Atopische Dermatitis und allergische Rhinitis ‐ gibt es Co‐Effekte in der Therapie?

Summary Atopic dermatitis and allergic rhinitis frequently appear together in the same patients. The pathogenesis of both disorders is complex and still incompletely understood. Nevertheless, pathophysiological overlaps suggest the existence of potential therapeutic co‐effects. While data pointing towards a positive effect of allergen elimination for both diseases is still limited, there is now increasing evidence showing beneficial effects of specific immunotherapy in patients suffering from atopic dermatitis and additional type I allergies. H₁‐antihistamines were also found to exert moderate positive effects on the symptoms of atopic dermatitis in single studies. In summary, a limited therapeutic co‐effect of the above mentioned treatment options can be expected in case of the parallel existence of atopic dermatitis and allergic rhinitis in the same patient. More studies on this issue during the next years are desirable. In addition, a better understanding of the pathophysiology should have a positive impact on the treatment of atopic manifestations such as atopic dermatitis and allergic rhinitis.     

Maligne Melanome unter systemischer Therapie mit Fumarsäreestern – Zufall oder Therapiefolge?

Psoriasis is today generally considered a systemic disease. Systemic therapies are used frequently. In Germany fumaric acid esters – FAE (Fumaderm^®) – are employed in more than 50 % of the patients requiring such therapy. We report for the first time the development of melanoma in two patients during their treatment with FAE. The logical question is – are the tumors coincidental or might they be treatment‐related? Further investigations of pathways and immunologic effects as well as careful reports of side effects are necessary to estimate the risks of malignancy of FAE.     

Rund‐ oder Flachstrickversorgung in der Erhaltungstherapie beim Beinlymphödem? – Übersicht von Literatur und technischen Daten

To date, there have been no studies comparing flat‐knit and round‐knit compression garments for maintenance therapy of lymphedema of the leg. According to expert opinion, flat‐knit fabrics are generally recommended for this purpose. Given the differences in the clinical presentation of lymphedema in terms of disease stage and location as well as patient adherence, and, last but not least, for economic reasons, it seems questionable whether all patients with lymphedema of the leg actually do require flat‐knit compression garments. Considering technical aspects, published data and our own clinical experience, it seems reasonable that the choice of compression stockings be based on clinical findings and not on the diagnosis. Typical indications for flat‐knit garments include significant differences in leg circumference as well as deep skin folds and edema of the toes/forefoot. However, there are also patients with lymphedema who benefit from round‐knit fabrics with a high degree of stiffness. In any case, prior to maintenance therapy, it is essential to adequately decongest the legs using compression bandages and/or adaptive compression systems.     

Hepatosplenisches T‐Zell‐Lymphom unter Therapie mit TNF‐α‐inhibierenden Biologics: (k)ein Risiko für Patienten mit Psoriasis?

Tumor necrosis factor (TNF)‐α antagonists have considerably improved the therapeutic approach to chronic inflammatory disorders including psoriasis vulgaris. Recently, some cases of highly aggressive hepatosplenic T‐cell lymphoma (HSTCL) have developed in patients with inflammatory bowel diseases (IBD) being treated with infliximab or adalimumab. Analysis of the published data suggests that the emergence of HSTCL is favored by the combination of purine analogues and infliximab or adalimumab in the therapy of a granulomatous inflammation involving Vδ1⁺γδ T cells. Because psoriasis vulgaris is different from IBD in regard to the type of inflammation, the concomitant therapies used and the tissue‐specific subsets of γδ T cells, the use of infliximab or adali‐mumab in psoriasis may not necessarily be associated with an increase in the risk of HSTCL.     

Sind die klassischen Methoden zur mykologischen Diagnostik noch „State‐of‐the‐Art“?

The diagnostic workup of cutaneous fungal infections is traditionally based on microscopic KOH preparations as well as culturing of the causative organism from sample material. Another possible option is the detection of fungal elements by dermatohistology. If performed correctly, these methods are generally suitable for the diagnosis of mycoses. However, the advent of personalized medicine and the tasks arising therefrom require new procedures marked by simplicity, specificity, and swiftness. The additional use of DNA‐based molecular techniques further enhances sensitivity and diagnostic specificity, and reduces the diagnostic interval to 24–48 hours, compared to weeks required for conventional mycological methods. Given the steady evolution in the field of personalized medicine, simple analytical PCR‐based systems are conceivable, which allow for instant diagnosis of dermatophytes in the dermatology office (point‐of‐care tests).     

Forschen für die Praxis: Regulatorische T‐Zellen – Therapeutische Zielzellen?

Regulatory T cells (Tregs) are essential for induction and maintenance of immunological tolerance. They contribute to prevention of autoimmunity by control and modulation of immune responses. The prevalence of autoimmune diseases, chronic infections, cancer and allergies has markedly increased in the last decades. In additions the treatment of these disorders is often unsatisfactory so that improvements are needed. This has stimulated intensive research in the biology of Tregs. Recent studies revealed that naturally occurring CD4⁺CD25⁺ Tregs (nTregs) and induced Tregs (iTregs) are critical for the control of inadequate immune reactions. In humans, various iTreg populations are generated to inhibit naïve as well as activated effector T cells. Key molecules of signal transduction, essential for suppressor function of iTregs, have been identified and may be target molecules to modulate the activity of suppressor T cells with novel biologicals. Precise insight into the properties of Tregs may contribute to the development of innovative therapeutic approaches which directly affect Tregs in patients or use adoptive transfer of Tregs.