[Medical rehabilitation in dermatology : Goals, program content, and application process]. / Medizinische Rehabilitation in der Dermatologie : Ziele, Inhalte und Antragstellung.

BACKGROUND: Medical rehabilitation plays an important role in the management of patients with chronic dermatoses and dermato-oncological diseases. OBJECTIVES: Which dermatological indications qualify for a medical rehabilitation? What forms need to be completed for a successful application? Which treatments are provided and what are goals to be accomplished during dermatological rehabilitation? MATERIALS AND METHODS: Evaluation of current guidelines, directives, and recommendations as well as exemplary reviews. RESULTS: Dermato-oncological diseases and every chronic dermatological disease that is associated with a limitation of body functions and structures, activity and participation is eligible for medical rehabilitation. They include need, ability to absolve a rehabilitation, and a favorable prognosis. Treatments range from therapy of the underlying dermatological condition to interdisciplinary treatment of comorbidities with the aim of restoring functional health. CONCLUSIONS: Medical rehabilitation follows a holistic approach and represents a significant addition to outpatient and acute inpatient care, often leading to a long-term improvement in clinical outcome, participation, and activity.

Rehabilitation Interventions in the Multidisciplinary Management of Patients With Sclerotic Graft-Versus-Host Disease of the Skin and Fascia.

Graft-versus-host disease (GVHD) is a multisystemic disorder that affects 30%-80% of patients who undergo allogeneic hematopoietic stem cell transplantation 10%-15% of GVHD patients develop sclerotic features affecting the skin or deeper tissues, leading to functional limitations and poor quality of life. There is limited literature regarding the indications and efficacy of specific rehabilitative interventions in sclerotic GVHD (sclGVHD). In this article, we summarize the current evidence supporting rehabilitation intervention in sclGVHD and offer our approach to the multidisciplinary management of this disease. In addition, we review techniques that have been employed in other sclerotic skin diseases (eg, iontophoresis, extracorporeal shock waves, botulinum toxin A, adipose derived stromal vascular fraction), but that require further validation in the sclGVHD setting. Ultimately, optimal care for this complex disease requires a multidisciplinary approach that includes a rehabilitation and adaptive program tailored to each patient's needs.

[Dermatological rehabilitation : Program content, opportunities and application submission]. / Rehabilitation in der Dermatologie : Inhalte, Chancen und der Weg dorthin.

Among dermatologists, the opportunities regarding medical dermatological rehabilitation for cutaneous chronic inflammatory and dermato-oncological diseases are not fully exhausted. However, rehabilitation offers the chance to approach important aspects such as comorbidities, psychosocial burden and limitations at work in addition to treating the underlying disease itself. Furthermore, rehabilitation has the potential to relieve the dermatologist from healthcare responsibilities and to achieve treatment and healthcare targets much faster. The patients themselves are the ones who profit from a holistic dermatological and social medical regimen. In the following article the reader learns about the details of a specific dermatological rehabilitation program, how to successfully apply for it and which wording is essential.

[Five years' experience of cosmetic camouflage of disfiguring skin disorders: Patient satisfaction]. / Cinq ans d'expérience d'un atelier de maquillage médical correcteur des dermatoses affichantes : évaluation par la satisfaction des patients.

INTRODUCTION: Living with disfiguring disorders can impair the emotional well-being and relationships of patients as well as their social and professional life. Since 2010, courses in medical cosmetic correction for disfiguring diseases have been conducted at the dermatology department of the Timone University Hospital in Marseille and they form part of an educational program. The aim of this study was to assess the satisfaction of patients taking part in this program. PATIENTS AND METHODS: This is a retrospective study of 55 patients taking part in make-up sessions from January 2010 to December 2014 and subsequently completing a questionnaire. RESULTS: The median patient age was 46 years with most being women (n=49, 89 %). They presented pigmentary disorders (54.5 %), inflammatory diseases (27.3 %) and scars (18.2 %). 75 % of patients stated that they had improved their knowledge and 82 % remarked that the technique was personalized to their needs. The technique was considered as easy by 62 % and reproducible by 87 % of patients. 55 % of patients considered that cosmetic camouflage improved their quality of life and 56 % stated that it helped them accept the gaze of others. CONCLUSION: In our study skin camouflage appears easy to use and meets patient expectations.

Evaluation of the Role of Balneotherapy in Rehabilitation Medicine.

Balneotherapy is a treatment with healing waters, which includes bathing and physiotherapy in thermal water, therapeutic drinks, medical massage, and water jet massage. It is based on the buoyancy, physical properties, temperature, and chemical effects of mineral water. Throughout European and Japanese medical institutions, balneology and hot spring therapy is very much a part of routine medical treatment. The mechanism of balneotherapy is not yet completely understood. Balneotherapeutic procedures are mainly performed for the prevention, treatment, and rehabilitation of musculoskeletal diseases, but they have also proven useful for various other indications such as for the treatment or rehabilitation of dermatological diseases, immuno-inflammatory diseases, chronic pain syndromes, chronic cardiac diseases, and metabolic syndromes or neurological diseases as well as in the rehabilitation of patients with psychiatric conditions. Balneotherapy works well in the case of muscle tension, as it is relieving and relaxing, and it may be associated with improvement of various diseases. However, further investigations are necessary to determine the effectiveness, safety, standard procedures, and potential side effects of balneotherapy.

Validity and internal consistency of the French version of the revised Skin Management Needs Assessment Checklist in people with spinal cord injury.

STUDY DESIGN: Cross-sectional psychometrics study. OBJECTIVES: To determine the construct validity and internal consistency of the revised Skin Management Needs Assessment Checklist (revised SMnac). SETTING: Six spinal cord rehabilitation centers. METHODS: One-hundred and thirty-two community-dwelling individuals with spinal cord injury (SCI) were included. Construct validity was assessed by a Spearman's rank correlation coefficient between the revised SMnac and several questionnaires: Rosenberg Self-Esteem Scale, Ways of Coping Questionnaire, Hospital Anxiety and Depression Scale (HADS), Braden scale; or clinical variables: educational level, presence of a pressure ulcer (PU), history of multiple PUs, time since injury, and pain. RESULTS: The study evidenced construct validity with a fair to moderate correlation coefficient between the revised SMnac and Rosenberg scale (rs = 0.25; p = 0.03), active coping (rs = 0.29; p = 0.001), HADS (rs = -0.43; p < 0.0001), and time since injury (rs = 0.49; p < 0.0001). The presence of PU and history of multiple PUs were strongly correlated with the revised SMnac score (respectively, p = 0.01 and 0.001). Internal consistency was excellent (α = 0.907). CONCLUSION: These results show that the revised SMnac is a valid tool to assess PU self-management in individuals with SCI. Further studies are needed to assess the revised SMnac's responsiveness to change.

[Rehabilitation of Children and Adolescents with Chronic Skin Diseases]. / Rehabilitation von Kindern und Jugendlichen mit chronischen Hauterkrankungen.

Chronic skin diseases are a common indication for inpatient rehabilitation in children and adolescents. Atopic eczema and psoriasis play the most important role. But other rare congenital dermatoses such as ichthyoses or epidermolysis bullosa can also be rehabilitated. Patients with skin diseases are often considerably stigmatized and report a limited quality of life and participation. The somatic and psychosocial development of the children is also often severely affected by severe forms of the diseases. The concept of inpatient rehabilitation is, on the one hand, the development of an individually adapted topical therapy plan, which often follows a step concept and is adapted to the severity of the skin symptoms. On the other hand, the disease management of children and affected families is promoted. Specific skills such as dealing with itching, learning of cream and dressing techniques, as well as the targeted application of medical baths with suitable additives are taught and practiced. In addition, the motivation for an adapted dealing with the disease and specific resources is promoted in order to comply better with the considerable psychosocial burdens.The results after the rehabilitation show, depending on the basic disease, not only an improved skin condition but also an improved quality of life and participation.

Impact of Cosmetic Camouflage on the Quality of Life of Children With Skin Disease and Their Families.

BACKGROUND/OBJECTIVES: Cosmetic camouflage is known to improve quality of life in adults. Few data are available regarding cosmetic camouflage in children, and thus it is not often selected as a mode of treatment. We sought to determine whether cosmetic camouflage leads to improved quality of life of pediatric patients with visible dermatoses and their parent or primary caregiver. METHODS: Patients aged 5 to 17 years with visible skin disease and their parent were assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Family Dermatology Life Quality Index (FDLQI) before and after consultation regarding cosmetic camouflage. RESULTS: Twenty-two children with skin conditions were included in the study. The mean CDLQI decreased from 6.82 (SD = 1.28) to 3.05 (SD = 0.65; P = .0014), while the mean FDLQI decreased from 7.68 (SD = 1.15) to 4.68 (SD = 0.92; P = .0012). CONCLUSIONS: Our study highlighted improvement in quality of life in patients with skin disorders who were managed with cosmetic camouflage.

Prophylaxis and rehabilitation of patients with chronic dermatosis (review of literature).

The article covers main aspects of sanatorium-and-spa treatment in chronic skin diseases.

¿Qué genodermatosis es? / Can You Identify the Genodermatosis?

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Wound care management of a patient with stage III lymphedema.

PURPOSE: The sequelae for patients living with stage III lymphedema, including immobility, functional impairment, isolation and emotional burden, that affect quality of life are highlighted. METHOD: The case patient's medical history upon initial evaluation, descriptive wound characteristics and treatment plan are described in detail. RESULTS: A comprehensive treatment regimen resolved the patient's wound. DISCUSSION: The definition, staging and prevalence of lymphedema are reviewed. CONCLUSION: Successful lymphedema wound treatment includes working with experienced healthcare providers, management of wound drainage and odor, the use of higher pressure compression, and complying with lifestyle changes.

Dermatological rehabilitation.

Chronic and chronically recurring diseases often cannot be treated causally and usually lead to a considerable impairment in social and occupational participation. In order to deal appropriately with such restrictions, a more comprehensive therapeutic approach is required in the sense of a bio-psychosocial model of disease and health which serves as the basis for modern dermatological rehabilitation. Multimodal, quality-controlled dermatological rehabilitation gives patients with chronic skin diseases a treatment option that goes beyond the primarily symptom-oriented outpatient care provided by office-based physicians and the acute care of inpatient facilities. This paper presents the complex opportunities offered by dermatological rehabilitation. The aim of this paper is to put dermatologists working in the practical field in a position to help their patients with chronic skin diseases to realize their statutory right to participate in society. For this purpose, it will impart the understanding of medical rehabilitation that is necessary so that the dermatologist in charge can advise his or her patient competently, in order to successfully arrange for the corresponding care appropriate to the indication and taking into account personal circumstances and insurance-related requirements.

[Behavioral problems of somatic chronically ill adolescents: parent-child-agreement and differences]. / Verhaltensauffälligkeiten bei körperlich chronisch kranken Jugendlichen: Übereinstimmungen und Unterschiede im Selbst- und Elternurteil.

BACKGROUND: Adolescents with a chronic somatic disease often show comorbid mental health problems which interfere with adherence and disease management. As adolescents often pass their rehabilitation treatment without their parents and therapists frequently lack resources necessary for assessing information from both the patients and their parents, the question arises what conclusions can be drawn on the basis of self report data only and how general agreement between parent and adolescents can be rated. METHODS: Parent-child-agreement of chronically ill adolescents and their families are analyzed using intra-class-correlation (ICC). Data of 367 adolescents with obesity, chronic respiratory disease, skin disease and diabetes between the age of 12.0 and 16.11 years were collected at the beginning of rehabilitation treatment. Parents received their questionnaire via post. Psychological symptoms were identified using the German version of the Strength and Difficulties Questionnaire (SDQ-Deu). RESULTS: There was medium to high agreement between parent and child ratings regarding "emotional problems", "peer relationship problems" and "total difficulty score" for all diagnoses. CONCLUSIONS: Therapists of chronically ill adolescents can act on the assumption that parent-child-agreement is medium to high. Consequently, self-ratings appear a useful diagnostic indicator for rehabilitation treatment.

[International Classification of Function, Disability and Health (ICF). Basis for cutaneous rehabilitation management]. / Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF). Grundlage des Handelns und Denkens in der dermatologischen Rehabilitation.

Functioning and health are central issues in medical rehabilitation. With the International Classification of Functioning, Disability and Health (ICF), the World Health Organization implemented in 2001 a system for the description and classification of functioning that is accepted worldwide. Applying the bio-psycho-social perspective, this model based on interdependencies, comprises the components Body Function, Body Structure and Activity and Participation as well as contextual influences of health: the Environmental and Personal factors. The ICF is of prime importance in clinical practice, teaching, and research. It provides a universal language to be used in health care permitting the characterization of the specific functional problems of individuals. The rehabilitation of skin diseases takes advantage on the ICF in rehabilitation management. In this paper we describe the philosophy of the ICF and its implementation in rehabilitation of patients with chronic skin problems on the basis of a case study.