Therapie der Akne mit Antiandrogenen – Eine evidenzbasierte Übersicht

Background: Increased sebaceous gland activity with seborrhea is one of the major pathogenetic factors in acne. Antiandrogen treatment targets the androgen‐metabolizing follicular keratinocytes and the sebaceous gland leading to sebostasis, with a reduction of the sebum secretion rate of 12.5 – 65 %. Antiandrogens can be classified based on their mechanism of action as androgen receptor blockers, inhibitors of circulating androgens by affecting ovarian function (oral contraceptives), inhibitors of circulating androgens by affecting the pituitary (gonadotropin‐releasing hormone agonists and dopamine agonists in hyperprolactinemia), inhibitors of adrenal function, and inhibitors of peripheral androgen metabolism (5α‐reductase inhibitors, inhibitors of other enzymes). Methods: All original and review publications on antiandrogen treatment of acne as monotherapy or in combination included in the MedLine system were extracted by using the terms “acne”, “seborrhea”, “polycystic ovary syndrome”, “hyperandrog*”, and “treatment” and classified according to their level of evidence. Results: The combinations of cyproterone acetate (2 mg)/ethinyl estradiol (35 µg), drospirenone (3 mg)/ethinyl estradiol (30 µg), and desogestrel (25 µg)/ethinyl estradiol (40 µg) for 1 week followed by desogestrel (125 µg)/ethinyl estradiol (30 µg) for 2 weeks showed the strongest anti‐acne activity. Gestagens or estrogens as monotherapy, spironolactone, flutamide, gonadotropin‐releasing hormone agonists, and inhibitors of peripheral androgen metabolism cannot be endorsed based on current knowledge. Low dose prednisolone is only effective in late‐onset congenital adrenal hyperplasia and dopamine agonists only in hyperprolactinemia. Treatment with antiandrogens should only be considered if none of the contraindications exist. Conclusion: Antiandrogen treatment should be limited to female patients with additional signs of peripheral hyperandrogenism or hyperandrogenemia. In addition, women with late‐onset or recalcitrant acne who also desire contraception can be treated with antiandrogens as can those being treated with systemic isotretinoin. Antiandrogen treatment is not appropriate primary monotherapy for noninflammatory and mild inflammatory acne.     

Die Anwendung des Excimerlasers 308 nm zur Psoriasis‐Behandlung

Background and Objective: Standard phototherapy for psoriasis (311 nm UVB or photochemotherapy) exposes the non‐affected skin to potentially damaging irradiation. The use of 308 nm XeCl excimer laser allows the selective irradiation of psoriatic lesions. We evaluated its therapeutic effectiveness. Patients/Methods: 28 patients with plaque stage psoriasis were involved in the study, 26 of them could be evaluated. In each patient a single plaque was chosen and then exposed to the laser irradiation thrice weekly. The initial dose was twice the MED (minimal erythema dose); the dosage was increased by one MED every second treatment. The usual dosages were 2 – 5 MED, while the cumulative UVB dosage was 3.6 – 15.2 J/cm². 17 Patients were treated 6 times, while 11 were treated 10 times. The Psoriasis Severity Index (PSI) was calculated for the individual plaque in order to assess the effectiveness of the therapy. The patients were followed regularly for 3 months following treatment, and then checked again at 1 year. Results: Most patients showed clear improvement. In 90 % the PSI at the end of treatment was reduced by at least 50 %; in 72 % it was only 33 % of the pre‐treatment value. The results between the patients receiving 6 and 10 treatments were similar. In 6 patients, the psoriatic lesion was still absent after 1 year, while in an additional 7, there had been long term improvement. The most common side effects were erythema and pruritus (100 %), blisters (35 %) and post‐inflammatory hyperpigmentation (80 %). Conclusion: The use of the 308 nm excimer laser is effective for chronic localized psoriasis and may lead to long‐lasting remissions.     

Neuere Aspekte in der UV- und Photochemotherapie

Zusammenfassung Neue Daten zeigen, dass aus pharmakologischer Sicht die topische PUVA-Therapie der systemischen PUVA-Therapie überlegen ist. Die bessere Verträglichkeit führt dazu, dass die Bade-PUVA-Therapie zunehmends anstelle der oralen PUVA-Therapie eingesetzt wird. Schmalband-UVB hat Breitband-UVB in der Therapie der Psoriasis abgelöst und sich bei einer Reihe anderer Dermatosen, wie Vitiligo, atopisches Ekzem oder polymorphe Lichtdermatose, als effektiv und der PUVA gleichwertig erwiesen. Die UVA1-Phototherapie ist als wirksame Behandlung der atopischen Dermatitis und sklerosierender Hauterkrankungen der Haut etabliert. Für zahlreiche andere Indikationen ist die Datenlage noch unzureichend. Die Hochdosistherapie ist weitgehend verlassen, da rezente Vergleichsstudien keinen Vorteil gegenüber einer Mitteldosis-UVA1-Therapie nachweisen konnten.     

果酸联合甘草锌颗粒治疗寻常型痤疮的疗效观察

目的观察果酸联合甘草锌颗粒治疗寻常型痤疮的疗效。方法将患者随机分为治疗组和对照组,治疗组给予口服甘草锌颗粒,同时每隔3周进行1次果酸治疗;对照组仅予口服甘草锌颗粒治疗。疗程为12周。结果治疗组与对照组的总有效率分别为82.5%、65%,治疗组的疗效明显优于对照组,2组疗效比较差异具有统计学意义(P0.05)。结论果酸联合甘草锌颗粒治疗寻常型痤疮疗效较好,安全性高,具临床推广价值。     

15 % Azelainsäuregel in der Behandlung der Akne. Zwei doppelblinde klinische Vergleichsstudien

Background: Topical measures are still the mainstay in the therapy of mild‐to‐moderate acne vulgaris. Azelaic acid 20 % in a cream formulation has been established as an efficacious and safe topical drug for 15 years. A new non‐alcoholic hydrogel formulation containing 15 % azelaic acid was clinically tested against two standard drugs – 5 % benzoyl peroxide (BPO) and 1 % clindamycin. Patients and Methods: In two independent, randomized, blinded comparative trials 15 % azelaic acid gel was clinically tested against 5 % benzoyl peroxide (BPO) gel in 351 patients and against 1 % clindamycin gel in 229 patients. The drugs were applied b. i. d. for 4 months. Results: Azelaic acid 15 % gel proved to be as effective as BPO and clindamycin with median % reduction of the inflamed lesion (papules and pustules) of 70 %, and 71 % respectively. The azelaic acid gel was well‐tolerated, the side effects (local burning and irritation) were distinctly less than with BPO but more pronounced than with clindamycin. Despite these side effects, the treatment was well‐accepted by the majority of patients. Conclusions: Azelaic acid gel is an effective topical monotherapy for mild‐to‐moderate acne vulgaris; its new gel form is an enrichment of acne therapy.     

发光二极管在皮肤科的应用进展

【摘要】 发光二极管（LED）可产生包括蓝光、黄光、红光、红外光等不同波长的光。LED光以其安全、可操控性强、纯色性好、低能量等特点在皮肤科得到广泛应用,如蓝光多用于痤疮治疗,黄光多用于黄褐斑治疗,红光可用于雄激素性脱发的治疗,红外光具有促进皮肤修复的功能等。临床中,多波段联合应用也成为一种趋势,红光与蓝光、红光与黄光、黄光与红外光等组合在痤疮、激光术后修复、皮肤年轻化等方面卓有成效。     

Phototherapy promotes healing of cutaneous wounds in undernourished rats

BACKGROUND

Various studies have shown that phototherapy promotes the healing of cutaneous wounds.

OBJECTIVE

To investigate the effect of phototherapy on healing of cutaneous wounds in nourished and undernourished rats.

METHODS

Forty rats, 20 nourished plus 20 others rendered marasmus with undernourishment, were assigned to four equal groups: nourished sham, nourished Light Emitting Diode treated, undernourished sham and undernourished Light Emitting Diode treated. In the two treated groups, two 8-mm punch wounds made on the dorsum of each rat were irradiated three times per week with 3 J/cm² sq cm of combined 660 and 890nm light; wounds in the other groups were not irradiated. Wounds were evaluated with digital photography and image analysis, either on day 7 or day 14, with biopsies obtained on day 14 for histological studies.

RESULTS

Undernourishment retarded the mean healing rate of the undernourished sham wounds (p < 0.01), but not the undernourished Light emission diode treated wounds, which healed significantly faster (p < 0.001) and as fast as the two nourished groups. Histological analysis showed a smaller percentage of collagen in the undernourished sham group compared with the three other groups, thus confirming our photographic image analysis data.

CONCLUSION

Phototherapy reverses the adverse healing effects of undernourishment. Similar beneficial effects may be achieved in patients with poor nutritional status.     

Dissatisfaction and acne vulgaris in male adolescents and associated factors

BACKGROUND

Acne vulgaris has high prevalence, disturbing quality of life during adolescence.

OBJECTIVES

To measure dissastifaction and acne in 18-year-old male individuals and its associated factors.

METHODS

A questionnaire was applied by trained interviewers to all boys during selection for the military service. Dissatisfaction and acne was evaluated using a self-administered face scale. Facial, prestrernal and dorsal acne were evaluated separately.

RESULTS

A total of 2,200 adolescents, aged 18 years, were interviewed. Among these, 1,678 had acne on the face and 974 (54.05%) showed some degree of dissatisfaction. Regarding the impact of acne located on the chest, 326 out of 686 adolescents (47.52%) reported dissatisfaction. For acne located on the back, 568 out of 1,103 affected individuals (51.50%) showed dissatisfaction. Facial / dorsal acne and dissatisfaction were statistically associated with lower income, lower education levels and with non-whites. Presternal acne and dissatisfaction were statistically asssociated with lower income and lower education levels.

CONCLUSION

This population-based study found a high prevalence of acne on the face, back and chest, with high rates of dissatisfaction.     

Neue und etablierte Indikationen der UV‐B‐311‐nm‐Phototherapie

Phototherapy with ultraviolet (UV) irradiation of wavelengths between 280 and 320 nm (UV‐B) is a safe and effective treatment for a variety of inflammatory skin diseases. In addition to standard broad band UVB, narrow band phototherapy with fluorescent bulbs emitting near monochromatic UV between 310 – 315 nm has become an important treatment for diseases such as psoriasis, atopic dermatitis or vitiligo. Other diseases respond favorably to narrow band UV‐B phototherapy, the number of potential indications for such phototherapy is continuously growing. The differential effects of narrow band UV‐B phototherapy in comparison to other UV phototherapies, as well as new and established indications for this treatment modality are reviewed.     

Stellenwert von Itraconazol in der Behandlung von Pilzinfektionen der Haut,Nägel und Schleimhäute

Itraconazole is an antifungal drug from the triazole group with distinct in vitro activity against dermatophytes, yeasts and some molds. Itraconazole has a primarily fungistatic activity. Itraconazole accumulates in the stratum corneum and in nail material due to its high affinity to keratin, as well as in sebum and vaginal mucosa. Together with terbinafine and fluconazole, itraconazole belongs to the modern highly effective systemic antifungal drugs with a favorable risk‐benefit ratio and for this reason is a preferred therapy option for fungal infections of skin, nails and mucous membranes. Compared to terbinafine in the treatment of fingernail and toenail fungal infections, itraconazole offers the advantage of a broad antifungal spectrum and better effectiveness against onychomycosis caused by yeasts yet appears inferior with regard to the more common dermatophyte infections. Itraconazole constitutes an important therapy option, along with fluconazole, terbinafine, ketoconazole and griseofulvin, for the treatment of dermatophyte infections of glabrous skin (tinea pedis, tinea manuum, tinea corporis and tinea cruris) in adults following unsuccessful topical therapy. In the oral therapy of tinea capitis, itraconazole plays an especially important role, in particular for disease caused by Microsporum canis (for children, however, only off‐label use is feasible currently). In the treatment of oropharyngeal candidiasis, candidiasis of the skin and vulvovaginal candidiasis, itraconazole and fluconazole are the preferred treatment options in cases in which topical therapy has proven unsuccessful.     

Chronic urticaria in adults: state-of-the-art in the new millennium

Chronic urticaria has been explored in several investigative aspects in the newmillennium, either as to its pathogenesis, its stand as an autoimmune orauto-reactive disease, the correlation with HLA-linked genetic factors, especiallywith class II or its interrelation with the coagulation and fibrinolysis systems. Newsecond-generation antihistamines, which act as good symptomatic drugs, emerged andwere commercialized over the last decade. Old and new drugs that may interfere withthe pathophysiology of the disease, such as cyclosporine and omalizumab have beendeveloped and used as treatments. The purpose of this article is to describe thecurrent state of knowledge on aspects of chronic urticaria such as, pathophysiology,diagnosis and the current therapeutic approach proposed in the literature.     

DRGs in der Dermatologie: Erlösoptimierung durch Sicherung der Kodierqualität

Background: High‐quality coding of patient clinical data is mandatory for an effective DRG classification to result in adequate allocation of funding for in‐patient treatment. The aim of the study was to determine the effect of controlled documentation on patient clinical data and to ascertain the outcome of calculated DRG‐based yields depending on higher coding quality of patient treatment. Patients and methods: In a prospective study, 1914 patient clinical records from the Department of Dermatology, University of Muenster, were captured using different documentation standards and the data was analysed. Grouping was performed on the basis of the Australian Refined DRG system v4.1. Dermatological patients were broken down into eleven groups based on principle diagnosis. Results: As a result of a controlled documentation, case mix, case mix index and patient clinical complexity level (PCCL) value were increased within identical samples. Furthermore, it was shown that high‐quality coding may result in exact and reasonable classification of patient clinical data. Conclusions: Different documentation standards may cause undesired effects on the monetary yields of in‐patient treatment. It appears that high‐quality coding and controlled documentation may guarantee adequate yields. Faulty, incomplete and (up)coding could be a potential economic risk for hospitals.     

Zur Frühtherapie der Säuglingshämangiome*

Summary: Since about 10 years
we notice a change of view in the treatment of infant hemangiomas.
In the meantime the recommended opinion of a waiting conduct in the therapy of those cutaneous eruptions was left. Because of the unpredictability of the growing hemangiomas we decided to carry out an early treatment. The contact cryosurgery and the laser therapy are considered as an effective treatment. However, 80 % of the infant hemangiomas belong to the superficial form; so we think that
the contact cryosurgery is the most effective early therapy in those skin abnormalities.     

Clinical efficacy of Velac®, a new tretinoin and clindamycin phosphate gel in acne vulgaris

Velac®, a new gel formulation containing both tretinoin (0.025%) and clindamycin phosphate (1.2%), is effective in acne vulgaris using a once daily application. The single formulation enhances compliance in young patients and improves the therapeutic results. Treatment with Velac was found to be more effective than tretinoin alone in inflamed lesions and at least comparable in open and closed comedones. In two of the three studies the overall acne severity grade was significantly more reduced when compared with tretinoin. Velac is also more effective than clindamycin alone in the treatment of the non-inflamed lesions. In the two multicentre studies the reduction of the overall acne severity grade was also more favourable for the new gel formulation. A more rapid response occurred with Velac than with either component used (clindamycin or tretinoin) alone.