[Off-label prescription of drugs in the statutory health insurance]. / Off-Label-Use von Arzneimitteln in der gesetzlichen Krankenversicherung.

Prescribing a medication for a condition not described in the label approved by national and international regulatory bodies (in Europe the EMEA, European Medicines Agency) is a medical necessity recognised by law. In many clinical fields, studies allowing approval of drugs are lacking. Nonetheless doctors are obliged to prescribe off-label medication in certain situations. In this tension of conflicting interests, knowledge of the applicable standards is essential. Due to the various aspects concerning social and drug law, civil and even criminal law on the one hand and requirements for therapy and diagnostic guidelines and criteria set by evidence-based medicine on the other, the subject matter becomes complex and intricate. The legal and medical facts are described and practical advice is presented for dealing with the issue in hospital and general practice.

[The international classification of functioning, disability and health (ICF) in dermatological rehabilitation: conception, application, perspective]. / Die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) in der Dermatologischen Rehabilitation: Konzept, Anwendung, Perspektive.

Medical rehabilitation represents the interdisciplinary management of a person's functional health. This term implies concepts of functioning, disability and health and represents the core notion of the international classification of functioning, disability and health (ICF). Four components -- anatomic structure, body functions, activities and participation, environmental factors and personal factors -- make the ICF applicable from a biological, individual and social perspective. At present the ICF is used as a system of classification, a research tool and as a theoretical basis in rehabilitation medicine. Its clinical application will depend on the improvement of its practicability and compatibility with currently used tools in dermatologic rehabilitation. ICF offers the opportunity to define, weight and classify diseases of the skin and their psychosocial consequences.

[Stigmatization and quality of life of patients with psoriasis and atopic dermatitis]. / Stigmatisierungsgefühl und Lebensqualität bei Patienten mit Psoriasis und Neurodermitis.

BACKGROUND AND OBJECTIVE: Psoriasis and atopic dermatitis patients are often influenced by the psychosocial consequences of their skin diseases. In order to assess these experiences reliably, the stigmatization feeling and the quality of life of these patient groups were studied. PATIENTS/METHODS: The short form of the "Questionnaire on Experience with Skin Complaints" (QES) was validated in a sample of 463 in-patients with psoriasis and atopic dermatitis. In addition, the Dermatology Life Quality Index (DLQI) was ascertained. RESULTS: The dimensions "impairment of self-esteem and withdrawal", "rejection experienced", "concealment", and "composure" of the QES could be confirmed by factor analysis. As expected, middle high correlations between the QES and the DLQI were found in both patient groups. However, the stigmatization experience and the quality of life were not significantly different in a subgroup of psoriasis and atopic dermatitis patients with comparable sociodemographic characteristics. CONCLUSIONS: The short form of the QES with 23 items is a valid instrument for the examination of social and psychic burdens of psoriasis and atopic dermatitis patients. The recording of the stigmatization feeling and of the quality of life determines different, supplementary aspects of the illness-related stress of patients with chronic skin diseases.

[A case of giant condyloma acuminatum. On differential diagnosis of giant condylomas from Buschke-Löwenstein tumors and verrucous carcinoma]. / Ein Fall von Condyloma acuminatum giganteum. Zur Differentialdiagnose der Riesenkondylome von den Buschke-Löwenstein-Tumoren und dem verrukösen Karzinom.

We report on a 67-year-old man with a large papillomatous tumour of the penis clinically resembling verrucous carcinoma. HPV 6 and HPV 11 DNA could be isolated by hybridization techniques. The tumour showed exclusively exophytic growth with anastomosing acanthosis and papillomatosis. Groups of vacuolated cells were present in the spinous and granular layers. Endophytic and destructive proliferations and cytologic criteria of malignancy were absent. This tumor was a giant condyloma acuminatum and not either a Buschke-Löwenstein tumour or a verrucous carcinoma. There was no recurrence 2 years after local excision. The differential diagnosis of giant condylomas and Buschke-Löwenstein tumours is discussed.

Stasis papillomatosis. Clinical features, etiopathogenesis and radiological findings.

Stasis papillomatosis can be divided into localized and widespread forms. Ten patients with this disease are discussed with emphasis on their clinical and lymphoradiological findings. Using isotope lymphography we were able to find an overall lymphostasis in only four patients. In all patients, local lymphatic disturbances were detected by means of indirect lymphography with intradermal lymph cysts as the most specific sign. Local dermal lymphostasis seems to be the common final pathogenesis in spite of different etiologies (ie, primary lymphedema, chronic venous insufficiency, trauma recurrent erysipelas, and local lymphangiodysplasia of unknown origin). A maximum variant was seen, following en-bloc resection of subcutaneous tissue in a patient suffering from congenital lymphedema.

De Sanctis-Caccione syndrome: xeroderma pigmentosum with oligophrenia, short stature and neurologic disorders. / De-Sanctis-Cacchione-Syndrom: Xeroderma pigmentosum mit Oligophrenie, Minderwuchs und neurologischen Störungen.

A 6 year-old boy with de Sanctis-Cacchione syndrome is reported. This syndrome is characterized by the triad xeroderma pigmentosum (XP), mental deficiency and neurological disturbances. The patient's cells were assigned to genetic complementation group A by use of the cell fusion technique. DNA repair capacity as measured by unscheduled DNA synthesis (UDS) was drastically reduced to 7.5%, compared with 100% of the controls. The rate of sister chromatid exchange (SCE), an indicator of the hypermutability in XP, was clearly elevated after ultraviolet radiation of skin fibroblasts of the patient.

[Tumor form of lymphostatic papillomatosis of the skin]. / Tumorform einer Papillomatosis cutis lymphostatica.

The case of a patient with two plantar papillomatous tumours that had had a relapsing course over 10 years is presented. The tumours were located on the right forefoot and the left great toe. Several operations were performed for different diagnoses, i.e. plantar verrucae, verrucous carcinoma and pyoderma vegetans. Histologically, the papillomas proved to be pseudocarcinomatous hyperplasias with multiple ectatic dermal lymph plexuses. Indirect lymphography revealed a circumscribed lymphatic dysplasia with cystic-ectatic cutaneous vessels within the tumour area. Draining lymphatic collectors were conspicuously reduced in number. Isotope lymphography showed a normal lymph transport rate from the foot to the groin. It is concluded that the circumscribed disturbance of lymphatic drainage is the decisive cause of the reactive papillomatous hyperplasia. Thus, these papillomas clinically resembling verrucous carcinoma represent the tumour variant of a papillomatosis cutis lymphostatica.

[Ichthyosis and alopecia after maprotiline: corneolysis caused by temporary disorder of keratinization]. / Ichthyose und Alopezie nach Maprotilin: Korneolyse infolge passagerer Keratinisierungsstörung.

A 37-year-old woman developed ichthyosiform desquamation of the skin and a severe diffuse alopoecia 3 weeks after taking the antidepressant maprotilin. No signs of inflammation were present. Histology revealed acanthosis with preserved stratum granulosum, follicular hyperkeratosis and dystrophic changes of the hair follicle. Electron microscopy revealed rarefication of tonofilaments and necrobiotic changes of epidermal keratinocytes with vacuolar degeneration of the cytoplasm and disorganization of the organelles. Pathogenetically this disease represents a drug-induced transitory disorder to keratinization, which had resulted in desquamation of the stratum corneum and alopecia. The authors propose the designation corneolysis for this pathogenetic principle.