Epinephrine inhalers in emergency sets of patients with anaphylaxis

Emergency sets are prescribed to allow patients with anaphylaxis to treat themselves before professional aid arrives. The need for epinephrine in this setting is well‐accepted, but how it should be administered is still controversial. Epinephrine preparations can be administered orally, subcutaneously, intramuscularly or as aerosols. Primatene Mist? is one epinephrine inhaler, which is approved for asthma treatment in the USA, and InfectoKrupp^®Inhal is another one approved to support the treatment of acute laryngo‐tracheitis and of allergic reactions with a nebulizer. Both are possible components of the emergency set for patients with anaphylaxis. The following review article summarizes data currently available on the use of epinephrine preparations in first‐aid treatment of anaphylaxis. Studies have shown that the plasma concentrations needed for hemodynamic stabilization cannot be reached with epinephrine inhalers. Since most cases of hypotension in anaphylaxis cannot be effectively treated with epinephrine inhalers, the prescriber should be aware of this before including them in an emergency pack.     

Outcome survey of insect venom allergic patients with venom immunotherapy in a rural population

Background: Hymenoptera venom anaphylaxis is a frightening event that affects physical and psychical functioning. Patients and Methods: Retrospective survey of 182 Hymenoptera venom allergic patients living in a rural area using a questionnaire targeting on patients' satisfaction during therapy, fear of anaphylactic recurrences and changes in lifestyle before and after venom immunotherapy (VIT). Additionally, patients' self‐assessment of quality of life, daily outdoor time and re‐sting rate were recorded. Results: 146 patients returned the questionnaire (58.9% male, 41.1% female, 25.3% honey bee allergic, 67.8% wasp allergic, 41.1% re‐sting rate, mean follow‐up time 6.5 years).Measurement of the parameters fear,satisfaction and changes in lifestyle revealed a significant improvement after VIT.This correlated with the patients'self‐assessment of quality of life,when 89.7% declared an improvement after VIT.Although the improvement was higher in patients with re‐stings, also patients without re‐stings clearly benefited from VIT. Interestingly,females were significantly more affected by Hymenoptera venom allergy than males,whereas both genders showed a similar improvement after VIT. Conclusions: Patients with Hymenoptera venom sting allergy significantly benefit from VIT in regard to both biological and psychological outcome. VIT should still be provided to all Hymenoptera venom allergic patients as standard of care.     

PPL and MDM skin test: New test kit is helpful in detecting immediate‐type allergy to beta‐lactams

Background: The diagnosis of PPL (major determinant) and MDM (minor determinant) sensitization as relevant allergens in beta‐lactam allergy has been recently hampered by withdrawal from the market of formerly available test kits. We investigated a new PPL/MDM test kit in the work‐up of beta‐lactam allergy. Patients and Methods: 15 patients with history of beta‐lactam allergy were investigated for specific IgE and received patch, skin prick (SPT) and intracutaneous tests (ICT; immediate and late readings) using the relevant beta‐lactams. In addition the new test kit was used for parallel SPT and ICT. Results: 14 women and 1 man (16–73 years) with immediate (n = 7), delayed (n = 7) or unclear (n = 1) reactions to beta‐lactams 8–300 months previously (penicillin G/V n = 3, aminopenicillins n = 7, cephalosporins n = 4, unknown n = 2) were tested. In patients with immediate type reactions, n = 2 had specific IgE, n = 4 reacted to the new test kit (n = 3 MDM, all of whom reacted exclusively to this test, n = 1 PPL).Two patients with non‐immediate reactions reacted to other beta‐lactams. Conclusions: Our data show that the new test kit may be helpful in detecting patients with immediate type allergy to beta‐lactams. Without this test, in those three patients reacting exclusively to MDM, and oral provocation test would have been necessary to clarify their allergy. Data from larger groups of patients are needed to determine the sensitivity and specificity of this test kit.     

Quality‐of‐life in wasp venom allergy – validation of the German version of the “Vespid Allergy Quality of Life Questionnaire” (VQLQ‐d)

Background: Little is known about the quality of life of patients who are allergic to insect venom. This fact is due to the lack of specific instruments assessing the interaction of type 1 allergy and its psychological burden. Patients and methods: The only established questionnaire on health‐related quality‐of‐life in patients with wasp venom allergies is the “Vespid Allergy Quality of Life Questionnaire” (VQLQ). This questionnaire was translated from Dutch into German and validated with 79 patients with wasp venom allergy, including the use of the well‐established general quality‐of‐life questionnaire WHOQOL‐BREF. Results: In the German version VQLQ‐d we could reproduce the validity and reliability of the original Dutch version. Cronbach's alpha of the VQLQ‐d was α= 0.95. The results of the VQLQ‐d corresponded to the total score of the WHOQOL‐BREF. Conclusion: The VQLQ‐d enables measurement of quality‐of‐life in patients with wasp venom allergy in the German‐speaking population. This economic tool makes it possible to better describe and treat affected patients. Furthermore, it can be used to advance research in this field.     

Tumescent contravenom: murine model for prehospital treatment of Naja naja neurotoxic snake envenomation

Background

Snake envenomation is a neglected global health problem. There is a need for a prehospital treatment of neurotoxic snakebite that prolongs survival and allows time for a victim to reach a hospital for antivenom therapy. Tumescent epinephrine consists of a large volume of dilute epinephrine (2 mg/l) injected subcutaneously. It functions as “contravenom” by causing capillary vasoconstriction and delaying venom absorption.

Methods

A murine model of neurotoxic envenomation using lidocaine as a surrogate for neurotoxic snake venom was first developed in a pilot study. A lethal dose of lidocaine was injected subcutaneously into control and treatment groups. Mice in the treatment group were then treated with a tumescent infiltration of dilute epinephrine in saline, while control mice either received no treatment or tumescent infiltration with saline alone. The experiment was repeated using lethal doses of neurotoxic Naja naja cobra venom. The main end‐points were survival rate and survival time.

Results

None of the control mice survived a lethal (LD₁₀₀) dosage of subcutaneous lidocaine. Mice given an LD₁₀₀ of subcutaneous lidocaine and treated immediately with tumescent epinephrine had 80% survival. Following LD₅₀ doses of Naja naja venom, 50% of control mice survived, while 94% survived when treated immediately with tumescent epinephrine (P < 0.01). All animals died following LD₁₀₀ doses of Naja naja venom, but survival was significantly prolonged (P < 0.0001) by immediate tumescent epinephrine.

Conclusions

Tumescent epinephrine, when given immediately after toxin injection, improves survival rates in mice following neurotoxic doses of lidocaine or Naja naja cobra venom.

     

Versorgung der Akne vulgaris in Deutschland – Patientenbefragung in einem bundesweiten Apothekennetzwerk

Background: No empirical “real world” data on the health care of patients with acne vulgaris in Germany currently exist. The objective of this study was to get an informative basis of health care of patients with acne vulgaris in Germany, taking into account both doctor‐prescribed medication and self‐medication. Patients and Methods: Surveying both medically and self‐treated patients, n = 504 patients with acne vulgaris were interviewed in 48 pharmacies nationwide. In addition to socio‐demographic data, the duration of illness, localization and therapy as well as patient‐relevant outcomes such as patient benefit, psychological strain and markers of compliance were evaluated. The participation and significance of individual treatment providers were also evaluated. Results: A large percentage of the patients found acne vulgaris to be burdensome. Despite the longstanding necessity of treatment and the chronic course of the illness, the treatment of acne vulgaris was deemed a rather satisfactory experience by most of those affected. Dermatologists were most frequently consulted for treatment. A great number of medicinal products were further acquired through self‐medication or after consulting with a pharmacist. The medically regulated therapies predominantly complied with the latest guidelines. Conclusions: Acne vulgaris is a burdensome, socio‐economically relevant illness, and dermatologists treat most cases in Germany. Surveying across a network of pharmacies offers a unique access to relevant treatment data. Selection effects, particularly by choice of doctors and self‐medication, were minimized.     

Anstrengungsinduzierte Anaphylaxie

Exercise-induced anaphylaxis is a mast cell dependent reaction, which is induced by allergen exposure in combination with physical activity. Typically, the reaction occurs within 2 hours after allergen exposure followed by physical activity. Not only food allergens but all kinds of allergens including drugs can induce this form of anaphylaxis. The clinical symptoms of exercise-induced anaphylaxis are the same as in any other type of anaphylaxis. Thus not only the skin and mucosa but also other organ systems like the lungs, cardiovascular system and gastrointestinal tract can be affected. The diagnostic work up should cover a detailed clinical history including the assessment of symptoms and possible trigger factors including suspected allergens. Besides classical allergy diagnostics like skin prick tests and specific IgE determination, tryptase should be measured for the differential diagnosis to exclude mast cell dependent diseases. The diagnosis of exercise-induced anaphylaxis is made by the means of a double-blind placebo-controlled provocation test. Both, a sufficient amount of allergen and of physical activity must be achieved for a valid test. After the diagnosis is made, patients should be extensively counseled and provided with an emergency kit including an epinephrine auto injector.     

Long-term management of facial atopic eczema with pimecrolimus cream 1% in paediatric patients with mild to moderate disease

Background The aim of this post hoc analysis was to evaluate whether treatment of patients with atopic dermatitis (AD) with pimecrolimus cream 1% can decrease the development of flares necessitating the use of a topical corticosteroid on the face and thus reduce the need for use of topical corticosteroids in this sensitive skin area. Patients and methods In a controlled, double‐blind, multicentre study, 140 patients, aged 2 to 17 years, with facial involvement and mild to moderate disease after treatment of the initial flare with prednicarbate 0.25% cream were randomized to an intermittent treatment with pimecrolimus cream 1% twice daily or vehicle for 24 weeks. If a flare occurred, defined as an exacerbation (unacceptable severity of itching/scratching or onset of oozing) not controlled by study medication, patients were treated with prednicarbate 0.25% cream instead. Results Patients in the vehicle group needed prednicarbate treatment on the face on 20.7% of the days vs. 11.7% of the study days in the pimecrolimus group (P = 0.0024). Fifty per cent of patients in the pimecrolimus group had no flare on the face during the treatment period compared with 37.5% of patients in the vehicle group (P = 0.012). The median time to first flare in pimecrolimus‐treated patients was twice as long as in patients receiving vehicle (138 vs. 68 days, P = 0.01). Three adverse events (one case of skin burning) suspected to be related to use of the study medication were reported for three patients (3.9%) in the pimecrolimus group. Conclusion Long‐term intermittent treatment of facial AD in children and adolescents with pimecrolimus cream 1% does significantly reduce the need for topical corticosteroids.     

Cost‐of‐illness in patients with moderate and severe chronic psoriasis vulgaris in Germany

Background: Data regarding costs of outpatient and office‐based care, as well as out‐of‐pocket expenses, for psoriasis patients in Germany are not available. Aim of this study was to assess average annual cost and cost per flare of outpatient and office‐based care for patients with moderate to severe chronic psoriasis vulgaris from several perspectives. Methods: In this multi‐center, cross‐sectional, retrospective and prospective cost‐of‐illness study, direct (medical and non‐medical) and indirect costs were considered from patient, third‐party payer (TPP) and societal perspectives. Results: Out of 227 patients enrolled consecutively in 17 centers, 192 cases could be analyzed. On average, TPP reimbursed 864 € per patient annually, 60 % for prescribed medication and 22 % for hospitalization. Patients spent 596 € yearly mainly for alternative therapies and OTC‐medication/skin care products as well as for additional expenses (e. g. ultraviolet lamp, clothes or cleaning agents). Indirect costs per patient amounted to 1,440 € yearly. Total annual costs per patient were 2,866 € and 4,985 € if treated with systemic drugs additionally. 1,173 € if treated topically and/or with phototherapy. Conclusions: The relatively high average annual costs per patient indicate need for efficient control of psoriasis. This cost‐of‐illness study provides basic data for further decision making, including economic assessment of innovative therapies for psoriasis.     

Akuttherapie und Management der Anaphylaxie

Anaphylaxis, the maximal manifestation of an immediate allergic reaction, is a life-threatening systemic reaction. The immediate therapy is chosen according to the clinical manifestations and new German guidelines are in preparation. Required measures include immediate removal of allergen, adequate positioning, assessment of severity and organ involvement and activation of emergency medical services. In anaphylaxis with primarily cardiovascular involvement, epinephrine is the treatment of choice and given together with volume substitution, oxygen, H₁-antihistamines and corticosteroids. Obstruction of the airways is treated with intramuscular and inhaled epinephrine, or alternatively β₂-sympathicomimetics, and oxygen. Abdominal or cutaneous involvement, such as generalized urticaria, usually can be treated with intravenous H₁-antihistamines, glucocorticoids and surveillance. In patients with anaphylaxis, the elicitor of the reaction has to be diagnosed by allergy testing. Patients with sustained risk for anaphylaxis should receive a self-medication kit and should be educated about behavioral patterns needed for prophylaxis and therapy of anaphylactic reactions. Patient educational intervention increases knowledge about anaphylaxis, and practical competence and thus, is a basis of a successful management of anaphylaxis.     

Psychosomatic or allergic symptoms? High levels for somatization in patients with drug intolerance

Patients with dermatological diseases often have associated psychological problems. For patients with allergic diseases, only a few publications have focused on psychological aspects. The objective of this study was to assess the psychometric profile, including somatization, depression, anxiety and health‐related quality of life (HRQoL), of patients suffering from drug intolerance or hymenoptera venom allergies. In a prospective cohort study design, patients who were admitted to hospital for a challenge test for an alternative drug (n = 49, 24.5% men) or for induction of desensitization therapy with hymenoptera venom (n = 58, 37.9% men) were included. Psychometric screening questionnaires focusing on somatization (Symptom Check List), depression and anxiety (Hospital Anxiety Depression Scale), and also on HRQoL (Short Form questionnaire) were assessed. The scores were compared with population scores and between the two groups. Both groups had significantly higher somatization scores (P ≤ 0.003) than the normal population, and the challenge‐test group had lower HRQoL than the normal population. Between‐group analysis revealed significantly higher somatization scores in the challenge‐test group (P = 0.011) and more impaired HRQoL (physical health domain P < 0.001). Anxiety/depression scores were not significantly different from those of the normal population, or between groups, although abnormally high scores for anxiety were frequent (18% and 12% for the challenge‐test and allergy groups, respectively). Somatization, reduced HRQoL and anxiety seem to be part of the symptoms of patients with allergic diseases, especially for patients with drug intolerance. Standardized questionnaires could help to discover patients who may need psychological support. This may help to improve the patients’ symptoms and quality of life.     

Epinephrine‐supplemented local anesthetics for ear and nose surgery: Clinical use without complications in more than 10,000 surgical procedures

Introduction: Local anesthetics supplemented with epinephrine are generally regarded as contraindicated for surgical procedures involving the fingers, toes, penis, outer ear and the tip of the nose [ 1 ], but epinephrine is essential if automated tumescence local anesthesia (Auto‐TLA) is used. Materials and methods: Infiltration anesthesia supplemented with 1 : 200,000 epinephrine was used from 1985 – 1997 in our department, while Auto‐TLA supplemented with 1 : 1.000,000 epinephrine was introduced in 1997 for all surgical procedures involving the ear or nose. During this period, 10,201 patients underwent surgery at these locations. In addition, dermal blood flow was analyzed by acral photoplethysmography (APPG) and laser Doppler flowmetry (LDF) in the right ear lobe of five normal volunteers and during epinephrine supplemented Auto‐TLA. Results: Epinephrine‐induced complications were not observed in a single patient. Cosmetic skin flap surgery was performed in 4,953 of these patients. Even in patients with extended surgical procedures that took up to one to two hours and that included extensive skin flaps or skin grafts, we observed no increase in complications when compared to procedures performed either under general anesthesia or local anesthesia without epinephrine supplementation. Measuring blood perfusion of the earlobe showed a 69 % reduction of LDF and a 42 % reduction of arterial inflow (APPG) immediately following anesthesia. Conclusion: Epinephrine supplementation of local anesthetics does not block blood perfusion in the ear and did not induce organ, tissue or flap necrosis. Local anesthesia with epinephrine supplementation is therefore safe for acral areas such as the ear or nose. Despite the relatively small influence on blood perfusion, epinephrine supplementation results in a relatively bloodless operating field and longer effectiveness of local anesthesia. The relative absence of blood in the operating field of the ear and nose significantly reduces the duration of surgery and increases the healing rate, as less electrocautery is needed.     

Isotretinoin therapy and the incidence of acne relapse: a nested case-control study

Background Previous studies on predictors of acne relapse in patients treated with isotretinoin had either small sample sizes, short follow‐up periods, or lacked population‐based data. Objectives To identify and quantify predictors of acne relapse, and predictors of receiving a second isotretinoin treatment. Methods Using the Régie de l’Assurance Maladie du Québec (RAMQ) and Quebec’s hospital discharge (Med‐Écho) administrative databases, a population‐based cohort of 17 351 first‐time isotretinoin users was assembled between 1984 and 2003. A nested case–control analysis was performed to determine predictors of acne relapse (as defined by receiving an antiacne medication). A second nested case–control analysis was performed to determine predictors of receiving a second isotretinoin treatment. The index date of cases was the calendar date of dispensing an antiacne medication (isotretinoin or other). Five controls were matched to each case on follow‐up time. Rate ratios were estimated using conditional logistic regression. Results A total of 7100 (41%) subjects experienced an acne relapse. These were matched to 35 500 controls. Being male, under 16 years of age and living in an urban area, and receiving isotretinoin cumulative doses greater than 2450 mg and an isotretinoin treatment longer than 121 days were statistically associated (P < 0·05) with acne relapse. The publishing of the different Canadian acne guidelines had no impact on the incidence of acne relapse (P > 0·05). A total of 4443 (26%) subjects required a second isotretinoin treatment. These were matched to 22 215 controls. There was a greater probability of receiving a second isotretinoin treatment after the publishing of the Canadian acne guidelines (P < 0·05). Conclusion A relatively high rate of subjects experienced an acne relapse after an isotretinoin treatment.     

Transglutaminases as diagnostically relevant autoantigens in patients with gluten sensitivity

Background: Patients with gluten sensitivity, i. e. celiac disease and dermatitis herpetiformis have anti‐endomysial antibodies recognizing transglutaminases, which are usually detected on appropriate tissue sections. It would be desirable to have available a reliable, tissue‐independent serological diagnostic tool. We compared disease‐specificity and sensitivity of tTG versus eTG‐based detection systems for the diagnosis of anti‐endomysial IgA‐antibodies. Patients and Methods: We examined 204 serum samples in duplicates with commercial human ELISA‐kits: 54 healthy blood donors, 20 celiac disease, 29 dermatitis herpetiformis and 101 with other autoimmune dermatoses. Results: The tTG‐based ELISA proved to be very disease‐specific (100 %) and sensitive for the diagnosis of gluten sensitivity (95 % celiac disease; 96.6 % dermatitis herpetiformis). The eTG‐based ELISA was also perfectly specific (100 %), but only 15 % of celiac disease‐sera and 44.8 % of dermatitis herpetiformis‐sera yielded positive results. Conclusions: The human tTG‐ELISA fulfills all criteria of a screening test and, because of being investigator‐independent, inexpensive and highly reproducible, compares favorably with the current diagnostic gold standard (indirect immunofluorescence and biopsy) of celiac disease and dermatitis herpetiformis. The low sensitivity of the eTG‐ELISA may have technical reasons, but could theoretically also be linked to disease activity or indicate the existence of an as yet undefined disease subset. Studies are currently under way to address these issues.     

A costly revolution for a subgroup of patients with metastatic melanoma

ORIGINAL ARTICLE: Hauschild A, Grob JJ, Demidov LV et al. Dabrafenib in BRAF‐mutated metastatic melanoma: a multicentre, open‐label, phase 3 randomised controlled trial. Lancet 2012; 380: 358–65. Background Dabrafenib, an inhibitor of mutated BRAF, has clinical activity with a manageable safety profile in phase I and II studies in patients with BRAF (V600)‐mutated metastatic melanoma. Hauschild et al. aimed to assess the efficacy of dabrafenib in a phase III trial of patients with BRAF (V600)‐mutated metastatic melanoma. Methods Patients were enrolled into a phase III trial between December 2010 and September 2011. This report is based on the cut‐off date of 19 December 2011. Patients with previously untreated stage IV or unresectable stage III BRAF (V600)‐mutated melanoma were randomly assigned (3:1) to receive dabrafenib (150 mg twice daily, orally) or dacarbazine (1000 mg m^?2 intravenously every 3 weeks). Patients were stratified according to American Joint Committee on Cancer stage. The primary endpoint was investigator‐assessed progression‐free survival (PFS) and was analysed by intention to treat. Safety was assessed per protocol. Findings Of the 733 patients screened, 250 were randomly assigned to receive either dabrafenib (187 patients) or dacarbazine (63 patients). Median PFS was 5·1 months for dabrafenib and 2·7 months for dacarbazine, with a hazard ratio of 0·30 (95% confidence interval 0·18–0·51, P < 0·0001). At cut‐off, 107 (57%) patients in the dabrafenib group and 14 (22%) in the dacarbazine group remained on randomized treatment. Treatment‐related adverse events (grade 2 or higher) occurred in 100 (53%) of the 187 patients who received dabrafenib and in 26 (44%) of the 59 patients who received dacarbazine. The most common adverse events with dabrafenib were skin‐related toxic effects, fever, fatigue, arthralgia and headache. The most common adverse events with dacarbazine were nausea, vomiting, neutropenia, fatigue and asthenia. Grade 3–4 adverse effects were uncommon in both groups. Interpretation Dabrafenib significantly improved PFS compared with dacarbazine.     

Effects of Emollient Containing Bee Venom on Atopic Dermatitis: A Double-Blinded,Randomized, Base-Controlled,Multicenter Study of 136 Patients

BackgroundAtopic dermatitis (AD) is a common, complex disease that follows a chronic relapsing course and significantly affects the quality of life of patients. Skin barrier dysfunction and inflammatory processes induce and aggravate this skin condition. Proper use of an emollient for hydration is a keystone of AD treatment. Bee venom is known to have anti-inflammatory effects and has been widely used in traditional medicine to treat various inflammatory disorders.ObjectiveTo find out the beneficial effect of an emollient containing bee venom in the treatment of patients with AD.MethodsThis study included 136 patients with AD who were randomized to receive either an emollient containing bee venom and silk-protein or a vehicle that was identical except for the bee venom for 4 weeks. The patients were instructed to apply the emollient twice daily on their entire body and not to use other medications, including topicals, during the course of the study. The eczema area and severity index (EASI) score, transepidermal water loss, and visual analogue scale (VAS) score of itching were evaluated at the first visit and after 2 and 4 weeks. The investigator global assessment was evaluated at 2 and 4 weeks after the application of emollient containing bee venom or vehicle.ResultsPatients applying emollient containing bee venom showed significantly lower EASI score and VAS value compared to patients applying emollient without bee venom.ConclusionEmollient containing bee venom is a safe and effective option for patients with AD.     

Intradermal injection of Newcastle disease virus‐modified autologous melanoma cell lysate and interleukin‐2 for adjuvant treatment of melanoma patients with resectable stage III disease

Background: The value of active specific immunotherapy (ASI) for the treatment of solid tumours still has to be assessed. The objective was to test an autologous tumour cell vaccine for adjuvant treatment of stage III melanoma patients. Patients and Methods: After open vaccination of 12 patients, another 17 patients were recruited for a randomized double‐blind trial comparing treatment with the vaccine (n = 9) and with a placebo (n = 8). Intracutaneous vaccinations were given postoperatively in weeks 2, 4, 6, 12, 24 and thereafter every 6 months if sufficient vaccine material was available. Patients were followed for 60 – 84 months. Results: Median disease‐free survival time was 5 months for open‐treated, 4 months for verum‐treated and 6 months for placebo‐treated patients. Corresponding median overall survival times were 30.5, 18 and 18.5 months, respectively. There were no remarkable differences between the verum and the placebo group. Conclusions: Adjuvant treatment of melanoma patients with an autologous ASI vaccine did not show clinical efficacy in this cohort of melanoma patients.     

Erfolgreiche Reduktion des SCORAD‐Scores bei Kindern mit atopischem Ekzem im 6‐Wochen‐Vergleich durch Kurzschulung mit einem vereinfachten Hautmodell

Background: In order to achieve a long‐term stabilizing effect on the clinical condition of the skin of patients with atopic eczema, it is imperative to perform consistent topical skincare. Because of time pressures during normal office visits, it is impossible to thoroughly counsel patients who suffer from atopic eczema. We performed a randomized and prospective comparative study to evaluate the outpatient effectiveness of a short‐time but impressive teaching and counselling method using the skin model developed by Kardorff and Schnelle‐Parker. Patients and methods: Thirty outpatients between 3 and 6 years old with moderate or severe atopic eczema were evaluated. Half of the patients were trained by an active, 10‐min demonstration with the skin model on day 0 and day 14. Patients in the control group received verbal instructions of the same duration, as in routine dermatological practice. The SCORAD score was measured blindly on days 0, 14 and 42. Results: After 42 days, the SCORAD score of the patients taught by the use of the Kardorff‐Schnelle‐Parker skin model was significantly reduced compared to the control group (P < 0.006). Conclusions: By counselling atopic children, even of preschool age, with the easily understandable skin model incorporating the sense of touch, better compliance concerning regular skincare can be achieved. We expect positive effects in the long‐term management of atopic eczema.     

High‐dose intravenous corticosteroid pulse therapy in alopecia areata: Own experience compared with the literature

Background: Seven prospective studies including 193 patients have been published on high‐dose intravenous corticosteroid pulse therapy in alopecia areata (AA).We compare these data with a retrospective analysis of our own consecutive patients. Patients and Methods: Between 1998 and 2002,25 patients with severe AA were treated at the Department of Dermatology, University of Bern, with infusions of 500 mg methylprednisolone on 3 consecutive days.In addition to the inpatient records, in 2004 all patients were followed up by a questionnaire. Results: Four of 10 patients with multifocal AA and 3 of 9 patients with ophiasis‐type AA had full re‐growth of hair, whereas all 6 patients with AA totalis/universalis failed to respond. Conclusion: Intravenous corticosteroid pulse therapy may be helpful in the treatment of multifocal and ophiasis‐type AA.Patients with an initial episode of short duration have better chances for success.