[Pityriasis rubra pilaris after COVID-19 vaccination: causal relationship or coincidence?] / Pityriasis rubra pilaris nach COVID-19-Impfung: Kausaler Zusammenhang oder Koinzidenz?

Numerous cutaneous side effects associated with COVID-19 vaccines have been described since their clinical approval. These include, among others, injection site reactions, urticarial, maculopapular and pityriasiform rashes or temporary exacerbations of a pre-existing chronic inflammatory skin disease. Herein we report about three cases of pityriasis rubra pilaris that occurred for the first time in close temporal relationship with the administration of a COVID-19 vaccine.

[Mucous pseudocysts-when and how to treat?] / Mukoide Pseudozysten ­ wann wie therapieren?

The treatment of mucous pseudocysts must consider their tendency for recurrence. There are numerous established treatment options available. The decision on the optimal therapy, however, depends on the clinical presentation and symptoms as well as on possible side effects. This review presents surgical as well as nonsurgical treatment options for digital mucous pseudocysts and an algorithm is suggested. For recurrent and symptomatic lesions with pain or deformation of the nail plate, surgical excision of the pseudocyst and closure with a flap can be considered.

Successful treatment of bullous pemphigoid with omalizumab as corticosteroid-sparing agent: report of two cases and review of literature.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering disease that is characterized by formation of subepidermal bullae due to functional disturbance of the hemidesmosomal proteins on the keratinocytes at the basal membrane zone. In recent years, several studies have emphasized the important role of IgE autoantibodies in the pathogenesis of BP. Consequently, a therapeutic approach using IgE depleting antibodies, such as a humanized monoclonal anti-IgE antibody (e.g. omalizumab) may represent a new option for treatment of this autoimmune disease. METHODS: In this paper, we report about the successful treatment of BP with omalizumab in two patients and provide a review of the current literature on the relationship between IgE antibodies and this autoimmune blistering disease. RESULTS: Two patients with therapy-resistant BP were treated with humanized monoclonal anti-IgE antibody omalizumab 300 mg subcutaneously every 3 weeks as corticosteroid-sparing agent. Under this therapy, both patients experienced a significant improvement of skin condition and almost complete resolution of pruritus. The treatment was well tolerated. CONCLUSION: Until recently IgG autoantibodies against the basal membrane proteins BP180 und BP230 were considered to be causative in the pathogenesis of BP. However, new in vitro studies as well as data from experimental mouse models have indicated that in addition to specific IgG, also IgE antibodies against BP180 and BP230 play a role in the development of this disease. Based on these new findings, new treatment modalities of BP became possible.

Chronic spontaneous urticaria and internal parasites--a systematic review.

Chronic spontaneous urticaria (CSU) is defined as persistent wheals, angioedema, or both lasting for >6 weeks due to known or unknown causes. Some epidemiological studies and case reports suggest that internal parasite infections (PI) can cause CSU. Here, we provide a systematic overview of published findings on the prevalence and relevance of PI in CSU and we discuss possible pathomechanisms. The prevalence of PI in CSU was investigated by 39 independent studies and comorbidity reportedly ranged from 0 to 75.4% (two-thirds of these studies reported infection rates of 10% or less). The prevalence of PI in adult and pediatric CSU patients ranged from 0% to 75.4% and from 0% to 37.8%, respectively. CSU patients were more often diagnosed with protozoa and had a significantly higher risk of toxocariasis seropositivity and Anisakis simplex sensitization when compared to healthy controls. Patients with chronic urticaria more frequently had seropositivity of fasciolosis, Anisakis simplex sensitization, and the presence of Blastocystis hominis allele 34 (ST3) as compared with control subjects. In 21 studies, efficacy of treatment with antiparasitic drugs ranged from 0 to 100% (35.7% of 269 CSU patients benefitted). In 9 (42.8%) of 21 studies, more than 50% of efficacy was observed. The reported rate of urticaria comorbidity in PI patients in 18 independent studies is 1-66.7%. Urticaria including CSU might be a quite common symptom of strongyloidiasis and blastocystosis. Pathogenic mechanisms in CSU due to PI may include specific IgE, Th2 cytokine skewing, eosinophils, activation of the complement, and the coagulation systems.

[Bullous pemphigoid: a new look at a well-known disease]. / Bullöses Pemphigoid: Ein neuer Blick auf eine bekannte Krankheit.

BACKGROUND: Bullous pemphigoid is an autoimmune blistering disease that is associated with appearance of subepidermal blisters. IgG antibodies against components of the epithelial basement membrane (BP 180 and 230 antigens) can be typically found in serum of patients. Direct immunofluorescence reveals usually a linear deposition of IgG and/or C3 along the basement membrane, but other immunoglobulins may also be present. CASE PRESENTATION: Our patient had no detectable formation of tense blisters of his skin; instead, the clinical picture was rather compatible with a prurigo simplex subacuta or a pruritic variant of atopic dermatitis. He also had a markedly elevated total serum IgE level. The diagnosis was confirmed by detection of circulating IgG against BP 180 in patient's serum in ELISA and detection of linear IgG deposits along the basement membrane zone of epidermis in the direct immunofluorescence. CONCLUSION: Atypical clinical presentations of bullous pemphigoid without blister formation are possible. Recent studies show that an increased total IgE level in serum of patients may occur frequently. The aim of this report is to provide the reader with a brief insight in the new findings in pathogenesis and therapy of bullous pemphigoid.

[Double sensitization to PR10 and PR-14 proteins]. / Doppelsensibilisierung auf PR-10- und PR-14-Proteine.

A patient with mild oral allergy syndrome presented with a history of anaphylaxis induced by both hazelnuts and peaches. The ensuing work-up showed a double sensitization to proteins in both pathogenesis-related group 10 (e.g. Bet v1, Cor a1, Pru p1) and 14 (e.g. Pru p3, Cor a8). Such double sensitization profiles are increasingly being recognized in Europe.

[Folliculotropic mycosis fungoides]. / Follikulotrope Mycosis fungoides.

BACKGROUND: Folliculotropic mycosis fungoides represents a rare variant of the CD4-positive cutaneous T-cell lymphoma mycosis fungoides. It is characterized by tropism of the lymphocytic infiltrate for hair follicle and other adnexal structures. CASE PRESENTATION: Our patient presented with a 20-year history of pruritic skin lesions, which had been diagnosed as atopic dermatitis. The diagnosis of folliculotropic mycosis fungoides was confirmed by skin biopsy. Since topical therapy was ineffective, systemic therapy was initiated promptly. Treatment with pegylated interferon alpha-2b 25 µg/week led to significant improvement of the skin condition. CONCLUSION: Due to its polymorphic clinical presentation, folliculotropic mycosis fungoides is diagnosed with delay and in a later stage than classical mycosis fungoides. Thus we recommend an early skin biopsy in patients with therapy-resistant pruritic skin lesions.

[Squamous cell carcinoma as the most common oral carcinoma. Diagnosis and therapy]. / Plattenepithelkarzinom als das häufigste Mundhöhlenkarzinom. Diagnostik und Therapie.

BACKGROUND: About 5 % of all malignant tumors affect oral cavity. With a share of 95% squamous cell carcinoma is the most common type of the malignant tumors of oral mucosa. CASE REPORT: In our case the patient developed a squamous cell carcinoma of buccal mucosa about 2 years after excision of verrucous leukoplakia with epithelial dysplasia at the same location. Although chronic alcohol abuse, tobacco use and infection with HPV 16 are the most important risk factors for development of squamous cell carcinoma of the oral cavity, our patient had none of these risk factors. We treated the patient in accordance with current guidelines by complete excision of the tumor as well as an elective neck dissection of the ipsilateral side. Untill the present time the patient is free of recurrence. CONCLUSIONS: Although rare, squamous cell carcinoma of oral mucosa may also occur in patients that have no risk factors for it. Therefore, every dental and medical examination in each patient should include an inspection of the entire oral mucosa.

[Anaphylaxis to PR-10 proteins (Bet v1 homologues)]. / Anaphylaxie auf PR-10-Proteine (Bet v1-Homologe).

Secondary food allergies to PR-10 proteins (Bet v1 homologues) are the most common food allergies in Germany. Clinically they present with an oral allergy syndrome (intraoral pruritus and perhaps swelling). When drinks containing PR-10 proteins are rapidly consumed, for example after sporting activities, large concentrations of allergen can be reached without any intraoral symptoms and then lead to anaphylaxis. This phenomenon has often been described for soja milk and occurred in our case with an apple drink with 60% fruit concentration. It seems likely that such cases of anaphylaxis are not adequately represented in the anaphylaxis registry.

[Morbihan disease as a special form of rosacea: review of pathogenesis and new therapeutic options]. / Morbus Morbihan als Sonderform der Rosazea: Einblick in die Pathogenese und neue Therapieoptionen.

Morbihan disease is classified as a special form of rosacea, which presents with persistent facial erythema and solid edema because of marked involvement of the lymphatic vessels. The cheeks, nose and forehead are particularly affected. Currently, the treatment options of this cosmetically very disturbing disease are limited. However, every attempt should be made to provide treatment because of the great emotional suffering of the patients. We review some new currently available therapeutic options for Morbihan disease. In our patient, we were able to achieve a significant improvement with systemic isotretinoin 30 mg/day over a period of 12 months.