[Dermatophytosis caused by rare anthropophilic and zoophilic agents]. / Dermatophytosen, verursacht durch seltene anthropophile und zoophile Erreger.

The basis for effective treatment of any dermatomycosis is the correct and timely identification of the pathogen, which allows the targeted choice of the most suitable antimycotic and is important for the prevention of repeated infections. In recent years, infections with dermatophytes seem to have increased. In fact, from 2007 to 2018, there was an increase in the number of samples processed in the Mycology Laboratory of the Department of Dermatology at the University Hospital Jena. The most common isolated dermatophytes between 2007 and 2018 were Trichophyton (T.) rubrum, T. interdigitale, Microsporum (M.) canis and T. benhamiae. However, dermatophytoses may also be caused by rare anthropophilic agents such as Epidermophyton floccosum, zoophiles such as T. verrucosum, T. quinckeanum or Nannizzia (N.) persicolor as well as by geophiles such as N. gypsea. Therefore, these dermatophytes should at least be known, so that in case of unusual observations investigations can be performed accordingly. Changes in the pathogen spectrum of dermatophytoses have taken place over time and it is expected that the occurrence of dermatophytes will be subject of continuous fluctuations, which may mean that the incidence of some of these "rare" dermatophytes, as described here in five clinical examples, may be changing.

[When sunscreens do not help: allergic contact dermatitis to UV filters]. / Wenn Sonnenschutzprodukte nicht mehr helfen: Allergisches Kontaktekzem auf UV-Filter.

Ultraviolet (UV) filters may cause allergic and more frequently photoallergic contact dermatitis. Therefore, a photopach test should always be performed in case of a suspected contact sensitivity to UV filters. We report a case of a 65-year-old woman with a recurrent erythema of the face and décolleté after sun exposure despite application of a sunscreen. The (photo)patch test revealed a contact sensitivity to the UV filter butyl-methoxybenzoylmethane. Treatment with a topical glucocorticoid and avoidance of the particular UV filter led to a rapid improvement.

Gram-negative bacterial toe web infection - a systematic review.

Gram-negative bacterial toe web infection (GNBTWI) is a frequent therapeutic challenge in clinical practice with high recurrence rates and frequent need of systemic drugs. The aim of this systematic review was to provide an updated overview and evidence-based data on pathogens, risk factors and treatment of GNBTWI along with promoting a consistent international terminology. This systematic review is based on a search in PubMed database for English and German articles published between 1980 and 2016. A total of seven articles were considered appropriate for inclusion in this review regarding to treatment and outcome. Throughout the medical literature, a variety of terms for bacterial toe web infections is used. Only few data on the incidence of GNBTWI were published. GNBTWI has been shown to have a significant male predominance. Pseudomonas aeruginosa is the most commonly identified organism beside a high mixed infection rate. We identified the following predisposing factors: interdigital tinea, occlusion and humidity, history of self-medication with antifungals, antibiotics and glucocorticosteroids. As for treatment, debridement of macerated skin lesions and the hyperkeratotic rim showed good response in three published cases. Bacteriological workup of swabs including an antibiogram is recommended for identification of the proper topical and systemic therapy. Autosensitization dermatitis and frequent recurrences are common complications of GNBTWI. Despite the fact, that GNBTWI is an accepted disease entity, scarce data on GNBTWI exist in the medical literature. Randomized controlled trials are missing although needed for evidence-based therapy. To facilitate communication and exchange of updates of GNBTWI, we promote the suggested terminology for bacterial toe web diseases.

[Polymorphic and itchy rash in a 21-year-old woman]. / Polymorphes und juckendes Exanthem bei einer 21-jährigen Frau.

Pityriasis lichenoides et varioliformis acuta (PLEVA) is a common inflammatory disease which usually occurs in children and young adults. Characteristic is a polymorph clinical picture with papules, erosions, ulcers and haemorrhagic crusts compatible with many differential diagnoses. We report about a patient with PLEVA and describe possible differential diagnoses.

[Scleredema adultorum Buschke and exulcerated necrobiosis lipoidica in diabetes mellitus type 1]. / Scleroedema adultorum Buschke und exulzerierte Necrobiosis lipoidica bei Diabetes mellitus Typ 1.

HISTORY AND ADMISSION FINDINGS: A 53-year-old woman suffering from brown plaques occasionally ulcerating at both lower legs and in the course of disease on the back of the foot presented at our department. Moreover she complained about an increasing sclerosis of her skin at the back over the last 15 years. She had suffered from diabetes mellitus type-1 for more than 40 years. INVESTIGATIONS: Skin biopsies form the ulcerated plaques showed changes typical for necrobiosis lipoidica. Biopsies of the back were diagnosed as scleredema adultorum Buschke. Laboratory tests displayed a normal antinuclear antibody titer. The differential diagnosis of systemic sclerosis could be ruled out. TREATMENT AND COURSE: We repeatedly performed debridement of ulcers, cream-PUVA therapy, applied a vacuum-sealing and topical corticosteroids at the lower legs. Meanwhile she received oral pentoxyfillin. The scleredema was treated with UVA-1 phototherapy but had to be stopped for high photosensitivity. Additionally physiotherapy was prescribed. Nonetheless the course of disease was chronic and therapy-resistant. CONCLUSION: Skin diseases are common in diabetes mellitus. Necrobiosis lipoidica and scleredema adultorum Buschke are rare complications but often refractory to treatment.

[Certificate "Tropical and Travel Dermatology (DDA)": quality-assured medical education for dermatologists with a "migration perspective"]. / Das Zertifikat "Tropen- und Reisedermatologie (DDA)" : Qualitätsgesicherte Fortbildung für Hautärzte mit "Migrationsperspektive"

Under the conditions of economic pressure in the medical system and the DRG system for hospitals in Germany, so-called "uneconomic" services and fields of specialized dermatologic competence such as pediatric dermatology, trichology, occupational dermatology and tropical dermatology are increasingly being neglected. While hospitals tend to train fewer residents in these subspecialties, there is a demand for additional high-quality training opportunities that are certified by the German Dermatologic Academy (DDA). Tropical and travel-related skin diseases are more frequently observed in Germany which can be explained by the increased world-wide travel activities, but also by the international migration from developing countries into Europe. Furthermore, dermatologists trained in Germany are working more and more also internationally. Thus, they require knowledge and experience in tropical and travel-related dermatology. The certificate "Tropical and Travel Dermatology (DDA)" was developed and published in 2013 in a cooperation between the International Society for Dermatology in the Tropics in cooperation with the German Academy of Dermatology (DDA). It consists of 3 full day teaching modules (basic, additional and special seminar). The first seminar cycle in 2013/2014 showed a high demand from dermatologists in hospitals and private practices. While the basic and the special seminars were held in Germany, the additional seminar took place in cooperation with the Regional Dermatology Training Center (RDTC) in Moshi, Tanzania. Many attending dermatologists fulfilling the requirements for the new certificate have practiced in developing countries or plan to do so. In order to gain practical experience on the basis of the knowledge acquired in the qualifying seminars, the International Society for Dermatology in the Tropics supports dermatologists to find internships and work placements in dermatological units in developing countries.

[Flagellate dermatitis after bleomycin chemotherapy in a patient with malignant germ cell tumor]. / Flagellanten-Dermatitis nach Bleomycingabe bei einem Patienten mit malignem Keimzelltumor.

HISTORY AND CLINICAL FINDINGS: A 49-year-old patient with malignant germ cell tumor within the first cycle PEB (platinum [P], etoposid [E] and bleomycin [B]) presented with an itchy linear papular erythema with discrete vesicles. The rash had appeared three days ago i. e. four days after the second application of bleomycin. INVESTIGATIONS: Visual diagnosis of a flagellate dermatitis. TREATMENT AND CLINICAL COURSE: Primary treatment consisted of systemic antihistamines, local and systemic application of steroids. Bleomycin treatment was stopped and substituted by ifosfamide. CONCLUSION: Flagellate dermatitis occurs with an incidence up to 66 % after bleomycin treatment. There is no association between bleomycin dose and incidence or severity of the lesions. Flagellate dermatitis is a self-limiting condition but hyperpigmentation may persist. Similar lesions may occur with bendamustine and docetaxel, the intake of insufficiently cooked shiitake mushrooms as well as in dermatomyositis and Still's syndrome.

Serum inhibin B as a marker for spermatogenesis.

Inhibin B generated by Sertoli cells provides negative feedback on FSH secretion. In men, inhibin B seems to be the physiologically important form of inhibin. Serum inhibin B was measured by two-site immunoenzymatic assay in 40 normal men (27 years of age) with sperm concentrations 100 +/- 9.2 x 10(6)/mL, 51 subfertile men (31 years of age) with sperm concentrations 6.8 +/- 0.8 x 10(6)/mL, 16 men with varicocele with sperm concentrations 54.3 +/- 0.8 x 10(6)/mL (31 years of age), men with hypogonadotrophic hypogonadism, men with Klinefelter syndrome, and men with obstructive and non-obstructive azoospermia. In men with normal sperm concentrations (>20 x 10(6) mL) serum inhibin B was 201 +/- 17 pg/mL and FSH 4 +/- 0.5 IU/L. Varicocele patients showed normal sperm concentrations > 20 x 10(6)/mL, normal serum inhibin B (173 +/- 21 pg/mL), and normal FSH levels (4.6 +/- 0.6 IU/L). In patients with sperm concentrations < 20 x 10(6)/mL the inhibin B level was 118 +/- 14 pg/mL and the FSH level was 10 +/- 1.1 IU/L. In all patients, except those with hypogonadotrophic hypogonadism and Klinefelter syndrome. inhibin B and FSH were inversely correlated (r = -.41, p > 0.01). There was a positive correlation between inhibin B and sperm concentrations (r = .34, p < .01). In varicocele men there was a correlation of r = .574, p < .05. Inhibin B may be a marker of exocrine testicular function and may offer an improved diagnosis of testicular dysfunction.

Painful ulcers in calciphylaxis - combined treatment with maggot therapy and oral pentoxyfillin.

BACKGROUND: Calciphylaxis is a rare syndrome developing predominantly in female patients suffering from end-stage renal disease (ESRD) with secondary hyperparathyroidism. Skin lesions begin as superficial patches that quickly progress to painful necrotic ulcers. Histopathological findings are calcification of small arteries and arterioles and infarction of subcutis and skin. The prognosis of calciphylaxis is poor due to an increased risk of systemic infection. METHODS: We report on a 50-year-old woman suffering from calciphylaxis. Initial treatments were not tolerated due to pain and therefore the patient was treated with maggot therapy and 800 mg/day of oral pentoxyfillin. RESULTS: Over a period of 6 months a complete remission of her skin lesions was achieved. CONCLUSION: Patients suffering from ulcers due to calciphylaxis may benefit from the use of maggot therapy, which cleanses ulcers and prevents systemic infection.