Glutamine promotes human CD8+ T cells and counteracts imiquimod-induced T cell hyporesponsiveness.

T cells protect tissues from cancer. Although investigations in mice showed that amino acids (AA) critically regulate T cell immunity, this remains poorly understood in humans. Here, we describe the AA composition of interstitial fluids in keratinocyte-derived skin cancers (KDSCs) and study the effect of AA on T cells using models of primary human cells and tissues. Gln contributed to ∼15% of interstitial AAs and promoted interferon gamma (IFN-γ), but not granzyme B (GzB) expression, in CD8+ T cells. Furthermore, the Toll-like receptor 7 agonist imiquimod (IMQ), a common treatment for KDSCs, down-regulated the metabolic gatekeepers c-MYC and mTORC1, as well as the AA transporter ASCT2 and intracellular Gln, Asn, Ala, and Asp in T cells. Reduced proliferation and IFN-γ expression, yet increased GzB, paralleled IMQ effects on AA. Finally, Gln was sufficient to promote IFN-γ-production in IMQ-treated T cells. Our findings indicate that Gln metabolism can be harnessed for treating KDSCs.

Real-world effectiveness and safety of the LAight-therapy in patients with hidradenitis suppurativa.

BACKGROUND AND OBJECTIVES: Hidradenitis suppurativa (HS)/Acne inversa (Ai) is a chronic debilitating disease with limited therapy options. The device-based LAight therapy was approved in Europe in 2017. The aim of this study was to evaluate the effect of real-world care with at least one treatment with LAight therapy on disease activity and burden in 3,437 patients. PATIENTS AND METHODS: Patients were included in the analysis if they had a diagnosis of HS and received at least one treatment. The endpoints Hidradenitis Suppurativa Severity Score System (IHS4), pain on the numeric rating scale (pain-NRS) and Dermatology Life Quality Index (DLQI) were analyzed using a linear mixed model for repeated measures (MMRM) over 26 weeks of care with LAight therapy. Furthermore, responder rates were calculated for all endpoints, and the therapy's safety profile and patient satisfaction were thoroughly examined. RESULTS: A significant decrease in IHS4, pain-NRS, and DLQI was achieved during 26 weeks of care with LAight. The BMI at baseline had a significant negative effect on therapy response for pain-NRS and DLQI. CONCLUSIONS: This study confirms that LAight therapy leads to satisfactory disease control in all stages of severity and is a valuable addition to the therapeutic repertoire of HS.

Digital decision support for structural improvement of melanoma tumor boards: using standard cases to optimize workflow.

PURPOSE: Choosing optimal cancer treatment is challenging, and certified cancer centers must present all patients in multidisciplinary tumor boards (MDT). Our aim was to develop a decision support system (DSS) to provide treatment recommendations for apparently simple cases already at conference registration and to classify these as "standard cases". According to certification requirements, discussion of standard cases is optional and would thus allow more time for complex cases. METHODS: We created a smartphone query that simulated a tumor conference registration and requested all information needed to provide a recommendation. In total, 111 out of 705 malignant melanoma cases discussed at a skin cancer center from 2017 to 2020 were identified as potential standard cases, for which a digital twin recommendation was then generated by DSS. RESULTS: The system provided reliable advice in all 111 cases and showed 97% concordance of MDT and DSS for therapeutic recommendations, regardless of tumor stage. Discrepancies included two cases (2%) where DSS advised discussions at MDT and one case (1%) with deviating recommendation due to advanced patient age. CONCLUSIONS: Our work aimed not to replace clinical expertise but to alleviate MDT workload and enhance focus on complex cases. Overall, our DSS proved to be a suitable tool for identifying standard cases as such, providing correct treatment recommendations, and thus reducing the time burden of tumor conferences in favor for the comprehensive discussion of complex cases. The aim is to implement the DSS in routine tumor board software for further qualitative assessment of its impact on oncological care.

Hidradenitis Suppurativa Is Associated with Severe Sexual Impairment.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit, often affecting and deforming intimate regions. HS is associated with severe pain, pruritus, and constant, purulent, malodorous discharge expected to impair sexual health of patients. METHODS: We performed a cross-sectional, multicentric study involving 199 German patients from the health services research project "Epidemiology and Care in Acne inversa (EpiCAi)." The sexual health, HS severity, and quality of life of the studied group were evaluated using a specially designed questionnaire. RESULTS: Regardless of gender, HS has an enormous impact on patients' sexual health. The patients scored, on average, 28.8 ± 5.3 points on the Relation and Sexuality Scale (RSS). Multiple linear regression revealed that females and patients with Hurley III stage had higher sexual dysfunction (p = 0.012). Sexual dysfunction is associated with pain (ß = 0.25), the number of active lesions, the affected areas (ß = 0.14), and psychosocial aspects, including low quality of life (ß = 0.404), stigmatization (ß = 0.411), depression (ß = 0.413), and anxiety (ß = 0.300). Patients already see a substantial decrease in sexual frequency in the early stages of HS, while functional impairment and fear increase with the severity of the disease. CONCLUSION: Sexual health and management of its dysfunctions should be part of a holistic approach to HS patients.

Outpatient care concept and potential inpatient cost savings associated with the administration of dalbavancin - A real-world data and retrospective cost analysis.

BACKGROUND: The treatment of acute bacterial skin and skin structure infections (ABSSSI) usually involves intravenous (i.v.) antibiotics requiring hospitalisation and increasing hospital costs. Since 2014, dalbavancin is approved for ABSSSIs treatment. However, evidence of its health economic impact on the German healthcare system is still limited. METHODS: Diagnosis-related groups (DRG) based cost analysis was used to evaluate real-world data (RWD) from a German tertiary care center. All patients treated with i.v. antibiotics in the Department of Dermatology and Venereology at the University Hospital of Cologne were included to detect potential cost savings from a payer perspective. Thus, for the inpatient care German diagnosis-related groups (G-DRG) tariffs, length of stay (LOS), main- and secondary DRG-diagnoses and for the outpatient setting 'Einheitlicher Bewertungsmaßstab' (EBM) codes were evaluated. RESULTS: This retrospective study identified 480 inpatient cases treated for ABSSSI between January 2016 until December 2020. Complete cost data were available for 433 cases and the detection of long-hospital-stay patients based on surcharges for exceeding the upper limit LOS led to 125 cases (29%) including 67 females (54%) and 58 males (46%) with an overall mean age of 63.6 years; all treated for International Classification of Diseases (ICD -10th revision) code A46 'erysipelas'. A sub-analysis focussed on DRG J64B with a total of 92 cases exceeding the upper limit LOS by a median of 3 days resulted in a median surcharge of €636 (mean value €749; SD €589; IQR €459-€785) per case. In comparison, we calculated outpatient treatment costs of approximately €55 per case. Thus, further treatment of these patients in an outpatient setting before exceeding the upper limit LOS might result in a cost-saving potential of approximately €581 per case. CONCLUSION: Dalbavancin appears a cost-efficient option to reduce inpatient treatment costs by transitioning to an outpatient setting of patients with ABSSSI potentially exceeding the upper limit LOS.

[Inflammatory dermatoses in skin of color]. / Entzündliche Dermatosen auf pigmentierter Haut.

Acne, rosacea, atopic dermatitis, and psoriasis vulgaris are common inflammatory dermatoses. Of note, the epidemiology and clinical presentation of these common dermatologic diseases varies considerably between people with different colors of skin. Yet, most dermatology textbooks present and describe the clinical pictures of White people. To provide excellent dermatological care for all patients, it is of central importance to know the epidemiology and recognize key clinical characteristics of these diseases in patients with skin of color (SOC). In acne, cultural habits of Blacks (use of steroid-based lighteners, comedogenic hair care products) may lead to manifestation of specific forms of acne. In addition, postinflammatory hyperpigmentation and keloids pose particular therapeutic challenges in this patient group. Atopic dermatitis in Asians shows a clinical and histological picture that is similar to psoriasis in Whites. By contrast, atopic dermatitis manifests on the extensor side in Black people. Due to the difficulty of recognizing erythema in SOC, the severity of the respective inflammatory diseases in these individuals is often underestimated. The treatment of acne, rosacea, atopic dermatitis, and psoriasis does not differ between people of different skin colors. The exception is the necessary therapy for postinflammatory hyperpigmentation in all the inflammatory dermatoses mentioned, and for keloids in acne.

[Physiologic hyperpigmentation on darker skin]. / Physiologische Hyperpigmentierungen auf dunkler Haut.

Many, even common, normal variations and nuances of skin of color are less frequently described or often misinterpreted as pathological. Recognizing these physiologic changes is gaining relevance in our increasingly diverse patient population and enables the physician to encourage the acceptance by the patients as well as to manage our resources wisely. Therefore, we explain common hyperpigmentation on dark skin such as demarcation lines, mucosal hyperpigmentation, melanonychia striata, and circumscribed dermal melanocytosis. The aim of this article is to facilitate the classification of these phenomena in clinical practice.

[Anatomical and functional differences of the skin in various ethnic groups]. / Anatomische und funktionelle Unterschiede der Haut verschiedener Ethnien.

Besides the differences in skin and hair color among different ethnic groups, morphological and functional differences in skin and hair have also been demonstrated. The color of skin and hair is determined by two types of melanin, eumelanin (brown to black pigment) and phaeomelanin (red to yellow pigment). In addition to the individual mixture of these pigment types, there are also differences in the melanosome arrangement of Caucasian, Asian, and African skin. Although the epidermis thickness is the same in all people, darker skin has a higher number of stratum corneum layers and a thicker dermis with a higher number of fibroblasts. The hairs of different ethnic groups also vary regarding shape and thickness: they are round in Asians, elliptical in Blacks and intermediate in Whites. Hair diameter is the greatest in Asians, followed by Blacks and is the smallest in Whites, whereas the number of hairs is highest in Whites, followed by that in Asians and Blacks.

Ecological site distribution of sand fly species of Mokolo, an endemic focus of cutaneous leishmaniasis in northern Cameroon.

Leishmaniasis is a vector borne disease present in two major clinical forms (cutaneous and visceral) in the northern part of Cameroon. The disease is classified as a neglected tropical disease by the World Health Organization and thus, requires more attention. The aim of this study was to correlate the previously established composition and abundance of sand fly fauna with the putative vector status and the ecological behavior in the Mokolo cutaneous leishmaniasis focus to propose fighting strategies integrating vectors control. Over a 12-month period light traps were used for sand flies' collection in urban, peri-urban and sylvatic environment found in Mokolo, an endemic focus of leishmanisis in northern Cameroon, microscope and taxonomic keys were used for their identification. Nineteen (19) species were identified belonging to the genera Sergentomyia, and Phlebotomus. The influence of human population density on sand fly's species density and composition was assessed trough the evaluation of ecological distribution of sand flies in Mokolo. It came out that, Se. coronula and Se. thomsoni mandarai are strictly wild species and Ph. duboscqi, a domestic species. The other species are generalists.The number of Se. antennata and Se. adami decreases with the increase of the density of human population while Se. distincta, Se. vorax and Ph. duboscqi increase with the density of human population in the study site. Based on its previous reports in the Leishmania transmission in West Africa, Ph. duboscqi should still be considered as the main suspected vector in Mokolo. Ph. duboscqi, Se. distincta, Se. affinis ssp. vorax and Se. schwetzi are highly represented around human dwellings.

LAight® Therapy Is an Effective Treatment Option to Maintain Long-Term Remission of Hurley I and II Hidradenitis Suppurativa: Results from Period B of RELIEVE, a Multicenter Randomized, Controlled Trial.

BACKGROUND: Hidradenitis suppurativa is a chronic, inflammatory, burdensome skin disease where current first-line treatments are limited to topical and/or systemic antibiotics which cannot be applied for long-term disease management. Period B of the RELIEVE study analyzes whether LAight® therapy can sustain or even increase remission after a first topical antibiotic treatment cycle. METHODS: The RELIEVE study was performed as a two-period multicenter randomized controlled trial with blinded assessment. For period A from week 0 to week 16, the 88 participating Hurley I and II patients were randomized to either a group receiving topical clindamycin 1% solution combined with 8 additional bi-weekly treatments with LAight® therapy (group TC + L) or a group which was treated with topical clindamycin 1% solution only (group TC). After 16 weeks, patients entered open-label period B and both groups were treated exclusively with LAight® therapy for an additional 16 weeks (8 sessions, group TC + L/L and group TC/L). RESULTS: In total, 88 patients were enrolled in RELIEVE. Seventy-eight patients entered period B; 39 belonged to group TC + L/L and 39 to group TC/L. The IHS4-response at the start of period B was 62% (group TC + L/L) and 33% (group TC + L). During the 16 weeks of additional monotherapy with LAight, in both groups >90% of patients who responded to therapy in period A maintained their IHS4-response at week 32. IHS4 response rates continued to rise up to 79% of the TC + L/L group and up to 71% of the TC/L group during period B at week 32. Achievement of HiSCR and certain patient reported outcomes confirmed primary endpoint results. CONCLUSION: LAight® therapy is an effective approved therapy option for Hurley I and II HS that can be used continuously to maintain treatment success. During 16 weeks of follow-up in period B, over 90% of patients with response after period A maintained their treatment outcome, while more than 60% of prior nonresponders gained response. The fact that LAight® therapy can be applied continuously, is very effective and is well tolerated makes it a valuable treatment tool in the design of HS long-term treatment modalities.

[Virus-induced exanthems in returning travellers]. / Virusbedingte Exantheme nach Fernreisen.

Dermatological diseases are among the most common travel-associated diseases. In particular, viral infections not only with tropical and subtropical pathogens, but also with viruses common in Germany, which are often accompanied by skin rashes and general symptoms, are of great importance. In addition to an accurate travel history and possible risk exposures, epidemiological information on country-specific risks in combination with molecular and serological analyses is helpful in making the correct diagnosis. This article provides an overview of important virus-induced exanthems in returned travellers.

Holistic health record for Hidradenitis suppurativa patients.

Hidradenitis suppurativa (HS) is a recurrent inflammatory skin disease with a complex etiopathogenesis whose treatment poses a challenge in the clinical practice. Here, we present a novel integrated pipeline produced by the European consortium BATMAN (Biomolecular Analysis for Tailored Medicine in Acne iNversa) aimed at investigating the molecular pathways involved in HS by developing new diagnosis algorithms and building cellular models to pave the way for personalized treatments. The objectives of our european Consortium are the following: (1) identify genetic variants and alterations in biological pathways associated with HS susceptibility, severity and response to treatment; (2) design in vitro two-dimensional epithelial cell and tri-dimensional skin models to unravel the HS molecular mechanisms; and (3) produce holistic health records HHR to complement medical observations by developing a smartphone application to monitor patients remotely. Dermatologists, geneticists, immunologists, molecular cell biologists, and computer science experts constitute the BATMAN consortium. Using a highly integrated approach, the BATMAN international team will identify novel biomarkers for HS diagnosis and generate new biological and technological tools to be used by the clinical community to assess HS severity, choose the most suitable therapy and follow the outcome.