Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.     

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.     

G‐DRG Version 2004: Veränderungen aus Sicht der Dermatologie

In the year 2004 the obligatory introduction of the new hospital funding system based on a Diagnosis Related Groups (DRG) system will become reality for all German hospitals. After all fundamental items of the new G‐DRG version were made generally known, the possible consequences had to be considered. The first mandatory German case‐based lump sum catalogue differs importantly from the previous payment models and requires intensive study. Economic considerations will increasingly play a role in the daily routine of hospitals and influence treatment patterns. Therefore, comprehensive knowledge of basic principles of G‐DRG is essential. In the following aspects of the reimbursement system with special relevance to dermatology are reviewed in detail. Additionally, the revised classification system versions OPS‐301 SGB V and ICD‐10‐GM 2004 and the German coding standards version 2004 must be appropriately applied for dermatologic purposes.     

Stärken‐ und Schwächen‐Analyse: Grundlage der Leistungsausrichtung im wettbewerbsorientierten Umfeld

Hospitals in the German health care system are confronted with increasing economic competition due to paradigm shifts in funding inpatient treatment. Major hospitals, such as university hospitals, will be under significantly greater pressure to keep up the ability to compete by uniform per case payment. The new hospital funding system based on a Diagnosis Related Group (DRG) system and the economic competition involved require analyses of organisational and locational factors. Cooperativeness and efficient utilisation of resources, properties and staff will be determining factors to secure existence. Adequate responses and strategies are essential to cope with the growing operating requirements. Carrying out an analysis identifying one's own strengths and weaknesses, opportunities and threats will help to focus activities and sustainable strategies into areas where the strengths and the greatest opportunities lie. An example of the process of strategic planning and positioning is shown for a university department of dermatology.     

Periokuläre Dermatitis

Background: Perioral dermatitis paradoxically sometimes spares the entire perioral region. There may be isolated periocular involvement (periocular dermatitis). Patients/methods: The records of 23 patients with only periocular dermatitis were reviewed with respect to the following parameters: clinical findings, history of atopy, topical facial treatment, prick and patch tests, CAP‐SX1, previous treatment, time to healing and relapses. 23 patients with no history of periocular dermatitis were matched for age and sex (case‐control study). Results: The predominant clinical finding in the affected group was micropapules primarily in the lateral corner of the eye and lower eyelid. The groups differed significantly (p < 0.05) with regard to the history of atopic diseases and reactive prick tests. 22 patients regularly used face‐care or eye‐care products. These patients did not differ significantly from the control group with regard to frequency and type of product used. 6 patients had been previously treated with topical corticosteroids. The time to healing was 2 – 8 weeks (median: 4 weeks). Conclusions: Periocular dermatitis is a variation on perioral dermatitis, whereby similar pathogenetic factors are observed. The elimination of topical corticosteroids and the gradual reduction of skin‐care products regularly lead to clearing of the condition.     

Wirksamkeit,Nebenwirkungen und Patientenzufriedenheit bei Leitungsanästhesie durch Handblock vor Behandlung der palmaren Hyperhidrose mit Botulinumtoxin A

Background: The treatment of palmar hyperhidrosis with botulinum toxin type A (BTX A) injections is one of the most effective therapeutic options. However, without adequate anaesthesia this treatment is not feasible in most patients. The anaesthesia of the radial, median and ulnar nerves (wrist block) is despite the absence of good data considered effective but risky. Patients and methods: Between 1. 10. 1999 and 30. 9. 2001 retrospectively the efficacy, side effects and the patient satisfaction regarding the overall performance of the wrist block prior to the treatment of the palmar hyperhidrosis with BTX A was investigated. The study took place at the department of dermatology in Mannheim. Results: Of the 38 patients treated, 33 were finally included into the trial. The patients chose the average score of 7,9 ± 2,1 (sd) on a scale from “0” to “10” (not at all effective‐maximally effective) for the efficacy of the wrist block in reducing pain. The patients were very content with the wrist block and granted it the average score of 7,7 ± 2,1 (sd) on a scale from “0” to “10” (not at all content‐maximum content). Unwanted effects could be seen in 31/33 patients (93,9 %): these were dizziness, headache or haematoma at the spot of injection as well as pain caused by the injections of the local anaesthesia or paresthesias such as tickling of the hand or arm. All side effects caused by the wrist block were reversible and lasted – except in one patient – only for a short time. 29/33 patients (87,9 %) recommended the wrist block prior to treating palmar hyperhidrosis with BTX A and 28/33 patients (84,9 %) could not imagine to agree to such a treatment without local anaesthesia. Conclusion: The wrist block effectively reduces pain due to the treatment of palmar hyperhidrosis with BTX A. Major side effects are rare; patient acceptance and satisfaction are high.     

Intraoperative Detektion von Sentinel‐Lymphknoten beim malignen Melanom der Haut‐Vitalfärbung allein versus Vitalfärbung plus Gammasonde

Background: Compared with intraoperative sentinel lymph node identification using blue dye only, the introduction of a hand‐held gamma probe has improved the identification rates. In this retrospective study, further aspects related to the introduction of gamma‐guided preparation are analysed in detail. Patients and methods: 81 patients who underwent sentinel biopsy using the blue dye technique were compared to 247 patients whose operations were guided by blue dye and gamma probe. Results: After the introduction of radio‐guided surgery, the sentinel node identification rate increased from 87.7 % to 99.2 % (P < 0.00001). The number of harvested sentinel lymph nodes increased from 1.4 ± 0.9 to 1.8 ± 0.09 (P < 0.00001). The “clinical false‐negative rate” decreased from 15.8 % to 9.6 %. The percentage of positive completion lymphadenectomy decreased from 50 % to 24.6 %. The risk of postoperative seroma decreased as a consequence of gamma guided preparation (5.1 % versus 15 %, P = 0.01). Regarding overall survival and recurrence‐free survival, there were no significant differences between both groups. The 5‐year‐probability of nodal basin failure was 7.9 % after negative sentinel biopsy and 25.3 % after positive sentinel lymphonodectomy plus consecutive completion lymphadenectomy. Conclusions: Combined application of blue dye and gamma‐probe improved sensitivity and decreased the risk of postoperative seroma. The probability of recurrence and survival was not influenced by the technique of intraoperative sentinel node identification.