- Dermatologica Helvetica

Transcription

 Wissenschaftliches
Programm SGDV
 Programme scientifique
SSDV
 Traktandenliste SGDV
 Ordre du jour SSDV
 Freie Mitteilungen
 Communications libres
 Posters
 Posters
DH
DERMATOLOGICA HELVETICA
Août 2015 – Volume 27 – N° 6
97. Jahresversammlung der SGDV
97e Réunion annuelle de la SSDV
97. Jahresversammlung
97ème Réunion annuelle
ZÜRICH, 26.– 28.8.2015
26-28. August 26-28 août 2015 - Zürich
n
Ce numéro a été réalisé grâce à une aide pour la formation continue des
dermatologues suisses des firmes:
e
G
ä
ef
s
in
e
k
,
se
au
eH
t
Oh
Dieses Heft wurde für die Fortbildung der Schweizer Dermatologen dank
einer Hilfe die folgenden Firmen realisiert:
te s
y
ro
of P
. E.
f Dr
Reic
hm
Die Original Mavena® B12 Salbe
zur Behandlung von Psoriasis ist zurück
Mavena® B12 Salbe
Vitamin B12 verringert die Entzündung
Urea, Omega-3-Fettsäuren und Polyphenole
lindern Hautrötungen und Juckreiz
kortisonfrei
www.mavena.com
28973-0815-004d
Besuchen Sie
uns auf der 97. SGDV
Jahresversammlung
vom 26.–28.8.15
in Zürich
Mavena® B12 Salbe (Medizinprodukt zur äusserlichen Behandlung von Psoriasis)/Zusammensetzung: Funktionsstoff: Cyanocobalamin (Vitamin B12) – 1 g Salbe enthält 0,7 mg Cyanocobalamin. Sonstige Bestandteile:
Aqua Purificata, Persea gratissima (Avocado) Oil, Persea gratissima (Avocado) Oil Unsaponifiables, Glycerol, Hydroxyethyl Urea, Dipolyhydroxystearate, Salvia Hispanica Seed Oil, Hydrogenated Vegetable Oil, Hydrogenated Castor Oil,
Magnesium Sulfate, Magnesium Stearate, Zanthoxylum Alatum Extract, Sodium Chloride, Polysorbate, Polyaminopropyl Biguanid. Darreichungsform und Inhalt: Mavena® B12 Salbe ist eine rosafarbene Salbenzubereitung mit einem
Fettgehalt von 25 g%. Sie ist in Tuben zu 100 g und 25 g erhältlich.
DH
RUBRIKEN DER DERMATOLOGICA HELVETICA RUBRIQUES DE DERMATOLOGICA HELVETICA
Weiterbildung - Formation continue
Redaktionsbüro, Bureau éditorial:
DERMATOLOGICA HELVETICA
JH Saurat : Chefredaktor, Editeur en chef
M Harms : Chefredaktor StV, Editeur en chef adjointe
A Navarini : Assoziierter Redaktor, Rédacteur associé
C Hsu : Redaktor für die Social Media, Editeur sur les médias sociaux
Carine Herreras ([email protected]) : Redaktionsbüro, Bureau éditorial
Atar Roto Presse SA, Genève : Druck, Impression
Août 2015 - Volume 27 - N° 6
SOMMAIRE
4
11
17
26
35
38
44
SGDV - SSDV
Grussworte – Messages de bienvenue
Wissenschaftliches Programm SGDV –
Programme scientifique SSDV
PflegefachGruppe – Séance infirmières
Traktandenliste SGDV –
Ordre du jour SSDV
Freie Mitteilungen –
Communications libres
Posters
Sektionen, Sections :
JH Saurat : Journal Club, Focus
Chefärzte, Médecins chef-de-service : Case reports, coups d’oeil (Koordination:
Redaktionsbüro, Coordination : Bureau rédactionel, C Herreras, [email protected])
A Navarini : Peer-reviewed contributions
A Navarini : Weiterbildung der Assistenzärzte, Formation post-graduée des
assistants
M Harms : Das diagnostische Photo, Photo du mois, terminologie
JP Grillet : Humor, Billet d’humour
J Hafner, C Mainetti : Tribune des Präsidenten, Tribune du président
M Tomasik : Neues aus dem Generalsekretariat, Nouvelles du secrétariat général
R Barbézat : Neue Mitglieder, Nouveaux membres
Neues aus den kantonalen Dermatologengesellschaften, den Kommissionen
und Arbeitsgruppen, Nouvelles des sociétés cantonales de dermatologie et
vénéréologie, des commissions et des groupes de travail (Koordination: Redaktionsbüro, Coordination : Bureau éditorial, C Herreras, [email protected])
Neues aus der Industrie, Nouvelles de l’industrie (Koordination : Redaktionsbüro,
Coordination : Bureau éditorial, C Herreras, [email protected])
Ständige Kommission für Kommunikation, Commission permanente pour la
communication :
AK Lapointe, AM Skaria : Redaktoren Westschweiz, Editeurs députés pour la
Suisse romande
E Bianchi, F Pelloni : Redaktoren Tessin, Editeurs députés pour le Tessin
B.Schlagenhauff, J Hafner : Redaktoren deutsch-sprachige Schweiz, Editeurs
députés pour la Suisse alémanique
e-mail : [email protected]
Authors instructions (peer reviews)
Size : Papers should comprise approximately 700-2000 words including figures, tables and references.
Title page : The first page of each paper should indicate the title, the authors’ names, the institute where the work was conducted,
and a short title for use as running head.
Full address : The exact postal address of the corresponding author complete with postal code must be given.
Key words : For indexing purposes, a list of 3–5 key words in English is essential for all papers.
Abstract : Normally each paper needs an abstract of not more than 150 words. It should contain the following information: purpose
of the study, procedures, results, conclusions and message of the paper. Abstracts submitted for publication in the section Original
Papers should be structured as follows:
Background : What is the major problem that prompted the study
• Objective : What is the purpose of the study ?
• Methods : How was the study performed ?
Results : Most important findings ?
• Conclusion : Most important conclusion ?
Footnotes : Avoid footnotes. When essential, they are numbered consecutively and typed at the foot of the appropriate page.
Formatting rules :
• Do not use any special page layout. If you would like to see what your manuscript looks like with embedded tables and illustrations, remember that we need text and illustrations as separate files !
• Enter your text continuously flush left. Do not use hard returns ("enter") within a paragraph, only at its end.
• Do not use footer and header functions.
• Use boldface and italics as well as sub- and superscript where appropriate.
• Use your word-processing program to insert Greek letters, mathematical symbols, etc.
Legends : The legends to your figures are part of the text and should be listed at the end of your text file.
Line Drawings
Black and White Half-Tone Images, Color Illustrations
Scans
• For processing and retouching scanned half-tone images, Photoshop is recommended. Please save the original scan as well as
your processed version.
• Export black and white half-tones and color illustrations as TIF or EPS format, as close as possible to their anticipated size in print.
• Save them as separate files, not embedded in the text.
• Scanned line drawings must be digitalized with a resolution of at least 800, better 1000 dpi (dots per inch) after scaling.
• Scanned half-tone images should be digitalized with a final resolution of 300 dpi, a 12 bit grayscale accuracy and a density range
of 2.8. Screen values must lie between 5 % and 95 %.
• Scanned color illustrations must be digitalized in RGB mode with a resolution of at least 300 dpi, a 32 bit accuracy and a density
range of 2.8.
• Summary.
Make sure that your original has the resolution values in this table after scaling, otherwise the printing quality may be inadequate.
ISSN : 1420-2360
ANZEIGENREGIE – REGIE DES ANNONCES
Carine HERRERAS
Tél. +41 79 667 32 48
E-mail : [email protected]
Detailled authors instruction will soon be avaible on our upcoming website.
Warnung – Avertissement
Für den Inhalt ausserhalb des redaktionellen Teils (insbesondere Anzeigen, Industrieinformationen, Pressezitate und Kongressinformationen) übernehmen Redaktion und Verlag keine Gewähr. Eine Markenbezeichnung kann warenzeichenrechtlich geschützt sein, auch wenn bei ihrer Verwendung in dieser Zeitschrift das Zeichen® oder ein anderer Hinweis auf etwa bestehende
Schutzrechte fehlen sollten.
L’éditeur et la rédaction déclinent toute responsabilité concernant le contenu non rédactionel du périodique (en particulier les annonces, les informations émanant de l’industrie, les citations
tirées de la presse et les informations issues de congrès). Une marque déposée peut jouir d’une protection légale même si elle est mentionée dans le périodique sans le symbole ® ou toute
autre marque signalant, le cas échéant, une telle protection juridique.
Dosierungsangaben von Medikamenten:
Autoren und Verlag haben alle Anstrengungen unternommen, um sicherzustellen, dass Auswahl und Dosierungsangaben von Medikamenten im vorliegenden Text mit den aktuellen Vorschriften und der Praxis übereinstimmen. Trotzdem muss der Leser im Hinblick auf den Stand der Forschung, Änderungen staatlicher Gesetzgebungen und den unterbrochenen Fluss neuer
Forschungsergeenisse bezüglich Medikamentenwirkung und -nebenwirkungen darauf aufmerksam gemacht werden, dass unbedingt bei jedem Medikament der Packungsprospekt konsultiert werden muss, um mögliche Änderungen im Hinblick auf Indikation und Dosis nicht zu übersehen. Gleiches gilt für spezielle Warnungen und Vorsichtsmassnahmen. Ganz besonders gilt
dieser Hinweis für empfohlene neue und/oder nur selten gebrauchte Wirkstoffe.
Alle Rechte vorbehalten. Ohne schriftliche Genehmigung des Verlags dürfen diese Publikation oder Teile daraus nicht in andere Sprachen übersetzt oder in irgendeiner Form mit mechanischen oder elektronischen Mitteln (einschliesslich Fotokopie, Tonaufnahme und Mikrokopie) reproduziert oder auf einem Datenträger oder einem Computersystem gespeichert werden.
Posologie des médicaments:
Les auteurs et l’éditeur ont tout mis en œuvre pour s’assurer que le choix des médicaments et la posologie préconisés dans ce texte soient conformes aux recommandations et à la pratique
au moment de la publication. Cependant, compte tenu des recherches en cours, des changements dans les législations et de l’afflux constant de données nouvelles concernant la thérapie
médicamenteuse et l’effet des médicaments, il est vivement recommandé au lecteur de vérifier sur la notice jointe à chaque emballage si aucune modification n’est intervenue dans la posologie et si aucune nouvelle contre-indication ou précaution à prendre n’a été signalée. Cela est particulièrement important lorsque l’agent recommandé est nouveau ou peu employé. Tous
droits de reproduction, même partielle, sous n’importe quelle forme, strictement réservés.
Dermatologica Helvetica – Volume 27(6) – Août 2015
3
Rapport d'activité du président de la SSDV, 2011 à 2015
Chères et chers collègues,
Pour terminer mon deuxième mandat en tant que président de la SSDV, j'aimerais vous présenter un rapport
concernant les travaux et les modifications intervenus
durant les quatre dernières années.
En résumé, avec le comité, le secrétariat général et
vous tous, nous avons réussi tous ensemble à renforcer
la SSDV, structures et organes compris, et à améliorer
la communication tant au plan interne qu'externe.
Moins de 10 % de l'ensemble des dermatologues de
Suisse ne sont pas membres de la SSDV.
Dans le cadre de la politique de la santé en Suisse,
la SSDV a œuvré activement tout en menant des
échanges intenses et en assurant une bonne collaboration avec les sociétés de médecine proches, nationales et internationales.
Un rapport d'activité comporte toujours le danger de
ne pas citer expressément des personnes et personnalités ayant contribué de manière décisive au succès de
la société. Je prie donc les intéressés de m'en excuser.
Les objectifs atteints et les étapes importantes sont
le résultat d'une collaboration très large d'un grand
nombre d'individus, d'organes et groupes de travail, et
le succès appartient donc à vous tous.
SGDV – SSDV
1re année de mandat (septembre 2011 à août 2012)
Secrétariat général et comptabilité financière
La première année de mon mandat a débuté avec la
Réunion annuelle de la SSDV à Genève, qui fut préparée par la Dresse Christa Prins, le Prof. Dr Gürkan
et l'équipe genevoise, avec l'International Society of
Dermatopathology. Le congrès aurait mérité encore
davantage de participants de la Suisse alémanique car
le programme était extraordinaire et très instructif.
L'une des premières et des plus urgentes tâches
consista durant le mandat 2011-2012 à restructurer
la comptabilité financière. Avec l'introduction de la
recherche en matière d'approvisionnement en soins
de la population (Registre SDNTT), la SSDV est devenue imposable. Deuxième champ problématique, la
gestion séparée de Dermarena (formation continue
transmise via Internet) en tant qu'association n'était
plus soutenable au plan juridique. Pour des raisons
de gouvernance, il fallait intégrer Dermarena dans la
SSDV. En troisième lieu, le secrétariat général devait
être déchargé de l'encaissement des cotisations des
membres. Indépendamment de cela, Madame Monica
Pongratz, secrétaire générale de la SSDV, souhaitait
transférer les comptes bancaires de l'UBS à Coire à la
Banque cantonale neuchâteloise. L'UBS n'assurait plus
un service convivial.
Par ailleurs, Madame Monica Pongratz trouvait en la
société fiduciaire Fiduconsult SA (La Chaux-de-Fonds)
et en la personne de Madame Anne-Mirjam Gaberel
des partenaires fiables à proximité du secrétariat général de l'époque.
Membres
Au moment où j'ai repris la fonction de président, il y
avait environ 70 à 75 % des dermatologues cliniciens
en Suisse qui étaient membres ordinaires ou extraordinaires de la SSDV. Dans les autres sociétés de médecine, ce taux fluctue entre 50 et 100 %. Nous nous
sommes fixés pour objectif d'augmenter notre degré
d'organisation à 85-90 %. L'admission de tous les médecins assistants en cours de formation postgraduée
était également une priorité.
Formation, formation postgraduée et formation continue
Il y a lieu d'observer au plan international une forte ten-
dance aux formations postgraduées et continues sous
le format "update". Ces formations remplacent de plus
en plus les colloques d'une heure. Les sociétés de dermatologie des cantons de Genève et Vaud ont été les
premières, en collaboration avec les cliniques des HUG
et du CHUV, à inaugurer les Rencontres Romandes de
Dermatologie et Vénéréologie (RRDV).Ont suivi les
journées zurichoises de formation post-graduée en
dermatologie (ZDFT), qui ont été créées, sur proposition du président ZDG Erich Küng, par Lars French et
Reinhard Dummer accompagnés de Stephan Lautenschlager, des membres de la ZDG et des deux équipes
des cliniques zurichoises. Ceci fut fondé sur le modèle
de la Münchner Fortbildungswoche Pate, la ZDFT devant conserver volontairement un format "restreint et
raffiné". Enfin, les cliniques universitaires de Berne et
Bâle, en concours avec l'ambulatoire dermatologique
de l'Hôpital Triemli de la ville de Zurich et de la clinique
dermatologique de l'hôpital San Giovanni à Bellinzone, ont mis sur pied les Swiss Derma Days. En 2015,
les Swiss Derma Days ont connu une extension et une
consolidation avec les STI Reviews and updates.
A l'occasion d'une séance à large assise, en janvier
2012, le comité s'est prononcé pour organiser les trois
formations postgraduées transrégionales en les échelonnant au cours du premier semestre, et tenir la Réunion annuelle SSDV au deuxième semestre (comme
jusqu'alors selon un tournus entre les cinq cliniques
universitaires) ; il décida simultanément de supprimer
en contrepartie le traditionnel Colloque de printemps
de la SSDV.
DOIT, Dermokrates et Dermarena
La SSDV dispose de trois instruments forts, basés sur
Internet, pour la formation initiale, la formation postgraduée et continue: DOIT (études de médecine), Dermokrates (Thesaurus électronique de la DDG, ÖGDV et
SSDV) ainsi que Dermarena (transmission en direct de
sessions de formation postgraduée et continue ayant
lieu en Suisse). Comme déjà mentionné, l'intégration
de Dermarena (jusqu'alors une association) dans la
SSDV était imminente. Lors d'une séance en novembre
2011, une task force et Vahid Djamei (consultant informatique auprès de la SSDV) décidaient de transformer
l'association Dermarena en un groupe de travail, d'augmenter les contingents de formations postgraduée et
de les répartir entre les cinq cliniques universitaires.
Politique de la santé : référendum contre le projet de loi
"Managed care"
En octobre 2011, les Chambres fédérales acceptaient
le projet de loi dit managed care mis au point pendant
plusieurs années en collaboration avec la FMH. Ce
projet de loi prévoyait une incitation financière pour
les assurés s'obligeant, dans le domaine ambulatoire,
à s'affilier un réseau de médecins. Il s'agissait d'une
forme modérée de gate-keeping, qui aurait rendu
inutilement compliqué l'accès des patients aux spécialistes. La dermatologie, en tant que spécialité majoritairement axée sur l'ambulatoire, connaît une grande
fréquence de consultations et aurait été touchée
négativement par le projet de loi en question. Voilà
pourquoi la SSDV, en collaboration avec la SGORL, la
SG Ophthalmologie et trois sociétés cantonales de médecine (Genève, Bâle-Campagne et Schaffhouse) s'est
élevée contre ce projet et exigea lors de la Chambre
médicale de septembre 2011 – donc déjà avant le scrutin au sein du Conseil national et du Conseil des Etats
– de procéder à une consultation de base auprès des
médecins pour savoir si, en cas d'acceptation de la loi
managed care par le Parlement, la FMH devait saisir la
voie du référendum. Le corps médical prit sous réserve
4
04.14
Tretinac .
®
Die hohe Kunst der
Akne-Behandlung.
Service
Qualität
■ Wirksam bei schweren und therapieresistenten Akneformen1
■ Gegen alle pathogenetisch wichtigen Mechanismen der Aknebildung 2
■ Erlaubt die individuelle Behandlung (5 mg, 10 mg, 20 mg)1
Tretinac® Z: Isotretinoinum 5 mg resp. 10 mg resp. 20 mg, Kapseln I: Schwere Formen der Akne. D: Initial 0.5 mg / kg / Tag; üblicherweise 0.5 –1.0 mg / kg / Tag, bis zu 2.0 mg / kg / Tag. KI: Schwangerschaft, Stillzeit, Leberinsuffizienz,
Hypervitaminose A, stark überhöhte Blutlipidwerte, gleichzeitige Anwendung mit Tetrazyklinen. VM: Isotretinoin ist teratogen. Kindern unter 12 Jahren, psychische Störungen, Funktionsstörungen der Haut und des Unterhautzellgewebes, Augenleiden, Hörstörungen, Funktionsstörungen des Bewegungsapparates, des Bindegewebes und der Knochen, benigne Erhöhung des Schädelinnendrucks, Funktionsstörungen der Leber und der Galle, Niereninsuffizienz,
Fettstoffwechsel. IA: Vitamin A, Tetrazykline, niedrigdosierte Gestagene. UAW: Sehr häufig: Anämie, erhöhte Sedimentationsrate der roten Blutkörperchen, Thrombozytopenie, Blepharitis, Konjunktivitis, erhöhte Transaminasen,
Cheilitis, Dermatitis, trockene Haut, Pruritus, Arthralgie, Myalgie, Erhöhung der Triglyzeride im Blut, Verminderung der Lipoproteine hoher Dichte (HDL). P: 30 und 100 Kapseln. Liste A, SL. Ausführliche Informationen siehe
www.swissmedicinfo.ch
Kassenzulässig
Referenzen: 1. Tretinac (Isotretinoinum): aktuelle Fachinformationen siehe swissmedicinfo.ch. 2. Ganceviciene R, Zouboulis CC: Isotretinoinum: State of the Art Treatment for Acne Vulgaris. Journal der Deutschen Dermatologischen
Gesellschaft 2010; 8: 47-59. doi: 10.1111/j.1610-0387.2009.07238.x
Zulassungsinhaberin: Pro Farma AG, Lindenstrasse 12, CH-6340 Baar, www.profarma.ch
la décision de recourir au référendum le cas échéant
et commença, avec trois task forces de diverses couleurs (fmCH, Table ronde et l'ASMAC-VSOP), à préparer
le référendum au plan technique. La FMH était donc en
mesure, quelques jours seulement après l'acceptation
du projet de loi, de commencer la récolte de signatures. Le corps médical réussit, dans le délai prescrit de
100 jours, à réunir plus de 130 000 signatures authentifiées et à déposer le référendum à temps. Il s'agit dans
l'histoire de la Confédération de l'un des plus grands
nombres de signatures récoltées pour un référendum
(l'exigence est de 50'000 signatures valables). La votation de juin 2012, placée sous le slogan "Limiter le libre
choix du médecin ?" connut sans autre un succès très
net, avec 76 % de voix opposées au projet. En s'engageant infatigablement en faveur de cette cause, JeanPierre Grillet, past-president de la SSDV, a contribué de
manière essentielle à ce grand succès.
Fin de la collaboration avec la Ligue suisse contre le cancer
En janvier 2012, une délégation de la section Prévention de la Ligue suisse contre le cancer rencontrait
Monica Pongratz, Ralph Braun et Jürg Hafner. La ligue
communiquait à la SSDV qu'elle mettait fin avec effet
immédiat à la collaboration dans le cadre de la campagne nationale de lutte contre le cancer de la peau.
Le bus Cancer de la peau, connu de toutes parts, faisait
également partie de cette campagne. Cette dénonciation de la collaboration a eu lieu à brève échéance,
avant la prochaine campagne déjà envisagée pour mai
2012. Le professeur bernois Marcel Zwahlen (Institut
de médecine sociale et préventive) avait conseillé la
Ligue. Il soutenait la critique devenue audible au plan
international, selon laquelle les dépistages du cancer
de la peau manquaient leur véritable but, à savoir la
réduction de la mortalité due au mélanome, et qu'il
fallait donc admettre que les dépistages déclenchaient
purement et simplement le phénomène connu sous
le nom de sur-diagnostic – une sorte de pseudo-progrès. Durant les trois dernières années, de la littérature
scientifique avait toutefois paru, qui contredisait l'hypothèse du sur-diagnostic dans le cas du mélanome.
La ligue suisse contre le cancer a poursuivi sa prévention contre la maladie en la focalisant entièrement sur
la prophylaxie primaire, avant tout sur la protection
contre les UV chez les petits enfants.
La SSDV décida de poursuivre la campagne nationale
indépendamment de la Ligue suisse contre le cancer,
en l'organisant toute seule. Monika Pongratz fournit
un énorme travail supplémentaire pour que la campagne nationale 2012 soit un succès. Huit firmes, qui
ont dans leur assortiment des produits leaders dans le
domaine de la protection contre le rayonnement UV
ou dans celui du traitement de kératoses actiniques,
ont participé à notre action par des contributions de
sponsors. La campagne 2012 fut un grand succès auprès du public.
2e année de mandat (septembre 2012 à août 2013)
SGDV – SSDV
La deuxième année de mon mandat commença avec
la magnifique Réunion annuelle à Berne, organisée
par le professeur Luca Borradori et l'équipe de la Clinique universitaire dermatologique de l'Hôpital de l'Île
à Berne.
Secrétariat général
L'année de la SSDV de septembre 2012 août 2013 fut
encore placée sous le signe de la réorganisation ainsi
que de la préparation des fêtes du centième anniversaire. Monica Pongratz demanda au comité de la SSDV
un étoffement du personnel à hauteur de 40 %, ce qui
lui a été accordé sans délai. Elle engagea à titre de collaboratrice et d'adjointe Madame Ruth Barbezat qui,
peu de temps auparavant, travaillait encore dans la
section Prévention de la Ligue suisse contre le cancer.
Elle était donc prédestinée à l'organisation de la campagne nationale de lutte contre le cancer de la peau.
Préparation des festivités pour les 100 ans de la SSDV à
Montreux
Le jubilé de la SSDV a été préparé à temps par Michel
Gilliet et son équipe lausannoise, ainsi que le Convention Team Luzern très compétent en la matière, avec
Madame Christine Della Chiara. A Montreux, le Music
and Convention Centre, l'Hôtel Eden Palace au Lac et
le Caveau des vignerons ont été réservés, et Michel Gilliet invita au congrès toute une série d'invités illustres
au plan international. En même temps parut le livre
"Spirit and Soul of Swiss Dermatology and Venereology 1913–2013" contenant les articles d'un bouquet
coloré de coauteurs provenant de tous les domaines
de la dermatologie suisse et de la politique sanitaire
de notre pays.
Départ de Monica Pongratz et repourvoi du secrétariat
général
Au grand regret du comité et de toute la SSDV, Monica
Pongratz donna son congé en mai 2013 en sa qualité
de secrétaire générale. Les dernières années furent
pour elle épuisantes et la réorganisation du secrétariat
général ne se passait pas à ses yeux comme elle l'aurait
souhaité. Pendant les cinq mois qui suivirent, le secrétariat général connut une exploitation réduite, assurée
par Ruth Barbezat et le président.
Ce départ a été l'occasion pour le président et le comité de réfléchir aux procédures en place au sein de
la SSDV. Il fut décidé en particulier d'associer encore
plus étroitement les commissions permanentes à la
solution des multiples tâches spéciales et, à nouveau,
de confier davantage les connaissances techniques
ainsi que le développement scientifique aux groupes
de travail.
Le poste de direction du secrétariat général fut mis
au concours. Après une évaluation attentive, Madame
Monika Tomasik Sansonnens, licenciée en droit, a été
présentée au comité et choisie. En même temps, Ruth
Barbezat et le président se mirent à la recherche de
nouveaux locaux, en un lieu aisément atteignable, et
ils en trouvèrent au Dalmazirain 11 à 3005 Berne, tout
près du Marzili. Le nouvel établissement de la centrale
de la SSDV avec sa nouvelle direction s'est révélé être
un choix heureux.
Remaniement des statuts
A l'occasion de l'assemblée générale à Montreux, les
statuts retravaillés ont été approuvés. Les catégories
de membres ont été réordonnées dans le but d'inclure
davantage les jeunes dermatologues, dès le départ,
dans la SSDV et de mettre sur pied une collaboration
régulière avec l'industrie. Les commissions permanentes et groupes de travail ont été renouvelés et
Dermarena fut intégrée en tant que propre groupe de
travail au sein de la SSDV. Immédiatement auparavant,
l'association "Dermarena" fut dissoute à une majorité
des deux tiers.
Les 100 ans de la SSDV
Les 100 ans de la SSDV ont été fêtés comme il se doit
lors de la 95e Réunion annuelle à Montreux (18-21 septembre 2013), sous la forme d'un congrès très impressionnant et d'une fête digne et magnifique. De très
nombreuses personnes ont contribué au succès de la
fête et du congrès. Parmi les organisateurs les plus importants, il y a certainement lieu de mentionner le Prof.
Dr med. Michel Gilliet et toute son équipe à Lausanne,
Madame Della Chiara et le Convention Team Luzern
ainsi que – last but not least – la secrétaire générale
encore présente à la fête, Monica Pongratz. Nos remerciements très spéciaux vont à toutes ces personnes.
Sous la forme écrite, le jubilé a d'abord été consigné
dans un livre kaléidoscopique intitulé "Spirit and Soul
of Swiss Dermatology and Venereology 1913–2013".
Sur le plan journalistique, le Dr med. Siegfried Borelli
6
Les 100 ans de l'ambulatoire dermatologique de l'hôpital
de la ville Triemli
Le 14 novembre 2013, le Prof. Dr med. Stephan Lautenschlager et son équipe organisaient le jubilé des cent
ans de l'ambulatoire de la ville dans la salle des fêtes de
l'hôpital de Zurich Triemli. Lors de cette manifestation
impressionnante et très belle, étaient présents les autorités de la ville de Zurich, les représentants de l'hôpital
Triemli, ainsi que les chefs de service ou leurs adjoints
de toutes les cliniques dermatologiques universitaires
et non universitaires de Suisse. La grande performance
du Prof. Lautenschlager et de son équipe, qui ont
formé durant les douze dernières années un département dermatologique moderne à partir de l'ancienne
fondation chargée d'histoire de la "Polyclinique de la
ville", a été très bien présentée. Le programme a essentiellement mis en valeur la tâche éminemment importante de la vénéréologie au plan médical et social,
qui était le principal souci au moment de la création
de la fondation, il y a 100 ans, par le Dr Max Tièche et
sa femme. L'ambulatoire dermatologique a maintenu
jusqu'à ce jour cette tâche cruciale. En même temps,
cette institution s'est développée, précisément dans
les 20 dernières années, pour devenir un grand département moderne de dermatologie et vénéréologie, au
cœur de la ville de Zurich.
Entrée dans les locaux du nouveau secrétariat général à
Berne
Le 1er octobre 2013, Madame Monika Tomasik, lic. en
droit, qui fut choisie en tant que nouvelle directrice
du secrétariat général, a pris possession des nouveaux
locaux à la Dalmazirain 11 au centre de Berne, avec
Madame Ruth Barbezat qui, pour sa part, a loyalement
maintenu à flot le secrétariat général pendant les mois
qui ont précédé.
Le nouveau secrétariat général offre en tout premier
lieu un espace de travail approprié à l'équipe d'étatmajor constituée par Madame Tomasik et Madame
Barbezat. Durant les deux dernières années, cet espace
est devenu – toujours davantage – le "port d'attache"
de la SSDV et de ses organes. La situation centrale en
Suisse, la proximité avec les principaux partenaires du
domaine de la santé ainsi qu'avec les autorités politiques font de notre secrétariat général un espace de
réunion qui convient à tous les intéressés.
Les commissions permanentes et groupes de travail reprennent un rôle actif
Durant la nouvelle année SSDV de septembre 2013
à août 2014, le recours pertinent à l'imagination des
commissions permanentes (travail politique) et des
groupes de travail (travail clinique et scientifique) fut
au cœur des préoccupations. Par contre, le secrétariat
général devait se concentrer sur ses tâches essentielles
en tant qu'état-major de la SSDV.
Permettez-moi ici d'exprimer un avis subjectif. De mon
point de vue, en qualité de président de la SSDV, la séparation logique du travail d'état-major du secrétariat
général et du travail de direction du comité ainsi que
du travail technique des commissions permanentes et
groupes de travail ont très nettement augmenté l'efficacité et amélioré le climat de travail de toutes les parties prenantes.
En parallèle, la comptabilité financière a été adaptée
aux évolutions enregistrées au sein de notre société, et
a fait l'objet d'une nouvelle consolidation. Sur conseil
de notre société fiduciaire Fiduconsult SA, nous avons
introduit une double révision des comptes annuels.
En une première phase, les experts de Fiduconsult
vérifient les comptes annuels et, en une deuxième, les
deux réviseurs opérant à titre bénévole et choisis par
l'assemblée générale les contrôlent à leur tour. Depuis
2012, Konstantine Buxdorf dirige le département des
finances. Grâce à son organisation claire et à son grand
engagement personnel, elle assure en continu le suivi
dans son domaine de tâches complexe.
Cette quatrième année a commencé à Bâle, où le professeur Peter Itin et l'équipe bâloise ont organisé sous
le titre "Bâle le fait à sa manière" un congrès cliniquement et scientifiquement fort, au cours duquel – une
fois encore – la corrélation entre les domaines clinique
et pathologique a joué un rôle important. Quant à
l'atmosphère, cette Réunion annuelle a également
constitué un véritable point d'orgue, tout comme les
trois précédentes.
Communication : Dermatologica Helvetica
En été 2014, le Prof. Dr med. Jean-Hilaire Saurat et la
SSDV ont décidé d'établir une plus étroite collaboration entre la revue de la société Dermatologica Helvetica et la fondation qui lui est attachée, à savoir l’Association pour la Promotion de la Publication et de la Recherche en Dermatologie (APPRD), et la SSDV d'autre
part. A l'avenir encore, Dermatologica Helvetica doit
être gérée en tant que journal par un éditeur indépendant et son board. Toutes les recettes générées par
les annonces et les publications de logo doivent être
comptabilisées par la SSDV dans le cadre du nouveau
concept de sponsoring (voir ci-dessous) et transférées à l'APPRD. Un éventuel excédent est à répartir par
moitié entre la fondation APPRD et la SSDV. Actuellement, nous sommes déjà heureux si les recettes des
annonces permettent de couvrir les frais.
Le Prof. Saurat a mandaté le Dr Christophe Hsu au
poste de rédacteur des médias sociaux (newsletter DH
via e-mail et Facebook). Les cliniques ont à nouveau
livré régulièrement de bons articles à propos de casuistiques et de constats riches d'enseignements ("Coup
d'œil"). De nombreux intervenants présentant des exposés-clés lors de nos importants congrès ont accepté
de laisser imprimer un condensé de leurs exposés dans
Dermatologica Helvetica. Hormis cela, le Prof. Saurat
poursuit son activité dans les ressorts appréciés que
sont le "Journal Club" et "Focus" ; les "Pages vertes"
consacrées à la politique de la santé et aux affaires
internes de la SSDV ont été remplies de nouvelles en
continu et sans peine, au cours des deux dernières
années. L'équipe rédactionnelle de DH pense qu'avec
ces mesures, le maintien de la revue devrait être assuré
pour les prochaines années.
Communication : site Internet
Notre site Web datant de 2009 répond aux plus grandes
exigences techniques. Il a été installé voici cinq ans
par Monsieur Vahid Djamei et sa société Swiss4ward,
en coopération avec une firme informatique macédonienne, et moyennant des coûts notables. La charge
financière fut pour la SSDV, compte-tenu du produit
hautement développé, extrêmement avantageuse.
Il faut constater aujourd'hui que le potentiel du site
Web de la SSDV n'a été, depuis lors, exploité que dans
une très petite mesure. La banque de données des
membres, multifonctionnelle, n'a pas été activée. Les
multiples possibilités de communication au sein de
la société tout comme vers l'extérieur n'ont guère été
utilisées.
En 2015, nous avons mis en ligne les principaux canaux de notre formation postgraduée et continue
ainsi que les principales nouveautés de la politique de
la santé sur la page d'accueil du site Web. Par ailleurs,
nous avons relié la banque de données multimodale
des membres, via une interface électronique, à notre
banque de données de base qui est du dernier cri au
secrétariat général. Ainsi, pour la première fois, le gros
SGDV – SSDV
a donné, en sa qualité d'éditeur de la revue "Dermatologie Praxis", l'opportunité à toutes les cliniques
universitaires et non universitaires de faire état de leur
histoire jusqu'à nos jours en des articles détaillés. Pour
ceci aussi, nous adressons ici tous nos remerciements.
7
potentiel technique de notre site Web est entièrement
utilisé.
Dans une prochaine étape, nous allons désormais
mettre en ligne, moyennant recours aux commissions
permanentes et groupes de travail, toujours plus de
contenus dermatologiques sur notre site. Il s'agit également de mettre davantage d'informations médicales
à disposition des patients.
SGDV – SSDV
Communication : prix scientifiques
Depuis quelque temps déjà, la SSDV dispose de quatre
grands prix scientifiques et de plusieurs autres, de
moindre importance, qui sont sponsorisés par l'industrie et font l'objet d'un concours annuel. Les prix sont
annoncés sur le site Web sous la rubrique "Awards".
Communication : Campagne nationale du cancer de la
peau (1-5 juin 2015)
L'organisation et le déroulement de la campagne
nationale de prévention du cancer de la peau a fait
chaque année l'objet d'un nouveau développement,
depuis que la SSDV l'assume à elle seule (2012). Ralph
Braun (président du groupe de travail Dermato-oncologie jusqu'en 2014) et Ruth Barbezat y ont très notablement contribué. A titre de principales nouveautés,
une coopération plus étroite a été instaurée avec
Euromelanoma, un dépistage sur tout le corps a été
introduit (au lieu du check-up de lésions particulières),
et, après une suspension durant les années 2012 et
2013, la collecte de données a été réintroduite en 2014
(questionnaire Euromelanoma, données générées en
pool pour toute l'Europe). Enfin, une exclusion de responsabilité (disclaimer) a été introduite.
La campagne nationale de prévention du cancer de
la peau est effectuée de plus en plus par les cliniques
et départements dermatologiques. Pour les cabinets
médicaux, la campagne s'avère être un projet difficile,
pour diverses raisons. Le flux des patients n'est pas
simple à réguler. Certaines années, ils sont trop nombreux, et pendant d'autres, ils sont trop peu ou aucun
ne vient. Environ 10 % des patients abusent de la campagne pour montrer au dermatologue une situation
totalement différente. Certains patients sont très grincheux ou plein de reproches envers les médecins alors
que ceux-ci leur mettent à disposition leur temps et
leur savoir, gratuitement. Tous ces facteurs ont causé
chez certains collègues libres praticiens une grande
frustration à l'égard de cette action. Dans certaines
villes, les collègues effectuent le dépistage du cancer
de la peau sous la forme d'une action de groupe, dans
un lieu de vie publique (hôpital public, cliniques privées ou autres institutions).
La SSDV propose également depuis 2014, hormis
l'organisation qui a fait ses preuves depuis longtemps
sous la forme d'un "Walk in" et d'un "First come first
served", la possibilité de procéder à une préréservation
via un call center (intervalles toutes les 10 minutes).
Dès 2015, le secrétariat général assumera lui-même la
fonction de call center. Les cabinets de dermatologues
qui aimeraient procéder selon ce modèle n'ont pas
besoin de se renseigner au sujet de l'octroi du rendezvous. Ils reçoivent quelques jours à l'avance une liste
des participants qui viendront à leur cabinet.
La "visibilité" assortie d'effets publicitaires de la Campagne nationale de prévention du cancer de la peau
doit encore être améliorée. Nous avons pu engager
en la personne du Dr Ueli Reber, de la société Firma
First Aid Marketing à Berne, un expert des relations
publiques dans le domaine de la santé, qui établira et
élargira pour nous le contact avec les médias.
Concernant le matériel d'information, nous collaborons à nouveau, dès 2015, avec Euromelanoma. Euromelanoma met à disposition un matériel publicitaire
détaillé ainsi que des textes d'informations concernant
le cancer de la peau. Ces textes en anglais ont été
traduits dans nos trois langues nationales et nous les
mettons à disposition sur le site Web d'Euromelanoma
pour la Suisse, ainsi que sur notre propre site Web. La
commission permanente pour la communication, fondée en 2014, qui se compose de trois représentants
des trois régions linguistiques (Bettina Schlagenhauff,
Anne Carine Lapointe et Enrica Bianchi), ainsi que – ex
officio – du président de la SSDV, a investi beaucoup
de temps dans la préparation de cette campagne.
L'efficacité du dépistage du cancer de la peau a été
mise en doute de diverses parts, au courant des années passées. Mais durant les trois dernières années,
plusieurs importantes publications ont paru, qui ne
laissent guère de doute sur l'efficacité de la prévention
primaire, secondaire et tertiaire du cancer de la peau.
On doit également se demander qui donc, à défaut
des dermatologues, doit s'occuper de la prévention du
cancer de la peau. Cela relève de notre travail et de nos
intérêts essentiels que de le faire nous-mêmes.
Concept de sponsoring de la SSDV
Les activités susmentionnées ont été créées et développées durant les 20 dernières années par divers
acteurs. Pour ce faire, ces organisateurs s'adressaient
à chaque fois, sans se concerter à l'interne, à environ
20 sponsors réguliers de la dermatologie et de la vénéréologie, pour leur demander s'ils soutiendraient
financièrement chacune de leur activité. Ainsi, au fil
des années, une sorte de loi de la jungle s'est installée, et la SSDV a décidé, lors de sa séance de comité du
4.9.2014, d'établir un nouveau concept de sponsoring
pour la société, et de mettre de l'ordre dans ce secteur.
Ceci a réussi jusqu'ici, à la satisfaction de tous les intéressés.
Politique de la santé: ordonnance du Conseil fédéral visant à revaloriser les prestations médicales des médecins
de premier recours
Comme d'autres pays occidentaux, la Suisse enregistre
une pénurie des médecins de famille. En 2013, les
médecins de famille suisse (Médecins de Famille et de
l’Enfance (MFE)) ont mis sur pied une initiative devant
renforcer la médecine générale par toute une série de
mesures. Le conseiller fédéral Alain Berset a convaincu
le comité des initiants de retirer leur texte en leur proposant d'accorder 200 millions de recettes supplémentaires à la consultation du médecin de famille, par la
voie d'une ordonnance. Comme la loi sur l'assurancemaladie prescrit que des modifications portées au
système tarifaire Tarmed doivent avoir lieu sans conséquence sur les coûts, le conseiller fédéral Berset est allé
chercher les 200 millions de francs dans les prestations
techniques au chapitre Tarmed consacré aux médecins spécialistes (à l'exception de la gynécologie et de
l'obstétrique), en réduisant les prestations de ces spécialistes à concurrence de 7.8 %.
Là-dessus, la fmCh déposait un recours auprès du Tribunal administratif fédéral, assisté en cela par l'étude
du Dr en droit et avocat Daniel Staffelbach. Indépendamment de cette démarche, l'association des hôpitaux de Suisse H+ a saisi la même voie de droit. Le
Tribunal administratif fédéral a cependant déclaré qu'il
n'était pas possible de déposer recours contre une
ordonnance (contrairement à la contestation d'une loi,
qui elle peut être attaquée par un référendum).
A l'heure actuelle, d'autres démarches visant à manifester l'opposition des spécialistes sont débattues. Simultanément, la révision de la structure tarifaire Tarmed se
poursuit à plein régime. La commission permanente
pour les tarifs ambulatoires, qui se compose des Dr
med. Jean-Pierre Grillet, André Skaria, Gionata Marazza
et Christian Schuster, a consacré en automne 2014 et
au printemps 2015 beaucoup de temps et d'énergie
à cette thématique. Le remaniement du contenu de
Tarmed est souhaité par tous les acteurs. Il est également question d'un relèvement de la rémunération de
18 %, ce qui correspond à l'augmentation moyenne
des salaires dans toutes les branches depuis 1994. Les
travaux concrets de préparation au sein du Bureau
8
des tarifs et conventions du secteur ambulatoire, en
concours avec les sociétés de médecins spécialistes
en dermatologie/vénéréologie, chirurgie plastique,
constructive et esthétique, en orthopédie et traumatologie de l'appareil locomoteur (Tarmed, chapitre 04),
avancent cependant très péniblement. Nos délégués
ne se sentent pas pris au sérieux par leurs interlocuteurs du bureau des tarifs de la FMH. Il est maintenant
possible, après une discussion approfondie avec l'un
des chefs du bureau des tarifs, Monsieur A. Prantl, que
la révision du chapitre 04 trouve cependant une fin
constructive.
Politique de la santé : projet MARS
Dans les années à venir, l'approvisionnement médical
dans le secteur ambulatoire en Suisse doit être soumis
à un contrôle qualité et à des statistiques au plan national. Il s'agit là du dénommé projet MARS (Modules
Ambulatoires des Relevés sur la Santé) de l'Office fédéral de la santé publique. Vous trouverez de plus amples
informations à ce sujet sur le site Web de la SSDV, sous
la rubrique "Presse et news". Là encore, nous avons
affaire à une décision déjà prise. Le corps médical exercera certainement une très forte pression pour que ces
mesures demeurent pragmatiques et applicables, sans
charges supplémentaires notables.
Politique de la santé : création d'un institut fédéral pour la
qualité de la médecine
La création d'un institut fédéral pour l'assurance qualité dans la médecine, prévue par l'OFSP et impliquant
30 emplois à plein temps, a été rejetée à une large
majorité par les commissions consultatives et le Parlement, lors de la phase des débats préliminaires déjà, de
sorte que ce projet ne sera pas poursuivi en un premier
temps. Par conséquent, l'Académie suisse pour la qualité en médecine (ASQM), supportée par le corps médical, a pris une avance importante au plan du calendrier
pour élargir son travail et obtenir une légitimité face
au public. L'assurance de la qualité en médecine doit
demeurer une tâche spécifique du monde médical. A
cet effet, le corps médical doit se défendre de manière
très déterminée.
Petite révision du programme de formation postgraduée
en Dermatologie et Vénéréologie
Monsieur le Dr Peter Bloch a pris sur lui en 2014, d'entente avec le comité, la petite révision du programme
de formation postgraduée. Il s'agissait par-là de fixer
les chiffres des interventions exigées à des valeurs
réalistes, de définir les cours obligatoires de formation
postgraduée de manière applicable, et d'y inscrire plus
expressément la chirurgie au laser de la peau et des
muqueuses orificielles. Pour sa part, le SWIF a exigé
qu'au maximum quatre des cinq années de formation
postgraduée puissent être effectuées dans une seule
clinique A, et que par conséquent, un changement de
poste au moins soit obligatoire en l'espace de cinq ans.
Cette prescription a été imposée de la même manière
à tous les programmes médicaux de formation postgraduée.
Mots de conclusion
Il me tient ici à cœur de vous remercier tous de la
grande confiance que vous avez témoignée durant
les quatre années écoulées au comité de la SSDV, au
secrétariat général, aux nombreux organes de notre
société ainsi qu'à moi-même, en tant que président. Je
vous souhaite – ainsi qu'à nous tous – de poursuivre
une bonne collaboration, de garder confiance en soi et
de tout mettre en œuvre pour la solution de nos tâches
communes. Je vous prie de reporter la confiance en la
SSDV sur mon successeur élu, Monsieur le Dr Carlo
Mainetti, et de vous engager à l'avenir encore, avec
beaucoup d'élan, pour nos patients et notre discipline
médicale.
Votre dévoué
Jürg Hafner
Prof. Dr med. Jürg Hafner
Président SSDV 2011-2015
SGDV-Vorstandsmitglieder 2015
Ausschuss / Bureau
HAFNER Jürg
BUXTORF-FRIEDLI Konstantine
FRENCH Lars
HOHL Daniel
MAINETTI Carlo
MARAZZA Gionata
Präsident / Président ; Kommunikation ; SIWF / ISFM ; fmCh
Schatzmeisterin / Trésorière ; MepV / Odim
Vizepräsident / Vice-Président ; Treas. EDF ; Chefarzt DER USZ
Weiter-, Fortbildung / Form. post-grade et continue ; SIWF / ISFM
Präsident elect / Président elect ; Primario DER Bellinzona
Komm ambulante Tarife / Comm tarifs ambulatoires ; AG DerChir
Vorstand / Comité
BIANCHI Enrica
BLOCH Peter
BOEHNCKE Wolf-Henning
BORRADORI Luca
GILLIET Michel
ITIN Peter
LAPOINTE Anne-Karine
LAUTENSCHLAGER Stephan
SCHLAGENHAUFF Bettina
SCHUSTER Christian
SIMON Dagmar
TSCHARNER Gion
Kommunikation / Communication ; SIWF / ISFM
Weiterbildungsprogr. / Progr. formation post-grade ; EADV ; UEMS
Komm. stat. Tarife (SwissDRG) ; Méd chef de service DER HUG
Komm. Facharztexamen / Comm.Ex. spéc. ; Chefarzt DER Insel BE
UEMS ; Treas. ESDR ; Méd chef de service DER CHUV
Past Präsident / Past présid. ; Orphan Drugs ; Chefarzt DER US BS
Kommunikation / Communication
Past Vizepräsident / Past vice-prés. ; Chefarzt DER Amb STZ (ZH)
Kommunikation / Communication ; e-Health
Komm / Comm Orphan Drugs ; Komm / Comm ambulante Tarife
Qualitäts-Management stationär / Qualité stationnaire
Qualitäts-Management ambulant / Qualité ambulatoire
Generalsekretariat / Secrétariat général
TOMASIK SANSONNENS Monika
Leiterin Generalsekretariat
BARBEZAT Ruth
Stv Leiterin Generalsekretariat
SGDV – SSDV
Comité SSDV 2015
9
97. Jahresversammlung
97ème Réunion annuelle
e
G
ä
ef
s
in
e
k
,
se
e
t–
u
a
H
Oh
n
äs
se
ZÜRICH, 26.– 28.8.2015
Co
ur t
es
fP
yo
rof
Dr.
E.
hm
Reic
ann
o
Cou
H
e
n
h
of P
r tesy
r of M
. De
tm a
a
e
k
,
ut
ine
G
ef
r
Programm / Programme
www.ctlg-congress.ch
10
oder
und
5%.
sion
che
der
hern
ose,
erz,
gem
öhte
Unsere SGDV pulsiert – dank Ihnen und dank dem günstigen Standort «Schweiz»
Liebe Kolleginnen und Kollegen
Dieses Jahr haben wir das Haupt-Programm der SGDV-Jahresversammlung auf zwei
Tage «komprimiert», denn am Samstag, 29.08.2015 findet in Zürich die alljährliche
Street Parade statt. Dann pulsiert Zürich aus anderen Gründen, und wir tun besser daran,
entweder einzutauchen oder abzuhauen.
Aus den Erfahrungen der Vorjahre ist der Abgesang am Samstag-Morgen ohnehin dünner
besucht, und vielleicht zwingt uns hier das Schicksal zu einem klugen Schritt. Das
Programm gibt den fünf Unikliniken Gelegenheit, Klinik, histopathologischklinische
Korrelation und Wissenschaft jeweils aus einem Guss zu präsentieren, und die nicht-universitären Kliniken und Abteilungen erhalten eigene Plattformen für ihre Präsentationen.
Dazwischen gibt es genügend Raum für Pausen, Produkte-orientierte Weiterbildungssymposien der Industrie (Lunch- bzw. Snack-Symposien, immer drei parallel) und persönlichen Austausch. Am Mittwoch-Abend trifft sich die «SGDV-Jugend» zu einem kleinen
Fest im Tennis-Club Zürich-Fluntern (auch ältere Semester sind herzlich willkommen) und
am Donnerstag-Abend findet der traditionelle Gesellschaftsabend statt, dieses Mal im
exotischen Ambiente der Thai-Lodge des neu eröffneten Elefantenparks des Zoos Zürich.
Mit dem Titel «Ohne Gefässe keine Haut – ohne Haut keine Gefässe» beleuchten wir
dieses Jahr die vitalen Zusammenhänge zwischen der vaskulären Medizin und der
Dermatologie. Durch die enge Zusammenarbeit der ETH mit der Universität finden die
Grundlagenforschung und die translationelle Forschung am Standort Zürich besonders
günstige Voraussetzungen. Auch dieses Jahr haben sich sechs Pioniere und jüngere
Forscher bereit gefunden, durch attraktive Key Lectures unsere Augen für die rasante und
teilweise revolutionäre biomedizinische Entwicklung zu öffnen.
Last not least ist es für mich persönlich eine schöne Gelegenheit, Sie alle in meiner
Heimatstadt Zürich empfangen zu dürfen und nach vier erfüllten Jahren das Präsidentenamt an meinen gewählten Nachfolger, Dr. Carlo Mainetti (Bellinzona), weiterzugeben.
Die SGDV vereint in sich ein unglaubliches fachliches und menschliches Potenzial. Dieses
Potenzial besser zu nutzen und allen Beteiligten – zuerst unseren Patienten, dann aber
auch unseren jüngeren und unseren etablierten Ärzten, und schliesslich unseren fachlichen, wissenschaftlichen und politischen Partnern – zur Verfügung zu stellen, war das
Ziel meiner Präsidentschaft. Ich danke Ihnen allen, liebe Mitglieder, dem SGDV-Vorstand
und seinen Gremien, sowie unserem hoch-effizienten Generalsekretariat für die erfolgreiche Zusammenarbeit in den letzten vier Jahren und bitte Sie, diese auf meinen Nachfolger Carlo Mainetti zu übertragen und mit ihm zusammen weiter auszubauen.
Ihr
Jürg Hafner
06.15 11:21
SGDV – SSDV
er
Vorwort
des Präsidenten der SGDV
11
hr
m
4 15:15
Notre SSDV vit – grâce à vous et grâce la place favorable qu’est la Suisse
Chères et chers collègues,
Cette année, nous avons «comprimé» le programme principal de la Réunion annuelle de la
SSDV sur deux jours, car le samedi 29.08.2015 aura lieu à Zurich la Street parade, comme
chaque année. Zurich vit alors pour d’autres raisons, et nous avons meilleur temps soit de
nous immerger dans la fête, soit de quitter les lieux.
Les expériences des années précédentes ont montré que les adieux du samedi matin sont
de toute façon peu fréquentés, et peut-être que le destin nous contraint ici de franchir
sagement un pas. Le programme donne l’occasion au cinq cliniques universitaires de
présenter chacune d’un seul jet la clinique, la corrélation clinico-histopathologique et la
science, alors que les cliniques non universitaires et les départements reçoivent de propres
plateformes pour leurs présentations. Dans l’intervalle, il y a suffisamment d’espace pour
des pauses, des symposiums de formation postgraduée axés sur des produits de l’industrie
(symposiums-lunch ou snack, toujours trois en parallèle) et pour des échanges personnels.
Le mercredi soir, la «Jeunesse de la SSDV» se rencontre dans le cadre d’une petite fête
organisée au Tennis-Club Zürich-Fluntern (les membres plus âgés sont cordialement invités)
et le jeudi soir a lieu la traditionnelle soirée de la société, cette fois dans l’ambiance exotique
de la Thai-Lodge du parc aux éléphants récemment inauguré au Zoo de Zurich.
Sous le titre «Sans vaisseaux pas de peau - et sans peau pas de vaisseaux», nous portons
cette année un éclairage sur les relations vitales entre la médecine vasculaire et la dermatologie. Du fait de l’étroite collaboration entre l’EPF et l’Université, la recherche fondamentale
et la recherche traditionnelle trouvent des conditions particulièrement favorables sur la
place de Zurich. Cette année encore, six pionniers et chercheurs relativement jeunes ont
déjà réussi, à travers des Key lectures attrayantes, à ouvrir nos yeux sur le développement
très rapide et en partie révolutionnaire de la biomédecine.
Last but not least, c’est pour moi une belle occasion personnelle de pouvoir vous accueillir
tous dans ma ville natale de Zurich et de pouvoir passer le témoin, après quatre ans de
charge présidentielle, à mon successeur élu, M. Dr Carlo Mainetti (Bellinzone).
SGDV – SSDV
matiinem
t auf
isten
ostastärn, da
nsiva
dung
unter
Message de bienvenue
du Président de la SSDV
12
La SSDV réunit en son sein un incroyable potentiel technique et humain. L’objectif de ma
présidence était de mieux utiliser ce potentiel et de le mettre à disposition de tous les
intéressés - d’abord de nos patients, mais aussi de nos jeunes médecins et de ceux qui sont
déjà établis, et finalement de nos partenaires spécialistes, scientifiques et politiques. Je vous
remercie tous, chères et chers membres, le comité de la SSDV et ses organes, ainsi que
notre secrétariat général hautement efficace, de votre collaboration couronnée de succès
ces dernières années et je vous prie de bien vouloir la reporter sur la personne de mon
successeur, Carlo Mainetti, et de poursuivre avec lui le développement de notre société.
Votre dévoué
Jürg Hafner
Ialugen Plus® Creme
Guérit les plaies infectées.
Naturelle et multifonctionnelle.
- Cicatrisation de 30 % plus rapide et 50 % plus d’efficacité.1, 2, 3
- Désinfectant à large spectre grâce à la sulfadiazine d’argent.
- Aucune résistance due à son action antibactérienne.
Baux S et al. Étude clinique de l’activité et de la tolérance de Ialugen Plus® dans le traitement des brûlures. Étude comparative (vs. sulfadiazine argentique), randomisée et
multicentrique. Brûlures 2004; 4(4): 233–236.
2
Koller J. Topical treatment of partial thickness burns by silver sulfadiazine plus hyaluronic acid compared to silver sulfadiazine alone: a double-blind, clinical study. Drugs Exp
Clin Res 2004; 30(5–6): 183–190.
3
Costagliola M et al. Second-degree burns: a comparative, multicenter, randomized trial of hyaluronic acid plus silver sulfadiazine vs. silver sulfadiazine alone. Curr Med Res
Opin 2005; 21(8): 1235–40.
1
C : crème : natrii hyaluronas 2 mg, sulfadiazinum argenticum 10 mg pro 1 g; compresses : tela cum unguento 4 g.
Unguentum : natrii hyaluronas 0,5 mg, sulfadiazinum argenticum 10 mg pro 1 g. I : prophylaxie et traitement des plaies
infectées : ulcère, décubitus, escarres, brûlures. D : crème: une couche de 2–3mm de crème 1 x par jour sous un
pansement; compresses : 1 x par jour 1 ou plusieurs compresses. CI : intolérance aux principes actives ou excipients,
grossesse, nourrissons pendant les deux premiers mois de vie. EI : rarement hypersensibilité. INT : traitement local
concomitant avec enzymes protéolytiques. PR : crème 20 g (liste C); 25 g*, 60 g* et 500 g (liste B); compresses : 5 (liste
C); 10/30 (liste B). *Admis aux caisses-maladies.
Pour de plus amples informations, veuillez consulter www.swissmedicinfo.ch
IBSA Institut Biochimique SA, Headquarters and Marketing Operations
Via del Piano 29, CH-6915 Pambio-Noranco, www.ibsa.ch
Remue le monde.
Grusswort
des Tagungspräsidenten
Liebe Kolleginnen und Kollegen
Willkommen in der pulsierenden Finanz- und Wissensmetropole Zürich! Wir freuen
uns, Sie zur Jahresversammlung zum Thema «Gefässe» herzliche begrüssen zu
können. Wir alle sind von den blutgefüllten Schlagadern und Venen unseres Körpers
abhängig, die das Wohlbefinden und die Integrität unseres Körpers sicherstellen.
Strömende Strukturen sind aber auch wichtig in anderen Bereichen, wie Flüsse für
die Fruchtbarkeit unseres Landes und Wissensaustausch für die Fortschritte in der
Medizin. Die Jahrestagung der SGDV ist ein wichtiges zentrales Gefäss für die
Dermatologie in der Schweiz. Hier findet der Austausch zwischen den niedergelassenen Kollegen, pharmazeutischer Industrie und Universitätskliniken statt. Der
ständig zunehmende Informationsfluss erfordert unsere Aufmerksamkeit. Insbesondere wird es immer zentraler, wichtige Informationen herauszufiltern und im eigenen
Gedankengerüst sicher zu verankern, damit sie durch die Flut unwichtiger Daten
nicht weggespült werden kann. Auch der Austausch mit fachfremden Disziplinen
muss sorgfältig gepflegt werden, um die Dermatologie in der Medizin weiter solide
zu verankern. Wir freuen uns, dass Sie alle nach Zürich geströmt sind, um am
Erfahrungsaustausch aktiv teilzunehmen und zu gegebener Zeit mit uns mit verschiedenen Gefässen anzustossen.
Bitte verzeihen Sie uns, dass wir die Jahrestagung dieses Mal nach vorne verschoben haben, um den Strom der Tanzwütigen am Samstag während der Streetparade
nicht zu behindern. Auf jeden Fall werden Sie jetzt auch auf Wunsch in der Lage
sein, daran teilzunehmen.
Prof. Dr. med. Reinhard Dummer
Tagungssekretär
SGDV – SSDV
Prof. Dr. med. Lars E. French
Tagungspräsident
14
PA RT
Ein optimaler Schutz
mit einem Minimum an Filtern
•
Eine ausgezeichnete Photostabilität
•
Wasserfeste Formulierungen,
ohne Alkohol und reich an
Avène Thermalwasser
www.eau-thermale-avene.ch
A I R E / PA
NER
ZIEHT
SCHNELL EIN
N
RT
E
DAS BESTE ZUM
SCHUTZ VOR UVB
UND UVA STRAHLEN
Message de bienvenue
du Président de la réunion annuelle
Chers collègues
Bienvenue à Zurich, la métropole trépidante des finances et du savoir! Nous sommes heureux de vous accueillir pour cette assemblée annuelle relative au thème des
«vaisseaux». Nous sommes tous dépendants des artères et des veines remplies de
sang de notre corps qui assurent le bien-être et l’intégrité de celui-ci. Mais des
structures fluides sont aussi importantes dans d’autres domaines comme le sont les
fleuves pour la fertilité de notre pays et l’échange de connaissances pour les progrès de la médecine. Le congrès annuel de la SSDV constitue une artère centrale
primordiale pour la dermatologie en Suisse. Ici s’effectue un échange d’expérience
et d’informations entre les collègues en cabinet, l’industrie pharmaceutique et les
cliniques universitaires. Le flot d’informations en croissance constante sollicite
fortement notre attention. Pour qu’elle ne soit pas balayée par le flux de données
insignifiantes, il devient notamment essentiel de sélectionner les informations
importantes et de les ancrer dans notre cheminement de pensée. Il faut aussi
entretenir soigneusement les échanges avec des disciplines étrangères aux spécialités existantes pour faciliter l’implantation durable de la dermatologie en médecine.
Nous sommes heureux que vous ayez afflué à Zurich pour prendre part activement
à cet échange d’expérience et pour, le moment venu, trinquer avec nous à la santé
de tous.
Veuillez nous excuser d’avoir avancé cette année la date du congrès annuel pour ne
pas entraver le flot des fervents danseurs du samedi lors de la Streetparade. En tout
cas, vous êtes aussi en mesure maintenant d’y participer si vous le souhaitez.
Prof. Dr. med. Reinhard Dummer
Secrétaire du congrès
SGDV – SSDV
Prof. Dr. med. Lars E. French
Président du congrès
16
U
–
–
Wissenschaftliches Programm /
Programme scientifique
Mittwoch/Mercredi, 26.8.2015
14.30–15.30
Klinikdirektoren Kommissionssitzung / Séance de la
commission des directeurs de cliniques
(Leonardo Boutique Hotel Rigihof)
15.30–16.00
Kaffeepause / Pause café
16.00–20.00
Sitzung des Vorstandes der SGDV / Séance du comité SSDV
(Leonardo Boutique Hotel Rigihof)
19.00–22.30
Party der «Jungen Dermatologen SGDV» (ältere Semester sind
herzlich willkommen) / Party de la «Jeunes Dermatologues de la
SSDV» (membres plus âgés sont cordialement invités)
(Tennis Club Fluntern, Rolf Balsigerstrasse 4, Zürich)
20.00–22.30
Vorstandsessen
Donnerstag/Jeudi, 27.8.2015
Hörsäle/Salles
08.00–18.00
Enregistrement/Registration
08.00–10.00
Installation des posters / Postermontage
08.00–09.00
Arbeitssitzungen der Arbeitsgruppen SGDV (siehe S.14)
Séances des groupes de travail SSDV (voir page 14)
08.00–11.00
Fachexamenkommission Sitzung /
Y-23-G-24
Séance de la Commission des examens de spécialistes
09.00–10.00
SDNTT Meeting
09.30–11.00
Workshops der Arbeitsgruppen SGDV (siehe S.14)
Atelier des groupes de travail SSDV (voir page 14)
10.00–11.00
DermaArena
11.00–11.30
Begrüssungskaffee im Kreise der Aussteller / Café d’ouverture au
millieu de l’exposition
d
4
11.45–12.00
35-F-47
35-F-47
Eröffnung der Jahresversammlung /
Y24-G-45
Ouverture de la Réunion annuelle
Chairs: Lars French, Zürich / Reinhard Dummer, Zürich /
Jürg Hafner, Zürich
SGDV – SSDV
%
17
10.00–11.00
DermaArena
11.00–11.30
Begrüssungskaffee im Kreise der Aussteller / Café d’ouverture
au
Hörsäle/Salles
millieu de l’exposition
Snack Symposium I:
Y03-G-85
Eröffnung der
Jahresversammlung
/
Y24-G-45
Wirksamkeit
und
Sicherheit von Ustekinumab
in der Psoriasis
Ouverture
de
la
Réunion
annuelle
– Eine Erfolgsgeschichte der IL-12/IL-23 Inhibition
Chairs:
Lars French,
ReinhardLausanne
Dummer,/ Zürich /
Lars
French,
Zürich / Zürich
Curdin/Conrad,
Jürg
Hafner,
Zürich
Nikhil Yawalkar, Bern (Janssen-Cilag AG)
16.50–17.30
11.45–12.00
4
12.00–12.30
Key Lecture
1:
Snack
Symposium
II:
Y03-G-95
Michael
Detmar,
Zürich
Photoprotektion
– neuste Erkenntnisse und Praxisrelevanz
Cutaneous
vessels:
surprising
functions
Ulrike
Sattler,lymph
Toulouse
(F) / Günther
Hofbauer,
Zürichin tumor
spread,
wound
healing
(Pierre
Fabre
(Suisse)
SA) and cutaneous inflammation
12.30–14.00
Lunch und Zeit zur Besichtigung
der Industrieausstellung / Y03-G-91
Snack-Symposium
III:
Lunchtreatment
et temps libre
pourinla Rosacea
visite de l’exposition des industries
New
options
Hörsäle/Salles
(Brimonidine and Ivermectine)
Thomas
Witten
Spirig)
LUNCH Dirschka,
SYMPOSIUM
I: (D) / Liv Krämer, Zürich (Galderma Y03-G-85
„Small Molecules“ – Inhibition intrazellulärer Signalwege als
Key
LectureTherapie
2:
Y24-G-45
zukünftige
der Psoriasis und Psoriasis Arthritis
/
Nicole
Lindenblatt,
Zürich
L’inhibition des voies signalétiques intracellulaires comme
Skin
Tissuefutur
Engineering
– what
wel‘arthrite
can learnpsoriasique
from nature
traitement
du psoriasis
et de
Jan
Plock,
Zürich
Lars French, Zürich / Curdin Conrad, Lausanne / Damiant Thaçi,
Angiogenesis,
Arteriogenesis
and Vasculogenesis – Vascular
Lübeck (D) / (Celgene
Gmbh)
Regeneration under Critical Ischemia
LUNCHA.SYMPOSIUM
II: / E. Guenova, Zürich /
Y03-G-95
Chairs:
Navarini, Zürich
Aktinische
Keratose: mehr als nur Läsionsbehandlung – die
R.
Hunger, Bern
Fläche im Fokus! Neue Schweizer Guidelines & TherapieoptiTransfer
der Universität Irchel
zum Zoo Zürich;
Treffpunkt:
onen beivon
Feldkanzerisierung
/ Kératose
actinique:
plus que
Taxistand
(Stock
D) / Transfer des
de l’Université
Irchel
au zoo
simplement
un traitement
lésions – la
surface
enZurich;
focus!
Lieu
de recontre:
Station de taxissuisses
(ètage D)
Nouvelles
recommandations
& les options thérapeutiques du champ de cancérisation
Apéro
imHofbauer,
Zoo Zürich
/
Günther
Zürich
(MEDA Pharma GmbH)
Apéritif au Zoo Zurich
Bei
schönem Wetter:
Haupteingang Zoo
Thematische
Falldemonstrationen
1/
Y24-G-45
Par
beau temps:
Présentation
deEntrance
cas 1 principale du Zoo
Bei
schlechtem Wetter:
HalleBâle)
(Universitätsspital
Basel Eingang
/ Hôpital Masoala
Universitaire
Par
mauvais
temps:
Entrance
Masoala
Chairs:
M. Gilliet,
Lausanne
/ L.salle
Weibel,
Zürich / H. Beltraminelli, Bern
xtension
ffectiveeported
fects of
76.
mässiger
f krankMethotMTX-naTX-naive
Arthritis
pie. Bei
aben,
in
er Komachsene
t einem
ht
mehr
anspreprochen
die eine
herapie,
nen
eine
lle zwei
einer
nallVorteil
uläre
juimärem
Woche
40 mg
er DosierzinsufInhaltselinisieh Lebenopporktionen,
tikörper,
gischen
te nach
Anwenumonie,
ruritus),
Fasciitis,
x, oraler
Husten,
n (PyePruritus,
merzen,
ulässig.
tsreakti12/2013
ulässig.
9/2014
13.15–14.00
17.45–18.15
18.30
19.00
14.15–14.45
SGDV – SSDV
35-F-47
20.00
14.45–15.05
Nachtessen
in der Thai Lodge
im KaengFallvorstellungen
Krachan Elefantenpark
/ I/
Klinisch-pathologische
Korrelation,
SGDP
Dîner
dans
le
Thai
Lodge
dans
le
Kaeng
Krachan
parc
des
éléphants
Corrélations pathologiques et cliniques, présentations SGDP I
15.05–15.25
Freie Mitteilungen I / Communications libres I (FC1–FC2)
15.30–16.00
Thematische Falldemonstrationen 2 / Présentation de cas 2
(Universitätsspital Genf / Hôpital Universitaire Genève)
Chairs: G. Hofbauer, Zürich / AK. Lapointe, Lausanne/ K. Kerl, Zürich
16.00–16.20
Klinisch-pathologische Korrelation, Fallvorstellungen SGDP II /
Corrélations pathologiques et cliniques, présentations SGDP II
16.20–16.40
Freie Mitteilungen II / Communications libres II (FC3–FC4)
16.40–17.45
Kaffeepause bei den Ausstellern / Pause café auprès des exposants
18
Schenken Sie Ihren Patienten
wieder bewegende Momente
NEU!
Otezla® – bei Plaque Psoriasis und Psoriasis Arthritis1
Breites Wirksamkeitsspektrum* 1,2
Vorteilhaftes Sicherheitsprofil1,3
Bewiesene Langzeitverträglichkeit+1,4,5
Patientenfreundliche orale Einnahme1
*Wirksamkeit auf die Haut, Gelenke, Skalp, Nägel, Dactylitis und Entesitis1,2 +Bewiesene Langzeitverträglichkeit über 2 Jahre1,4,5
Referenzen: 1. Otezla® Fachinformation, Arzneimittelkompendium der Schweiz, www.swissmedicinfo.ch. 2. Kavanaugh A et al. Longterm (52-week) Results of a Phase III Randomized, Controlled
Trial of Apremilast in Patients with Psoriatic Arthritis. J Rheumatol. 2015; 42(3):479–488. 3. Busa S and Kavanaugh A. Drug safety evaluation of apremilast for treating psoriatic arthritis. Expert
Opinion Drug Safety, 2015;14(6):979-985. 4. Papp K et al. Two-Year safety of Apremilast, an Oral Phosphodiesterase 4 Inhibitor, in Patients With Moderate to Severe Psoriasis: Results From a Phase
3, Randomized, Controlled Trial (ESTEEM 1). Poster 1055 presented at 73rd Annual Meeting of the American Academy of Dermatology; März 20–24, 2015; San Francisco. 5. Mease PJ et al. Longterm (104) Week Safety Profile of Apremilast, an Oral Phosphodiesterase 4 (PDE4) Inhibitor, in Patients with Psoriatic Arthritis: Results from a Phase 3, Randomized, Controlled Trial and Open-Label
Extension (PALACE 1). Poster 1564 presented at 73rd American College of Rheumatology (ACR) Annual Meeting; 14–19 November 2014; Boston.
Otezla® (Apremilast) Z: Apremilast + Hilfsstoffe I: Plaque Psoriasis: Otezla ist indiziert zur Behandlung von erwachsenen Patienten mit mittelschwerer bis schwerer Plaque Psoriasis, die auf
eine andere systemische Therapie nicht angesprochen haben, eine solche nicht tolerieren oder wenn eine solche kontraindiziert ist. Psoriasis Arthritis: Otezla ist als Monotherapie oder in Kombination mit krankheitsmodifizierenden Antirheumatika (DMARDs) zur Behandlung der aktiven Psoriasis Arthritis bei erwachsenen Patienten indiziert, die auf eine vorhergehende Therapie mit
DMARDs nicht angesprochen haben oder eine solche nicht tolerieren oder wenn eine solche kontraindiziert ist. D: Die empfohlene Dosierung von Otezla beträgt 30mg zweimal täglich oral unter
Anwendung eines initialen Titrationsschemas. KI: Überempfindlichkeit gegenüber dem Wirkstoff oder einem der Hilfsstoffe; Schwangerschaft. VM: Nierenfunktionsstörung: Bei Patienten mit
schwer eingeschränkter Nierenfunktion muss die Dosis auf einmal 30 mg Otezla pro Tag reduziert werden. Depressionen. UAW: Durchfall, Übelkeit, Erbrechen, Bronchitis, Infektion der oberen
Atemwege, Nasopharyngitis, Verminderter Appetit, Dyspepsie, Schlafstörungen, Fatigue, Kopfschmerzen, Migräne, Rückenschmerzen, Gewichtsabnahme, Hautausschlag. IA: Verabreichung
starker CYP3A4-Induktoren wie z.B. Rifampicin, Phenobarbital, Carbamazepin, Phenytoin und Johanniskraut können die Wirksamkeit von Otezla vermindern und werden nicht empfohlen.
P: Otezla Starterpackung (4x 10 mg, 4x 20 mg, 19x 30 mg) mit insgesamt 27 Filmtabletten; Otezla Einmonatspackung (56 x 30 mg) mit 56 Filmtabletten. Abgabekat.: A. Ausführliche
Informationen: www.swissmedicinfo.ch; Stand der Information Juni 2015 TI: Celgene GmbH, Bändliweg 20, 8048 Zürich. iai108_b_2015
Celgene GmbH | [email protected] | www.celgene.com | T +41 44 437 88 00 | F +41 44 437 88 88
Hörsäle/Salles
16.50–17.30
Snack Symposium I:
Y03-G-85
Wirksamkeit und Sicherheit von Ustekinumab in der Psoriasis
Lars French, Zürich / Curdin Conrad, Lausanne /
Snack Symposium II:
Y03-G-95
Photoprotektion – neuste Erkenntnisse und Praxisrelevanz
Ulrike Sattler, Toulouse (F) / Günther Hofbauer, Zürich
(Pierre Fabre (Suisse) SA)
Snack-Symposium III:
Y03-G-91
New treatment options in Rosacea
Thomas Dirschka, Witten (D) / Liv Krämer, Zürich (Galderma Spirig)
Key Lecture 2:
Y24-G-45
Nicole Lindenblatt, Zürich
Skin Tissue Engineering – what we can learn from nature
Jan Plock, Zürich
Angiogenesis, Arteriogenesis and Vasculogenesis – Vascular
Chairs: A. Navarini, Zürich / E. Guenova, Zürich /
R. Hunger, Bern
18.30
Transfer von der Universität Irchel zum Zoo Zürich; Treffpunkt:
Taxistand (Stock D) / Transfer de l’Université Irchel au zoo Zurich;
Lieu de recontre: Station de taxis (ètage D)
19.00
Apéro im Zoo Zürich /
Bei schönem Wetter: Haupteingang Zoo
Par beau temps: Entrance principale du Zoo
Bei schlechtem Wetter: Eingang Masoala Halle
Par mauvais temps: Entrance salle Masoala
20.00
Nachtessen in der Thai Lodge im Kaeng Krachan Elefantenpark /
Dîner dans le Thai Lodge dans le Kaeng Krachan parc des éléphants
SGDV – SSDV
17.45–18.15
20
PA RT
Une protection optimale
avec un minimum de filtres
•
Une excellente photostabilité
•
Des formules résistantes à
l’eau, sans alcool et riches
en Eau thermale d’Avène
www.eau-thermale-avene.ch
A I R E / PA
NER
TOUCHER
SEC
N
RT
E
LE MEILLEUR DE
LA PROTECTION
UVB ET UVA
22
Arbeitssitzung/
Séance du comité
Dermato-Chirurgie
Y03-G-91
Kapazität 90
fixe Hörsaalbestuhlung
Y21-F-70
Kapazität 40
seminar
Y22-F-62
Kapazität 40
seminar
Y-22-F-68
Kapazität 40
seminar
Arbeitssitzung/
Séance du comité
Dermatolo-Pathologie
Arbeitssitzung/
Séance du comité
Dermato-Onkologie
Y03-G-85
Kapazität 141
Fixe Hörsaalbestuhlung
Y03-G-95
Kapazität 141
fixe Hörsaalbestuhlung
08.00–09.00
Hörsäle / Salles
Robin Kaufmann, Robert Hunger, Bern: Epitheliale Hauttumore nach Nierentransplantation: Analyse der Berner Datenbank.
Andreas Arnold, Basel: Melanom bei Organtransplantation
Christian Surber, Basel: Sonnenschutz und Hautkrebs
Günther Hofbauer, Zürich: Swiss Transplant Cohort study and ongoing skin cancer studies
Carlo Mainetti, Bellinzona: Clinical practice guidelines for skin cancer in OTR
Dr. med. Gionata Marazza, Bellinzona: Introduction
Dr. med. Patrick Perrier, Lausanne: How to have a nice surgical scar – tips & tricks before, during and after the surgical procedure
Dr. med. André Skaria, Vevey: Surgery of the ear – main surgical procedures and reconstructive techniques
Dr. med. Alexandre Campanelli, Genève: Wedge resection for tumours on the lid and the lip
Dr. med. Severin Laeuchli, Zürich: Surgery of the nail part II
Dr. med. Marco Stieger, Bern: Update on the litterature – What’s new in 2014–2015?
Current practice of effective camouflage (To be announced)
How to use magistral recipes in your practice (Tobias Plaza, Uster)
New and old topicals from heaven & hell (Alexander Navarini, Zurich)
Dermato-Pathologie Slide View
Programm/Programme: 09.45–12.00
Prof. Dr. Bernhard Zelger (Univ. Innsbruck): Vaskulitiden und vaskuläre Neoplasien
Dermato-Pathologie:
09.30–10:00
10:00–10:30
10:30–11:00
Clinical Skills: Programm
Programm/Programme:
2) Dr Joachim Krischer:
1) Dr. Bettina Rümmelein:
Laser:
Programm/Programme:
–
–
–
–
–
–
Dermato-Chirurgie
Programm/Programme:
–
–
–
–
–
Dermato-Onkologie/Transplantation
Programm/Programme:
09.30–11.00
Workshops der Arbeitsgruppen SGDV, Donnerstag, 27.8.2015 / Atelier des groupes de travail SSDV, jeudi le 27.8.2015
SGDV – SSDV
23
Arbeitssitzung/
Séance du comité
SGEDS
Arbeitssitzung/
Séance du comité
Dermato-Allergologie
Arbeitssitzung/
Séance du comité
Dermato-Pädiatrie
Y21-F-65 Theatersaal
Kapazität 222
konzert
Y13-L-11/13
Kapazität 30
seminar
13-M-12
Kapazität 44
seminar
SGDV – SSDV
Y35-F-08
Kapazität 14
seminar
08.00–09.00
Hörsäle / Salles
Introduction & Chair (Oliver Ph. Kreyden, Muttenz)
Laser-Peeling (Bettina Rümmelein, Zürich)
Middle deep and deep Peeling (Torsten Walker, Ludwigshafen)
Superficial Peeling and Yellow Peel (Clara Boudny Frey, Aarau)
LIVE TREATMENTS
– Yellow Peel (Clara Boudny Frey, Aarau) 10 Min.
– Jessner Peel (Daniel Fuchs, Zürich) 10 Min.
– TCA 35% Peeling (Torsten Walker, Ludwigsahfen) 10 Min.
Kiss and Goodby (Oliver Ph. Kreyden)
Prof. Dr. Andreas J. Bircher (Basel): Begrüssung und Einführung
Dr. Petra Becker-Wegerich (Meilen): Nebenwirkungskabinett Filler
– Schönheit mit unvorhergesehenen Konsequenzen!?
– Fälle aus der Praxis
Prof. Dr. An Goossens (Leuwen, Belgien): New cosmetic allergens
Diverse Referenten: Fälle aus den Kliniken / der Praxis
Dr. Jan Izakovic (Basel): Begrüssung und Einführung
Prof. Dr. Peter H. Itin (Basel): Genetische Aspekte vaskulärer Malformationen
Dr. Lisa Weibel (Zürich): Vaskuläre Anomalien: der Weg zur Diagnose
PD Dr. Stéphanie Christen-Zäch/Dr. Sarah Norrenberg (Lausanne): Physikalische Therapiemethoden vaskulärer Läsionen
Dr. Martin Theiler (Zürich): Neuere Therapiestrategien bei vaskulären Neoplasien und Malformationen
–
–
–
–
–
–
–
–
Antonio Cozzio: Einführung, Konstitution der Arbeitsgruppe
Michael Kunz: Klinische Studien zu CTCL in Zürich, Stand 2015
Werner Kempf: Klinikopathologische Korrelation von CTCL/CBCL Fällen
Helmuth Beltraminelli/Christoph Schlapbach: Interessenschwerpunkte in Bern
Olivier Gaide: Interessenschwerpunkte in Lausanne
Emmanuella Guenova: Interessenschwerpunkte in Zürich
Gayathri Nair: Transplantation bei kutanen Lymphomen – Vorgehen und eigene Erfahrungen
Antonio Cozzio: Weitere Projekte der AG CL
Kutane Lymphome:
09:30–09:35
09:35–10:00
10:00–10:20
10:20–10:40
10:40–11:00
Dermato-Pädiatrie:
Programm/Programme:
10:05–10:45
10:45–11:00
09:30–09:35
09:35–10:05
Dermato-Allergologie:
Programm/Programme:
10.55–11.00
09.30–09.35
09.35–09.50
09.50–10.10
10.10–10.25
10.25–10.55
SGEDS
Programm/Programme:
09.30–11.00
Workshops der Arbeitsgruppen SGDV, Donnerstag, 27.8.2015 / Atelier des groupes de travail SSDV, jeudi le 27.8.2015
Hörsäle/Salles
PHCH/STE/0714/0001
nen
hrimit
nes
mg
pie
pez.
enekmppie,
nen
Ar® in
dig.
die
en:
Freitag/Vendredi, 28.8.2015
08.00–08.30
Enregistrement / Registration
08.30–09.00
Thematische Falldemonstrationen 3 /
Y24-G-45
Présentation de cas 3
(Universitätsspital Bern / Hôpital Universitaire Berne)
Chairs: S. Lautenschlager, Zürich/ B. Schlagenhauff, Küssnacht a. R. /
Peter Häusermann, Basel
09.00-09.20
Klinisch-pathologische Korrelation, Fallvorstellungen SGDP III /
Corrélations pathologiques et cliniques, présentations SGDP III
09.20–09.40
Freie Mitteilungen III / Communications libres III (FC5–FC6)
09.40–10.30
Kaffeepause / Pause Café
09.45–10.25
Snack-Symposium IV:
Y03-G-85
The blind spot in the management of psoriasis
Wolf-Henning Boehncke, Genf (Pfizer AG)
Snack-Symposium V :
Y03-G-95
Kosmetika und Kontaktdermatitiden – wenn weniger mehr ist.
Peter Schmid-Grendelmeier, Zürich (Beiersdorf AG, Eucerin)
Snack-Symposium VI:
Y03-G-91
Oncolytic immunotherapy in advanced melanoma – local and
systemic effects
Reinhard Dummer, Zürich / Michel Gilliet, Lausanne
(Amgen Switzerland AG)
10.30–11.00
Y24-G-45
(Universitätsspital Lausanne / Hôpital Universitaire Lausanne)
Chairs: Peter Itin, Basel / K. Buxtorf, Plan-les-Ouates /G. Kaya, Genf
11.00–11.20
Klinisch-pathologische Korrelation, Fallvorstellungen SGDP IV /
Corrélations pathologiques et cliniques, présentations SGDP IV
11.20–11.40
Freie Mitteilungen IV / Communications libres IV (FC7–FC8)
11.45–12.15
Key lecture 3:
Beatrice Amann Vesti, Zürich
Skin as mirror of circulation
Chairs: C. Brand, Luzern / Simone Goldinger, Zürich / A. Arnold, Basel
Hörsäle/Salles
SGDV – SSDV
15 11:37
12.15–14.00
Lunch und Zeit zur Besichtigung der Industrieausstellung /
Lunch et temps libre pour la visite de l’exposition des industries
12.45–13.30
Lunch Symposium III:
Y03-G-85
New treatment options in PDT, Sun protection and Aesthetics
Günther Hofbauer, Zürich (Galderma Spirig)
Lunch Symposium IV:
Y03-G-95
Innovative biologic therapies in Dermatology:
what have we learned?
Nikhil Yawalkar, Bern / Lars French, Zürich / Peter van de Kerkhof,
Nijmegen (NL) (Novartis Pharma (Schweiz) AG)
12.45–13.30
Erweiterte Vorstandssitzung
24
14.00–14.30
Y13-M-12
Y24-G-45
Lunch Symposium IV:
Y03-G-95
Innovative biologic therapies in Dermatology:
what have we learned?
Nikhil Yawalkar, Bern / Lars French, Zürich / Peter van de Kerkhof,
Hörsäle/Salles
Nijmegen (NL) (Novartis Pharma (Schweiz) AG)
16.50–17.30
12.45–13.30
14.00–14.30
14.30–15.10
15.10–15.40
17.45–18.15
15.40–16.00
18.30
16.00–16.30
16.30–17.00
19.00
17.00–17.30
Snack Symposium I:
Y03-G-85
Erweiterte
Vorstandssitzung
Y13-M-12
Wirksamkeit
und Sicherheit von Ustekinumab in der Psoriasis
Y24-G-45
Lars French, Zürich / Curdin Conrad, Lausanne /
(Stadtspital Triemli / Hôpital de ville Triemli)
Chairs:
A. Cozzio, Zürich
Snack Symposium
II: / G. Tscharner, Bern / W. Kempf Zürich
Y03-G-95
Photoprotektion – neuste Erkenntnisse und Praxisrelevanz
Ulrike Sattler, Toulouse (F) / Günther Hofbauer, Zürich
(Pierre Fabre (Suisse) SA)
(Spitäler/Hôpitaux: Aarau, Bellinzona, Luzern, St. Gallen)
Chairs: A. Navarini, Zürich / C. Schuster, St. Gallen /
Snack-Symposium III:
Y03-G-91
J. Kamarachev, Zürich
New treatment options in Rosacea
Key lecture 4:
Thomas Dirschka, Witten (D) / Liv Krämer, Zürich (Galderma Spirig)
Daniel Hohl, Lausanne
The EADV is key for European and Swiss dermatology
Key Lecture 2:
Y24-G-45
Chairs: P. Bloch, Thalwil / JP. Grillet, Genf / C. Mainetti, Bellinzona
Nicole Lindenblatt, Zürich
Skin Tissue Engineering – what we can learn from nature
Key lecture 5:
Jan Plock, Zürich
Ernst Reichmann, Zürich
Angiogenesis, Arteriogenesis and Vasculogenesis – Vascular
Cultured skin with blood and lymph capillaries – a milestone
in tissue engineering
Chairs: A. Navarini, Zürich / E. Guenova, Zürich /
Chairs: E. Laffitte, Genève / W. Hötzenecker, Zürich /
R. Hunger, Bern
C. Conrad, Lausanne
Transfer von der Universität Irchel zum Zoo Zürich; Treffpunkt:
Kaffeepause / Pause de Café
Taxistand (Stock D) / Transfer de l’Université Irchel au zoo
Zurich;
Hörsäle/Salles
Lieu de recontre: Station de taxis (ètage D)
Generalversammlung SGDV (statutarisch) /
Apéro
im Zoogénérale
Zürich / de la SSDV (statutaire)
Assemblée
Thematische
Falldemonstrationen
Bei
schönem Wetter:
Haupteingang Zoo7 / Présentation de cas 7
(Universitätsspital
Zürich
Zürich)
Par beau temps: Entrance/ Hôpitaux
principaleUniversitaire
du Zoo
Chairs:
WH. Boehncke,
Genf / E.Masoala
Bianchi,Halle
Lugano/
Bei
schlechtem
Wetter: Eingang
P. Häusermann,
Basel
Par
mauvais temps:
Entrance salle Masoala
Klinisch–pathologische
Korrelationen
V/
Nachtessen
in der Thai Lodge
im Kaeng Krachan
Elefantenpark /
Corrélations
pathologiques
etKaeng
cliniques
V parc des éléphants
Dîner
dans le Thai
Lodge dans le
Krachan
17.50–18.10
Freie Mitteilungen V / Communications libres V (FC9–FC10)
18.10–18.15
Verabschiedung und Schluss der Jahresvesammlung 2015 /
Clôture de la Réunion annuelle 2015
SGDV – SSDV
17.30–17.50
20.00
25
*–
on
on
Tagesprogramm: Pflegefachgruppe/
Programme: Séance infirmière
Freitag/Vendredi, 28.8.2015
5 –7
oder
SGDV – SSDV
ARD)
rapie.
rexat5 mg
h s.c.
. Die
auch
ngen
wird
onen
örper
ulver
en zu
erin:
V019)
60003-360-03/14
ent of
acific
www.
matol.
26
09.00–09.15
Begrüssung und Einführung / Accueil et introduction
Marianne Schärli, Heiko Müller
09.15–10.00
Beratung von Patientinnen und Patienten
mit einem Handekzem
Kathrin Thormann, Barbara Nydegger Inselspital Bern
10.00–10.45
Croyances, attitudes et implantation de la pratique fondee
sur des preuves en suisse romande
Jenny Gentizon, centre hospitalier universitaire vaudois
10.45–11.15
Kaffeepause und Besuch der Industrieausstellung /
Pause-café et visite des exposants
11.15–12.00
Die Herausforderungen des Patientengesprächs
während der allergologischen Hauttestung
Karin Grando, Universitätsspital Zürich
12.00–12.45
La photophérèse aux HUG
Béatrice Boget-Sommeillier und Yvette Halvick,
Hôpitaux Universitaires de Genève
12.45–13.45
Lunch und Besuch der Industrieausstellung /
Pause-repas et visite des exposants
13.45–14.30
Patienten mit Psoriasis – Die Rolle der Angehörigen bei der
Akzeptanz und Umsetzung der Behandlungspläne
Markus Musholt-Meijer, Pflegezentrum Gehrenholz Zürich
14.30–15.15
Dermatologie im Wandel: Anforderungen an die Pflege
Marianne Schärli, Universitätsspital Zürich
15.15–15.30
Perspectives et clôture / Ausblick und Abschluss
15.30–16.00
Café/Kaffee
Die Referate werden in der jeweiligen Landessprache gehalten und simultan
übersetzt. / Les présentations sont tenues dans la langue maternelle et sont
traduits simultanément.
Anmeldungen für das Programm der Pflege per E-Mail an:
[email protected] / Inscriptions pour le programme des soins par
courriel à: [email protected]
!
u
Ne
Auftragen & loslegen...
...mit der Therapie und dem Alltag
Ciclocutan Nagellack
®
Wirkstoff: Ciclopiroxolamin 80mg /g
Kassenzulässig!
Ciclocutan® Nagellack
Artikelnummer
Pharmacode
EAN-Code
Produkt
Inhalt
FAP - Preis
Verkaufspreis
2530103
6000550
7680631910010
Ciclocutan® Nagellack Lös 80mg/g
3g
CHF 14,95
CHF 29,45
2530203
6000567
7680631910027
Ciclocutan Nagellack Lös 80mg/g
2 x 3g
CHF 22,30
CHF 42,00
®
Vorteile
• Preisgünstig
• Wasserfest
• Kein tägliches Auftragen
• Inklusiv Pflegeset
Ciclocutan® Nagellack
Z: Ciclopiroxolamin 80mg / g Nagellack
I: Zur Behandlung von Nagelmykosen die durch Dermatophyten und / oder andere Ciclopiroxsensitive Pilze hervorgerufen sind, bei denen die Nagelmatrix nicht betroffen ist. D: Der Lack wird während des ersten Monats jeden zweiten Tag auf den
betroffenen Nagel aufgetragen. Im 2 Behandlungsmonat erfolgt die Applikation mind. 2-mal wöchentlich ab dem 3 Monat kann auf 1 Anwendung pro Woche reduziert werden. Im Allgemeinen beträgt die Behandlung 6 Monate für Fingernägel
und bis 9 Monate für Zehennägel. KI: Bekannte Überempfindlichkeit gegen Ciclopiroxolamin oder einen der sonstigen Bestandteile. VM: Eine für die Behandlung erkrankter Nägel benützte Feile darf für die Pflege gesunder Nägel nicht mehr
verwendet werden. IA: keine UW: Sehr selten: Rötung, Schuppung, Brennen und Jucken an den behandelten Stellen. Selten: Allergische Kontaktdermatitisen. Abgabekategorie: B
Ausführliche Angaben entnehmen Sie bitte dem Arzneimittel-Kompendium der Schweiz oder unter www.swissmedicinfo.ch
Allgemeine Informationen /
Informations générales
Datum/Date: 26.–28.8.2015
Kongressort / Lieu du congrès
A) Leonardo Boutique Hotel Rigihof, Universitätsstrasse 101,
8006 Zürich, Tel. 044 360 12 00
Alle Sitzungen der SGDV am Mittwoch 26.8.2015 finden im
Leonardo Boutique Hotel Rigihof statt. / Tous les séances de la SSDV le
mercredi 26.8.2015 ont lieu au Leonardo Boutique Hotel Rigihof.
B) Universität Zürich-Irchel, Winterthurerstrasse 190,
8057 Zürich, Tel. 044 635 44 03
Die Workshops der Arbeitsgruppen SGDV, der Kongress am Donnerstag und
Freitag finden an der Universität Irchel statt. / Les ateliers des groupes de travail
SSDV, le congrès le jeudi et ventredi on lieu à l’université Irchel.
Wissenschaftliche Organisation / Organisation scientifique
Prof. Dr. med. Lars French (Tagungspräsident / Président de la reunion annuelle)
Prof. Dr. med. Reinhard Dummer (Tagungssekretär / Secrétaire du congrès)
Prof. Dr. med. Jürg Hafner (Präsident SGDV, Président de la SSDV)
PD Dr. Dr. Antonio Cozzio, PD Dr. Dr. Emmanuella Guenova
PD Dr. Jivko Kamarachev, PD Dr. Katrin Kerl, PD Dr. Dr. Alexander Navarini
Administratives Sekretariat / Secrétariat administrative
Convention Team Lucerne AG, Oberseeburg 10, 6006 Luzern,
Tel. 041 371 18 60 Fax 041 371 18 61 E-mail [email protected]
Desk: Tel. 044 635 35 00, Natel 079 699 94 79
Kongresssprachen / Langues du congrès
Deutsch, Französisch und Englisch / Allemand, français et anglais
(keine Simultanübersetzung / pas de traduction simultanée)
SGDV – SSDV
Kongressgebühr / Frais d’inscription
Mitglieder SGDV / Membres SSDV
DO
FR
1 Tag / 1 Jour
ganzer Kongress / tout le congrès
CHF
CHF
150.–
250.–
Assistenzarzt, Studenten, Passivmitglieder
Médecins assistants, étudiants, membre passif
DO
FR
1 Tag / 1 Jour
CHF
CHF
60.–
100.–
Nicht-Mitglieder SGDV / Non Membres SSDV (1 Tag / 1 Journée )
DO
FR
CHF 550.–
1 Tag / 1 Jour
CHF 1000.–
(Ehrenmitglieder mit ärztlicher Tätigkeit = Normaltarif,
im Ruhestand = Passivmitglied /
Membres d’honneur : actif = tarif normal,
retraité = tarif membre passif)
28
Party der «Jungen Dermatologen / Party des «Jeunesses Dermatologues»
(26.8.2015, 19.00–22.30)
Mitglieder, Nicht-Mitglieder SGDV / Membres, Non-Membres SSDV:
CHF 50.–
Assistenzärzte, Studenten / Médecins assistants, étudiants
kostenlos/gratuit
Grillabend mit Musik und Tanz im Tennisclub Fluntern. Auch ältere Semester
sind herzlich willkommen. / Barbecue avec musique et dance. Les Membres plus
àgés sont cordialement invités
Ort : Tennis Club Fluntern,
Rolf Balsigerstrasse 4, 8044 Zürich
Der Tennisclub Fluntern befindet sich in
der Nähe des Zürcher Zoo’s. Die Anlage
kann bequem mit dem öffentlichen
Verkehr erreicht werden (Tram Nr. 6 bis
zur Endstation Zoo). / Le Tennis Club
Fluntern se trouve près du Zoo Zurich et
peut être atteint par le traffic public
(tram No 6 /stop Zoo)
SITUATIONSPLAN
Endstation
Tram Nr. 6
Nachtessen / Dîner (27.8.2015, 19.00–23.00)
Mitglieder, Nicht-Mitglieder SGDV / Membres, Non-Membres SSDV:
Assistenzärzte, Studenten / Médecins assistants, étudiants
CHF 120.–
CHF 60.–
Geniessen Sie einen unvergesslichen Abend bei den Dickhäutern im Kaeng
Krachan Elefantenpark im Zoo Zürich. / Profitez d’une soirée inoubliable avec
les éléphants dans le Kaeng Krachan parc des éléphants au Zoo de Zurich.
8 Punkt/Crédits
8 Punkt/Crédits
Hotelreservation / Réservation d’hotel
Zurich Tourismus
Im Hauptbahnhof
8021 Zürich
Tel.: 044 215 40 40 Fax 044 215 40 44
E-Mail [email protected]
SGDV – SSDV
Crédits / Credits
Vous pouvez faire valoir / es können geltend gemacht werden:
JV 2. Tag / RA 2ème jour 27.8.2015
JV 3. Tag / RA 3ème jour 28.8.2015
29
Zahlungsweise / Mode de Paiement
(Banküberweisung / Virement bancaire)
Bank / Banque : UBS AG, CH-6002 Luzern
Kontoinhaber / Titulaire du compte: Convention Team Lucerne AG
Vermerk / Remarque: «SGDV 2015 Zürich
Konto / compte 469471.05F
BIC / Swift: UBSWCHZH80A
Clearing No. 248
IBAN: CH570024824846947105F
Bei Eingang der schriftlichen Absage bis zum 10.8. 2015 wird der volle Betrag,
abzüglich CHF 25.– Bearbeitungsgebühr pro Person zurückerstattet. Ab diesem
Datum erfolgt keine Rückerstattung. /
En cas d’annulation, cette dernière doit être arrivée par écrit avant le 10.8.2015;
les frais d’inscription seront remboursés, moins CHF 25.– pour les frais de
dossier. Passé ce délai, aucun remboursement ne pourra être effectué.
Präsentations-Vorbereitung / Conference Preview
Die Redner werden gebeten, ihre Präsentation mind. 1 Stunde vor Beginn des
Vortragsblocks im Regieraum des Vortragsraumses abzugeben. /
Les orateurs sont priés de déposer leurs présentations au moins une heure
avant le début du bloc d’exposés à la salle de conference.
ctinic
Poster
Grösse / Format
schen
d auf
ische
Stelle
ntakt
t von
oder
n der
them,
n. Bei
rden,
osion,
zung.
n mit
g Gel:
2014.
Höhe/Hauteur:
Breite/Largeur:
Postermontage / Mise en place des posters:
Posterabbau / Démontage des posters:
180 cm 120 cm 26.8.2015, 15.00–18.00 h
27.8.2015, 08.00–11.00 h
28.8.2015, 18.15–20.00 h
Öffentliche Verkehrsmittel / Transport publics
Ab Bahnhof SBB Tram Nr. 10, ab Bellevue Tram Nr. 9 bis Haltestelle «Irchel»
Del la gare: Tram no 10, du Bellevue tram No 9 (Arrèt « Irchel »)
SGDV – SSDV
Parking
Parking Irchel (nur limitierte Plätze) / Parking Irchel (places limitées)
30
g
n
n
n
nf
n
ns
er
er
n,
n
e;
er
e
e
d
e
er
Sponsoren/Sponsors
Das wissenschaftliche und organisatorische Komitee bedankt sich bei den
nachfolgenden Firmen für ihre finanzielle Unterstützung. /
Le comité scientifique et d’organisation remercie les entreprises suivantes de
leur soutien financier:
Platin/platine :
Celgene GmbH
Galderma Spirig
MEDA Pharma GmbH
Novartis Pharma Schweiz AG
Gold/or :
AbbVie AG
Amgen Switzerland AG
Beiersdorf Eucerin
Janssen-Cilag AG
Pfizer AG
Pierre Fabre (Suisse) SA
Silber/argent :
Eli Lilly (Suisse) SA
La Roche-Posay
LEO Pharma
Bronze/bronze:
Allergan AG
GlaxoSmithKline AG
Weitere/en plus: Merz Pharma (Schweiz) AG
RAUSCH AG
SGDV – SSDV
4:30:17 PM
31
Ausstellerliste / Liste des exposants
Wir danken folgenden Firmen für ihr Interesse und ihre Beteiligung./
Avec tous nos remerciements aux exposants.
Firma
A. Menarini AG
AbbVie AG
ALCINA AG
Allergan AG
Allergopharma AG
Alma Lasers GmbH
Almirall AG
AMGEN Switzerland AG
Asclepion Laser Technologies GmbH
Beiersdorf AG /Division Eucerin
Calista Medical
CAPCOOL (Tech-brun-Tex GmbH)
Celgene GmbH
Cutera Switzerland GmbH
Cynosure GmbH
Dermapharm AG
Eisenhut Instrumente GmbH
Eli Lilly (Suisse) SA
esthetic med
FotoFinder Systems GmbH
Galderma Spirig
Gebro Pharma AG
IBSA
Janssen-Cilag AG
Karger Verlag
La Roche-Posay
LASERMED AG-Innovating Medicine
LEO Pharma
Louis Widmer SA
SGDV – SSDV
e
Ort
Zürich
Baar
Muttenz
Zürich
Therwil)
Nürnberg (D)
Wallisellen
Zug
Jena (D)
Reinach
Frauenfeld
Bronschhofen
Zürich
Zürich
Hamburg (D)
Hünenberg
Frittlingen (D)
Vernier
Dübendorf
Bad Birnbach (D)
Egerkingen
Liestal
Pambio-Noranco
Zug
Basel
Vernier
Roggwil/Epalinges
Regensdorf
Schlieren
32
HOMOLOGUÉ ET REMBOURSÉ!
Le premier et unique inhibiteur de l’IL-17A
Cosentyx®
90-70-40
Une nouvelle ère dans le traitement du psoriasis*1
Effet puissant
Profil de sécurité
9 / 10 patients atteignent PASI 75**1,2
•
• 7 / 10 patients atteignent PASI 90**
• 4 / 10 patients atteignent PASI 100**
Taux d’incidence d’effets indésirables
comparable à étanercept
1,2
1,2
1,2
Efficacité durable
Schéma de traitement mensuel
1
90 % des patients peuvent maintenir un PASI 90
de la semaine 16 jusqu’à la semaine 52
1,2
* Cosentyx®/- SensoReady® est indiqué dans le traitement du psoriasis en plaques modéré à sévère chez les patients adultes.
** À la semaine 16; le critère primaire était PASI 75 à la semaine 12.
Références: 1. Information professionnelle Cosentyx®, mise à jour février 2015, disponible sous www.swissmedicinfo.ch 2. Langley RG et al. Secukinumab in Plaque Psoriasis – Results of Two Phase Three Trials.
N Engl J Med. 2014 Jul 24;371(4):326 – 38.
Cosentyx® (sécukinumab): C: Poudre pour solution injectable: Après reconstitution, chaque flacon contient 150 mg de sécukinumab dans 1 ml d’eau pour préparations injectables. Solution injectable (seringue et stylo préremplis):
Chaque seringue préremplie ou stylo prérempli contient 150 mg de sécukinumab. I: Cosentyx/Cosentyx SensoReady est indiqué dans le traitement du psoriasis en plaques modéré à sévère chez les patients adultes qui n’ont pas
répondu aux autres traitements systémiques (y compris le traitement par ciclosporine ou par méthotrexate, ainsi que la puvathérapie) ou qui ne peuvent pas les suivre en raison de contre-indications ou d’intolérance. P: La dose
recommandée est de 300 mg, en injection sous-cutanée, administrée aux semaines 0, 1, 2 et 3 en traitement d’initiation, puis tous les mois à partir de la 4 semaine en traitement d’entretien. Chaque dose de 300 mg est administrée
en deux injections sous-cutanées de 150 mg. En cas d’effets indésirables graves, une interruption temporaire du traitement doit être envisagée. Des candidoses mucocutanées rares sont plus souvent survenues avec une posologie
de 300 mg; envisager une réduction de dose de 150 mg pour les cas graves. Pour plus de détails et groupes de patients particuliers, cf. www.swissmedicinfo.ch. CI: Graves réactions d’hypersensibilité au principe actif ou à l’un des
excipients. PE: Infections: Prudence chez les patients ayant une infection chronique ou des antécédents d’infections récidivantes. Si un patient développe une infection grave, le placer sous surveillance étroite; ne pas administrer
tant que l’infection n’a pas disparu. Ne pas administrer aux patients atteints de tuberculose active. Envisager un traitement antituberculeux avant le début d’un traitement chez les patients atteints de tuberculose latente. Maladies
inflammatoires chroniques intestinales: Des cas isolés de maladies inflammatoires chroniques intestinales ont été observés, dans certains cas graves; dans la plupart des cas il s’agissait d’exacerbations d’une maladie de Crohn
préexistante. Face à de tels cas, réévaluer attentivement le traitement et envisager son arrêt. Le sécukinumab n’a démontré aucune efficacité chez les patients atteints de la maladie de Crohn active. Maladies malignes: Les études
cliniques jusqu’à un an n’ont montré aucune augmentation du risque de maladies malignes. Pas encore de résultats disponibles concernant la sécurité à long terme. Réactions d’hypersensibilité: En cas d’apparition d’une réaction
anaphylactique ou d’une autre réaction allergique grave, interrompre l’administration immédiatement, prendre des mesures thérapeutiques appropriées. Aggravation du psoriasis en cas d’arrêt du traitement («rebond»): En cas
d’interruption du traitement chez les patients qui y ont répondu en premier lieu, prendre en compte le risque de rebond. Vaccinations: Il est recommandé de compléter toute vaccination prévue avant le début du traitement. Respecter
un certain délai entre les vaccins vivants et le début du traitement conformément aux directives actuelles en matière de vaccination concernant les principes actifs immunosuppresseurs. Ne pas administrer les vaccins vivants de
manière concomitante avec Cosentyx/Cosentyx SensoReady. Association à d’autres biomédicaments: L’administration concomitante avec d’autres biomédicaments n’a pas été étudiée et n’est pas recommandée. Personnes
allergiques au latex (seringue préremplie/stylo prérempli): Le capuchon de l’aiguille peut contenir du caoutchouc sec (latex). Grossesse: Seulement utiliser durant une grossesse si l’emploi l’emporte clairement sur les risques
éventuels. Allaitement: Prudence en cas d’administration chez les femmes qui allaitent. Pour plus de détails, cf. www.swissmedicinfo.ch. IA: Les vaccins vivants ne doivent pas être administrés de manière concomitante. Les patients
prenant des médicaments dont la dose est déterminée de manière individuelle et qui sont métabolisés par les enzymes CYP450 3A4, 1A2 ou 2C9, doivent faire l’objet d’un contrôle au début et à la fin d’un traitement par sécukinumab
et la dose de ces substances doit être adaptée au besoin. Pour plus de détails, cf. www.swissmedicinfo.ch. EI: Très fréquent: infections des voies respiratoires supérieures (18.6 %); fréquent: herpès oral, rhinorrhée, diarrhée, urticaire;
occasionnel: candidose orale, tinea pedis, candidose de l’œsophage, neutropénie, conjonctivite, enzymes hépatiques élevés, bilirubine élevée. Pour plus de détails, cf. www.swissmedicinfo.ch. Pr: Seringue préremplie de 150 mg:
emballages à 1 et 2; stylo prérempli de 150 mg: emballages à 1 et 2; poudre pour solution injectable en flacon de 150 mg: emballage à 1. Catégorie de vente: B. 18.02.2015. V1
27677
e
Pour de plus amples informations, veuillez consulter www.swissmedicinfo.ch.
Novartis Pharma Schweiz AG, Risch; adresse: Suurstoffi 14, 6343 Rotkreuz, tél. 041 763 71 11
Ausstellerliste / Liste des exposants
Firma
Mavene Health Care (Schweiz) Gmbh
MAVIG GmbH VivaScope Systems
MEDA Pharma GmbH
Medic Service AG
MediTron S.A.
Medizinische Laboratorien Medica
Merz Pharma (Schweiz) AG
MSD Merck Sharp & Dohme AG
NMS Bio-Médical S.A.
Novartis Pharma Schweiz AG
Orcos Medical AG
Permamed AG
Pfizer AG
Pharma Medica AG
Pierre Fabre (Suisse) SA
Polymed Medical Center
Pro Farma AG
Roche Pharma (Schweiz) AG
Schweizerische Psoriasis +
Vitiligo Gesellschaft
Skintes GmbH
Verein Lichen Sclerosus
Viollier AG
Visiomed AG
V-Skin Medical Beauty GmbH
Waldmann Lichttechnik GmbH
Ort
Hünenberg
München (D)
Wangen-Brüttisellen
Volketswil
Frauenfeld
Zürich
Allschwil
Luzern
Praroman
Rotkreuz
Küsnacht ZH
Therwil
Zürich
Roggwil
Allschwil
Glattbrugg
Baar
Reinach
Bern
Zürich
Rheinfelden
Basel
Bielefeld (D)
Freienbach
Küttigen
SGDV – SSDV
Inserat
34
Traktandenliste
der 97. Generalversammlung der SGDV (staturarisch)
Freitag, 28. August 2015 von 16.30 bis 17.00 Uhr
Ordre du jour
97 Assemblée Générale de la SSDV (statutaire)
Vendredi 28 août 2015 de 16h30 à 17h00
e
Universität Zürich-Irchel / Hôpital universitaire Zurich-Irchel
6. Jahresrechnung 2014
6.1. Jahresrechnung SGDV
6.2. Revisionsbericht
6.3. Genehmigung der Jahresrechnung 2014
6.4. Genehmigung Revisorenbericht 2014
6.5. Entlastung des Vorstandes für das Jahr 2014
7. Budget 2016
7.1. Vorstellung Budget
7.2. Genehmigung Budget
7.3. Festsetzung des Mitgliederbeitrags 2016
7.4. Sonderbeitrag Revision Tarmed
8. Statutenänderung
8.1. Vorstellung der Statutenänderungen
8.2. Genehmigung der Statutenänderungen
1. Approbation de l’ordre du jour du 28.08.2015
2. Election des scrutateurs
3. Approbation du procès-verbal de la 96e
assemblée générale de la SSDV du 05.09.14
(Bâle)
4. Membres
4.1. Nouveaux membres
4.2. Mutations
4.3. A la mémoire des membres défunts
5. Comité
5.1. Elections de renouvellement
5.2. Elections complémentaires
6. Comptes annuels 2014
6.1. Comptes annuels SSDV
6.2. Rapport de révision
6.3. Approbation des comptes annuels 2014
6.4. Approbation du rapport de l’organe de révision 2014
6.5. Décharge du Comité pour l’exercice
annuel 2014
7. Budget 2015
7.1. Présentation du budget
7.2. Approbation du budget
7.3. Fixation de la cotisation de membre 2016
7.4. Cotisation extraordinaire révision Tarmed
8. Modification des statuts
8.1. Présentation des modifications des
statuts
8.2. Approbation des modifications des statuts
Die Unterlagen werden ca. 4 Wochen vor der Generalversammlung auf der Website zur Verfügung
gestellt.
Les documents seront mis à disposition pour consultation environ 4 semaines avant l’Assemblée générale sur notre site Internet.
Mitglieder, welche die Einladung samt Unterlagen
auf postalischem Weg bevorzugen, werden gebeten, dies dem Generalsekretariat mitzuteilen: SGDV,
Dalmazirain 11, 3005 Bern, Tel. 031 352 22 02, Fax
031 352 22 05, [email protected].
Les membres qui préfèrent recevoir l’invitation et
les documents annexes par courrier postal, sont
priés d’aviser le Secrétariat général : SSDV, Dalmazirain 11, 3005 Bern, tél. 031 352 22 02, fax 031 352 22
05, [email protected].
Prof. Dr. med. Jürg Hafner
Präsident SGDV
Prof. Dr méd. Jürg Hafner
Président SSDV
SGDV – SSDV
1. Genehmigung der Traktandenliste vom
28.08.2015
2. Wahl der Stimmenzähler
3. Genehmigung des Protokolls der 96. Generalversammlung der SGDV vom 05.09.2014
(Basel)
4. Mitglieder
4.1.Neumitglieder
4.2. Mutationen
4.3. Gedenken der verstorbenen Mitglieder
5. Vorstand
5.1.Erneuerungswahlen
5.2.Ersatzwahlen
35
FORUM : Discussion forum on Derm Helv. Journal club,
Focus and more... What’s hot ?
Fo r u m
www.dermatologicahelvetica.com/forum
36
fellow ships
Call 2015
IBSA FOUNDATION
funds each year several young
researchers to promote and
facilitate the realization of their
postdoctoral traineeships with
12 month fellowships
of € 24,000.00 in the following
five research fields
1
in DERMATOLOGY
1
in ENDOCRINOLOGY
1
in FERTILITY/INFERTILITY
1
in ORTHOPEDICS/RHEUMATOLOGY
1
in PAIN MEDICINE
evaluation criteria
The evaluation of proposals is carried
out by the International scientific board
of the Foundation. The IBSA Foundation
Direction will make final decision upon
considering the recommendations
of the International scientific board.
Final award decisions are indisputable.
Awardees will be invited to attend
a ceremony that will take place in the first
quarter of 2016 at the headquarters
of the Foundation in Lugano (CH).
Publications related to the research
funded by IBSA Foundation should
acknowledge the support of IBSA
Foundation in the acknowledgement
section of the manuscript.
elegibility criteria
The applicant, at the deadline for the submission
of proposals, be under 35 and in possession of a
doctoral degree in medicine, biology, pharmacy,
biotechnology or have full-time equivalent clinical
or research experience.
Applicants should include in the proposal 3 separate files:
•
•
•
Short Curriculum vitae with relevant publications
Short description of the proposal, containing background and significance, specific aims,
research plan, and references (4 pages max)
Letter of acceptance by the host institution for the 12 month duration of the fellowship
Applicants are invited to submit proposals no later than 31st December 2015
•
by e-mail at [email protected] and by hard copy by regular mail to:
IBSA FOUNDATION for scientific research
Via del Piano, 29 6915 • Pambio Noranco (CH)
www.ibsafoundation.org
FC1
FC2
Lrig1 and CD44v3 expression in human folliculosebaceous unit
MicroRNA expression pattern varies between differentiation stages of cutaneous squamous cell
carcinoma
L. Barnes, J. Puenchera, J.H. Saurat, G. Kaya
F R E E CO M M U N I C AT I O N S
University of Geneva, Geneva
38
The expression of Lrig1 in human epidermis is described as clusters of Lrig1 positives keratinocytes in
the basal layer of the interfollicular epidermis (IFE).
The Lrig1 clusters are believed to be stem cell clusters. In contrast to human, the expression of Lrig1
in the mouse has been described only in the infundibulum, isthmus and the sebaceous glands (SG) of
the folliculosebaceous unit (FSU). Lrig1+ cells located in the isthmus were shown by lineage tracing
to feed the isthmus itself, the infundibulum and the
SG. However upon injury they were able to repopulate interfollicular epidermal compartments.
We have observed similar clusters in the isthmus
and SG of the human FSU. We also studied the expression of EGFR and CD44v3 in these clusters. Two
human skin sections presenting hair follicles and
sebaceous glands were stained for the human form
of Lrig1, EGFR and CD44v3. The previously described clusters of Lrig1+ cells in the IFE were detected
in the basal layer, and these clusters were negative
for EGFR and CD44v3. In addition we found Lrig1
highly positive clusters in the isthmus and also the
SG. EGFR and CD44v3 expression was reduced in
these clusters.
This staining pattern suggests that at least two clusters of Lrig1+ keratinocytes are present in human
epidermis, (i) the epidermal interfollicular involved
in the homeostasis of the epidermis, as previously
described, and (ii) a second follicular, similar to the
murine follicular Lrig1 niche, which may have similar functions, that would be the feeding of the upper FSU, the infundibulum and the SG.
In the mouse skin the Lrig1 niche feeds the upper
FSU but also contributes to the regeneration of all
the epidermal compartments only in case of injury.
Indeed in homeostatic conditions, the mouse epidermis appears to self-renew autonomously. The
human epidermis may have evolved towards a
different model with two distinct epidermal Lrig1
niches, an epidermal Lrig1 niche and a follicular
one. Hair follicles are much more scattered in human skin, this may be an explanation to the need
for an additional reservoir of Lrig1+ quiescent cells
in the epidermis.
The distribution of Lrig1+ cells, in the human follicular isthmus and some undifferentiated SG cells
questions about their contribution to the maintenance of SG homeostasis. The regulation of the
EGFR/Lrig1 loop, putatively tuned by CD44v3, may
be involved in acne and comedogenesis, the acneiform eruptions associated with EGFR inhibitors and
sebaceous neoplasia.
B. Burger1, B. Stöcklin1, S. Herms1, A.W. Arnold2, A. Volz2,
P.H. Itin2
1 Dpt of Biomedicine, University Hospital Basel, Basel
2 Dpt of Dermatology, University Hospital Basel, Basel
Development of cutaneous squamous cell carcinoma (cSCC) is promoted by an accumulation of DNA
damages through UV-light exposure, but can also
be the character of an inherited genetic skin disease
such as epidermodysplasia verruciformis. Usually,
the development of cSCC initiates with actinic keratoses, which can shift into well, moderately, or low
differentiated tumors. During this step of cSCC formation the expression pattern of messenger RNA
(mRNA) is modified. MicroRNAs (miRNA) are short
RNAs known to regulate the expression of mRNA.
Data addressing the miRNA expression pattern of
cSCC are scarce.
We hypothesize that the miRNA expression pattern
differs between differentiation stages of cSCC in
the immunocompetent population. Therefore we
screened the miRNA expression in actinic keratoses
as well as in several cSCC tumour stages and compared it to healthy epidermis of the same individuals.
Suitable tumour areas were carefully localized in
FFPE-tissue and isolated by punching, preventing
contamination by non-tumorous tissue. The analysis of these samples showed several miRNAs with
significantly altered expression pattern specific for
the tumour stage. Evaluation of expression by Ingenuity Pathway Analysis classified different miRNA
families and could help to identify mRNAs that
may be affected by altered miRNA expression and
possibly support tumorigenesis. Finally, our results
point to differentially regulated pathways, which
could be relevant in cSCC development.
FC3
Store operated calcium entry controls IL-17A-induced calcium signals in human primary keratinocytes
B. Darbellay, NC. Brembilla, WH. Boehncke
Institute of Dermatology, University Hospital of Geneva,
Geneva
Ionized calcium is a 2nd messenger of the cell which
controls a wide range of cellular activities. Notably,
calcium signaling regulates epidermal homeostasis
and immune responses. Cytosolic Ca2+ signals are
generated by Ca2+ influxes from the extracellular
medium and Ca2+ releases from the intra-cellular Ca2+-stores, mainly the endoplasmic reticulum
(ER). As the Ca2+ content of the ER is limited, Ca2+
releases rely on the Ca2+ influx store-operated Ca2+
entry (SOCE) to refill Ca2+ stores. SOCE is controlled
by the stromal interaction molecules (STIMs) STIM1
and STIM2 and the Orai family of Ca2+ channels
Orai1–3. STIMs are transmembrane ER Ca2+ sensors
that activate Orai, and thus SOCE, upon Ca2+ store
depletion.
Imiquimod Crème 3.75%
Das neue Konzept in der Therapie
der Aktinischen Keratose
1, #
Einzige Flächentherapie zur
Detektion und Eradikation subklinischer
und klinischer Läsionen2
Effektivität auf der gesamten
sonnenexponierten Fläche: 92.2% 2,3,*
Einfaches Behandlungsschema2:
2 on – 2 off – 2 on
AK
AK
AK
AK
AK
#
AK
Zyclara® ist angezeigt für die topische Behandlung von klinisch typischer, nicht hyperkeratotischer, nicht hypertropher, sichtbarer oder tastbarer aktinischer Keratose (AK) im Gesicht oder
auf der unbehaarten Kopfhaut bei immunkompetenten Erwachsenen, wenn andere topische Behandlungsmöglichkeiten kontraindiziert oder weniger geeignet sind.
* Gemessen nach Lmax Konzept. Die Anwendung des Lmax Wirksamkeitskonzepts zeigt eine mediane prozentuale Reduktion aller aktinischer Keratose Läsionen (einschliesslich klinischer und
subklinischer Läsionen) von Lmax bis zum Studienende um 92.2%.
Referenzen: 1: Stockfleth E et al. Reduction in lesions from L max: a new concept for assessing efficacy of field-directed therapy for actinic keratosis. Results with imiquimod 3.75%.
Eur J Dermatol. 2014; 24(1):23-27. 2: Stockfleth E. Lmax and imiquimod 3.75%: the new standard in AK management. JEADV 2015; 29(Suppl.1):9-14. 3: Stockfleth E. From a new vision
of actinic keratosis to imiquimod 3.75%, the new treatment standard. JEADV 2015; 29 (Suppl.1):1-2.
Zyclara® Crème (Imiquimod 3.75%): I: Topische Behandlung aktinischer Keratose im Gesicht oder auf unbehaarter Kopfhaut bei immunkompetenten Erwachsenen, wenn andere topische
Behandlungen kontraindiziert / weniger geeignet sind. D: 1× tägl. 2 Zyklen je 2 Wochen, getrennt durch 2-wöchigen behandlungsfreien Zeitraum: max. 2 Sachets dünn auftragen, 8h auf der
Haut belassen. KI: Überempfindlichkeit gegen Inhaltsstoffe. WV: Behandlung von klinisch atypischen oder malignitäts-verdächtigen Läsionen. Kontakt mit Augen, Lippen und Nasenlöchern
vermeiden. Anwendung auf geschädigter Haut nach Behandlung mit anderen Arzneimittel oder chirurgischen Eingriffen. Meiden von Sonnenlicht auf behandelter Haut. Starke Hyperkeratose,
Hypertrophie (Hauthörner). Verschlechterung der Hauterscheinung während der Behandlung. Vorsicht bei Patienten mit reduzierter hämatologischer Reserve, Funktionsstörungen von Herz,
Leber, Niere, eingeschränkte Immunfunktion, Autoimmunerkrankungen, Schwangerschaft, Stillzeit. IA: Nicht untersucht. Interaktionen mit systemisch applizierten Wirkstoffen nur in geringem
Masse. Vermeiden von gleichzeitiger Anwendung anderer Imiquimod-haltiger Crème auf denselben Hautstellen. UW: Herpes simplex, Infektion, Pusteln, Lymphadenopathie, Anorexie, erhöhte
Blutzuckerwerte, Schlaflosigkeit, Depression, Reizbarkeit, Kopfschmerzen, Schwindelgefühl, Bindehautreizung, Augenlidödem, verstopfte Nase,
pharyngolaryngeale Schmerzen, Übelkeit, Diarrhoe, Erbrechen, trockener Mund, Hauterkrankungen, Dermatitis, Gesichtsödem, Myalgie, Arthralgie,
Rücken-/Gliederschmerzen, allg. Störungen (evtl. grippeartige Symptome), Alopezie an Behandlungsstelle. (UW < 0,1% s. AIPS). (A). Kassenzulässig.
Ausführliche Informationen: Packungsbeilage, AIPS (www.swissmedicinfo.ch) oder MEDA Pharma GmbH, 8602 Wangen-Brüttisellen. Januar 2014.
Psoriasis is an auto-inflammatory/immune and hyper-proliferative skin disease. The pathogenesis of
psoriasis involves pro-inflammatory signals, such
as IL-17 secretion by inflammatory cells, which promote the development of cutaneous lesions. This
model is confirmed by the efficiency of anti-inflammatory therapies, including IL-17A pathway neutralization, in the management of psoriasis. Here we investigate the role of pathological calcium signaling
in the hyper-proliferation of keratinocytes and in
the inflammation associated with psoriasis to assess
the therapeutic potential of the topical modulation
of Ca2+ signaling.
Our results show that IL-17A, but not IL-17C, lL-17E
and IL-17F, triggers cytosolic calcium signals in primary human keratinocytes from healthy skin in
vitro. We show that IL-17A triggers calcium release
from the ER, which is associated with a decrease of
the calcium content of the ER that activates STIM1
and STIM2, which in turn activates Orai1. Accordingly, IL-17A induced calcium influxes are suppressed
by the silencing of STIM1, STIM2 and Orai1 with
small interfering RNA (siRNA). Our results also show
that the other channels of the Orai family, Orai2 and
Orai3, are not involved in this process. We further
show that STIM1-YFP forms clusters, which are characteristic of the activated STIMs, following stimulation of keratinocytes with IL-17A. Finally, using Förster resonance energy transfer between STIM1-YFP
and Orai1-CFP, we show that STIM1 tightly interacts
with Orai1 upon IL-17A stimulation in keratinocytes.
We conclude that IL17-A induces Ca2+ signals
controlled by SOCE in primary human keratinocytes. Pathological Ca2+ signals induced by cytokines may thus play a role in the pathogenesis of
psoriasis.
FC4
Pseudolymphomatous and erythema multiformelike skin lesions following immunization with the
rVSV-ZEBOV Ebola vaccine
G. Kaya1, A. Huttner2, J.A. Dayer3, S. Yerly3, L. Kaiser3, C.A.
Siegrist4
1 Service de Dermatologie - HUG, Genève
2 Service de Contrôle de l’Infection - HUG, Genève
3 Service des Maladies Infectieuses - HUG, Genève
4 Centre de Vaccinologie - HUG, Genève
Introduction : The safety and immunogenicity of a
replication-competent recombinant vesicular stomatitis virus (rVSV)–based vaccine expressing a
Zaire ebolavirus (ZEBOV) glycoprotein was assessed
in 51 healthy subjects.
Observation : A mild maculopapular rash predominant on the limbs developed between days 7 and
9 in 3 participants and lasted 7 to 15 days. The rash
was associated with a few tender vesicles on fingers
or toes. Histologic analysis of one papule revealed
a dermal pseudolymphomatous T-lymphocytic infiltrate. Erythema multiforme-like vesicular lesions
reflected subepidermal dermatitis with necrotic
keratinocytes containing rVSV antigens.
Discussion : Skin lesions following vaccination can
be observed. Among those, pseudolymphomatous
lesions after hepatitis B vaccine, erythema multiforme after H1N1 vaccine and Stevens-Johnson
syndrome after influenza vaccine have been repor-
ted. This is the first study to identify skin lesions following immunization with the rVSV-ZEBOV Ebola
vaccine.
Conclusion : The rVSV-ZEBOV vaccine can target the
skin, causing clinically and histologically diverse
lesions.
FC5
Basophil activation test with well characterized
donor basophils using patients’ serum to investigate the pathophysiology of chronic urticaria
O. Hausmann1, T. Pecaric-Petkovic2, C. Diaz2, A. Bünter2,
L. Jörg1, W. Pichler2
1 Dpt of Rheumatology, Immunology and Allergology,
Inselspital, University Hospital Bern, Bern
2 ADR-AC GmbH (Adverse Drug Reactions - Analysis &
Consulting), Bern
Background : Chronic spontaneous urticaria (CU) is
a common skin disorder caused by degranulation of
mast cells. The pathophysiology of chronic urticaria
is still incompletely understood. IgG autoantibodies
against the IgE receptor (FceRI) or against IgE itself
as well as other serum components may play a role,
but their relevance remains unclear.
Methods : Well-characterized donor basophils (n=6)
primed with a donor-specific IL-3 concentration
(range 0.1-1 ng/ml) were co-incubated with sera
of CU patients (n=20). CD63 upregulation on basophils was measured by flow cytometry to quantify
basophil activation. To discriminate between distinct serum components we a) inhibited the IgE/
FceRI signalling cascade using BTK inhibitor (BTK-i) ;
b) analysed, whether CU sera enhanced basophil
reactivity of "non-responder" basophils c) quantified the different autoantibody specificities (antiIgE, anti-FceRI) using ELISA.
Results : Our results show that in the acute phase of
CU, basophil-activating factors are exclusively present in the IgG serum fraction and signal transduction is mediated by Bruton’s tyrosine kinase (BTK).
Experiments using patients’ serum on "non-responder" basophils indicate that the serum of certain patients contains basophil priming component(s) that
enhance the IgE-FceRI signalling cascade. We found
anti-FceRI/anti-IgEautoantibodies in CU patients as
well as in healthy controls with significantly higher
titers for anti-IgE autoantibodies.
Conclusion : We propose a two signal theory of CU
meaning that anti IgE/anti-FceRI autoantibodies become relevant only in the presence of serum components, which leads to enhanced basophil activation and clinical manifestation of CU. This "second
signal" might explain the transient nature of CU, as
autoantibodies are usually persistent and also found
in healthy controls. The nature of the second signal
is unclear at present and could be heterogeneous,
also different in e.g. NSAID, infection or anti-thyroid
autoantibody linked CU.
40
FC6
FC7
Prospective double-blind placebo-controlled study of the effect of Xolair ® (Omalizumab) in chronic
urticaria patients
Easy-to-use compression therapy: Donning devices and modified stockings (sock and superimposed leggings)
L. Jörg1, T. Pecaric-Petkovic2, S. Reichenbach1, M. Coslovsky3, W. Pichler1, O. Hausmann1
Department of Dermatology, Zurich
Introduction : Omalizumab, a monoclonal antibody
directed against the Fc portion of free IgE in serum
has been shown to be effective in chronic spontaneous urticaria. The mode of action of omalizumab
is still not fully understood.
Methods : We conducted a single center, randomized, double-blind, placebo-controlled trial, which
investigated 30 patients with chronic spontaneous
urticaria resistant to high dose treatment with antihistamines. They were randomly assigned to two
groups in a 2 :1 ratio to receive either 300mg omalizumab or placebo. The treatment period was set for
a total of 3 months (applications at month 0, 1, 2, 3)
of omalizumab, followed by a visit 2 months after the
last treatment. The primary endpoint was the FcεRI
receptor density change on blood basophils during
the first 12 weeks of treatment with omalizumab
and 2 months after stopping treatment. Secondary
endpoints were basophil releasability(stimulation
with anti-IgE [not omalizumab]), basophil activation
test of patient serum using donor basophils (CUBAT) and urticaria activity score.
Results : 300mg of omalizumab led to a significant
reduction of FcεRI receptor density on
basophils as soon as one week after the first injection (baseline : 80.31 ± 47.18 compared to 78.29 ±
45.09 (10^3 receptors per basophil), 1 week : 72.89
± 47.79 compared to 27.83 ± 20.87, p=0.001). This
effect continued during the treatment phase and
even 2 months after the last injection (93.81 ± 56.50
compared to 21.09 ± 15.23, P=0.002). Values for basophil releasability and basophil activation test of
patient serum using donor basophils (CU-BAT) were
unchanged despite treatment (CU-BAT: CD63 (activation marker): 10.75 % (7.35) in control group, 8.35 %
(15.20) in omalizumab group (p=0.778)).
Conclusion : We demonstrate a rapid and prolonged
reduction of FcεRI receptor density on
the surface of basophils under treatment with omalizumab. However, no change in basophil releasability using serial dilutions of anti-IgE antibodies (not
omalizumab) could be documented. As CU-BAT
using well-characterized, omalizumab-naïve donor
basophils did not change during the treatment
phase, autoreactive serum factors seem to remain
unaltered. This points towards a primarily cellular
effect of omalizumab on basophils. If skin mast cells
show the same reaction pattern is currently under
investigation.
Background : Compression therapy is highly effective in the treatment of postthrombotic syndrome
and of venous leg ulcers. Approximately 50-60 %
of patients cooperate with compression therapy,
and 40-50 % of patients do not adhere to treatment. Besides annoying, but basically manageable
complaints such as skin dryness and feelings of
constraint, difficulties in donning have been identified as major limitating factor.
Therefore, we seeked for concepts or tools to overcome the donning difficulties of compression stockings. We systematically investigated the value of
donning devices and the possibility to compose a
modular stocking kit of a light sock and superimposed leggings.
Patients and methods : 40 patients with advanced
stage of chronic venous insuffiency, aged over 65
years old. Kikuhime interface pressure measurement device. 20 mmHg (class 1), 40 mmHg (class
3) and a novel, modular stocking kit. Observation
of donning success. Measurement of substocking
interface pressure at rest and during exercise (dynamic stiffness index).
Results : 60 % of patients were able to done strong
compression stockings without any help, and this
amount could be raised to 88 % with the use of donning devices (p=0.001). Superimposing two light
stockings raised the success to 70 % (p=0.22).
100 % of patients were able to done the modular
stocking kit (p=0.001). Substocking interface pressure was comparable to a strong stocking (34.3
mmHg vs 37.25 mmHg ; p=0.1), and the dynamic
stiffness index, as well (16.3 vs 16.6 ; p=0.79).
Conclusions : The use of donning devices significantly improves the ability of elderly patients with
chronic venous insufficiency to done their compression stockings. A modular compression stocking kit
composed of a sock and superimposed leggings
produces subbandage interface pressure that is
comparable to a strong compression stocking,
while it is significantly easier to done. Summarizing
we have shown two pragmatic ways to significantly
improve the donning success of compression stockings in elderly patients.
FC8
Reactive angioendotheliomatosis (reactive angiomatosis) and polychondritis : a new association ?
G.A. Roux, J. Di Lucca, M. Vernez, M. Gilliet, D. Hohl
CHUV, Lausanne
Background : Reactive angioendotheliomatosis is a
cutaneous vascular proliferation seen as red-to-blue
patches and plaques infiltrated often with purpura,
sometimes necrosis and ulceration can be seen.
This vascular proliferation may be associated with a
variety of conditions, many of which have in comDermatologica Helvetica – Volume 27(6) – Août 2015
1 Dpt of Rheumatology, Immunology and Allergology,
Inselspital, University Hospital of Bern, Bern
2 ADR-AC GmbH, Adverse Drug Reactions, Analysis and
Consulting, Bern, Switzerland, Bern
3 Clinical Trials Unit, University of Bern, Bern
C. Luder, K. Sippel, J. Hafner
41
mon luminal obstruction by thrombi or abnormal
proteins such as chronic disseminated intravascular coagulation (DIC), cryoglobulinemia, infections,
paraproteinemia with myelomatosis, leukemia,
dermal amyloid angiopathy, intravascular immunoglobulin deposits associated with a monoclonal
gammopathy, the antiphospholipid syndrome, the
lupus anticoagulant, sarcoidosis, systemic diseases,
hepatopathy, and arteriovenous fistulae used for
hemodialysis.
Case report : A 75 years old woman presented painful red papules, some with annular disposition, of
the limbs associated with a livedo racemosa of the
thighs and the lower back. She was diagnosed of a
low grade follicular (non-Hodgkin’s) lymphoma in
1996 treated with chemotherapy without relapse.
She is also known for an autoimmune background
with Hashimoto’s disease diagnosed in 2009 and
Sjögren’s syndrome in 2012. The biopsy of a nodule
revealed intraluminal proliferation of endothelial
cells with some occluded and dilated vessels and
proliferation of vessels arranged in a lobular pattern.
Blood tests revealed an inflammatory syndrome.
Serum protein electrophoresis, blood film, blood
culture, TB spot, cryoglobulins, antiphospholipids
and ANCA were normal. A total body scanner did not
reveal recurrence of the lymphoma. She described
also recent dysphagia and pain in the nasal area. In
a second time, she developed painful inflammation
of both ears sparing the non-cartilaginous ear lobe.
The cartilaginous biopsy was not conclusive but all
skin and systemic symptoms disappeared after 3
days of non steroidal anti inflammatory intake.
Conclusion : We report the first case of angioendotheliomatosis possibly related with Sjögren’s
syndrome and relapsing polychondritis. This may
represent a new cause or entity of angioendotheliomatosis.
FC10
Efficacy of IL-1β Canakinumab in steroid-refractory Pyoderma Gangrenosum Patients : Preliminary
Results of an open label prospective multicenter
clinical trial
J-T. Maul1, A. Kolios1, B. Meier1, K. Kerl1, Traidl-Hoffmann2, M. Hertl3, D. Zillikens4, M. Röcken5, C. J. Ring2, A.
Facchiano6, C. Mondino6, N. Yawalkar7, E. Contassot1, A.
Navarini1, L. French1
Institute of Dermatology, University Hospital of Zurich,
Zurich
1 Dpt of Dermatology, University Hospital of Zurich, Zurich
2 Dpt of Dermatology and Allergy, Technical University,
Munich, Germany
3 Dpt of Dermatology, University of Marburg, Germany,
Marburg
4 Dpt of Dermatology, University of Lübeck, Germany,
Lubeck
5 Dpt of Dermatology, University of Tübingen, Germany,
Tubingen
6 Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome,
Italy
7 Department of Dermatology, Inselspital Bern, Bern
Background : Solar lentigines are a common aesthetic impairment and challenging to treat. Qualityswitched (QS) laser therapy is a safe and meanwhile
established treatment option for removing solar
lentigines. Triple combination (TC) therapy with the
active pharmaceutical ingredients hydroquinone
5 %, tretinoin 0.03 % and dexamethason 0.03 % is
often used for skinlightening. Pigmanorm® cream,
which contains this active substances, is approved
in Switzerland and Germany for the treatment of
benign acquired melanin conditioned hyperpigmentation as solar lentigines. This is the first study
comparing efficacies and safety of a QS Laser to a TC
cream - both combined with UV protection - in the
treatment of solar lentigines.
Objective : This prospective, open-label trial compares the efficacy and safety of a QS Ruby Laser
(QSRL) and a TC cream in the treatment of solar lentigines.
Background : Pyoderma gangrenosum (PG) is a rare
neutrophilic ulcerative skin disease frequently associated with systemic disease. It is very challenging
to treat when unresponsive to steroids.
Canakinumab is a human monoclonal antibody
against IL-1β that selectively blocks IL-1β and has
no known cross-reactivity with other interleukin-1
family members.
Methods : Five adult (age >18) patients with clinically and histologically confirmed PG were enrolled
in this prospective open label study between April
2011 and December 2014. Canakinumab 150 mg
was administered subcutaneously to all patients
at week 0 and 2, with optional dose escalation to
300 mg at week 2 in case of an inadequate response (PGA >2), and 150-300 mg on week 8 if the
physician’s global assessment (PGA) score was still
between 1 and 3. The primary clinical endpoint was
to assess if canakinumab can induce clinical impro-
FC9
A prospective trial comparing q-switched ruby
laser and a triple combination skin lightening
cream in the treatment of solar lentigines
L. Imhof, M. Barysch, J. Dreier, I. Kolm, R. Dummer
Patients and Methods: In total fifthteen patients
with symmetrically distributed solar lentigines on
the back of both hands were included. The lesions
on the back of the right hand of each patient were
treated in one or two sessions with a QSRL, the ones
on the back of the left hand with a TC cream containing hydroquinone 5 %, tretinoin 0.03 % and dexamethason 0.03 % for 7 weeks accompagnied by UV
protection. Clinical results were evaluated 4 weeks,
8 weeks and 20 weeks after baseline.
Results: In this study the QSRL laser provided significant lightening (p <0.05) compared to the hydroquinone 5 %, tretinoin 0.03 %, dexamethason
0.03 % application. Both procedures were generally
well-tolerated. Comparing the side effects the laser
produced significantly more crusting and hyperpigmentation than the skin lightening cream.
Conclusion : Both QSRL and TC cream were capable
in reducing solar lentigines in Fitzpatrick skin typ
I-IV with an acceptable side-effect profile. The physician’s and patients’ assessment suggests that QSRL
provides faster, superior and longlasting lightening
compared to TC cream. The lightening effect of the
latter was observed less durable.
42
vement (PGA score at least -1 from baseline) and/
or complete clinical remission (PGA 0 or 1) as measured by the PGA at week 16. Secondary endpoints
were the percentage of patients with complete clinical remission and the percentage of patients with
partial clinical improvement at weeks 2, 4, 8 and 12 ;
the change in target lesion diameter and area compared to baseline, and the quality of life measured
by DLQI. The cytokine expression analysis was done
using real-time quantitative PCR. Expression of
mature IL-1β in PG skin sections was assessed using
immunohistochemistry staining for mature IL-1β.
Quantification of serum levels of IL-1β was determined using a sandwich radio-immunoassay with
quantitative measurement of IL-1β.
Observations : We found high interleukin-1β levels
in serum and skin lesions of PG during our prospective examination of the effectiveness of the human
anti–interleukin-1β monoclonal antibody canakinumab. Four of five patients with severe steroid-refractory PG had a clear response to canakinumab with
a significant decrease in ulcer diameter (p =0.03),
a decrease in Physician Global Assessment (PGA)
and a significant improvement in Dermatology Life
Quality Index (DLQI) (p =0.01). Three of five patients
achieved complete remission. No drug-related major adverse events occurred during the study period.
Conclusions : Our data indicate that the proinflammatory cytokine IL-1β plays a key pathogenic role
in PG and offers a rationale for further clinical trials
evaluating canakinumab for the treatment of PG.
43
P1
Beware of false prophets, which come to you in wolf`s
clothing – Acute hemorrhagic edema of infancy
B. Ackermann, O. Brandt, P. Itin
Dpt of Dermatology, University Hospital Basel, Basel
A 7-month-old boy was hospitalized in the pediatric
intensive care unit due to acute appearance of localized
petechiae and increased irritability. According to the
mother, the skin lesions had developed just a few hours
before and apart from a slight cold during the preceding
days the child had otherwise been in good health.
Physical examination revealed confluent petechiae and a
violaceous ecchymosis on the right lower leg that were
tender to palpation. Indeed, within 1 hour after admission
the eruptions progressed and the child developed additional petechiae accompanied by edematous swellings of
the left lower leg, soles, and the scrotum.
Vital signs were normal, but blood analysis showed elevated leukocytes (34.4 x 10^9/l). All other laboratory parameters, such as liver function tests, renal and coagulation
profiles, C-reactive protein, and procalcitonin were within
normal range and urinalysis and faecal occult blood testing unremarkable. Although an early septic meningococcal infection was unlikely, intravenous treatment with
ceftriaxone was started, lumbar puncture performed and
a symptomatic treatment with analgetics initiated.
When consulted by the pediatricians, we diagnosed the
child with acute hemorrhagic edema of infancy due
to the typical clinical picture. As there were no signs of
meningococcal infection, Ceftriaxone was stopped, a
symptomatic treatment with prednicarbat cream initiated and mefenamic acid continued. Within two days the
skin changes as well as the irritability improved markedly
and the boy could be discharged in good general health.
Acute hemorrhagic edema of infancy is a cutaneous leukocytoclastic vasculitis typically presenting with a triad
of annular lesions, edema and fever. It is mostly seen in
children younger than 5 years of age with a peak between
4 months and 2 years. As the disease is frequently preceded by viral upper respiratory tract infections and usually
resolves spontaneously within 1-3 weeks, at best analgetic treatment is required.
Acute hemorrhagic edema of infancy should be known
by clinicians as a rare form of leukocytoclastic vaskulitis
with a dramatic apprearance on first sight but a benign
course and prognosis.
P2
POSTERS
Cathepsin S expression in inflammatory skin diseases
VC. Amann1, T. Schindler2, I. Kleiber-Schaaf1, M. Drach1, R.
Dummer1
1 Dpt of Dermatology, University Hospital Zurich, Zurich
2 F. Hoffmann - La Roche AG, Roche Innovation Center, Basel
Cathepsin S (CTSS) is a lysosomal cysteine proteinase
from the peptidase C1 family. It is known to play a role in
lysosomal and extracellular proteolysis. CTSS is involved
in the lysosomal degradation of the MHC class II-associated invariant chain (Ii, CD74) during MHC II assembly in
antigen-presenting cells, and is thus involved in antigen
presentation through the MHC class II immune response.
A highly specific, orally bioavailable small molecule inhibitor of CTSS has been shown to prevent progression of
lupus nephritis in mice. The authors thereby established
CTSS as a therapeutic target in LE. We hypothesized that
CTSS is a target in cutaneous LE and other inflammatory
skin diseases, and therefore investigated the expression
of CTSS in human skin.
The immunohistochemical expression of CTSS in human
skin samples was evaluated in a semiquantitative manner.
CTSS was stained with the rabbit polyclonal IgG Anti-CTSS
antibody (Sigma, St.Louis, MO, USA). Skin samples of cutaneous lupus erythematodes with positive direct immunofluorescence (n=31), Lichen ruber (n=9) and Psoriasis
(n=7) were evaluated. Samples of normal skin were used
as a control (n= 10). Furthermore, costaining for Cathepsin S with CD3 and with CD68, respectively, was done.
The expression of CTSS in human skin was granular and
cytoplasmatic. CTSS was mainly expressed in cells of the
inflammatory infiltrate and in few epidermal cells. CTSS
expression was higest in LR, followed by CLE and psoriasis. Costaining of CTSS with CD68 and CD3 showed that
both T-lymphocytes and macrophages expressed CTSS.
The expression was mostly localized perivascularly. Normal skin showed low CTSS expression, localized mainly in
the epidermis and in inflammatory cells in the dermis.
Cathepsin S is highly expressed in the inflammatory infiltrate in Cutaneous Lupus Erythematosus, in Lichen Ruber
and in Psoriasis. Healthy control skin showed close to no
expression of CTSS. Treating LR or CLE by CTSS inhibition
could potentially not only diminish disease activity by targeting autoimmune regulation, but also prevent further
tissue damage, since CTSS plays a role in ECM degradation. In our opinion, lichen ruber would be an attractive
disease for a proof of concept study using CTSS inhibitors.
P3
Frequency and utility of special stains in dermatopathology laboratories: a study of two laboratories from
Subsaharan Africa
S. Kiprono1,2, J. Muchunu1, H. Beltraminelli3
1 Regional Dermatology Training Center (RDTC) at Kilimanjaro
Christian Medical University College (KCM-CU), Moshi, Tanzania
2 Dpt of Dermatology, Provincial General Hospital, Kakamega,
Kenya
3 Dpt of Dermatology, Inselspital Bern University Hospital, Bern
Light microscopy studies are often essential to establish
an accurate diagnosis and to start appropriate treatment.
Expertise in dermatopathology is currently slowly increasing in sub-Saharan Africa. In the few existing pathology/
dermatopathology laboratories within the African continent most biopsy skin specimens are analysed using the
hematoxylin and eosin (H&E) stain alone. The availability
of special stains is variable and limited to few centres.
We have here analysed all skin biopsy specimens submitted to two University Hospitals in Tanzania and Kenya. All
specimens were first stained with H&E. All cases in which
a definitive and clear diagnosis could not be made based
on the H&E staining alone was further processed and analysed. A total of 386 specimens were included. A proper
histological diagnosis was possible with H&E alone in 344
(89.1 %) of the 386 specimens. Inflammatory diseases
were the most frequent histological diagnoses (51 %),
followed by tumours (38.3 %) and infections (7.8 %). In
36 cases encompassing most frequently skin infections,
a total of 45 additional special stains were needed. Periodic acid-Schiff (PAS) was the most frequently used special
stain (n=22). Immunohistochemistry and immunofluorescence were not available. These techniques appeared
to be necessary for a correct diagnosis in 13 and 7 case,
respectively.
Our results show that in Subsaharan Africa a proper histological diagnosis is possible in almost 90 % of the skin
biopsy specimens by using uniquely the H&E staining. For
the remaining 10 % of cases, PAS followed by Gram and
mucin stainings are required for the diagnosis.
44
Z: 1 g Lubex / Der-med enthält disodium undecylenamido MEA-sulfosuccinate 30 mg. I: Therapieunterstützende Hautreinigung bei verschiedenen Hauterkrankungen, auch im
Intimbereich. D: Wie flüssige Seife anwenden. UW: Selten: Hautrötung, Brennen. P: 150 ml* + 500 ml*. Liste D. Ausführliche Informationen siehe Arzneimittel-Kompendium der
Schweiz.
Permamed AG, CH-4106 Therwil, Tel. 061 725 20 20, Fax 061 725 20 40, E-Mail: [email protected], www.permamed.ch
IS/ LU/DM/D/08-12
Die richtige Reinigung
und Basistherapie ...
... besänftigen selbst wilde Haut
bei infizierter Haut
bei trockener Haut
je 150 ml + 500 ml

kassenpflichtig
P4
Safety and Efficacy of Adalimumab in Patients with Moderate to Severe Hidradenitis Suppurativa: Results from
First 12 Weeks of PIONEER I, a Phase 3, RCT Trial
T. Birchler1, A.B. Kimball2, C.C. Zouboulis3, A.W. Armstrong4,
N.J. Korman5, J.J. Crowley6, C. Lynde7, K. Belknap8, Y. Gu8, D.A.
Williams8
1 AbbVie AG Schweiz, Baar
2 Harvard Medical School, Boston, MA, United States, Boston,
USA
3 Dpt of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany, Dessau, Germany
4 University of Colorado, Denver, CO, United States, Denver, USA
5 University Hospitals (UH) Case Medical Center, Cleveland, OH,
United States, Cleveland, USA
6 Bakersfield Dermatology, Bakersfield, CA, United States, Bakersfield, USA
7 The Lynde Centre for Dermatology, Markham, ON, Canada,
Markham, Canada
8 AbbVie Inc., North Chicago, IL, United States, Chicago, USA
This multicenter study evaluated safety and efficacy of
adalimumab (ADA) in patients (pts) with moderate to
severe hidradenitis suppurativa (HS). The 12-wk doubleblind, placebo (PBO)-controlled period is reported here.
Anti-TNF naïve pts diagnosed with HS for ≥1 year, with
total abscess and inflammatory nodule (AN) count of ≥3
and HS lesions in ≥2 body areas (Hurley Stage II or III),
were randomized 1:1 to ADA (160mg at wk0 ; 80mg at
wk2 ; 40mg weekly from wk4) or matching PBO. Efficacy
was analyzed for all randomized pts (intent-to-treat [ITT]),
and safety for all ITT pts who received at least 1 dose of
study drug. Non-responder imputation was used for missing data.
The 307 ITT pts (63.8 % female, 76.2 % white, 20.2 %
black) had mean age of 37.0 years, mean HS duration of
11.5 years, and median AN count of 11. A significantly
higher proportion of pts randomized to ADA achieved
the primary efficacy endpoint HiSCR (Hidradenitis Suppurativa Clinical Response defined as ≥50 % reduction
from baseline in AN count with no increase in abscess or
draining fistula counts) at wk12 ; ADA (64/153, 41.8 %)
vs PBO (40/154, 26.0 % ; p=0.003). Adverse events (AE)
reported by >10 % of pts were exacerbation of HS (13.2 %
PBO, 9.2 % ADA) and nasopharyngitis (10.5 % PBO, 5.9 %
ADA). Cellulitis was reported by 2 pts for each PBO and
ADA. Serious AEs included pyelonephritis (n=1 ADA) and
breast cancer (n=1 PBO). No deaths occurred.
In PIONEER I, a Phase 3 randomized PBO-controlled study
of ADA in HS, significantly more pts randomized to ADA
achieved HiSCR vs pts randomized to PBO. AEs were comparable to PBO and consistent with the ADA safety profile ; no new risks were identified.
P5
Efficacy and Safety of Adalimumab in Patients with
Moderate to Severe Hidradenitis Suppurativa : Results
from PIONEER II, a Phase 3, Randomized, PlaceboControlled Trial
POSTERS
T. Birchler1, G.B. Jemec2, A. Gottlieb3, S. Forman4, E.J. Giamarellos-Bourboulis5, Z. Reguiai6, Y. Gu7, M. Okun7
1 AbbVie AG Schweiz, Baar
2 University of Copenhagen, Roskilde, Denmark
3 Tufts Medical Center, Boston, Massachusetts, United States
4 Forward Clinical Trials, Tampa, Florida, United States
5 Dpt of Internal Medicine, University of Athens, Medical School,
Athens, Greece
6 CHU de Reims, Hôpital Robert Debré, Service de Dermatologie,
Reims Cedex, France
7 AbbVie Inc., North Chicago, Illinois, United States
Introduction : PIONEER II evaluated the safety and efficacy
of adalimumab (ADA) vs placebo (PBO) in patients (pts)
with moderate to severe hidradenitis suppurativa (HS).
Data from the first 12 weeks (wks) are reported.
: This multicenter study included a 12-wk
Methods double-blind PBO-controlled period (PerA). Pts were randomized 1 :1 to blinded ADA 40mg weekly starting at Wk4
(following 160mg at Wk0 ; 80mg at Wk2) or matching PBO.
At baseline (BL), pts had a diagnosis of HS for ≥1 year, a
total abscess and inflammatory nodule (AN) count of ≥3,
HS lesions in ≥2 body areas (1 at Hurley Stage II or III) and
had no prior TNF-α inhibitor treatment. PerA efficacy was
analyzed for all randomized pts (intent-to-treat [ITT_A
Population]) ; safety was analyzed for the ITT_A Population who received ≥1 dose of study drug. The primary
endpoint was HiSCR (HS Clinical Response ; ≥50 % reduction from BL in AN count and no increase in abscess or in
draining fistula counts) at Wk12.
Results : Of the 326 in the ITT_A Population, 67.8 % were
women ; 83.7 % were white ; mean age was 35.5 (SD
11.13) years ; mean HS duration was 11.5 (SD 9.03) years.
BL characteristics were similar between groups. 93.9 %
completed PerA. HiSCR rate at Wk12 was significantly
higher for pts randomized to ADA (96/163, 58.9 %) vs PBO
(45/163, 27.6 % ; p<.001). Statistically significant treatment differences were observed for all 3 ranked secondary endpoints (Wk12, ITT_A Population): 1) among pts with
Hurley Stage II, significantly more ADA pts (44/85, 51.8 %)
achieved AN count of 0, 1 or 2 vs PBO (28/87, 32.2 % ;
p=.010) ; 2) significantly more ADA pts (48/105, 45.7 %)
achieved ≥30 % reduction and ≥1 unit reduction from
BL in Patients’ Global Assessment of Skin Pain numerical
rating scale (NRS) based on 24-hour recall of worst pain vs
PBO (23/111, 20.7 % ; p<.001) among pts with BL NRS ≥3 ;
3) ADA pts achieved a significantly greater mean reduction from BL in modified Sartorius Score (n=163, -28.9) vs
PBO (n=162, -9.5 ; p<.001). 57.7 % (ADA) and 66.9 % (PBO)
reported ≥1 treatment-emergent adverse event (TEAE).
TEAEs in ≥10 % of pts in any treatment arm were headache (12.9 % ADA ; 12.9 % PBO) and exacerbation of HS
(4.3 % ADA ; 12.9 % PBO). 1.8 % (ADA) and 3.7 % (PBO) had
serious TEAEs. There were no deaths.
Conclusions : Significantly more HS pts treated with ADA
achieved clinically relevant reduction in objective disease
activity and pain vs PBO. The safety profile for pts in both
treatment groups was comparable.
P6
Allergic to an antiallergic drug – Immediate type reactions to corticosteroids
M. Blickenstorfer, A. Bircher, S. Link, I. Heijnen, O. Brandt
Dpt of Dermatology and Allergy Unit, University Hospital Basel,
Switzerland, Basel
Background : Corticosteroids are frequently used in the
treatment of numerous diseases and are indispensable
drugs in emergency medicine. They are usually well tolerated and – in cases of short-term use – only rarely induce
considerable side effects.
While contact allergy is a well-known complication of
corticosteroids, allergic type-I reactions to glucocorticoids are considered as rare events. However, more than
100 cases of glucocorticoid-induced immediate, partly
life-threatening allergic reactions have been published.
Noteworthy, when occurring as part of an emergency
treatment, aggravation of clinical symptoms/ signs are
frequently misdiagnosed as worsening of the underlying
disease.
Cases : We present two female patients who were treated
with intravenous corticosteroids for acute dyspnea and
developed deterioration of pulmonary signs and hypotension, respectively, requiring epinephrine.
Skin and cellular tests performed with a corticosteroid
panel demonstrated sensitizations to methylprednisolone 21-hydrogen succinate, which thereupon was
46
P7
Scleromyxedema associated with an IgG lambda gammopathy : striking response to intravenous immunoglobulins (IVIG)
R. Blum, HW. Klötgen, L. Borradori
Dpt of Dermatology, Bern University Hospital, Bern
Scleromyxedema is a chronic generalized form of cutaneous mucinosis, associated with a monoclonal gammopathy and systemic manifestations. This potential fatal
disease poses a therapeutic challenge.
We here report the case of a 67-year-old patient , in whom
scleromyxedema was diagnosed in 2013 based on typical clinical features (sclerodermoid eruption consisting
of multiple, firm papules involving predominantly the
face and extremities, including fingers) and histological
findings (proliferation of fibroblasts, irregularly arranged
collagen bundles, mucin deposits). Work up disclosed the
presence of an IgG lamba monoclonal gammopathy with
evidence for a small cell lymphocytic lymphoma. Starting
from September 2014, the patient was given cycles of IVIG
2g/kg, every month. The regular administration of IVIG
resulted in a remarkable regression of the skin infiltration and sclerodermoid changes with significant quality
of life improvement. First subjective and objective signs
of improvement were observed after two IVIG cycles. Our
observation confirms a recent large retrospective study,
which described the effectiveness of IVIG in scleromyxedema either alone or in combination with corticosteroids,
MTX, photophoresis, PUVA and/or thalidomide. Patients
almost invariably require a maintenance therapy, since
the response is transient.
P8
Evidence and efficacy of topical anti-age compounds
D.A. Bossard, X. Calvo, S. Rozati, A.A. Navarini
Institute of Dermatology, University Hospital of Zurich, Zurich
A variety of products are available to counter cutaneous
signs of aging. Active compounds are often embedded
or combined with moisturizers or a similar base to be
used for an extended period of time. Even though active
compounds are used, outright claims of efficacy are seldom made avoiding registration of products as drugs in
a lengthy and costly process. This study aimed to analyze
the available data on over-the-counter topical cosmeceuticals.
We limited our analysis to clinical trials published between
01.01.1999 and 15.05.2014, resulting in 836 articles, of
which 81 met the inclusion criteria of this review analyzing a total of 66 products containing single compounds
or mixtures. Trials were examined for clinical endpoints,
efficacy data, and surrogate markers of anti-aging.
In double-blind studies, tretinoin improved fine wrinkles
and caused epidermal thickening after 3 months. Treti-
noin can be encapsulated by cyclodextrin, reducing side
effects such as erythema or irritation with comparable
clinical efficacy. Estrogen preparations such as 17-betaestradiol for 24 weeks can increase epidermal thickness
by 75 %. Trials investigating antioxidants showed promising results but had small sample sizes. Niacinamide 4 %
showed a high (51.6 %) but marginally significant improvement in facial wrinkle count after 12 weeks.
Multiple products contain combinations of active ingredients. A study including 37 females applying a product
containing over 110 growth factors and cytokines yielded
significant results after 1 month and peaked at 42 %
reduction in coarse wrinkles and 30 % reduction in fine
wrinkles (both highly significant) after 3 months.
Biomechanical agents such as tetrahydroxypropyl ethylendiamine can induce a shortterm contraction of keratinocytes resulting in a decreased cell surface area, which
apparently reduced wrinkles by 13 %.
A lack of standard endpoints and parameters was the
main limitation of this study. Except for head-to-head
trials, no direct comparison between studies is possible.
This review of current anti-aging products demonstrated
that real rejuvenating effects on human skin can be achieved with topical products. Regulatory agencies should
motivate well-controlled trials analyzing efficacy of such
products without subsequently enforcing automatic registration as drugs. In addition, in contrast to single compound drugs, evaluation of products containing multiple
compounds may require new approaches of measuring
efficacy and side effects.
P9
A localized abdominal mass due to morbid obesity – a
rare manifestation of lymphedema
O. Brandt, P. Itin, P. Häusermann
Dpt of Dermatology, Basel
A heavily overweight 37-year old male presented to our
clinic in March, 2015, because of a skin lesion on his lower
abdomen. He had noticed the appearance of the eruption for the first time 2 years before and was now worried
about its fate. Although the dermatosis caused neither
pain and pruritus nor any other sensations, he reported
that every now and then he would squeeze some of the
nodules within the lesion hoping thereby to diminish the
progression of the eruption. He denied any other physical
trauma, radiation or infections at the site of the eruption.
The patient was 174 cm tall, weighed 168 kg and had a
body mass index (BMI) of 55. Due to his obesity he had
difficulties walking and thus needed a crutch. His medical
history was significant for a well-controlled diabetes mellitus, hypertension, and an obesity hypoventilation syndrome. Evaluations for thyroid abnormalities and chronic
inflammatory diseases were negative.
Physical examination revealed an ill-defined, extensive reddish-brown, plaque-like hyperplasia at the most
dependent portion of the pannus interspersed with lutescent papules and nodules. The lesion was indurated
and non-tender, no subcutaneous focal mass was palpable and inguinal lymph nodes were unremarkable.
Due to the clinical similarities seen in Papillomatosis cutis
lymphostatica of the leg, a secondary localized lymphedema of the abdomen due to morbid obesity was suspected and confirmed by histology.
As massive obesity is rapidly increasing in the western
world, massive localized lymphedema will become an increasingly important dermatologic issue. Moreover, chronic lymphedema are prone to infections and, although
rarely, transform into malignancies such as liposarcoma.
Thus, dermatologists as well as other medical specialties
should be aware of this currently still scarce entity.
Dermatologica Helvetica – Volume 27(6) – Août 2015 POSTERS
consequently avoided. Of note, subsequent therapies
with prednisone and betamethasone, respectively, were
well tolerated by the patients.
Conclusions : Allergic immediate type reactions after
administration of glucocorticoids are serious events probably occurring more often than hitherto assumed. Detailed history taking and a specific allergologic diagnostic
panel are crucial for identifying the culprit corticosteroid
and alternatives for potential future treatments.
Physicians of all specialties and medical staff should be
aware of the hidden risk of anaphylactic reactions when
treating patients with corticosteroids in order to react
adequately in emergency cases.
47
P10
Arciform lesions in a patient with mycosis fungoides
M. Bucher, O. Gaide
Dermatology Unit, CHUV, Lausanne
Background : The treatment of Mycosis fungoides (MF)
ranges from topical steroids to systemic chemotherapy
and sometimes can be challenging. We report here a case
of atypical urticaria occurring after the interruption of MF
treatment.
Observation : A 23-year-old man, known for a long-standing atopical dermatitis, with a two-year history of cutaneous lymphoma MF (CTCL-type MF, stage IIa) resistant to
PUVA and steroids, was successfully treated for 6 months
with low-dose interferon alfa-2a (Pegintron). This treatment was interrupted due to poor tolerance and side
effects (elevated liver enzymes and thrombopenia). 2
weeks after treatment discontinuation, the patient presented annular and arciform evanescent wheals with
central healing all over the body. A skin biopsy revealed
dermal edema, discrete inflammatory infiltrate and atypical lymphocytes. PCR demonstrated a monoclonal TCR
rearrangement in the lesion. Considering both clinical
and histopathological aspects, an urticaria-like condition
was suspected. Oral glucocorticoids, but not antihistaminic were effective in controlling the disease.
Discussion : The relative immediate occurrence an urticarial eruption after the interruption of interferon treatment
of MF suggests a potential relationship between the two
conditions. The demonstration of a persistent T-cell clone
in the skin not only shows that interferon did not completely extinguish the cutaneous lymphoma, but also raises
the possibility of a link between urticaria and MF.
Conclusions : Our case illustrated an exceedingly rare
concentric arciform dermatosis occurring in a complex
clinical background. It also reminds us that many patients
with unexplained urticaria often have serious underlying
disease.
P11
Comparative analysis of TRAIP expression in melanocytic nevi versus malignant melanoma
E. Chiticariu, D. Hohl, M. Huber
POSTERS
Service of Dermatology, University Hospital Center of Lausanne,
Lausanne
The TRAF-interacting protein (TRAIP) is a RING-type E3
ubiquitin ligase involved in the control of cell proliferation. TRAIP was reported to interact with the two tumor
suppressor genes CYLD and Syk but its precise role in carcinogenesis remains unknown. Our aim was to assess the
role of TRAIP in melanoma pathogenesis.
TRAIP mRNA relative expression level was analysed in 10
melanoma cell lines and normal melanocytes from two
different donors and 39 clinical samples by quantitative
RT-PCR. TRAIP expression at protein level was analysed by
western blot and immunohistochemistry. TRAIP mRNA
synthesis was suppressed in two melanoma cell lines
using lentiviral infection with two plasmids expressing
shRNAs targeting TRAIP. Statistical analysis was performed by using ANOVA test and Pearson correlation coefficient.
TRAIP was overexpressed in 50 % of melanoma cell lines
compared with normal human epidermal melanocytes
both at mRNA and protein level and positively correlated with MKi67 (Pearson r = 0.9631 ; R2=0.9276 ; 95 %CI =
0.8703-0.9899 ; p< 0.0001). TRAIP was also overexpressed
in malignant melanoma and metastatic melanoma compared with benign nevi (p<0.001). Suppression of TRAIP
expression in two melanoma cell lines with shRNAs giving
a knock-down efficiency greater than 75 % (p<0.001) was
leading to MKi67 mRNA downregulation by more than
60 % (p<0.05). We further assessed the effect of TRAIP-KD
on melanoma proliferation by using the BrdU incorporation 48h post-transduction. DNA synthesis was reduced
with >45 % in the TRAIP KD cells compared with the
control (p<0.05), indicating an arrest of melanoma cells
proliferation.
We conclude that TRAIP is involved in proliferation control
of the melanocytic cell lineages, with possible implications in melanoma progression and invasiveness.
P12
Which Fungus Originally was Trichophyton Mentagrophytes ? Historical Review and Illustration by a clinical
case
A. Chollet1, V. Cattin2, M. Fratti4, B. Mignon3, M. Monod4
1Dpt of Dermatology, University Hospital CHUV, Lausanne, Switzerland
2Dermatologist, Private practice, Neuchâtel, Switzerland
3Laboratory Veterinary Mycology, Faculty of Veterinary Medicine,
University of Liège, Liège, Belgium
4Laboratory of Dermatology, University Hospitals CHUV, Lausanne, Switzerland
Introduction : Several dermatophytes producing numerous pyriform or round microconidia were called Trichophyton mentagrophytes. Among these dermatophytes
are the teleomorph species A. benhamiae, A. vanbreuseghemii and A. simii, and other species such as T. interdigitale, T. erinacei and T. quinckeanum for which only the
anamorph is known. Confusion exists about which fungus
should be really called T. mentagrophytes and about the
rational use of this name in practice.
Case report : The patient presented with a 2-week history of pruritic lesions involving the mental region with
extension on the basis of the nose. Physical examination
revealed erythematous plaques with follicular pustules
and yellow crusts. Direct mycological examination of
purulent material and scales showed high numbers of
septate filaments and spores. Culture assay produced a
growing fungus with a white powdery surface attesting
to the production of numerous pyriform microconidia.
Fungal genomic DNA was isolated and the sequences of
the PCR products were found to be 100 % identical to the
sequences AF378740 and AF506034 from A. vanbeuseghemii. The patient improved in 2 months with a topical
and oral terbinafine (250 mg/d) therapy.
Discussion: According to both clinical signs and the type
of hair parasitism, this case was exactly compatible to the
first description of a non-favic dermatophytosis by Gruby
in 1842 under the name of "mentagrophyte" from which
was derived the dermatophyte epithet mentagrophytes.
In addition, the phenotypic characters of the isolated fungus in cultures perfectly matched with those of the first
description of a dermatophyte under T. mentagrophytes
by Blanchard 1896. In conclusion, T. mentagrophytes corresponds to the fungus later named A. vanbreuseghemii.
However, because the neotype of T. mentagrophytes was
not adequately designated in regard to the ancient literature, we would privilege the use of A. vanbreuseghemii
and abandon the name of T. mentagrophytes.
P13
Lichen planus pigmentosus-inversus in a Pakistani man
S. Conrad, K. Kerl, M. Maiwald
Dpt of Dermatology, University Hospital of Zurich, Zurich
A 56-year-old man of Pakistani origin was hospitalized in
our department due to atopic eczema. In addition to eczema, clinical examination revealed dark-brown streaks in
48
P14
Secukinumab is superior to Ustekinumab in clearing
skin of subjects with moderate to severe plaque Psoriasis : 16-week results from the clear study
C. Conrad1, D. Thaci2, A. Blauvelt3, K. Reich4, T. Tsen-Fang5, F.
Vanaclocha6, K. Kingo7, M. Ziv8, A. Pinter9,S. Hugot10, R. You11,
M. Milutinovic10
1 Dpt of Dermatology, University Hospital of Lausanne CHUV,
Lausanne, Switzerland
2 Comprehensive Center for Inflammation Medicine, University
Hospital Schleswig-Holstein, Lübeck, Germany
3 Oregon Medical Research Center, Portland, Oregon, USA
4 Dermatologikum Hamburg and Georg-August-University Göttingen, Germany
5 Taiwan University Hospital, National Taiwan University College
of Medicine, Taipei, Taiwan
6 Hospital 12 de Octubre, Madrid, Spain
7 Dermatology Clinic, Tartu University, Tartu, Estonia
8 Emek Medical Center, Afula, Israel
9 University of Frankfurt, Frankfurt, Germany
10 Novartis Pharma AG, Basel, Switzerland
11 Novartis Beijing Novartis Pharma Co. Ltd, Shanghai, China
Background : CLEAR is a phase 3b study comparing the
efficacy and safety of secukinumab with ustekinumab in
moderate to severe plaque psoriasis.
Methods : In this 52-wk, multicenter, double-blind, parallel-group study (NCT02074982), subjects were randomized 1:1 to subcutaneous injection of secukinumab (300
mg) or ustekinumab (dosing per label). Secukinumab was
administered at Baseline, Wks 1, 2 and 3, then every 4 wks
from Wk 4 to 48. Primary objective: demonstrate the superiority of secukinumab vs. ustekinumab in PASI90 response at Wk 16 (non-responder imputation).
Results : Secukinumab (79.0 % ; n=334) was superior to
ustekinumab (57.6 % ; n=335) in PASI90 response at Wk 16
(P<0.0001 [logistic regression model]). PASI100 response
(clear skin) at Wk 16 was also achieved by a significantly
greater proportion of subjects receiving secukinumab
(44.3 %) than ustekinumab (28.4 %) (P<0.0001). Secukinumab was superior to ustekinumab with respect to
PASI75 responses at Wk 4: 50.0 % vs. 20.6 % of subjects,
respectively (P<0.0001). Secukinumab’s safety profile was
similar to that of ustekinumab and consistent with that
seen in secukinumab pivotal phase 3 studies.
Conclusions: Secukinumab treatment – even at early
timepoints – has demonstrated superiority to ustekinumab in clearing skin of subjects with moderate to severe
psoriasis, with a comparable safety profile.
P15
Pyoderma gangrenosum in a psoriasic patient – ustekinumab is not the solution
J. Czernielewski, F. Kuonen, M. Gilliet, C. Conrad
Dpt of Dermatology, University Hospital of Lausanne , Lausanne
Background : Pyoderma gangrenosum (PG) is a non-infectious, neutrophilic inflammatory skin disease characterized by rapidly evolving, chronic and painful ulcerations
with undermined violaceous borders. Pathergy, typically
upon a trivial trauma, represents the most important
trigger factor. PG is often associated with an underlying
disease, most commonly inflammatory bowel diseases,
rheumatic or haematological diseases, or malignancies.
Though the etiology has remained elusive, treatments
with the best clinical evidence are tumor necrosis factor
(TNF)-inhibitors, high-dose systemic corticosteroids, and
cyclosporine suggesting a pivotal role of inflammatory
pathways in the development of PG.
Case report : Here, we report the case of a 31 year-old
woman, suffering from severe plaque-type and guttate
psoriasis since 1998. Topical steroids, phototherapy, and
isotretinoine became insufficient and in 2012, she was
prescribed the anti-TNF adalimumab showing excellent
clinical response. During anti-TNF treatment and after a
trauma to her tibial bone, a non-specific subcutaneous
mass persisted for approximately one year. In 2013, the
patient presented a secondary loss of efficacy of her psoriasis treatment and anti-drug antibodies against adalimumab were detected. She was switched to another
therapeutic class, ustekinumab, an anti-IL12/23 antibody.
While psoriasis responded well to the novel treatment,
the tibial mass progressed rapidly, became painful and ulcerated upon switching to ustekinumab. The patient presented herself to our clinic and was diagnosed with PG,
initially triggered by pathergy phenomenon but controlled by the ongoing anti-TNF treatment. The patient was
switched back to anti-TNF and infliximab was introduced
with ongoing good efficacy concerning her psoriasis
and remission of the PG. Due to a second loss of efficacy with recurrence of psoriasiform plaques but ongoing
remission of the PG, we decided to restart ustekinumab.
Intriguingly, while psoriasis improved again quickly, the
PG reoccurred in form of painful, inflammatory, swollen
masses at the same site. In the absence of anti-drug antibody infliximab was subsequently reintroduced.
Conclusion: These findings suggest that, while anti-TNF
is an effective treatment for PG as previously described,
the blockade of IL-12/23 by ustekinumab is not able to
control PG and does not represent a valuable therapeutic
option.
P16
Dermatoscopy for the diagnosis of atypical giant Molluscum Contagiosum
B. Darbellay, B. Cortes
Institute of dermatology, University Hospital of Geneva, Geneva
axillary and groin region. They have developed 3 month
earlier and have been asymptomatic since. The patient
was nevertheless disturbed by these streaks. There were
no oral, hair, nail or other skin lesions. He denied any
recent drug use or wearing of tight clothing. Differential
diagnosis encompassed acanthosis nigricans, DowlingDegos disease, Addison’s disease, haemochromatosis,
mycosis, fixed drug eruption and ashy dermatosis. A skin
biopsy was performed to determine the identity of these
lesions located in skin folds. To our surprise, histology
showed classical signs of lichen planus with epidermal
hyperplasia and hypergranulosis, vacuolar alteration of
basal layer and dense lichenoid infiltrate composed of
lymphocytes and accompanied by pigment incontinence.
Patient received a topical treatment with tacrolimus 0.1 %
ointment, which after several months of therapy did not
affect the course of axillary and inguinal lesions.
Literature research demonstrated a rare entity of pigmented lichen planus preferentially affecting flexural-fold
areas of the body. Approximately 20 cases have been reported to date. Even though initially described in Caucasians of Eastern European origin, several reports followed
describing lichen planus pigmentosus-inversus (LPPI)
in darker skinned individuals. LPPI is therefore characterized by the presence of the hyperpigmented macules
in intertriginous regions. All reported cases have similar
histology reminiscent of lichen planus with prominent
pigment incontinence. Clinical course is variable, with
some cases spontaneously resolving without therapy and
others persisting for longer period of time. Both topical
steroids and calcineurin inhibitors can be of use and are
recommended to accelerate the healing process.
In conclusion, we describe a case of LPPI in a patient with
a dark skin type in whom the diagnosis was made based
on localization and histologic findings.
49
Introduction : Molluscum contagiosum (MC) is a frequent
infectious disease that mainly affects children. Usually
the diagnosis is easily made on clinical examination. We
report the case of an atypical and painful giant MC.
Case report : A 10-years old girl presented with a 3-month
history of a slowly growing ulcerated papule of the right
hallux. She reported occasional bleeding. Physical examination revealed a 15mm red-white ulcerated nodule with
a shiny brain-like appearance and multiple lobes located
on the right hallux. Dermoscopy revealed multiple white
clods surrounded by a crown of irregular, tortuous, dilated or punctiform blood vessels on a yellow-brown background. The clods were homogenous in size and colours
and were organized in several parallel lines. Histopathology showed lobulated endophytic hyperplasia producing
a circumscribed intradermal mass containing large cells
with cytoplasmic, faintly granular eosinophilic inclusions
and peripheral nuclei, consistent with a giant MC.
Discussion : MC is an epidermal infection caused by a poxvirus and is characterized by 2-5mm white, pink-red, or
flesh-coloured raised, smooth papules with a central pit
that may be located anywhere on the skin and appears
usually in crops. Generally, they are asymptomatic and
resolve spontaneously within 6 to 12 months without
leaving scars. Rarely, MC present as giant lesions, which
are generally associated with immunosuppression but
are also seen in immunocompetent patients. Giant MC
are often isolated and present without recent history of
multiple typical MC. They are associated with frequent
clinical misdiagnosis. In the reported case, the giant MC
appears dermoscopically as several adjacent classical
MC, which are characterized by a white round clods surrounded by blood vessels forming a crown-like structure.
Correlation analysis suggests that the white clods seen in
dermoscopy are the molluscum bodies observed in histopathology: the ratios of the diameter of the clods divided by the distances between the centres of the adjacent
clods were not statistically different in dermoscopy from
the same parameters measured between the molluscum
bodies in histopathology. Brain-like aspect of the lesion
and homogenous white clods with linear organization
surrounded by crown-like blood vessels on dermoscopy
seem to be important diagnostic clues.
Conclusion: Dermatoscopy can be usefull for the diagnosis of atypical giant MC to avoid unnecessary surgical procedures.
P17
Facial hypertrichosis following treatment of focal alopecia aerata with minoxidil
B. Darbellay, C. Huber
POSTERS
Institute of dermatology, University Hospital of Geneva, Geneva
Introduction: Topical minoxidil is widely used as an off-label treatment of alopecia aerata (AA). We report the case
of a facial hypertrichosis developing surprisingly early
and fast after a very low total dose of topical minoxidil.
Case report: A 28-years old Hispanic woman presented
with a 1-week history of two rapidly growing patches of
hair loss on the scalp. Physical examination revealed two
3cm non-cicatricial alopecic patches with exclamation
point hairs consistent with alopecia aerata. A treatment
of topical clobetasol propionate 0.05 % and minoxidil 5 %
once a day at night was started. Minoxidil 5 % was preferred to 2 % as the patient did not want to apply it twice a
day. She was instructed to apply a droplet of minoxidil on
each patch and to wash her hands carefully afterwards.
Within 6 weeks, the patient interrupted the treatment
as the alopecic patches were rapidly recovering. Three
weeks after treatment interruption, the patient presented
to our clinic with a massive hair overgrowth on the front,
cheeks and neck, which started to develop immediately
after treatment initiation and was socially burdensome
for the patient. Application’s instructions had been followed carefully and the total amount of minoxidil used
was inferior to 0.5g. Hypertrichosis fully regressed within
6 months of treatment interruption consistent with a side
effect of minoxidil therapy. In the meantime, topical clobetasol was reintroduced as AA recurred.
Hypertrichosis is reported to occur in 4 % of women
treated with topical minoxidil and is thus a well known
side-effect of this treatment. Some demographic groups
(including Hispanic) and women with previous hairy face
seem to be prone to develop this side effect, which is generally limited to the face although generalized hirsutism
had been reported. Minoxidil-induced hypertrichosis is
supposed to be dose-dependent and is generally considered to occur when this treatment is misused, which was
not the case with this patient.
Conclusion : Topical minoxidil is an off-label therapy that
should be prescribed with caution, particularly in women
with hairy face prior to treatment initiation.
P18
Bathing induced localized hyperpigmentation imitating erythema ab igne
M. Drach, M. Nägeli, P. Schmid-Grendelmeier, J. Kamarachev, T. Kündig
Institute of Dermatology, University Hospital of Zurich, Zürich
We present the case of a 51 year old woman who consulted our ambulance due to symmetrical, livedo-like reticulated dark-brown skin lesions on the legs and the gluteal
region, whereas the knee region was not affected. The
lesions were whether pruriginous nor bullous. No enlargement of the inguinal lymph nodes.
In the patients history was rheumatic disease and protrusions of the intervertebral discs but no underlying skin
disease. Drugs: Acetylsalicyl acid (ASS), ProtonPumpInhibotors, Sirdalud and fentanyl-patch. She uses regularily a
body lotion and takes a hot bath.
Gross examination showed symmetrical lesions of the
distal legs and the gluteal region as well as the proximal
legs. The knees were not affected. Clinical diagnosis was
compatible erythema ab igne.
A biopsy taken at a peripheral dermatological institute
showed an unspecific, cutaneous vascular inflammation
with no sign of livedo-vasculopathia.
We performed a punch biopsy specimen of the affected
region and stained it with H&E and iron.
The histology showed normal epidermis with regular
maturation of the keratinocytes with a basal hyperpigmentation. The vessels in the dermis showed a discrete
perivascular inflammatory cell infiltrate composed of
lymphocytes and histiocytes with no sign of epidermotropism. In the special stains there was no deposition of
hemosiderin in the iron staining. This histology is rather
unspecific and does not reflect the changes seen in
erythema ab igne but rather with unspecific hyperpigmentation without major inflammation.
Thus we reinvestigated the patient and discovered that
she took regular sitting baths in quite hot water exactly
reflecting the involved skin areas.
Thus, repeated hit bathing under equal conditions seemed to have to induced these permanent hyperpigmentation in this patient.
50
Enbrel .
Posez les jalons.
®
En cas de psoriasis en plaques* –
pour que votre choix d’aujourd’hui
tienne compte des exigences
de demain.5‐7
* Pour vos patients adultes atteints de psoriasis en plaques modéré à sévère et vos jeunes patients# (à partir de 6 ans)
atteints de psoriasis en plaques chronique sévère.5
# Enfants et adolescents à partir de 6 ans en cas de réponse insuffisante ou d’intolérance à un autre traitement systémique ou à une photothérapie.5
Information professionnelle abrégée – Enbrel ® (étanercept)
Indications: Adultes: polyarthrite rhumatoïde active (PR) et arthrite psoriasique (APS) lorsqu’un traitement antérieur par antirhumatismaux de fond (DMARD) a été insuffisant; PR sévère, active et évolutive non
précédemment traitée Pfizer
par méthotrexate;
spondylarthrite ankylosante (SA) en cas de réponse inadéquate au traitement conventionnel; psoriasis en plaques (PSO) modéré à sévère. Enfants et adolescents: arthrite
AG
juvénile idiopathique (AJI): polyarthrite (facteur rhumatoïde positif ou négatif) et oligoarthrite extensive à partir de 2 ans, lorsqu’un traitement antérieur par méthotrexate a été insuffisant, rhumatisme psoriasique à
Schärenmoosstrasse 99
partir de 12 ans, lorsqu’un traitement antérieur par méthotrexate a été insuffisant, et l’arthrite associée à une enthésite à partir de 12 ans en cas de réponse insuffisante au traitement conventionnel. Psoriasis à
Postfach
partir de 6 ans, en cas de réponse insuffisante à un autre traitement systémique ou à une photothérapie. Posologie: Adultes: 25 mg 2 ×/sem. par voie s.c. ou 50 mg 1 ×/sem. (PSO: 50 mg 2 ×/sem. possible aussi
8052
Zürich Enfants et adolescents: AJI: 0,4 mg/kg PC (max. 25 mg par inj.) 2 ×/sem. ou 0,8 mg/kg PC (max. 50 mg par injection) 1 ×/sem. par voie s.c. PSO: 0,8 mg/kg PC (max. 50 mg
pendant les 12 premières
semaines).
par inj.) 1 ×/sem. par voie s.c. Contre-indications: Hypersensibilité à la substance active ou à l’un des excipients; septicémie ou risque de septicémie. Ne pas commencer un traitement chez un patient présentant
une infection. Précautions: Rechercher infections (y compris tuberculose et infection par le VHB actives ou latentes), insuffisance cardiaque décompensée,
réactions allergiques, réactions hématologiques et troubles du SNC, de même que risque accru de lymphome et de maladie maligne. L’utilisation d’Enbrel ®
n’est pas recommandée pendant la grossesse et l’allaitement. Interactions: Le méthotrexate n’a pas d’effet sur la pharmacocinétique de l’étanercept.
Effets indésirables: Infections (y compris infections des voies respiratoires et infections graves), tumeurs malignes, réactions au site d’injection, production
d’auto-anticorps et autres. Depuis la mise sur le marché d’Enbrel ®, des cas de troubles de l’hématopoïèse et de démyélinisation du SNC ont été rapportés.
Pfizer AG
Présentation: Enbrel ®: poudre et solvant pour la préparation d’une solution injectable; 4 flacons perforables à 25 mg. Enbrel ® solution injectable et stylo
Schärenmoosstrasse 99
pré-rempli: 4 seringues pré-remplies à 25 mg ou 2 seringues pré-remplies à 50 mg. Enbrel ® MyClic (solution injectable en stylo pré-rempli): 2 stylos préPostfach
remplis à 50 mg. Catégorie de vente B. Titulaire de l’autorisation: Pfizer AG, Schärenmoosstrasse 99, 8052 Zurich. Pour de plus amples renseignements,
8052 Zürich
voir l’information professionnelle sur le produit, sous www.swissmedicinfo.ch. (IP V026)
60003-360-03/14
1. Nast A et al. S3 – Guidelines on the treatment of psoriasis vulgaris (English version). Update, JDDG 2012;10 (Suppl 2):S1–S95. 2. Menter A, Gottlieb A et al. Guidelines of Care for the Management of
Psoriasis and Psoriatic Arthritis, J Am Acad Dermatol. 2008;58:826–850. 3. Watson T & de Bruin D, Getting Under the Skin: The Inscription of Dermatological Disease on the Self-Concept, Indo-Pacific
Journal of Phenomenology, 2006;6(2):1–12. 4. Gottlieb AB. PSORIASIS: EMERGING THERAPEUTIC STRATEGIES, Nature Rev Drug Discov 2005;4(1):19–34. 5. Information professionnelle Enbrel ®,
www.swissmedicinfo.ch 6. Ortonne et al. Efficacy and safety of continuous versus paused etanercept treatment in patients with moderate-to-severe psoriasis over 54 weeks: the CRYSTEL study. Expert
Rev Dermatol. 2008;3:657–665. 7. Nguyen Tu, Koo J. Etanercept in the treatment of plaque-psoriasis. Clinical, Cosmectic and Investigational Dermatology 2009;2:77–84.
P19
The recessive mutation G2375R in desmoplakin causing
cardiomyopathy, skin fragility and hair abnormalities in
human inhibits the binding of desmoplakin to intermediate filaments
B. Favre1, N. Begré1, J. Bouameur1, L. Fontao2, L. Borradori1
1 Dpt of clinical research-Dermatology, University of Bern-Inselspital, Bern
2 Dpt of Dermatology, University Hospital of Geneva, Geneva
Desmoplakin (DP) is an essential component of desmosomes. The latter are specialized protein complexes that
mediate cell–cell adhesion through the desmosomal
cadherins and serve as anchorage sites for intermediate
filaments (IFs) in all epithelia, as well as the myocardium.
In this study, we investigated the effect of the recessive
mutation G2375R, located in the second plakin repeat domain (PRD-B) of DP, on the interaction of DP with various
types of IFs. This mutation was found in a patient suffering
from arrhythmogenic right ventricular cardiomyopathy,
a pemphigus-like skin phenotype, and woolly hair. Our
results in overlay assays and transfection studies show
that the mutation G2375R systematically inhibits the binding of full length DP or its carboxyl-terminal portion to
various keratins and the muscle-specific IF protein desmin. In yeast three-hybrid and overlay assays we further
found that DP preferentially binds to dimeric/polymeric
epidermal keratins 5 and 14 or 1 and 10 compared to
monomeric keratins , while the coil 1 domain of dimeric
keratins 5/14 and 1/10 is a major binding site for DP. Finally, truncation of the carboxyl-extremity of DP reduces
its interaction with all tested IFs. Our findings indicate
that the tight interaction of DP with keratins depends
on several carboxyl-terminal domains of DP and on the
quaternary structure of keratins, mainly of their coil 1 and
that an amino acid substitution in the DP tail critically affects the binding of DP to IFs, explaining the devastating
consequences observed in vivo.
P20
Allopurinol induced toxic epidermal necrolysis
L. Felderer, W. Hoetzenecker, L. French, A. Cozzio, E. Guenova
POSTERS
Institute of dermatology, University Hospital of Zurich, Zurich
Stevens-Johnson syndrome (SJS) and toxic epidermal
necrolysis (TEN) are a rare, but severe adverse cutaneous
drug reactions. Allopurinol has been reported to be the
most common causative agent for SJS/TEN in Europe. The
human leukocyte antigen-B*58:01 is present in >50 % of
patients with SJS/TEN.
We report the case of a 57 year old woman, referred to
us from the hospital in Zug for acute blistering skin rash.
3-4 days ago she felt ill with chills and fever, 48 hours
later erythematous macules appeared on her arms. Subsequently, the macules spread all over the body and additional symptoms of cough with sputum and redness of
the eyes appeared. Finally, the development of blisters
preceded her presentation at the hospital in Zug. The past
medical history of the patient was positive for arthrosis
and newly diagnosed gout and negative for allergies.
For the treatment of the gout allopurinol in combination
of diclofenac was initiated 3 weeks ago. The current flulike symptoms were self-treated with Panadol Grippe,
Demo Grippe C, Demo Natur capsules and Similasan eye
drops. During the last two years the patient also occasionally made use of Nervasin tablets (containing an antihistamin and baldrian) at night. The colleagues in Zug
suspected a severe adverse cutaneous drug reaction and
referred the patient to us.
By the time of presentation at our department the patient
had already developed the classical clinical picture of TEN
with generalized macular-papular rash with blister formation involving >30 % of the total body area, facial oedema,
conjunctivitis, and enoral and genital ulcers. The Nikolski
sign was positive. Histological examination of a cryosection showed the characteristic for TEN with subepidermal acantolysis and confluent necrosis of the overlying
epidermis. The diagnosis of TEN with a SCORTEN score of
2 points was established and the patient was hospitalized
at the intensive care unit for burn injuries. A systemic
treatment with a total of 3g/kg body weight intravenous
immunoglobulins in 4 consecutive days in combination
with best supportive care was initiated. A temporary intubation was necessary to prevent a respiratory decompensation following the severe TEN-involvement of the
pulmonary mucosa.
TEN is a life-threatening condition with a lethality rate of
approximately 30 %. In our patient a complete restitution
ad integrum could be achieved. Although allergological
investigations are still pending, allopurinol is suspected
to be the culprit drug.
P21
Aquarium granuloma in a 58-year old fish fanciers
S. Fiechter , M. Wüest, P.H. Itin, K. Ivanova
Dpt of Dermatology, University Hosptial Basel, Basel
Mycobacterium marinum is an aerobic, non tuberculous
acid-fast bacillus that lives in aquatic environments and
affects persons working with fish or keeping home aquariums or pools. Skin infections are quite rare in our environment. The diagnosis is often delayed because of the
lack of clinical suspicion and need for special diagnostic
procedures.
We present the case of a 58-year old man with an asymptomatic plaque on his right middle finger which persists
since three years, initially presented as small papule. Histological examination three years ago revealed a virus
papilloma without any granulomatous inflammation,
PAS- and Ziehl-Neelsen staining was negative. The patient
was treated with cryotherapy, mechanical removal and
aldara cream without long term improvement. The physical examination in our clinic found a solitaire, indolent,
brownish-reddish verrucous plaque on the dorsum of his
middle finger without any regional lymphadenopathy.
After the patient told us having a home aquarium our first
differential diagnosis was a swimming pool granuloma.
New biopsy showed an unspecific chronic inflammation
of the dermis with reactive epidermal hyperplasia, but
no granulomatous inflammation. PAS- and Ziehl-Neelson staining as well as PCR analysis for M. marinum were
negative. Because of suggestive history and typical clinical presentation another biopsy for culture was made
which was positive for M. marinum. We started a peroral
treatment with clarithromycin 500mg and cotrimoxazol
500mg twice daily for three months. Clinical control after
this period showed a complete remission of the lesion.
M. marinum infection of the skin has a worldwide distribution. It is important for clinicians to be aware of this diagnosis especially by professionals that are in risk groups.
Successful therapies with minocycline, clarithromycin,
lymecycline, ethambutol have been reported in the literature.
P22
A good clinical response to lenalidomide (Revlimid®) in
a patient with severe refractory Jessner-Kanof lymphocytic infiltration
L. Fischer, A-K. Lapointe, M. Gilliet, J. Di Lucca
Dpt of Dermatology, University Hospital CHUV, Lausanne
52
P23
Fixed drug eruption – still an often missed diagnosis
V. Frauenknecht , C. Manrique, A. Bircher
Institute of dermatology, University Hospital of Basel, Basel
Background : Fixed drug eruption is a characteristic cutaneous adverse drug reaction. It occurs in every age group
with a peak in the third decade. Analgesics as well as antibiotics are common elicitors. It presents most often with
solitary lesions, more rarely in a multilocular or generalized distribution pattern. Pathogenetically cytotoxic and
resident epidermal memory T cells are considered to be
relevant.
Case reports and results : We report on 4 patients (2 females, 17 and 76 years ; 2 males 69 and 20 years) – who
were initially not diagnosed and had recurrent and / or
disseminating fixed exanthems. Differential diagnoses included particularly infections, and in one case melanoma.
An allergological workup including prick, patch and intradermal tests, as well as provocation tests, if necessary,
were performed. Two each reacted to paracetamol and to
naproxen, respectively.
Results : In all 4 patients the putative elicitors could be
confirmed by the above mentioned diagnostic workup.
Conclusions: Although fixed drug eruption has a typical
clinical pattern, it may be initially missed if it is not considered in the differential diagnosis or if manifestations
such as atypical localization, multilocular or generalized
distribution are present. A careful and detailed history,
histology and an allergological workup is necessary in
making the diagnosis and identifying the culprit drugs.
P24
Expression of heat shock protein 90 in vitiligo
K. Gadaldi, N. Yawalkar
Dpt of Dermatology, Inselspital Bern University Hospital, Bern
Vitiligo is a pigmentary disorder with unpredictable often
progressive course, characterized by a gradual loss of
melanocytes. Although the exact cause of vitiligo remains
unknown, autoimmunity is thought to play a predominant role in the development of this disease. Heat shock
proteins (HSPs) are intracellular proteins upregulated in
response to stress. Recently HSP 90 has been suggested
as a putative autoantigen in a subset of patients with vitiligo. However, the expression of HSP 90 in vitiligo lesions
has not been elucidated so far.
We sought to analyze expression and distribution of
HSP90 in vitiligo lesions (n=10) and healthy skin samples
(n=8) using immunohistochemistry and double immunofluorescence. Immunoreactivity for HSP90 was significantly enhanced in vitiligo lesions compared to healthy
skin samples. Positive staining was mainly found in keratinocytes and mononuclear cells in the dermis of vitiligo
lesions. Interestingly, strong immunoreactivity for HSP90
was also detected in few remaining melanocytes in vitiligo lesions.
Our data add further evidence for HSP90 in the pathogenesis of vitiligo. Blocking HSP90 may open new treatment
opportunities in vitiligo and further studies are warranted
to confirm the pathogenic role of HSP90 in the aetiology
of this pigmentary disorder.
P25
Molecular aspects of sensitization to skin colonizing
Malassezia spp. in atopic dermatitis
M. Glatz1, P. Bosshard2, R. Crameri3, P. Schmid-Grendelmeier1
1 Allergy Unit of the Dpt of Dermatology and Dpt of Immunology, University Hospital of Zurich, Zurich
2 Mycology Laboratory of the Dpt of Dermatology University
Hospital of Zurich, Zurich
3 Swiss Institute of Allergy Research SIAF, Davos
Malassezia spp. is a genus of lipophilic yeasts and comprise the most common fungi on healthy human skin. This
genus currently encompasses 14 species, and 9 of these
species are frequently isolated from human skin. Despite
its role as a commensal on healthy human skin, Malassezia spp. is attributed a pathogenic role in atopic dermatitis
(AD). Here we report the latest findings on the molecular
mechanisms by which Malassezia spp. may contribute to
skin inflammation in AD.
Three Malassezia species, namely M. furfur, M. sympodialis and M. globosa, produce 14 currently characterized
immunogenic proteins (allergens). These allergens elicit
a specific IgE response. Furthermore, some of these allergens interact with human immune cells such as dendritic
cells or T cells, supposedly through Toll-like receptors 2
and 4, and elicit a pro-inflammatory immune response. For
example, the allergen Mala s 11 from M. sympodialis is a
manganese-dependent superoxide dismutase (MnSOD).
The IgE-mediated sensitization to this protein correlates
to the severity of AD, and this protein induces the release
of pro-inflammatory cytokines such as Interleukin (IL-)6,
Introduction : Jessner-Kanof lymphocytic infiltration (JLIS)
is characterized by asymptomatic erythematous papules
of the skin with perivascular or periadnexal lymphocyte
infiltration under a normal to slightly modified epidermis.
Certain consider it as a dermal variant of lupus erythematous, ie lupus tumidus. Thalidomide has been found effective in severe case of cutaneous lupus or JLIS refractory to
conventional therapy. Lenalidomide, a thalidomide analogue, has been developed for the treatment of multiple
myeloma. Compared to thalidomide, it seems less toxic
especially in terms of neuropathy. Some trials suggest
lenalinomide as an alternative therapy for refractory cutaneous lupus. We report the first case of a good response
to lenalidomide in JLIS.
Case report : A 73 years old patient presented with a
history of JLIS. Skin biopsies and negative autoimmune
blood testing confirmed the diagnosis. He was refractory
to multiple treatments: hydroxychloroquine +/- quinacrine, neotigason, methotrexate, dapsone, azathioprine.
Thalidomide was given with good clinical response, but
the patient rapidly developed a severe neuropathy preventing maintainance of treatment. Lenalidomide was
started at a dosage of 5mg/day combined with plaquenil 200mg/day for its anti-thrombotic effect. By the third
week of treatment the patient rapidly improved with
complete healing of the lesions by the 8th week. Clinical
tolerance was good with no sign of neuropathy. However,
after 8 weeks, the patient developed moderate thrombocytopenia which persisted 2 weeks after the reduction
of lenalinomide dosage to 5mg every 2 days. We then
observed a rapid recurrence of the lesions and stopped
the treatment.
Discussion : Treatment with lenalinomide has been reported in 2 patients with lupus tumidus but this is the first
case of good response in JLIS. As previously reported in
cutaneous lupus, thalidomide and lenalinomide seem to
have similar efficacy. Skin recurrences are frequent upon
the discontinuation of these 2 drugs suggesting a maintenance therapy is needed. Neuropathy and deep venous
thrombosis are more frequent with thalidomide, whereas
lenalidomide is more often responsible for myelotoxicity
and skin drug reactions. Our case underlines these problems since the patient developed the major side effects
of both drugs. Lenalidomide might be a potential alternative or adjunctive treatment for patients with refractory
JLIS, but larger studies are needed to clarify its role in this
indication.
53
IL-8, IL-12p70 and TNF-alpha by dendritic cells. Mala s 11
also activates auto-reactive T cells that may react against
its human homologue. Another species, M. globosa, produces the very recently characterized allergen MGL_1304,
that induces the degranulation of mast cells and the release of IL-4 by basophils.
In canine atopic dermatitis, also M. pachydermatis plays
an important pathogenetic role ; allergen-specific immunotherapy with Malassezia extracts is even very successfully used in veterinary dermatology.
In conclusion, these Malassezia spp. allergens may be
involved in the molecular mechanisms that lead to skin
inflammation and may therefore be of significance for the
course of AD. Sensitization to Malassezia can be determined by specific IgE to Malassezia spp (m227) and in
case of possible autoreactivity by determing IgE to Asp
f 6 (MnSOD from Aspergillus fumigatus, m222), which is
strongly crossreacting with Mala s 11.
P26
Real life experience with check point and kinase inhibitors in Swiss advanced Melanoma patients
J. Mangana1, A.L. Frauchiger1, C. Kaufmann1, U. Held2, R. Von
Moos3, E. Romano4, O. Michielin4, M.P. Levesque1, R. Dummer1, S.M. Goldinger1
POSTERS
1 Institute of Dermatology, University Hospital of Zurich, Zurich
2 Horten Center for Patient oriented Research and Knowledge
Transfer, University of Zurich, Zurich
3 Medical Oncology, Hospital of Chur, Chur
4 University Hospital of Lausanne , Lausanne
Background : Metastatic melanoma is an aggressive
disease with a median survival in untreated Stage IV
patients of only 6–9 months. Recent therapeutic developments in immunotherapy and targeted therapy have
shown substantial improvement in response in metastatic melanoma. The current project intends to determine
the benefit of the introduction of these new molecules
in advanced melanoma across several regions of Switzerland.
Methods : This is a retrospective multi-center analysis
of 328 Swiss advanced melanoma patients treated with
standard chemotherapy, checkpoint inhibitors (anti
CTLA-4 or anti PD1 antibodies) and kinase inhibitors (Vemurafenib, Dabrafenib/Trametinib, Encorafenib and Binimetinib) either in first or second line setting from January
2008 until June 2013.
Results : Median overall survival (mOS) from date of diagnosis of metastatic melanoma of all patients was 13.4
months. mOS of patients treated either with checkpoint
or kinase inhibitors (n = 196, 17.1 months) between 20082013 was significantly prolonged (p < 0.001) compared
to patients treated with standard chemotherapy within
2008-2009 (n = 88, 9.4 months). There was no significant
difference in survival in BRAF mutated and wildtype patients (mOS 14.0 and 15.3 months, respectively, p = 0.84).
284 patients were further analyzed for survival in terms
of treatments. One-year-survival was 71 % (CI 60-79 %) in
100 patients treated with ipilimumab, 55 % (CI 45-65 %) in
96 patients treated with targeted therapies and 37 % (CI
27-48 %) in 88 patients treated with standard chemotherapy. Proportion of patients surviving 2 years was 33 % for
patients treated with ipilimumab, 24 % for patients with
targeted therapy, and 14 % in patients treated with chemotherapy.
Conclusions : Treatments with check-point and kinase
inhibitors beyond clinical trials significantly improve mOS
and are consistent with published prospective data. Survival is independent from BRAF mutation status alone.
National melanoma registries and cancer statistics are
useful for monitoring outcomes of approved therapies
or newly established treatment protocols across multiple
institutions and patient populations.
P27
A multicenter, open label, phase II study to assess the efficacy and safety of APO866 in the treatment of patients
with refractory or relapsed cutaneous T-cell lymphoma
S.M. Goldinger1, S. Gobbi1, A.L. Frauchiger1, R. Fink-Puches2,
CD. Klemke3, B. Dréno4, M. Bagot5, C. Assaf6, R. Dummer1
1 Institute of dermatology, University Hospital of Zurich, Zurich
2 Dpt of Dermatology, Medical University of Graz, Graz
3 Dpt of Dermatology, University Medical Center Mannheim, University of Heidelberg, Heidelberg
4 CHU Hôtel-Dieu, Hospital of Nantes, Nantes
5 Département de Dermatologie, AP-HP, Hôpital Saint-Louis
Paris, Paris
6 Dpt of Dermatology, University Hospital Charité, Berlin
Background : Cutaneous T-cell lymphoma (CTCL) is characterized by the accumulation of clonal T-cells in the
skin. Given the nature of the disease and the toxicities of
treatments used, the intensity and duration of long-term
therapy is limited. Current investigations focus on more
sustainable and safe treatment for CTCL. APO866 is a drug
that induces cell death by inhibiting the biosynthesis of
NAD+ from niacinamide (vitamin B3). Here, we report
the results of an open label, phase II study of APO866 in
patients with relapsed and refractory CTCL.
Methods : This multi-centre, open label, single-arm GCPconducted phase II study aimed to determine efficacy,
safety and tolerability of APO886 in patients with histologically confirmed relapsed or refractory Stage Ib to IVb
CTCL (NCT00431912). APO866 was administered every 28
days for a total of 3 cycles by continuous intravenous infusion at 0.126 mg/m2/h during 96 h. The primary efficacy
endpoint considering cutaneous and extra-cutaneous
disease (measured by TBI and imaging) was assessed at
week 16. A pre-specified interim efficacy analysis was
planned after 11 patients. Descriptive statistics were used
for safety.
Results : The study was stopped due to lack of efficacy
after recruitment of 14 patients (February 2007 – January 2011). Two patients withdrew their consent due to
disease progression. The intention-to-treat set included
14 patients. At week 16 one patient had partial response
(PR), 6 showed stable disease (SD) and 5 progressive disease (PD). No complete response (CR) was observed. The
per-protocol set included 5 patients (1 PR and 4 SDs). The
most frequently reported drug-related AE was diarrhea
(43 %), followed by vomiting, lymphopenia, and thrombocytopenia (21 % each). Grade 4 AEs included lymphopenia and sepsis.
Conclusions : APO866, a drug inhibiting nicotinamide
phosphoribosyltransferase (NMPRTase), revealed a reasonable toxicity profile but was not powerful enough to demonstrate efficacy in CTCL. Due to its mode of action and
its immunosuppression involving all lymphocytes this
drug might play a role in the treatment of autoimmune
diseases. Future research for this indication is needed.
P28
Epidemiology of pyoderma gangrenosum in two major
health centers in switzerland
A. Gübeli1, A. Kolios1, A.A. Navarini1, W. Kempf2, M. Anliker3,
L. French1
1 Dpt of Dermatology, University Hospital of Zurich, Zurich
2 Kempf and Pfaltz, Histologic Diagnostics, Zurich
3 Clinic for Dermatology/Allergology, Cantonal Hospital of
St.Gallen, St.Gallen
Background : Pyoderma gangraenosum (PG) is a rare neutrophilic disease of the skin resulting in ulceration. Its diagnosis and treatment remains difficult, as only few studies
on this disease have been conducted.
Objective : A retrospective analysis was performed to
54
Für ein Leben mit Psoriasis,
jedoch ohne deren Ausprägungen.1
Stark und anhaltend wirksam bei mittelschwerer
bis schwerer Plaque-Psoriasis und Psoriasis-Arthritis.2,3
Se
it 2010
pr
hr
t
aus 3
rung
Erfah sdaten
re
5 Jah
axisbewä
Stelara® (Ustekinumab, humaner monoklonaler IgG1κ-Antikörper) I: Plaque-Psoriasis: Behandlung erwachsener Patienten mit mittelschwerer bis schwerer Plaque-Psoriasis, bei denen andere systemische Therapien einschliesslich Ciclosporin, Methotrexat oder PUVA nicht angesprochen haben, kontraindiziert sind oder nicht vertragen wurden. Psoriasis-Arthritis: Behandlung erwachsener Patienten mit aktiver Psoriasis-Arthritis, als Monotherapie oder in Kombination mit MTX, wenn das Ansprechen
auf eine vorhergehende Therapie mit DMARDs unzureichend gewesen ist. Stelara® verbessert die körperliche Funktionsfähigkeit bei Patienten mit Psoriasis-Arthritis. D: Die Anw. sollte unter Anleitung und Aufsicht eines in Diag. und Beh. der Psoriasis
erfahrenen Arztes erfolgen. PsO: Erw. ab 18 Jahren: 45mg als s.c. Injektion Woche 0, 4, anschliessend alle 12 Wochen. Pat >100kg: 90mg. PsA: Erw. 45mg als s.c. Injektion Woche 0, 4, anschliessend alle 12 Wochen. Bei ungenügendem Ansprechen kann
die Dosis auf 90mg gesteigert werden. Kein Ansprechen nach 28 Wochen: Therapie absetzen. KI: Schwerwiegende Überempfindlichkeit gegenüber dem Wirkstoff oder einem der Hilfsstoffe. VM: Vor Verabreichung von Stelara® soll der behandelnde
Arzt die ärztespez. Firmeninformation zum Produkt, insbesondere zu den pot. Risiken, gelesen haben. Zudem soll er sicherstellen, dass der Pat. die pot. Risiken, die in der Patbroschüre und der Patientenkarte aufgeführt sind, verstanden hat. Infektionen:
Stelara® darf Patienten mit einer klinisch bedeutsamen, aktiven Infektion nicht verabreicht werden. Tb: Abklärung auf TB-Infektion vor Therapiestart. Einleitung antituberkulöse Therapie bei latenter TB vor Therapiestart. Reversibles posteriores Leukoenzephalopathie Syndrom. Maligne Tumoren. Überempfindlichkeitsreaktionen. Immunisierungen: Keine Verabreichung von Lebendimpfstoffen während der Behandlung mit Stelara®. Kombination mit immunsuppressiver Begleittherapie, Phototherapie,
intensive Sonnenbestrahlung vermeiden. Immuntherapie. UAW: Infektion der oberen Atemwege, Nasopharyngitis, Dentalinfektionen, schwerwiegende Reaktionen (einschliesslich Anaphylaxie, Angioödema), Schwindel, Kopfschmerzen, Schmerzen
im Mundrachenraum, Diarrhoe, Erbrechen, Juckreiz, Rückenschmerzen, Muskelschmerzen, Arthralgie, Erschöpfung, Erythem und/oder Schmerzen an der Injektionsstelle. IA: Es wurden keine Wechselwirkungsstudien durchgeführt. Sicherheit und
Wirksamkeit von Stelara® in Kombination mit immunsuppressiven Wirkstoffen oder Phototherapie wurden nicht untersucht. SS: Stelara® darf in der Schwangerschaft nur angewendet werden, wenn klar notwendig. Bei der Entscheidung über eine Beendigung des Stillens oder ein Absetzen der Stelara® Therapie, sollte der Nutzen des Stillens für das Kind und der Nutzen der Stelara®-Therapie für die Mutter berücksichtigt werden. Packungen: Stelara® Injektionslösung in Fertigspritze, 45mg (0,5ml)
bzw. 90mg (1ml). Kassenzulässig. Abgabekat.: B. Ausführliche Informationen: www.swissmedic.ch oder www.swissmedicinfo.ch; Zulassungsinhaberin: Janssen-Cilag AG, Gubelstrasse 34, 6300 Zug (109277)
PHALP/STE/0315/0003a
1. Fachinformation Stelara®, Arzneimittelkompendium der Schweiz, Stand der Information: Mai 2014, www.swissmedicinfo.ch. 2. McInnes I et al. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicenter, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 2013; 382: 780-789. 3. Papp K et al. Long-term safety of ustekinumab in patients with moderate-to-severe psoriasis: final results from 5 years of follow-up. Br J Dermatol 2013; 168: 844-854.
determine the prevalence, disease characteristics and
treatment of PG patients at the University Hospital Zurich
and the Cantonal Hospital St. Gallen between 2002 and
2012.
Methods : Data was collected on lesion characteristics,
demographics, comorbidities, laboratory results, mortality and treatment.
Results : In total 38 patients (24 females) were diagnosed
with PG, with a total of 64 admissions to hospital and a
mean age at disease manifestation of 59 years. 84 %
had an underlying disease associated with PG (50 % had
one comorbidity and 34 % were multimorbid), of which
52.6 % had a cardiovascular disease, 21.1 % a hematological disorder, 18.4 % an inflammatory or autoimmune
mediated condition and 15.8 % suffered from an IBD.
CRP, leukocyte and neutrophil concentrations during active PG episodes were analyzed. Of the 44 admissions with
available CRP 65.9 % had elevated values. In 47 disease
episodes 49 % had a leukocytosis. 52.2 % of the 46 admissions had a neutrophilia. No patients had a leukopenia or
neutropenia. Of five microbiologic smears only two positive were correlated with CRP elevation (MRSA superinfection and septic shock), one positive did not show CRP
elevation and another two negative had elevated CRP
levels and neutrophilia.
The most affected body parts were the lower extremities
in 67.7 %. 14 patients had recurrences, nine during and
three after PG therapy (of two the treatment was unknown). 32 (50 %) PG episodes had healed completely at
discharge from hospital, with a mean time to complete ulcer healing of 7.1 months. Of those 50.1 % had been treated with topical or intralesional steroids and 43.8 % with
tacrolimus. 65.6 % had received systemic steroids, 28.1 %
cyclosporine A and 28.1 % Dapsone®. In 25 % of episodes
with complete ulcer healing a surgical intervention had
been conducted. One death was registered (pseudomonas aeruginosa sepsis, 2.6 % mortality rate).
Conclusions : PG patients in Switzerland showed a high
prevalence of comorbidities, esp. cardiovascular. Treatments lead to good healing rates after discharge from
hospital. Interestingly we found elevated CRP, leukocyte
and neutrophilic granulocyte levels in 50-65 % of cases.
Further investigation is needed to support these findings.
of IL-12/Th1 responses. As IL-4 therapy also improves
psoriasis in humans and suppresses IL-23/Th17 responses
without blocking IL-12/Th1, selective IL-4-mediated IL-23/
Th17 silencing is promising as treatment against harmful
inflammation, while sparing the IL-12-dependent Th1 responses.
P30
Expression of CD164 on malignant T cells in leukemic
cutaneous T cell lymphoma
E Guenova, D. Ignatova, YT. Chang, E. Contassot, LE. French,
W. Hoetzenecker, A .Cozzio
Dpt of Dermatology, University Hospital Zurich, Zurich
P29
IL-4 abrogates Th17 cell-mediated inflammation by
selective silencing of IL-23 in antigen-presenting cells.
E. Guenova1, Y. Skabytska2, W. Hoetzenecker1, D. Ignatova1, A.
Cozzio1, M. Röcken2, T. Biedermann3
POSTERS
1 Dpt of Dermatology, University Hospital of Zürich, Zurich
2 Dpt of Dermatology, Eberhard Karls University, Tubingen, Tubingen
3 Dpt of Dermatology and Allergy, Technische Universität München, Munich
Interleukin 4 (IL-4) can suppress delayed-type hypersensitivity reactions (DTHRs), including organ-specific autoimmune diseases in mice and humans. Despite the broadly
documented antiinflammatory effect of IL-4, the underlying mode of action remains incompletely understood,
as IL-4 also promotes IL-12 production by dendritic cells
(DCs) and IFN-γ-producing Th1 cells in vivo. Studying the
impact of IL-4 on the polarization of human and mouse
DCs, we found that IL-4 exerts opposing effects on the
production of either IL-12 or IL-23. While promoting IL12-producing capacity of DCs, IL-4 completely abrogates
IL-23. Bone marrow chimeras proved that IL-4-mediated
suppression of DTHRs relies on the signal transducer and
activator of transcription 6 (STAT6)-dependent abrogation of IL-23 in antigen-presenting cells. Moreover, IL-4
therapy attenuated DTHRs by STAT6- and activating transcription factor 3 (ATF3)-dependent suppression of the IL23/Th17 responses despite simultaneous enhancement
Primary cutaneous T cell lymphomas (CTCL) represent a
heterogeneous group of non-Hodgkin lymphomas arising
from malignant transformation of skin-homing T cells.
Early stage CTCL disease is limited to the skin. Late stage
IV disease is characterized by the presence of malignant
cells in the blood and carries a poor prognosis. Easy and
unequivocal detection of malignant cells in the blood of
CTCL patients is of important diagnostic, prognostic and
therapeutic value and is essential for disease monitoring
under treatment. Here we report that CD164 expression
on total lymphocytes from L-CTCL patients was significantly upregulated compared to healthy controls. CD164
expression was in most cases limited to CD26+CD4- positive malignant T lymphocytes, unequivocally identified by
the expression of a specific Vβ clone. These data are in line
with the recent finding from Wysocka et al and suggest
that increased expression of CD164 may be a promising
diagnostic marker for L-CTCL.
P31
Delayed granulomatous dermatitis with panniculitis
two years after tattooing:
a case report
C. Guillod1, A. Rammlmair1, F. Ghitti1, E. Laffitte2, H. Beltraminelli3, C. Mainetti1
1 Dpt of Dermatology, Bellinzona Regional Hospital, Bellinzona,
Switzerland
2 Dpt of Dermatology, Geneva University Hospitals, Geneva,
Switzerland
3 Dermatopathologie Labor, Dermatologische Universitätsklinik,
Inselspital, Bern, Switzerland
Introduction : As the number of tattooed people has increased in the last years, also the adverse reactions after
tattooing have risen. Tattoo skin complications can be
divided into three main categories: inflammatory, infectious and neoplastic. Clinically, the inflammatory reactions include focal oedema, pruritus, papules or nodules ;
histologically they manifest as lichenoid, eczematous,
foreign body granulomatous, sarcoidal and rarely as psoriasiform, morpheaform and vasculitic reactions.
Case report : In September 2014 a 44-year-old man presented to our Dermatology Clinic for evaluation of dermatitis within a tattoo on his right shoulder. He had been
tattooed twice in the same location, at first in 1999 and
subsequently in 2012, tattooing a different motive on top
of his previous tattoo. At the physical examination, he
presented yellowish crusts and exudations over the red
dye on erythematous ground. Laboratory and radiological investigations were normal, in particular no evidence
for an internal organ sarcoidosis.
A deep skin biopsy showed a stratum corneum with hyperkeratosis. In the superficial dermis a granulomatous
inflammation was detected in the area of the tattoo. The
adipose tissue revealed more mixed-inflammation and
56
P32
An uncommon cutaneous manifestation of cat scratch
disease
D. Guillot, L. Flatz
Dpt of Dermatology and Allergology, Kantonsspital St.Gallen,
St.Gallen
A 60-year-old woman was admitted to the hospital due to
chills, fever, diarrhea and vomiting. The patient was under
triple-immunosuppression consisting of infliximab, azathioprine and hydrocortisone for the treatment of colitis
ulcerosa. She reported that she got a scratch from her
own cat several days earlier. PCR for Bartonella henselae
performed on a liver biopsy was positive. The initial therapy consisted of ceftriaxone, metronidazole, fluconazole
and was then switched to doxycyline, gentamycine and
rifampicine. 4 weeks later the patient presented recurrent
fever and red macules on her hands, feet and legs. Over
several days the macules evolved into papules, nodules
and concentric circles of erythema. A skin biopsy showed
a granulomatous reaction. No gram-negative rods of Bartonella henselae were found.
A literature search revealed several different cutaneous
manifestations of Bartonella henselae infection including
erythema multiforme, erythema nodosum, thrombocytopenic purpura and bacillary angiomatosis.
P33
Perimalleolar leg ulcers in patients under antiangiogenic cancer drugs
J. Hafner1, R. Wälchli1, L.E. French1, S. Läuchli1, D.O. Mayer2
1 Dpt of Dematology, Zurich
2 Dpt of Surgery, Zurich
We present a novel etiology of refractory leg ulcers.
Patient 1, a 78-years-old female, received pazopanib for
metastatic renal cancer. Pazozanib is a multivalent tyrosine kinase inhibitor to VEGFR1-3, PDGFR and KIT. Following minor trauma she developed a 6 x 3 cm large and
refractory leg ulcer at the right lateral malleolus. Arterial
and venous examination reveiled no vascular pathologies. Pazopanib was stopped for three weeks. During this
period the wound was excised, topical negative pressure
treatment applied to stimulate granulation tissue formation, and finally the wound was covered with a split skin
graft, which took completely. Pazopanib had to be reintroduced because of tumor progression and the wound
recurred within three weeks.
Patient 2, a 67-years-old female, received bevacizumab
for recurrent metastatic breast cancer. She developed
small, but extremely painful skin ulcers above the medial
malleolus on both sides. The legs were slightly swollen
and the disease pattern reminded of chronic venous
insufficiency. Venous and arterial examination, however,
showed no vascular pathology. The patient was treated
with intermittent pneumatic compression (lymph drainage) and a wound spray containing neem oil which has
been shown to be particularly effective in other chronic
wounds. Treatment is still ongoing.
Up to now there is one patient in the Japanese literature
who developed a leg ulcer after initiation of pazopanib
during the treatment of malignant fibrous histiocytoma,
but otherwise the phenomenon is not yet recognized
and/or published. Our two cases strongly support the
hypothesis that VEGF-inhibitors can trigger leg ulcers in
patients without any form of macrovascular disease at the
legs. T
P34
Perimalleolar leg ulcers in a patient with congenital
dyserythropoietic anemia type I
J. Hafner1, C. Bachmann1, K. Schad1, L.E. French1, S. Läuchli1,
DO. Mayer2
1 Dpt of Dermatology, Zurich
2 Dpt of Surgery, Zurich
We present a rare etiology of refractory leg ulcers. The
group of congenital dyserythropoietic anemias encompasses three different forms of congenital anemia with
similar signs and symptoms. CDA are generally very rare
with approximately recognized patients out of 500 families world-wide.
CDA-I is caused by a gene mutation of the CDAN gene
on chromosome 15q15 which encodes for the codanin-I
protein (function unknown). CDA-I is defined by a unique,
pathognomonic red blood count with macrocytosis and
hyperchromia. Raised iron level can lead to secondary
hemochromatosis. Interferon treatment improves the
anemia, and chelation helps avoid iron overload. Congenital skeletal deformities, particularly of hands and feet,
are typical of CDA-I.
Refractory perimalleolar leg ulcers can represent a major
problem during the second half of life of these patients.
They may result from disturbed hemorheology and cutaneous microthrombosis with skin hypoxia, comparable to
the situation in sickle cell anemia.
Our patient benefitted from wound surgery (excision),
topical negative pressure treatment and a split skin graft,
with a complete take, leaving behind two healed legs.
P35
Lookalikes : erythema ab igne and livedo racemosa
O. Hasan Ali, M.D. Anliker, L. Flatz
Dpt of Dermatology and Allergology, St. Gallen
A 17-year-old male teenager came to our outpatient clinic presenting a painless skin discoloration with a reticulate pattern on his left thigh. The skin changes appeared
about 2 weeks ago, intensified rapidly and had since then
shown no signs of regression. There was no precipitating
trauma and no color fluctuation during the day. No other
location on his body was affected. He presented himself
in good health and there were no concomitant medical
conditions.
multiple lobular and septal, partly sarcoidal granulomas,
partly foreign body granulomas type, thus illustrating a
foreign body reaction accompanied by a mixed panniculitis. A microbiological culture of the biopsy specimen was
negative, in particular for Mycobacteria and deep fungal
infections.
A therapy was started with topic and oral steroids, which
showed only a transient improvement. Thus, we began
a 3-months antibiotic oral therapy with Doxycycline 100
mg orally twice a day, obtaining a complete resolution of
skin lesions.
Discussion : The clinical picture of exudation and crusting
as well as the histological characteristics of a hyperkeratosis pattern are typical for complications resulting from
the red colour in tattoos, which can cause a strong allergic
reaction. In our case, the superficial skin reaction was accompanied by a mixed panniculitis, highlighting just how
intricate the pathophysiological mechanisms of complications induced by tattoos can be. The Doxycycline therapy
over three months has resolved the situation. We believe
that thanks to its anti-inflammatory properties, this drug
could be useful in the therapeutic arsenal of treatments
for inflammatory complications induced by tattoos.
57
Further questioning revealed that he had frequently
placed his laptop on his thighs, thus having his left thigh
subjected to repetitive low-heat exposure emitted from
the laptop battery. Skin examination revealed a reticulate,
mesh-like, non-elevated macule that was strictly limited
to his left thigh. Patient history, particularly the reference to a heat source, and clinic strongly hinted towards
erythema ab igne (EAI).
Due to the recent onset of the lesion and rapid development we wanted to rule out livedo racemosa (LR), which
may present with the same appearance as EAI. Hence we
performed blood tests and a skin biopsy. Blood screen
showed no pathological findings and included markers
for coagulopathies, autoimmune disorders and hepatitis.
Histology showed no signs of vasculitis and was compatible with EAI. We advised the patient to remove the heat
source and use heat-protective gear during laptop usage.
We performed a clinical follow-up after six months where
we saw notable regression of the reticulate lesion further
supporting our diagnosis. Since EAI is potentially linked
to a higher risk of developing squamous and Merkel cell
carcinoma at the sites of appearance we recommended a
clinical checkup every two years.
P36
IVIG – induced pompholyx: a case report
O. Hasan Ali, L. Flatz
POSTERS
Dpt of Dermatology and Allergology, St. Gallen
Intravenous immunoglobulins (IVIGs) constitute a valuable and effective treatment option for conditions
involving the immune system. Despite the fact that they
are approved for only a few specific indications, their offlabel use in treatment extends beyond 60 medical conditions. Usually IVIG therapy is limited by high cost and not
by side effects, given it is mostly well tolerated. Systemic
adverse reactions are considered rare.
Here we report the case of a 30-year old patient, who
suffered from Chronic inflammatory demyelinating
polyneuropathy (CIDP). The treatment consisted only of
administration of IVIGs (Privigen). He was admitted to our
outpatient clinic due to development of a mildly pruritic
eczematous rash that first appeared on his palms and
soles and, by the time of his appointment, had spread
to his shins. Skin examination showed grouped vesicles
that formed circular non-confluent patches with discrete
erythema at the aforementioned body sites. The eczema
had first appeared shortly before his fourth cycle of IVIGs.
Patient history revealed no signs of atopy or previous episodes of eczema. Blood-screen showed no abnormalities.
The Patient took no concomitant medication and did not
suffer from additional medical conditions. Histology was
compatible with pompholyx.
Given the typical onset location being soles and palms, as
well as a lack of concomitant medication we diagnosed
IVIG-induced pompholyx. We treated the patient with
topical clobetasol propionate and advised his neurologists to be cautious in continuing his IVIG therapy since
literature suggests a high probability of the eczema to
progress and spread to other skin sites when IVIG is continued. Remarkably, the time between first administration
and eruption was about three months and thus markedly longer than that of most other cases. Hence, we want
to foster awareness not to discard IVIG as a cause of skin
symptoms if the time between the first administration
and onset of symptoms exceeds 10 days.
P37
Successful use of rituximab in the management of
patients with oral mucous membrane pemphigoid without potentially life- and sight-threatening disease
S. Häfliger1, D. Perruchoud1, C. Houriet1, H.W. Klötgen1, V.
Suter2, M. Horn3, L. Borradori1
1 Institue of Dermatology, University Hospital of Berne, Berne
2 Dept. of Oral Surgery and Stomatology, University of Berne,
Berne
3 Institute of Immunology, University Hospital of Berne, Berne
Mucous membrane pemphigoid (MMP) is a rare autoimmune subepithelial blistering disorder characterized
by predominant involvement of the mucosae, a chronic
course, and a tendency towards scarring of the affected
areas. A common oral presentation is desquamative gingivitis, accompanied by bleeding erosions and paresthesia. Treatment of MMP and desquamative gingivitis is
often challenging.
We here describe two patients with MMP with isolated
oral involvement and gingivitis, which were resistant to
conventional therapies. The patients were given a cycle
of rituximab (2 x 1 g infusion ; anti-CD20 mAb, Mabthera®). Rituximab resulted in either complete response of
the oral disease or in a significant regression of pain and
lesions, an increased quality of life and reduction of the
sulfone antibiotic dose.
Depletion of CD20+ B lymphocytes by rituximab has recently emerged as a very effective therapeutic option for
pemphigus resulting in long-term control of the disease.
There is some evidence that rituximab could be helpful
in controlling progressive ocular disease of MMP, whereas
laryngeal involvement appears to be more resistant.
Our observations in the two here described patients as
well as in other MMP cases treated in Berne suggest that
rituximab is a very useful second-line therapeutic option
not only in case of life- and sight-threatening complications of MMP, but also in isolated chronic oral disease,
which would otherwise require long-term immunosuppression and result in a decreased quality of life.
P38
Asymmetric periflexural exanthema of childhood, report of two cases occurring in sisters
S. Häfliger, K. Kernland Lang, Z. Spanou
Institute of Dermatology, University Hospital of Berne, Berne
Asymmetric periflexural exanthema of childhood is classified as a rare self-limited and spontaneously resolving
exanthema with unknown etiology occurring in children
of in average 2 years of age. We report two sisters of 6 and
8 years of age, who presented with an unilateral, itchy
rash. The eruption started two days before in the axillary
fold, and then spread to the trunk. No other family member was affected. The patients did not have any preceding
systemic sign or drug history. On examination, there were
disseminated morbilliform papules and pustules with an
unilateral distribution on the trunk without lymphadenopathy. Low-potency topical steroids were started. The
lesions resolved completely after 2 weeks.
Clinical course and features were characteristic for asymmetric periflexural exanthema of childhood, also called
unilateral laterothoracic exanthema. Our observation was
peculiar for the involvement of two children in the same
family, since concomitant development of the disease
in various family members has been rarely described.
Nevertheless, reports of familial cases as in our case, the
occurrence of the disease during Spring and Winter and
the lack of response to antibiotics are consistent with a
viral etiology. However, no specific virus has not been
identified yet. The disease generally lasts 3 to 6 weeks and
spontaneously resolved without recurrence.
58
Traumatic tattoo after road accident: successful treatment with QS Nd :YAG laser
K. Heidemeyer1, D.L. Perruchoud1, N. Dietrich1, M. Adatto2
1 Institute of Dermatology, Unsiversity Hospital of Berne, Berne
2 M. Adatto, Institute of Dermatology, Unsiversity Hospital of
Berne ;Skinpulse , Lasers and Beauty Centres, Geneva, Berne
We here present a case of traumatic tattoo in a 59 years
old male caucasian caused by asphalt particles in the left
periorbital region after a bicycle accident. The patient
was treated using a Q-switched (QS) Nd : YAG laser 1064
nm (C6, Cynosure ; Wayland ; MA, USA). He underwent 4
sessions using the following parameters : 10 nanosecond
pulse duration, 4mm spot size, 2-7J/cm2 fluence, interval 2 month, leading to a complete clearance of discoloration. The laser treatment was well tolerated besides a
slight localized erythema lasting for 2 days.
Traumatic tattoos occur accidentally by forced penetration of foreign bodies into the dermis with varying
depths. They are mostly caused by asphalt, dust, petroleum, graphite products, sand, metals, glass or fireworks
particles. QS lasers are commonly used for treatment of
pigmented skin lesions as well as for professional tattoos
and permanent make-up removal, either at 532, 694, 755
or 1064 nm.
Traumatic tattoos may be potentially treated with QS Nd:
YAG laser. The good results observed in our case emphasize the efficacy and safety of QS lasers in this particular
indication.
P40
Comparable whole exome sequence data from FFPE
and snap-frozen skin samples
R. Higgins1, R. Wälchli1, A. Smith2, M. Theiler2, J. Hafner1, L.
Weibel2, A.A. Navarini1
2 Institute of Dermatology, University Hospital of Zurich. Kinderspital, Zurich., Zurich
Multiple skin conditions have been shown to follow
Blaschko’s lines, which correspond to the patterns of cell
migration during embryological development. Several
of these diseases have been demonstrated to be caused
by genetic factors such as a de novo somatic mutation
causing a cutaneous mosaicism. Thus, genetic investigation of skin biopsies in affected areas and subsequent
comparison to germline DNA may allow identification
of underlying genetic risk factors. The most frequently
available types of biopsies are formalin fixed and paraffin
embedded (FFPE) samples that are suitable for immunohistology. A drawback of this mode of preservation is that
the DNA in these samples is altered chemically, mainly by
the deamination of cytosine to deoxyuracil. This process
results in non-reproducible and misleading sequencing
artefacts of C>T variants, therefore extra-stringent quality
controls have to be in place to ensure accuracy. Snap-freezing of biopsies in liquid nitrogen keeps DNA intact and
might thus be a better starting material. Recently, treatment of FFPE extracted DNA with an enzyme UDG prior to
sequencing was shown to reduce these artefacts. Here we
asked whether the quality and quantity of DNA extracted
from FFPE and snap-frozen tissue is comparable, also in
terms of coverage during sequencing and if FFPE samples
show more sequencing artefacts.
Three normal skin samples were split, one half being FFP
embedded and the other snap frozen. DNA was extracted from both sample types using the DNA Blood mini kit
from Qiagen for the snap frozen samples and the GeneRead FFPE kit with a UDG incubation step for the FFPE
samples. DNA was sheared with ultrasound to a fragment
size of 150-250bp. The Agilent SureSelectXT v5 exon kit
was used to isolate protein-coding sequences, and Illumina HiSeq were used for whole exome sequencing.
Analysis showed comparable DNA purity and as well as
no significant increase of C>T variants in FFPE vs snapfrozen samples which would indicate presence of formalin-induced artefacts. In 91.45 % bases 20x coverage
was achieved in both FFPE and snap-frozen samples. The
comparison of FFPE vs Snap frozen skin samples revealed
comparable quality of sequences between the two materials, therefore we conclude that both sample types are
valid and can be included in sequencing studies.
P41
Lack of rare protein-damaging genetic variants in severe familial acne and hidradenitis suppurativa
R. Higgins1, P. Bachmann2, P. Itin3, S. Müller3, A.A. Navarini1
2 Private Practice,
3 University Hospital, Basel, Basel
Acne vulgaris and hidradenitis suppurativa are distinct
but closely related chronic inflammatory skin conditions.
Severe acne is driven by increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles by Propionibacterium acnes. HS arises
due to alterations of the terminal follicular epithelium in
the apocrine gland–bearing skin. Both conditions cause
scarring, keloids, disfigurement and impairment of quality of life. Both conditions have a high heritability and in
the case of familial HS, rare coding variants in the gamma
secretase enzyme complex were shown to cause disease.
A Swiss family of 6 persons affected by acne and HS presented in our department. The mother and 4 offspring
were all affected by severe acne, and HS was present in
the mother and one son. The father was unaffected. The
parents were non-consangineous. After informed consent
to the NEUTROGENE study, DNA was isolated from blood
of all six family members, sheared by ultrasound, proteincoding regions isolated using the Agilent SureSelectXT V5
kit and whole exome whole exome sequencing was performed on Illumina HiSeq appliances.
Given the small dataset, the genetic analysis was performed utilizing clinical information and available candidate gene information. As mother and all offspring were
affected by severe acne, we looked for rare (minor allele
frequency of ≤ 0.01) protein-damaging (CADD Phred
Score >15) coding heterozygous variants present in the
mother and all offspring but not the father. No such variants were found in 16 candidate genes reported for acne
and HS (PSENEN, PSEN1, NCSTN, CYP1A1 and others), nor
in 244 genes previously reported for other dermatologic
conditions. Using an exome-wide search in all 22’500
protein-coding genes, two rare and one novel damaging
variant were identifed whose relevance for the skin condition remains unclear however. Next, we will examine the
presence of mutations in these genes in other, unrelated
cases of acne and HS, as well as expression of the respective gene products in sebacous and apocrine glands.
P42
Prurigo pigmentosa in Caucasian monozygotic twins :
first observation
C. Houriet, D. Perruchoud, D. Simon, L. Borradori
Dpt of Dermatology, Inselspital, University of Bern, Bern
Prurigo pigmentosa (PP) is a rare acquired inflammatory dermatosis, first described by Nagashima in 1971
in Japan, affecting primarily young Asian women. So far,
P39
59
only few cases of PP have been described in Caucasian
patients. Evidence exists suggesting that race and ethnicity as well as environmental factors predispose to PP. We
here present the first case of PP occurring in two 28-yearold female Caucasian monozygotic twins. In the affected
twins, the skin lesions showed the relapsing course and
clinical features typically described in PP, while the histopathological findings were consistent with the diagnosis.
The twins developed PP at different time frames and in
different enviromental settings. Our peculiar and striking
observation emphasizes the importance of the genetic
background on the development of PP.
P43
Treatment of hidradenitis suppurativa with IL-1β antibody canakinumab : a case series
C. Houriet, C. Schlapbach, N. Yawalkar, R. Hunger
Dpt of Dermatology, Inselspital, University of Bern, Bern
Hidradenitis suppurativa (HS) is a chronic inflammatory
disorder presenting with abscesses, fistules and scarring
predominantly in the intertriginous regions. Many treatment strategies are available but often the course of
the disease is frustrating for both patient and physician.
Different biological treatments, such as TNF-α inhibitors
and most recently IL-1 antibodies have been attempted
for moderate to extensive disease. In a small case series
good results were reported with the use of IL-1 receptor
antagonist Anakinra.
We report three cases with extensive HS (Hurley Stage III)
treated with monoclonal IL-1β antibody Canakinumab
previously treated with different modalities. Two of them
even received TNF-α inhibitors before treatment. Two patients had a drastic reduction in the mean pain score and
a mean decrease in the modified Sartorius score. In one
patient neither pain reduction nor reduction in disease
severity was noted. IL-1 antibodies seems to be a promising therapeutic option for patients with severe HS.
P44
The phytotherapeutic fenugreek as trigger of toxic epidermal necrolysis
N. Bentele-Jaberg1, T. Mehra2, M. Nägeli1, Y. Chang1, A. Cozzio1, L. French1, W. Hoetzenecker1
POSTERS
2 Medical Directorate, University Hospital of Zurich, Zurich
60
We describe the case of a 32-year-old woman, who presented with generalized painful exanthema, blisters and
erosions one month after giving birth to a healthy girl.
The patient’s medical history was inconspicuous for comorbidities, however included the incidental intake of
pain killers and an herbal preparation (fenugreek), which
she took regularly over the last four weeks to improve
lactation. Based on the clinical characteristics we suspected toxic epidermal necrolysis (TEN), a severe cutaneous
adverse drug reaction, which was confirmed by skin biopsy. The patient was treated with high-dose intravenous
human immunoglobulins and was discharged two weeks
after hospital admission in good condition. The allergological work-up identified fenugreek as the most likely
causative agent. Given the increased self-medication of
freely-available phytotherapeutics by patients in industrialized countries, herbal mixtures should be taken into
consideration in the diagnostic workup of TEN.
P45
Bazex syndrome (acrokeratosis paraneoplastica)
W. Hötzenecker, E. Guenova, A. Cozzio
Dpt of Dermatology, University Hospital of Zurich, Zurich
A 61-year-old woman presented with abdominal pain,
which had worsened in the last two months. Skin examination revealed marked hyperkeratosis on both foot soles
with yellowish, adherent scales. Bazex syndrome (acrokeratosis paraneoplastica), a paraneoplastic condition of the
skin, was suspected. CT scans and explorative laparotomy
showed abdominal tumor formation consistent with ovarian cancer (stage III). After tumor debulking the patient
was started on chemotherapy (taxole, carboplatine). At 3
months after diagnosis, resolution of the hyperkeratosis
was noted. The association of acral hyperkeratosis and
malignancy was first described by Bazex in 1965. Bazex
syndrome is characterized by rapid appearance of hyperkeratosis on the ears, nose, hands, and feet. In two-thirds
of cases, cutaneous lesions precede the symptoms or
diagnosis of malignancy. Thus, the suspicion of Bazex syndrome should result in prompt tumor search with a focus
on the upper aerodigestive tract, where more than half
of acrokeratosis paraneoplastica-associated malignancies
are found.
P46
A new sexually transmitted infection : abscessing deep
trichophytia in a 26-year-old man
S. Huber, M. Ebnoether, K. Ivanova, P.H. Itin
Dpt of Dermatology, University Hospital Basel, Basel
Abscessing deep trichophytia is a rare variant of common
dermatophyte infection. Sexually transmitted tinea corporis is possible but rarely reported in the literature.
We present the case of a 26-year-old man who was sent
to our department because of extensive skin lesions in
the pubic region with concomitant fever, pain and malaise. First symptoms started four weeks ago with itching
erythema which improved slightly after treatment with
stromectol because of suspected scabies. Nine days
before admission the symptoms were rapidly worsening
with itching, scaling erythema and pustules with cicatrical alopecia in the pubic area. Direct microscopy from a
pubic hair revealed dermatophytes.
Five days later the patient’s 24-year-old girlfriend reported itching anular erythema in the genital region which
started one week ago. Tinea inguinalis was proven with
direct microscopy from her scales. The fungal cultures
from both patients showed trichophyton mentagrophytes, a zoophilic dermatophyte. The girlfriend completely recovered after four weeks systemic and local therapy with terbinafine. In our male patient initially peroral
terbinafine was started which was temporary changed
to intravenous fluconazole because of persisting fever.
In addition intravenous cefazoline was given because of
bacterial superinfection. Local treatment with potassium
permanganate baths and terbinafine cream was administered. After eleven days the symptoms improved and we
continued with out-patient treatment. Controls after two
and six weeks showed further improvement and antifungals were stopped after totally eight weeks therapy. The
patient’s source of infection remains unclear, possible
could be contact with dogs or cats in a bed and breakfast
where the pair stayed days before first symptoms started.
Endlich wieder tun,
was mir wichtig ist.
Gelenke beschwerdefreier
und vor weiterer Zerstörung
optimal geschützt3
Hautbild klarer2
Entzündung
eingedämmt1
HUMIRA® – Alltag möglich machen.4
Referenzen
1. Tracey D et al. Tumor necrosis factor antagonist mechanisms of action: a comprehensive review. Pharmacol Ther. 2008;117(2):244-279.
2. Gordon K et al. Long-term efficacy and safety of adalimumab in patients with moderate to severe psoriasis treated continuously over 3 years: results from an open-label extension study for patients from REVEAL. J Am Acad
Dermatol. 2012;66(2):241-251.
3. Mease PJ et al. Adalimumab for long-term treatment of psoriatic arthritis: 2-year data from the Adalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT). Ann Rheum Dis. 2009;68(5):702-709.
4. Revicki DA et al. Impact of adalimumab treatment on patient-reported outcomes: results from a Phase III clinical trial in patients with moderate to servere plaque psoriasis. J Dermatolog Treat. 2007: 18(6): 341-350.
Fachinformation Humira® (Adalimumab): Z: Wirkstoff: Adalimumab. I: Erwachsene Patienten mit mässig bis stark ausgeprägter, aktiver rheumatoider Arthritis (RA), welche ungenügend auf krankheitsmodifizierende
Antirheumatika (DMARDs) angesprochen haben, in Monotherapie oder in Kombination mit Methotrexat (MTX) bzw. anderen DMARDs; kürzlich diagnostizierte (< 3 Jahre) MTX-naive Patienten mit mässig bis stark ausgeprägter
RA, in Kombination mit MTX. Kinder und Jugendliche im Alter von 4-17 Jahren mit polyartikulärer juveniler idiopathischer Arthritis (pJIA) nach ungenügendem Ansprechen oder Intoleranz auf DMARDs, in Kombination mit
MTX oder bei MTX Unverträglichkeit als Monotherapie. Bei Kindern, die jünger als 4 Jahre sind, wurde Humira nicht untersucht. Erwachsene Patienten mit Psoriasis-Arthritis (PsA), die ungenügend auf DMARDs angesprochen
haben, in Monotherapie oder Kombination mit DMARDs. Erwachsene Patienten mit aktiver ankylosierender Spondylitis (AS), die nur unzureichend auf herkömmliche Therapien angesprochen haben. Erwachsene Patienten
mit Morbus Crohn (MC) mit mässiger bis hoher Krankheitsaktivität, die nur unzureichend auf herkömmliche Therapien angesprochen haben, sowie erwachsene Patienten, die nicht mehr auf Infliximab ansprechen oder dieses
nicht vertragen. Erwachsene Patienten mit mittelschwerer bis schwerer aktiver Colitis Ulcerosa (UC) die auf die herkömmliche Therapie unzureichend angesprochen haben oder die eine Unverträglichkeit oder Kontraindikation
gegen eine solche Therapie haben. Erwachsene Patienten mit mittelschwerer bis schwerer, chronischer Plaque Psoriasis (PsO) in Monotherapie, bei denen eine systemische Therapie oder eine PUVA-Therapie angezeigt ist. D:
RA, AS, PsA: Eine Injektion (40 mg) subkutan alle zwei Wochen. Im Fall einer Verminderung der Wirkung unter Monotherapie bei RA kann eine Erhöhung der Dosierungsfrequenz auf 40 mg Adalimumab einmal wöchentlich von
Vorteil sein. pJIA: 24 mg/m2 Körperoberfläche bis zu einer maximalen Einzeldosis von 40 mg Adalimumab subkutan alle zwei Wochen. MC, UC: 160 mg in Woche 0, 80 mg in Woche 2 und danach alle zwei Wochen 40 mg als
subkutane Injektion. UC Patienten, bei denen nach primärem Ansprechen ein Wirkverlust auftritt, können von einer Dosiserhöhung auf 40 mg pro Woche profitieren. PsO: 80 mg in Woche 0, 40 mg in Woche 1 und danach alle
zwei Wochen 40 mg als subkutane Injektion. KI: Überempfindlichkeit gegen Inhaltsstoffe, aktive Tuberkulose (TB), schwere Infektionen wie Sepsis oder opportunistische Infektionen, mittelschwere bis schwere Herzinsuffizienz
(NYHA Kl. III-IV). WH: Infektionen, einschliesslich opportunistische Infektionen, TB und Hepatitis B Reaktivierung, neurologische Ereignisse einschliesslich demyelinisierende Störungen, allergische Reaktionen einschliesslich
anaphylaktische Reaktionen, maligne Tumore, Immunsuppression, Impfungen, Lebendimpfungen, Lebendimpfungen bei Neugeborenen nach in utero Exposition, Herzinsuffizienz, gleichzeitige Anwendung von biologischen
DMARDs oder anderen TNF-Antagonisten, hämatologische Ereignisse, Auto-Antikörper, Anwendung in der Geriatrie. Interakt.: keine bekannt/nicht untersucht. SS: Empfängnisverhütung, Anwendung nur wenn der Nutzen das
potentielle Risiko übersteigt, Stillen für 5 Monate nach Behandlung nicht empfohlen UAW: Reaktionen an der Injektionsstelle, Infektionen des Respirationstraktes, Mundinfektionen, Haut- und Weichteilinfektionen, systemische
Infektionen, Harnwegsinfektionen, Leukopenie , Kopfschmerz, Parästhesien, Husten, Diarrhoe, Motilitätsstörungen, Abdominalschmerzen, Mundulzeration, oropharyngeale Schmerzen, Übelkeit, Erhöhung der Leberenzyme,
Hautausschlag, Pruritus, Arthritis, muskuloskelettale Schmerzen, Müdigkeit, Überempfindlichkeitsreaktionen. P: Eine gebrauchsfertige Spritze*, ein vorgefüllter Injektor* oder 2 Durchstechflaschen mit Injektionslösung
(pädiatrische Patienten) pro Packung. Abgabekategorie B. Kassenzulässig*. Ausführliche Informationen siehe Arzneimittel-Fachinformation: www.swissmedicinfo.ch. Zulassungsinhaberin: AbbVie AG, Neuhofstrasse 23, 6341 Baar.
* Erwachsene Patienten
CHHUD150297 06/2015
P47
Aberrant splicing in TMC8 leads to the phenotype of
epidermodysplasia verruciformis
E. Imahorn1, Z. Yüksel2, I. Spoerri1, W. Kempf3, P.H. Itin4, B. Burger1
1 Dpt of Biomedicine, University Hospital Basel and University
Basel, Basel
2 Medical Genetics Dpt, Eskişehir Osmangazi University, Eskişehir
(Turkey)
3 Kempf and Pfaltz Histological Diagnostics, Zürich
4 Dpt of Dermatology and Dpt of Biomedicine, University Hospital Basel, Basel
Epidermodysplasia verruciformis (EV) is a rare recessive
genodermatosis associated with a high susceptibility to
infections with certain types of HPV (EV-HPV) and an increased risk for development of cutaneous squamous cell
carcinomas (cSCC) on UV exposed skin. While EV patients
infected by EV-HPV develop wart-like lesions starting during childhood, in the general population asymptomatic
infections at much lower virus copy numbers per cell are
common.
The majority of patients are carriers of homozygous or
compound heterozygous mutations in either the TMC6 or
TMC8 gene. We present a large family with at least three
children clinically diagnosed with EV. EV-HPV could be
detected in their lesional skin. Investigations of both TMC
genes revealed a novel splice site mutation in TMC8, which
was homozygously present in the examined children but
heterozygously in the non-affected consanguineous parents. Whereas nonsense and frameshift mutations are
reported to lead to a loss of the affected proteins, nothing
is known about the effect of splice site mutations in TMC6
and 8. Analyses of cDNA of all affected children and both
parents revealed several aberrant splice products ; the
parents additionally showed the wild type splice product.
Whether the aberrant splice products influence the phenotype of the patients remains to be elucidated.
P48
One versus two cm excision margins for cutaneous malignant melanomas thicker than 2 mm: A retrospective
study
M. Jafari1, R. Hunger2, M. Shafighi1
POSTERS
1 University Clinic for Plastic, Reconstructive and Hand Surgery,
Bern University Hospital, Bern
2 University Clinic for Dermatology, Bern University Hospital,
Bern
Background One of the major controversies in the primary management of melanoma is how much surrounding normal skin should be excised around a primary
cutaneous melanoma. Balancing cosmesis, function and
morbidity with oncologic outcomes requires careful decision-making with respect to determination of the appropriate margins. Currently most guidelines recommend a
safety margin of at least 2 cm for melanomas with a tumour thickness of more than 2 mm. No data exist on the
impact of narrower surgical margins. We now analyzed in
a retrospective study, whether 1 cm surgical excision margin has caused any disadvantages in important outcome
parameters, in comparison to 2 cm margins.
Methods We conducted a retrospective study in patients
with primary melanomas thicker than 2 mm undergoing
tumour excision with one cm or two cm margins in our
center. Patients’ charts were reviewed for data including
patient gender, age, tumour location, tumour type, Breslow thickness, presence of ulceration, findings of sentinel nodes, locoregional metastases, distant metastases,
death attributable to melanoma, disease-free survival,
and overall survival.
Results 325 (138 female, 187 male) patients with a median
age of 61.84± 14.71 years and mean Breslow thickness
of 4.36± 3.99 mm, were considered for the study with a
median follow-up of 1852 days (1995- 2012). There was
no significant difference between two groups regarding
local recurrence (P = 0.739), locoregional (P = 0.311),
distant metastases (P = 0.571) and death attributable to
melanoma (P= 0.625), during the follow-up period. Furthermore, the survival analysis showed no differences for
disease-free (P = 0.800 ; HR, 0.948 ; 95 % CI 0.627 to 1.433)
and overall-survival (P = 0.951 ; HR, 1.018 ; 95 % CI 0.575
to 1.803).
Conclusions : Our study did not show any significant differences in important outcome parameters like local- or
distant metastases, overall survival. A prospective study
testing one versus two cm excision margin is warranted.
P49
A prospective clinical trial to assess lapatinib effects on
cutaneous squamous cell carcinoma and actinic keratosis
D. Jenni, M. Karpova, B. Mühleisen, J. Dreier, J. Mangana, J.
Hafner, R. Dummer
Background: Anti-epidermal growth factor receptor
(EGFR) targeted therapy is widely used in many epithelial cancer types. We investigated lapatinib effects on
cutaneous squamous cell carcinoma (cSCC) scheduled
for resection and in co-existing precursor lesions (actinic
keratosis (AK)) in a phase 2 mode of action clinical trial
including a histological work-up of the cSCC.
Patients and methods : We initiated a prospective single
center open label non controlled clinical study with translational intentions to investigate changes in size and histopathological features in cSCC after a 14-day period of
neoadjuvant lapatinib therapy prior to surgery, to quantify the impact on AK and Bowen’s disease (BD) in the
same patient after 56 days and to evaluate the tolerability
in patients with cSCC and AK lesions.
Setting : Outpatient clinic of the department of dermatology of the university hospital Zurich as a tertiary referral
center.
Participants : Patients with cSCC scheduled for surgical
removal and at least 2 co-existing precancerous lesions
(AK or BD).
Intervention : Oral lapatinib at a dose of 1500mg per day
q.d. for a treatment duration of 56 days including surgery
of one cSCC 14 days after treatment start.
Results : 10 immunocompetent male patients were included with a mean age of 73 years (range 59 to 87). 8
patients were treated with the study medication lapatinib 1500mg per day for a total duration of 56 days according to the protocol and were available for full analysis, 2
patients had to discontinue after during the first 2 weeks
because of adverse events (diarrhea, pancreatitis). Tolerability was acceptable with only 1 related grade III adverse
event. A reduction in tumor size of cSCC was documented
in 2 out of 8 evaluable patients after 14 days of treatment.
The mean regression of captured precursor lesions was
30 % after 56 days of treatment and 36 % 28 days after
therapy cessation.
Conclusions and Relevance : Short term lapatinib resulted in a cSCC tumor reduction in 2 out of 8 patients. In
addition, there was a clinically documented reduction of
actinic keratosis in 7 out of 8 patients encouraging larger
clinical trials, especially in high risk cSCC patients such as
organ transplant recipients.
62
Metastatic squamous cell carcinoma in hereditary junctional epidermolysis bullosa: Importance of proper follow up of epidermolysis bullosa patients with chronic
wounds
I. Joggi, H-W. Klötgen, H. Beltraminelli, R. Blum, L. Borradori,
K. Kernland
Institute of Dermatology, University Hospital of Bern, Bern
Epidermolysis bullosa encompass a large spectrum of
inherited diseases characterized by skin fragility and blistering of the skin and mucosa following mild mechanical
trauma. The potential complications, morbidity and impact on quality of life are extremely variable with occasional friction blisters up to generalized and lethal disease.
We report a 46-year-old patient with hereditary junctional
epidermolysis bullosa (EB) who presented to our Department with a 5-year history of a progressive exophytic and
putrid ulceration on the left lower limb. The ulceration
covered the entire circumference of the lower leg. He had
on the left side two enlarged inguinal lymph nodes. The
extensive work up confirmed the diagnosis of a metastatic giant squamous cell carcinoma. MRI- and CT-investigation showed disseminated left inguinal lymphadenopathies. Light microscopy studies of the excised lymph node
excision showed an infiltrating squamous cell carcinoma.
The patient underwent amputation with lymphadenectomy. The patient received a limb prosthesis, resulting in
a significant increase of the quality of life. Squamous cell
carcinoma is a devastating complication typically occurring in patients with distinct subsets of dystrophic EB and,
more rarely, in junctional EB as in our case. It constitutes
one of the major causes of death. In affected patients, it
is important to help chronic wounds to heal appropriately to avoid cancer development. Regular follow up of EB
patients with wounds is mandatory.
P51
PASS syndrome: a new auto-inflammatory skin disease
N. Kaparos, M. Leuenberger, J. Berner, J. Di Lucca, L. Fischer,
C. Conrad, D. Hohl, M. So, M. Gilliet
Dpt of Dermatology, University Hospital , Lausanne
Background : PASS Syndrome is a rare inflammatory disease characterized by a chronic-relapsing course of Pyoderma gangrenosum, Acne vulgaris, hidradenitis Suppurativa and ankylosing Spondylitis. Although the etiology
and the pathogenesis of PASS are currently unknown, an
auto-inflammatory mechanism may be implicated.
Case report : We report the case of a 32 year-old man of
Congolese origin, hospitalized in our clinic for spontaneously recurrent painful exulcerating nodules of the
legs along with purulent hidradenitis suppurativa lesions
in the inguinal folds, dissecting cellulitis of the of the
scalp, facial acne lesions and a seronegative spondylarthritis. The exacerbations were marked by fever along
with elevated serum levels of IL-1b. The skin biopsy of the
leg lesions revealed a dense neutrophilic infiltrate in the
upper and lower dermis, which, together with the clinical
aspect, was consistent with the diagnosis of pyoderma
gangrenosum. The diagnostic criteria of PASS Syndrome
were fulfilled. We started a treatment with the interleukin-1 (IL-1) receptor antagonist (Anakinra) and observe a
rapid clinical response after only 4 days. We did not detect
mutations in the gene PSTPIP1 found in PAPA and PAPASH
syndromes, which are autoinflammatory skin diseases
with shared clinical features.
Conclusion : We provide the first evidence that PASS is an
auto-inflammatory disease based on the aberrant expression of IL-1 and the rapid clinical response to IL-1 signaling blockade. Nevertheless, the absence of mutations in
the gene PSTPIP1 evoke that other specific mutations in
the IL-1 pathway may be involved.
P52
Acquired amegakaryocytic Thrombocytopenia associated with Eosinophilic Fasciitis (Shulman syndrome)
N. Kaparos, J. DiLucca
Dpt of Dermatology, University Hospital (CHUV), Lausanne, Lausanne
Introductio : Eosinophilic Fasciitis (EF) is a rare scleroderma-like syndrome characterized by symmetrical skin
swelling, progressive thickening and stiffness of subcutaneous tissue. The definitive diagnosis relies on muscle IRM
signs and histopathological modifications from the fascia
and lower subcutis. The pathogenesis remains unclear
but the immune-allergic disorder hypothesis is the most
considered. Thus, EF is frequently associated with autoimmune disorder especially autoimmune cytopenia. We report the 3rd case of EF associated with amegakaryocytic
thrombocytopenia (AATP).
Case report : A 74 years old woman progressively developed muscle weakness, myalgia and skin stiffness of
the limbs with the clinical (“peau d’orange” appearance,
groove sign), biological (hypergammaglobulinemia, aldolase elevation) and IRM’s (hyper-signal and thickening of
the fascia) signs of EF, without any clinical and immunological sign of systemic sclerosis. The skin biopsy revealed
thickening and collagenization of the fatty subcutaneous
septa associated with mild plasmocyte and lymphocyte
infiltrate. The patient rapidly developed a severe thrombocytopenia (< 15 G/L) with good response to weekly platelet transfusion. A bone marrow biopsy showed a global
hypoplasia (<20 %) with marked decreased of megakaryocytes and T lymphocyte infiltrate (15 %). Six weeks after prednisone (0.75-1mg/kg/d) and cyclosporine (3mg/
kg/d) introduction, the patient recovered her previous
functional activities and platelet count was maintained
between 40-50 G/L without platelet transfusion.
Discussion : The most frequent reported association of
hematologic disease with FE is aplastic anaemia. AATP is a
very rare autoimmune cytopenia characterized by severe
thrombopenia with the other cell lines preserved and a
marked decrease or total absence of megakaryocytes in
the bone marrow. This entity is associated with autoimmune diseases and could evolve in aplastic anaemia. Dermatologic prognosis of FE after corticosteroids is usually
good. Unfortunately, aplastic anaemia or AATP are often
refractory to steroids or intravenous immunoglobulin.
The current standard first line therapy is cyclosporine,
which could be combined with antithymocyte globulin.
In case of failure, hematopoietic stem cell transplantation
or thrombopoietin receptor agonist must be considered.
Blood count must be regularly checked in FE to screen
autoimmune cytopenia that could worse prognosis.
P53
Porokeratoma: a possible association with human papillomavirus infection
P. Caseiro Silverio1, X.C. Pham2, G. Kaya2
1 Dpt of clinical pathology, University Hospital of Geneva, Geneva
2 Dermatopathology Unit, Dpt of Dermatology, University Hospital of Geneva, Geneva
Porokeratoma is a rare, relatively newly described and still
unclear entity. Here, we describe the case of a 52-year-old
male patient who presented with four well-defined, verrucous and hyperkeratotic lesions. Microscopically, one
of the lesions showed acanthopapillomatosis overlying
compact orthokeratosis. Prominent broad and confluent
P50
63
cornoid lamellae were present, with no granular layer and
some dyskeratotic keratinocytes. PCR sequencing and in
situ hybridization revealed the presence of human papillomavirus (HPV) type 16 in the lesion. The association of
porokeratoma and HPV infection has not previously been
reported.
P54
Phototoxic side effects of kinase-inhibitors. A case report
JB. Kirchhoff, DP. Perruchoud, HW. Klötgen, R. Blum, L. Borradori
Dpt of Dermatology, Inselspital Bern University Hospital, Bern
Vandetanib (Caprelsa) is a new multikinase inhibitor targeting EGFR, VEGF receptors
and the RET receptor 2. This inhibitor is used for the treatment of locally advanced or metastatic medullary thyroid
cancers.
We here describe a 61-year-old patient who was admitted for a severe cutaneous reaction. Past history revealed that the patient was given Vandetanib treatment for
metastasizing medullary thyroid carcinoma 4 weeks prior
admission. Two weeks later in November, the patient
spent some hours sitting in the sun. The patient showed
Stevens-Johnson/Lyell-like cutaneous changes on the entire face, V-area of the chest, shoulders, upper and lower
arms and hands. He had red-purple, dusky, flat macules,
superficial blisters, erosions and crusted lesions. Light
microscopy studies showed extensive dyskeratosis, apoptotic keratinocytes, vacuolar changes of the basal layer of
the epidermis and necrosis, and an lymphocytic cellular
infiltrate in the dermis with some eosinophils. The lesions
had a striking photodistribution. The patient was given
potent topical corticosteroids and antiseptic wraps. Within 2 weeks, the lesions were completely healed, leaving
postinflammatory pigmentary changes.
Kinase-inhibitors are increasing used in oncologic indications. Common side effects include abdominal pain and
diarrhea, prolonged QT interval, hypertension, headache
and fatigue as well as a variety of cutaneous adverse reactions. Cutaneous adverse effects occur frequently
during vandetanib treatment, such as folliculitis, dry skin,
paronychia and genital lesions. Phototoxic reactions, as
observed in our case, are very frequent and observed
in up to 40 % of cases. All patients need to be informed
about the increased photosensitivity and need a careful
photoprotection to avoid significant skin toxic effect.
P55
PAPA-Syndrome (pyogenic arthritis, pyoderma gangraenosum and acne): Report of a case with characterization of the pathogenic mutation in the PSTPIP1 gene
HW Klötgen1, S Häsler1, N Yawalkar1, F Förger2, C Rieubland3,
L Borradori1
POSTERS
1 Department of Dermatology, University Hospital of Berne-Inselspital, Bern
2 Department of Rheumatology, Immunology and Allergology,
University Hospital of Berne-Inselspital, Bern
3 Human Genetics, Department of Pediatrics, University Hospital
of Berne-Inselspital, Bern
64
recurrent pyoderma gangraenosum involving the legs.
Clinical history revealed that during childhood the patient had suffered from recurrent sterile osteomyelitis and
oligoarthritis that significantly improved by the age of 16.
During his adolescence he also had episodes of neutropenia, a monoclonal gammopathy IgG kappa, Coombspositive anemia, hepatosplenomegaly and glomerulonephritis. He also developed severe papulopustular acne,
followed by a first episode of pyoderma gangraenosum
on his right leg. There were no family members suffering
from similar symptoms. Based on the clinical history and
clinical findings, PAPA-syndrome was suspected. Genetic analyses disclosed the presence of c.74G>A mutation
of the PSTPIP1-gene, resulting in the substitution of the
amino acid Glu250Lys.
PSTPIP1 (http://ghr.nlm.nih.gov/gene/PSTPIP1) is an enzyme which is involved in a variety of pathways, including
T-cell activation and actin cytoskeleton regulation. It further has a critical role in innate immunity and the inflammatory response. Our observation reminds us that the
possibility of a PAPA-syndrome should be considered in
all young patients with pyoderma gangraenosum, severe
acne and a past history of osteomyelitis and oligoarthritis.
IL-1 blockade with Anakinra or Canakinumab, which has
been used successfully described in anecdotal cases of
PAPA, should be considered.
P56
Cutaneous borreliosis with a T-cell-rich pseudolymphomatous infiltrate and simultaneous involvement by Bcell chronic lymphocytic leukemia
H. Köhl1, E. Hübscher2, D. Kazakov3, M. Tinguely1, W. Kempf1
1 Kempf und Pfaltz, Histologische Diagnostik, Zurich
2 Dermatology Practice, Biel
3 Dpt of Pathology, Faculty of Medicine in Pilsen, Charles University, Prague
Pseudolymphomatous infiltrates in cutaneous Borrelia
infection commonly present with dense B-cell infiltrates
and plasma cells. Cutaneous infiltrates of B-cell chronic
lymphocytic leukemia (B-CLL) tend to accumulate at
sites of infection, including Borrelia infection, and epithelial skin neoplasms. We report an unusual constellation in a 74-year-old man who complained of malaise
and a solitary plaque on the left chest since 2 months.
Hematologic examinations revealed a B-cell chronic lymphocytic leukemia. Skin biopsy of the plaque showed a
dense dermal T-cell-rich infiltrate composed of small to
medium-sized CD4+ T-cells with focal exocytosis and an
admixture of a few small B-cells as well as plasma cells.
The infiltrate simulated mycosis fungoides (plaque stage).
Molecular studies showed a polyclonal rearrangement of
T-cell receptor genes, but a monoclonal B-cell population.
Specific cutaneous involvement by B-CLL was confirmed
by the detection of t(14 ;18)(q32 ;q21) (BCL2-IGH) using
FISH in neoplastic B cells within the skin infiltrates. Borrelia burgdorferi (sensu lato) DNA detected by nested polymerase chain reaction in the skin biopsy and serological
findings proved Borrelia infection. Complete resolution
of the cutaneous infiltrates was observed after antibiotic
treatment. This case demonstrates that Borrelia infection
of the skin can present with dense T-cell-rich pseudolymphomatous infiltrates mimicking mycosis fungoides and
masking the synchronous presence of neoplastic B cells
in the context of B-CLL.
PAPA-Syndrome is a rare autoinflammatory disease associated with severe osteo-articular and cutaneous manifestations, including acne and pyoderma gangrenosum.
This inherited autosomal dominant disease is caused by
mutations in the proline-serine-threonine-phophataseinteracting protein (PSTPIP 1) on chromosome 15. Until
2013 approximately 30 cases have been described so far.
We describe a 24-year-old patient with a 2-year history of
Admis par les caisses maladie
Pour le traitement des
kératoses actiniques (KA)
Efficace. Simple. Rapide.
1,2
Picato® Gel 150 mcg/g
Picato® Gel 500 mcg/g
KA sur le visage et sur
le cuir chevelu
KA sur le tronc et sur
les extrémités
1 x par jour pendant
3 jours consécutifs
1 x par jour pendant
2 jours consécutifs
1
1
Références
1. Information professionnelle Picato® Gel: www.swissmedicinfo.ch ou Compendium Suisse des Médicaments. 2. Lebwohl et al. Ingenol Mebutate Gel for Actinic Keratosis. N Engl
J Med 2012;366:1010 – 1019.
PICATO 150 mcg/g et 500 mcg/g GEL
Composition: 1 g Picato® gel contient 150 mcg resp. 500 mcg de mébutate d’ingénol. Indications: Picato® est indiqué pour un cycle du traitement topique de kératoses
actiniques non-hyperkératosiques et non-hypertrophiques chez l’adulte. Posologie: Kératose actinique du visage et du cuir chevelu: Le gel Picato® 150 mcg/g doit être
appliqué sur la zone atteinte une fois par jour pendant 3 jours consécutifs. Kératose actinique du tronc et des extrémités: Le gel Picato® 500 mcg/g doit être appliqué sur la
zone atteinte une fois par jour pendant 2 jours consécutifs. Contre-indications: Hypersensibilité au principe actif ou à l’un des excipients. Précautions: Éviter tout contact
avec les yeux. Picato® ne doit pas être avalé. L’utilisation de Picato® n’est pas recommandée tant que la peau ne s’est pas remise de traitements antérieurs par d’autres
médicaments ou interventions chirurgicales. Picato® ne doit pas être appliqué au niveau de plaies ouvertes ou de lésions cutanées comportant une altération de la fonction
barrière. Picato® ne doit pas être utilisé à proximité des yeux, dans les narines, à l’intérieur des oreilles ou sur les lèvres. Après l’application topique de Picato®, des réactions
cutanées locales telles qu’érythème, exfoliation/desquamation et formation de croûtes peuvent apparaître. Il est démontré que ces réactions cutanées locales sont en
rapport avec l’effet clinique. Une biopsie doit être réalisée en cas de lésions ayant un aspect clinique atypique pour des kératoses actiniques ou en cas de lésions suspectes
de malignité, afin de déterminer le traitement approprié. Effets indésirables: Très fréquents: Pustules au site d’application, douleur, érythème, érosion, vésicules, tuméfaction,
exfoliation, croûte. Fréquents: Infection au site d’application, céphalées, œdème périorbitaire, œdème palpébral, prurit, irritation. Occasionnels: Douleur oculaire, écoulement,
paresthésie, ulcère. Interactions: Aucune étude d’interactions n’a été réalisée. Les interactions avec des médicaments absorbés par voie systémique sont considérées
comme extrêmement minimes, car Picato® n’est pas absorbé par voie systémique. Présentation: Picato® 150 mcg/g, gel: Boîtes de 3 tubes à 0.47 g* (liste B); Picato®
500 mcg/g, gel: Boîtes de 2 tubes à 0.47 g* (liste B). Mise à jour de l’information: Avril 2014. *Admis par les caisses-maladie.
®
Pour des informations plus détaillées, veuillez consulter l’information professionnelle actuelle sur www.swissmedicinfo.ch.
LEO and the LEO Lion Design are registered
LEO Pharma
Tél: 043 343 75 75
trademarks of LEO Pharma A/S.
Eichwatt 5
Fax: 043 343 75 70
©2015 LEO Pharma Inc. All rights reserved. Janvier 2015.
CH - 8105 Regensdorf
www.leo-pharma.ch
P57
The influence of systemic treatment on immune accessibility of melanoma : a retrospective histopathological
investigation
L. Krähenbühl1, S.M. Goldinger1, V.C. Amann1, S. Matsushita2,
W. Kempf1, M.P. Levesque 1, R. Dummer1
2 Dpt of Dermatology, Kagoshima University, Kagoshima-shi,
Japan
The last few decades have shown major progress in the
field of immunohistochemical (IHC) stainings in histopathology. Microscopically analyzing melanoma slides
using conventional stainings as well as specific markers
and multiplex stainings have been crucial for better understanding of melanoma and it’s susceptibility to certain
treatments. PD1 and PD-L1 are targets of new anti-tumor
medications, some of which have recently been approved
by the relevant authorities. Specific markers are now available for staining. Published data indicate differing survival depending on PD-L1 status. We previously presented
preliminary data on the influence of systemic treatments
on immune accessibility. A clinical correlation of these
findings has not yet been performed so far. Furthermore,
the correlation of PD-L1 expression and survival should
be further investigated. Therefore, we have performed various IHC stainings of tumor samples before and after relevant treatments. We retrospectively identified patients
with available pre- and post-treatment tumor samples
and appropriate follow up data. Immunotherapy, targeted therapy as well as chemotherapy have been applied in
these patients. Samples were stained for H&E, PD1, PD-L1,
CD3, CD8, CD68, CD163 and IDO. In the histological analysis we specially emphasized on lymphocyte infiltration
into the tumor. Our results demonstrate a switch from a
previous stage of immune privilege to immune accessibility after treatment. The morphological correlate of this
phenomenon is redistribution from a previous grenz zone
like pattern to intratumoral infiltration. To investigate correlation of this phenomenon with improved outcome, we
analyzed time to progression as represented by time to
change of treatment or death.
P58
Symmetrical drug-related intertriginous and flexural
exanthema (SDRIFE) to Pseudoephedrin
E. Kretzschmar, J. Genser, B. Ballmer-Weber
POSTERS
Background : Symmetrical drug-related intertriginous and
flexural exanthema (SDRIFE), formerly called baboon syndrome, is an uncommon variant of exanthematous drug
eruption, most often induced by antibiotics particular by
betalactams. The rash presents as a sharply demarcated
V-shaped erythema in the gluteal/perianal or inguinal/
perigenital areas, often with involvement of at least one
other flexural area such as the axillae, elbows or knees.
Case description: Here we report on a twenty-two-year
old female patient who presented herself four times
on the emergency department with an inguinal burning exanthema, twice after intake of Aspirin complex ®
(acetylsalicylic acid (ASS), pseudoephrin), once after an
unknown symptomatic over-the-counter combination
product and once after Rinoral® (pseudoephedrin). After
the first three episodes an allergy work up has been initiated comprising scratch and patch testing with various
analgetics including ASS and Aspirin complex®, and a
lymphocyte transformation test (LTT) to ASS. All tests
were negative and the diagnosis of “aspirin hypersensitivity” was done with the recommendation to avoid all ASS
containing products in the future. After the fourth epi-
sode of SDRIFE after intake of Rinoral® the investigation
was revisited. Skin test with Rinoral® was negative, however, LTT with Pseudoephedrin was positive (SI 2.3). An oral
provocation test with 500 mg ASS was negative. We established the diagnosis of Pseudoephedrin induced SDRIFE.
Discussion and Conclusion : Pseudoephedrin is a rare elicitor of drug allergic reactions. Our case underlines the
importance of a detailed medical history when investigating drug allergy and that allergy work up should include
all compounds of a combination product. Furthermore, it
stresses the need of drug provocation in the absence of
positive allergy tests to establish or exclude the diagnosis
of drug allergy.
P59
Borrelia infection-associated fasciitis : 2 cases
C. Lang, I. Masouye, M. Mühlstädt, S. Quenan, G. Kaya, E. Laffitte
Service de dermatologie et vénérologie, Hôpitaux Universitaires
de Genève, Genève
Introduction : Chronic Borrelia infection can have several clinical presentations. We report two cases of fasciitis
associated with Borrelia infection.
Observations : A 70 year-old man presented with a widespread deep cutaneous sclerosis of the limbs associated
with fatigue, arthralgias and night sweats. He remembered a tick bite several months earlier in Sweden. A CT scan
revealed a bilateral infiltration of the superficial and deep
fascia of the thigh. A deep cutaneous biopsy showed a
moderate perivascular interstitial infiltrate composed of
lymphocytes and eosinophils throughout the dermis reaching skeletal muscle and fascia. In the blood, there was
no eosinophilia, Western blot was positive for Borrelia IgG
and anti-VLSE was strongly positive. Borrelia PCR on deep
skin biopsy, synovial liquid and CRL was negative. Borrelia fasciitis was diagnosed ; the patient was treated with
intravenous ceftriaxone for one month with a progressive
improvement of the deep sclerosis.
A 79 year-old woman presented with non pruriginous
erythematous lesions with sclerous changes of the skin
involving thighs, groins, abdomen, axillary regions and
breasts. She reported a tick bite on the left groin one year
ago. Laboratory tests revealed an eosinophilia, a slightly
elevated CRP and ESR and a discrete hypergammaglobulinemia. An MRI showed a deep infiltration of sub-cutaneous fat and fascia of the abdomen and thighs. A deep
skin histology revealed a lympho-plasmacytic infiltrate of
the fascia with fibrosis and scarce eosinophils. A Western
blot was repeteadly positive for Borrelia IgM although anti-VLSE was negative, as well as the PCR of the deep tissue.
Eosinophilic fasciitis (EF) was diagnosed, possibly associated with a chronic Borrelia infection. After one month
course of intravenous ceftriaxone without any other therapy, we observed a complete resolution of the disease.
Discussion : EF is a rare disorder characterized by scleroderma-like skin indurations and fascia thickening, with or
without eosinophilic infiltration depending on the stage
of the disease. Etiology remains uncertain but Borrelia has
been rarely highlighted as a possible triggering factor.
In our two cases, the positive serology and the clinical
response to IV ceftriaxone was strongly suggestive of a
causative role of Borrelia.
Conclusion : Borrelia should be screened in EF and exams
should be repeated in case of strong clinical suspicion.
66
Relapsing Nicolau livedoid dermatitis (Nicolau syndrome) following subcutaneous glatiramer acetate
injection
C. Zecca1, C. Gobbi1, R. Blum2, C. Mainetti3
1 Neurocenter of Southern Switzerland, Dpt of Neurology, Lugano Regional Hospital, Lugano
2 Dermatopathologie Labor, Dermatologische Universitätsklinik,
Inselspital, Bern
3 Dpt of Dermatology, Bellinzona Regional Hospital, Bellinzona
Introduction : Injectable immune treatments for multiple
sclerosis (MS) as interferon beta and glatiramer acetate
(GA) are associated with frequent but generally non
serious local skin reactions. Nicolau Livedoid Dermatitis
(NLD), also named Nicolau syndrome or embolia cutis
medicamentosa, is a rare und forgot complication following injection of several drugs, is characterized by cutaneous, subcutaneous and muscular aseptic necrosis in a
livedoid pattern.
Case report : In October 2014, a 58-years-old female with
MS treated with subcutaneous GA since 2006, presented
at the Neurology department with painful skin lesion
developed a day after GA injection in her left abdomen.
She reported correct injection practice. She had no fever.
Blood cell count, reactive C protein, renal function, creatine kinase, IgE, autoimmune screening, lupus anticoagulants and cryoglobulins were unremarkable. Superficial
ultrasonography showed diffuse oedema without fluid
collections. The patient was dismissed with symptomatic
AINS treatment, and GA was stopped.
After two days, she developed a livedoid violaceous patch
with dendritic extensions below the injection site became
apparent, and she was referred to the Dermatology department. Here, a NLD was diagnosed and confirmed by
skin biopsy. Retrospectively, a similar skin lesion in her
right abdomen had been documented in 2007 after GA
injection, that had need of a surgical debridement due
to the secondary formation of an abscess. The patient
continued a topical conservative treatment with progressive improvement and healing. GA was definitively suspended.
Discussion : The pathogenesis of NLD is not clear. It seems
that accidental intravascular or perivascular drug delivery
may lead to vasospastic and/or thrombotic phenomena,
causing ischemia and necrosis of the skin, which can
extend up to the muscular plane. For NLD no standard
treatment exists. Some authors promote the use of low
molecular weight heparin, thrombolytic agents, vasodilators or even surgical debridement in extreme cases of skin
and soft tissue necrosis.
In the literature have been a few reports of NLD induced
by GA. But no recurrent cases under GA treatment have
been reported so far.
Neurologists, but also all physician should be aware of
NDL as its course might include complications such as
sepsis and renal failure following rhabdomyolysis, and
consider stopping the triggering drug for possible NDL
recurrence.
P61
Acromegaly : a clinical diagnosis for the dermatologist ?
C. Mainetti
Dpt of Dermatology, Bellinzona Regional Hospital, Bellinzona
Introduction : Acromegaly is characterized by an acquired
continued somatic disfigurement, mainly involving the
face and extremities, but also many other organs, that is
associated with systemic manifestations. The disease is related to the increased secretion of growth hormone (GH).
This GH overproduction derived from a benign pituitary
tumour (adenoma) in more than 95 % of cases.
Case report : In December 2014 a 52-years-old woman
with a history of carpal tunnel syndrome since 2006 and
of treated right breast cancer in 2013 was addressed to
the family doctor for suspected onychomycosis of the
hands. Physical examination revealed a distal onycholysis of the thumbs. The hands were squat with hardened
skin. The feet were large and wide. I asked if she had
increased the number of shoes and the patient confirmed to me that took two numbers in more compared to
ten years ago. Even his face showed a coarse nose and a
mouth enlarged on a plot of seborrhea without signs of
early rhinophyma. Suspecting an acromegaly I asked the
patient to take photos of documents since he was the age
of 20 years. These confirmed the disfiguring facial already
incurred since 2004, when the patient was 42-years-old.
The direct examination and culture mycological collection of nail remained negative. The laboratory results of
GH and IGF-1 values were significantly increased and the
brain MRI showed a pituitary macro-adenoma of 11 x 8 x
11 mm.
Discussion : The diagnosis of acromegaly is clinical and
needs to be confirmed with laboratory tests. Clinical diagnosis is suggested by the typical change of the patient
related to progressive acral enlargement and modification of facial appearance, as assessed by serial photographs.
Skin changes was observed nearly 70 % of patients, who
have sweaty, and oily skin. Skin thickening is due to glycosaminoglycan deposition and to increased collagen
production by connective tissue. Nail abnormalities in
acromegaly are an unusual complication, in particular
ingrowing fingernails or flat and wide nails.
In the literature it is reported as acromegaly remains under-recognized and under-diagnosed. The dermatologist
in this case should have a privileged position for its trained habit to observe the morphological peculiarities of
patients : for acromegaly may therefore play a key role in
early clinical diagnosis, thus avoiding a protracted illness
has systemic consequences devastating for patient.
P62
Psychological impact and changing behaviors implications after genetic counseling in melanoma patients
from Southern Switzerland
C. Mangas1, E. Cattaneo2, P. Zanetti2, C. Mainetti1, I. Massari2
1 Dermatology Dpt. Ospedale Regionale Bellinzona e Valli, Bellinzona
2 Servizio di psichiatria e psicologia medical. Organizzazione
sociopsichiatrica cantonale, Lugano
Background : Psychological aspects and potential changing of preventive behavior for individuals during genetic counseling for cutaneous melanoma (CM) have been
investigated with different conclusions. We present the
results of a questionnaire designed to evaluate these
items in a cohort of patients who underwent genetic
counseling for CM.
Methods : From June 2010 until June 2012, individuals
from Southern Switzerland with personal or family history
of two ore more invasive CM or one CM and one or more
pancreatic cancer among first- or second-degree relatives
were included in a research study to detect germline
mutations in CM risk associated genes (CDKN2A, CDK4,
MITF and MCR1). Just before genetic testing, patients
complete three questionnaires based on GenoMEL (International Consortium for melanoma research) protocols
regarding genetic testing, risk perception and sun related
behaviour. We arbitrary decided to identify three categories (good/adequate, discrete and low/bad knowledge/
behaviour) based on the range of the scored obtained in
each test. The international Hospital Anxiety and Depres-
P60
67
sion Scale (HADS) was also answered. Patients completed
same questionnaires from GenoMEL protocols and HADS
again one year after the first visit.
Results : 57 patients, corresponding to 41 families were
included (25 men and 32 women). In seven patients, corresponding to four different families, we found a high-risk
mutation in CDKN2A gene (p.V126D). Questionnaires
were completely answered by 41 patients (5 patients with
mutation). Before the genetic test male had an average
of risk perception higher than female but female had an
average of adequate sun related habits higher than male.
The score average about knowledge of genetic testing,
melanoma risk and risk perception ranged from 47.36
to 46.07 after the genetic test (p=0.021), corresponding
always to the category of good knowledge. The score
average about protective sun related habits ranged from
140.95 to 145.63 after the genetic test (p=0.036), which
means always an adequate sun related behavior. The
score average of anxiety reduced after genetic test results
(p=0.066). No differences were detected regarding to
mutation status.
Discussion : This set of patients had already before genetic
counseling an adequate management and information
about CM. Anyway, improving of protective behavior and
anxiety reduction was noted after genetic test.
P63
Psoriasis treatment - patient related benefit - an analysis of the Swiss registry SDNTT
J-T Maul1, V. Djamei1, A. Kolios1, B. Meier1, P. Juno2, J. Czernielewski3, N. Yawalkar4, O. Odermatt5, E. Laffitte6, C. Spehr7, M.
Anliker5, M. Streit8, M. Augustin7, S.Rustenbach7, C. Conrad3,
J. Hafner1, WH.Boehncke6, L. Borradori4, M. Gilliet3, P. Itin2, L.
French1, P. Häusermann2, A.A. Navarini1
POSTERS
2 Dpt of Dermatology, University Hospital Basel, Basel
3 Dpt of Dermatology, University Hospital, Lausanne
4 Dpt of Dermatology, University Hospital Bern , Bern
5 Dpt of Dermatology, Kantonspital St. Gallen
6 Dpt of Dermatology, University Hospital Geneva, Geneva
7 Dpt of Dermatology, University Hospital Hamburg
8 Dpt of Dermatology, Kantonsspital Aarau
Background : The Swiss psoriasis registry SDNTT (Swiss
Dermatology Network for Targeted Therapies) records the
real-life long-term safety, effectiveness and patient benefit of treatment regimens of psoriasis.
Patients and medhods : Patients with moderate-to-severe
psoriasis were included in the SDNTT for an observation
period of 5 years when treatment with a conventional
systemic agent or biologic was started for the first time.
Standardized physician and patient case report forms
were obtained every three to six months. Baseline data
of patients included until April 30th 2014 were analyzed.
Results: Between March 2011 and April 2014 (37 months),
297 patients from seven registered dermatology clinics in
Switzerland were recruited in the SDNTT. Initially 134 patients received biologics and 145 received conventional
systemic therapy as a first treatment ; combination therapies were given to 18 patients. At onset of treatment,
67.2 % of patients had moderate-to-severe psoriasis (PASI
>10 or BSA >10 or DLQI >10). 11.6 % of patients had not
had any conventional systemic therapy before baseline.
In 45.6 % of patients the impact on QoL (DLQI >10) was
severe (median 11.07). After one year of treatment 87.1 %
were satisfied with the treatment. The average PASI reduction, considering all patient groups, was almost 70 % after
one year of treatment. In our real-world setting 52.2 % of
patients treated with biologics and 46.9 % of patients
treated with conventional systemic drugs reached PASI75
after 1 year, and PASI90 was reached in 25 % of cases with
biologics and 32.6 % of cases with traditional systemic
drugs.
Conclusions : In a real-world setting of a national regis-
ter, use of the available current therapeutic regimens for
psoriasis in moderate to severely attached patients led to
improvement of PASI by approximately 70 %, but current
therapeutic targets of PASI75 and PASI90 were reached in
less than 50 % and 30 % at one year, demonstrating the
gap in efficacy reported in clinical trials and that in a realworld setting.
P64
Multiple palpebral syringomas occurring after initiation
of braf inhibition therapy in a patient with metastatic
melanoma
O. Seyde1, R. Mérat2, E. Fernandez3, G. Kaya2
1 Service de Pathologie Clinique, HUG, Genève
2 Service de Dermatologie, HUG, Genève
3 Service d’Oncologie, HUG, Genève
Introduction : A variety of skin lesions have been observed in melanoma patients treated with BRAF inhibitors.
Observation : A 61 year-old male patient with stage IV metastatic melanoma carrying BRAF v600E mutation treated
with Dabrafenib presented with a sudden bilateral palpebral skin eruption characterized by small papules three
weeks after the beginning of BRAF inhibitor therapy. Histological examination showed a dermal cystic epithelial
proliferation with tadpole appearance and abundant cytoplasm, consistent with syringoma with clear cell aspect.
Discussion : Several cutaneous adverse events during
BRAF inhibitor therapy for melanoma have been reported. Most of these events range from squamoproliferative
lesions to eruptive nevi and second primary melanoma.
Rare skin lesions such as acneiform eruption, eccrine
syringometaplasia and panniculitis have been observed
during Dabrafenib treatment. Here we report a previously
undescribed cutaneous side effect of BRAF inhibition therapy that resolved three months after combined Dabrafenib and Trametinib (MEK inhibitor) therapy.
Conclusion : Clinicians using BRAF-inhibitors for melanoma should be aware of the possibility of occurrence of
multiple syringomas on the face as a cutaneous adverse
event during therapy.
P65
Psammomatous melanotic schwannoma : a challenging
histological diagnosis
R. Mérat1, I. Szalay-Quinodoz2, E. Laffitte1, G. Kaya1
1 Service de Dermatologie, HUG, Genève
2 Dianapath, Centre de Pathologie, Genève
Introduction : Psammomatous melanotic schwannoma
(PMS) is a rare pigmented tumor that can be part of the
Carney’s complex. This tumor is composed of Schwann
cells capable of melanogenesis and arises most frequently in the paraspinal sympathetic chain or in the gastrointestinal tract, but only 20 cases of cutaneous or subcutaneous melanotic schwannoma have been reported
located mainly in the upper part of the body.
Observation : We report a case of isolated PMS in a 35
year-old female patient localized on the buttocks simulating a pilonidal cyst. The tumor had been noticed by the
patient for many years, slowly increasing in size during
the months before it was surgically removed. Histological
examination showed a circumscribed subcutaneous proliferation of spindle-shaped cells with frequent nuclear
grooves and prominent intracytoplasmic melanin pigment. Numerous psammoma bodies were observed. The
spindle cells stained positive for S-100, Melan-A and HMB45. No evidence of association with a Carney’s complex
was present. The malignant nature of the tumor could not
68
PIGMANORM® CREME WIDMER
DIE EINZIGARTIGE WIRKSTOFFKOMBINATION BEI HYPERPIGMENTIERUNG
Für die gezielte Therapie melaninbedingter
Hyperpigmentierungen wie
• Chloasma und chloasmaartige Hyperpigmentierungen
• Alterspigmentierungen
• Narbenpigmentierungen
• Postinflammatorische Pigmentierungen
• Epheliden
PIGMANORM® CREME WIDMER. Z: Wirkstoffe: 1 g Creme enthält: Hydrochinonum 50 mg, Tretinoinum 0,3 mg, Dexamethasonum 0,3 mg. I: Melaninbedingte Hyperpigmentierungen der Haut. D/A: Die
PIGMANORM® CREME wird einmal täglich sparsam auf die hyperpigmentierten Stellen aufgetragen.
Die Applikation soll sich auf die veränderten Hautstellen beschränken. Auf eine grossflächige Anwendung (über max. 10 % der Gesamtoberfläche) soll verzichtet werden. Die Behandlungsdauer beträgt
durchschnittlich 7 Wochen. Nur in Ausnahmefällen sind längere Zeiten bis max. 3 Monate zu erwägen. KI: Nicht melaninbedingte Pigmentierungen, Vitiligo, Melanom und Melanomverdacht, Unverträglichkeit gegen Tretinoin oder einen anderen Bestandteil des Präparates. Akute Entzündungen
und Ekzeme der Haut. Kinder unter 12 Jahren. Hautinfektionen. VM: Kontakt mit Augen, Lippen und
Nasenschleimhäuten vermeiden. Die behandelten hyperpigmentierten Stellen nicht intensiver
Sonnenbestrahlung aussetzen. SS/S: Es gibt keine hinreichenden Daten zur Anwendung bei
Schwangeren. UW: Irritationen der Haut, Brennen, Pruritus und Trockenheit sowie Überempfindlichkeitsreaktionen auf einen Bestandteil des Präparates können vor allem zu Beginn der
Therapie auftreten. P: Tube zu 30 ml, Liste B. Kassenzulässig. Ausführliche Informationen entnehmen Sie bitte der Fachinformation auf www.swissmedicinfo.ch. Louis Widmer AG, 8952 Schlieren.
be initially excluded based solely on morphology and the
lack of significant mitotic activity. Therefore a follow-up as
for a metastatic malignant melanoma was initiated.
Discussion : If it does not occur in an already recognized
Carney’s complex, the diagnosis of PMS depends on histological analysis. The main histological differential diagnosis is malignant melanoma which shares common
features such as melanin synthesis and positive staining
for S100, Melan-A and HMB-45.
Conclusion : Distinguishing PMS from malignant melanoma can be challenging for dermatopathologists who
should be aware of this rare pigmented cutaneous tumor.
P66
Pulsed treatment of Vismodegeib ultra-fast response
and lack of recurrence in a giant BCC
A. Miles, O. Gaide, M. Gilliet
Institute of Dermatology, University Hospital of Lausanne, Lausanne
Background : Vismodegib (trade name Erivedge) is a novel and specific hedgehog inhibitor indicated for patients
with basal cell carcinoma (BCC) which cannot be treated
with surgery or radiation.
The recommendation of administration is one tablet of
150mg per day until the reccurence or intolerable adverse
effects. In clinical trials, common adverse effects included
gastrointestinal disorders (nausea, vomiting, diarrhoea
and constipation), muscle spasms, fatigue, hair loss, and
dysgeusia.
Case reports : In winter 2014, a 91-yr-old woman was reffered to our consultation for a BCC of corner of the mouth,
which had been neglected for years. The lesion extended
from the middle of the lower lip to the nostril, causing
an important shrinkage of the corner of the mouth. The
teeth were therefore apparent through an important skin
gap, which interfered with both speech and eating. The
patient was presented at our Tumor Board, where plastic surgeon decided not to operate, due to the complex
facial reconstruction needed, anticipating several hours
of general anesthesia in this elderly lady (who would have
refused the procedure anyway). Radio-oncologists argmunted that radiotherapy could not hope to be curative
without leading to several complications, including dental loss, and further retraction of the cheek, leading to further functional impairment of the function. We therefore
opted for vismodegib (Erivedge). The response was the
fastest we had observed, with a near complete response
after only 3 weeks of treatment at 150mg/day. Despite
the excellent response, the patient decided to interrupt
the treatment. After discussing the risk inherent with this
decision, the patient agreed to take a pulsed treatment of
3 weeks every 2 months. After 6 month of this regimen,
the patient still has no sign of recurrence. However, she
did develop a mild diminution of her hair density and
some dysgeusia, jeopardizing the future of this treatment.
Conclusion : Vismodegib treatment offers a new therapeutic possibility for giant BCC, with spectacular responses visible after just few weeks. The pulsed regiment
presented here may be an efficient mean to diminish the
side effects of this therapy.
POSTERS
P67
Clinical features of a large hidradenitis suppurativa patient cohort at a Swiss tertiary center
T. Weidner, S. Meyhöfer, TJ. Maul, AGA. Kolios, LE. French, A.A.
Navarini
Dpt of Dermatology, University Hospital Zurich, Zurich
Hidradenitis suppurativa (HS) is a chronic inflammatory
disease of the skin and subcutis affecting predominantly
the large skin folds, namely the inguinal, genital, perianal,
axillar and submammary regions. HS can run in the family
and some cases have been shown to be driven by genetic
variants. The majority of cases are sporadic, however, and
environmental factors such as smoking as well as obesity
and subsequently humid microenvironment in the skin
folds have been shown to play a major role for disease elicitation and maintenance. Treatment options include surgical excision, topical and systemic antibiotics, intralesional steroids, systemic retinoids and most recently tumor
necrosis factor alpha antagonists.
Using a full-text search of the patient records at University
Hospital of Zurich between 01.01.2012 and 31.12.2014,
we identified 324 cases. 200 patients had a confirmed
and 124 a putative diagnosis of HS. Among the confirmed
cases, a slight male predominance of 53 % was found. The
mean age of all confirmed HS patients was 38 years. 20 %
were newly diagnosed with HS during the observation
period. 72 % of patients had a history of tobacco use. The
number of regions affected was 2.9 (+/- 1.4 SD). The groin
area was most often affected, followed by the axilla and
genital region. Patients consulted an average of twice a
year, and 18 % came for an emergency consultation. The
majority of the confirmed cases had Hurley stage II (48 %),
followed by Hurley I (37 %) and Hurley III (15 %). Fistulas
were identified in 40 % of the confirmed cases.
Limitations of our study included a lack of information
about the body mass index, impairment of quality of life
and partially incomplete scoring of lesions by treating
physicians. An analysis of treatment outcomes is currently
ongoing.
Taken together, at our center in Zurich, HS commonly presents as a chronic condition of younger patients with a
history of smoking, tends to produce recurring abscesses
in more than one intertriginous region as well as fistulas.
P68
Solid facial edema in acne
S. Kuhn-Régnier, J. Mangana, J.T. Maul, B. Meier, K. Kerl, L.E.
French, A.A. Navarini
Solid facial edema is a rare complication of acne vulgaris and was first described by Connelly and Winkelmann
in 1985. Here we report two cases from Switzerland. An
18-year old man, otherwise healthy, presented with
numerous papules and pustules on the forehead and
cheeks, compatible with acne papulopustulosa. A biopsy
confirmed acneiform skin lesions. He had been treated
with topical retinoids for 6 months to no avail – instead,
during treatment, facial edema developed that was centered around the periorbital area. Treatment with oral
prednisone and isotretinoin 20mg led to regression of the
edema after two months. Our second patient with solid
facial edema was a 20-year old man. He suffered from papulopustular acne that was resistant to topical retinoids
as well. A skin biopsy confirmed the clinical diagnosis
of acneiform lesions. Only after 8 months of isotretinoin
treatment 20mg did the edema slowly disappear.
Our cases show a strikingly similar clinical appearance
to the cases described by Connelly and Winkelmann in
1985, as well as to cases of Morbihan’s disease that occurs
in rosacea. Even 30 years after the first recognition of this
disease, the cause of the edema remains unknown. In two
of their four cases, a triggering factor was present such
as trauma or insect bite – however, our patients did not
report such an event. Taken together, the rare cases of
solid facial edema in both acne and rosacea might hold
the key to understanding a specific inflammatory pattern
that creates both persisting inflammation and disturbed
fluid homeostasis that can occur in slightly different pre-
70
P69
Resiquimod Gel 0.06 % can induce immune reactions
inducing complete regression of nodular Basal- cell
Carcinomas
M.C. Nägeli1, R. Rubino2, J. Dreier1, O. Atsushi1, C. Surber1, L.E.
French1, R. Dummer1
2 Galderma-Spirig, Egerkingen
Background and Objective : Nodular Basal-cell carcinomas (BCC) are very frequent in elderly patients.
Although most basal-cell carcinomas are treated surgically, only few effective topical therapies exist for nodular
BCC. In a phase I/II study we investigated the efficacy of
a new topical therapy for nodular BCC with Resiquimod
Gel 0.06 %.
Methods : In this open label, trial patients with untreated, histological confirmed nodular BCC on the head,
neck, torso or arms were included. At our site 4 patients
received Resiquimod Gel 0.06 %, self-applied once daily
for 5 consecutive days followed with 2 days break for one
lesion. After 3 cycles (3 weeks) the therapy was stopped
after having reached the biological endpoint (skin ulceration followed by clinical clearance of the lesion, the primary end point. The treated area was explored histologically 2 months after having stopped the treatment.
Results: In all 4 patients with nodular BCC the local reaction peaked after 3 weeks. Histologically, a complete remission in 3 out of 4 patients (75 %) complete response
has been demonstrated. Only one patient showed adverse events (a possibly related dyspnea, which was reversible after stopping therapy). Gene expression analysis
showed increased Th1 and pro-inflammatory cytokines
and decreased Th2 cytokines, showing a Th1 response
pattern.
Conclusion and Limitations : Resiquimod Gel 0.06 % applied topically seems to be highly effective for the treatment of nodular BCC, but further trials including more
patients are needed to confirm the results
(Funded by Spirig Pharma ltd ; ClinicalTrials.gov number,
NCT01808950)
P70
Familial cutaneous leishmaniasis to l.major : comparable efficacity of paromomycin oinment and antimonial injections
A. Neub1, S. Asner2, P. Buffet3, C. Conrad1, M. Gilliet1, J. Di
Lucca1
1 Service de Dermatologie, CHUV, Lausanne
2 Service de Pédiatrie, CHUV, Lausanne
3 Pierre and Marie Curie University, Paris
Introduction: Cutaneous leishmaniasis is a frequent traveler’s dermatosis. The incubation period ranges from 3
weeks to 3 months. Treatment decision depends on the
localisation, clinical aspect of the lesion(s), infecting species and the age of the patient. Here we report a case of
three family members infected with L. major successfully
treated with different treatment approaches.
Case report: A family consulted for lesions that had
appeared after their vacation in Israel 4 months before
with slowly growing. The 40-year old woman presented 3
crusty nodular lesions on the arm and the back and an additional large ulceration (5 cm) on the leg. Her 49-year old
husband presented 5 crusty nodular lesions on the limbs.
Their 3-year old son presented a single infracentimetric
nodule of the glabella. Leishmania major was identified
by polymerase chain reaction in skin biopsy from the
adults and skin scratching from the son. The parents were
successfully treated with a combination of cryotherapy
and intralesional infiltration of antimonials (Glutamine®),
once weekly over 3 weeks. The women’s ulceration had
to be treated 2 weeks longer. The boy was initially monitored. After 2 weeks however, the lesion was progressing
towards the eye and he developed a second nodule on
the ankle. In order to avoid a painful treatment and potential scarring following cryotherapy, we started a topical therapy with Leshcutan® (15 % Paromomycin and 12 %
methylbenzethonium chloride ointment), applied twice
a day under occlusion. The treatment had to be interrupted after a few days because of eyelide irritation, but
the lesions resolved completely without scarring after 20
days. None of the patients showed recurrence at 1 month
follow up.
Discussion: Our case illustrates that there are multiple
treatment approaches in cutaneous leishmaniasis. For
up to 3 lesions with a diameter < 30mm local treatment
is the therapy modality of choice. The combination of
cryotherapy and intralesional injection of antimonials
achieves a better cure rate (89 %–91 %) than cryotherapy
(57 %–68 %) or intralesional antimonials alone (44–75 %).
However, paromomycin, an aminosidine antibiotic, can
also be an effective as an ointment applied topically. Advantages are lack of pain during administration and avoidance of scarring, which may be particularly important
for the pediatric population. Disadvantages are irritation
after topical application and the poor availability of the
drug.
P71
BRAF resistance profile in melanoma for the identification of new treatment options
V. Paulitschke1, P.F. Cheng1, O.M. Eichhoff1, D.S. Widmer1, C.
Gerner2, R. Kunstfeld3, H. Pehamberger3, R. Dummer1, M.P.
Levesque1
1 Institute of Dermatology, University Hospital Zurich, Zurich
2 Institute of Analytical Chemistry, University of Vienna, Vienna
3 Institute of Dermatology, Medical University Vienna, Vienna
The FDA-approved BRAF inhibitor vemurafenib achieves
outstanding clinical response rates in patients with melanoma, but early resistance is common. Understanding the
pathologic mechanisms of drug resistance and identification of effective therapeutic alternatives are key scientific
challenges in the melanoma setting.
Despite intensive efforts the breakthrough to understand
and prevent resistance to BRAF inhibition is not achieved.
This might be due to the plasticity and heterogeneity of
melanoma which allow the tumor cells to adapt to biological processes. Proteomics facilitates the most biological
relevant insight into the pathophysiological conditions
derived from protein expression profiles and enables to
detect protein signatures. Subcellular fractionation of primary sensitive and resistant V600E mutated melanoma
cells and subsequent proteome analysis was performed.
Bioinformatic analysis revealed an enhanced expression
of the lysosomal compartment, increased potential for
metastasis, migration, adherence and Ca2+ ion binding,
enhanced expression of MAPK pathway, increased V-type
proteon ATPase activity, MHC-I expression and epithelialmesenchymal transition. The most informative proteins
to distinguish between sensitive and resistant cells were
also confirmed on RNA level. Polymerase I and transcript
release factor (PTRF) a protein involved in caveoli formation, revealed to be highly expressed in the BRAF resistant melanoma cells. Performing immunohistochemistry
on melanoma metastasis of patients with sensitivity,
intermediate response and resistance revealed a higher
expression in the resistant cohort indicating that this protein might serve as predictive biomarker.
sentation in dermatomyositis, angioedema, Heerfordt’s
syndrome and other conditions.
71
Employing high-throughput methods for cell line and
drug characterization may thus offer a new way to identify key features of vemurafenib resistance, facilitating the
design of effective rational therapeutic alternatives.
P72
Loss of 5-hydroxymethylcytosine is an important biomarker in malignant melanoma progression
O. Pavlova1, S. Fraitag2, D. Hohl1
1 Service of Dermatology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
2 Service of Dermatology, Necker-Enfants Malades Hospital,
APHP, Paris-Descartes University, Paris, France
Background: DNA methylation is one of the best studied
epigenetic modifications, which controls gene expression, cell differentiation and normal chromatin function.
Alterations in DNA methylation system, induced through
different pathogenetic mechanisms, appear on earliest
stages of carcinogenesis and increase with tumor progression. Ten-eleven translocation family of enzymes catalyze the oxidation of 5-methylcytosine (5-mC) to 5-hydroxymethylcytosine (5-hmC), which is an intermediate
of multistep DNA demethylation. Here, we aimed to analyze the expression of 5-hydroxymethylcytosine in benign
melanocytic lesions compared to malignant melanomas.
Methods: The present study describes a retrospective
analysis of 5-hmC staining in specimens from patients
with malignant and benign melanocytic lesions. Immunohistochemical assay was performed with primary rabbit anti-5-hmC-antibodies. Percent of 5-hmC positive cells
were counted by using ImageJ software. Positive staining
for 5-hmC was defined as a dark brown staining pattern,
restricted to the nuclear region. Slight or fine granular
cytoplasmic staining and the absence of staining were
considered as negative. Epidermal keratinocytes and
intradermal cells were used as internal positive controls.
Results: We found significant differences in 5-hmC expression levels between benign melanocytic lesions and malignant melanomas. All investigated nevi showed strong
nuclear 5-hmC staining pattern whereas in melanomas it
was significantly reduced or totally absent. In compound
Reed and Spitz nevi we detected less 5-hmC positive cells
compared to other nevi. However, Spitz nevi presented
higher levels of 5-hmC expression in contrast to melanomas. Progressively decreased 5-hmC expression was correlated with melanoma progression. In addition, proliferative nodules, arising within giant congenital nevi, showed
high 5-hmC levels, similar to congenital nevi. However, in
melanomas, associated with giant congenital nevi, and
childhood sporadic melanomas 5-hmC nuclear staining
was lost. Conclusions: The presence of 5-hmC in benign
nevi proves its biological function for normal melanocyte differentiation. In contrast, loss of 5-hmC plays the
critical role for initiation of oncogenic pathways, underlying melanoma progression.Thus, loss of 5-hmC can provide a simple, diagnostic tool for efficient distinguishing
between malignant melanomas and benign melanocytic
lesions.
P73
POSTERS
Granuloma annulare-like tattoo reaction
M.-A. Peeters, I. Masouye
Service de dermatologie, Hôpitaux Universitaires de Genève,
Genève
Introduction: The number of tattooed people has substantially increased in the past years. Among the numerous
adverse reactions reported, a wide range of inflammatory
reaction patterns have been described. Granuloma annulare reaction histologically at a tattoo site is rarely described. We report herein a new case.
Observation: A 39-year-old bresilian woman presented
with an itchy, infiltrated and hyperkeratotic reaction of
a tattoo on her right ankle for 6 months. This reaction
was restricted to the red part of the tattoo, realised one
year previously. Histopathological examination revealed
a fairly large epidermal acanthosis, irregular, with pseudoepitheliomatous places, sometimes emphasized by a
lichenoid infiltrate. The entire height of the dermis had
a fibrous appearance, with a lympho-histio-plasmocytic
infiltrate associated with a few polymorphonuclear neutrophils and numerous giant cells of foreign body. Large
areas of collagen necrobiosis were noted, surrounded
by palissadic granuloma. Mucin deposits were found at
colloidal iron coloration. Exogenous granular deposits
corresponding to the tattoo were disseminated over the
entire height of the dermis. No foreign bodies birefringent were found at polarized light. Special stains for organisms were negative. Considering the unusual presence
of neutrophils and plasma cells, an infectious process was
excluded by bacterial and mycobacterial culture. Clobetasol propionate ointment applied once daily provided
partial relief of pruritus. The patient received later an intralesional injection of triamcinolon but missed her last
control appointment.
Discussion: Adverse reactions to tattoos occur to the
exogenous pigment or its carrier solution. The majority of
cutaneous reactions to exogenous tattoo pigments can
be histologically classified as lichenoid (most frequently)
or granulomatous. Granuloma annulare reaction pattern
is exceptionnaly rare with only 6 cases reported in the literature. Those cases have been associated specially with
red pigment, but also with black and blue. The etiology
of this reaction is still uncertain but is generally accepted
to be a delayed-type hypersensitivity reaction. The time
taken for this reactions to develop in a tattoo can be highly variable from days to several years after tattoo application. Treatment of granulomatous reactions to tattoos has
variable success. Topical or intralesional corticosteroids or
laser ablation may be beneficial.
P74
Dermatology 100 years ago ? Test your knowledge !
D.L. Perruchoud, F. Schibler, S. Häsler, L. Borradori, R. Della
Torre
Dpt of Dermatology, Inselspital, Bern University Hospital, Berne
We here present an interactive quiz using historical clinical images of dermatological diseases made on glass
plates, which are stored in our Department archives in
Bern.
The selection included 85 photos taken between the
years 1914 and 1916.
The majority of the available images depicted infectious
cutaneous diseases, since 11 % and 12 % of the 85 cases
involved syphilis and cutaneous mycoses, respectively.
Sarcoidosis was depicted in 7 % of the 85 photographs,
while cutaneous lupus was illustrated in 6 % of the pictures. The remaining documentated skin diseases included cases of putative dermatitis herpetiformis, eczema
and cutaneous T-cell lymphoma in 5 % of cases, each.
More rarely, lues connata, port-wine-stains and hemangiomas, ichthyosis and dermatitis from iodine preparations were found.
Congress participants are invited to test their clinical
knowledge using these historic images. The originally
provided diagnoses well illustrate the significant changes
in the dermatological nomenclature and spectrum of pathologies which occurred in the last century.
72
Von Dermatologen empfohlen.1
Haarausfall?
DIREKT richtig behandeln.
Mit Neocapil.®
Medizinische Lösung gegen
anlagebedingten Haarausfall
Fördert das Wachstum neuer Haare
und belebt direkt 2-4
Generell gut verträglich bei lokaler
Anwendung 2-4
Wirkstoff Minoxidil: Wirksamkeit in
klinischen Studien belegt 3, 4
www.haarausfall.expert
Für Frauen: Neocapil ® 2%
1 Blumeyer A et al. S3-Guideline for the treatment of androgenetic alopecia in women and in men, JDDG, 6, 2011; 9 Suppl 6: 1–57. 2 Neocapil ® 2 % bzw. 5 % Fachinformation unter www.swissmedicinfo.ch 3 Olsen EA et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment
of androgenetic alopecia in men. J Am Acad Dermatol, 2002; 47 (3): 377–85. 4 Lucky AW et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil
solutions in the treatment of female pattern hair loss. J Am Acad Dermatol, 2004; 50 (4): 541–53.
Neocapil® 2 % & 5 % Lösung. Z: Neocapil 2 %: Minoxidil 20 mg/ml, Neocapil 5 %: 50 mg/ml Lösung. Hilfsstoffe: Ethanolum, Propylenglycolum, Excip. ad solutio.
I: Neocapil 2 %: Topische Behandlung der Alopecia androgenetica bei Männern und Frauen. Neocapil 5 %: Topische Behandlung der Alopecia androgenetica bei
Männern im Alter von 18–65 J. Bei Frauen auf ärztliche Verschreibung. Neocapil reduziert den übermässigen Haarausfall und fördert das Wachstum neuer Haare. D:
Erw. 18–65 J.: Äusserlich 2 × tgl. (Max. 10 Hübe = 1 ml) für mind. 4 Monate auf die gesunde, trockene Kopfhaut auftragen. Nicht auf andere Körperstellen auftragen.
Max. 2 ml/Tag. KI: Bekannte Überempfindlichkeit gegenüber einem Inhaltsstoff. VM: Vorsicht bei kardiovaskulären Erkrankungen, Arrhythmien, bei versehentlicher Einnahme, bei Anzeichen systemischer Wirkung durch erhöhte Resorption. Augen-und Schleimhautkontakt vermeiden, Spraydämpfe nicht einatmen. Nicht
mit anderen Topika zusammen verwenden. Veränderung der Haarfarbe und Haarstruktur möglich (bei grauem Haar beim Schwimmen). Pat. < 18 und > 65J. IA:
Antihypertonika, Arzneimittel gegen erektile Dysfunktion, Betablocker, andere Topika und Mittel, welche die Hautresorption verstärken. UAW: Häufig: Ekzematische
Reaktionen, allergische Kontaktdermatitis, Haarausfall und Alopezie, Hypertrichose inkl. Wachstum von Gesichtshaaren bei Frauen, lokale Erytheme, Pruritus, trockene, schuppende Haut. SS/ST: Keine kontrollierten Studien vorhanden. Während der Schwangerschaft /Stillzeit nicht anwenden. P: Pumpspray 50 ml (mit Sprühkopf
und Aufsatz mit verlängerter Spitze). Liste C; Liste B für Neocapil 5 % bei Frauen. Weiterführende Informationen finden Sie unter www.swissmedicinfo.ch. Stand der
Information: Neocapil 2 %: Dezember 2008, Neocapil 5 %: April 2010.
Zulassungsinhaberin: Spirig Pharma AG, 4622 Egerkingen.
er:
Für Männ
%
Neocapil 5
®
P75
P77
Trachyonychia
Pancreatic panniculitis in the absence of abdominal
symptoms : report of a case.
J. El-Kehdy, D.L. Perruchoud, E. Haneke
Dpt of Dermatology, Inselspital Bern University Hospital, Berne
We present the case of a 12-year-old boy affected by
dystrophy of all fingernails and toenails since about the
age of 3 years. The family history was positive for atopic
dermatitis (mother and maternal grandmother) and hay
fever (sister and brother).
Clinically, all nail plates were opaque, lusterless and rough
with superficial parallel longitudinal ridging and multiple
small punctate depressions. They had a grey-brown discoloration.
Trachyonychia is the main sign of twenty-nail dystrophy
(TND). It is a rare autosomal nail disease with slightly more
than 50 cases described in the literature. It may start at
birth, but most cases begin between 4 and 6 years of age
and slowly progress. TND can rarely also begin in adulthood. There is a slight male predominance. TND mayoccur as either isolated disease or, more rarely, as manifestation of lichen planus, atopic dermatitis, vitiligo or psoriasis
vulgaris. When the clinical diagnosis is unclear and there
is no underlying condition to explain the twenty-nail
dystrophy, a longitudinal nail biopsy may be useful. TND
usually resolves before the age of sixteen years. Therefore,
reassurance is important. Different treatment modalities
have been tried, including PUVA, intralesional triamcinolone acetonide alone or in combination with oral griseofulvin. We recommend to use a combination of betamethasone plus calcipotriol.
P76
Invasive squamous cell carcinoma of the thumb developping after anti TNF treatment for chronic acrodermatitis continua of Hallopeau
AM. Thielen1, I. Masouyé2, XC. Pham2
POSTERS
1 Cabinet de dermatolologie, Avenue de Frontenex 34, Genève
2 Service de dermatologie, Hôpitaux Universitaires de Genève
Chronic acrodermatitis continua of Hallopeau is a rare
disease characterized by the presence of aseptic pustules
on an inflammatory basis of the periungual and subungual region, inducing important physical and psychological morbidity. Association with invasive squamous cell
carcinoma has not been reported to date.
We present a case of a 74 year-old patient with unilateral
Hallopeau's acrodermatitis of his right hand with severe
involvement of the thumb for over 50 years. This disease
was refractory to multiple topical and systemic treatments, including acitretin, colchicine, thalidomide, PUVA
phototherapy, cyclosporine, methotrexate and infliximab.
Long term disease control could be observed with etanercept but this treatment was discontinued on patient's
request. Several weeks after reintroduction of etanercept
for disease recurrence, the patient developed an extensive HPV-negative invasive squamous cell carcinoma of
the thumb unresponsive to radiotherapy and requiring
amputation.
Treatment of psoriasis with phototherapy and cyclosporine is associated with an increased risk of non-melanoma
skin cancer. Contribution of chronic inflammation to promote tumorigenesis is also known. Due to the late onset of
invasive squamous cell carcinoma in our case, we discuss
a chronic inflammatory process and a long term antiTNF
treatment in addition to phototherapy and cyclosporine
as possible contributing factors in the development of
this agressive form of non-melanoma skin cancer.
S Radonjic-Hoesli, S Haesler, HW Klötgen, H. Beltraminelli, L.
Borradori
Clinic of Dermatology, University Hospital of Bern, Bern
Pancreatic panniculitis is a rare variant of panniculitis resulting in fat necrosis. It is found associated with a wide
range of different pancreatic diseases, such as pancreatitis, pancreatic carcinoma and other pancreatic anomalies.
We here present a patient who developed tender subcutaneous nodules on the lower limbs. The lesions progressively underwent ulcerations and discharge with brown
and yellow viscous secretions. Light microscopy studies
of a subcutaneous nodule showed a lobular panniculitis,
fat vacuoles, foam cells and ghost adipocytes. Work up of
the affected patient disclosed an increased levels of lipase
and amylase as well as the presence of billary stones. One
of the latter was most likely responsible for an acute pancreatitis.
Pancreatic panniculitis should be considered in all patients presenting with a panniculitis. In addition to subcutaneous nodules, fat necrosis may also affect periarticular,
abdominal and intramedullary adipose tissue. Most importantly, in up to 40 % of cases, skin manifestations can
precede the abdominal symptoms of pancreatic disease.
Hence, pancreatic panniculitis should be excluded also in
the absence of abdominal symptoms and of laboratory
abnormalities.
P78
5 quiz cases of 2015
A. Rammlmair1, C. Mangas1, G. Marazza1, P. Michalopoulos1,
H. Beltraminelli2, R. Blum2, L. Mazzuchelli3, C. Mainetti1
1 Dpt of Dermatology, Regional Hospital, Bellinzona
2 Dpt of Dermatology, University of Berne, Inselspital, Berne
3 Cantonal Institute of Pathology, Locarno
Background. Dermoscopy is a valuable aid in diagnosing
pigmented and not pigmented skin lesions. We report
five difficult cases from our clinic. In those cases dermoscopy was a clue for diagnosis.
Methods. Cases are reported with a short clinical description, dermoscopy image and a histological picture if
available. We propose a differential diagnosis by multiple
choice options. Final diagnosis and a short discussion is
shown at the end of the poster.
Case description.
Case 1. A 28 years old female patient with a melanocytic lesion of the left abdomen that changed in the last
months by appearing less pigmented. Dermoscopy
showed characteristics of regression with irregular dots
and vessels asymmetrically distributed.
Case 2. A 33 years old female patient with a melanocytic
lesion in the center of abdomen that has shown regression of pigmentation in the last months. Dermoscopy
showed hypopigmented area in the periphery with partially destroyed pigmented network and irregular dots.
Case 3. A young girl with a worrisome rapidly changed nevus on her leg without previous traumatism. Dermoscopy
showed a peripheral vascular ring with a dermal nevus
in the center. After some weeks, the nevus became to its
normal appearance.
Case 4. A 49 years old female patient is already known
for hysterectomy for adenocarcinoma of endometrium
in 2009. Her sister was operated in 2011 for neoplasia
of colon and endometrium. The patient shows a nodular erythematous skin lesion on the left chest and lateral
right trunk. Dermoscopy shows a non-melanocytic lesion
with yellow lobular-like and vascular structures.
74
P79
Acquired reactive perforating dermatosis in a patient
with generalized pruritus, fatigue, xerostomia and xerophthalmia – a case report
A. Rammlmair1, C. Guillod1, I. Marsteller2, C. Mondino3, P. Michalopoulos1, R. Blum4, L. Mazzucchelli5, C. Mainetti1
1 Institute of Dermatology, Regional Hospital of Bellinzona, Bellinzona
2 Institute of Gastroenterology, Regional Hospital of Bellinzona,
Bellinzona
3 Institute of Allergology, Regional Hospital of Bellinzona, Bellinzona
4 Institute of Dermatopathology, University Hospital of Berne,
Berne
5 Cantonal Institute of Pathology, Locarno
Background: Acquired reactive perforating dermatosis
(ARPD) is characterized histopathologically by transepidermal elimination of various substances from the upper
dermis and clinically by itching umbilicated skin-coloured papulo-nodules with a central crust. ARPD has been
frequently associated with diabetes mellitus, chronic
renal failure and dermatologic diseases. Primary biliary
cirrhosis (PBC) is a rare chronic cholestatic liver disease
characterized by gradual destruction of intrahepatic
bile ducts. Positive anti-mitochondrial antibodies (AMA),
especially the anti-M2 antibody, are key findings in PBC.
Fatigue and itching are common symptoms.
Case report: We present the case of a 60-years-old woman
(BMI 30) with insulin-dependent diabetes mellitus who
was admitted to our hospital for generalized pruritus
associated with fatigue. Physical examination revealed
jaundiced sclera and skin as well as xerostomia and xerophthalmia. On the trunk were present nodular perforating skin lesions.
Histopathological analysis of a biopsy of a nodular skin
lesion was consistent with collagenous perforating dermatosis.
Laboratory tests were consistent with cholestatic liver
disease, documented for at least 10 years, with only slight
"co-"elevation of transaminases. There were clearly positive titres for anti-mitochondrial and anti-M2 antibodies.
Hepatic biopsy showed chronic portal hepatitis of granulomatous aspect, with plasma cells and discrete signs
of inflammatory cholestasis. A fibrosis score ‘F3’ was diagnosed. Diagnosis of PBC was done.
Given the sicca syndrome, a salivary gland biopsy (focal
lymphocyte sialadenitis) and immunological tests (positive anti-SS-A antibodies) were performed: diagnosis of a
Sjögren syndrome (SSY) was considered.
APD-treatment with topical corticosteroids and injections
of triamcinolone followed by topical tretinoin led to a partial healing of the skin lesions. For PBC, a treatment with
ursodeoxycholic acid was started.
Conclusion: We report the case of ARPD in association
with newly diagnosed PBC and supposable SSY. To our
best knowledge, this is the second case in the literature
of ADP associated with PBC. Based on clinical data and
laboratory results, we suggest that PBC figures as ‘primum
movens’ in this case of ARPD, even though our patient is
diabetic. If diagnosing ARPD in the future, we recommend
an accurate systemic medical work up looking also for
rare systemic diseases like PBC.
P80
Fish tank granuloma caused by Myocobacterium marinum: report of two cases
I. Räber, R. Blum , D. Perruchoud
Dpt of Dermatology, Bern University Hospital, Switzerland
Mycobacterium marinum infections are observed worldwide in both salt and fresh water, including fish tanks. We
here present two patients who progressively developed
cutaneous nodules with a linear sporotrichoid distribution on the dominant hand and arm.
Light microscopy studies showed a mixed neutrophilicrich inflammation with epitheloid cell granulomas. Mycobacterium marinum was found in the culture of skin biopsies confirming the diagnosis of fish tank granuloma. The
patients were given a treatment of doxycycline, 100 mg
twice daily, which resulted in a complete resolution after
1-2 months.
Fish tank granulomas induced by Mycobacterium marinum infection should be always considered in the presence of multiple papulo-nodular lesions developing
along the lymphatic drainage. According to the geographic location and patient’s history, tuberculosis, other
mycobacteria (M. kansaii, M. chelonae), blastomycosis,
sporotrichosis, histoplasmosis and nocardiosis should be
searched or excluded. An adequate patient’s history (travel history, hobbies) is important for a correct and prompt
diagnosis.
Effective prevention with the use of gloves should be
advised to fish tank owners and immunosuppressed patients should avoid direct contact with fish tanks.
P81
A blossoming flower- pseudolymphomatous reaction
in red tattoo
I. Saulite1, K. Kerl2, A. Cozzio2, E. Guenova2
1 Dpt of Dermatology, Riga Stradins University, Riga
Decorative tattooing is a procedure of intradermal introduction of an exogenous pigment and/or dye with the
aim to create a permanent skin decoration. Rising prevalence of tattooed individuals leads to an increased number of reported tattoo-related complications.
Pseudolymphoma or cutaneous lymphoid hyperplasia
(CLH) is a benign reactive proliferation of lymphocytes
that may be a peculiar complication occurring secondary
to tattoos. We present a rare case of psedolymphomatous
reaction arising in a red tattoo providing clinical features,
histological and molecular aspects.
A 32-year-old woman presented with a livid red infiltrated nodular tumor sharply demarcated to the red part
of a red, black and green coloured tattoo 9 months after
the tattooing procedure. Histopathologic examination
of the lesion revealed a pseudolymphomatous reaction
showing lymphocytic infiltration with epidermotropism
and follikulotropism without atypical cells, in addition red
pigment deposition and eosinophilic infiltration could be
observed. Immunohistological staining showed that the
majority (>80 %) of the cells wereCD3- positive, approximately 50 % of the cells expressed CD3 and CD4, whereas
less than 2 % was positive for CD30. The proliferation marker Ki-67 was positive in less than 5 % of the cells. Polymerase chain reaction (PCR) of the T cell receptor detected
no T-cell clonality. Differential blood count and routine
laboratory tests remained within the normal range.
The presented case highlights tattooing as a risk factor for
severe adverse reactions related to compounds of the ink
leading to both diagnostic and treatment challenges.
Case 5. A 79 years old man presented with an homogenous pigmented papule on the back besides to a surgical
scar of melanoma (Breslow 5.9 mm, Clark IV, 4 mitosis/m2)
resected with 2 cm margins 5 months ago. Sentinel lymph
node biopsy and Positron emission tomography were negative for metastasis. Dermoscopy of the new skin lesion
showed a globular pattern.
75
P82
Human IL-9 producing T-helper cells- A novel T-helper
cell subset ?
C. Micossé, C. Schlapbach
Dpt of Dermatology, University Hospital Bern, Bern
After antigen encounter, naïve CD4+ T cells become activated, expand and differentiate into specific T-helper cell
subsets. These subsets can be defined by their cytokine
profile, by their homing receptor repertoire, and by distinct transcription factors. In recent years, several novel
T-helper cell subsets have been proposed. However, most
of them do not fulfill classical definition requirements for
separate Th subsets. Furthermore, to what extend these
proposed Th subsets simply represent the result of Th cell
plasticity, e.g. the ability of already defined Th subset to
acquire expression of additional cytokines, remains a subject of debate.
One of these new subsets, IL-9 producing "Th9" cells, has
been studied in mouse models, where a protective function in tumor immunity and a pathogenic role in autoinflammation has been found. We have recently described
in vivo differentiated T cells with a "Th9" phenotype in
humans, raising the possibility to investigate whether
these cells indeed represent a bona fide Th cell subset. To
this end, we are currently studying 1) the expression of
defined chemokine receptors, 2) the phenotypic stability,
3) the differentiation status, and 4) the contribution to
human inflammatory skin disease of human IL-9 producing CD4+T cells. Our preliminary data indicate these cells
are enriched in the population of CXCR3-/CCR4+/CCR6-/
CCR8+ effector memory T cells and show phenotypic
stability after repeated restimulation. Finally, we find IL-9
secreting Th cells in human inflammatory skin diseases
where they appear to secret IL-9 along with other disease
specific cytokines.
P83
Sensitization to mouse (Mus m 1) is a leading pattern
in Amaxhosa atopic dermatitis patients in Cape Town
Region, South Africa.
P. Schmid-Grendelmeier1, F. Thawer-Esmail2, A. Irvine3, H.
Carrara2, G. Todd2
POSTERS
1 Allergy Unit, Dept. fo Dermatology, University Hospital of Zürich, Zürich, Switzerland
2 Division of Dermatology, Faculty of Health Sciences, University
of Cape Town,, Cape Town, South Africa
3 Lady's Hospital for Sick Children, Dublin, Ireland
Background : The prevalence of Atopic dermatitis on (AD)
is on the rise in some African countries. Data on the prevalence, atopic characteristics and sensitization patterns in
AD patients from Africa are sparse.
Thus we wanted To define the prevalence of raised IgE
and sensitization patterns to different allergens in an African population with AD
Method : Subjects (n=102) with AD of Xhosa ethnic background attending a tertiary hospital were recruited. These
patients were then matched for age, sex and ethnicity
and compared with 155 healthy controls. The subjects
had bloods taken for IgE levels (both total and specific)
and for parasite serology. ImmunoCAP® ISAC wasused to
determine specific IgE against 103 allergens.
ImmunoCAP/RAST was used to compare the ISAC findings for HDM, peanut and egg white.
Results : The atopic eczema severity score according
to NESS (Nottingham eczema severity score) showed
23(22.5) with mild,, 45(44.1 %) with moderate and
34(33.3 %) with severe AD. The total IgE was raised in
91.8 % of the 73 patients compared to 48.7 % of the 148
controls whose samples were available for testing. Of the
73 patients,28 % had levels >5000 compared to 0.6 % of
148 controls.Higher IgE levels were found in more severe
disease. A positive specific IgE to at least one allergen was
found in 89.5 % of the patients (n=76) compared to 20.3 %
of controls(n=148). The most common inhalant allergens
to which the patients were sensitized were: house dust
mite, storage mites, grass, and pollen while egg proteins
were the highest prevalent food allergens.A striking
finding was the high sensitization rate to mouse allergen (Mus m 1), correlating to a certain degree inversely
with the socioeconomic status, as patiets in low-income
households were more often sensitized to Mus m 1.
Conclusion: As in other populations, IgE levels in the
Xhosa population are also higher in AD patients compared to controls and correlate to clinical severity. Sensitization patterns in AD patients are dominated by mites
and grass,and especially in childhood also to foods (egg
white, peanut). As found in patients with asthma in underprivileged tropical or inner-cities areas , sensitization
against mouse (Mus m1) was predominant finding in the
AD patients. Thus sensitization to Mus m1 seems to be a
leading leading marker namely for patients with lower
income also in AD.
P84
Elderly suffer less frequent but more severe from allergic diseases : Prevalence of atopy and respiratory allergic diseases in the elderly SAPALDIA population
P. Schmid-Grendelmeier1, B. Wüthrich1, Ch. Schindler2, M.
Imboden2, A. Bircher3, E. Zemp2, N. Probst2
1 Allergy Unit, Dept. of Dermatology, University Hospital of Zürich, Zürich
2 Dept of Epidemiology and Public Health, Swiss Tropical and
Public Health Institute, University of, Basel
3 Division of Allergology, Dpt of Dermatology, University Hospital, Basel
Background : Because of changing world demographics,
the elderly population is steadily increasing. Few studies have assessed the prevalence of atopy and allergic
diseases in elderly persons with objective measures. The
aim of this paper is to describe the prevalence of atopy,
self-reported allergic rhinitis and doctor's diagnosed asthma in persons over the age of 60 in Switzerland.
Methods : The cross-sectional examination of the Swiss
Study on Air Pollution and Health in Adults (SAPALDIA
1), performed in 1991, included 9,651 adults aged 18-60
years. In 2001-2002 the same subjects were invited for a
follow-up examination (SAPALDIA 2). Serum samples collected at baseline and follow-up were tested for specific
IgE sensitization with the Phadiatop® (Phadia, Uppsala,
Sweden, now Thermo Fisher Scientific) assay containing
a mixture of common respiratory allergens . Atopy was
defined as a positive result in the Phadiatop test according to guidelines by the manufacturer. The prevalence
rates of atopy, self-reported allergic rhinitis and doctor's
diagnosed asthma were evaluated by sex and age group
(≤60 or >60 years).
Results : 7,667 subjects (men = 3,692/women = 3,975)
participated in the follow-up by responding to a detailed
questionnaire (80 % of SAPALDIA 1 participants). Phadiatop results were available for 5,835 participants (men =
2,839/women = 2,996). Prevalence rates of atopy (Phadiatop positive) were 36.4 % in men aged ≤60 years versus 26.2 % in men aged >60 years and 30.6 and 18.1 % in
women, respectively (both p < 0.001). Prevalence rates
of self-reported allergic rhinitis in subjects >60 years old
were 13.0 % for men and 15.4 % for women (p = 0.12),
and for doctor's diagnosed asthma 6.6 % versus 7.6 %,
respectively (p = 0.40). Both rhinitis and asthma prevalences were higher in persons <60 years. The results
were not sensitive to potential bias from nonparticipation at follow-up as demonstrated by imputation of
sex- and age-specific allergic rhinitis and asthma among
76
JETZT ZUGELASSEN UND KASSENZULÄSSIG
Der erste und einzige IL-17A Inhibitor
1
Cosentyx®
90-70-40
Eine neue Ära in der Psoriasis-Behandlung*
Starke Wirkung
Sicherheitsprofil
9 / 10 Patienten erreichen PASI 75**1,2
•
• 7 / 10 Patienten erreichen PASI 90**
• 4 / 10 Patienten erreichen PASI 100**
1
Mit Etanercept vergleichbare
Inzidenzrate von Nebenwirkungen
1,2
1,2
1,2
Monatliches Therapieschema
1
Anhaltende Wirkung
90 % der Patienten können einen PASI 90
von Woche 16 bis Woche 52 aufrechterhalten
1,2
* Cosentyx®/- SensoReady® ist zur Behandlung erwachsener Patienten mit mittelschwerer bis schwerer Plaque-Psoriasis indiziert.
** In Woche 16; der primäre Endpunkt war PASI 75 in Woche 12.
27676
Referenzen: 1. Fachinformation Cosentyx®, Stand Februar 2015, erhältlich unter www.swissmedicinfo.ch 2. Langley RG et al. Secukinumab in Plaque Psoriasis – Results of Two Phase Three Trials.
N Engl J Med. 2014 Jul 24;371(4):326-38.
Cosentyx® (Secukinumab): Z: Pulver zur Herstellung einer Injektionslösung: Jede Durchstechflasche enthält nach Rekonstitution mit 1 ml Wasser für Injektionszwecke 150 mg Secukinumab. Injektionslösung (Fertigspritze und
Fertigpen): Jede Fertigspritze bzw. jeder Fertigpen enthält 150 mg Secukinumab. I: Cosentyx/-SensoReady ist zur Behandlung erwachsener Patienten mit mittelschwerer bis schwerer Plaque-Psoriasis indiziert, die auf andere
systemische Therapien einschliesslich Ciclosporin, Methotrexat oder PUVA nicht angesprochen haben, bei denen diese Therapien kontraindiziert sind oder die diese Therapien nicht tolerieren. D: Die empfohlene Dosis beträgt 300 mg
als subkutane Injektion mit Startdosen in den Wochen 0, 1, 2 und 3, gefolgt von monatlichen Erhaltungsdosen beginnend in Woche 4. Jede 300-mg-Dosis wird in Form von zwei subkutanen Injektionen zu je 150 mg verabreicht. Bei
schwerwiegenden unerwünschten Wirkungen soll eine temporäre Unterbrechung der Therapie erwogen werden. Seltene mukokutane Kandida-Infekte traten häufiger unter 300 mg auf, in schwerwiegenden Fällen eine Dosisreduktion
auf 150 mg erwägen. Einzelheiten und spezielle Patientengruppen s. www.swissmedicinfo.ch. KI: Schwere Überempfindlichkeitsreaktionen gegenüber dem Wirkstoff oder einem der Hilfsstoffe. VM: Infektionen: Vorsicht bei Patienten
mit einer chronischen Infektion oder rezidivierenden Infektionen in der Vorgeschichte. Wenn ein Patient eine schwerwiegende Infektion entwickelt engmaschig überwachen; bis zum Abklingen der Infektion nicht verabreichen. An
Patienten mit aktiver Tuberkulose nicht verabreichen. Bei Patienten mit latenter Tuberkulose vor Einleitung einer Therapie eine Anti-Tuberkulose-Behandlung erwägen. Chronisch-entzündliche Darmerkrankungen: Es wurden
Einzelfälle von chronisch-entzündlichen Darmerkrankungen beobachtet, in einigen Fällen schwerwiegend; meist Exazerbationen eines vorbestehenden M. Crohn. In solchen Fällen Therapie sorgfältig reevaluieren und Therapieabbruch
erwägen. Secukinumab zeigte keine Wirksamkeit bei Patienten mit aktivem M. Crohn. Maligne Erkrankungen: In klinischen Studien bis zu 1 Jahr kein erhöhtes Risiko für maligne Erkrankungen. Resultate zur Langzeitsicherheit noch
nicht vorhanden. Überempfindlichkeitsreaktionen: Bei Auftreten einer anaphylaktischen oder einer anderen schwerwiegenden allergischen Reaktion die Gabe unverzüglich abbrechen, geeignete Therapiemassnahmen einleiten.
Aufflammen der Psoriasis bei Absetzen der Therapie («Rebound»): Bei Absetzen der Therapie bei Patienten, die primär angesprochen haben, das Risiko eines Rebounds berücksichtigen. Impfungen: Es wird empfohlen, geplante
Impfungen vor Beginn der Therapie abzuschliessen. Zeitlichen Abstand zwischen Impfungen mit Lebendimpfstoffen und Therapiebeginn gemäss aktuellen Impfrichtlinien zu immunsuppressiven Wirkstoffen einhalten. Lebendvakzinen
nicht gleichzeitig mit Cosentyx/-SensoReady verabreichen. Kombination mit anderen Biologika: Die gleichzeitige Verabreichung mit anderen Biologika wurde nicht untersucht und wird nicht empfohlen. Latex-empfindliche Personen
(Fertigspritze/Fertigpen): Die Nadelkappe kann Trockenkautschuk (Latex) enthalten. Schwangerschaft: Nur dann während einer Schwangerschaft anwenden, wenn der Nutzen die möglichen Risiken eindeutig überwiegt. Stillzeit: Bei
der Verabreichung an stillende Mütter ist Vorsicht geboten. Einzelheiten s. www.swissmedicinfo.ch. IA: Lebendvakzinen sollten nicht gleichzeitig verabreicht werden. Patienten, die Arzneimittel einnehmen, deren Dosis individuell
eingestellt wird und die durch CYP450 3A4, 1A2 oder 2C9 metabolisiert werden, sollten zu Beginn und Ende einer Therapie mit Secukinumab kontrolliert werden und die Dosis dieser Substanzen bei Bedarf angepasst werden.
Einzelheiten s. www.swissmedicinfo.ch. UW: Sehr häufig: Infektionen der oberen Atemwege (18.6 %); Häufig: Oraler Herpes, Rhinorrhö, Diarrhö, Urtikaria; Gelegentlich: Orale Candidose, Tinea pedis, Candidose des Oesophagus,
Neutropenie, Bindehautentzündung, Leberenzyme erhöht, Bilirubin erhöht. Einzelheiten s. www.swissmedicinfo.ch. P: Fertigspritze zu 150 mg: Packungen zu 1 und 2; Fertigpen zu 150 mg: Packungen zu 1 und 2; Pulver zur Herstellung
einer Injektionslösung in Durchstechflasche zu 150 mg: Packung zu 1. Verkaufskategorie: B. Weitere Informationen finden Sie unter www.swissmedicinfo.ch. 18.02.2015. V1
Weitere Informationen finden Sie unter www.swissmedicinfo.ch.
Novartis Pharma Schweiz AG, Risch; Adresse: Suurstoffi 14, 6343 Rotkreuz, Tel. 041 763 71 11
nonparticipants. Symtosm were rated as highly affecting
Qualitiy of life.
Conclusions: According to our estimates, the prevalence
of allergic rhinitis among persons aged between 60 and
70 years in Switzerland in the present cohort is of the
order of 13-15 % and should not be underestimated. Aalthough it is lower than in age groups ≤60 years, the associated symptoms seem to burden this age group more
than younger patients
with topical minoxidil/propecia is a consistant management option, reducing hair loss and giving back selfconfidance to the patient.
P85
Institute of Dermatology, University Hospital of Zurich, Zürich
Reticular erythrokeratoderm - Clinical symptoms and
identification of disease causing mutations
We present a recent case of a 85 year-old female patient
with metastatic melanoma stage IV, first diagnosed in September 2009. The first systemic therapy she received was
Dacarbazine from February 2013 to October 2013, 9 cycles
in total. In August 2014 the melanoma progressed so that
the patient was started on immunotherapy with Ipilimumab at 3mg/kg body weight. She received two injections
with one month apart before she developed abdominal
pain with mild diarrhea (garde 1). CT scan showed colitis
of colon descendant and sigmoid. As recommended in the
safety guidelines we ceased immunotherapy and started
treatment with high-dose corticosteroids (Solu-Medrol
125mg i.v.) then tapered with oral corticosteroids. The clinical symptoms and infectious parameters improved fast.
A few days later the patient presented with increasing
worsening of the general condition. CRP (c-reactive protein) increased massively. The following CT scan showed
perforation most probably of colon sigmoid. Although an
emergency exploratory laparatomy with hemicolectomy
was performed, the patient died the next day by multiple
organ failure. We assumed that the colitis was due to
immunotherapy with Ipilimumab. Surprisingly histology
showed focal ulcero-granulate inflammation with distinct
fibrosis of the submucosa and focal vascular amyloidosis.
The pattern reminds of ischemic colitis caused by vascular amyloidosis. Unfortunately we cannot evaluate if the
amyloidosis was primary or secondary.
I. Spoerri1, R. De Lorenzo2, P.H. Itin2, B. Burger1
1 Dpt of Biomedicine, University Hospital Basel and University of
Basel, Basel
2 Dermatology, University Hospital Basel, Basel
Reticular erythrokeratoderma (RE) is a severe inherited
skin disease, which has been described in a single patient
worldwide. Anamnesis of the affected individual points
to a dominant pattern of inheritance. This index patient
was noticed at 6 month of age with a general redness
oft the skin and was diagnosed with ichthyosis vulgaris
at 4 years of age. At 12 years of age the appearance of
the skin had changed markedly, showing linear arrayed
red-brown streaks of hyperkeratosis with slight scaling
most prominently on the trunk, but more or less affecting the whole integument. Since the disease appeared
to consist a separate and new entity, it was named RE. The
reticular skin pattern remained stable in adulthood and
meanwhile we know 2 further adult patients, all affected
by the disease and closely related to the index patient.
The aim of our research project is to characterize RE and
its course in the affected members of the index family. The
presence of closely related non-affected family members
enables us furthermore to identify the genetic cause of
RE by a combination of Next Generation Sequencing methods and RNA array. Uncovering pathologic mutations in
RE might relate this disease to other, possibly more common or better investigated diseases, whose established
ways of treatment might be effective in RE as well.
P87
Perforated Colitis after Ipilimumab (anti CTLA-4 antibody) Therapy. An immune-related adverse event ?
P. Stieger , R. Dummer , L. French , M. Maiwald
P88
Stem Cell Transplantation in advanced leukemic primary cutaneous T cell lymphoma. A case series.
P86
Hair loss reduction through cg210: a novel molecule
used as monotherapy or in combination with established treatments
Ph. Spring, P. Perrier, M. Vernez
POSTERS
Ceddecc/Dermatologie CHUV, Epalinges/Lausanne
Introduction : Hair loss is a commun dermatological
condition. Etiology may be androgenic alopecia (with lack
of oligo-elements), telogen effluvium or diffuse autoimmune alopecia. Standard management such as topical
minoxidil or systemic use of finasterid often fails because
of lack of compliance or contra-indication. Patients usually have been using also several frustrating off-label treatments without improvement. Recently, the enhancer of
the anagen phase cg210 took place as a credible management alternative. It can be used as monotherapy or in
combination with other treatments.
Methods : We present two cases of androgenic alopecia
treated with cg210. First case is treated with finasterid
and topical minoxidil. The second case hasn't been treated until now.
Results : After 3 month daily application of cg210, the
parietal objective and subjective hair density has significantly improved in both conditions.
Discussion : Cg210, as topical monotherapy or combined
C. Murer1, P. Stieger1, U. Schanz2, G. Nair2, E. Guenova1, A. Cozzio1
2 Institute of Hematology, University Hospital of Zurich, Zurich
Cutaneous T-cell lymphomas (CTCLs) is a heterogeneous
group of extranodal non-Hodgkin lymphomas, which
represent approximately 75 % of all primary cutaneous
lymphomas. Standard therapeutic approaches are well
established and may achieve stable disease. However,
currently the only option for curing CTCL is stem cell
transplant. In 1994 the first hematopoietic stem-cell transplantation (HSCT) was successfully performed in a patient
with MF. Since then several case studies and larger series
have been published. On average, patients after HSCT
show decreased relapse rates (<40 % after 1 year, <50 %
after 3 years post-transplantation) and increased overall
survival (>60 % after 1 year, >50 % after 3 years) compared
to conventional therapies (chemotherapy). Prospecting
studies are missing, but HSCT seems to be an important
treatment option in advanced CTCL. We report on our
experience with four consecutive patients with advanced
leukemic CTCL who underwent HSCT for CTCL in 2013 to
2015.
78
IL-32 and cathelicidin in hidradenitis suppurativa pathogenesis
R.Hunger1, R. Thomi1, C. Schlapbach1, D. Yerly2
1 Dpt of Dermatology, Inselspital, Bern
2 Dpt of Clinical Immunology/Allergology, Bern
Hidradenitis suppurativa (HS), also called acne inversa, is
an immune-mediated chronic inflammatory disease of
the apocrine gland-bearing skin with a largely unknown
cause and mechanism of progression. Over the last years,
HS lesions were found to contain high levels of pro-inflammatory cytokines such as TNFα, IL-1β, IL-12, IL-23
and IL-10 and also high levels of antimicrobial peptides
(AMPs), such as β-defensins and cathelicidin.
In a descriptive approach, we now determined the expression of IL-32, a pro-inflammatory cytokine, whose
induction and expression fits well with the inflammatory milieu present in HS. Semi-quantitative PCR results
showed higher expression of IL-32 in HS lesions compared to healthy skin and also compared to psoriasis and
atopic dermatitis lesions. Furthermore, IL-32 positive cells
found in HS dermis were shown to be NK cells, T cells and
DCs by double immunofluorescence stainings.
To investigate the role of AMPs in HS pathogenesis,
human PBMCs were stimulated with PHA and various
concentrations of cathelicidin. Preliminary data show that
cathelicidin has a positive impact on the proliferation of
CD4+ T cells in healthy donors and HS patients. This still
holds true, when only T cells are incubated with cathelicidin, which implies that cathelicidin directly mediates this
proliferative effect onto CD4+ T cells. Therefore, we hypothesise that cathelicidin downregulates the activation
threshold for CD4+ T cells, through which mechansims
remains to be determined. In a further step, PBMCs from
patients suffering from psoriasis and atopic dermatitis will
be analysed with the same approach to detect differences
in proliferation or cytokine expression between these
inflammatory skin diseases, which could lead to a better
understanding of the pathophysiology of HS, which in
turn could lead to more effective therapeutic approaches.
P90
Hyaluronic acid filler in human immune deficiency virus-associated facial lipoatrophy : evaluation of tissue
distribution and morphology with magnetic resonance
imaging
D. Salomon1, M. Becker2, N. Balagué3, X. Montet2, S. Zurcher1,
A. Calmy4, L. Toutous Trellu1
1 Service de dermatologie, Hôpitaux Universitaires de Genève,
Genève
2 Service de radiologie,Hôpitaux Universitaires de Genève, Genève
3 Service de chirurgie plastique et reconstructive, Hôpitaux Universitaires de Genève, Genève
4 Service des maladies infectieuses, Hôpitaux Universitaires de
Genève, Genève
This prospective observational study evaluated morphologic and volumetric MRI findings of hyaluronic acid (HA)
injections used for the correction of HIV-facial lipoatrophy. Material and methods: Ten consecutive males with
HIV facial lipoatrophy underwent bilateral subdermal
submalar HA injection (mean=1.3 ± 0.6ml per side) and
MRI examinations prior to, then at 1, 6 and 12 months after injection. The MRI protocol had been validated using
a customized phantom. Two radiologists blinded to clinical data assessed morphologic and quantitative changes.
Results : HA was well tolerated. Cosmetic results assessed
by the global aesthetic score and patient satisfaction
measured by the quality of life score were good-excellent.
MRI revealed HA deposition in the subdermal and deep
fat compartments, mainly Bichat’s pad. Significant HA
volume increase was observed 1 month after injection
(mean increase = 331 %, p<0.0001), as compared to the
injected amount. No volume reduction occurred at 12
months (p = 0.9961). The measured bound water content
did not change (p>0.9991), whereas skin thickness and
tissue vascularization increased during the first 6 months
and decreased afterwards (p≤0.01). In conclusion, our
data show that cosmetic results of HA injections in HIV lipoatrophy are caused by water binding in the deep facial
fat and by transient increase in vascularization and skin
thickness.
P91
Vitiligo induced by sirsasana (headstand in yoga practice)
C. Triboulet, M. Gilliet, O. Gaide
Dpt of Dermatology, University Hospital Lausanne CHUV, Lausanne
Background : The pathogenesis of vitiligo has not been
totally clarified until now and many theories have been
proposed. Melanocytes adhesion deficit has been speculated and link with Koebner phenomenon (appearance of
vitiligo after an acute or chronic trauma), which may be
present in up to 31 % of Caucasian patients with common
vitiligo.
Case report : We report the case of a 44-year-old patient
presenting a symetrical serpiginous erythematous and
petechial periorbital lesion, with a finely squamous border. This lesion is completly asymptomatic. Our initial diagnosis was ortiented towards an allergic reaction (to his
moutain sunglasses), a dermatophytosis, and included
the "Venus necklace" of secondary syphilis. These last diagnoses could be easily eliminated by para-clinical exams.
At a later control, the patient came during the spring
and was more tanned, allowing us to spot a sligth symetrical depigmentation around the two orbits, which was
well objectivated by Wood-light examination, and led us
to diagnose an active non-segmental vitiligo. A biopsy
confirmed the diagnosis. When we asked about a trigger,
allowing for a Koebner effet, the patient explained he had
noticed that his practice of yoga, the Sirsasana position
(headstand) in particular, worsened the erythematous
periorbital border and the petechiae. After stopping the
practice, the lesions slowly disappeared. A treatment by
tacrolimus (Protopic®) led to a partial disparition of the
depigmented area, which is now currently limited to non
photo-exposed areas.
Conclusion : This case is, to the best of our knowledge, the
first description of a vitiligo induced by yoga, an unusual
trigger of the Koebner phenomenon characterizing this
disease.
P92
Black henna temporary tattoos : allergic contact dermatitis with clinical mirror effect
E. Tzika, M . Abosaleh, B. Cortès
Genève
Introduction : Black henne tattoos with additives presenting high allogenicity, especially paraphenylenediamine
(PPD), have become popular because of the darker results
and their increased duration. We report a case of allergic
contact dermatitis to black henna tattoo with original clinical presentation.
Observation : A 27-year old woman had a second black
henna tattoo on the dorsum of her right hand. The same
P89
79
night after sleeping while pressing her hand on the cheek,
she woke up with a warm feeling and itchness of her left
cheek as well as a swelling and redness on her left hand.
Few years ago, the patient reported no skin reaction after
a first tatoo. Clinical exam revealed erythematous papules
and vesicles within the tattoo pattern on the left hand
and similar lesions on the left cheek that strictly mirrored
the pattern of the hand. We made the clinical diagnosis
of contact dermatitis. The patient was treated with highpotency topical corticosteroids, and the lesions resolved.
An allergy patch test with standard series of allergens was
performed, showing a positive (+++) reaction for PPD.
Discussion : Henna is a plant from the lythraceae family. It
is relatively safe, but is usually mixed with other darknessenhancing substances, such as PPD, a very potent contact
allergen. PPD is a very potent contact sensitiser, included
in the European standard series for allergy patch testing.
It’s use is actually prohibited in skin cosmetics and limited
in hair dye to 6 %. However it continues to be found in
unregulated black henna tattoos at alarming concentrations of up to 30 %. For the puprose of tattooing, henna
is applied and left on the skin, living enough time for
sensitize persons to develop contact allergic reactions.
PPD is a common allergen that is also found in permanent hair dyes. Allergens that cause reactions in patients
who are sensitive to PPD include sunscreens containing
aminobenzoic acid, certain local anesthetics and sulfonamides.
Conclusion : During recent years there has been an increasing number of published cases of allergic contact dermatitis from henna tattooing. However, to our knowlegde,
there is the first case reported with such mirror effect.
P93
Ingenol mebutate treatment for recalcitrant chronic
actinic cheilitis
E. Tzika , I. Masouye, E. Laffitte
POSTERS
Genève
Introduction : Actinic cheilitis (AC) is a degenerative condition of the lip’s tissue, caused by excessive and repeated
exposure to ultraviolet light, considered a common precursor to squamous cell carcinoma. We report a case of
an actinic cheilitis resistant to different modalities treated
with success by ingenol mebutate (IM, Picato®).
Observation : A healthy 76-year old man presented to
our clinic with a leucokeratosic lesion of the lower lip. He
reported previous treatment with photodynamic therapy
by his dermatologist, 5 years ago. The clinical diagnosis
of AC was confirmed by skin biopsy, with an epithelium
atrophy and a moderate chorionic actinic elastosis, compatible with debutant actinic cheilitis. Initial treatment
consisted of topical 5 % imiquimod 3 times a week, but
proved inefficient after 6 applications, as well as daily use
for a month period. The patient then received a first ingenol mebutate 150mcg/g gel treatment for 3 consecutive
days, repeated after 3 weeks for some residual lesions. We
observed a complete clinical response without any local
side-effects ; after one year a discrete relapse of the AC
lesion was treated again with a 3 days application of IM.
Discussion : AC is a common condition with the potential
to progress into SCC. Many treatment modalities have
been used including surgery, cryosurgery, topical 5-fluorouracil, imiquimod, conventional and pulsed carbon
dioxide lasers, chemical peel, PDT and electrodesiccation
presenting various cure rates and side-effects. IM is a
macrocyclic diterpene ester, indicated for the treatment
of actinic keratosis ; there is usually an intense inflammatory reaction on the application site. In our case of recalcitrant AC, IM was effective without any local reaction, with
a sustained response despite a slight relapse after one
year.
Conclusion : Controlled studies and long-term follow-up
are necessary to evaluate the efficacy and recurrence rate
of IM as a novel treatment of AC.
P94
Improvement in nail psoriasis in the open-label extension of a phase-2 trial of ixekizumab in patients with
moderate-to-severe plaque psoriasis
P. Rich1, R.G. Langley2, A. Menter3, G. Krueger4, B. Zhu5, H.
Wei5, G.S. Cameron5, M.P. Heffernan5
1 Oregon Health & Science University School of Medicine, Portland, OR, United States
2 Dalhousie University, Halifax, Nova Scotia, Canada
3 Baylor University Medical Center, Dallas, TX, United States
4 University of Utah School of Medicine, Salt Lake City, UT, United
States
5 Lilly, Indianapolis, IN, United States
Introduction : Ixekizumab, an anti-interleukin (IL)-17A
monoclonal antibody, was effective in treating moderateto-severe psoriasis in a 20-week phase-2 study. We evaluated nail psoriasis response to ixekizumab during the
48-week open-label extension (OLE).
Method : In the phase-2 study, 142 patients (pts) were
randomized to receive subcutaneous ixekizumab 10, 25,
75, or 150mg or placebo at weeks (wks) 0, 2, 4, 8, 12, and
16. After 0–12 wks in a treatment-free period, eligible
patients could enter an OLE during which they received
ixekizumab 120mg every 4 weeks. Fingernail and toenail
psoriasis was evaluated using the Nail Psoriasis Severity
Index (NAPSI).
Results : Mean baseline NAPSI for all pts with nail psoriasis (N=60) was 40.6. Fifty-nine patients had ≥1 post-baseline visit ; 52 entered the OLE. At wk 20, pts receiving
ixekizumab 75 and 150mg, had a mean decrease in NAPSI
from baseline of 63.8 % (26.3 absolute change) and 52.6 %
(23.1 absolute change) vs. a 5.1 % increase (1.9 absolute
change ; p<0.01 between treatments) for pts receiving
placebo. After 48 weeks of OLE, NAPSI significantly improved by 81.7 % (-34.3 absolute change ; p<0.001) in the
44 patients remaining in the study, and by 91.7 % (n=12,
-30.8 absolute change ; p<0.001 vs baseline) in patients
initially assigned to placebo (n=16), who had no nail improvement at Week 20.
Conclusions : Improvements in nail psoriasis were observed by wk 20 with ixekizumab 75 and 150mg. Significant
and sustained improvements in nail psoriasis continued
in the 48-wk OLE period.
This abstract was previously presented at the 23rd EADV
congress in Amsterdam 2014.
P95
Impact of ixekizumab on blood neutrophil levels and
the incidence of infections caused by Candida albicans
or Staphylococcus aureus
A. Blauvelt1, D.K. Braun2, G.S. Cameron2, D. Shrom2, M.P. Heffernan2
1 Oregon Medical Research Center, Portland, OR, United States
Introduction : IL-17A plays an important role in neutrophil recruitment and protection against extracellular
pathogens such as C. albicans and S. aureus. Ixekizumab,
a monoclonal antibody directed against IL-17A, is in development for treating plaque psoriasis.
Method : Data from an open-label extension of a phase-2
study were used to assess the impact of ixekizumab 120
mg subcutaneously every 4 weeks on blood neutrophil
levels (neutropenia graded using CTCAE criteria) and
the incidence of candidal and staphylococcal infections
80
P96
Effects of ixekizumab treatment on quality of life during
48 weeks of open-label treatment in a phase-2 trial in
psoriasis
A. Armstrong1, M. Lebwohl2, B. Zhu3, D. Shrom3, E. Nikaï4, M.
Heffernan3
1 University of Colorado, Denver, CO, United States
2 Mount Sinai School of Medicine, New York, NY, United States
4 Lilly, Brussels, Belgium
Introduction : After 20 weeks, ixekizumab, an anti-IL-17A
monoclonal antibody, effectively controlled moderateto-severe chronic plaque psoriasis and significantly improved health-related quality of life (HRQoL). This analysis
assessed the effects of ixekizumab on HRQoL and treatment response after 48 weeks in an open-label extension
(OLE) of the initial phase-2 trial.
Method : In total, 120 patients entered the OLE and received ixekizumab 120mg subcutaneously every 4 weeks.
HRQoL was assessed with the Dermatology Life Quality
Index (DLQI). Endpoints were the proportion of patients
achieving: DLQI ≥5-point improvement, DLQI 0 or 1, DLQI
0, European Consensus Panel (ECP)-defined treatment
response of PASI ≥75 % improvement, at weeks 24 and 48
of the OLE.
Results : The mean baseline DLQI score for patients entering the OLE was 10.9±6.1. The mean DLQI score significantly decreased from baseline by 9.6±5.8 (89 % improvement, p<0.001) to 1.2±2.7 at week 24, and by 9.5±5.6
(88 % improvement, p<0.001) to 1.3±2.9 at week 48. At
Week 24, 77 % of patients achieved DLQI ≥5-point improvement, 83 % achieved DLQI 0 or 1 and 61 % achieved
DLQI 0. At week 48, respective percentages were 80 %,
79 % and 64 %. According to ECP treatment goals, continued therapy would be recommended for 98 % of patients at week 24 and 93 % at week 48.
Conclusions : Significant improvements from baseline
were observed in HRQoL after 24 weeks of ixekizumab
and those improvements were maintained after 48 weeks.
At both 24 and 48 weeks, most patients achieved the ECP
treatment goal.
This abstract was previously presented at the 23rd EADV
congress in Amsterdam 2014.
P97
Peristomal pemphigoid: another peculiar and misleading presentation of bullous pemphigoid
B. Weber1, H.W. Klötgen1, M.P. Horn2, L. Fontao3, L. Borradori1
1 Dpt of Dermatology, University Hospital Bern, Bern
2 Center of Laboratory Medicine, University Hospital Bern, Bern
3 Dpt of Dermatology, Hôpitaux Universitaires de Genève, Genève
Bullous pemphigoid (BP) represents a diagnostic challenge. We here describe a 89-year-old man with a
6-month history of erythema and erosions arising on the
skin around his stoma. Twenty years earlier he underwent
colostomy because of radiation-induced injury of the
colon following prostate carcinoma therapy. He hence
had regular stoma care with application of different selfadhesive bags. Since the lesions were considered related
to either irritant or allergic dermatitis, the patient was
treated by short courses of topical steroids, while all topical preparations and dressings used for stoma care were
changed without any response. Epicutaneous test reactions remained negative.
Light microscopy studies revealed a subepidermal blister
with eosinophilic perivascular dermatitis. Direct immunofluoresence microscopy (DIF) studies of the perilesional
skin showed linear IgG and C3 deposits at the basement
membrane zone (BMZ). Indirect immunofluorescence on
human salt split skin showed anti-BMZ IgG antibodies
staining the epidermal side of the BMZ. Western blot
analysis using full-length BP180 showed presence of anti-BP180 IgG autoantibodies. The patient was given oral
prednisolon (20 mg/d), which resulted in a rapid clinical
improvement.
Our observation illustrates the wide spectrum of cutaneous presentations of BP. The latter remains localized
around stomas, on irradiated areas or confined to a paralyzed extremity. Involvement of BP can further be limited
to the pretibial area (pretibial pemphigoid), the umbilical
area, the palmoplantar region or the vulvar region. In all
these cases, the diagnosis critically relies on positive DIF
studies, which are essential and required for a definite diagnosis. The latter cannot be made based uniquely on the
results of serological analyses.
P98
Utility of IgM-measurement for the diagnosis of syphilis : comparison of FTA-IgM, IgM-specific enzyme immunoassays (EIA) and Rapid Plasma Reagin (RPR) in early
syphilis in Geneva
S. Zürcher, L. Fontao, L. Toutous Trellu
Genève
Introduction : The EIA test, consisting of anti-treponemal
total immunoglobulins is currently widely used in screening for syphilis. Fast and safe diagnostic of early infections (primary and early secondary stages) remain challenging because of their high infectivity. Manual tests
such as, RPR, FTA and TPHA are widely used but are timeconsuming and imperfect. IgM antibodies are usually the
first to be produced during treponemal infection and the
detection of IgM by EIA appears to be sensitive enough
to point toward the precocity of syphilis [1] but still lack
standardization.
Methods : In the laboratory of dermatology at the Geneva
University Hospital, an in house developed FTA-IgM test is
performed in case of strong suspicion of an active infection. We assessed retrospectively the IgM index using EIA
(Euroimmun) in sera from our outpatient clinic followed
for syphilis, at 0-3-6-12 months post- treatment and compared the kinetic of EIA- IgM index, FTA-IgM and RPR.
(investigator-reported without requirement for microbiologic confirmation) in 120 patients with moderate-to-severe chronic plaque psoriasis.
Results : Safety data were available to Week 52 for all
patients and for some patients to Week 100. Overall, 4
patients experienced transient grade 1 neutropenia that
was not clinically significant ; no grade 2 or 3 neutropenia
occurred. Overall, 49 patients experienced a treatmentemergent infection of any kind: 5 reported candida (4 oral
and 1 vulvovaginal), 1 a vulvovaginal infection due to an
unspecified yeast and 2 a staphylococcal infection (ear
infection and impetigo), all of which resolved with proper
treatment and did not interfere with ixekizumab dosing.
None of these patients had concurrent neutropenia.
Conclusions : Ixekizumab treatment for 1 year was associated with a low incidence of neutropenia, which was
transient and not severe, as well as a low frequency of
candidal or staphylococcal infections in patients with
psoriasis. Further study is needed to fully understand the
impact of ixekizumab treatment on circulating neutrophil
levels and host defence.
This abstract was presented at the 73rd SID conference in
Albuquerque 2014.
81
POSTERS
Results : 86 samples from 35 patients with primary or secondary syphilis were analyzed. We found a good correlation between RPR titers and EIA-IgM index. When compared to RPR, EIA-IgM displays a 65 % sensitivity and a 70 %
specificity. When compared to EIA-IgM, FTA-IgM displays
a lower specificity and specificity.
Discussion : Overall, the correlation between IgM detected by FTA-IgM or EIA-IgM and RPR is good. However,
measuring IgM, in the post-treatment follow-up is of little
interest, since the downward trend is less obvious when
compared to RPR. Thus, as mentioned in the European
guideline 2014 [2], measuring IgM should be limited to
patients with suspected early infection when the confirmatory treponemal tests are positive and non-treponemal test is negative.
82
ancer immunology
makes it to clinic:
how cancer
will be treated
in the coming years
AUDITORIUM USI – UNIVERSITÀ DELLA SVIZZERA ITALIANA
LUGANO, SWITZERLAND • SEPTEMBER 26, 2015
A True Transformation
in the Treatment of aBCC
1
aBCC = advanced Basal Cell Carcinoma*
Roche Pharma (Schweiz) AG
suppor ts «pro Igel» and is
committed
to the protection and promot
ion of the
native hedgehog and its hab
itats.
1
1
*advanced Basal Cell Carcinoma (aBCC) = locally advanced and metastatic Basal Cell Carcinoma.
1. Sekulic A, Migden MR, Oro AE et al. Efficacy and safety of vismodegib in advanced basal-cell
carcinoma. N Engl J Med 2012;366:2171–2179.
Erivedge® (vismodegib). Indication: Treatment of adult patients with advanced basal cell carcinoma, for whom surgical treatment or radiotherapy is not an option. Dosage: One capsule (150 mg)
once daily. Contraindications: Hypersensitivity to the active substance or one of the excipients.
Pregnancy and breast-feeding. Women of child-bearing potential not adhering to the contraception
programme. Precautions: Erivedge is teratogenic. Patients must be appropriately informed that they
are accepting all the commitments in the contraception programme and must sign the proof of advice
form to confirm this. Women of child-bearing potential must not become pregnant or breastfeed
during the therapy or within 24 months following discontinuation and must use two reliable methods
of contraception. A pregnancy test must be carried out seven days before and at monthly intervals
during the therapy, and prescriptions must be limited to 28 days. Men must use condoms during
the treatment and for two months following discontinuation and must not donate sperm. Patients
must not donate blood during the treatment or for 24 months following discontinuation. Erivedge
may affect postnatal development. Fertility may be impaired; action to preserve fertility should be
discussed in advance. Undesirable effects: Muscle cramps, hair loss, dysgeusia and ageusia, weight
loss, reduced appetite, fatigue, nausea, diarrhoea, constipation, vomiting, amenorrhea. Interactions:
Erivedge is an inhibitor of CYP2C8, CYP2C9, CYP2C19 and of transport enzyme BCRP. P-glycoprotein inhibitors and drugs that affect stomach pH may change exposure to vismodegib. Packaging: Erivedge 150 mg, 28 capsules. Sales category A. For detailed information, please refer to the published
SmPC at www.swissmedicinfo.ch. Version: March 2014.
11/2014
The first in class
Hedgehog pathway inhibitor
É ET
HOMOLOGU
PAR
REMBOURSÉ
LES CAISSES
NOUVEAU LORS D’URTICAIRE
CHRONIQUE SPONTANÉE (UCS)
L’HEURE DU
CHANGEMENT
44 % des patients ne présentaient
plus ni prurit, ni papules avec Xolair®
300 mg à 12 semaines2
Xolair® est indiqué en traitement additionnel chez les adultes et adolescents (à partir de 12 ans) dans le traitement
de l’urticaire chronique spontanée (UCS) de longue durée non contrôlée par les antihistaminiques H1.*1
Références
1. Information professionnelle Xolair®, mise à jour août 2014, www.swissmedicinfo.ch.
2. Maurer M et al. Omalizumab for the Treatment of Chronic Idiopathic or Spontaneous Urticaria. N Eng J Med. 2013;368:924 – 935.
27000/08.2014
*
L’indication complète est disponible sous www.swissmedic.ch.
Xolair® (Omalizumab). C: Omalizumab; flacon de poudre contenant 150 mg d’omalizumab et solvant pour solution injectable. I: Asthme allergique: traitement additionnel, pour améliorer le contrôle de l’asthme chez les adultes et les
enfants (à partir de 6 ans) atteints d’asthme allergique persistant sévère (ayant un test cutané positif ou une réactivité in vitro contre un pneumallergène perannuel), et qui, malgré un traitement quotidien par un corticostéroïde inhalé à
forte dose et un bêta2-agoniste inhalé à longue durée d’action, présentent non seulement une réduction de la fonction pulmonaire (VEMS < 80 %) mais aussi des symptômes diurnes fréquents ou des réveils nocturnes et des exacerbations
de l’asthme. Urticaire chronique spontanée (UCS): Traitement additionnel chez les adultes et les adolescents (à partir de 12 ans), dans l’UCS de longue durée*, non contrôlée par les antihistaminiques H1 et pour laquelle aucune autre
affection sous-jacente n’a été identifiée dans le cadre d’un examen effectué par un médecin ayant de l’expérience dans ce type d’affections (* Les études d’enregistrement ont porté sur des patients atteints d’une UCS évoluant depuis
6 mois à 66 ans, en moyenne depuis 6 ans). D: Asthme allergique: adultes et enfants à partir de 6 ans: 75 – 600 mg de Xolair 1 – 2 x/mois en fonction du taux sérique initial d’IgE (U. I./ml) et du poids corporel du patient. Urticaire chronique
spontanée: adultes et adolescents à partir de 12 ans: dose initiale de 300 mg sous forme d’une injection sous-cutanée toutes les 4 semaines. La plupart des patients qui répondent au traitement montrent déjà une amélioration dans les
4 semaines qui suivent la première dose. Réévaluer la nécessité du traitement à intervalles réguliers. Plus d’informations, voir www.swissmedicinfo.ch. CI: Hypersensibilité au principe actif ou à l’un des composants. Pr: N’est pas indiqué
pour le traitement des exacerbations aiguës de l’asthme, du bronchospasme aigu ou de l’état de mal asthmatique. N’a pas été étudié dans le syndrome d’hyperimmunoglobulinémie E, l’aspergillose broncho-pulmonaire allergique, la
prévention de réactions allergiques, la dermatite atopique, la rhinite allergique, les allergies alimentaires, les maladies auto-immunes, les états dus à des complexes immuns, ni chez les patients avec insuffisance rénale ou hépatique préexistante. Réduction des corticostéroïdes sous surveillance médicale. Des réactions allergiques, des réactions anaphylactiques mettant en jeu le pronostic vital ou un choc anaphylactique peuvent survenir. Une maladie sérique et des
symptômes du même type ont été rarement rapportés. Rarement syndrome de Churg-Strauss et syndrome hyperéosinophilique. Des problèmes en rapport avec une immunogénicité, des infections parasitaires (helminthiases), des affections
malignes ou des événements thromboemboliques artériels (ATE) peuvent survenir. Plus d’informations, voir www.swissmedicinfo.ch. IA: Asthme allergique: il n’a pas été mis en évidence de modification de la tolérance en cas d’administration de médicaments antiasthmatiques d’utilisation courante. L’efficacité du traitement en association avec une immunothérapie spécifique n’a pas été établie. Urticaire chronique spontanée: les antihistaminiques H2 et les LTRA n’ont pas
eu d’influence importante sur la pharmacocinétique de l’omalizumab. Plus d’informations, voir www.swissmedicinfo.ch. EI: Très fréquents: pyrexie, céphalées. Fréquents: (rhino)pharyngite, douleurs de l’abdomen supérieur, douleurs,
érythème, prurit, gonflement, sinusite, infections des voies respiratoires supérieures, infections des voies urinaires, douleurs sinusales, myalgies, douleurs des membres, douleurs musculosquelettiques, douleurs articulaires. Occasionnels:
Vertiges, somnolence, paresthésies, syncope, hypotension orthostatique, bouffées vasomotrices, toux, bronchospasmes allergiques, nausées, diarrhées, dyspepsie, urticaire, éruption, prurit, photosensibilité, prise de poids, fatigue, gonflement des bras, symptômes grippaux. Post-commercialisation: anaphylaxie et réactions anaphylactoïdes, alopécie, thrombopénie idiopathique sévère, angéite granulomateuse allergique (syndrome de Churg-Strauss), arthralgies, myalgies,
gonflements articulaires. En outre: tumeurs malignes, événements thromboemboliques artériels (ATE), diminution des thrombocytes, augmentation des taux sériques d’IgE totales, infections parasitaires. Effets indésirables rares, très rares
et autres informations détaillées: www.swissmedicinfo.ch. P: 1 flacon de 150 mg d’omalizumab avec 1 ampoule de solvant de 2 ml. Liste: B. Admis par les caisses-maladie. Pour plus d’informations, consulter www.swissmedicinfo.ch.
TdA: Novartis Pharma Schweiz AG, Risch; adresse: Suurstoffi 14, 6343 Rotkreuz, tél. 041 763 71 11. V8

- Dermatologica Helvetica

Transcription

Similar documents

Free Radicals in Charcoal and the Combustion of Compositions

en format pdf

Treatment of cellulite

The EMPIRE BROADSWORD surfaces

ESPONELLÀ · COSTA BRAVA · GIRONA · SPAIN

Ms. Sani Mariama Moussa: H.E. Alpha Souley Bah Mr. Gerardo

Sommer GENUSS Summer DELIGHTS

s Wissen Sie, wie Spielzeug vor 5000 Jahren aussah? Kennen Sie

ressources, descriptions et traitements informatiques préprogramme