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1.
Hautarzt ; 70(11): 854-863, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31584113

RESUMO

The project "Pain-free Hospital" was the first attempt to improve the level of postoperative care by standardizing pain therapy standards (concepts) in the individual surgical disciplines. Dermatosurgery is no exception. In addition to drug therapy, it is also important to consider biopsychosocial aspects of the symptom pain, as this is the only way to prevent chronification of acute pain in the further course of a disease. Drug therapy should not only be adapted to the classic WHO system (only considering pain intensity), but should also address aspects of pain quality. In this article, we discuss these aspects in more detail and present our treatment concept for dermatosurgery.


Assuntos
Procedimentos Cirúrgicos Dermatológicos , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Dor , Humanos , Medição da Dor
3.
J Eur Acad Dermatol Venereol ; 32(1): 102-107, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28859231

RESUMO

BACKGROUND: Negative pressure wound therapy (NPWT) is an established treatment modality in dermatologic surgery, but proof of evidence for efficacy is inconclusive. PURPOSE: To evaluate patient characteristics, treatment modalities and outcomes in a single dermatosurgery centre with NPWT applied over chronic and acute surgical wounds. METHODS: Of all surgical patients between 2008 and 2015, we selected those who were treated and hospitalized due to NPWT for treatment of acute and chronic wounds. The medical records of 188 patients were retrospectively evaluated and statistically calculated. RESULTS: Method of surgical defect closure depends significantly on localization of the surgical defect, cardiovascular comorbidity and age. Hence, outcome depends significantly on the surgical situation that indexes NPWT, the underlying diagnosis and the vacuum system used, but is not associated with distinct treatment modalities or gender of the patients. Hospitalization significantly depends on the vacuum system used, surgical situation that indexes NPWT and underlying diagnoses. CONCLUSION: NPWT has a fixed role in distinct, well-defined clinical indications in dermatosurgery as the treatment of acute surgical wounds, fixation of skin grafts and treatment of skin substitutes, as well as an important treatment option for refractory, superinfected chronic wounds in dermatologic patients.


Assuntos
Procedimentos Cirúrgicos Dermatológicos , Tratamento de Ferimentos com Pressão Negativa , Neoplasias Cutâneas/cirurgia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Desbridamento , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Feminino , Humanos , Úlcera da Perna/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele
4.
Phys Rev Lett ; 121(25): 256602, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30608835

RESUMO

We report a study of quantum oscillations in the high-field magnetoresistance of the nodal-line semimetal HfSiS. In the presence of a magnetic field up to 31 T parallel to the c axis, we observe quantum oscillations originating both from orbits of individual electron and hole pockets, and from magnetic breakdown between these pockets. In particular, we reveal a breakdown orbit enclosing one electron and one hole pocket in the form of a "figure of eight," which is a manifestation of Klein tunneling in momentum space, although in a regime of partial transmission due to the finite separation between the pockets. The observed very strong dependence of the oscillation amplitude on the field angle and the cyclotron masses of the orbits are in agreement with the theoretical predictions for this novel tunneling phenomenon.

5.
Hautarzt ; 69(1): 48-57, 2018 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-28983646

RESUMO

In order to avoid chronification of pain, appropriate treatment has to be started as early as possible. Inpatient dermatology patients not only suffer from old age and associated multimorbidities but also from characteristic pain due to distinct dermatological diseases. In many cases clinicians have little experience with specific pain treatment but instead have many concerns about how to deal with analgesics. So far chronic pain has been treated according to the pain ladder of the World Health Organization (WHO), which prioritizes the intensity of pain. This article presents an easily implementable concept of pain therapy with special emphasis on the quality of pain. This provides information on whether it is neuropathic or nociceptive pain, which can ultimately be differentially treated. The primary aim is to provide treating dermatologists with a concept to assist in the initiation of an efficient and correct pain therapy. This brief introduction of an individualized pain treatment can reduce the risk of chronification of pain, which can severely impair the quality of life particularly in dermatology patients and also the frequent stigmatization due to the dermatosis.


Assuntos
Assistência Ambulatorial , Dermatologia , Dermatopatias/terapia , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Dor Crônica/classificação , Dor Crônica/terapia , Quimioterapia Combinada , Intervenção Médica Precoce , Humanos , Neuralgia/classificação , Neuralgia/terapia , Dor Nociceptiva/classificação , Dor Nociceptiva/terapia , Medição da Dor , Dor Pós-Operatória/classificação , Dor Pós-Operatória/terapia , Equipe de Assistência ao Paciente , Encaminhamento e Consulta , Dermatopatias/classificação
6.
HNO ; 66(7): 559-561, 2018 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-29177532

RESUMO

We report the case of a 19-year-old patient who presented with recurrent circular and scaly skin changes. The patient reported wrestling as his main leisure activity. After an unsuccessful attempt at local antibiotic treatment, detailed dermatological work-up revealed the skin changes to be tinea corporis gladiatorum. According to dermatological guidelines for dermatophytosis, systemic treatment with fluconazole and local ointments containing ciclopirox olamine and ketoconazole were administered, which rapidly led to significant improvement.


Assuntos
Tinha , Luta Romana , Humanos , Tinha/diagnóstico , Adulto Jovem
7.
Scand J Rheumatol ; 46(4): 288-295, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27996340

RESUMO

OBJECTIVE: To evaluate the influence of geographic variation on the risk of digital ulcer (DU) development in systemic sclerosis (SSc) patients. METHODS: This cross-sectional, multicentre study evaluated patients with SSc from centres located in different geographic regions of Brazil (subtropical and tropical climate zones). Demographic and clinical data were collected. RESULTS: The study included 141 patients with SSc (26 from the subtropical and 115 from the tropical zone). In total, 43 DUs were observed in 23 (16%) of the patients. By a simple logistic regression model, the presence of DUs was associated with a higher modified Rodnan skin score, previous necrosis or amputation of the extremities, flexion contracture of the fingers, active smoking, higher avascular score on capillaroscopy, higher severity of Raynaud's phenomenon, a higher Health Assessment Questionnaire Disability Index (HAQ-DI) score, a higher visual analogue scale score for Raynaud's phenomenon and overall disease, and the subtropical climate zone. Using multiple logistic regression, the presence of DUs was significantly associated with patients living in the subtropical climate zone [odds ratio (OR) = 5.4, p = 0.002], necrosis or amputation (OR = 5.2, p = 0.011), and a higher HAQ-DI score (OR = 2.6, p = 0.021). CONCLUSION: In this multicentre study in a continental country with different climates, patients with SSc living in a subtropical climate region had a 5.4 times higher risk of developing DUs than patients living in a warmer region (tropical climate), suggesting a more severe course of peripheral vasculopathy among patients living in geographic regions with relatively cold weather.


Assuntos
Dedos , Sistema de Registros , Escleroderma Sistêmico/epidemiologia , Úlcera Cutânea/epidemiologia , Adulto , Brasil , Contratura/epidemiologia , Estudos Transversais , Feminino , Dedos/irrigação sanguínea , Geografia , Humanos , Modelos Logísticos , Masculino , Angioscopia Microscópica , Pessoa de Meia-Idade , Razão de Chances , Doença de Raynaud/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Fumar/epidemiologia
8.
Hautarzt ; 67(5): 359-64, 2016 May.
Artigo em Alemão | MEDLINE | ID: mdl-26909810

RESUMO

Only a few cases of contact allergic gastritis in patients with nickel allergy have been reported in the literature. We report a case of probable contact-allergic gastritis in a 46-year-old woman. Clinical examination revealed lichenoid mucosal lesions of the gums adjacent to a bridge and crowns that had been implanted several weeks previously. Since implantation, the patient suffered from gastrointestinal complaints including stomach pain. Gastroscopy and histological investigation of stomach biopsies showed eosinophilic gastritis. Patch testing done under the diagnosis of contact allergic stomatitis showed positive reactions to gold sodium thiosulphate, manganese (II) chloride, nickel (II) sulphate, palladium chloride, vanadium (III) chloride, zirconium (IV) chloride, and fragrances. The crowns and the bridge contained gold, palladium, and zirconium, hence they were replaced by titan-based dentition. Shortly after replacing the artificial dentition, all gastrointestinal symptoms resolved spontaneously without further treatment. Delayed-type allergy to components in the artificial dentition seem to have caused the gastritis.


Assuntos
Coroas/efeitos adversos , Dermatite de Contato/diagnóstico , Dermatite de Contato/etiologia , Gastrite/diagnóstico , Gastrite/etiologia , Metais/administração & dosagem , Adulto , Materiais Dentários/efeitos adversos , Dermatite de Contato/prevenção & controle , Diagnóstico Diferencial , Feminino , Gastrite/prevenção & controle , Humanos , Testes do Emplastro/métodos
9.
HNO ; 63(7): 523-34; quiz 535-6, 2015 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-26160004

RESUMO

About 15% of all cutaneous melanomas develop in the head and neck region. Mucosal melanomas are rare and represent only 1% of all melanomas, however, most frequently, these are located in the nose, the paranasal sinuses and the oral cavity. Visual diagnosis and reflected-light microscopy are relevant for the evaluation of melanoma-suspect lesions. Histological investigation of resected tumors need special skills of the histopathologist and includes in case of high-risk tumors investigations of mutations in the tumor tissue concerning NRAS, BRAF and KIT. The risk of lymphatic or hematogeneous spread rises with increasing tumor thickness and the presence of further prognostic risk factors such as ulceration of the primary tumor or the presence of mitoses within the tumor.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Melanoma/patologia , Neoplasias Cutâneas/patologia , Neoplasias de Tecidos Moles/patologia , Diagnóstico Diferencial , Humanos
10.
HNO ; 63(8): 593-602; quiz 603-4, 2015 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-26219523

RESUMO

Resection margins of melanomas in the head and neck region often have to be adapted according anatomical circumstances. In the case of thicker primary tumors or after complete resection of locoregional lymph node metastases, adjuvant therapy with interferon-α can be performed; in some cases, adjuvant radiotherapy may also be indicated. In the case of inoperable lymph node or distant metastases, systemic treatment is required. Beside well-established mono- or polychemotherapy regimens, newer targeted therapies with BRAF inhibitors (vemurafenib, dabrafenib), mitogenic-activated protein kinase (MEK) inhibitors (trametinib, binimetinib, and cobimetinib), and kinase inhibitors (imatinib, sunitinib, nilotinib, dasatinib) are also available.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimiorradioterapia/métodos , Neoplasias de Cabeça e Pescoço/terapia , Melanoma/terapia , Recidiva Local de Neoplasia/terapia , Neoplasias Cutâneas/terapia , Terapia Combinada/métodos , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Melanoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico
11.
Zentralbl Chir ; 138(5): 521-9, 2013 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-23460105

RESUMO

The spinal cord is particularly susceptible to ischaemic injury following repair of extensive descending thoracic and thoracoabdominal aortic aneurysms (TAAA). For the past decade, the Mount Sinai group in New York has intensively studied the anatomy of the extensive vascular network surrounding the spinal cord, as well as its dynamic morphology in response to decreased blood pressure and flow. Along with clinical data, experimental findings gave rise to the Collateral Network Concept, by which spinal cord injury in open TAAA repair can be significantly reduced. With the more recent widespread use of endovascular repair, strategies to prevent ischaemic spinal cord damage after extensive segmental artery sacrifice/occlusion are still evolving. The hypothesis that dividing extensive aneurysm repair into two steps may mitigate the impact of diminished blood flow to the collateral network has led to a recently conducted series of staged repair experiments. By exploiting the resources of the collateral network, spinal cord injury could be minimised in staged open, as well as in staged hybrid repair and seems equally adoptable for endovascular procedures. The contribution presented herein provides an overview of clinical and experimental studies on the staged approach. Furthermore, it briefly assesses the anatomic rationale for the collateral network concept.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Complicações Intraoperatórias/prevenção & controle , Isquemia do Cordão Espinal/prevenção & controle , Circulação Colateral/fisiologia , Procedimentos Endovasculares/métodos , Alemanha , Humanos , Complicações Intraoperatórias/etiologia , Reoperação , Medula Espinal/irrigação sanguínea , Isquemia do Cordão Espinal/etiologia , Pesquisa Translacional Biomédica
12.
Hautarzt ; 64(1): 47-51, 2013 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-22915250

RESUMO

A five-day-old female infant presented with congenital red-livid papules and nodules on the head, chest, back and left arm. The nodule on the chest was ulcerated at birth. The pregnancy and delivery were uneventful. There was no history of birth trauma to account for the ulcerated lesion. The parents and the three older siblings were healthy without similar skin lesions. The skin biopsy showed in the deep layer of the dermis a multinodular, granulomatous histiocytic infiltrate. The histiocytic cells expressed S-100 and CD1a. There were additionally many eosinophils. The suspected diagnosis Langerhans cell histiocytosis was confirmed by the histologic results. The patient was referred to pediatric hematology-oncology where evaluation showed no evidence of systemic involvement. The clinical, radiological, sonographic and histological results led to the diagnosis of a congenital, monosystemic, oligolesional Langerhans cell histiocytosis of the skin. In addition to the case presentation, we review the current stand of knowledge of the pathogenesis, the clinical classification and the therapy of the Langerhans cell histiocytosis.


Assuntos
Histiocitose de Células de Langerhans/patologia , Dermatopatias/patologia , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Doenças Raras/patologia
13.
Br J Dermatol ; 167(2): 348-58, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22512270

RESUMO

BACKGROUND: Primary cutaneous B-cell lymphomas (PCBCL) are subdivided into the aggressive form, primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT) and two subtypes of indolent behaviour (primary cutaneous follicle centre lymphoma and primary cutaneous marginal zone B-cell lymphoma). The difference in clinical behaviour can be explained by the tumour cell itself, or the lymphoma microenvironment including the antitumour immune response. OBJECTIVES: To investigate the presence of regulatory T cells (Treg), CD4+CD25+FOXP3+, in the microenvironment of PCBCL in correlation with clinical outcome. METHODS: Tumour specimens of 55 consecutive cases of PCBCL were blinded and analysed for FOXP3, CD4 and CD25 expression by immunohistochemistry. Confocal images were taken with a Leica SP5. Statistical analyses were performed to determine significance. The test was considered significant when P<0.05. RESULTS: The CD4 and FOXP3 expression as well as the CD4/FOXP3 ratio were significantly increased in PCBCL of indolent behaviour in contrast to PCLBCL, LT (P=0.0002 for CD4, P<0.0001 for FOXP3 and P=0.0345 for FOXP3/CD4 ratio). CD25 expression did not differ in the three groups (P=0.9414). Within the group of patients with PCLBCL, LT we identified a subgroup with FOXP3+ tumour cells as demonstrated by CD20/FOXP3 double stainings. Patients with FOXP3+ PCLBCL, LT tumour cells showed a better prognosis on Kaplan-Meier analysis. CONCLUSION: High numbers of Treg in the lymphoma microenvironment correlate with a better prognosis in PCBCL. In PCLBCL, LT the presence of FOXP3+ tumour cells is beneficial for prognosis suggesting that FOXP3 expression of PCLBCL, LT tumour cells might serve as a tumour suppressor.


Assuntos
Biomarcadores Tumorais/metabolismo , Fatores de Transcrição Forkhead/metabolismo , Linfoma de Zona Marginal Tipo Células B/metabolismo , Linfoma Difuso de Grandes Células B/metabolismo , Neoplasias Cutâneas/metabolismo , Idoso , Idoso de 80 Anos ou mais , Antígenos CD4/metabolismo , Feminino , Humanos , Subunidade alfa de Receptor de Interleucina-2/metabolismo , Estimativa de Kaplan-Meier , Linfoma de Zona Marginal Tipo Células B/mortalidade , Linfoma Difuso de Grandes Células B/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/mortalidade , Microambiente Tumoral
14.
Hautarzt ; 63(3): 230-2, 2012 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-22382306

RESUMO

The diagnosis of scabies is clinically not always simple without the detection of mites. Histology can be difficult, particularly without clinico-pathologic correlation. [corrected] Even after adequate antiscabies treatment the dermatological symptoms and complaints can persist and necessitate an [corrected] intensive follow-up treatment. The case example described here underlines that in consideration of the multifaceted clinical appearance and the sometimes difficult detection of mites, scabies should always be considered as a differential diagnosis in cases of persistent pruritis.


Assuntos
Prurido/etiologia , Escabiose/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Humanos , Tecido Linfoide/patologia , Masculino , Prurido/patologia , Escabiose/patologia , Pele/patologia
15.
Hautarzt ; 63(5): 411-4, 2012 May.
Artigo em Alemão | MEDLINE | ID: mdl-21971770

RESUMO

Diagnosis of scarring alopecia is a particular diagnostic and therapeutic challenge. Frontal fibrosing alopecia was first described by Kossard as a scarring alopecia characterized by progressive recession of the frontal-temporal hair margins leading to permanent alopecia. Primarily affected are postmenopausal women. A 56 year-old woman presented with fibrosing alopecia in a male-pattern distribution. Evaluation of medical history, clinical, dermoscopic and histopathological findings led us to the diagnosis of frontal fibrosing alopecia with additional androgenetic pattern. Other forms of scarring alopecia have to be considered as differential diagnoses. This case emphasizes that dermoscopy of the scalp should become an integral part of the diagnosis of scalp diseases.


Assuntos
Alopecia/patologia , Alopecia/terapia , Glucocorticoides/uso terapêutico , Dermatoses do Couro Cabeludo/patologia , Dermatoses do Couro Cabeludo/terapia , Terapia Ultravioleta/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Hautarzt ; 62(10): 770-3, 2011 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-21437705

RESUMO

Reticulated telangiectatic erythema (RTE) is a rare skin reaction to extraneous materials. We present three cases in which asymptomatic persistent erythemas developed in the area of implantation after medical devices were inserted. Topical and systemic treatment did not improve the skin changes. Patch testing including applied materials showed negative results in all cases. Histological investigation of punch biopsy specimens showed moderate dilatated vessels and a slight lymphocytic infiltrate. Due to our findings and in synopsis with the clinical impression we diagnosed RTE. As RTE is asymptomatic in most cases, the devices need not be removed.


Assuntos
Desfibriladores Implantáveis , Terapia por Estimulação Elétrica/instrumentação , Eritema/etiologia , Reação a Corpo Estranho/etiologia , Bombas de Infusão Implantáveis , Próteses e Implantes , Telangiectasia/etiologia , Adulto , Idoso , Remoção de Dispositivo , Eritema/diagnóstico , Eritema/patologia , Feminino , Reação a Corpo Estranho/diagnóstico , Reação a Corpo Estranho/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro , Região Sacrococcígea , Pele/patologia , Linfócitos T/patologia , Telangiectasia/diagnóstico , Telangiectasia/patologia
18.
Br J Dermatol ; 164(2): 257-62, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20849467

RESUMO

BACKGROUND: Blaschkitis (BL) and lichen striatus (LS) are rare dermatoses occurring along the Blaschko lines of the skin with preferential occurrence in distinct age categories. Controversy exists regarding the pathogenesis and classification of BL and LS within the spectrum of blaschkolinear dermatoses. OBJECTIVES: To describe the clinicopathological characteristics of six cases of BL/LS with special emphasis on immunophenotyping the inflammatory infiltrate. Additionally, we review and critically discuss current concepts of the blaschkolinear dermatoses. METHODS: Skin biopsies from six patients with BL and LS were analysed retrospectively. The immunophenotypes of the inflammatory cells were determined and related to clinical features. RESULTS: The clinical characteristics of the diseases occurred equally in both genders and all ages. BL and LS had similar histopathological findings with respect to epidermal changes and composition of the inflammatory infiltrates. Characteristically, a lichenoid lymphocytic infiltrate with exocytosis of inflammatory cells and obvious alterations of the interface zone was observed. CONCLUSIONS: We characterize the two main blaschkolinear dermatoses BL and LS sensu stricto morphologically and open new insights into the pathogenesis of these diseases. We propose the concept of a wide spectrum of blaschkolinear dermatoses with BL and LS located somewhere within the spectrum. We do not think that it is helpful for clinicians to enlarge the spectrum of blaschkolinear diseases and to create numerous 'new' entities. Rather, our aim was to unify diseases with similar clinical and histopathological features and common genetic pathomechanisms underlying phenotypic variations.


Assuntos
Erupções Liquenoides/patologia , Dermatopatias/patologia , Adulto , Antígenos CD/metabolismo , Biópsia , Feminino , Humanos , Imuno-Histoquímica , Erupções Liquenoides/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dermatopatias/imunologia , Adulto Jovem
19.
Mycoses ; 54(5): e360-3, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20557465

RESUMO

Expression of CD30 is a distinct marker of lymphocytic activation, originally described in Reed-Sternberg cells of Hodgkin's disease. Recently, the first two cases in which CD30 was expressed in tissue samples derived from superficial cutaneous fungal infections have been reported. The objective of this study was to investigate the expression of CD30 in tinea corporis and to discuss the clinical relevance of CD30. Twenty-three skin biopsies from 23 patients with mycotic infections of the skin were analysed retrospectively. The immunophenotypic expression of CD30 was investigated. In the series investigated, some large CD30-positive cells located in the upper dermal infiltrate were noted in two of 23 biopsy specimens (8.7%). The existence of CD30-positive cells was independent of the density and composition of the accompanying inflammatory infiltrate. We showed that the expression of CD30 in dermatophytoses is not a consistent finding. Instead, as a sign of lymphocytic activation, CD30 expression is observed coincidentally in cutaneous fungal infections. Our data confirm the observation that CD30 antigen is expressed in a variety of benign and malignant skin disorders, including cutaneous fungal infections, probably as an epiphenomenon without clinical relevance.


Assuntos
Antígeno Ki-1/biossíntese , Pele/patologia , Tinha/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Histocitoquímica , Humanos , Imuno-Histoquímica , Imunofenotipagem , Masculino , Microscopia , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Case Rep Dermatol ; 2(3): 165-168, 2010 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-21060774

RESUMO

We report the successful treatment of plaque-like sclerodermiform mucinosis using tacrolimus ointment topically. We present a 70-year-old male with a large chronic erythema and hardening of the nuchal skin and shoulder area. Subjective symptoms were a moderate pruritus and a rather disabling stiffness. A biopsy specimen revealed typical features of lichen myxedematosus. In a subsequent clinical examination, no associated illnesses such as hypothyroidism or gammopathy were found. Since no established therapy exists for this condition, and as there was a lack of response to potent topical glucocorticosteroids, tacrolimus 0.03% ointment was used off-label twice daily. Surprisingly, this resulted in a rapid, almost complete clearance of the skin within three weeks of treatment.

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