[John Updikes "War with his skin"]. / John Updikes "Krieg mit seiner Haut".

The US author John Updike (1932-2009) wrote about the clinical picture of his psoriasis. In addition to the brilliant literal depiction of the inner conflicts of those suffering-particularly his own struggles-Updike also chronologically documented the course of his illness and therapeutic efforts, especially phototherapy which was commonly used at the time.

A Case of Leser-Trélat Syndrome Associated with a Renal Cell Carcinoma.

Seborrheic keratoses can often be found in elderly people. In general, they appear gradually. In cases of a sudden eruption with itching it might be paraneoplastic. Although some authors doubt the existence of the paraneoplastic Leser-Trélat syndrome, we present a case of sudden eruption of seborrheic keratoses connected with a newly diagnosed renal cell carcinoma. As far as we know, this is the first case report of a Leser-Trélat syndrome with a malignancy of the kidney.

Bilateral Paget's Disease of the Breast-Case Report of Long-Time Misdiagnosed Tumors with Underlying Ductal Carcinomas and Review of the Literature.

Paget's disease of the breast is often misdiagnosed. We report on a 72-year old patient with a history of 2.5 years without any malignant findings, followed by the identification of a bilateral Paget's disease with bilateral breast cancers. This case underlines how important histological examinations even in unusual clinical pictures are.

Malignant melanoma during treatment with fumaric acid esters - coincidence or treatment-related?

Psoriasis is today generally considered a systemic disease. Systemic therapies are used frequently. In Germany fumaric acid esters - FAE (Fumaderm(®) ) - are employed in more than 50 % of the patients requiring such therapy. We report for the first time the development of melanoma in two patients during their treatment with FAE. The logical question is - are the tumors coincidental or might they be treatment-related? Further investigations of pathways and immunologic effects as well as careful reports of side effects are necessary to estimate the risks of malignancy of FAE.

Successful treatment of pityriasis rubra pilaris (type 1) under combination of infliximab and methotrexate.

Pityriasis rubra pilaris (PRP) is often difficult to treat. A 65-year-old women presented with a two week history of widespread erythroderma and scaling with areas of sparing (nappes claires). She also had follicular hyperkeratoses and palmar fissuring. The clinical picture and histology led to the diagnosis of PRP. She failed to respond to initial therapy which included topical and systemic corticosteroids. She was then treated with intravenous methotrexate (MTX) 15-30 mg weekly. Because of the poor response we intensified her regime with infliximab (5 mg/kg). Altogether our patient received infliximab three times together with MTX, which was later given orally. We report for the first time the successful combination of infliximab and MTX for the treatment of PRP.