Wirksamkeit und Nutzen eines 5‐FU‐/Salicylsäure‐haltigen Präparates in der Therapie vulgärer und plantarer Warzen – systematische Literaturübersicht und Metaanalyse

Background: 1) Salicylic acid (SA) and 5‐Fluorouracil (5‐FU) are effective drugs in wart therapy. 2) In Germany, increasing data on the benefit and the economic efficiency of drugs at Level I of evidence‐based medicine are needed. Methods: Evaluation of the effectiveness and benefits of a drug combination containing 0.5 % 5‐FU and 10 % SA in the therapy of a) common and b) plantar warts in form of a two‐step procedure – 1. Systematic literature analysis, 2. Meta‐analysis of the randomised‐controlled studies (RCTs). Results: 1. The efficacy of 5‐FU/SA therapy was tested in a total of 625 patients (n = 8 RCTs) with common warts and 101 patients (n = 4 RCTs) with plantar warts. The therapeutic effect across all studies in common warts was 63.4 % response (complete healing) for 5‐FU/SA vs. 23.1 % for the 5‐FU‐free controls, respectively. In plantar warts, the response was 63.0 % vs. 11.0 %. 2. A meta‐analysis of n = 7 RCTs on common warts (n = 325 patients) showed a mean risk difference of 0.42 (CI 0.34 – 0.50, p < 0.05), thus a significant superiority of 5‐FU/SA over SA. A comparable result was also found for plantar warts. Conclusion: The combination of 5‐FU and SA is an effective and beneficial therapy for common and plantar warts.     

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.     

Vergleich der Wirksamkeit verschiedener topischer Glukokortikoidcremes und ‐salben im Vasokonstriktionstest: Überlegenheit von Hydrocortisonbutyrat gegenüber Hydrocortison

Background: Topical corticosteroids are the treatment of choice for numerous inflammatory or hyperproliferative skin diseases. The vasoconstriction assay is suitable to determinate corticosteroid activity. Patients and methods: 60 healthy volunteers were studied. Three corticosteroids in both cream and ointment bases, as well as one corresponding vehicle, were investigated in a double‐blind, randomised, intra‐individual clinical study, using a vasoconstriction assay. The potencies of hydrocortisone, hydrocortisone‐17‐butyrate and mometasone furoate were measured, while hydrocortisone‐17‐butyrate was also compared to the vehicle. Results: The sum score of the clinical evaluation was for Hydrocortisone 34 (cream) and 18 (ointment), for Hydrocortisone butyrate 47 (cream) and 55 (ointment) and for Mometasone furoate 57 (cream) and 50 (ointment). The chromametric values for blanching with hydrocortisone were 1.73 (cream) and 1.48 (ointment), hydrocortisone butyrate 2.87 (cream) and 3.26 (ointment) and mometasone furoate 2.98 (cream) and 2.84 (ointment). Conclusions: The clinical and chromametric evaluation of vasoconstriction showed activity for all corticosteroid formulations. Hydrocortisone butyrate was shown to be superior to hydrocortisone.     

Familiäres Auftreten einer segmentalen Typ‐2‐Manifestation der kutanen Leiomyomatose

Background: There are several malignant or benign skin diseases which can be explained by the phenomenon of mosaicism or segmental manifestation, e. g. segmental neurofibromatosis 1 or cutaneous leiomyomatosis. Loss of heterozygosity is a crucial element for segmental manifestations. Two types of segmental manifestations can be defined in autosomal dominant skin diseases such as cutaneous leiomyomatosis. Type 1 is caused by a novel postzygotic segmental mutation; type 2 reflects an additional postzygotic loss of heterozygosity of the gene locus responsible for cutaneous leiomyomatosis in a initially heterozygous embryo. Loss of heterozygosity is a genetic process when a heterozygous cell becomes homozygous or hemizygous by loosing the corresponding wild‐type allele. This phenomenon can be regarded as a precondition for tumor growth. In type‐2 cases, the segmental manifestation is more distinctive with additional disseminated disease because of a germline mutation with heterozygosity of all somatic cells outside the strongly affected area. Patients and Methods: A 74‐year‐old female patient and her 52‐year‐old son presented with segmental leiomyomas following the lines of Blaschko as well as disseminated skin tumors. The woman has undergone hysterectomy at the age of 29 because of multiple uterine leiomyomas, as had her mother and grandmother. Results: Based on their typical clinical appearance, these cases represent the rare familial occurrence of type‐2 manifestation of leiomyomas which indicates a postzygotic loss of the wild‐type allele. Conclusion: Very unusual is the familial occurrence in mother and son of this type‐2 manifestation of cutaneous leiomyomatosis. Apparently the gene locus is prone to a postzygotic loss of heterozygosity.     

Opportunistische filamentöse Mykosen: Aspergillose,Mukormykose, Phäohypho‐ und Hyalohyphomykose

Opportunistic filamentous mycoses are widely distributed all over the world. They are rarely observed in Europe but are common in developing countries. The most common are the aspergilloses (due to Aspergillus spp.) mostly in neutropenia and immunosuppression; the mucormycoses characterized by rapid progression in patients with diabetic ketoacidosis; the phaeohyphomycoses due to pigmented fungi causing either a mild superficial or a very serious deep disease and the hyalohyphomycoses due to hyaline filamentous fungi (Fusarium spp., Pseudallescheria spp., Scopulariopsis spp.). Cutaneous manifestations are usually secondary to dissemination from pulmonary or visceral disease; primary cases are less frequent and due to direct inoculation into the skin. We review epidemiological, clinical, diagnostic, and therapeutic data on the four most important opportunistic filamentous mycoses: aspergillosis, mucormycosis, phaeohyphomycosis and hyalohyphomycosis.