic features of basal cell carcinoma using the en-face mode in frequency domain optical coherence tomography. J Eur Acad Dermatol Venereol 2016; 30:1919-1925. [PMID: 27581090 DOI: 10.1111/jdv.13704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) has become a valuable non-invasive tool in the in vivo diagnosis of non-melanoma skin cancer, especially of basal cell carcinoma (BCC). Due to an updated software-supported algorithm, a new en-face mode - similar to the horizontal en-face mode in high-definition OCT and reflectance confocal microscopy - surface-parallel imaging is possible which, in combination with the established slice mode of frequency domain (FD-)OCT, may offer additional information in the diagnosis of BCC. OBJECTIVES To define characteristic morphologic features of BCC using the new en-face mode in addition to the conventional cross-sectional imaging mode for three-dimensional imaging of BCC in FD-OCT. METHODS A total of 33 BCC were examined preoperatively by imaging in en-face mode as well as cross-sectional mode in FD-OCT. Characteristic features were evaluated and correlated with histopathology findings. RESULTS Features established in the cross-sectional imaging mode as well as additional features were present in the en-face mode of FD-OCT: lobulated structures (100%), dark peritumoral rim (75%), bright peritumoral stroma (96%), branching vessels (90%), compressed fibrous bundles between lobulated nests ('star shaped') (78%), and intranodular small bright dots (51%). These features were also evaluated according to the histopathological subtype. In the en-face mode, the lobulated structures with compressed fibrous bundles of the BCC were more distinct than in the slice mode. CONCLUSION FD-OCT with a new depiction for horizontal and vertical imaging modes offers additional information in the diagnosis of BCC, especially in nodular BCC, and enhances the possibility of the evaluation of morphologic tumour features.
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Affiliation(s)
- T von Braunmühl
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany.
| | - D Hartmann
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany
| | - J K Tietze
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany
| | - D Cekovic
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany
| | - C Kunte
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany
| | - T Ruzicka
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany
| | - C Berking
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany
| | - E C Sattler
- Department of Dermatology, Ludwig-Maximilian University, Munich, Germany
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13
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Laniauskaite I, Ezmerli M, von Braunmühl T, Ruzicka T, Flaig MJ, Wolff H. Frontal fibrosing alopecia with facial papules - three cases. J Eur Acad Dermatol Venereol 2016; 31:e69-e71. [PMID: 27225957 DOI: 10.1111/jdv.13730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- I Laniauskaite
- Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - M Ezmerli
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - T von Braunmühl
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - M J Flaig
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - H Wolff
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
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Sattler EC, Hoffmann VS, Ruzicka T, Braunmühl TV, Berking C. Reflectance confocal microscopy for monitoring the density of Demodex mites in patients with rosacea before and after treatment. Br J Dermatol 2015; 173:69-75. [PMID: 25801631 DOI: 10.1111/bjd.13783] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Demodex mites seem to serve as a pathogenic trigger in many Demodex-associated diseases such as rosacea. In facial skin of patients with rosacea significantly higher numbers of Demodex mites have been shown compared with healthy controls. Reflectance confocal microscopy (RCM) allows the detection and quantification of Demodex mites in vivo noninvasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM. OBJECTIVES To use RCM to monitor the density of Demodex mites in patients with rosacea before and after treatment. METHODS In 25 patients with facial rosacea RCM was performed before and after therapy. Mosaics of 5 × 5 mm(2) and 8 × 8 mm(2) were scanned, and the total numbers of mites per follicle and per area were counted, along with the number of follicles per area. RESULTS In all patients Demodex folliculorum could be detected and quantified using RCM. RCM showed significant differences pre- and post-treatment (P = 0.0053 for 5 × 5 mm(2) and P < 0.001 for 8 × 8 mm(2)). The mean numbers of mites per follicle were 0.63 (range 0.16-2.28) per 8 × 8 mm(2) area and 0.70 (range 0.11-2.20) per 5 × 5 mm(2) area before treatment, and 0.41 (range 0.074-1.75) and 0.51 (range 0.094-1.70), respectively, after treatment. The corresponding mean numbers of mites were 155 (range 45-446) and 86.2 (range 12-286), respectively, before treatment and 96.2 (range 18-363) and 58.5 (range 12-230), respectively, after treatment. CONCLUSIONS By RCM, a reduction in the density of Demodex mites in facial skin of patients with rosacea under therapy, correlating to clinical improvement, can be quantified and monitored noninvasively. Possible reasons for this therapeutic effect are discussed.
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Affiliation(s)
- E C Sattler
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - V S Hoffmann
- Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilian University Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - T V Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - C Berking
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
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Reinholz M, Gauglitz G, Giehl K, Braun-Falco M, Schwaiger H, Schauber J, Ruzicka T, Berneburg M, von Braunmühl T. Non-invasive diagnosis of sweat gland dysplasia using optical coherence tomography and reflectance confocal microscopy in a family with anhidrotic ectodermal dysplasia (Christ-Siemens-Touraine syndrome). J Eur Acad Dermatol Venereol 2015; 30:677-82. [DOI: 10.1111/jdv.13085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/23/2015] [Indexed: 02/01/2023]
Affiliation(s)
- M. Reinholz
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - G.G. Gauglitz
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - K. Giehl
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - M. Braun-Falco
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - H. Schwaiger
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - J. Schauber
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - T. Ruzicka
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - M. Berneburg
- Department of Dermatology; University of Regensburg; Regensburg Germany
| | - T. von Braunmühl
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
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