Joachim Dissemond - Academia.edu (original) (raw)
Papers by Joachim Dissemond
CME, 2010
Meist entsteht ein Ulcus cruris durch eine venöse Insuffizienz. Doch das ist längst nicht die ein... more Meist entsteht ein Ulcus cruris durch eine venöse Insuffizienz. Doch das ist längst nicht die einzige Ursache. Was sonst noch hinter den chronischen Wunden stecken kann, zeigte eine Untersuchung mit 354 Patienten am Universitätsklinikum Essen.
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2016
Die Necrobiosis lipoidica (NL) ist eine seltene, granulomatöse inflammatorische Erkrankung der Ha... more Die Necrobiosis lipoidica (NL) ist eine seltene, granulomatöse inflammatorische Erkrankung der Haut unklarer Pathophysiologie mit potentieller Assoziation zum Diabetes mellitus. Weitere relevante Kofaktoren und Komorbiditäten wurden bislang kontrovers diskutiert. Differenziert ausgewertet wurden die Diagnosis-related-Groups (DRG)-Daten aller Patienten, die 2012 stationär in Deutschland behandelt und mit der Haupt- und Nebendiagnose NL kodiert wurden. Insgesamt konnten die Datensätze von 262 stationären Patientenfällen mit der Haupt- oder Nebendiagnose NL evaluiert werden. Frauen (63,4 %, n = 166) waren fast doppelt so häufig von einer NL betroffen wie Männer (36,6 %, n = 96). Die meisten (14,8 %) der Patienten mit NL lagen in der Altersgruppe zwischen 50 und 55 Jahren. Als Komorbiditäten wurde aus der Gruppe des metabolischen Syndroms am häufigsten ein Diabetes mellitus bei 34,4 % dokumentiert; eine essentielle Hypertonie wurde in 9,2 %, eine Adipositas in 4,6 %, eine Herzinsuffizie...
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2013
Hintergrund: In chronischen Wunden werden nahezu obligat Bakterien nachgewiesen. Patienten und Me... more Hintergrund: In chronischen Wunden werden nahezu obligat Bakterien nachgewiesen. Patienten und Methodik: Retrospektiv wurden die Resultate der bakteriologischen Abstriche aus den Jahren 2010 und 2011 von Patienten mit chronischem Ulcus cruris aus 10 dermatologischen Wundambulanzen, differenziert in 5 Regionen Deutschlands ausgewertet. Ergebnisse: Insgesamt konnten die Daten von 970 Patienten erhoben werden. Staphylococcus aureus fand sich bei 47,6 % der Patienten; bei 8,6 % der Patienten zeigte sich eine Methicillin-Resistenz (MRSA). Pseudomonas aeruginosa wurde bei 31,1 %, Enterobakterien bei 28,6 % und Proteus mirabilis bei 13,7 % der Patienten nachgewiesen. Bei dem regionalen Vergleich fand sich ein signifikantes Süd-Nord-Gefälle für Staphylococcus aureus, Pseudomonas aeruginosa und Enterobakterien. Zudem zeigte sich ein hochsignifikantes West-Ost-Gefälle für MRSA mit Nachweisraten von 13,5 % im Westen gegenüber 4,0 % im Osten. Es ergab sich bundesweit eine signifikante negative Korrelation zwischen Staphylococcus aureus und Pseudomonas aeruginosa bzw. Proteus mirabilis, sowie eine positive Korrelation für die Wundgröße und Bestehensdauer der Wunde mit dem Nachweis von Pseudomonas aeruginosa. Als mögliche Gründe für die regional signifikant unterschiedlichen Nachweisraten in den verschiedenen Regionen kommen neben unterschiedlichen klimatischen und therapeutischen Bedingungen insbesondere verschiedene regionale Versorgungsstrukturen in Betracht. Schlussfolgerungen: Unsere Daten zeigen das regionale, teils signifikant unterschiedliche Verteilungsmuster der Bakterien bei Patienten mit chronischem Ulcus cruris in Deutschland.
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2015
There are currently no therapeutic guidelines with respect to pyoderma gangrenosum (PG). In order... more There are currently no therapeutic guidelines with respect to pyoderma gangrenosum (PG). In order to systematically record currently practiced therapeutic options for PG, a questionnaire was developed and sent to experts at various German dermatology departments. Overall, 50 fully completed questionnaires were returned to us. On average, the diagnosis of PG is made 15 times per year. Of these patients, 11.1 % receive only topical therapy; 22.7 %, exclusively systemic therapy; and 66.2 %, both topical and systemic immunomodulatory therapy. Topically, the experts most commonly use class III (78 %) and class IV corticosteroids (88 %). All experts (100 %) reported the frequent use of systemic corticosteroids in the therapy of PG patients. Cyclosporine is used in 74 %, TNF-α inhibitors in 24 %, and azathioprine or mycophenolate mofetil each in 20 % of patients. Systemic agents such as dapsone (16 %), intravenous immunoglobulins (14 %), methotrexate (6 %), cyclophosphamide (4 %), tacrolim...
International wound journal, Jan 5, 2014
Numerous comorbidities and cofactors have been known to influence wound healing processes. In thi... more Numerous comorbidities and cofactors have been known to influence wound healing processes. In this multicentre study, clinical data of 1 000 patients with chronic leg ulcers from ten specialised dermatological wound care centers were analysed. The patient cohort comprised 567 females and 433 males with an average age of 69·9 years. The wounds persisted on average for 40·8 months and had a mean size of 43·7 cm(2) . Venous leg ulcers represented the most common entity accounting for 51·3% of all chronic wounds, followed by mixed-type ulcers in 12·9% and arterial ulcerations in 11·0% of the patients. Vasculitis was diagnosed in 4·5%, trauma in 3·2%, pyoderma gangrenosum in 2·8%, lymphoedema in 1·7%, neoplasia in 1·0% and delayed post-surgical wound healing in 0·6% of the included patients. In total, 70·5% of patients suffered from arterial hypertension, 45·2% were obese, 27·2% had non-insulin dependent diabetes, and 24·4% dyslipidaemia. Altogether 18·4% suffered from metabolic syndrome...
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2014
Chronic wounds are colonized by many different bacteria. We analyzed microbiological swabs from c... more Chronic wounds are colonized by many different bacteria. We analyzed microbiological swabs from chronic leg ulcers from 2012/2013 and matched the results with those from 2002/2003 and 2007/2008 from the same institution. Results from 100 patients from our specialized wound care center were evaluated retrospectively. The etiologies were broadly variable with chronic venous insufficiency being the most common. As the most common bacterium Staphylococcus aureus was found in 53% of patients; 9% of patients were positive for methicillin-resistant S. aureus (MRSA). Pseudomonas aeruginosa was detected in 25% of patients. Different fecal bacteria and Enterobacteriaceae were found in 49% of the patients; 11% of the swabs were sterile. The detection rate for S. aureus has regressed by 17.1% over the past decade and in the case of MRSA by 12.5%. In contrast, colonization with gram-negative bacteria species significantly increased by 11.7%. This tendency was also seen in 2007/2008, but with a h...
Medizinische Klinik (Munich, Germany : 1983), Jan 15, 2009
A 77-year-old female patient with an ulceration of the heel is described, which was treated over ... more A 77-year-old female patient with an ulceration of the heel is described, which was treated over a period of 2 years as a neurotrophic ulcer related to diabetes mellitus. After the initial examination in the outpatient wound healing clinic, a malignant melanoma already showing invasive growth with a penetration depth of 4.6 mm was detected in a biopsy. After diagnosis and exclusion of metastases, a phase-adapted complete excision was carried out. Furthermore, an adjuvant immunotherapy was introduced. Malignant melanoma is a primary cutaneous malignant tumor. Its thickness at the time of the initial diagnosis is crucial to the prognosis. Ulcerated and amelanotic melanomas still present a considerable clinical challenge due to the likelihood of being mistaken for benign diseases and the occurrence of filiae when diagnosis is made too late. This case report demonstrates the importance of differential diagnostic consideration of neoplasias, for example malignant melanoma, in cases of un...
MMW Fortschritte der Medizin, Jan 21, 2006
Currently, psoriasis is seen as a T-cell-mediated autoimmune disease that is characterized by an ... more Currently, psoriasis is seen as a T-cell-mediated autoimmune disease that is characterized by an increased expression of pro-inflammatory cytokines. The clarification of this pathogenetic cascade uncovered a number of points of departure for the development of causal therapy and led to the introduction of new medications--the so-called biologics. The following have already been approved in Germany: infliximab, etanercept, efalizumab and adalimumab. These are described, and their advantages and disadvantages in the clinical setting are discussed.
The Journal of dermatology, 2006
![Research paper thumbnail of [Leg ulcers: current aspects in diagnostic]](https://attachments.academia-assets.com/91025841/thumbnails/1.jpg)
](Deutsche medizinische Wochenschrift (1946), Jan 20, 2005
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2014
The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore ... more The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and débridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds.
Advances in Skin & Wound Care, 2014
OBJECTIVE: To evaluate the efficacy, tolerability, and safety of a novel wound dressing containin... more OBJECTIVE: To evaluate the efficacy, tolerability, and safety of a novel wound dressing containing epidermal growth factor (EGF) in a collagen-gel matrix on hard-to-heal venous leg ulcers. PATIENTS AND METHODS: The authors included 33 hard-to-heal venous leg ulcers found on 31 patients. The EGF-containing dressing was applied 3 times while best practice conservative wound treatment was continued. Patients were followed up with after 1, 2, and 3 months to evaluate (a) the wound size, (b) the ease of application and dissolution of the dressing, and (c) the wound dressing by means of a scale ranging from 1 to 5 (1 = best, 5 = worst). RESULTS: The protocol was completed by 25 of 31 patients. The reasons for discontinuation were wound infection, pain, and lost to follow-up (n = 2 each, respectively). After 3 months, the average wound surface was significantly reduced (from 33.69 cm 2 to 18.94 cm 2 , P = .023). On a scale from 0 to 100, the wound dressing was evaluated as very easy to apply and highly dissolvable (mean value of 97.14 and 98.11, respectively; 100 = very easy to apply or 100% dissolution). The dressing was generally well tolerated and scored a mean overall rating of 2.16 by healthcare specialists and 2.40 by patients. CONCLUSION: The authors' results demonstrate that the novel EGF-containing wound dressing was generally well tolerated and safe. Combined with the significant wound surface reduction, it can be regarded as an adequate novel treatment option for patients with hard-to-heal venous leg ulcers.
Medizinische Klinik, 2010
We report on a 36-year old patient with a chronic leg ulcer at the right malleolus lateralis whic... more We report on a 36-year old patient with a chronic leg ulcer at the right malleolus lateralis which persists since nine month and causes distinct pain. Furthermore telengiectatic erythema in terms of a naevus flammeus could be found at the right leg and foot as well as genital and gluteal. By birth the right leg of the patient was longer than the other one. In spite of initiation of several therapies the ulcer was refractory to different therapies. The clinical diagnosis of a chronic venous insufficiency of the right leg was clearly proven by apparative diagnostic. In consequence of all findings we diagnosed a Klippel-Trenaunnay syndrome consisting of the typical trias of naevus flammeus, hemihypertrophie of bone and soft tissue as well as angiodysplasies with a distinct chronic venous insufficiency. The presented case describes a patient with a Klippel-Trenaunnay syndrome as a seldom cause of a chronic leg ulcer. Although it is a very rare cause for a chronic wound it should be known by physicians to be considered in the differential diagnosis process.
Journal der Deutschen Dermatologischen Gesellschaft, 2004
ABSTRACT
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2011
Background: Pyoderma gangrenosum is a rare, destructive, ulcerative neutrophilic dermatosis of un... more Background: Pyoderma gangrenosum is a rare, destructive, ulcerative neutrophilic dermatosis of unknown origin that has been investigated insufficiently in clinical studies. According to current textbooks, it is often associated with chronic inflammatory bowel diseases or other autoimmune disorders. Patients and methods: We retrospectively analyzed data from 49 patients with pyoderma gangrenosum. Results: Our results showed that although only 6.1 % of patients had chronic inflammatory bowel disease, 22.4 % patients had a malignancy, 18.4 % had chronic renal insufficiency, and 42.8 % had anemia. A potentially relevant aspect that has received little attention is an association with endocrine diseases in 38.8 % of patients. 28.6 % of patients had diabetes. Given that 32.6 % of patients were obese, a potential association with metabolic syndrome may be considered as a possible new risk factor for pyoderma gangrenosum. Conclusions: The clinical data from the present study are insufficient for drawing any firm conclusions. We did, however, observe an association between pyoderma gangrenosum and certain as yet unreported co-factors, in particular metabolic syndrome. This should be considered in further studies.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2010
Background: The etiology of chronic leg ulcers is heterogenous and they exhibit quite different h... more Background: The etiology of chronic leg ulcers is heterogenous and they exhibit quite different healing rates depending on the underlying cause. Although the prevalence and incidence of chronic leg ulcers appear to be increasing, data on these patients in Germany are lacking. Patients and Methods: Altogether 100 German wound care professionals were asked to complete a questionnaire regarding the diagnosis and etiology of their patients with chronic leg ulcers. Results: We received the data on 31,619 patients. In these patients, venous insufficiency was the dominating causative factor in 47.6 % and arterial insufficiency in 14.5 %, 17.6 % of ulcers were due to combined arterial and venous insufficiency. Rarer causes included vasculitis (5.1 %), exogenous factors (3.8 %), pyoderma gangrenosum (3.0 %), infection (1.4 %), neoplasia (1.1 %), calciphylaxis (1.1 %) and drug-induced (1.1 %). The used diagnostic methods used varied widely between the medical and surgical specialties. Conclusions: Even though the results of our study cannot claim to be a representative overview, they demonstrate clearly that next to known etiologies, e. g. chronic venous insufficiency or peripheral arterial insufficiency, which are relevant in 79.7 % of all patients a multitude of other causes exist, which are responsible in 20.3 % of all patients for the development of chronic leg ulcers.
Der Hautarzt, 2009
The etiology of chronic leg ulcers is very heterogeneous. The primary aim of our investigation wa... more The etiology of chronic leg ulcers is very heterogeneous. The primary aim of our investigation was to analyze the etiology of leg ulcers in patients treated in our wound care center over a period of 5 years. In this open retrospective study, data of 354 patients was analyzed. We found a venous leg ulcer in 203 (57%), and in 52 (15%) patients a combined arterio-venous induced leg ulcer. The third most common cause was leg ulcers due to different types of vasculitis in 47 (13%) patients. An exclusively arterial induced leg ulcer was diagnosed in 13 (3.7%) patients. Overall 16 different etiologies were identified. In contrast to the few comparable other investigations, we found a higher incidence of immunologic und infectious causes for leg ulcers in our patients. Even if our results do not allow a representative overview about the prevalence of leg ulcer in Germany, they demonstrate the wide spectrum of leg ulcer causes in a dermatologic wound care centre.
Der Hautarzt, 2009
Zusammenfassung Wir berichten über eine 73-jährige Patientin mit akut aufgetretenen, äußerst sch... more Zusammenfassung Wir berichten über eine 73-jährige Patientin mit akut aufgetretenen, äußerst schmerzhaften perianalen Ulzerationen. Anamnestisch hatte sie aufgrund einer Mazeration der Rima ani bei Psoriasis vulgaris diverse Salben sowie später auch Kaliumpermanganatsitzbäder benutzt. Unmittelbar nach Durchführung der Sitzbäder kam es zu dem Auftreten von Nekrosen und in der Folge zu perianalen Ulzerationen. Nach Ausschluss der relevanten Differenzialdiagnosen konnten wir die Diagnose von perianalen Ulzerationen durch eine Verätzung mit Kaliumpermanganat sichern. Durch die Meidung der identifizierten Noxe und Einleitung einer modernen feuchten Wundtherapie konnte nach einer 8-monatigen konservativen Behandlung eine vollständige Abheilung erzielt werden.
CME, 2010
Meist entsteht ein Ulcus cruris durch eine venöse Insuffizienz. Doch das ist längst nicht die ein... more Meist entsteht ein Ulcus cruris durch eine venöse Insuffizienz. Doch das ist längst nicht die einzige Ursache. Was sonst noch hinter den chronischen Wunden stecken kann, zeigte eine Untersuchung mit 354 Patienten am Universitätsklinikum Essen.
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2016
Die Necrobiosis lipoidica (NL) ist eine seltene, granulomatöse inflammatorische Erkrankung der Ha... more Die Necrobiosis lipoidica (NL) ist eine seltene, granulomatöse inflammatorische Erkrankung der Haut unklarer Pathophysiologie mit potentieller Assoziation zum Diabetes mellitus. Weitere relevante Kofaktoren und Komorbiditäten wurden bislang kontrovers diskutiert. Differenziert ausgewertet wurden die Diagnosis-related-Groups (DRG)-Daten aller Patienten, die 2012 stationär in Deutschland behandelt und mit der Haupt- und Nebendiagnose NL kodiert wurden. Insgesamt konnten die Datensätze von 262 stationären Patientenfällen mit der Haupt- oder Nebendiagnose NL evaluiert werden. Frauen (63,4 %, n = 166) waren fast doppelt so häufig von einer NL betroffen wie Männer (36,6 %, n = 96). Die meisten (14,8 %) der Patienten mit NL lagen in der Altersgruppe zwischen 50 und 55 Jahren. Als Komorbiditäten wurde aus der Gruppe des metabolischen Syndroms am häufigsten ein Diabetes mellitus bei 34,4 % dokumentiert; eine essentielle Hypertonie wurde in 9,2 %, eine Adipositas in 4,6 %, eine Herzinsuffizie...
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2013
Hintergrund: In chronischen Wunden werden nahezu obligat Bakterien nachgewiesen. Patienten und Me... more Hintergrund: In chronischen Wunden werden nahezu obligat Bakterien nachgewiesen. Patienten und Methodik: Retrospektiv wurden die Resultate der bakteriologischen Abstriche aus den Jahren 2010 und 2011 von Patienten mit chronischem Ulcus cruris aus 10 dermatologischen Wundambulanzen, differenziert in 5 Regionen Deutschlands ausgewertet. Ergebnisse: Insgesamt konnten die Daten von 970 Patienten erhoben werden. Staphylococcus aureus fand sich bei 47,6 % der Patienten; bei 8,6 % der Patienten zeigte sich eine Methicillin-Resistenz (MRSA). Pseudomonas aeruginosa wurde bei 31,1 %, Enterobakterien bei 28,6 % und Proteus mirabilis bei 13,7 % der Patienten nachgewiesen. Bei dem regionalen Vergleich fand sich ein signifikantes Süd-Nord-Gefälle für Staphylococcus aureus, Pseudomonas aeruginosa und Enterobakterien. Zudem zeigte sich ein hochsignifikantes West-Ost-Gefälle für MRSA mit Nachweisraten von 13,5 % im Westen gegenüber 4,0 % im Osten. Es ergab sich bundesweit eine signifikante negative Korrelation zwischen Staphylococcus aureus und Pseudomonas aeruginosa bzw. Proteus mirabilis, sowie eine positive Korrelation für die Wundgröße und Bestehensdauer der Wunde mit dem Nachweis von Pseudomonas aeruginosa. Als mögliche Gründe für die regional signifikant unterschiedlichen Nachweisraten in den verschiedenen Regionen kommen neben unterschiedlichen klimatischen und therapeutischen Bedingungen insbesondere verschiedene regionale Versorgungsstrukturen in Betracht. Schlussfolgerungen: Unsere Daten zeigen das regionale, teils signifikant unterschiedliche Verteilungsmuster der Bakterien bei Patienten mit chronischem Ulcus cruris in Deutschland.
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2015
There are currently no therapeutic guidelines with respect to pyoderma gangrenosum (PG). In order... more There are currently no therapeutic guidelines with respect to pyoderma gangrenosum (PG). In order to systematically record currently practiced therapeutic options for PG, a questionnaire was developed and sent to experts at various German dermatology departments. Overall, 50 fully completed questionnaires were returned to us. On average, the diagnosis of PG is made 15 times per year. Of these patients, 11.1 % receive only topical therapy; 22.7 %, exclusively systemic therapy; and 66.2 %, both topical and systemic immunomodulatory therapy. Topically, the experts most commonly use class III (78 %) and class IV corticosteroids (88 %). All experts (100 %) reported the frequent use of systemic corticosteroids in the therapy of PG patients. Cyclosporine is used in 74 %, TNF-α inhibitors in 24 %, and azathioprine or mycophenolate mofetil each in 20 % of patients. Systemic agents such as dapsone (16 %), intravenous immunoglobulins (14 %), methotrexate (6 %), cyclophosphamide (4 %), tacrolim...
International wound journal, Jan 5, 2014
Numerous comorbidities and cofactors have been known to influence wound healing processes. In thi... more Numerous comorbidities and cofactors have been known to influence wound healing processes. In this multicentre study, clinical data of 1 000 patients with chronic leg ulcers from ten specialised dermatological wound care centers were analysed. The patient cohort comprised 567 females and 433 males with an average age of 69·9 years. The wounds persisted on average for 40·8 months and had a mean size of 43·7 cm(2) . Venous leg ulcers represented the most common entity accounting for 51·3% of all chronic wounds, followed by mixed-type ulcers in 12·9% and arterial ulcerations in 11·0% of the patients. Vasculitis was diagnosed in 4·5%, trauma in 3·2%, pyoderma gangrenosum in 2·8%, lymphoedema in 1·7%, neoplasia in 1·0% and delayed post-surgical wound healing in 0·6% of the included patients. In total, 70·5% of patients suffered from arterial hypertension, 45·2% were obese, 27·2% had non-insulin dependent diabetes, and 24·4% dyslipidaemia. Altogether 18·4% suffered from metabolic syndrome...
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2014
Chronic wounds are colonized by many different bacteria. We analyzed microbiological swabs from c... more Chronic wounds are colonized by many different bacteria. We analyzed microbiological swabs from chronic leg ulcers from 2012/2013 and matched the results with those from 2002/2003 and 2007/2008 from the same institution. Results from 100 patients from our specialized wound care center were evaluated retrospectively. The etiologies were broadly variable with chronic venous insufficiency being the most common. As the most common bacterium Staphylococcus aureus was found in 53% of patients; 9% of patients were positive for methicillin-resistant S. aureus (MRSA). Pseudomonas aeruginosa was detected in 25% of patients. Different fecal bacteria and Enterobacteriaceae were found in 49% of the patients; 11% of the swabs were sterile. The detection rate for S. aureus has regressed by 17.1% over the past decade and in the case of MRSA by 12.5%. In contrast, colonization with gram-negative bacteria species significantly increased by 11.7%. This tendency was also seen in 2007/2008, but with a h...
Medizinische Klinik (Munich, Germany : 1983), Jan 15, 2009
A 77-year-old female patient with an ulceration of the heel is described, which was treated over ... more A 77-year-old female patient with an ulceration of the heel is described, which was treated over a period of 2 years as a neurotrophic ulcer related to diabetes mellitus. After the initial examination in the outpatient wound healing clinic, a malignant melanoma already showing invasive growth with a penetration depth of 4.6 mm was detected in a biopsy. After diagnosis and exclusion of metastases, a phase-adapted complete excision was carried out. Furthermore, an adjuvant immunotherapy was introduced. Malignant melanoma is a primary cutaneous malignant tumor. Its thickness at the time of the initial diagnosis is crucial to the prognosis. Ulcerated and amelanotic melanomas still present a considerable clinical challenge due to the likelihood of being mistaken for benign diseases and the occurrence of filiae when diagnosis is made too late. This case report demonstrates the importance of differential diagnostic consideration of neoplasias, for example malignant melanoma, in cases of un...
MMW Fortschritte der Medizin, Jan 21, 2006
Currently, psoriasis is seen as a T-cell-mediated autoimmune disease that is characterized by an ... more Currently, psoriasis is seen as a T-cell-mediated autoimmune disease that is characterized by an increased expression of pro-inflammatory cytokines. The clarification of this pathogenetic cascade uncovered a number of points of departure for the development of causal therapy and led to the introduction of new medications--the so-called biologics. The following have already been approved in Germany: infliximab, etanercept, efalizumab and adalimumab. These are described, and their advantages and disadvantages in the clinical setting are discussed.
The Journal of dermatology, 2006
Deutsche medizinische Wochenschrift (1946), Jan 20, 2005
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2014
The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore ... more The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and débridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds.
Advances in Skin & Wound Care, 2014
OBJECTIVE: To evaluate the efficacy, tolerability, and safety of a novel wound dressing containin... more OBJECTIVE: To evaluate the efficacy, tolerability, and safety of a novel wound dressing containing epidermal growth factor (EGF) in a collagen-gel matrix on hard-to-heal venous leg ulcers. PATIENTS AND METHODS: The authors included 33 hard-to-heal venous leg ulcers found on 31 patients. The EGF-containing dressing was applied 3 times while best practice conservative wound treatment was continued. Patients were followed up with after 1, 2, and 3 months to evaluate (a) the wound size, (b) the ease of application and dissolution of the dressing, and (c) the wound dressing by means of a scale ranging from 1 to 5 (1 = best, 5 = worst). RESULTS: The protocol was completed by 25 of 31 patients. The reasons for discontinuation were wound infection, pain, and lost to follow-up (n = 2 each, respectively). After 3 months, the average wound surface was significantly reduced (from 33.69 cm 2 to 18.94 cm 2 , P = .023). On a scale from 0 to 100, the wound dressing was evaluated as very easy to apply and highly dissolvable (mean value of 97.14 and 98.11, respectively; 100 = very easy to apply or 100% dissolution). The dressing was generally well tolerated and scored a mean overall rating of 2.16 by healthcare specialists and 2.40 by patients. CONCLUSION: The authors' results demonstrate that the novel EGF-containing wound dressing was generally well tolerated and safe. Combined with the significant wound surface reduction, it can be regarded as an adequate novel treatment option for patients with hard-to-heal venous leg ulcers.
Medizinische Klinik, 2010
We report on a 36-year old patient with a chronic leg ulcer at the right malleolus lateralis whic... more We report on a 36-year old patient with a chronic leg ulcer at the right malleolus lateralis which persists since nine month and causes distinct pain. Furthermore telengiectatic erythema in terms of a naevus flammeus could be found at the right leg and foot as well as genital and gluteal. By birth the right leg of the patient was longer than the other one. In spite of initiation of several therapies the ulcer was refractory to different therapies. The clinical diagnosis of a chronic venous insufficiency of the right leg was clearly proven by apparative diagnostic. In consequence of all findings we diagnosed a Klippel-Trenaunnay syndrome consisting of the typical trias of naevus flammeus, hemihypertrophie of bone and soft tissue as well as angiodysplasies with a distinct chronic venous insufficiency. The presented case describes a patient with a Klippel-Trenaunnay syndrome as a seldom cause of a chronic leg ulcer. Although it is a very rare cause for a chronic wound it should be known by physicians to be considered in the differential diagnosis process.
Journal der Deutschen Dermatologischen Gesellschaft, 2004
ABSTRACT
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2011
Background: Pyoderma gangrenosum is a rare, destructive, ulcerative neutrophilic dermatosis of un... more Background: Pyoderma gangrenosum is a rare, destructive, ulcerative neutrophilic dermatosis of unknown origin that has been investigated insufficiently in clinical studies. According to current textbooks, it is often associated with chronic inflammatory bowel diseases or other autoimmune disorders. Patients and methods: We retrospectively analyzed data from 49 patients with pyoderma gangrenosum. Results: Our results showed that although only 6.1 % of patients had chronic inflammatory bowel disease, 22.4 % patients had a malignancy, 18.4 % had chronic renal insufficiency, and 42.8 % had anemia. A potentially relevant aspect that has received little attention is an association with endocrine diseases in 38.8 % of patients. 28.6 % of patients had diabetes. Given that 32.6 % of patients were obese, a potential association with metabolic syndrome may be considered as a possible new risk factor for pyoderma gangrenosum. Conclusions: The clinical data from the present study are insufficient for drawing any firm conclusions. We did, however, observe an association between pyoderma gangrenosum and certain as yet unreported co-factors, in particular metabolic syndrome. This should be considered in further studies.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2010
Background: The etiology of chronic leg ulcers is heterogenous and they exhibit quite different h... more Background: The etiology of chronic leg ulcers is heterogenous and they exhibit quite different healing rates depending on the underlying cause. Although the prevalence and incidence of chronic leg ulcers appear to be increasing, data on these patients in Germany are lacking. Patients and Methods: Altogether 100 German wound care professionals were asked to complete a questionnaire regarding the diagnosis and etiology of their patients with chronic leg ulcers. Results: We received the data on 31,619 patients. In these patients, venous insufficiency was the dominating causative factor in 47.6 % and arterial insufficiency in 14.5 %, 17.6 % of ulcers were due to combined arterial and venous insufficiency. Rarer causes included vasculitis (5.1 %), exogenous factors (3.8 %), pyoderma gangrenosum (3.0 %), infection (1.4 %), neoplasia (1.1 %), calciphylaxis (1.1 %) and drug-induced (1.1 %). The used diagnostic methods used varied widely between the medical and surgical specialties. Conclusions: Even though the results of our study cannot claim to be a representative overview, they demonstrate clearly that next to known etiologies, e. g. chronic venous insufficiency or peripheral arterial insufficiency, which are relevant in 79.7 % of all patients a multitude of other causes exist, which are responsible in 20.3 % of all patients for the development of chronic leg ulcers.
Der Hautarzt, 2009
The etiology of chronic leg ulcers is very heterogeneous. The primary aim of our investigation wa... more The etiology of chronic leg ulcers is very heterogeneous. The primary aim of our investigation was to analyze the etiology of leg ulcers in patients treated in our wound care center over a period of 5 years. In this open retrospective study, data of 354 patients was analyzed. We found a venous leg ulcer in 203 (57%), and in 52 (15%) patients a combined arterio-venous induced leg ulcer. The third most common cause was leg ulcers due to different types of vasculitis in 47 (13%) patients. An exclusively arterial induced leg ulcer was diagnosed in 13 (3.7%) patients. Overall 16 different etiologies were identified. In contrast to the few comparable other investigations, we found a higher incidence of immunologic und infectious causes for leg ulcers in our patients. Even if our results do not allow a representative overview about the prevalence of leg ulcer in Germany, they demonstrate the wide spectrum of leg ulcer causes in a dermatologic wound care centre.
Der Hautarzt, 2009
Zusammenfassung Wir berichten über eine 73-jährige Patientin mit akut aufgetretenen, äußerst sch... more Zusammenfassung Wir berichten über eine 73-jährige Patientin mit akut aufgetretenen, äußerst schmerzhaften perianalen Ulzerationen. Anamnestisch hatte sie aufgrund einer Mazeration der Rima ani bei Psoriasis vulgaris diverse Salben sowie später auch Kaliumpermanganatsitzbäder benutzt. Unmittelbar nach Durchführung der Sitzbäder kam es zu dem Auftreten von Nekrosen und in der Folge zu perianalen Ulzerationen. Nach Ausschluss der relevanten Differenzialdiagnosen konnten wir die Diagnose von perianalen Ulzerationen durch eine Verätzung mit Kaliumpermanganat sichern. Durch die Meidung der identifizierten Noxe und Einleitung einer modernen feuchten Wundtherapie konnte nach einer 8-monatigen konservativen Behandlung eine vollständige Abheilung erzielt werden.