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Dermatologica
Helvetica
94. Jahresversammlung der SGDV
94e Réunion annuelle de la SSDV
Bern - Berne 30 August - Août / 1 September - Septembre 2012
Dieses Heft wurde für die Fortbildung der Schweizer
Dermatologen dank einer Hilfe der folgenden Firma
realisiert:
Ce numéro a été réalisé grâce à une aide pour la formation continue des dermatologues suisses de la firme:
6 / 2012
Volume 24
La thérapie contre la chute
des cheveux de Spirig
pour le traitement systémique et topique
Alocapil®
C: Finastéride comprimés pelliculés à 1 mg. I: Alopécie androgénétique légère à moyennement sévère chez l’homme. D: 1x 1 comprimé par jour. CI: Femmes, enfants, grossesse, alopécie d’autre étiologie, hypersensibilité
à l’un des composants. PR: Influence sur la valeur PSA, très rares cas de cancer du sein connus. Les comprimés écrasés ou coupés ne doivent pas être manipulés par des femmes en âge de procréer. IA: Substrat de CYP3A4,
aucun indice d’interactions cliniquement pertinentes. EI: Fréquents: diminution de la libido, troubles de l’érection. G/A: Grossesse: contre-indiqué; allaitement: pas indiqué. P: Comprimés pelliculés, 28 et 98. Liste B. Pour
de plus amples informations, veuillez consulter le Compendium Suisse des Médicaments. 1110
Néocapil® 2 % et 5 %
C: 2%: Minoxidil 20 mg/ml solution. 5%: I: 2%: alopécie androgénétique chez l’homme. 5%: alopécie androgénétique chez l’homme, chez la femme sur prescription médicale. D: adultes >18 ans: usage externe 1 ml (=ˆ 10
vaporisations), vaporiser 2x par jour pendant au moins 4 mois sur le cuir chevelu sain et sec. Ne pas appliquer sur d’autres zones corporelles. Max. 2 ml/jour. CI: hypersensibilité connue à l’un des composants. PR: La prudence
est de rigueur en cas d’affections cardiovasculaires, d’arythmies, de prise accidentelle, de signes d’un effet systémique dus à une résorption accrue. Eviter tout contact avec les yeux et les muqueuses, ne pas inspirer les
vapeurs émanant du spray. Ne pas utiliser simultanément avec d’autres topiques. Cheveux gris et baignade dans le l’eau traitée chimiquement (modification de la couleur et de la structure des cheveux). Pat. <18 ans, >65
ans. IA: antihypertenseurs, médicaments contre la dysfonction érectile, bêtabloquants, autres préparations topiques, y compris corticostéroïdes, rétinoïdes, anthraline et médicaments augmentant la résorption percutanée.
EI: fréquents: réactions eczémateuses, dermatite allergique de contact, chute de cheveux et alopécie, hypertrichose, y compris croissance des poils du visage chez la femme, érythèmes locaux, prurit, peau sèche et desquamante. G/A: aucune étude contrôlée disponible, ne pas utiliser pendant la grossesse/période d’allaitement. P: Flacon de 50 ml avec vaporisateur et embout avec pointe prolongée. Liste C. Pour de plus amples informations,
veuillez consulter le Compendium Suisse des Médicaments 1110/130112
Innovation for skin and health
Spirig Pharma SA, CH-4622 Egerkingen, www.spirig.ch
Sommaire / INHALT
RUBRIKEN DER DERMATOLOGICA HELVETICA
RUBRIQUES DE DERMATOLOGICA HELVETICA
Weiterbildung
Formation continue
Redaktionsbüro / Bureau éditorial
J.-H. Saurat Chefredaktor
Editeur en chef
M. Harms
Stv. Chefredaktorin
Editeur en chef adjointe
A.A. Navarini
Assoziierter Redaktor
Editeur associé
A.M. Skaria Redaktor Westschweiz
Editeur député pour la Suisse
romande
T. Hofer
Redaktor Deutschschweiz
Editeur député pour la Suisse
alémanique
C. Mainetti
Redaktoren Tessin
F. Pelloni
Editeurs députés pour le Tessin
4
6
Grussworte /Messages de bienvenue
Wissenschaftliches Programm SGDV/
Programme scientifique SSDV
13
PflegefachGruppe / Séance infirmières
19
Provisorische Traktandenliste SGDV/Ordre du jour provisoire SSDV
23
Freie Mitteilungen/Communications libres 26Posters
e-mail : [email protected]
Journal-Klub / Journal-Club
Fokus / Focus
J.-H. Saurat Redaktionsbüro / Bureau éditorial
[email protected]
Klinische Fälle / Cas cliniques / Report
Universitätskliniken und praktizierende Ärzte
Les cliniques universitaires et les praticiens
Fragen und Antworten / Questions et réponses
A.-A. Ramelet, Lausanne
[email protected]
Neues aus dem Fachgebiet
Nouvelles professionnelles
Forum des Präsidenten der SGDV /
Tribune du Président de la SSDV
J.-P. Grillet
[email protected]
Neues aus der SGDV / Nouvelles de la SSDV
M. Pongratz
e-mail: [email protected]
Neues aus den Kliniken / Nouvelles des cliniques
Klinikdirektoren / Les directeurs des cliniques
Neues aus den kantonalen Fachgesellschaften /
Nouvelles des Sociétés cantonales de la spécialité
Präsidenten der Gesellschaften / Les présidents des sociétés
Ankündigungen (Kongresse/Kolloquien) und Berichte /
Annonces (congrès/colloques) et Bureau éditorial
[email protected]
Freies Forum / Tribune libre
[email protected]
Humor / Billet d’humour et d’humeur
J.P. Grillet
[email protected]
Neues aus der Industrie / Nouvelles de l’industrie
[email protected]
Druck / Impression
Atar Roto Presse SA, Vernier
ISSN : 1420-2360
ANZEIGENREGIE / RéGIE DES ANNONCES
Carine HERRERAS
Tél : +41 79 667 32 48
Fax: +41 22 372 94 95
E-mail : [email protected]
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.
3
PROGRAMM
94. Jahresversammlung der SGDV
30. August - 1. September 2012
Bern
PROGRAMME
94 Réunion Annuelle de la SSDV
30 Août - 1er Septembre 2012,
Berne
ème
SGDV - SSDV
Grusswort des Präsidenten der SGDV
Message de bienvenue du Président de la SSDV
Liebe Kolleginnen und Kollegen,
Chères consœurs, chers confrères,
Im Namen des SGDV-Vorstandes heisse ich Sie zur
SGDV-Jahresversammlung 2012 in Bern ganz herzlich willkommen. Das Berner Team hat ein praxisrelevantes und gleichzeitig aktuelles und attraktives
Programm zusammengestellt. Kommen Sie nach
Bern, zu Ihrer eigenen Fortbildung, aber auch zur
Generalversammlung der SGDV!
"Vom Symptom zur Diagnose": Das gilt auch für
unsere Fachgesellschaft – und last but not least für
die Gesellschaft überhaupt. In den vergangenen
zwei Jahrzehnten hat sich die globale und lokale
politische Ordnung grundlegend verändert, und
die elektronischen Arbeitsmittel haben unsere
Kommunikationsmöglichkeiten revolutioniert. Die
Hardware Mensch verändert sich in für uns überblickbaren Zeiträumen kaum, jedenfalls nicht in ihren archaischen Elementen, welche das Überleben
sichern. Was darüber hinausgeht, sind die menschliche Intelligenz und das menschliche Verhalten
jedoch erstaunlich plastisch, sodass auch für uns
Dermatologinnen und Dermatologen grosse Hoffnung besteht, dass wir die Herausforderungen der
näheren Zukunft weiterhin erfolgreich meistern
werden.
Hierfür brauchen wir jedoch Ihre aktive Teilnahme,
an unseren Fortbildungen, an unseren Diskussionen, in unseren Arbeitsgruppen und Vorständen
und last but not least an unserer Generalversammlung.
In diesem Sinn heisst Sie der ganze SGDV-Vorstand
an der SGDV-Jahresversammlung in Bern herzlich
willkommen.
Au nom du comité directeur de la SSDV, j’ai le plaisir
de vous souhaiter la bienvenue à la réunion annuelle 2012 de la SSDV à Berne. L’équipe bernoise vous
a concocté un programme à la fois tourné vers la
pratique, actuel et très intéressant. Venez à Berne,
pour continuer à vous former mais aussi participer
à l’assemblée générale de la SSDV!
"Du symptôme au diagnostic": cela vaut également
pour notre société professionnelle – et du reste aussi pour la société en général. L’ordre politique régional et mondial a connu de profondes mutations
au cours des deux dernières décennies, les outils de
travail électroniques ont révolutionné nos possibilités de communication. Le "hardware humain" n’évolue guère à l’échelle d’une vie humaine, et en aucun
cas en ce qui concerne ses mécanismes archaïques
propres à garantir la survie. Ce qui va encore plus
loin, ce sont l’intelligence et le comportement humains: leur étonnante plasticité nous permet, nous
aussi, de nourrir de grands espoirs quant à notre
capacité, en tant que dermatologues, à continuer
de maîtriser avec succès les défis du futur proche.
Pour ce faire, nous avons cependant besoin de votre
participation active, à nos programmes de formation continue, à nos débats au sein de nos groupes
de travail et de nos comités, et – last but not least
– à notre assemblée générale.
Dans cet esprit, l’ensemble du comité de la SSDV
vous souhaite la cordiale bienvenue à la réunion
annuelle de la SSDV à Berne.
Prof. Jürg Hafner,
Präsident SGDV
Président SSDV
4
Dermatologica Helvetica - Volume 24(6) - Juin 2012
Grusswort des Tagungspräsidenten
Message de bienvenue du Président de l’Assemblée annuelle
Chères Consœurs, chers Confrères,
Mit Freude dürfen wir Ihnen die nächste, neu gestaltete SGDV-Jahresversammlung ankündigen,
zu der wir Sie ganz herzlich vom 30. August bis 1.
September 2012 nach Bern einladen. Für diese Tage
können wir Ihnen nicht nur ein spannendes Programm versprechen, sondern auch eine Vielzahl
von organisatorischen und inhaltlichen Neuerungen.
"Vom Symptom zur Diagnose" wird das Hauptthema sein. Für die Fallvorstellungen werden die Kliniken ein übergreifendes Thema auswählen, welches
sie anhand von Kasuistiken und Hintergrundinformationen abhandeln. Um den verschiedenen Interessen der Dermatologen in der Praxis und Klinik
gerecht zu werden, haben wir für den Freitagnachmittag Workshops zu verschiedenen Themen und
die freien Mitteilungen eingeplant. Die Workshops
am Donnerstag sind neu fester Bestandteil der Jahrestagung. Die Arbeitsgruppen werden Vorträge
und Kasuistiken aus ihrem Spezialgebiet vorstellen
und mit Interessierten diskutieren. Am Samstag
wird es ein Get-together von Teilnehmern und Vertretern der Industrieaussteller geben. Eine weitere
Neuerung ist der Aus- und Umbau des Kursaals, der
bis dahin abgeschlossen sein wird und uns deutlich
bessere Tagungsmöglichkeiten garantiert.
Im Interesse der SGDV setzen wir uns dafür ein, dass
die Jahresversammlung der wichtigste Anlass für
alle Schweizer Dermatologen wird, an der in strukturierter und systematischer Art neues Wissen und
Kenntnisse oder Updates vermittelt werden.
Das Team der Berner Universitätsklinik für Dermatologie freut sich, Sie zur 94. Jahresversammlung
begrüssen zu dürfen.
Nous avons le plaisir de vous convier à la prochaine
réunion annuelle de la SSDV avec une nouvelle
formule, qui se tiendra à Berne du 30 août au 1er
septembre 2012. Un programme passionnant
vous attend pendant cette manifestation, de même
qu’une multitude de nouveautés sur le plan de
l’organisation, du format et du contenu.
"Du symptôme au diagnostic", tel sera le thème
principal de notre congrès. Pour les présentations
de cas, chaque service de dermatologie, universitaire ou cantonal, choisira un domaine distinct,
qui sera traité sur la base de cas cliniques. Nous
avons programmé des ateliers thématiques ainsi
que des communications libres le vendredi aprèsmidi, afin de répondre aux intérêts différents des
practiciens, et des dermatologues universitaires ou
en formation. Les ateliers du jeudi sont désormais
une constante de notre congrès annuel. Les groupes de travail présenteront des exposés dans leur
domaine pour des séances interactives. Le samedi,
participants et représentants des exposants et de
l’industrie auront l’occasion de se rencontrer pour
un bref brunch. Autre nouveauté, l’agrandissement
et la transformation complète des salles de conférences et d’exhibition du Kursaal de Berne, qui seront bientôt achevés, offriront à notre congrès un
cadre remarquable.
Nous avons fait tout le possible afin que cette réunion annuelle de la SSDV soit le rendez-vous de référence pour la formation post-grade pour tous les
dermatologues suisses.
L’équipe du service universitaire de dermatologie
de Berne se réjouit d’ores et déjà de vous accueillir
pour ce 94e congrès annuel.
Prof. Luca Borradori,
Prof. Dagmar Simon,
Tagungspräsident
Président du congrès
Tagungssekretärin/wissenschaftliches Programm
Secrétaire du congrès/programme scientifique
SGDV - SSDV
Liebe Kolleginnen und Kollegen,
Dermatologica Helvetica - Volume 24(6) - Juin 2012 5
Wissenschaftliches Programm
Programme scientifique
Mittwoch/Mercredi, 29.08.2012Hörsäle/Salles
14.30–16.30 Klinikdirektoren-Kommissionssitzung/
Séance de commission des directeurs de clinique
Adagio 5
16.30–17.00 Kaffeepause/Pause café
17.00–22.00 Sitzung des Vorstandes der SGDV/Séance du comité SSDV Adagio 5
SGDV - SSDV
Donnerstag/Jeudi, 30.08.2012
08.30–12.00 Fachexamenkommission Sitzung/
Séance de la Commission des examens de spécialistes
Adagio 1
10.00–12.00 SDNTT-Meeting
Adagio 5
12.30–13.30 DermArena (Vorstandssitzung/Séance du comité)
Adagio 5
14.00–15.30 Workshops der Arbeitsgruppen I/
Ateliers des groupes de travail I
• Andrologie/andrologie
• Ästhetische Dermatologie/dermatologie esthétique
• Pädiatrische Dermatologie/dermatopédiatrie
• Dermatopathologie/dermatopathologie
• Radiotherapie/radiothérapie
Vivace 5
Vivace 2
Vivace 3
Vivace 1
Vivace 4
16.00–17.30 Workshops der Arbeitsgruppen II/
Ateliers des groupes de travail II
• Akne/acné
• Clinical Skills
• Dermatoallergologie/dermatoallergologie
• Dermato-Onkologie/dermato-oncologie und/et
• Dermatochirurgie/dermatochirurgie
• Transplantation/transplantation
• Trichologie/trichologie
Vivace 1
Vivace 5
Vivace 6
Adagio 2
Vivace 3
Vivace 4
17.30–18.30 Firmenworkshop I/Atelier des entreprises I
Vivace 2
LEO Pharma
Chair: Nikhil Yawalkar, Bern (CH)
Psoriasis: Der Weg zur Patientenzufriedenheit und zum Therapieerfolg.
Wie mache ich meinen Patienten und mir das Leben einfacher ?/
Psoriasis: Tracer la voie vers la satisfaction des patients et le succès thérapeutique. Comment simplifier la vie des patients et la mienne ?
Alexander Nast, Berlin (D), Cristina Galfetti, Meisterschwanden (CH)
17.30–18.30
Firmenworkshop II /Atelier des entreprises II Vivace 6
Q-MED, a Galderma Division
Chair: Corazon Tinkelenberg, Q-MED, a Galderma Division
Wiederherstellung der Hydrobalance der Haut mit Restylane Skinbooster:
die Wissenschaft hinter den Studien/
Restauration de l’équilibre hydrique de la peau grâce à Restylane Skinbooster:
la science derrière les études
Magda Belmontesi, Pavia (I)
19.30
Vorstandsessen/Dîner du comité
Restaurant Schwellenmätteli (Dalmaziquai 11, Bern)
6
Sitzung der Swiss
Group of Aesthetic
Dermatology and
SKin Care (SGEDS)
SGDV - SSDV
Adagio 2
Kapazität 63
konzert
Sitzung der
Dermatoallergol.
Kommission
Vivace 6
Kapazität 100
konzert
Dermatoonkologie/Dermatochirurgie
Chair: Robert Hunger, A. Skaria
1. Nicht invasive Diagnostik bei der Lentigo maligna (Robert Hunger)
2. Slow Mo’s zur Behandlung der Lentigo maligna (R. Della Torre)
3. Das Plattenepithelkarzinom aus der Sicht des Dermatologen (Jürg Hafner)
4. Basaliome und Spinaliome des Kopf-Hals-Bereiches: Abklärung und
Therapie. Die Sicht des HNO-Spezialisten (R. Giger)
Dermatoallergologie
– Abklärung bei Verdacht auf Allergie auf orthopädische Implantate
(Peter Thomas, München)
– Diskussion und Fälle aus den Kliniken
– Schweiz. Leitlinien Handekzem (B. Ballmer-Weber, Zürich)
– Info zur CARPE-Studie (D. Simon, Bern)
Clinical Skills
– Translational Dermatology: Neue Zeichen, neue Tricks aus der Literatur
zusammengetragen zur direkten Anwendung in die Klinik
(Dr. S. Nobbe, Frauenfeld)
– Executive Summary: Effiziente Anwendung von klinischen Scores
(PD Dr. Dr. A. Navarini, London)
– IL-12 und IL-23 Blockade: Psoriasis, PRP and weiter: Therapeutische
Grenzen verschieben mit strategischer off-label Anwendung
(Dr. M. Anliker, St Gallen)
Vorstandssitzung
Clinical Skills
Vivace 5
Kapazität 44
konzert
Andrologie
Restore the Man
– Metabolic Syndrome
– Erectile Dysfunction
– Testosterone Deficiency Syndrome
Vorstandssitzung
Radiotherapie
Vivace 4
Kapazität 44
konzert
Transplantation
Introduction
Clinical case
Diagnostics in virally induced neoplasms
ATF3 linking UV and calcineurin inhibitors
Swiss Transplant Cohort ongoing studies
Clinical case
Akne
Programm
16.00–17.30
Trichologie
Programm
Pädiatrische Dermatologie
1. Generalversammlung SGPD
2. Myths and realities of common problems in pediatric dermatology
– Lab screening in vitiligo and treatment
– Isotretionin and acne
– Lab screening in alopecia areata and treatment
– Treatment of verruca vulgaris and molluscum contagiosum
Vorstandssitzung
Pädiatrische
Dermatologie
Vivace 3
Kapazität 44
konzert
Pause
15.30–16.00
Radiotherapie
1. Begrüssung und Auswertung/Besprechung der vorgängig
verschickten Fragebogen (S. Lautenschlager, Triemli, ZH)
2. Radiotherapie des chron. Handekzems: Erfahrungen und
Therapieprotokoll (A. Cozzio, Zürich)
3. Radiotherapie der Verruca vulgaris: Erfahrungen und
Literaturreview (H. Grob, Reinach)
4. Therapieresultate der letzten 10 Jahre im DA Triemli
(S. Lautenschlager, Triemli)
Ästhetische Dermatologie
Workshop-Filler und Botulinum live
1. Filler und Botulinum-basic (O. Kreyden, C. Boudny)
2. Filler und Botulinum - advanced (M. Hess Schmid, F. Bertram)
3. «Volumizing» (D. Fuchs, P. Becker-Wegerich)
4. Mesotherapie (B. Rümmelein, B. Schlagenhauff)
14.00–15.30
Vivace 2
Kapazität 120
konzert
12.30–13.30
Dermatopathologie
1. Generalversammlung SGDP
2. Slide view – Thema: Bedeutung der Morphologie in der Histologie,
vom histopathologischen Bild zur Diagnose
11.30–13.30
Vivace 1
Kapazität 18
seminar
Hörsäle/salles
Workshops der Arbeitsgruppen SGDV, Donnerstag, 30.8.2012/Ateliers des groupes de travail SSDV, jeudi le 30.8.2012
SGDV - SSDV
Freitag/Vendredi, 31.08.2012
Hörsäle/Salles
07.30–08.30 Registrierung und Postermontage/
Enregistrement, pose des posters
08.30–08.45 Eröffnung der Jahresversammlung/
Ouverture de l’Assemblée annuelle
08.45–09.15 Key Lecture 1:
Chairs: Peter Itin, Basel, Nikhil Yawalkar, Bern, Emmanuel Laffitte, Genève
Urtikaria – Probleme und Lösungen/
Urticaria – problèmes et solutions
Marcs Maurer, Berlin (D)
09.15–09.45 Thematische Fallvorstellung und Diskussion: Psoriasis/
Présentation thématique de cas et discussion: Psoriasis
(Lausanne)
09.45–10.15 Thematische Fallvorstellung und Diskussion: Diabetes und Haut/
Présentation de cas et discussion: Le diabète et la peau
(Basel)
Besuch der Poster- und Industrieausstellung/
Visite des posters et de l’exposition de l’industrie
11.00–11.30 Key Lecture 2:
Chairs: Gürkan Kaya, Genève, Daniel Hohl, Lausanne, Dagmar Simon, Bern
"The vascular system of the skin: a new therapeutic target"
Michael Detmar, Zürich (CH)
11.30–12.00
Key Lecture 3:
"Pannikulitis, keine Panik/Panniculite, pas de panique"
Bernard Cribier, Strasbourg (F)
12.00–12.30 Klinisch-pathologische Korrelationen (Teil 1)/
Corrélations pathologiques et cliniques (partie 1)
12.30–14.15
Lunch
13.00–14.00 Lunch Symposium I Vivace 3/4
Janssen-Cilag AG
Chairs: Nikhil Yawalkar, Bern (CH), Conrad Curdin, Lausanne (CH)
Praktische Erfahrung mit Biologikas in der Therapie der Plaque-Psoriasis/
Expérience pratique des médicaments biologiques dans le traitement
du psoriasis en plaques
Emmanuel Laffitte, Genève (CH)
13.00–14.00
Lunch Symposium II Vivace 6
Pierre Fabre Suisse SA
Chair: Robert Hunger, Bern (CH)
AKNE – optimale Therapieerfolge mittels angepasster Begleitbehandlung/
ACNE – des résultats thérapeutiques optimaux grâce à un traitement d’accompagnement adapté
Nathalie Castex-Rizzi, Thoulouse (F), Robert Hunger, Bern (CH),
Daniel Wallach, Paris (F)
13.00–14.00
Lunch Symposium III
Vivace 2
Basilea Pharmaceutica International Ltd
Chair: Andreas Bircher, Basel (CH)
Chronisches Handekzem – Neues zu Diagnostik und Therapie in der Praxis/
Eczéma chronique des mains – nouveau diagnostic et la thérapie dans la pratique
Thomas L. Diepgen, Heidelberg (D), Peter Elsner, Jena (D)
8
Arena
14.15–15.15 Thematischer Workshop 1/Atelier thématique 1
Vivace 6
Prävention und Therapie sonnengeschädigter Haut/
Prévention et traitement de la peau endommagée par le soleil
Chair: Robert Hunger, Bern (CH)
14.15 Einleitung
Neue diagnostische Möglichkeiten bei Hauttumoren/Präkanzerosen Robert Hunger, Bern (CH) 14.30 Sonnenschutzmassnahmen zur Prävention von Hautkrebs Christian Surber, Egerkingen (CH)
14.50 Feldkanzerisierung der Haut und ihre Behandlung
Günther Hofbauer, Zürich (CH)
Unterstützt von/soutenu par Almirall AG, Beiersdorf AG, MEDA Pharma GmbH
14.15–15.15 Thematischer Workshop 2/Atelier thématique 2
Vivace 3/4
Gestörte Hautbarriere und allergische Entzündung/
Barrière de la peau avec facultés affaiblies et l’inflammation allergique
Chair: Dagmar Simon, Bern (CH)
14.15 Einleitung
Dagmar Simon, Bern (CH)
14.20
Hautirritation und Hautschutz
Peter Elsner, Jena (D)
14.45
Startet der Atopic March in der Haut ?
Dagmar Simon, Bern (CH)
14.55
Praktische Therapieansätze
Kristin Kernland-Lang, Bern (CH)
Diskussion
Unterstützt von /soutenu par Galderma SA, Spirig Pharma AG, Merz Pharma (Schweiz) AG
14.15–15.15
14.15 14.35 14.55 Thematischer Workshop 3/Atelier thématique 3
Vivace 2
Lasertherapie/La thérapie au laser
Chair: Nathalie Dietrich, Bern (CH)
Lasertherapie in der Universitätsklinik für Dermatologie,
Inselspital Bern: Wo stehen wir heute?
Nathalie Dietrich, Bern (CH)
Was sollte nicht mit Laser behandelt werden ?
Nathalie Dietrich, Bern (CH)
Management of scars with ablative lasers and energy devices
Maurice Adatto, Genève (CH)
14.15–15.15 14.15
14.25
Freie Mitteilung/Communication libre
Chairs: Michel Gilliet, Reinhard Dummer, Peter Häusermann
Einführung/Introduction
M. Gilliet, Lausanne (CH)
14.39 FC1
Transient acantholytic dermatosis - the clinical spectrum, comborbidities
and unusual presentations
M.D. Anliker
Dermatology unit, Canton hospital of St. Gallen, St. Gallen
FC2
Expression of miRNA in cutaneous squamous cell cancer
B. Burger1, C. Brügger2, I. Spoerri2, W. Kempf3, P. Itin1
Department of Dermatology and Department of Biomedicine, University Hospital Basel
Department of Biomedicine, Research Group of Dermatology, University Hospital Basel
3
Kempf and Pfaltz Histological Diagnostics, Research Unit and Department of Dermatology,
University Hospital Zurich
1
2
FC3 Micrographic surgery in the Southern part of Switzerland:
two-year experience
G. Marazza1, S. Parvex-Leoni2, L. Mazzucchelli2, C. Mainetti1
Servizio di Dermatologia EOC – Ospedale Regionale Bellinzona e Valli, Bellinzona
Istituto Cantonale di Patologia, Locarno
1
2
Dermatologica Helvetica - Volume 24(6) - Juin 2012 SGDV - SSDV
14.32
Arena
9
14.46 FC4 S100B levels under therapy with the selective BRAF-inhibitor
vemurafenib: a single center experience
K. Neppach1, J. Mangana2, S. Goldinger2, R. Dummer2
RWTH Aachen University Hospital, Aachen, Germany
Institute of Dermatology, University Hospital of Zurich, Zurich
1
2
14.53
FC5 Morphological analysis of dermatoporosis by in vivo Arena
reflectance-mode confocal microscopy and ultrasonography
Sébastien Menzinger1, Jean-Hilaire Saurat2, Gürkan Kaya1
Department of Dermatology, University Hospital of Geneva
Swiss Center for Applied Human Toxicology, University of Geneva
1
2
15.00
FC6 Clinical presentations and diagnostic delay in
bullous pemphigoid: a prospective nationwide cohort
R. Della Torre1, C. Combescure2, B. Cortes3, G. Marazza4, H. Beltraminelli1,
L. Naldi5, L. Borradori1
Institute of Dermatology, University Hospital of Bern, Bern
Service d’épidemiologie clinique, Hôpitaux Universitaires de Genève, Genève 3
Service de Dermatologie, Hôpitaux Universitaires de Genève, Genève
4
Servizio di dermatologia, Ospedale Regionale di Bellinzona e Valli, Bellinzona 5
Servizio di Dermatologia, Ospedali Riuniti, Bergamo
1
2
15.07
FC7 Interleukin (IL)-26 is over expressed in psoriasis and regulates
TLR9 activation to self-DNA
S. Dürr1, S. Meller2, M. Gilliet1
Department of Dermatology, CHUV, Lausanne
Department of Dermatology, Heinrich-Heine University, Düsseldorf
1
2
15.45–16.30 Standespolitisches Seminar
Séminaire de politique professionnelle
Chair: Jürg Hafner, Zürich
Wie geht es weiter mit der Dermato-Venerologie in Europa?
L’avenir de la dermato-vénéréologie en Europe?
Harald Gollnick, Magdeburg (D)
16.30–17.45
17.30-18.30
Generalversammlung SGDV/Assemblée générale de la SSDV Arena
1. Föderale SGDV-Plattform/1ère plateforme SSDV
des dermatologues
18.30–19.00 Individueller Transfer zum Restaurant Rosengarten
(Bus Nr. 10, ca. 5 Min. – zu Fuss ca. 15–20 Min.)/
transfer individuel au Restaurant Rosengarten
(Bus no 10, approx. 5 min – à pied approx. 15–20 min)
ab 19.00 Apéro im Restaurant Rosengarten /Apéritif au Restaurant Rosengarten
(Alter Aargauerstalden 31b, Bern)
20.00 Bankett /Banquet
Verleihung der Posterpreise /Remise des prix posters
SGDV - SSDV
10
Avec de l’eau thermale de La Roche-Posay
LA GAMME DE SOIN
DES PEAUX GRASSES OU
À TENDANCE ACNÉIQUE
La routine idéale pour lutter contre les
imperfections
EFFACLAR GEL
Gel Moussant pour peaux grasses à imperfections
Agents nettoyants en nombre limité et en concentration optimale
pour purifier la peau en limitant les risques d’irritation.
Pidolate de zinc pour réduire la production de sébum.
Sans parabène, sans savon, sans alcool, sans colorant, pH 5.5.
EFFACLAR DUO
Soin anti-imperfections correcteur et désincrustant
Une formule complète pour une prise en charge efficace
des 2 types de lésions.
LA ROCHE-POSAY. L’EXIGENCE DERMATOLOGIQUE.
08.00–08.30 Registrierung /Enregistrement
08.20–08.50 Thematische Fallvorstellung und Diskussion: STI (Triemli)/
Présentation de cas et discussion: STI (Triemli)
Chairs: Lars French, Zürich, Robert Hunger, Bern,
Laurence Toutous-Trellu, Genève
08.50–09.20 Key Lecture 4:
Arena
Die neutrophilen Dermatosen: von der klinischen Morphologie
zur molekularen Diagnostik/
Les dermatoses neutrophiliques: de la morphologie clinique au
diagnostic moléculaire
Daniel Wallach, Paris (F)
09.20–10.00 Thematische Fallvorstellung und Diskussion: Innere Erkrankungen und Haut/Présentation de cas et discussion:
Maladies internes et la peau
(Aarau, Bellinzona, Luzern, St. Gallen)
Chairs: Luca Borradori, Bern, Christoph Brand, Luzern,
Jürg Hafner, Zürich
10.00–10.30 Thematische Fallvorstellung und Diskussion: Arena
Dermatogeriatrie
Présentation de cas et discussion:
Dermatogériatrie (Genève)
10.30–11.00 Klinisch-pathologische Korrelationen (Teil 2)
Corrélations pathologiques et cliniques (partie 2)
11.00–11.45 Get-together-Brunch in der Ausstellung /Get-together brunch dans l’exposition
11.45–12.15 Key Lecture 5
Chairs: Wolf-Henning Boehncke, Genève,
Stephan Lautenschlager, Zürich,
Mark Anliker, St Gallen
Vom Symptom zur Diagnose: Purpura
Norbert Sepp, Innsbruck (A)
Arena
12.15–12.45 Thematische Fallvorstellung und Diskussion: Dermatoonkologie
Dermato-oncologie (Zürich)
Arena
12.45–13.15 Thematische Fallvorstellung und Diskussion: Dermatoallergologie
Dermato-allergologie (Bern)
Arena
13.15 Schlusswort /Remarque finale
13.30 Ende der Jahresversammlung/
Clôture de l’Assemblée annuelle
Arena
Arena
Arena
SGDV - SSDV
Arena
12
Pflegefachgruppe / Séance infirmières
Freitag 31. August / Vendredi 31 août
09.00 - 17.00
Tagesprogramm / Programme du jour
31.08.2012 im Kursaal Bern
Saal / Salle: ADAGIO 5
09:00-09:15 09:15-10:00
Begrüssung und Einführung/Accueil et introduction
Therese Zürcher, Leiterin Pflegedienst, Universitätsklinik für Dermatologie,
Inselspital Bern
Prof. Dr. L. Borradori, Chefarzt, Universitätsklinik für Dermatologie,
Inselspital Bern
Chronisch Kranksein/Maladie chronique
Anja Kröner, Pflegeexpertin Hämatologie/Onkologie USZ
10:00-10:45 Projet autour de la douleur induite en dermatologie ambulatoire/
Vorstellung des Projekts: Schmerzbehandlung im dermatologischen
Ambulatorium
Isabelle da Ernestho Crespin, Florence Raffaelli, Infirmières HUG
10:45-11:15 Kaffeepause und Besuch der Industrieausstellung/
Pause-café et visite des exposants
11:15-12:00 Interdisziplinäre Zusammenarbeit bei einer seltenen Hauterkrankung,
epidermolysis bullosa/Collaboration interdisciplinaire lors d’une maladie de
peau rare, epidermolysis bullosa
Rosaria De Lorenzo, Study Nurse, dipl. Wundexpertin Dermatologie, UniversitätsSpital Basel
12:00-12:15 Epidermolysis bullosa, Nachsorge nach chirurgischer Fingerseparation/
Epidermolysis bullosa, suivi médical après séparation chirurgicale des doigts
Sarah Titz, dipl. Ergotherapeutin, Therapieteam Winterthur und Frühberatung mit
Therapiesprechstunde Brunnen
12:15-14:00 Lunch und Besuch der Industrieausstellung/
Pause-repas et visite des exposants
14:00-14:45 Recrudenscence de la gale: un enjeu de santé publique et suivi des cas de syphilis/
Zunahme von Scabiesfällen: eine Herausforderung im Gesundheitswesen und die
Weiterverfolgung von Syphilisfällen
Mélanie Michaud, Nicole Eicher, Infirmières de santé publique GE
14:45-15:15 Kaffeepause und Besuch der Industrieausstellung/
Pause-café et visite des exposants
15:15-16:00
EB-Insel: Handlungsanleitung zur Pflege von Menschen mit epidermolysis
bullosa (EB )/EB Insel: Protocole pour les soins des souffrants d’epidermolysis
bullosa (EB)
16:00 Ausblick und Abschluss/Perspectives et clôture
Therese Zürcher, Rosaria De Lorenzo
Die Referate werden in der jeweiligen Landessprache gehalten und simultan übersetzt/
Les présentations sont tenues dans la langue maternelle et sont traduites simultanément.
Anmeldungen für das Programm der Pflege per E-Mail an Frau Therese Zürcher/
Inscriptions pour le programme des soins par courriel à Madame Therese Zürcher
[email protected]
Mit freundlicher Unterstützung von:
Barbara Nydegger, Pflegeexpertin, Universitätsklinik für Dermatologie Inselspital Bern
13
SGDV - SSDV
Interdisziplinäre Zusammenarbeit bei
einer seltenen Hauterkrankung,
Epidermolysis bullosa,
eine grosse und spannende Herausforderung
Chronische Krankheiten bestimmen den Alltag von immer mehr Menschen. Internationale Studien prognostizieren alarmierende Entwicklungen. Die Weltgesundheitsorganisation (WHO) geht davon aus, dass bis zum
Jahr 2020 weltweit zwei Drittel aller Krankheiten chronisch sein werden.
Durch die diesjährige Einführung der DRGs (Diagnose
Related Groups) in der ganzen Schweiz, werden pflegeund betreuungsintensivere Patienten früher entlassen.
Daraus wird immer deutlicher, dass der Schwerpunkt in
der Pflege im ambulanten Bereich liegen wird (Von Reibnitz, 2009) und eine Interdisziplinäre Zusammenarbeit
resultieren wird mit gemeinsamer Festlegung von Zielen
und Behandlungsplan mit Patienten und deren Familien/
Angehörige.
Epidermolysis bullosa (EB) ist eine seltene erbliche Hauterkrankung, welche von der Geburt an bis zum Lebensende mit Blasenbildung an der Haut und Schleimhaut
verläuft. Da dies eine genetisch bedingte Erkrankung ist,
kann der Lebensverlauf gleichgestellt werden mit einer
chronischen Krankheit. Diese Erkrankung betrifft wie
bei einer chronischen Krankheit den Menschen in seiner
Ganzheit und hat weitreichende psychosoziale Auswirkungen auf die betroffenen Personen und ihre Umgebung. Laut der Statistik 2011 des DEBRA-Vorstand CH
(Verein für EB-Betroffene Menschen in der Schweiz, welche durch Spenden oder Mitgliedschaft unterstützt wird)
sind in der Schweiz 47 Personen davon betroffen. Anfang
2012 wurden 3 Buben mit EB geboren. Das Leben der betroffenen Menschen ist geprägt von täglichen Verbandswechseln, aufwändiger Hautpflege und starkem Juckreiz,
was auch mit Schmerzen verbunden ist. Aufgrund der lebenslangen immer wieder auftretenden Wunden ist bei
bestimmten Formen der EB ein erhöhtes Hautkrebsrisiko
vorhanden. Die Betroffenen sind auf die Hilfe ihrer Angehörigen angewiesen, welche dabei oft in eine fatale Mischung aus fachlicher Überforderung, körperlicher und
emotionaler Belastung geraten.
Die dermatologische Klinik des Universitätsspitals Basel,
führt seit Januar 2010 zusammen mit dem Inselspital
Bern (EB-Insel) zweimal jährlich eine EB-Spezialsprechstunde durch. Im EB-Team arbeiten Ärzte, EB-Spezialistin,
Pflege- als auch Wundexperten. Wir werden dort mit
komplexen Situationen vor allem von Seiten der EBDbetroffenen Menschen (EB dystrophica) konfrontiert, was
für das ganze Team jeweils eine grosse Herausforderung
bedeutet. Weiter kommt hinzu, dass es sich um eine seltene Erkrankung handelt und den Betreuungspersonen
nur wenig Literatur oder Fortbildungsmöglichkeiten zur
Verfügung stehen.
In der EB-Spezialsprechstunde und EB-Insel wurde uns
schnell die Notwendigkeit einer auf die individuelle Situation abgestimmten kontinuierlich verfügbaren Versorgungsorganisation bewusst, welche nur durch eine
verstärkte interdisziplinäre Zusammenarbeit und eine
Vernetzung vorhandener Versorgungsbereiche erzielt
werden kann. Durch die interdisziplinäre Zusammenarbeit können wir gemeinsam langfristige Behandlungspläne koordinieren und erstellen.
In den Beratungsgesprächen werden aktuelle Probleme
der betroffenen Menschen erkannt und angesprochen.
Dies bedeutet, die EB-betroffenen Menschen als aktive
Partner in Gesundheit, Prävention, Krankheit und Rehabilitation zu sehen. Beratung soll als Hilfe zur Selbsthilfe
den betroffenen Menschen ermöglichen:

Sachgerechte und wohlüberlegt Entscheidungen
zu treffen

Lebensnotwendige Selbstpflegekompetenzen zu
e
ntwickeln

Probleme zu erkennen und angemessen darauf zu
r
eagieren

Antworten auf Fragen zu bekommen und die
richtigen Ansprechpartner zu finden
(London, 2003 zitiert in Knipping, 2007)
Durch das erlernte Selbstmanagement (SM) wird ein
grösseres Selbstvertrauen dazu vermittelt, mit den eigenen Fähigkeiten die jetzige Situation verbessern zu können, was zu einer Verbesserung des Allgemeinzustandes
und somit zu einer Erhöhung der Lebensqualität führt.
Die Pflegenden müssen lernen Kompetenzen abzugeben, Wünsche der betroffenen Menschen zu akzeptieren.
Das Betreuungsteam muss sich darauf einstellen, dass
die Betroffenen selbständig sind und "ihr eigenes Ding
durchziehen". Das Konzept SM ist in der Betreuung von
EB-betroffenen Menschen ein zentrales Konzept, da diese lebenslang betroffen sind und es keine Heilung gibt.
Durch ein erhöhtes SM wird die Autonomie der betroffenen Menschen gefördert und die Adhärenz positiv beeinflusst.
Die Angehörigen haben eine zentrale Rolle im ganzen
Ablauf und deshalb ist ein verstärktes Bewusstsein für
den Miteinbezug von Angehörigen wichtig. Mit den Familienmitgliedern fühlt sich der EB-betroffener Mensch
verbunden, er pflegt mit ihnen Kontakt, freut sich über
ihre Anwesenheit, macht sich Sorgen um sie. Die Familie ist wichtig in Zeiten, in denen sich EB-betroffene
Menschen überfordert fühlen und sich in die Familie
zurückziehen und sich in diesem geschützten Rahmen
sicher fühlen. Familienmitglieder und Angehörige müssen nicht verwandt sein, manchmal übernehmen gute
Freunde die Funktion einer Familie (Handel, 2003). Dies
verlangt ein gemeinsames Konzept und Austausch aller
Beteiligten. Das Betreuungsteam sollte sich deren Wichtigkeit bewusst sein und diese als eine Ressource des EBbetroffenen Menschen nutzen. Wir sollten zur Erhaltung
und Förderung deren Gesundheit beitragen indem die
Angehörigen ihre Stresskompetenz erhöhen und ihnen
aufzeigen, wie Gedanken bewusst in eine gute Situation
gesteuert werden können. Dies wird erreicht, indem die
Angehörigen das soziale Netz fördern. Wir zeigen ihnen
unterstützende Dienste und deren Angebote auf. Beispiele dafür sind Pro Infirmis (kostenlose Fachberatung
für Menschen mit Behinderung und deren Angehörige), DEBRA CH (Verein für zusätzliche Hilfeleistungen,
welche nicht durch die Sozialversicherungen abgedeckt
werden), Spitex, Sternschnuppe (erfüllt Herzenswünsche
von schwer- und langzeiterkrankten Kinder). Eine weitere
Aufgabe des Betreuungsteam ist, den Angehörigen das
Wissen und Verstehen von Krankheitssymptomen und
-Verläufen zu vermitteln.
Dies erfordert von uns Betreuungsteam eine ganze Anzahl verschiedener Fähigkeiten und Fertigkeiten. Das
Ziel unserer interdisziplinären Zusammenarbeit ist: Mit
dem grossen Wissen, Erfahrungen und Engagement der
einzelnen Disziplinen wie zum Beispiel: Handchirurgie,
Ergotherapie, Pädiatrie, Augenarzt, Gynäkologie, Gastroenterologie, den EB-betroffenen Menschen und deren
Angehörige möglichst gut auf den Alltag mit ihrer Behinderung/Abhängigkeit vorzubereiten und zu unterstützen. Ihnen dabei helfen, die Folgen ihrer Krankheit in ihr
Leben zu integrieren. Denn manchmal führen Unwissenheit oder Unsicherheit im Umgang mit der Erkrankung zu
einer Rehospitalisation.
Literaturverzeichnis
•
•
Knipping, C. (2007) Lehrbuch Palliative Care. Bern: Huber.
Von Reibnitz, C. (2009). Case-Management. In: Panfil E-M,
Schröder G (Hrsg.) Pflege von Menschen mit chronischen
Wunden. Lehrbuch für Pflegende und Wundexperten.
Bern: Huber (S.474).
Rosaria De Lorenzo, Schweizerische Pflegefachgruppe Dermatologie, Study Nurse &
dipl. Wundexpertin SAfW
14
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/03-12
Die richtige Reinigung
und Basistherapie ...
... besänftigt selbst wilde Haut
Lubex
®
Der-med
®
bei infizierter Haut
bei trockener Haut
je 150 ml + 500 ml

kassenpflichtig
Allgemeine Informationen
Informations générales
Datum/Date 30.8.–1.9.2012
Kongressort/Lieu du congrès
Kursaal Bern, Kornhausstrasse 3, CH-3003 Bern 25,
Tel. +41 31 339 55 00, Fax +41 31 339 53 14
Wissenschaftliche Organisation/Organisation scientifique
Prof. Dr. med. Luca Borradori (Tagungspräsident /Président de l’Assemblée annuelle)
Prof. Dr. med. Dagmar Simon, Prof. Dr. med. Nikhil Yawalkar, Prof. Dr. med. Robert Hunger
Administratives Sekretariat/Secrétariat administratif
Convention Team Lucerne AG, Oberseeburg 10, 6006 Luzern,
Tel. 041 371 18 60, Fax 041 371 18 61, E-Mail [email protected]
Registrierung und Sekretariat während des Kongresses/Enregistrement et secrétariat pendant le congrès
• Donnerstag/jeudi, 30.8.2012 12.00–18.30
• Freitag/vendredi, 31.8.2012 07.30–19.00
• Samstag/samedi, 1.9.2012 08.00–13.30
Desk: Tel. +41 31 339 54 75 / Mobile 079 699 94 79
Kongresssprachen/Langues du congrès
Deutsch, Französisch, Englisch/allemand, français, anglais (keine Simultanübersetzung/pas de traduction
simultanée)
Kongressgebühr/Frais d’inscription
Mitglieder SGDV/Membres SSDV (1 Tag/1 journée)  FR/ve  SA/sa
CHF 100.–
Mitglieder SGDV/Membres SSDV (ganzer Kongress/tout le congrès) CHF 250.–
(ordentliche, ausserordentliche Mitglieder/membres ordinaires, extraordinaires)
Mitglieder SGDV/Membres SSDV (nur Workshop am 30.8./seulement atelier le 30.8.) CHF 50.–
Assistenzarzt/-ärztin, Studenten, Passivmitglieder
Assistants, étudiants, membres passifs (1 Tag /1 journée)

FR/ve  SA/sa CHF 50.–
ganzer Kongress/tout le congrès
CHF 100.–
nur Workshop am 30.8./seulement atelier le 30.8. CHF 25.–
Nicht-Mitglieder SGDV/Non-membres SSDV (1 Tag/1 journée)  FR/ve  SA/sa
CHF 400.–
Nicht-Mitglieder SGDV/Non-membres SSDV (ganzer Kongress/tout le congrès) CHF 1000.–
Nicht-Mitglieder SGDV/Non-membres SSDV (nur Workshop am 30.8./seulement atelier le 30.8.) CHF 100.–
(Ehrenmitglieder mit ärztlicher Tätigkeit = Normaltarif; im Ruhestand = Tarif Passivmitglied/
membres d’honneur actifs = tarif normal; retraité = tarif membre passif )
Bankett /Banquet (31.8.2012) CHF 100.–
Credits/Crédits
Es können geltend gemacht werden/Vous pouvez faire valoir:
SGDV - SSDV
JV 1. Tag/RA 1er jour: Workshops 4 Credits /Crédits
JV 2. Tag/RA 2e jour
8 Credits /Crédits
JV 3. Tag/RA 3e jour 5 Credits /Crédits
Zahlungsweise/Mode de paiement
(Banküberweisung/Virement bancaire)
UBS, 6002 Luzern
Kontoinhaber/Titulaire du compte: Convention Team Lucerne AG
Vermerk/Remarque: "SGDV 2012"
Konto/compte: 469471.09Q
BIC/Swift: UBSWCHZH80A/Clearing No. 248
IBAN: CH180024824846947109Q
Bei Eingang der schriftlichen Absage bis zum 10. August 2012 wird der volle Betrag abzüglich CHF 25.–
Bearbeitungsgebühr pro Person zurückerstattet. Ab diesem Datum erfolgt keine Rückerstattung.
À réception de l’annulation, écrite auprès du Secrétariat administratif avant le 10 août 2012, les frais
d’inscription seront remboursés, après déduction de CHF 25.– pour les frais de dossier. Passé ce délai, aucun
remboursement ne pourra être effectué.
16
Präsentationsvorbereitung/Conference Preview
Die Redner werden gebeten, ihre Präsentation mind. 1 Stunde vor Beginn des Vortragsblocks im Regieraum
des Vortragsraumes abzugeben.
Les orateurs sont priés de déposer leurs présentations au moins une heure avant le début du bloc d’exposés
à la salle de régie.
Poster/Posters
Grösse/Format: Höhe/Hauteur: 146 cm
Breite /Largeur: 118 cm
Postermontage/Mise en place des posters: 30.8.2012, 14.00–18.00 / 31.8.2012, 08.00–08.30
Posterabbau/Démontage des posters: 1.9.2012, 12.30–14.30
Öffentliche Verkehrsmittel/Transports publics
Ab Hauptbahnhof Tram Nr. 9 Richtung Guisanplatz (Haltestelle: Kursaal, Distanz zum Bahnhof ca. 5 Minuten)
De la gare tram no 9 en direction "Guisanplatz" (arrêt: Kursaal) (Distance jusqu’à la gare env. 5 minutes)
Parking
Wir bitten die Teilnehmer die öffentlichen Verkehrsmittel zu benutzen, da im Kursaal Bern nur eine beschränkte Anzahl Parkplätze zur Verfügung steht.
Nous recommandons aux participants d’utiliser les transports publics; le nombre de places de parc du Kursaal Bern étant très limité.
Sponsoren/Sponsors (Stand per Juni 2012)
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:
Abbott AG
Janssen-Cilag AG
Gold/or
Astellas Pharma AG
Basilea Pharmaceutical International Ltd
Galderma SA
LEO Pharma
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Silber/argent
Almirall AG
A. Menarini AG
La Roche-Posay
MSD Merck Sharp & Dohme AG
Bronze/bronze
Pfizer AG
Weitere/en plus
Beiersdorf AG, Division Eucerin
MEDA Pharma GmbH
Merz Pharma (Schweiz) AG
Spirig Pharma AG
SGDV - SSDV
Platin/platine
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Wir danken folgenden Firmen für ihr Interesse und ihre Beteiligung
Avec tous nos remerciements aux exposants
Firma Exposant Ort /Lieu
Firma /Exposant Ort /Lieu
A. Menarini AG
Abbott AG aha! Allergiezentrum Schweiz ALCINA AG Allergan AG Allergopharma AG AllergyCare AG Almirall AG Astellas Pharma AG
Basilea Pharmaceutica
International Ltd Beiersdorf AG, Division Eucerin Biotest (Schweiz) AG BOURGEAY Cosmetic CALISTA Dermapharm AG DermoScan GmbH ebi-pharm ag Eisenhut Instrumente Esthetic-Med GmbH Galderma SA Gebro Pharma AG HUCO/FILORGA IBSA IDIB GmbH AG Zürich
Baar
Bern
Muttenz
Pfäffikon
Therwil
Adliswil
Wallisellen
AG Wallisellen
Janssen-Cilag AG La Roche-Posay
Lasermed AG –
Innovating Medicine LEO Pharma Louis Widmer SA MSD Merck Sharp & Dohme AG MEDA Pharma GmbH Merz Pharma (Schweiz) AG
NMS Bio-Médical S.A. Orcos Medical AG Pacifica Handels AG Permamed AG Pharma Medica AG Pierre Fabre, Dermo-Kosmetik Polymed Medical Center Pro Farma Quantel Derma GmbH Schweiz. Psoriasis und Vitiligo
Gesellschaft SIGVARIS AG
Spirig Pharma AG Stallergenes AG Tao Cosmetics Viollier AG Waldmann Lichttechnik GmbH Zeller Medical AG Baar
Vernier
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St Gallen
Egerkingen
Dietlikon
Ammersbek/
Hamburg (D)
Basel
Küttigen
Romanshorn
SGDV - SSDV
Basel
Reinach
Rupperswil
Meyrin-Genève
Wallisellen
Hünenberg
Regensburg (D)
Kirchlindach
Frittlingen (D)
Dübendorf
Lausanne
Liestal
Saint-Blaise
Pambio-Noranco
Chiasso
Roggwil/Givisiez
Regensdorf
Schlieren
Luzern
Wangen
Allschwil
Praroman
Küsnacht
Baar
Therwil
Roggwil
Allschwil
Glattbrugg
Baar
Erlangen (D)
18
Provisorische Traktandenliste
der 94. Generalversammlung der SGDV
Freitag, 31. August 2012 von 16.30 bis 17.30 Uhr
Ankündigung
1. Föderale Dermatologen-Plattform
(erweiterter Vorstand)
Freitag, 31. August 2012 von 17.45 bis 18.30 Uhr
Kursaal Bern
www.kursaal-bern.ch
16.30 Generalversammlung SGDV
TEIL 1 – Einführung und Jahresberichte
Einführung
1. Genehmigung der Traktandenliste vom 31. August 2012
2. Wahl der Stimmenzähler
3. Genehmigung des Protokolls der 93. Generalversammlung der SGDV 2. September 2011 in Genf
Berichte der Kommissionen und Arbeitsgruppen
Die Berichte werden an der Generalversammlung nicht mehr diskutiert
5. Berichte der Präsidenten der ständigen SGDV-Kommissionen
5.1.
Kommission zur Wahrung der Standesinteressen, Dr. Thomas Hofer
5.2.
Kommission für Weiter- und Fortbildung, Prof. Lars French
5.3.
Kommission für Qualitätssicherung, Prof. Ralph Braun
5.4.
Kommission für Facharztprüfung, Prof. Luca Borradori
5.5.
Medienkommission, Prof. Jürg Hafner
5.6.
Therapeutikakommission, Prof. Peter Itin
6. Berichte der Präsidenten der SGDV-Arbeitsgruppen
6.1.
Akne, Dr. Martin Kägi
6.2.
Andrologie, Dr. Christian Sigg
6.3.
Dermatoallergologie Prof. Andreas Bircher / Prof. Dagmar Simon
6.4.
Dermatochirurgie, Dr. André Skaria
6.5.
Dermatoonkologie, Prof. Ralph Braun
6.6.
Dermatopathologie, PD Dr. Gürkan Kaya
6.7.
Dermatopädiatrie, Dr. Stéphanie Christen-Zäch
6.8.
Röntgentherapie, Prof. Stephan Lautenschlager
6.9.
Swiss Group for Esthetic Dermatology and Skin Care – SGEDS, Dr. Oliver Kreyden
6.10. Transplantation, PD Dr. Günther Hofbauer
6.11. Trichologie, Prof. Ralph Trüeb
7. Weitere Berichte:
7.1.
Ehrenrat, Dr. Jörg Knüsel
7.2.
Schweizerische Stiftung zur Bekämpfung der Geschlechtskrankheiten,
Prof. Stephan Lautenschlager
7.3.
fmCh, Prof. Jürg Hafner
7.4. UEMS/EADV, Dr. Peter Bloch
7.5. SDNTT
7.6. Doit/Dermokrates
8. Bericht zu Preise/Unterstützungen:
8.1.
Stiftung Spirig Pharma AG
8.2.
Fonds Widmer
8.3.
Prof. U. W. Schnyder - Posterpreis
8.4. SGDV-Posterpreis
8.5.
Posterpreis Bruno-Bloch Stiftung
TEIL 2- statutarisch: Mitgliedermutationen – Vorstand - Finanzen – Abstimmung
9. Mitglieder – Vorstand SGDV
9.1.
Bekanntmachung Neumitglieder SGDV 2011/2012
9.2.
Statusänderungen der Mitglieder der SGDV im Jahr 2011/2012
Bericht des Präsidenten
4. Jahresbericht des Präsidenten SGDV
19
9.3.
Ernennungen / Verlängerungen - Vorschläge des Vorstandes:
o
Präsident elect SGDV – Vorschlag: Prof. Jürg Hafner kandidiert für ein 2. Mandat
o
Ausschuss- und Vorstandsmitglieder SGDV

Austritt Ausschuss: Dr. André Skaria
Eintritt Ausschuss: Prof. Daniel Hohl, Dr. Gionata Marazza

Austritt Vorstand: Dr. Rosmarie Holzinger-Schultheiss
Eintritt Vorstand: Dr. Christian Schuster, Dr. Gion Tscharner

Nachfolge Quästorin: Dr. Konstantine Buxtorf-Friedli
o
Ehrenmitglieder – Vorschlag: Prof. Roland Kaufmann, Frankfurt
10. Bericht der Quästorin, Dr. Rosmarie Holzinger-Schultheiss
10.1. Jahresrechnung per 31. Dezember 2011 der SGDV
10.2. Jahresrechnung per 31. Dezember 2011 der Stiftung zur Bekämpfung von
Geschlechtskrankheiten
10.3. Jahresrechnung per 31. Dezember 2011 des SDNTT
11. Bericht der Rechnungsrevisoren, Dr. Rolf Ingold und Dr. Martin Kägi
12.Genehmigung
12.1. der Jahresrechnungen 2011
12.2. des Berichts der Rechnungsrevisoren
12.3. Entlastung des Vorstands für das Geschäftsjahr 2011
13. Festlegung des Mitgliederbeitrags 2011
13.1.ROKO
14. Genehmigung der Reglemente 2012 der SGDV
14.1.Mitgliederbeitragsreglement
14.2.Spesenreglement
14.3.Gebührenreglement
14.4.Beitrittsreglement
15. Budget 2012, Dr. Rosmarie Holzinger-Schultheiss
15.1. Abstimmung :
a) Personeller Ausbau Generalsekretariat auf (+ CHF 50’000.- = CHF 170’000.-)
b) Kampagnen und PR CHF 30’000.
15.2. Genehmigung Budget 2012
TEIL 3 – Themenzentrierte Diskussion
16.Gesundheitspolitik
16.1. Rückblick Managed Care-Vorlage
16.2. Ausblick Einheitskasse
16.3. Aufhebung Kontrahierungszwang
17.
Nationale Hautkrebskampagne
17.1. nationale Hautkrebskampagne 2012
17.2. nationale Hautkrebskampagne 2013
18. Medien / ICT SGDV
18.1. Dermatologica Helvetica www.derma.ch
18.2.www.derma.ch
18.3.DermArena
18.4. Doit / Dermokrates
SGDV - SSDV
19. Weiter- und Fortbildung
19.1. Fortbildungs-Plattform SIWF
17.45 - 1. Föderale SGDV-Plattform
Plattformdiskussion des SGDV-Vorstandes mit den:
•
•
PräsidentInnen der regionalen Dermatologenverbände,
PräsidentInnen der Arbeitsgruppen und Kommissionen der SGDV
Prof. Jürg Hafner
Präsident SGDV
30. Mai 2012
20
Ordre du jour provisoire
94ème Assemblée Générale de la SSDV
Vendredi 2 septembre de 16h30 à 17h30
Annonce
1ère plateforme fédérale des dermatologues
(Comité élargi)
Vendredi 2 septembre de 17h45 à 18h30
Kursaal Bern
www.kursaal-bern.ch
16.30 Assemblée Générale de la SSDV
PARTIE 1 – Introduction et rapports annuels
Introduction
1. Adoption de l’ordre du jour du 31 août 2012
2. Désignation des scrutateurs
3. Adoption du procès-verbal de la 93ème Assemblée Générale de la SSDV
du 2 septembre 2011 à Genève
Rapport du Président
4. Rapport annuel du Président de la SSDV
PARTIE 2 – statutaire : Mutations des membres – Comité – Finances - Votations
9. Membres – Comité SSDV
9.1.
Nouveau membres SSDV 2011/2012
9.2.
Mutations des membres de la SSDV en 2011/2012
9.3.
Nominations / Prolongations – Propositions du Comité de la SSDV :
o
Président elect SSDV – Proposition: Prof. Jürg Hafner postule pour un 2e mandat
o
Membres du Bureau et du Comité de la SSDV

Sortie du Bureau du Comité: Dr Skaria
Rapports des commissions et groupes de travail
Les Rapports ne seront plus discutés lors de l’Assemblée Générale
5. Rapports des Présidents des commissions permanentes
5.1.
Commission des intérêts professionnels, Dr. Thomas Hofer
5.2.
Commission de la formation post-graduée et continue, Prof. Lars French
5.3.
Commission de la promotion de qualité, Prof. Ralph Braun
5.4.
Commission des examens de spécialiste, Prof. Luca Borradori
5.5.
Commission des médias, Prof. Jürg Hafner
5.6.
Commission thérapeutique, Prof. Peter Itin
6. Rapports des Présidents des groupes de travail
6.1.
Acné, Dr. Martin Kägi
6.2.
Andrologie, Dr. Christian Sigg
6.3.
Dermatoallergologie Prof. Andreas Bircher, Prof. Dagmar Simon
6.4.
Dermatochirurgie, Dr. André Skaria
6.5.
Dermatopathologie, Prof. Werner Kempf
6.6.
Darmatopédiatrie, Dr. Stéphanie Christen-Zäch
6.7.
Radiothérapie, Prof. Stephan Lautenschlager
6.8.
Swiss Group of Esthetic Dermatology and Skin Care – SGEDS, Dr. Oliver Kreyden
6.9.
Transplantation, PD Dr. Günther Hofbauer
6.10. Trichologie, Prof. Ralph Trüeb
7. D’autres rapports:
7.1.
Commission de déontologie, Dr Jörg Knüsel
7.2.
Fondation pour la défense des maladies sexuellement transmissibles,
Prof. Stephan Lautenschlager
7.3.
fmCh, Prof. Jürg Hafner
7.4.
UEMS/EADV, Dr. Peter Bloch
7.5. SDNTT
7.6. Doit/Dermokrates
8. Rapport au sujet des Prix/Bourses :
8.1.
Fondation Spirig Pharma SA
8.2.
Fonds Widmer
8.3.
Prof. U.W. Schnyder – Prix Poster
8.4.
Prix Poster SSDV
8.5.
Prix Poster Fondation Bruno-Bloch
21
Entrée au Bureau du Comité: Prof. Daniel Hohl, Dr. Gionata Marazza

Sortie du Comité: Dr. Rosmarie Holzinger-Schultheiss
Entrée au Comité: Dr. Christian Schuster, Dr. Gion Tscharner

Succession trésorière: Dr Konstantine Buxtorf –Friedli
o
Membre d’honneur : Proposition : Prof. Roland Kaufmann, Frankfurt
10. Rapport de la Trésorière, Dr Rosmarie Holzinger-Schultheiss
10.1. Comptes au 31 décembre 2011 de la SSDV
10.2. Comptes au 31 décembre 2011 de la Fondation pour la lutte contre les maladies
sexuellement transmissibles
10.3. Comptes au 31 décembre 2011 du SDNTT
11. Rapport des vérificateurs des comptes, Dr Rolf Ingold et Dr Martin Kägi
12.Adoption
12.1.
12.2.
12.3.
Des comptes 2011
Du rapport des vérificateurs des comptes
Décharge au Comité pour la gestion de la Société de l’année 2011
13. Fixation de la cotisation 2013
13.1.ROKO
14. Adoption des règlements 2013 de la SSDV
14.1. Règlement des cotisations
14.2. Règlement des indemnités
14.3. Règlement des émoluments
14.4. Règlement d’admissions des nouveaux membres
15. Budget 2013, Dr Rosmarie Holzinger-Schultheiss
15.1.Votation
a) Expansion du personnel du secrétariat général (+ CHF 50’000.- = CHF 170’000.-)
b) Campagne et communications CHF 30’000. 15.2
Adoption du Budget 2013
PARTIE 3 – Discussion focalisée
16. Politique de la santé
16.1. Rétrospective Managed-Care
16.2. Perspective caisse unique
16.3. Suppression de l’obligation de contracter
17. Campagne de la prévention nationale contre le cancer de la peau
17.1. Prévention nationale contre le cancer de la peau 2012
17.2. Prévention nationale contre le cancer de la peau 2013
18. Média SSDV / ICT SGDV
18.1. Dermatologica Helvetica
18.2. Site web de la SSDV www.derma.ch
18.3.DermArena
18.4. Doit / Dermokrates
19. Formation postgraduée et continue
19.1. Plateforme ISFM - Formation continue
17.45 – 1ère plateforme SSDV des dermatologues
Discussion entre le comité de la SSDV et les:
SGDV - SSDV
•
•
Président(e)s des groupement des dermatologues régionaux
Président(e)s des groupes de travail et des commissions de la SSDV
Prof. Jürg Hafner
Président SSDV
Le 18 juin 2012
22
Transient acantholytic dermatosis- the clinical
spectrum, comborbidities and unusual presentations
M.D. Anliker
Dermatology unit, Canton hospital of St. Gallen, St. Gallen
Introduction: Transient acantholytic dermatosis
(M.Grover) is not very well understood and the
population and possible associations are ill-defined.
Aim is to analyse the patients with clinical and/or
histopathologic diagnosis during the last 8 years.
Methods: Systematical search for M.Grover in the
databank of all patients seen in the dermatological
dept. Review of all histopathologies when available
and search for concomitant diseases in the databank of the pathology institute and clinics.
Results: The 55 patients had a median age of 75years.
5% were women; prostate cancer occurred in 15.3%
of men, other life-threatening cancers in 18.2%,
prostate hyperplasia in 15,3%. 2/55 were suffering
from metastasizing melanoma, one of which was
under BRAF-Inhibitor treatment. Histopathology
showed two to four different patterns of M. Grover
in 63% of patients, only one subtype in 27%. Therapy
included the use of oral Steroids (5,4%) UV-therapy
(7, 2%) and azathioprin (7,2%) in severe cases.
Discussion: All though for the majority M. Grover
is benign, it can have a great impact on quality of
life with the need for systemic treatment; it can be
a gateway for serious infections and could occur as
a side effect of BRAF inhibition. Malignant tumours
occurred in over 30%; it could therefore be called
a paraneoplastic skin affection. Most biopsies show
several subtypes simultaneously.
FC 2
Expression of miRNA in cutaneous squamous cell
cancer
B. Burger1, C. Brügger2, I. Spoerri2, W. Kempf3, P. Itin1
Department of Dermatology and Department of Biomedicine, University Hospital Basel
2
Department of Biomedicine, Research Group of Dermatology, University Hospital Basel
3
Kempf and Pfaltz Histological Diagnostics, Research Unit
and Department of Dermatology, University Hospital Zurich
1
Squamous cell cancer (SCC) is one of the most common skin cancers, accounting for about 16% of total skin cancers, and belongs to the heterogenous
group of non-melanoma skin cancer. 1% of all cutaneous SCCs lead to death. Development of SCC
is promoted by several risk factors including UV exposure, immune status, HPV infection, and genetic
condition. Several patient groups are known to be
at a high-risk for SCC development, e.g. organ transplant patients, patients with epidermodysplasia verruciformis, and patients with epidermolysis bullosa.
Numerous pathways, such as for example the EGFR,
Ras, NFκB, TNF-α pathway, have been reported to
be involved in SCC development. Interestingly the
influences of regulatory non-coding RNAs on SCC
development and proliferation have rarely been focused on. MicroRNAs (miRNA) constitute an important group of regulatory non-coding RNAs, which
play a major role in cell differentiation. miRNAs are
strongly conserved small RNAs (about 21-22 nucleotides in average), which regulate between 30% and
60% of all mRNAs in human cells. Usually, they bind
to the 3’-UTR of the mRNA and lead to degradation
of mRNA or inhibit translation. Up to now more than
1000 human miRNAs are known. On average 1 miRNA regulates 300 genes and 1 gene is regulated by
300 different miRNAs.
We isolated total mRNA of formalin-fixed and paraffin-embedded (FFPE) SCCs and determined the relative expression of specific miRNAs by quantitative
PCR (qPCR). Here we present and discuss our results
and argue also the difficulties in the interpretation
of such data.
FC 3
Micrographic surgery in the Southern part of Switzerland: two-year Experience
G. Marazza1, S. Parvex-Leoni2, L. Mazzucchelli2, C. Mainetti1
Dermatologia, Ospedale Regionale Bellinzona e Valli,
Bellinzona
2
Istituto Cantonale di Patologia, Locarno
1
Micrographic surgery is a technique developed
in the 1930s by Frederic Mohs that has numerous
advantages for the surgical treatment of certain cutaneous tumours, such as for instance, basocellular
and squamocellular carcinoma, especially localized
to the face and with aggressive histology. So far, this
technique has only been adopted within Swiss Dermatologic University Hospitals and rarely by dermatologic surgeons in their private practice. Since
June 2010, patients can also benefit from it in Ticino
– the Southern part of Switzerland - at the "Cantonal
Service of Dermatology" within the "San Giovanni"
Hospital in Bellinzona. The adoption of this technique has been possible thanks to the close collaboration with the "Cantonal Institute of Pathology"
in Locarno. The goal of this oral communication is
to present the first two years of activity from a statistical perspective, with respect to surgical activity
and histopathological analysis. The data colle cted
during these two years will be compared to public
available data within the international literature.
FC4
S100B levels under therapy with the selective
BRAF-inhibitor vemurafenib: a single center experience
K. Neppach1, J. Mangana2, S. Goldinger2, R. Dummer2
RWTH Aachen University Hospital, Aachen, Germany
Department of Dermatology, University Hospital Zürich
1
2
Background:The incidence of melanoma is increasing worldwide especially in high risk populations.
BRAF is the most commonly mutated gene in human melanomas noticeably prevalent in young patients. Recently, the selective BRAF-inhibitor Vemurafenib improved survival rates in patients carrying
the BRAF mutation with the majority of patients experiencing partial response or stable disease. Regular follow-up examinations of advanced-melanoma
patients can detect early metastases and therefore
have an important influence on the outcome, with
the melanoma-affine S100B being used as a standard monitoring tool.
Dermatologica Helvetica - Volume 24(6) - Juin 2012 F REE COMMU N I C AT I O N S
FC 1
23
Materials and Methods: Twenty-eight patients with
unresected stage III or IV melanoma were treated with
Vemurafenib at the Department of Dermatology of the
University Hospital of Zurich during 2010 and 2011.
Investigating each patient’s records, a retrospective
analysis comparing individual S100B-levels before,
during, and after the chemotherapy was performed.
Results: S100B levels rose in patients not under or after
discontinuation of treatment with Vemurafenib corresponding to disease progression. Eighty-three percent
of patients who experienced disease progression also
presented with rising levels of S100B. This rise in S100B
coincided with or in some cases occurred before actual clinical manifestation of disease progression as
defined by the response evaluation criteria in solid
tumors (RECIST). In eighty-six percent of the patients
with PET/CT-detected regression of tumor mass, serologic levels of S100B fell accordingly.
Conclusions: S100B should be routinely monitored in
patients with advanced melanoma, as it accurately reflects the tumor mass, thereby potentially indicating
whether and when therapy should be adjusted. In Vemurafenib patients, levels of S100B seem to reflect and
sometimes even foreshadow radiologically confirmed
responses to treatment. The question of how S100B
fares in BRAF-wildtyp e patients should be addressed
by further studies.
FC5
Morphological analysis of dermatoporosis by in vivo
reflectance-mode confocal microscopy and ultrasonography
S. Menzinger1, J.H. Saurat2, G. Kaya1
Department of Dermatology, Geneva University Hospital
SCAHT, Centre Médical Universitaire, Geneva
1
F REE COMMU N I C AT I O N S
2
Background: Dermatoporosis is defined as a chronic
cutaneous fragility and insufficiency syndrome. It results from chronological aging, long-term and unprotected sun exposure, genetic factors, or the chronic
use of topical and systemic corticosteroids. There is
currently a lack of non-invasive tools for the evaluation
and quantification of dermatoporosis.
Objectives: The aim of this study was to define the
dermal-epidermal modifications which characterize
dermatoporosis, using non-invasive methods such as
in vivo reflectance-mode confocal microscopy and ultrasonography.
Material and Methods: 18 patients with stage I dermatoporosis and 8 healthy volunteers were included
in the study. Posterior surface of the right forearm was
analyzed in all subjects, and stellate pseudoscars and
senile purpura in patients with dermatoporosis were
analyzed when possible. We used a commercially
available, reflectance-mode confocal microscope
(RCM) (Vivascope 1500; Lucid Inc, Rochester, NY) and
measured different histometric parameters (thickness
of the epidermis and its different layers, cellular architecture, aspect of the dermis and its vascularization).
We also used a commercially available ultrasound skin
system (Episcan; Longport Inc, PA) to define the dermal-epidermal thickness in all subjects.
Results: The dermal-epidermal thickness measured
with the ultrasound skin system was significantly different between the two groups: mean value: 1.33 mm
(volunteers group) vs 0.8 mm (dermatoporosis group).
The significant differences measured with RCM were:
(i) epidermal thickness: mean value: 74 µm vs 56 µm;
(ii) number of dermal papillae: mean value: 3.9 papillae/area (0.5mmx0.5mm) vs 0 papillae/area; (iii) the
depth of solar elastosis: mean value: 14 µm vs 44 µm.
We noted also a horizontal lining of the vessels in the
upper dermis. The thickness of the epidermis seemed
to be lower in stellate pseudoscars (mean value: 56
µm) compared to normal skin (mean value: 65 µm) in
patients with dermatoporosis. Stellate pseudoscars
are also characterized by a modified dermis, with a linear organization of the collagen bundles.
Conclusion: Ultrasonography and in vivo RCM are useful tools for the diagnosis of dermatoporosis. Dermalepidermal atrophy, reduction of dermal papillae/area
and the importance of dermal elastosis seem to be the
major histometric parameters which characterize dermatoporosis.
FC6
Clinical presentations and diagnostic delay in bullous pemphigoid: a prospective nationwide cohort
R. Della Torre1, C. Combescure2, B. Cortes3, G. Marazza4, H.
Beltraminelli1, L. Naldi5, L. Borradori1
Department of Dermatology, Inselspital Bern
Service d’épidemiologie clinique, Hôpitaux Universitaires
de Genève
3
4
Dermatologia, Ospedale Regionale Bellinzona e Valli, Bellinzona
5
Dermatologia, Ospedali Riuniti, Bergamo
1
2
Background: Prospective systematic analyses of the
clinical presentation of bullous pemphigoid (BP) are
lacking. Little is known about the time required for its
diagnosis. Knowledge of the disease spectrum is important for prompt diagnosis, management and inclusion of patients in future controlled therapeutic trials.
Objectives: The aims of the study are : 1) to characterize the clinical features of BP at time of diagnosis; 2)
to assess the diagnostic delay in BP; and 3) to determine if an increased diagnostic delay has an impact
on prognosis.
Methods: All new cases of BP diagnosed in Switzerland
between 1 January 2001 and 31 December 2002 were
prospectively registered by means of a standardized
data collection form.
Results: 117 patients with BP were included in the
study. Ninety seven cases (82.9%) had typical features with vesicles, blisters and/or erosions at time of
diagnosis, while in the remaining cases (17.1%) only
excoriations, eczematous and/or urticarial infiltrated
lesions were observed. Head/neck as well as palmoplantar involvement were found in up to 20% of patients, while mucosal lesions were present in 14.5%
of the cases. Diagnosis was made after a mean of 6.1
months after the first symptoms. In patients, in whom
the diagnostic delay was more than 4 months, lesions
were more often limited to one body area, while the
type of lesions did not affect the diagnostic delay. The
latter had no impact on the first-year mortality of affected patients.
Conclusion: BP often presents with bullous lesions at
time of diagnosis after a mean diagnostic delay of 6
months. Nevertheless, up to 20% of patients lack obvious blistering and postbullous erosions, mimicking
thus a variety of inflammatory dermatoses. Localized
disease is associated with an increased diagnostic delay, which has however no impact on prognosis.
24
FC7
Interleukin (IL)-26 is over expressed in psoriasis and
regulates TLR9 activation to self-DNA
S. Dürr1, S. Meller2, M. Gilliet1
1
2
Department of Dermatology, Heinrich-Heine University, Düsseldorf
Interleukin-26 is a Th17-derived cytokine belonging,
like IL-22, to the IL-10 family. It is expressed in many
autoimmune disorders including Crohn’s disease
rheumatoid arthritis and multiple sclerosis. IL-26 binds
to the IL-26 receptor expressed exclusively by epithelial cells. In the gut, IL-26 mediates STAT1 and STAT3
activation of intestinal epithelial cells, leading to the
expression of IL-10 and IL-8 and inhibition of proliferation. In the skin, by contrast, the effect of IL-26 is less
clear and does not appear to have a major effect on keratinocyte activation. Interestingly, we found that IL-26
is highly overexpressed in psoriasis compared to other
inflammatory skin diseases suggesting a pathogenic
role in this disease. Moreover, we found that IL-26 is
a highly cationic protein with amphiphatic structure.
This unique structure endowed IL-26 with direct antimicrobial activity and with the capacity to form complexes with extracellular host-derived DNA. IL26-DNA
complexes were readily internalized by plasmacytoid
dendritic cells leading to DNA-mediated activation of
TLR9 and production of high levels of IFN-a. Accordingly, Th17 cells were found to trigger TLR9 activation
of pDCs through their release of IL-26.
F REE COMMU N I C AT I O N S
Thus we uncover an unexpected function of IL-26 via
the breaking of innate tolerance to extracellular nucleic acids leading to type I IFN-driven inflammation.
These findings may provide a new mechanism for the
pro-inflammatory function of Th17 cells and shed new
light on the pathogenesis of psoriasis.
P1
Gain without pain. Daylight-PDT (D-PDT) in practice in Switzerland
L.R. Braathen1
1
Dermatology, Im Holenacker 16, Ittigen
Daylight Photodynamic Therapy (D-PDT) is a new
innovative development of topical PDT. Skin reaction course, therapeutic and cosmetic results as well
as pain were recorded in 18 patients treated with
D-PDT in a skin specialist private practice in Switzerland.
We used a sunscreen (Louis Widmer F15 Gel (SPF15))
and methyl aminolevulinate (MAL) in a cream base
(Metvix), and the patients exposed themselves to
daylight for 90-120 min.
The local skin tissue reactions, its course and the
therapeutic and cosmetic results were similar to
conventional PDT using lamp illumination, but
there was practically no pain during the daylight
exposure. The patient compliance and satisfaction
was excellent.
D-PDT is an excellent alternative to conventional
PDT. It is especially suitable for treating pain sensitive patients with large field cancerisation areas.
P2
Two cases of juvenile mycosis fungoides
P. Cesana1, P. Itin1, P. Haeusermann1
Department of Dermatology, University Hospital Basel
POSTERS
1
Mycosis fungoides in children is a rare disease. It is
prone to be mis- or late diagnosed because of its
low prevalence, its manifestation in the early stage
and especially the ambiguity of its clinical manifestations. In this work, we report the clinicopathological features of two adolescent boys (14y and
12y) with confirmed diagnosis of Mycosis fungoides. Interestingly, both patients markedly differed
in their clinical presentation as well as their histopathologic-, immunopathologic- and molecular
laboratory results. Both patients received a stageadapted treatment regime according to the actual
guidelines for the treatment of Mycosis fungoides
in adults. Thereby, topical corticosteroids or a combinatory approach additionally using narrow-band
UVB were administered. Particular attention was
paid long-term adverse-effects. As expected, the
chosen regimen proved to be effective, resulting in
a high-grade partial remission.
P3
Eosinophilic spongiosis and hairy cell leukemia, a
case report
A. Chollet, M. Gilliet, M. Vernez
Service de dermatologie et vénéréologie, CHUV, Lausanne
We report herein the case of a 71-year-old man
with a one-week history of non-pruritic, well-circumscribed, disseminated, raised infiltrated annular erythematous plaques. No other complaint was
reported. The patient was in good general health
apart from long-standing hypertension treated
with torasemide and felodipine. Physical examination revealed splenomegaly. No adenopathy was
found. Skin biopsy and laboratory workup were performed. Skin biopsy showed an eosinophilic spongiosis and a superficial inflammatory infiltrate with a
large number of eosinophils. No flame figures were
observed. Direct immunofluorescence was negative. No monoclonal rearrangement of T-cell receptor chain was detected by PCR. Laboratory findings
included a slightly elevated ESR (29 mm/h, normal
value <20 mm/h), discrete thrombocytopenia (123
G/l, normal value 150-350 G/l), normal serum creatinine, an antinuclear antibody titer of 1:320, normal
protein electrophoresis and immunofixation. Viral
screening for HBV, HCV and HIV was negative. The
peripheral blood smear showed mononuclear cells
of middle size with round nuclei, dense chromatin
and abundant cytoplasm with indistinct outlines.
These cells expressed CD19, CD20, CD 25, CD103
and CD123 by flow cytometry. These findings were
consistent with the diagnosis of hairy cell leukemia.
A massive infiltration by hairy cells was observed
on bone marrow examination. The patient started
chemotherapy with cladribine and skin lesions improved in conjunction with clobetasol ointment.
To the best of our knowledge, the association of
eosinophilic spongiosis and hairy cell leukemia has
never been described in the literature. Eosinophilic
spongiosis is commonly encountered in bullous
pemphigoid, pemphigus, Well’s syndrome, arthropod bites, incontinencia pigmenti (first stage) and
drug reactions. In this particular case, we strongly
believe that the lesions observed were caused by
the underlying hematological malignancy. Th e
disappearance of the lesions with chemotherapy
supports this hypothesis. We propose that haematological malignancies and in particular Hairy Cell
Leukemia should be included in the differential diagnosis of eosinophilic spongiosis and suggest that
clinicians request a peripheral blood smear in cases
where no other apparent causes are found.
P4
Cutaneous gamma-delta T cell lymphoma in a patient with a hemophagocytic syndrome
I. Gschwind1, AK. Lapointe1, L. Feldmeyer1, L. de Leval2,
D. Hohl1, M. Gilliet1, C. Conrad1
Department of Pathology, CHUV, Lausanne
1
2
Cutaneous gamma-delta T cell lymphoma (CGD-TCL)
is a rare and extremely aggressive peripheral T-cell
lymphoma with a mean survival of 15 months. Due
to its panniculitis-like clinical picture it was previously added to subcutaneous panniculitis-like T cell
lymphomas (SPTCL), whereas now the SPTCL designation is only used for lymphomas with an alpha-beta phenotype having an indolent course. So far only
about 40 cases of CGD-TCL have been described in
the literature. It has gained greater significance and
recognition over the last decade. Nevertheless, it remains a challenge for dermatologists to make an early diagnosis and is often misdiagnosed for months,
even after repeated biopsies, as cytophagic histiocytic panniculitis or other forms of benign panniculitis.
26
Behandlung der aktinischen Keratose
Wirkt lang anhaltend
und punktgenau*
Stimuliert bei Bedarf das körpereigene Immunsystem der Haut
* Krawtchenko N et al. A randomised study of topical 5% imiquimod vs. topical 5-fl uorouracil vs. cryosurgery in immunocompetent patients with actinic keratoses: a comparison of clinical and histological outcomes including
1-year follow-up. BJD 2007; 157(Suppl.2):34–40.
Aldara® 5% Creme (Imiquimod): Immunmodulator. Indikationen: Topische Behandlung des Erwachsenen. 1. Äusserliche spitze Kondylome der Genital- u. Perianalregion. 2. Multiple oberfl ächliche Basalzellkarzinome (Biopsiebestätigt; max. 2 cm Tumordurchmesser) am Rumpf (mit Ausschluss der Anal- und Genitalregion), an der Halsregion oder den Extremitäten (ohne Hand und Fuss), wenn chirurgische Entfernung nicht angezeigt und Nachkontrolle
gewährleistet ist. 3. Klinisch typische, nicht-hyperkeratotische, nicht-hypertrophische aktinische Keratosen im Gesicht und auf dem Kopf. Dosierung: Jeweils vor dem Zubettgehen auftragen. Äusserl. spitze Kondylome: 3x
wöchentlich dünn auftragen (max. 16 Wochen) und 6–10 Std. auf der Haut belassen. Oberfl. Basalzellkarzinom: Während 6 Wochen 5x wöchentlich und 8 Std. auf der Haut belassen. Aktinische Keratosen: Während 16 Wochen
3x wöchentlich und 8 Std. auf der Haut belassen. Kontraindikationen: Überempfi ndlichkeit auf Wirkstoff oder einen Hilfsstoff. Behandlung von Kindern und Jugendlichen. Vorsichtsmassnahmen: Offene Geschwüre, Wunden,
chirurgische Eingriffe: erst nach vollständiger Abheilung. Kein Okklusivverband, kein Kontakt mit Augen, Lippen und Nasenschleimhaut, keine Sonneneinwirkung auf die behandelte Haut. Verschlechterung entzündlicher
Hauterscheinungen möglich. Vorsicht bei Patienten mit Autoimmunerkrankungen oder Organtransplantaten. Heftige lokale Entzündungsreaktionen der Haut möglich. Vorsicht bei Vorhautbehandlung unbeschnittener Männer. Nicht
empfohlen bei inneren spitzen Kondylomen der Genitalregion. Während Schwangerschaft und Stillzeit: nur bei absoluter Notwendigkeit. Empfehlungen bzgl. Geschlechtsverkehr und Empfängnisverhütung bei spitzen Kondylomen
sowie weitere indikationsspezifi sche Warnhinweise und Vorsichtsmassnahmen: s. Kompendium. Interaktionen: Nicht untersucht. Interaktionen mit systemisch applizierten Wirkstoffen
sind nur in sehr geringem Masse zu erwarten. Vorsicht bei Patienten mit immunsupressiver Behandlung. Unerwünschte Wirkungen: Sehr häufi g: Reaktionen am Applikationsort (bis 40%).
Häufi g: Infektionen; Kopfschmerzen; Myalgie; Juckreiz, Schmerzen, Brennen am Applikationsort; Müdigkeit. (UW ≤ 1%: s. Kompendium). Packung: OP mit 12 Sachets zum Einmalgebrauch.
(A). Kassenzulässig. Ausführliche Informationen: Packungsbeilage, Arzneimittel-Kompendium oder MEDA Pharma GmbH, 8602 Wangen-Brüttisellen. Stand der Information: Mai 2009.
We report the case of a 45-year-old woman referred
to our clinic with extended erythematous subcutaneous plaques on her legs. At that time, she was
treated with high dose systemic steroids, ciclosporin, and biweekly immunoglobulin perfusions for
a hemophagocytic syndrome, which had been diagnosed at about the same time as the cutaneous
lesions appeared. A skin biopsy revealed a mixed
lobular and septal panniculitis. Due to the patient’s
history, a differential diagnosis of SPTCL with concurrent hemophagocytic syndrome was taken into
consideration. But a second skin biopsy remained
without arguments for a lymphoma despite the
identification of a T cell clone. Instead, histology was
compatible with cytophagic panniculitis. Despite
intensive therapy, the patient’s condition worsened
and the skin lesions progressed. Finally, a third biopsy showed an atypical subcutaneous lymphoid
infiltrate consisting of T cells with a gamma-delta
phenotype. In agreement with clinical-pathological
findings, the diagnosis of CGD-TCL was confirmed 6
months after the first symptoms. The patient underwent two cycles of polychemotherapy (CHOP) and
could be released from the hospital with clinical improvement but residual disease.
Conclusion: CGD-TCL is a extremely rare and highly
malignant peripheral T-cell lymphoma with pronounced treatment resistance. Thus, prompt diagnosis and aggressive therapy are essential. Recent
findings suggested that allogenic stem cell transplantation could lead to complete remission, an option that might be considered in our patient for the
future. This case again underlines the importance of
persistency and repeated biopsies in patients with
differential diagnosis that includes SPTCL and CGDTCL.
P5
Cutaneous Reactive Angiomatosis with Combined
Histological Pattern and Clinical Presentation
Mimicking a Cellulitis
M.A. Corti1, L. Borradori1, F. Rongioletti2, H. Beltraminelli1
1
Section of Dermatology and Department of Dermatopathology, University of Genoa, Italy
POSTERS
2
Background: Cutaneous reactive angiomatosis
(CRA) is a very rare, benign, reactive proliferation
of endothelial cells, pericytes or histiocytes that affect only the skin. There are different forms of CRA
including reactive angioendotheliomatosis (REA),
diffuse dermal angiomatosis (DDA) and reactive
intralymphatic histiocytosis (IH). The etiology and
pathomechanism of CRA are not completely understood although a unifying hypothesis has been discussed in the literature.
Case report: We present the case of a 72-year-old
woman with reduced general conditions and extended cellulitis-like plaques of the skin of the pelvis
region and the legs. Histopathological analysis revealed a CRA presenting patterns of different forms:
RAE, DDA and IH. An infection of unknown origin or
a small arteriovenous fistula of the right lower leg
were supposed as possible causal diseases. Under
systemic prednisolone therapy (0.5 mg/kgBW/d)
the clinical course was positive.
Discussion: Differential diagnosis of localized atypical sudden skin rush with general symptoms should
involve CRA. Different histopathological forms of
CRA are known although the clinical presentation is
frequently similar. CRA has been often described associated with many different systemic diseases: the
most frequent of them is rheumatoid arthritis but
also infections and arteriovenous shunts are included. The link among these diseases is the tendency
to a vasculopathic process with consequent vascular occlusion that generates an hypoxic stimulus as
stimulating factor for the endothelial proliferation.
This could explain the supposed pathogenesis of
different CRA as a continuum of the same regeneration mechanism after an occlusive or inflammatory
vasculopathic process. Our case supports the hypothesis about the overlapping between different
forms of CRA and gives hints about a better understanding of its pathomechanism.
P6
The transposition advancement flap (TAF) for repair of postsurgical defects on the upper lip
R. Della Torre1, M. Stieger1, A.M Skaria1,2
1
Centre de Dermatochirurgie, Vevey
2
Background: Skin cancer of the lip is frequent and
reconstruction after Mohs surgery might be challenging mostly when the postsurgical defect has a
size more than 1 cm2 and is situated adjacent to the
phyltrum.
Objective: We present a combination of a transposition and advancement flap for the reconstruction of
postsurgical defects of the upper lip.
Methods: Demonstration of the technique and practical application for this kind of reconstruction
Results: The transposition advancement flap (TAF)
presents excellent results for medium defects of the
upper lip medially adjacent to the phyltrum.
Conclusion: The transposition advancement flap
(TAF) can be used in the reconstruction of the major part of postsurgical lip defects in the medial two
fifth of the upper lip without any risk of lip distortion. As this flap is easy to perform it is an important
tool in the armamentarium of the dermatologic surgeon.
P7
Island pedicle flaps for medial canthus repair
R. Della Torre1, M. Stieger1, A.M Skaria1,2
1
Centre de Dermatochirurgie, Vevey
2
Background: Skin cancer of the medial canthus is
frequent and reconstruction after Mohs surgery
might be challenging. Different reconstructions are
recommended in literature for this area. Flap reconstructions are mostly transposition flaps from the
glabella, a skin with different properties than the
canthal region requiring mostly correction in a second stage
Objective: We adopted different reconstructions
with island pedicle flaps for medial canthal lesions
which does not need correction in a second stage.
28
Methods: We reviewed the medical records and
photographs of patients which had a pedicle island
flap reconstruction for medial canthal defects after
Mohs surgery. There are always three different possibilities to choose a pedicle island flap around the
canthus or to combine two of them.
Results: 16 patients were reconstructed by pedicle
island flaps for defects of the medial canthal area.
Follow up was one year for all patients, all patients
showed ex cellent to good results without web deformation and without ectropion.
Conclusion: This flap is not mentioned in textbooks
for the reconstruction of canthal lesions and we
think that its value for this localization is probably
underestimated.
P8
Intense pulsed light treatment of telangiectasia
after radiotherapy for breast carcinoma
N. Dietrich1, M. Adatto2
Private practice, Geneva
1
2
Chronic radiodermatitis after radiotherapy for carcinoma of the breast is a common sequela of treatment and often is an additional psychologically
distressing factor for the affected patient. We present the case of a 68-year-old woman with extensive
post-radiotherapy skin telangiectasia of the chest
wall and axilla who was treated with intense pulsed
light with a considerable improvement in appearance.
with accumulation of tumor cells within small vessels. Immunohistochemistry disclosed a large cell
lymphoma of B cell type.
Comment: The histologic appearance of IVL is diagnostic consisting of large malignant lymphoid
blasts filling the lumina of small vessels, witout infiltration of the surrounding tissue. The classic immunophenotype of the malignant lymphocyte in
IVL is B-cell-associated as it was observed in this
case. The clinical presentation on the other hand is
remarkably protean but the majority of cases can be
grouped into a few discrete presentations: (a) central nervous system (CNS) involvement, (b) cutaneous involvement, (c) fever of unknown origin, and
(d) hemophagocytic syndrome. Skin lesions can appear as maculopapular eruptions, nodules, plaques,
tumors, hyperpigmented patches, palpable purpura, ulcers, and infiltrative "peau d’orange" and have
been misdiagnosed as cellulitis, gangrene, vasculitis,
squamous cell carcinoma, and Kaposi’s sarcoma. Because of the various modes of presentation, the rarity of IVL and its aggressive course, the diagnosis is
often made postmortem. The timely acquisition of a
tissue biopsy is critical for an antemortem diagnosis
giving the patient a chance for specific therapy.
P10
Constitutional intraepidermal ascent of cells (CONIAC): a potential pitfall in the diagnosis of melanocytic lesions
K. Kerl1, W. Kempf1, J. Kamarashev1, G. Spallone2, T. Wiesner3, LE. French1, R. Dummer1
1
Institute of dermatology, University Hospital of Rome
3
Institute of dermatology, University Hospital of Graz
P9
Intravascular large b-cell lymphoma: diagnosis on
skin biopsy
J. Kamarashev1, A. Häffner2, B. Himmelmann3, F. Solomon3
1
Dermatological clinic Pfäffikon
3
Hirslanden Hospital, Zürich
2
Introduction: Intravascular lymphoma (IVL) is an
extremely rare subtype of extranodal diffuse large
B-cell lymphoma, recognized as a distinct entity by
the WHO classification of the hematologic malignancies. IVL is defined as the intravascular proliferation of clonal lymphoid blasts with little to no involvement of the organ parenchyma. First reported
in 1959 by Pfleger and Tappeiner as "angioendotheliomatosis proliferans systemisata" the disease was
long considered to be angioproliferative, until in
the mid 1980s immunophenotyping demonstrated
the neoplastic cell to be of lymphoicytic and not of
endothelial origin. It has been reported in patients
ranging from 34–90 years of age, with a median age
of 70 years and equal gender distribution.
Observation: A 75-year-old male presented with a
2-month history of fever and malaise. He developed
a systemic inflammatory response syndrome (SIRS)
with rapidly progressive signs of inflammation and
C-reactive prot ein levels over 400mg/l. Erythema
on the inner side of the thighs was observed. A skin
biopsy revealed a malignant angiotropic lymphoma
Background: Transepidermal melanocytic migration (TEM) is an important diagnostic criterion for
malignancy,especially in association with cytologic
atypia. However, TEM may also be observed in benign melanocytic tumors, such as Spitz nevus, acral
nevi, or nevi in infancy. We discuss the value of TEM
for the diagnosis of melanocytic tumors in a young
patient previously diagnosed as having 11 cutaneous melanomas.
Observation: A 17-year-old patient with a history of
11 cutaneous melanomas diagnosed in the past 3
years by different expert dermatopathologists presented in our department. The previous histological
diagnoses of melanoma were mainly based on the
presence of important TEM. A reevaluation of all histological specimens in light of the clinical context
and the lack of genomic aberrations as detected by
array-comparative genomic hybridization led to a
revision of the previous diagnoses. The stri king TEM
observed represents, in our opinion, a constitutional
element of the melanocytic nevi in this patient and
not a marker of malignancy.
Conclusion: Awareness of this finding is important
to avoid overdiagnosis of melanoma in cases of melanocytic nevi.
Dermatologica Helvetica - Volume 24(6) - Juin 2012 POSTERS
2
29
P11
Classification of merkel cell carcinoma (MCC) patients of the dermatology department of Zürich
according to the new AJCC 2010 staging system
for MCC
J. Mangana, L.E French, R. Dummer, A. Cozzio
Background: Merkel cell carcinoma (MCC) is a rare,
aggressive cutaneous neoplasm with high propensity for local recurrence as well as regional lymph
node and distant metastases. Its incidence is increasing more rapidly than the incidence of melanoma,
with a mortality rate higher than for melanoma. Recently, both the American Joint Committee on Cancer (AJCC) and the International Union for Cancer
Control (UICC) proposed a new TNM classification
system for MCC. This four-stage system allows better prognostic discrimination of MCC patients.
Material and methods: We retrospectively analyze
clinical, histological, and virological information
for all patients treated for MCC at the Department
of Dermatology of the University Hospital of Zürich
since 2000.
Results: Thirty patients with MCC have been treated
between 2000 and 2012. All MCC cases have been
reclassified according to the AJCC 2010 staging system. Previously, we found MCPyV (Merkel cell polyoma virus) in 67% of MCC patients in Switzerland.
Conclusions: We report on the prognosis of MCC in
dependence of presence of MCPyV, and propose
an algorithm for diagnosis, staging and therapeutic
procedures in MCC patients.
P12
Coral reef squamous cell carcinoma of the leg
A. Moser, J. Hafner, K. Schad
P O S T ER S
A 77-years-old female presented with a rapidly
growing nodular and scaly plaque of 5.5x4cm in diameter at her right lower leg. The patient’s history
revealed multiple squamous cell carcinomas in the
past few years.
Upon clinical examination we suspected a squamous
cell carcinoma (SCC). The lesion was completely excised and the defect repaired with a split skin graft.
Histology confirmed a well differentiated SCC of the
keratoacanthoma (KA)-type. Seven months later
the patient presented with a 8x3 cm measuring
plaque with a coral reef-like rim of nodules at the
contralateral left lower leg, growing to a diameter
of 8x3cm. The lesion was totally excised and histology confirmed again a well differentiated SCC of the
KA-type.
Only 4 months later a new coral reef-like ring of
nodules showed along the margins of the split skin
graft of the former operation at the ipsilateral left
leg. The clinical presentation together with the recurrent course was suspici ous of keratoacanthoma
centrifugum marginatum, a finding that was supported by histology.
Keratoacanthoma centrifugum marginatum (KACM)
is a variant of keratoacanthoma. Patients typically
report rapid peripheral growth within few weeks
without spontaneous regression. It usually appears
as a single lesion, only few cases with multiple lesions are described in the literature. In patients with
multiple keratoacanthomas Grzybowksy syndrome
(GS) should be looked for. In our patient, GS was excluded on clinical grounds.
The incidence of KACM is unknown, but is certainly
a rare skin cancer. The median age of patients is 60
years. Diagnosis is made by clinical course, appearance and histologic features. There is low evidence
for treatment modalities. Surgery is the best established treatment modality. Alternative therapeutic
options are radiation therapy, oral retinoids, intralesional methotrexate or EGF-R inhibitor.
P13
Increased histopathological diagnosis of melanoma in situ: A real increase in melanoma frequency
and/or enhanced sensibility of dermatologists/
dermatopathologists ?
DS. Nikolic, G. Kaya
Dermatopathology Unit, University Hospital of Geneva
Background: Malignant melanoma (MM) is one of
the leading causes of cancer-related death in developed countries and its occurrence has been linked
to excessive sun exposure and genetic factors. Recent data indicate that the overall incidence of MM
is still increasing1. Systematic skin examination by
dermatologists is a major preventive intervention
and it has been demonstrated that increased access
to dermatological examination reduces MM-linked
mortality2. Main histopathological subtypes of MM
include melanoma in situ (MIS), superficial spreading melanoma (SSM), nodular melanoma (NM) and
acro-lentiginous melanoma (ALM). Our goal was to
analyze the incidence of different subtypes of MM
diagnosed at the University Hospital of Geneva during the last 6 years and to discuss the reasons explaining the differences observed.
Methods: We retrospectively analyzed all the histopathological reports of the Dermatopathology Unit
of the University Hospital of Geneva du ring the
2006-2011 period using Diamic® software. All cases
registered as MM were collected and subsequently
dispatched according the following histopathological diagnoses: MIS, SSM, NM, ALM, desmoplastic
melanoma, metastatic melanoma, regressive melanoma, lentigo maligna melanoma and unclassified
melanoma.
Results: The overall annual number of dermatopathological examinations varied from 7800 (2006)
to 10389 (2011) showing a progressive increase. The
diagnosis of MM varied from 106 in 2006 to 181 in
2011, representing a 70.75% increase. The percentage of MIS increased from 22 (20.75%) in 2006 to 86
(47.51%) in 2011. The mean percentage of MIS over
the 2006-2011 period was at 33.68% and showed a
gradual increase of 128.96%. In counterpart, there
were no striking differences in the SSM subtype
with a mean percentage of 41.20%. The same trend
was observed for the other subtypes. The global increase in MM diagnosis was thus mostly due to the
increase in MIS diagnosis.
Conclusion: Our results demonstrate that there
was a greater number of MM diagnosed during
the 2006-2011 period in our Dermatopathology
30
UNGENIESSBAR…
WUNDERBAR…
THERAPIERBAR!
.. iche Pinselstrich zum gesunden Nagel
Der tagl
• Leichte bis mässig starke
Pilzerkrankungen der Nägel
(ohne Matrixbefall)
• Kein Feilen
• Einfache abendliche Anwendung
• Praktisch unsichtbar
Gekürzte Fachinformation Ciclopoli® Nagellack
Z: Nagellack mit 80 mg/g Ciclopirox I: Durch Dermatophyten und/oder andere Ciclopirox-sensitive Pilze hervorgerufene leichte bis mässig starke Pilzerkrankungen der
Nägel, bei denen die Nagelmatrix nicht betroffen ist. D/A: Zur topischen Anwendung auf Fingernägeln, Fussnägeln und unmittelbar angrenzenden Hautbereichen (Perionyx,
Hyponychium). 1-mal täglich dünn auftragen. KI: Überempfindlichkeit gegenüber Ciclopirox oder einen der sonstigen Bestandteile. Kinder unter 6 Jahren. VM: Bei Auftreten
einer Überempfindlichkeitsreaktion muss das Arzneimittel abgesetzt werden. Cetylstearylalkohol kann lokale Hautreaktionen wie z.B. irritative Kontaktdermatitis hervorrufen.
UW: Sehr selten: Rötung, Schuppung, Brennen und Jucken an den behandelten Stellen. P: 3,3ml und 6,6ml. Abgabekategorie B, kassenpflichtig. Weitere Informationen
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entnehmen Sie bitte dem Arzneimittelkompendium der Schweiz. Astellas Pharma AG, Grindelstrasse 6, 8304 Wallisellen.
kassenpflichtig
Unit. Most of this increase is linked to an increase
in MIS diagnosis. Several factors could explain this
observation: better detection of early abnormal lesions by dermatologists, overall increase in MM or
enhanced sensibility of dermatopathologists to MIS
diagnosis.
P15
Primary cutaneous marginal B cell lymphoma,
lymphoplasmocytic variant : a rare and indolent
form of cutaneous B cell lymphoma
C. Prins1, N. Barouti1, I. Masouyé2
1
P14
Primary cutaneous follicle center lymphoma presenting as a giant tumor of the scalp
P. Pham1, T. Tirefort2, V. Greloz3, C. Prins1
1
2
Service d’hématologie, Geneva University Hospital
3
P O S T ER S
Introduction: Primary cutaneous follicle center lymphoma (PCFCL) is a cutaneous B cell lymphoma
with an excellent prognosis and manifesting in middle-age adults. We describe an exceptional case of
PCFCL in a patient presenting with a giant tumor of
the scalp.
Case report: A 56-year-old man with an unremarkable medical history developed a multinodular
mass on the scalp measuring 19xx16x4 cm over
18 months. Three skin biopsy specimens showed a
dense and diffuse infiltrate throughout the dermis
and the subcutis, made of large lymphocytes, which
labeled with CD20 and Bcl-6, whereas staining
for Bcl-2, IRF4 and CD10 was negative. The tumor
showed focally a nodular growth pattern. These
findings were consistent with follicle center lymphoma of predominantly diffuse pattern of growth.
BCL2 rearrangement with t(14;18) could not be
detected using FISH. Staging procedures including PET/CT did not reveal any evidence of systemic
spread of the lymphoma except a suspicious spinal
lymph node on the right side. According to ISCL/
EORTC classification of cutaneous lymphomas, the
diagnosis of PCFCL, stage T2bN1M0 was made. Because of the exceptional size of the tumor, its location and possible nodal involvement, the patient received systemic chemotherapy R-CHOP followed by
consolidation radiotherapy. A spectacular response
with 90% reduction of the tumor mass could be observed after two chemotherapy courses. The patient
is in remission 8 months after diagnosis.
Discussion: PCFCL is a cutaneous B cell lymphoma
with an excellent prognosis and is mainly treated
by local radiotherapy. The histological differential
diagnosis is diffuse large B-cell lymphoma, leg type.
This distinction is important, since the latter has an
intermediate prognosis and is usually treated with
systemic chemotherapy. Our case is exceptional in
its presentation. Despite the size of tumor, we observed a spectacular response to treatment. Local
recurrences can occur in PCFCL and long term follow-up is thus mandatory.
2
In the WHO-EORTC classification of 2005, primary
cutaneous marginal B cell lymphomas are a separate entity and it has appeared over the years that
it is a heterogeneous group of lymphomas with the
classical variant being the most frequent one. Two
other types have been described in the literature,
the plasmocytic type and the lymphoplasmocytic
type. The latter differs from the two others in that
it occurs frequently on the legs as small brownreddish papules and that it effects older patients; in
some regions of Europe it is highly associated with
Lyme disease whereas the two former are more frequently found in younger patients on the trunk, the
arms, the head and neck.
We present a case of a primary cutaneous lymphoplamocytic marginal B cell lymphoma in a 80 yearold female patient. She was seen in our department
because of multiple brown-reddish papules on both
legs which were completely asymptomatic. Histology revealed nodular aggregates throughout the d
ermis consisting in small B lymphocytes, lymphoplasmocytoid cells and numerous plasma cells. we
also observed a fibrous stroma with bizarre multinucleate histiocytic cells and an important vascular
proliferation. By immunostaining, the plasma cells
predominantly expressed kappa-light chain. PCR
analysis showing immunoglobulin heavy-chain
gene rearrangement confirmed a monoclonal population of B-lymphocytes. Blood count was normal
and no tumoral cells were present in blood flow cytometry. B2-microglobuline and LDH were normal.
A Ct scan did not reveal hepato-splenomegaly nor
adenopathies. PCR analysis for the presence of EBV,
CMV, borrelia burgdorferi and HHV8 in skin samples
were negative. Immunoglobulines IgG and IgM
were elevated 14.4 g/L and 5.8 gr/l respectively. We
concluded that the patient suffered from a primary
marginal zone B cell lymphoma, lymphoplasmocytic variant. Because of severe obesity, respiratory
insufficiency and adenocarcinoma of the colon in
remission, we deci ded not to treat the patient. After
a follow up of 5 years, the patient has a few more
lesions, is otherwise stable and has no evidence of
extracutaneous progression.
Primary marginal zone B cell lymphoma, lymphoplasmocytoid variant (formerly called immunocytoma) is a rare cutaneous B-cell lymphoma affecting the elderly. The clinical presentation with small
brownish macules and papules on both legs is misleading. In addition, our patient had unusual histological features, the stromal reaction with vascular
proliferation and multinucleate histiocytic cells being only reported in a few cases1. Our observation
confirms the indolent course of this cutaneous lymphoma as described in the literature.
32
P16
P17
Pruritic acquired nevus of Ota
Spindle-cell shaped variant of primary cutaneous
follicle center lymphoma with a metastasis mimicking Klatskin tumor
1
Department of Dermatology, University Hospital of Geneva
2
Department of Ophthalmology, University Hospital of
Geneva
3
Private practice, Meyrin.
Introduction: Nevus of Ota is a unilateral, asymptomatic cutaneous and mucosal hyperpigmentation of the face that is congenital or may appear
in early childhood or puberty. We present a case of
symptomatic acquired nevus of Ota in a 32-year-old
woman.
Observation: A 32-year-old Kurdish Iraqi woman,
previously in a good health, presented to our clinic
with brownish mottled macules which appeared
progressively in 8 days on the the face following the
distribution of the first and second divisions of the
left trigeminal nerve and partially the iris and sclera
of the left eye. She reported to have an intense pruritus in association with the pigmentation. We performed a biopsy on the left forehead, which confirmed the diagnosis of nevus of Ota. Special stains
and immunohistochemistry revealed increased
numbers of mast cells. Magnetic resonance imaging showed no abnormalities and ophthalmologic
exams concluded an acute acquired melanocytosis
of the left iris and sclera.
Discussion: Dermal melanocytosis which has been
described to be congenital in most of the cases can
appear during the first year of life and less often in
adolescence. In adults, the cases of late onset dermal melanocytosis are rare and referred to an acquired dermal melanocytosis. Hulke was the first to
describe a unilateral hyperpigmentation of the face
and sclera in 1861, and then Ota and Tanino, defined it as a clinical entity in 1939. The origin is still
unclear, but several hypotheses suggest a defect in
the process during the melanocyte migration from
the neural crest to the epidermis. The melanocytes
are thought to be reactivated by unknown factors.
Our patient reports an itchy sensation, which can be
explained by the inflammatory process stimulated
by the migration of melanocytes. It can also be related to the neuronal activation of the ophthalmic and
maxillary division of the fifth cranial nerve in the
whole process, as neurons and skin are both issued
from the same embryologic tissues. Another explanation might be the increased quantity of mast
cells in the lesion. Interestingly, the pruritus faded
spontaneously 10 weeks after the onset of the lesion. As a therapeutic approach for the pigmentation, the patient is currently undergoing a Laser QS
YAG 1064 nm treatment. To our knowledge, this is
the first case report of acquired nevus of Ota associated with pruritus.
S. Rozati, K. Kerl, W. Kempf, R. Dummer, A. Cozzi
Introduction: Primary cutaneous follicle center cell
lymphoma (pcFCL) is an indolent type of primary
cutaneous B cell lymphoma (pcBCL) very rarely disseminating to other organs. Spindle-cell shape variant of pcFCL is rare and the data on the prognosis is
sparse. The possibility of a worse prognosis of this
special subtype of FCL has been discussed but not
confirmed yet. We report a rare case of this variant
found to have infiltrated the hepatic hilum, mimicking a Klatskin tumor.
Clinical history: A 61 year old male presented with
4 reddish and non-scaling nodules on his left upper back. Biopsy showed cutaneous follicle center B
cell lymphoma (pcFCL) which was confirmed upon
complete negative staging, as per the most recent
guidelines. Over the next few years the multiple
local recurrences were locally treated with different methods (radiation therapy, intralesional interferon and excision). Eventually, more than 2 years
after his initial presentati on, patient presented with
signs and symptoms of Hilar cholangiocarcinoma
(Klatskin tumor) which resulted in extensive surgery
followed by post-op complications and a long rehabilitation period. Surprisingly the histopathology
and immunohistochemistry of the liver specimen
showed an infiltrate of neoplastic B-lymphocytes
with CD20+, CD79a+,CD3+, Bcl-6+, MuM1- and
CD10- tumor cells suggesting a metastasis of the
known pcFCL. Molecular genetic analysis revealed
identical clones of neoplastic B-lymphocytes in the
skin and liver specimens.
Conclusion: By reason of there being only few reported cases of the spindle cell variant and within
those only a few having documented course of
disease, there is the need to further investigate the
possible more aggressive nature of this variant. Emphasis should also be put on that even in indolent
primary tumors such as pcFCL metastasis should be
considered in the differential diagnosis of Klatskin
mimicking tumors for a less aggressive approach.
P18
Lymphome à grandes cellules B intravasculaires
(LBIV)
M. Sahil, E. Laffitte, C. Pham, C. Prins
Introduction: Le LBIV est un lymphome disséminé
dans les sites extra-ganglionnaires dont la peau.
Nous rapportons le cas d’un patient qui présente un
infiltrat cutané d’un LBIV.
Observation: Nous présentons le cas d’un patient de
94 ans avec un état fébrile, une baisse de l’état général et des plaques érythémateuses et purpuriques
des membres inférieurs évoluant depuis 3 mois. Un
diagnostic de LBIV est posé sur la base d’une biopsie cutanée montrant de nombreux blastes CD20+
dans la lumière des vaisseaux.
Dermatologica Helvetica - Volume 24(6) - Juin 2012 P O S T ER S
S. Quenan1, V. Strueven2, N. Saxer1, E. Laffitte1, G. Kaya1,
I. Masouye1, J. Krischer3, F. Hafezi2, F-A. Le Gal1
33
Discussion: Le LBIV est considéré comme une entité à part entière dans la classification de l’OMS de
2008. Le LBIV est très rare et touche des sites extraganglionnaires (SNC, peau, poumon, reins, glandes
surrénales et moelle osseuse). Dans la pathogénie, on discute un défaut de molécules d’adhésion
nécessaires à la migration des lymphocytes dans
les régions extravasculaires, d’où l’accumulation
de ces cel lules dans les capillaires provoquant une
occlusion des petits et moyens vaisseaux dans les
organes atteints (thromboses, hémorragies, nécroses tissulaires). L’étiologie est inconnue, mais certaines associations avec les virus EBV et HTLV sont
décrites.
Le diagnostic est souvent retardé en raison du tableau clinique variable (rash symétrique, douloureux,
induré ; nodules, plaques érythémateuses ou hyperpigmentées, télangiectasies, purpura palpable,
ulcères). La peau joue un rôle important car elle est
l’organe le plus fréquemment atteint (39%) et la biopsie cutanée permet alors de poser le diagnostic.
En l’absence d’atteinte cutanée, la biopsie en peau
saine aux membres inférieurs est recommandée car
dans 60% des cas, la maladie cutanée reste infraclinique.
Il s’agit d’un lymphome très agressif, répondant
mal à la chimiothérapie. Néanmoins l’adjonction du
Rituximab à une chimiothérapie contenant des anthracyclines (R-CHOP) a considérablement amélioré
la survie des patients qui passe de 38 à 89%. Une
autogreffe est réservée aux patients qui rechutent
mais dont la maladie reste chimiosensible.
Conclusion: Les LBIV sont rares, de mauvais pronostic et diagnostiqués tardivement en raison de leur
présentation clinique peu spécifique. Le rôle du dermatologue est prépondérant car cette maladie se
manifeste le plus souvent par des lésions cutanées
et la biopsie permet alors de poser le diagnostic.
P19
Intravascular large B-cell Lymphoma
M. Sahil, X-C. Pham, E. Laffitte, C. Prins
P O S T ER S
Introduction: Intravascular large B-cell Lymphoma
(IVLBCL) is a rare extranodal lymphoma, which can
be present in any organ including the skin. We report a case of IVLBCL presenting with skin manifestation.
Case report: A 94-year old man presented with a
3-month history of generalized fatigue, fever, weight
loss and symmetrical, painful, indurated erythematous and purpuric plaques over his thighs. A skin
biopsy showed atypical lymphocytes filling blood
vessels within the dermis and subcutaneous tissue.
These cells labeled with CD20, thus confirming the
diagnosis of IVLBCL.
Discussion: IVLBCL is part of the Word Health Organization lymphoma classification of 2008. Involvement of the skin or the central nervous system is
common, but many organs can be affected. Thus
symptoms are variable. Accumulation of neoplastic lymphocytes within lumina of small to medium
sized vessels in any organ leads to vascular occlusion. It has been postulated that the lack of expr ession of adhesion molecules such as CD29 or CD54
by neoplastic cells is responsible for the intravascu-
lar growth pattern. A plethora of cutaneous lesions
has been reported : symmetrical eruption, painful,
indurated nodules or plaques, telangectasias, hyperpigmented patches, palpable purpura, ulcers. IVLBCL has a dismal prognosis and responds poorly to
chemotherapy. Nevertheless, rituximab given concurrently with anthracycline-based chemotherapy
has been shown to significantly improve outcome.
Conclusion: Since cutaneous involvement is not uncommon in IVLBCL, dermatologists should be aware
of this condition. A skin biopsy may be helpful to
make the diagnosis.
P20
A case of intravascular large B-cell Lymphoma
presenting with cutaneous lesions
M. Sahil, C. Prins, E. Laffitte, X-C. Pham
Introduction: Intravascular large B-cell Lymphoma
(IVLBCL) is a rare extranodal lymphoma which typically occurs in elderly persons. The brain and the
skin are the most commonly affected organs. We
report a case of IVLBCL presenting with cutaneous
lesions.
Case report: A 94-year old man with a 3-month history of generalized fatigue, fever and weight loss,
presented with symmetrical, painful and indurated
erythematous and purpuric plaques over his thighs.
A skin biopsy showed large atypical lymphocytes
filling blood vessels within the dermis and subcutaneous tissue. These cells labeled with CD20. The diagnosis of IVLBCL was made. The patients died from
pneumonia a few months after diagnosis.
Discussion: IVLBCL is considered as a rare variant of
extranodal diffuse large B-cell lymphoma. Involvement of the skin or the central nervous system is
common, but many organs can be affected. Thus
symptoms are variable. Accumulation of neoplastic lymphocyte s within lumina of small to medium
sized vessels in any organ leads to vascular occlusion. The pathogenesis remains unclear. It has been
postulated that the lack of expression of adhesion
molecules such as CD29 or CD54 by neoplastic
cells is responsible for the intravascular growth pattern. Cutaneous lesions are not specific: nodules or
plaques, telangectasias, hyperpigmented patches,
palpable purpura or ulcers. IVLBCL has a poor prognosis and responds poorly to chemotherapy.
Conclusion: Since cutaneous involvement is common in IVLBCL, dermatologists should be aware of
this condition, especially in elderly persons with
constitutional symptoms. Early diagnosis can be
made by skin biopsy.
P21
A case of glomangiomatosis mimicking blue rubber bleb nevus syndrome
N. Saxer-Sekulic, G. Kaya
Background: We describe the case of a 23 year-old
female patient who presented with multiple small
blue papules on her buttocks, painful on palpation
34
Rundum sicherer
UVB-UVA Sonnenschutz für
überempfindliche, allergische
Haut und Babyhaut
100% mineralischer Schutz
Ohne chemische Filter
Sehr hoher Schutz SPF 50+
Höchste Verträglichkeit
Ohne Parabene
Extra wasserfest
Partner Sonnenschutzkampagne der
Unser langjähriges Engagement in der Hautkrebsprävention
and increasing in number. Identical lesions have
been observed in her mother and sister. Clinically,
the diagnosis of blue rubber bleb nevus syndrome
(BRBNS) has been made. The patient had no history
of gastrointestinal bleeding.
Methods: Histological slides of paraffin-embedded
biopsy material from the patient mentioned above
have been analyzed on Hematoxylin-Eosin-stained
sections and on sections immunohisto-chemically
stained for smooth muscle actin, CD34 and D2-40.
Results: Histological examination revealed a preserved epidermis overlying a dermal and subcutaneous vascular proliferation with no atypia, composed of large vessels surrounded by several layers
of non-atypical glomus cells, with a homogenous
appearance and round, centrally located nuclei. The
glomus cells were po sitive for smooth muscle actin. CD34 staining identified the blood vessels. No
D2-40-positive cells have been observed within the
proliferation area.
Conclusion: The histological features of the biopsy
specimen of our patient were typical for a glomangioma. Clinically, these lesions may, especially if they
are multiple, mimic BRBNS, as described previously
(1). Both type of lesions show blue to blue-black vascular papules varying in size, are generally painless
with some exceptions, and found on the face, trunk
or extremities. Histologically, BRBNS lesions show
irregular cavernous channels in the deep dermis
and subcutis with no glomus cells. Gastrointestinal
involvement, often as gastrointestinal bleeding, is
well-known in BRBNS and uncommon in glomangiomas. Both diseases can be inherited, but familiar cases are more frequent in glomangiomatosis.
Histological examination is very helpful to distinguish these lesions with clinically almost identical
aspects.
P22
Male genital changes and their implication in sexual life after allogeneic hematopoietic stem cell
transplantation (HSCT)
S. Müller1, A. Rovo2, J. Halter2, J. Passweg2, A. Tichelli2,
P. Haeusermann1
1
Department of Hematology, University Hospital Basel
P O S T ER S
2
Background and Methods: in women, genital
chronic graft-versus-host disease (gcGvHD) is well
described, but only limited data with regard to male
recipients after HSCT exist. In a prospective crosssectional single center study, we aimed to address
this issue in post HSCT male recipients performing
a whole body skin examination, focusing on genital
changes. Furthermore posttransplant sexual contentedness and sexual functioning were assessed
by two self-assessment questionnaires: the 5-Item
Version of the International Index of Erectile Function (IIEF-5) and the modified Brief Sexual Symptom
Checklist (mBSSC). Results: all 155 asked patients accepted to participate. The characteristics of the study
population are listed in table 1. The median time between HSCT and genital examination was 50 months
(range 21-72). Thirty-one out of 155 patients (19%)
showed remarkable genital skin changes, 21/155
patients (13%) had gcGvHD-related inflammatory
genital lesions (12 had Zoon`s-like balanoposthitis;
6 lichen sclerosus-like lesions; 5 phimosis; 2 patients
had more than one feature). Patients with gcGvHD
had significantly higher coincidence of oral mucosal
(p<0.0001), ocular mucosal (p<0.002) and non-mucosal cutaneous cGvHD (p<0.026) compared to patients without gcGvHD (table 2). Further posttransplant genital lesions included unspecific balanitis,
hyperpigmentation and melanotic macules of the
glans penis, vitiligo and penis deviation. The rate of
questionnaire returning was 51% (79/155) for the
mBSSC and 65% for the IIEF-5 (88/155); 64% out of
the patients, who returned the mBSSC reported to
be uncontented with sexual functioning. The major sexual problem reported was erectile dysfunction affecting 58/88 (65%) of those who returned
the IIEF-5. Only 9 out of 21 patients with gcGvHD
returned the questionnaires, reporting no relevant
uncontentedness or sexual dysfunction. This small
return rate does not allow further interpretation in
this particular aspect. Conclusions: the high participation in this study reflects the great interest of
posttransplant male recipients regarding genital issues. gcGvHD was observed in 13% of the evaluated
population mostly in correlation with mucosal and
non-mucosal skin cGVHD. Erectile dysfunction was
the most prevalent sexual problem reported. Transplantation centers should be aware of possible male
genital changes and their implications in sexual life.
A regular screening should be standard part of the
post-transplant control.
P23
Rapidly growing skin tumor in a child – mimicking
Spitz nevus
Z. Spanou, H. Beltraminelli, K. Kernland- Lang
A 6-year old boy was referred to our department
with a three-month history of rapidly growing de
novo pigmented lesion on the right thigh. Pain,
itching or previous trauma as well as concomitant
disease were denied. There was no family history of
melanoma. The solitary dark brown pigmentedoval
dermal tumor measuring 1x0.5 cm was suggestive
of a Spitz nevus. Diascopy showed an increased
number of blood vessels. Dermoscopy, however,
did not confirm a characteristic “starburst” pattern
typical of Spitz nevus, but a more globular arrangement of brown pigment. The lesion was excised and
histology revealed an angiomatoushistiocytoma.
Histiocytomas represent a benign proliferation of
soft-tissue tumors. They are rare in childhood andappear most often in middle-aged persons with a female predominance. Many variants ofhistiocytomas
have been described. The etiology is not known, a
correlation to a prior minor trauma or insect bite is
suspected.
When affirmative diagnosis can be made affirmative based on the clinical picture no treatment is
necessary. In rare cases when diagnosis is not sure,
a biopsy or excision for histology is indicated. When
removal is required surgery is the treatment of
choice.
36
Cardiac involvement in sarcoidosis revealed by
painful nodules on the legs
M. Abosaleh, M. Sahil, F. Poffet, F-A. Le Gal, C. Prins
A 50-year-old healthy woman was admitted because of painful nodules on the legs. During the two
weeks preceding hospitalization she had fever, fatigue and severe joint pain. On clinical examination,
a diagnosis of erythema nodosum was made.
A chest X-ray done on admission revealed bilateral
hilar and mediastinal adenopathy and multiple
nodular opacities in the bilateral lungs suggesting
sarcoidosis confirmed by a CT scan. Lung function
tests were normal. LBA showed lymphocytes confirming the diagnosis of sarcoidosis. A diagnosis of
Löfgren’s syndrome was made.
Further investigations revealed a left anterior hemibloc which had not been known hitherto. Cardiac
MRI revealed a pericarditis and electrophysiological
evaluation was normal ie ventricular arrythmias or
other conduction system disorders could not be set
off by the electrical stimulation.
No treatment was necessary for the cardiac and pulmonary involvement. However, erythema nodosum
was widespread and crops of new lesions appeared
continuously so that a treatment of prednisolone 70
mg per day (0.75 mg/kg) was initiated for 4 weeks
with a favorable outcome.
Sarcoidosis and erythema nodosum are a classical
association. A cardiac involvement is present in 2030 % of all sarcoidosis cases of which only 5% are
symptomatic. Malignant arrhythmias are the main
complication, some of them leading to death. Electrocardiograms are a simple and effective means in
detecting conduction disorders and should therefore be performed in this setting.
P25
Successful Resolution of Idiopathic Abdominal
Pyoderma Gangrenosum with Infliximab Therapy:
a case report and review of the literature
M. Bucher, P. Spring, M. Gilliet
Dermatology Unit, CHUV, Lausanne
Background: Pyoderma gangrenosum (PG) is a rare
non infectious neutrophilic dermatosis, associated
with underlying systemic diseases in 70% of cases.
New agents, such as tumor necrosis factor alpha
(TNF-α ) inhibitors, have been reported to be efficacious in neutrophilic dermatosis, however their
efficacy in idiopathic PG has been scarcely documented.
Method and results: We report the case of an
86-year-old woman referred with a painful and extensive (18 × 4 cm) non-healing wound of the pubis.
This necrotic ulcer was surrounded by purple undermined borders with advancing zones of erythema. Bacterial swaps were negative and skin biopsy
revealed deep subacute neutrophilic inflammation,
confirming the diagnosis of pyoderma gangrenosum. A search for associated underlying conditions
was negative.
Therapy and outcome: First line treatment with sys-
temic steroids and topical tacrolimus failed. Moreover, the patients did not tolerate treatment with
dapsone. Dramatic improvement of the condition
occurred after introduction of infliximab, a chimerical monoclonal antibody acting as TNF-α inhibitor.
This treatment led to complete closure of the ulcer
within 4 months.
Conclusions: This case shows a dramatic therapeutic response of idiopathic refractory PG to the antiTNF-α antibody infliximab. Our case suggests the
pivotal role of TNF-α in the pathogenesis of the disease.
P26
Morbus grover and wells syndrome on radioderm
D. Bühler, M.D. Anliker
Institute of dermatology, Kantonal Hospital of St. Gallen
Introduction: Radiation therapy can cause acute or
chronic skin reactions. We report two cases of radiodermatitis with consecutive skin diseases confined
to the treatment field.
Subjects: A female patient with pleomorphic high
grade sarcoma NOS at the left thigh was treated
with radiation therapy with photons, dose 33 x 2
Gray = 66 Gray, field left thigh. Thus she developed
an eosinophilic cellulitis Wells. The clinical appearance showed a 20 cm x 9 cm area with poikilodermia
and hyperthermia. We treated local with Tacrolimus
(Protopic). Infiltration/inflammation was normalised
and erythema subsided.
A male patient with spinal metastases of a prostate
carcinoma was treated with radiation therapy with
electrons, dose 12 x 2.5 Gray = 30 Gray, field L1-L3.
He developed an brown squamous skin disease
with polygonal papules and erythematous papules
in the border areas. We treated with a local steroid
and antiseptic.
Results: Histologic analysis of skin biopsies revealed
a widespread dermal infiltrate of scattered eosinophils degranulating and so called “flame figures” in
the first case, consistent with the diagnosis of eosinophilic cellulitis Wells;, in the second acantholysis
above the epidermal basal cell layer and sleevelike
blistering in the lower half of the epidermis, resembling pemphigus and Hailey-Hailey type of M. Grover.
Discussion: Acute and chronic skin reactions on
radiation are common. We describe a localised appearance of transient acantholytic dermatosis Grover and eosinophilic cellulitis Wells in a field of radiation for the first time and discuss reported skin
manifestations after radiotherapy.
P27
Eosinophilic Fasciitis treated with Adalimumab – a
case report and review of the Literature
C. Bull1, O. Distler2, L. French1, A. Cozzio1
1
Department of Rheumatology, University Hospital Zürich
2
Objective: Eosinophilic fasciitis (EF) is a scleroderma
like disease with diffuse fasciitis, sclerosis and induration of the skin accompanied with eosinophilia.
P24
37
Current therapies include corticosteroids as well as
other immunosuppressant agents like MTX or Cyclosporine. Recently a few cases of therapy resistant
EF have been reported to respond to the anti TNF-a
blocker Infliximab. We want to report a case of therapy resistant EF following successful treatment with
the TNF-a blocker Adalimumab, and review cases of
EF which have been treated with TNF-a blockers.
Methods: A 39 year old caucasian male with biopsy
proven EF and previous unsuccessful treatment
including UVA1 light therapy, systemic corticosteroids, MTX, and Cyclosporine was treated with s.c.
injections of 40mg Adalimumab every 2 weeks over
a period of 11 month. Regular assessment of clinical outcome with VAS for pain and fatigue as well as
LOSSI and assessment of working ability were performed. Additional a literature search with search
terms "EF anti TNF-a" as well as "EF treatment" was
done in PubMed and Medline.
Results: Our patient showed continuous improvement under Adalimumab with LOSSI improving
from 46 to 10 and restoring full working ability. All
of the cases reported in the literature used Infliximab and all cases reported improvement of EF.
Conclusions: As previously shown with another TNFa blocker Infliximab, Adalimumab was very effective
in the treatment of EF in our patient, and under consideration of those previously reported cases, TNF-a
blockers may be beneficial for patients with therapy
resistant EF.
revised to LAD and treatment with Prednisone in
combination with Dapson was started, under which
he showed slow but continuous improvement. Numerous allergy tests, including a Lymphocytictransformationtest (LTT), to the previous taken medication came back negative, although one must keep
in mind that the sensitivity of these test are quite
low in regards to TEN and LAD.
Discussion: As shown in this case LAD can present as
TEN. Various drugs have been implicated in causing
LAD, interestingly in the majority of reported cases
there was no proof o f correlation between the proclaimed drug and LAD and often various antibiotics
where given prior to the outbreak of the blisters. In
our case two different antibiotics as well as 2 NSAR
could have caused LAD. Since allergy tests all came
back negative we could not securely proof the correlation between any of the mentioned drugs and the
LAD. Anyhow, histology and direct immunofluorescence enable to distinguish between TEN and LAD
and should be included in all cases in question.
P29
First case report of the use of anti-TNF therapy in
the treatment of psoriasis in a patient with acute
on chronic pancreatitis
H. Clayton1, L. Flatz1, S. Vollenweider-Roten2, M. Gilliet1,
A. Schoepfer3, C. Conrad1
1
P28
Linear IgA dermatosis presenting as toxic epidermal necrolysis
C. Bull, S. Nobbe, J. Kamarachev, L. French, T. Harr, K.
Kerl
P O S T ER S
Objective: Linear IgA dermatosis (LAD) is a rare and
always acquired autoimmune blistering disorder
with supepidermal blistering and characteristic
linear IgA deposition along the basement membrane. LAD can occur sporadically but also multiple
drugs have been implicated in causing LAD, most
frequently Vancomycin. LAD is often diagnosed by
its characteristic clinic in combination with the typical findings in histology and direct immunofluorescence, but the clinical presentation is variable and
may mimic other blistering disorders, and LAD can
therefore be a challenging diagnosis.
We want to report a case of proclaimed drug related
LAD which presented clinically as TEN.
Report: A 51 year old men was initially treated with
Levofloxacin for an acute tonsillitis. After development of a macular and papular exanthema he was
admitted to his local hospital where he was treated
with Clemastin and Ceftriaxone as well as Paracetamol and Acetylsalicylacid upon which he de veloped blisters on the whole integument including
mucous membranes. He then was admitted to our
inpatient clinic with the estimated diagnosis of TEN.
A skin biopsy from the edge of a blister was taken,
and histology showed a subepidermal blister without extensive necrosis of the epidermis and with
extensive lichenoid inflammation. Direct immunofluorescence showed linear deposition of IgA along
the basement membrane zone. The diagnosis was
Private Practice, Vevey
3
Department of Gastroenterology and Hepatology, CHUV,
Lausanne
2
We present the case of a 75-year-old patient with
severe psoriasis also suffering from chronic alcoholinduced pancreatitis with recurrent flares of acute
pancreatitis. His last episode of acute pancreatitis
required a proximal pancreatectomy. He suffered
further post-surgical life-threatening complications,
including bilateral pulmonary emboli, splenic infarction, and an ischemic liver and was admitted to
intensive care. He presented to our clinic 4 months
later with extensive erythemato-squamous welldefined plaques with a psoriasis area and severity
index (PASI) of 12.9. Since his diagnosis of psoriasis in 2007, he had received a variety of treatments
including phototherapy (UVB, PUVA), acitretin and
methotrexate, of which only methotrexate had
shown some efficacy. His recent life-threatening
episode of acute pancreatitis and ischemic liver
precluded the re-introduction of methotrexate.
Ciclosporin was also excluded as it has been reported to induce acute pancreat itis. A biological therapy, such as a TNF inhibitor was therefore considered.
To date there are no reports in the literature of antiTNF treatments in a patient with recurrent acute on
chronic pancreatitis. However, animal models have
shown that anti-TNF treatment may have a beneficial effect on acute pancreatitis.
Thus, an anti-TNF treatment was initiated. Enbrel
was initially chosen due to its shortest half-life of all
available TNF blockers. Unfortunately only a slight
improvement in the PASI score was observed after
3 months despite frequent concomitant use of topical class IV steroids. As no side-effects had been observed under anti-TNF therapy, Enbrel was switched
to Humira and a reduction in the PASI score from 8.9
38
Bei Hautproblemen
bietet Louis Widmer
die Lösung
Unreine Haut
SKIN APPEAL:
LIPO SOL SCHAUM
LIPO SOL TONIQUE
SKIN CARE GEL
SEBO FLUID
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COVERSTICK 01+ 02
Akne
ACNE LOTION
ACNE CREME*
LIPO SOL LOTION*
ACNE GEL*
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ACNE CREME PLUS*
Kopfhaut-Seborrhoe + Psoriasis
SHAMPOO EXTRA-MILD
SEBO SHAMPOO
SEBO-PSOR LOTION*
LOTIO DECAPANS*
Hyperkeratosen
CARBAMID+VAS 0.03 CREME*
CARBAMID CREME NEUE FORMEL Widmer*
CARBAMID EMULSION*
BAIN EXTRA-DOUX*
Hyperpigmentierungen
PIGMANORM® CREME*
Herpes simplex
®
LIPACTIN Gel
Seborrhoische Dermatitis
EFALITH® CREME*
Wundbehandlung
WUNDSALBE Widmer
Rosazea
NIDAZEA® Widmer*
* kassenzulässig
DER HAUT ZULIEBE
Louis Widmer AG
8952 Schlieren-Zürich
Tel. 043 433 77 00, Fax 043 433 77 99
www.louis-widmer.com
to 2.8 was observed within just 6 weeks of treatment.
One year after starting anti-TNF therapy the patient
continues to show complete clinical remission of his
psoriasis. The patient’s pancreatitis remained stable
throughout the entire treatment with regular c linical and laboratory monitoring.
This is, to our knowledge, the first case report of the
successful use of an anti-TNF agent in a patient with
a chronic inflammatory disorder also suffering from
acute on chronic pancreatitis. Anti-TNF therapy appears to be a safe treatment for these patients as no
relapses of the patient’s underling chronic pancreatitis were observed. This raises further questions regarding the role of TNF in the pathogenesis of pancreatitis and the potential use of anti-TNF therapy in
its treatment.
P30
Long-term treatment with ustekinumab does
not compromise the immune response to T-cell
dependent or T-cell independent vaccines in patients with moderate to severe psoriasis: A comparison of ustekinumab-treated versus untreated
psoriasis patients
C. Brodmerkel1, R. Langley2, K. Papp3, M. Bourcier4, Y.
Poulin5, V. Ho6, L. Guenther7, MC. Hsu1, PO. Szapary1
1
Janssen R&D, Spring House, PA, USA
Dalhousie University, Halifax, NS, CA
3
Probity Medical Research, Waterloo, ON, CA
4
Dermatology Clinic, Moncton, NB, CA
5
Centre Dermatologique du Quebec Metropolitain, Quebec, CA
6
University of British Columbia, Vancouver, BC, CA
7
The Guenther Dermatology Research Centre, London,
P O S T ER S
2
Objective: The impact of long-term continuous
Ustekinumab (UST) (anti-IL12/23p40 mAb) treatment on the ability of patients to mount a response
to pneumococcal vaccine (T-cell independent response) and tetanus toxoid (T-cell dependent response) was assessed.
Methods: This study was a comparison of patients
treated with UST (> 3 yrs), during the long-term
extension of the Phase 3 PHOENIX 2 trial (n=60), to
"control" patients with moderate-to-severe psoriasis not receiving systemic therapy (n=56). Patients
were vaccinated with 23-valent pneumococcal vaccine and tetanus (Tdap vaccine). Serum samples
were collected pre-vaccination and 4 wks post-vaccination and assessed for antibody responses to the
vaccinations.
Results: Results showed no differences in the ability of UST-treated patients to mount a sufficient response to pneumococcal or tetanus toxoid vaccination compared to controls. The majority of patients
in both groups achieved >2-fold increase from prevaccination to post-vaccination antibody levels in at
least 7 of 14 serotypes of the pneumococcal vaccine
(96.6% UST-treated vs. 92.6% untreated control).
84.7% of patients in the UST-treated group achieved
at least a 4-fold increase in antibody against tetanus
toxoid vs. 77.8% in the control group. In an ex vivo Tcell stimulation assay, no differences were detected
in response to anti-CD3/CD28 or tetanus toxoid between patients in the UST-treated group and control group.
Conclusions: These results from both in vivo and
ex vivo testing demonstrated that long-term treat-
ment with UST doesnot compromise the immune
response to T-cell dependent or T-cell independent
vaccines in patients with moderate to severe psoriasis.
P31
Long Term Efficacy and Safety of Ustekinumab
in Patients with Moderate to Severe Psoriasis
Through 5 Years of Follow-up: Results from the
PHOENIX 1 Long-Term Extension
A. Kimball1, K. Papp2, Y. Wasfi3, D. Chan3, R. Bissonnette4,
H. Sofen5, N. Yeilding3, S. Li3, P. Szapary3, K. Gordon6
1
Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
2
Probity Medical Research, Waterloo, ON, Canada
3
Janssen Research & Development, LLC., Spring House,
PA, USA
4
Innovaderm Research, Inc., Montreal, Quebec, Canada
5
Dermatology Research Associates, Los Angeles, CA, USA
6
North Shore University Health System and University of
Chicago Pritzker School of Medicine, Chicago, IL, USA
The efficacy and safety of ustekinumab (UST) in patients with moderate to severe psoriasis through 3
yrs have previously been reported. Here, we report
the efficacy and safety results through 5 yrs of follow-up in the PHOENIX 1 trial.
Patients(n=766) were randomized to receive placebo, UST45mg, or 90mg at Wk0 and Wk4. UST patients continued with q12wk dosing. Placebo patients crossed over to receive UST45mg or 90mg at
Wk12. PASI75 responders receiving UST from Wk0
(n=322) were re-randomized at Wk40 to continue
maintenance treatment on their original dose until the end of the study, or to withdraw from UST
and reinitiate treatment upon loss of 50% of their
Wk40 PASI improvement. Partial responders (Wk28
PASI50<75 or Wk40<PASI75) switched to q8wk dosing for the duration of the study. Efficacy (Wk244)
and safety (Wk264) evaluations included all patients
who received at least 1 dose of UST.
A total of 68.7% (517/753) of treated patients continued to receive UST through the last scheduled
yr5 dose, with similar high retention rates observed
in the 45mg and 90mg groups. In the overall population analysis, PASI75 responses were 63.4% & 72.0%
and PASI90 responses were 39.7% & 49.0% for the
45mg and 90mg groups, respectively. Among Wk40
PASI75 responders randomized to continue maintenance treatment, efficacy was similarly sustained;
PASI75 responses were 79.1% & 80.8% and PASI90
responses were 47.8% & 58.9%, for the 45mg and
90mg groups, respectively. Among partial responders switched to q8wk dosing, PASI75 responses were
57.6% & 55.1% and PASI90 responses were 27.2% &
27.5% for the 45mg and 90mg groups, respectively.
UST was generally well-tolerated through 5yrs (3104
patient years of follow-up [PY]). Rates of adverse
events(AEs), serious AEs, and infections per 100 PY
for the 45mg and 90mg groups, respectively, were
220.9 & 209.0, 5.3 & 5.4, and 83.7 & 81.6. Rates of
serious infection, non-melanoma skin cancer, other
malignancy and investigator-reported major adverse cardiovascular events (cardiovascular death,
MI or stroke) per 100PY for the UST groups combined were 1.03, 0.4 (BCC : SCC ratio=13:1), 0.48, and
0.35, respectively. No apparent dose effect was ob-
40
P32
Successful treatment of hypertrophic palmar psoriasis using ustekinumab
N. Irla, N. Yawalkar
Hypertrophic palmar psoriasis is often recalcitrant
to therapy and associated with significant impairment of quality of life. Ustekinumab, an interleukin-12 and interleukin-23 antagonist has proven to
be efficacious for moderate to severe plaque psoriasis. We present a case of disabling hypertrophic palmar psoriasis with concomitant plaque psoriasis on
the body and nail involvement successfully treated
with ustekinumab. The patient had not responded
to previous treatments with topical steroids, vitamin D analogues, tar, phototherapy, ionizing radiation therapy, methorexate, acitretin, alitretinoin
and etanercept. Three months after induction therapy with ustekinumab (90 mg on week 0 and 4) a
marked improvement of most psoriatic lesions on
his hands and body was seen. After receiving a further dose of ustekinumab 90mg at week 16 further
amelioration including his nail psoriasis was observed at 6 months. Therapy with ustekinumab was
safe and well tolerated. The signifi cant improvement of our case suggests that ustekinumab is an
effective treatment option for hypertrophic palmar
psoriasis. Further clinical studies are warranted to
confirm efficacy and safety of ustekinumab in this
form of psoriasis.
P33
Acitretin-refractory oral, esophageal and cutaneous lichen ruber planus controlled with alitretinoin
A. Kolios1, E. Marques Maggio2, C. Gubler3, A. Cozzio1,
R. Dummer1, L. French1, A. Navarini1
1
Department of Pathology, University Hospital Zürich
3
Clinic of Gastroenterology and Hepatology, University
Hospital Zürich
2
Therapy-refractory to classical treatment options of
Lichen planus (LP) could be a challenging approach
for dermatologists. There are some case reports
about successful treatments of cutaneous and oral
LP but not in esophageal.
We present an unique case of a patient with cutaneous, oral and esophageal Lichen planus which was
refractory to classical treatment options (topical clobetasol propionate and pimecrolimus, intramuscular triamcinolone acetonide) and could not tolerate
systemic acitretin dosed up to 25mg daily because
of systemic side effects. Alitretinoin was started at a
dose of 30mg daily. Both oral and skin changes and
dysphagia completely resolved in 4 weeks without
any side effects and used the drug for 6 months. No
papules, enoral striae or dysphagia recurred over
the time of treatment.
Further studies are needed to better understand
the impact of Alitretinoin in LP. Our observation
suggests as a new, well-tolerating treatment option
for esophage al LP after failed response to previous
standard treatments.
P34
Disabled Nails Dystrophies - successful treatment
with Alitretinoin
C. Mainetti1, G. Marazza1, I. Terrani1, G. Kaya2, R.
Braun3
Bellinzona
2
3
1
Introduction: Alitretinoin is a rexinoid for the treatment of recalcitrant chronic hand dermatitis. At the
present other clinical indications for his utilisation
are described. Recently a successful treatment with
alitretinoin has been reported for lichen planus of
nails.
Case report: We report a case of a 43 years old mechanic without familiar or personal history for dermatologic diseases. In October 2010, the patient developed disabled nails dystrophies (trachyonychia)
at the first and the fifth finger of the right hand, at
the third and the fourth finger of the left hand and
also at the left big toe. He underwent an acitretin
(25 mg daily) treatment for three months without
improvements. He was strong disabled in his professional activities. In July 2011 appeared erythemato-squamous plaques on both feet. The histological
specimens of a feet skin lesion biopsy and of a big
toe’s nail showed a dermo-epidermitis with spongiosis, compatible with a chronic eczema without signs
for psoriasis or lichen planus. In November 2011, we
began a treatment with alitretinoin 30 mg daily. After 2 months, the skin lesions were healed and the
nails alterations were improved. After 6 months the
affected nails appeared normalized.
Discussion: Our observation describe the efficacy
of alitretinoin treatment for disabled eczematous
nails dystrophies. Until today and according to our
knowledge of the literature, alitretinoin has never
been prescribed for this disorder. It is possible that
invalided nails dystrophies of different aetiology
show a good response to alitretinoin therapy.
P35
Postoperative pyoderma gangrenosum – any preventive measures ?
C. Mainetti1, G. Ferrari1, D. Ferrara2, L. Bronz3, N. Momcilovic3
Bellinzona
2
3
Reparto di Ginecologia ed Ostetricia, Ospedale Regionale Bellinzona e Valli, Bellinzona
1
served, and these rates were consistent with those
reported at 3yrs of follow-up.
In PHOENIX 1, consistent with data reported
through yr3, the majority of patients remained on
UST through up to 5yrs of therapy and maintained
clinical responses. UST was generally well-tolerated, without evidence of cumulative toxicity with increased duration of exposure.
41
Introduction: Pyoderma gangrenosum (PG) is a
painful, inflammatory and necrotizing disease causing ulceration and abscesses. We would like to underline the interest of administration of systemic
corticosteroids pre- and post-mastectomy in order
to prevent disease relapse in a patient with history
of breast cancer and recurrent postoperative PG.
Case report: We report the case of a 65-years-old
obese woman, with history of recurrent, mutilating and painful post-operative ulcers secondary to
laparoscopic cholecystectomy in 1989, right breast
mastectomy for a benign fibroadenoma in 1995, left
carpal tunnel release surgery in 1998 and abdominal hysterectomy with bilateral salpingo-oophorectomy for chronic metrorrhagia in 2008.
The histological examination performed in 1998 revealed lesions compatible with PG. The patient was
consequently treated with systemic prednisone for
several months allowing granulation tissue to develop. The residual skin defect was succes sfully closed
by skin graft. In 2008 PG appeared in the form of
abdominal ulcers in the fourth postoperative day. A
combined systemic corticosteroid and cyclosporine
treatment was administered over 3 months and
proved effective.
In January 2012 the patient was diagnosed with
lobular cancer of the left breast and modified radical
mastectomy with axillary clearance was performed.
High dose systemic corticosteroids were started
4 hours prior surgery and continued daily over 14
days with progressive tapering. The skin defect was
closed by subcutaneous sutures and with no postoperative PG occurrence.
Discussion: Skin pathergy has been described in 25
to 50% of PG. In these cases, surgery and debridement are contraindicated because they can foster
further ulceration. Postoperative PG is also known
as postoperative progressive skin gangrene of Cullen. This remains a rare post-operative complication
of unknown aetiology. A disorder in the neutrophils
function has been postulated.
There is no consensus in the literature concerning
prophylactic measures allowing to preventing the
occurrence of postoperative PG in the event of elective surgery. According to our experience we recommend the use of subcutaneous sutures to avoid
skin pathergy and the administration of high dose
systemic corticosteroid prior and after surgery.
P36
A complicated case of Henoch-Schönlein purpura
in an adult
C. Mangas de Arriba1, I. Terrani1, I. Masouyé2,
L. Berwert3, H. Zwahlen3, C. Mainetti1
Servizio di Dermatologia, Ospedale Regionale Bellinzona
e Valli, Bellinzona
2
3
Servizio di Nefrologia, Dipartimento di Medicina interna,
Ospedale Regionale Bellinzona e Valli, Bellinzona
P O S T ER S
1
Introduction: Henoch-Schönlein purpura (HSP) is
characterized by the presence of immunoglobulin
A (IgA) dominant immune deposits in the small vessels that usually affect children. We present a case of
HSP in an adult with a complicated course.
Case: A 56-years-old man with a history of arterial
hypertension consults for palpable purpura erup-
tion initially limited to lower limbs after an upper
respiratory tract infection treated with amoxicillinclavulanic 6 weeks ago. A punch biopsy was performed for histological and direct immunofluorescenze showing a leucocitoclastic vasculitis of
small vessels with IgA vascular deposits suggestive
for a HSP. Laboratory tests with haematology, renal
and liver parameters, including urinalysis were initially all normal. But, one week after, patient came
back to emergency room with a strong abdominal
pain, migratory arthralgies and new palpable purpura lesions around umbilicus and both groins. An
abdominal TC showed an important swelling of the
intestinal wall of pylorus. The urinalysis showed proteinuria superior to 3 g/day and haematuria with
10 to 20 red blood cells per high-powered field. A
glomerulonephritis with IgA mesangial deposits
was observed in the renal biopsy. Metilprednisolone bolus for three days was started and abdominal and articular pain was rapidly resolved. For renal
involvement, a 4 months period of oral prednisone
in decreasing dose was proposed. After a 8 months
follow-up period, no recurrence of the purpura was
observed and the renal function kept normal, with
progressive reduction in proteinuria and microhaematuria levels.
Discussion: This case illustrates how checking periodically laboratory tests is mandatory in HSP, especially in adults in which renal involvement often
occurs (40-50% of the cases). Moreover, 20-30% of
such patients experience long-term renal impairment. In spite an initial normal value, creatinin levels and repeated urinalysis is recommended for follo
w-up. Treatment options with immunosuppressive
drugs are indicated when severe renal involvement
occurs in order to avoid a fatal course.
P37
Livedo reticularis and cerebrovascular accidents
in the elderly: a deep vision
C. Mangas de Arriba1, P. Pedrazzi2, I. Masouyé3, C. Mainetti1
1
Servizio di Dermatologia, Ospedale Regionale Bellinzona
e Valli, Bellinzona
2
Servizio di Neurologia EOC, Ospedale Regionale Bellinzona e Valli , Bellinzona
3
Introduction: Sneddon syndrome is an uncommon
disorder that is characterized by stroke and generalised livedo racemosa of the skin. This syndrome is
usually diagnosed in young women after exclusion
of other vasculitic or autoimmune diseases. Nevertheless, we need to think on it also in clinically suspected cases in the elderly. .
Case: A 74-years-old man with a history of arterial hypertension, diabetes mellitus, hypercholesterolemia, ischemic cardiac events, carotid artery
stenosis and recurrent clinical cerebral ischemic
events (first one diagnosed at 60 years-old) consults
for a chronic, persistent and generalized livedo reticularis. On physical examination an irregular broken circles generalized livedo predominantly localized on legs, buttocks, periumbilical, low back and
both arms is observed. Telangiectasic and violaceus
macular area on legs are also identified. Laboratory values including cell blood count, coagulation
42
Das sind
Tage Zeit
für’s Leben ohne Belastung
durch die Therapie1
* In der Erhaltungstherapie. 1 Fachinformation STELARA®, Arzneimittelkompendium der Schweiz, Stand der Information: März 2012. 2 Griffiths CE et al. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J
Med 2010; 362(2): 118-128. 3 Papp KA et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomized, double-blind placebo-controlled trial (PHOENIX 2).
Lancet 2008; 371: 1675-1684. 4 Leonardi CL et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomized, double-blind placebo-controlled trial
(PHOENIX 1). Lancet 2008; 371: 1665-1674.
STELARA® (Ustekinumab, humaner monoklonaler IgG1κ -Antikörper) I: STELARA® ist für die Behandlung erwachsener Patienten mit mittelschwerer bis schwerer Plaque-Psoriasis indiziert, bei denen andere systemische Therapien einschliesslich Ciclosporin, Methotrexat oder PUVA nicht angesprochen haben, kontraindiziert sind oder nicht vertragen wurden. Die Sicherheit und Wirksamkeit von STELARA® ist für einen Zeitraum von > 4 J. nicht geprüft. D: Die Anw. sollte unter
Anleitung und Aufsicht eines in Diag. und Beh. der Psoriasis erfahrenen Arztes erfolgen. Folgendes muss der Arzt sicherstellen: 1. Der Pat. versteht, dass STELARA® einen neuen Weg für die PsO-Behandlung beschreitet. Obwohl die Wirksamkeit und Sicherheit für eine Dauer von bis zu 4 J. untersucht wurde, können pot. Langzeitfolgen zum jetzigen Zeitpunkt nicht abgeschätzt werden. 2. Der Pat. hat seine Zustimmung zur Therapie gegeben. 3. Der Pat. hat die Patientenkarte erhalten. Erw. ab 18 Jahren: 45mg als s.c. Injektion Woche 0,4, anschliessend alle 12 Wochen. Pat > 100kg: 90mg. 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 TBInfektion 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: Infektionen der oberen Atemwege, Nasopharyngitis, Zellulitis, Virusinfektionen der oberen Atemwege, Herpes Zoster, Depressionen, Schwindel, Kopfschmerzen, Halsschmerzen, verstopfte Nase, Diarrhoe, Juckreiz, Rückenschmerzen, Muskelschmerzen, Erschöpfung,
Erythem an der Injektionsstelle, Reaktionen an der Injektionsstelle (u. a. Schmerzen, Schwellung, Juckreiz, Induration, Blutung, Blutergussbildung und Irritation). Schwere Infektionen. Maligne Tumore. Überempfindlichkeitsreaktionen (einschl. Hautausschlag, Urtikaria), schwerwiegende Reaktionen (einschl. Anaphylaxie, Angioödema) IA: Es wurden keine Wechselwirkungsstudien durchgeführt. Sicherheit und Wirksamkeit von STELARA® in Kombination mit immunsupressiven
Wirkstoffen oder Phototherapie wurden nicht untersucht. SS: Anwendung in der SS vorzugsweise zu vermeiden. Packungen: STELARA® Injektionslösung in Fertigspritze, 45mg (0,5ml) bzw. 90mg (1ml). Kassenzulässig. Abgabekat.: B. Ausführliche Informationen: Arzneimittel-Kompendium der Schweiz. Zulassungsinhaberin: JANSSEN-CILAG AG, Sihlbruggstrasse 111, 6340 Baar (HCC 107.461)
HCC107612 – 05/2012
Ein Biologikum für die mittelschwere bis
schwere Plaque-Psoriasis mit signifikanter
Wirksamkeit und Verträglichkeit auf
Placeboniveau1-4
tests, inflammatory indexes, syphilis and hepatitis
serology, cryoglobulin and autoimmune antibody
panels, including lupus anticoagulants and anticardiolipin antibodies, were all normal. An elliptical biopsy from white area of the livedo (biopsy 1) and a
punch biopsy from telangectasic violaceous lesions
(biopsy 2) were performed. histological analysis of
biopsy 1 demonstrated an endomyofibrosis in a
medium-sized arteriole from the deep dermis, i.e. a
sub-endothelial proliferation of alpha-smooth muscle actin positive cells leading to partial occlusion of
the lumen. In biopsy 2, we only observed unspecific
telangectasias in the superficial dermis.
Finally, the diagnosis of Sneddon syndrome was
proposed which motivated to family doctors and
neurologist to continue anticoagulation treatment.
Discussion: We present an atypical case of Sneddon syndrome due to the age of the patient and
the concomitant violaceous skin lesions associated.
Deep biopsies taken from white areas of the livedo
have more sensitivity to c onfirm the diagnosis.
P38
Flagellate erythema: first manifestation of juvenile dermatomyositis
P. Michalopoulos1, M. Bianchetti2, R. Mazzi3, C. Mainetti1
P O S T ER S
1
Servizio di Dermatologia EOC, Ospedale Regionale Bellinzona e Valli, Bellinzona
2
Reparto integato di Pediatria degli ospedali Regionali di
Bellinzona e Mendrisio, Bellinzona
3
Studio medico, Locarno
Introduction: Dermatomyositis (DM), as with most
diseases in children, is different than in adults and
is manifested differently in each patient. DM in children usually starts before the age of 10 years with a
severe, persistent "sunbrun" eruption, often initiated after an outdoor exposure, and mild nonspecific
constitutional symptoms (fatigue, malaise, fever).
Case report: We report the case of a 12-years-old
girls who, after seaside holidays, developed on both
cheeks a edematous erythema with partly linear
configuration. Initially we putted the differential
diagnosis of erythema infectsiosum thinking of the
characteristic "slapped-cheeks". However Parvovirus
B19 serology was negative.
Three weeks later the patient developed a papular rash on the tops of the knuckles, a periungueal
erythema with visible teleangiectases associated to
cuticular hypertrophy. Furthermore she manifested
a symmetrical proximal muscle weakness with difficulty to walk to school and to keep weight on
her arms. Laboratory tests showed an elevation of
serum skeletal muscle enzymes. Clinically no evidence for vasculopathic lesions, cutaneous necrosis
or calcinosis. Hence we made the diagnosis of classic juvenile DM. A systemic corticosteroids therapy
in association with methotrexate 20mg once a week
and hydroxychloroquine was started.
Discussion: The onset of juvenile DM can be insidious and initial cutaneous signs are often nonspecific, causing delays in diagnosis. Linear or flagellate
erythema is a unusual clinical presentation in DM.
The presence of linear lesions in patients with DM
was first described in 1975 and in 1981 a case of
a 14-year-old patient with "zebra-like" DM was re-
ported. Not only DM but also Bleomycine adverse
effects and Shiitake mushrooms intoxication can
present with linear, flagellate skin lesions.
P39
Angiolymphoid hyperplasia with eosinophilia - a
case report and comparison with kimura’s disease
M.C. Nägeli1, H.P. Bochsler2, A. Cozzio1, J. Kamarachev1,
K. Kerl1, L.E. French1
1
General practitioner , Wallisellen
2
A case of a 27 year old female patient presented with
a one-year history of a progressively enlarging skincolored nodule above her right ear. Examination
revealed the nodule’s dimensions reached about
1x1cm in size, and protruded visibly. The nodule
was clinically non-adherent to deep structures and
was not painful, but slightly pruriginous. The clinical
examination and history was otherwise unremarkable. Histological examination of the surgically removed nodule revealed the diagnosis of angiolymphoid hyperplasia with eosinophilia (ALHE). There
was a noticeable proliferation of small capillary vessels with plump protruding endothelia (hobnail) in
lobular order, as well as an infiltration predominantly consisting of eosinophilic granulocytes, lymphocytes and plasma cells. Laboratory results showed
no eosinophilia and normal IgE levels.
ALHE shares certain similarities with Kimura’s disease
(KD) but should not be confused with it although
both entities were previously thought to be related.
Both AHLE and KD histologically reveal lymphoid infiltration with eosinophils and vascular proliferation,
but the presence of plump and protruding hobnail
endothelial cells in ALHE, and lymphoid follicles and
sclerosis in KD, are distinguishing features.
ALHE, a benign proliferation of endothelial cells
of unknown etiology, usually affects middle-aged
women and presents as subcutaneous nodules,
plaques, or papules of the head and neck, associated in 20% of cases with blood eosinophilia. KD,
a chronic, allergic inflammation of unknown etiology mainly affecting young male Orientals, typically
presents as cervical lymphadenopathy and subcutaneous nodules also of the head and neck region.
Spontaneous remission is rare in both diseases.
Complete surgical excision is the preferred mode of
therapy if applicable, but several others treatments
have been reported to be successfull.
Our patient fully recovered after surgical excision an
d has not ralapsed within 7 months.
P40
"PLEVA pemphigoides" – a new entity ?
S. Nobbe1, L. Weibel1, S. Gobbi1, A. Kühne2, K. Kerl1, A.
Cozzio1
1
Private Dermatology Practice , Buchs
2
We describe the case of a 12 year old boy presenting
with a rash on his trunk, neck and proximal extremities. Clinical examination revealed disseminated
reddish to brown papules with some scaling and
44
P41
Extensive acquired reactive perforating collagenosis: full reponse to acitretin
T. Renker, L. Borradori, D. Perruchoud, H. Beltraminelli,
M. Brönnimann, E. Haneke, N. Pelivani
Acquired reactive perforating collagenosis is a rare
cutaneous condition characterized by transepidermal elimination of collagen, treatment of which is
frequently challenging
We here describe a 84-year-old man with type 2
diabetes mellitus who presented with a two-month
history of pruritic lesions on his back. Clinical examination showed several erythematous plaques with
central adherent keratotic plug. Histopathological
examination revealed a central crater and collagen
fibres that had perforated the epidermis, the pattern
of which was consistent with an acquired reactive
perforating collagenosis. The patient was started
on topical keratolytics and Acitretin 20mg daily. All
lesions cleared within 4-5 months, leaving residual
hypopigmented scarring.
The cause of acquired reactive perforating collagenosis remains unclear, although it may represent
a cutaneous reaction pattern to superficial trauma
and scratching. The disorder has been frequently
observed in pa tients with diabetes mellitus and
renal failure. Many anecdotal treatments have been
reported, such as topical retinoid, corticoidsteroids,
antibiotics and keratolytics, ultraviolet (UV)-B-phototherapy, systemic antibiotics, (rifampicin, doxycycline) and retinoids or allopurinol.
Our case was striking and unusual in our experience,
based on the excellent response to acitretin, which
resulted in complete clearing of the lesions.
P42
Ertapenem: a new therapeutic tool in the management of severe acne inversa
D. Ferrara, C. Prins
Acne inversa (AI) is a chronic inflammatory disease
of the terminal hair follicles and sebaceous glands.
The initial lesion is a superficial erythematous nodule that enlarges, spreads downwards and eventually ruptures with the formation of sinuses, fistulas
and scarring. Weight excess and smoking are cofactors.
We present a 48 year old female patient, with a
20 year history of chronic recalcitrant flexural AI
(Hurley stage 3), who underwent numerous surgical interventions and treatments including intralesional corticosteroid, doxycycline, zinc gluconate,
isotretinoin, dapson and infliximab. Dapson had to
be stopped rapidly because of severe haemolytic
anemia. The only efficient treatment was infliximab.
However a diagnosis of papillary cancer of the thyroid prevented us from continuing the perfusions.
In 2012, the patient was put on a broad spectrum
antibiotic after a severe relapse of the disease in
the groin and buttocks. Intravenous ertapenem w
as given daily for 6 weeks based on the promising
results of a small series1. Improvement was noted
already at the end of the first week and by the end
of the sixth week, all lesions had healed and no new
ones had appeared. IV antibiotics were followed
by oral metronidazole, moxifloxacin and rifampicin according to the literature. Severe side effects
occurred and the combination of antibiotics was
substituted by cotrimoxazole. After a follow up of 4
months, cotrimoxazole is well tolerated and the patient still in remission.
Our observation shows another good result obtained in AI with broad spectrum antibiotics. and
underlines a potentially crucial role played by Gram
negative bacteria in the pathogenesis and maintenance of the disease. Cotrimoxazole seems to
be a possible substitution in patients who cannot
tolerate the triple association of oral antibiotics. In
future, further studies on a larger scale should however be undertaken to confirm the efficacy of longterm broad spectrum antibiotics in AI.
P43
The effectiveness of imiquimod on mixed lower
limbs ulcers
N. Barouti, C. Prins, M. Gilliet
Background: Physiopathology of wound healing is
still incompletely understood. It has been shown
recently that plasmacytoid dentritic cells (pDC) play
a major role in wound repair. These cells rapidly infiltrate the skin upon injury and induce a temporary
release of type I IFN (IFN-alpha/beta) via toll-like
receptor 7 and 9-dependent recognition of nucleic acids from injured cells. Interferon alpha in turn
stimulates epidermal regeneration and wound repair through the induction of a Th17 based inflammatory response. Imiquimod is a synthetic toll-like
crust formation. Furthermore, several tense blisters
were noted on affected but also on non-affected
skin. Histopathologic examination of a skin biopsy
showed a lichenoid lymphocytic infiltrate with vacuolization of the basal layer of the epidermis and
scattered apoptotic keratinocytes. Direct immunofluorescence revealed C3 deposits in linear pattern
at the dermoepidermal junction. ELISA investigations showed elevated BP180 IgG antibodies.
The clinical presentation and routine histology result were well consistent with the diagnosis of PLEVA. However, at the same time the tense bullae,
direct and indirect immunofluorescence and the
ELISA results were compatible with the diagnosis
of bullous pemphigoid. Under treatment with systemic steroids and dapsone, all skin lesi ons healed
with residual hyperpigmentation. During treatment
course, the level of BP180 IgG antibodies returned
to normal range.
According to the described findings and in analogy
to the entity of lichen planus pemphigoides, we
here propose the term PLEVA pemphigoides as a
new diagnosis for the condition seen in our patient.
45
receptor 7 agonist that triggers type I IFN production by pDCs. We therefore hypothesize that applying Imiquimod to the wound edge of chronic ulcers
might enhance wound healing.
Methods: A 78 year old male patient with a mixed
chronic wound on the right leg and a 92 year old
female patient with a chronic arterial wound on her
right big toe had non healing ulcers respectively for
4 years and 3 months. Both underw ent intense debridement of the wound edges in order to transform
their chronic wound into an acute wound. Aldara
(imiquimod) cream 5%, 12,5gr, was applied to the
wound edge 3 to 5x/week for 4 weeks. The centre
of the wound was hydrated with Ocentilline gel
(octenidin) and covered by an interface dressing.
Wound healing was followed with photographic
data every week.
Results: After two week of treatment, wound edges
flattened and reepithelialisation started from the
wound edges. At 4 weeks of treatment one patient’s
ulcer had completely healed while the other showed
reepithelisation of the lower third of the ulcer.
Conclusion: To our knowledge no chronic leg ulcers
have been treated with Aldara Cream 5%. Based on
the current knowledge of woundhealing imiquimod cream could be a promising new treatment for
chronic leg ulcers. Further studies are necessary to
confirm these first positive results.
P44
Fluorescent Overlay Antigen Mapping for Mucous
Membrane Pemphigoïd
F. Poffet, L. Fontao, N. Saxer, C. Pham, G. Kaya, E. Laffitte
P O S T ER S
Introduction: We report a case of Mucous Membrane Pemphigoïd (MMP) in a young patient where
Fluorescent Overlay Antigen Mapping (FOAM) with
confocal microscopic technique was useful to detect anti laminin 332 autoantibodies in the skin, and
then permit us to confirm the diagnosis.
Observation: A 22-year-old man developed chronic
erosions on the gingival mucosa without any known
triggering factors. Histology and direct immunofluorescence (IF) from an oral lesion were consistent
with the diagnosis of MMP (IgG, A and C3 linear at
the dermoepidermic junction (DEJ)). Noteworthy,
we founded no circulating antibodies (Ab) directed
on any known skin antigens, indirect IF (on human
skin, monkey oesophagus or rat bladder), BP180
ELISA, Desmogleins 1 and 3, Western Blot on dermic
and keratinocytes extracts were all negative.
There was no ocular or skin involvement at the time
of diagnosis, and a therapy with Doxycycline, Nicotinamide and topical Triamcinolone was started
with partial effect. Dapsone was then introduced in
association with Azathioprine resulting in a better
control of the disease. During treatment tappering, a flare of the disease occurred, with oral, nasal
and scalp erosions. A biospy of the scalp lesion was
done, and to better characterize the site of autoAb
deposition at the DEJ we performed a FOAM analysis, which allows precise localization of bound autoAb by confocal microscopy. We found only marginal colocalisation of bound IgG with anti-beta4
integrin subunit and anti-type VII collagen Ab. In
contrast, a strong colocalisation was observed with
anti-laminin 332 (formerly laminin5) Ab, suggesting
that this patient had anti-laminin 332 autoantibodies deposition in the lesional skin.
Discussion: MMP is a chronic autoimmune blistering disease of mucous membranes and skin. BP180
is the target antigen in about 70% of MMP patients,
but other autoantigen have been described, such as
laminin 332. This observation i s of particular importance since 25% of patients with laminin-332 Ab develop malignancy. Diagnosis of MMP is sometimes
difficult because in half of patients circulating antiDEJ Ab are not detectable. Here we found by FOAM
that bound autoAb were targeted to antigens overlapping with laminin 332.
Conclusion: FOAM is a rarely used technique that
may be useful for the antigen caracterization in difficult or atypical autoimmune blistering diseases,
specially for patients in whom circulating autoantibodies are not detectable
P45
Cutaneous IgA associated leucocytoclastic vasculitis induced by alcohol
M. Stieger, H. Beltraminelli, R.E. Hunger
The exact pathophysiology of IgA-associated leucocytoclastic vasculitis remains unclear. The most
common forms are “hypersensitivity” vasculitis and
Henoch-Schönlein purpura. The association with an
underlying disease, such as infections and connective tissue disease as well as drug intake is well described. The identification of an associated trigger
factor is challenging and most of the cases remain
idiopathic.
We report a 47-year-old man presenting with palpable purpura. The histopathological examination
revealed a cutaneous leucocytoclastic vasculitis
with perivascular IgA deposits. There was no associated symptom, such as abdominal pain, arthralgia
or fever. The patient did not take any medication.
Laboratory findings including ANCA , renal tests
with urine sediments was unremarkable. The lesions healed quickly under compression and bed
rest. In the follow up, the patient developed recurrent purpura. A careful patient history revealed that
the appearanc e the lesions was always related to
acohol intake. Multiple voluntary provocation tests
with different kinds of liquor resulted in lesions after
beer, red wine, white wine and hard liquor indicating that alcohol itself is the causative agent. There
was no apparent connection to the amount of consumed alcohol.
Alcohol is known to cause allergic-type reactions,
even with anaphylaxis. Only one case of alcoholinduced vasculitis has been described. Alibrandi
et al. postulated alcohol-induced purpura due to
degranulation of mast cells. Kitazawa et al. showed
that alcohol has an immunological effect by increased tumor necrosis factor –a production. TNFa is one of the cytokines associated with HenochSchönlein purpura. We thus advised the patient to
be cautious concerning alcohol consumption and
will follow him closely to exclude extracutaneous
involvement.
46
Rapid amelioration of generalized pustular psoriasis by infliximab is associated with reduced innate immune responses and downregulation of
IL-12 and IL-23
MM. Tang, Z. Spanou, H. Tang, F. Schibler, N. Pelivani,
N. Yawalkar
Generalized pustular psoriasis (GPP) is a severe
inflammatory disease characterized by recurrent
eruptions of sterile pustules on erythematous skin.
Although TNF antagonists may lead to rapid resolution of this disease, the mechanisms of action of
these agents remain to be investigated. Here we
evaluated the immune response in the skin of a patient with rapid amelioration of GPP after treatment
with infliximab and acitretin. Skin biopsy specimens
were obtained before and 72 hours after initiation
of treatment. Immunohistochemical stainings were
performed to characterize alterations of the infiltrate, the apoptosis marker caspase 3 and key cytokines like TNF-alpha, IL-12, IL-23 and the chemokine
CXCL8/IL-8. In parallel with clinical improvement a
striking decline of neutrophils, myeloid and plasmacytoid dendritic cells, M1 macrophages and
partly of CD4+ T cells was observed. No evidence
for increased involvement of apoptosis mediated
through the caspase 3 pathway was detected. A
marked reduction particularly of IL-12 and IL-23 and
to a lesser degree for TNF-alpha and CXCL8/ IL-8 was
observed.
In conclusion swift clinical improvement of GPP by
infliximab is associated with a marked reduction
particularly of innate and partially of the acquired
immune cells as well as IL-12 and IL-23.
P47
Lymphocytic thrombophilic arteritis – an underrecognized cause of livedo racemosa ?
M. Theiler, W. Kempf, C. Kegel, A. Cozzio
We present a case of a 35-year-old women, who was
referred with extensive livedo racemosa on the lower as well as upper extremities since 7 years. Apart
from the aspect, she complained no further symptoms. Nodules or ulcerations never occurred.
Thorough work-up produced no clues for disturbances in hemostasis, collagen-vascular disease or
systemic vasculitis. In particular, antiphospholipid
antibodies were repeatedly negative.
Histology showed small, thrombosed arteries in the
reticular dermis with a dense lymphocytic infiltration of the vessel walls.
This histology and clinical presentation is consistent
with a condition known in the literature as "macular
arteritis" or "lymphocytic thrombophilic arteritis".
Since 2003 a total of 17 cases have been published.
All patients presented with long-lasting, asymptomatic pigmented macules and/or livedo racemosa and
histologically proven lymphocytic arteritis. Mainly
patients from African-American or Asia n descent
were affected. Systemic involvement, ulcerations
or other complications never occurred. A common
trigger, such as medications or infections, could not
be found.
Because of the benign character of the disease,
many patients have not been treated at all. Lowdose aspirin or clopidogrel do not seem to improve
the condition, the effect of warfarin is unclear so
far.
In our patient, high doses of systemic corticosteroids (50mg prednisolone daily) led to a complete
clearance of lesions with quick recurrence on tapering. Steroid-sparing agents as azathioprine hardly
seem adequate in the clinical setting, antimalarial
drugs might be an alternative though.
We think that "lymphocytic thrombophilic arteritis"
is an important and probably underrecognised differential diagnosis in patients with livedo racemosa.
P48
Idiopathic facial aseptic granuloma: high frequency of ocular involvement
L. Weibel1, M. Theiler2, HS. Scheer1
Department of Dermatology, University Children’s Hos-
1
pital and University Hospital Zürich
2
Introduction and objectives: Idipoathic facial aseptic granuloma (IFAG) is a newly recognized pediatric
entity characterized by abscess-like painless red to
violaceous nodules located on the cheeks of toddlers/preschool-aged children with slow spontaneous healing. The occurrence of chalazions has been
reported in a few patients. We aimed to assess the
frequency of ocular lesions in children with IFAG
and to describe their clinical course.
Methods: We collected demographic and clinical
data of all patients presenting with IFAG at our Department of Pediatric Dermatology during the last 2
years. Values are presented as median (range).
Results: We identified 9 children (5 female, 4 male)
with IFAG who presented at the age of 2.7 (1.8 –
8.3) years after a disease duration of 2.9 (1 – 36.5)
months. Six patients had a solitary facial lesion at
the time of presentation and three had 2 or 3 lesions. Six of the 9 children had a history of docu
mented chalazions, with usually recurrent course,
and three had mild keratitis. In 5 of these 6 patients
the ocular lesions antedated the occurende of facial nodules. The ocular lesions were treated with
topical antibiotics and steroids. For all facial nodules
zink containing creams were applied until full recovery. Four patients with rather new and fluctuating
facial nodules were treated with systemic antibiotics (azithromycin, metronidazol) for 4 weeks resulting in gradual improvement.
Conclusions: This case serie reports a high frequency of ocular lesions, in particular chalazions, in IFAG.
This suggests that IFAG belongs to the spectrum of
childhood rosacea; thus the use of metronidazole
may represent a beneficial treatment option. Children with IFAG should routinely be investigated for
ocular involvement.
P46
47
P49
Hypercoguable state with platelet hyperaggregation presenting with necrotic livedo and toe cyanosis in a patient with essential thrombocytemia
and antiphospholipids syndrome
D. Ferrara1, F. Boehlen2, X-C. Pham1, N. Barouti1, C. Chizzolini3, E. Laffitte1
Dermatology Unit, University Hospital of Geneva
Angiology and Hemostasis Unit, University Hospital of
Geneva
3
Immunology and Allergology Unit, University Hospital of
Geneva
1
2
The association of antiphospholipid antibody syndrome (APLS) and essential thrombocytemia (ET)
has been described and increases the thrombotic
risk among affected patients. We report the case of
a 67 years old patient presenting with ET and APLS
associated with hypercoagulable state and platelet
hyperaggregation displaying painful necrotic livedo
of the lower limbs, ischemic necrosis of the left 4th
toe and erythromelagia. Skin biopsy showed multiple dermal and hypodermal thrombosis with no
vasculitis. Blood panel confirmed a 518 G/L thrombocytosis under anaglelide (1mg/day) treatment.
The V617F mutation for the Jak2 gene, the presence of APLS (lupus anticoagulant, anti-cardiolipin
and anti-?2 glycoprotein I antibodies) and speckled
antinuclear antibodies (titer 1/320) were detected.
Combined aspirine (100 mg/ day), fondaparinux
(7.5mg/day) and anagrelide (1mg/day) treatment
was ineffective with worsening of the livedo and
occurrence of left 4th toe cyanosis. Lower l imbs duplex ultrasound and transcutaneous oxygen measurements were normal, fostering the hypothesis of
very distal occlusive disease. Platelet hyperaggregation was eventually confirmed by in vitro aggregation studies. A combined iloprost (50 µg/day for 15
days), fondaparinux (7.5 mg/day) and anagrelide
(1.5 mg/day) treatment and the increase of aspirin
doses (300 mg twice/day) allowed normalization of
platelet aggregation in vitro with clinical resolution
of the lower limbs livedo and toe cyanosis. The association between ET and APLS has been reported: in
one series up to 66% of ET patients had at least one
anti-phospholipid antibody. This association may
increase the thrombotic risk. Our patient presented
with both TE and skin signs of APLS (necrotic livedo,
toe cyanosis and erythromelagia). The adjustment
of aspirin doses allowed the normalization of platelet hyperaggregation. The latter combined with the
continuation of the anticoagulants and a 15 days
cure of iloprost led to the clinical and biological
resolution.
P O S T ER S
P50
Disseminated herpes simplex in Ipilimumabtreated patient with advanced malignant melanoma- a potential serious side-effect
M.D. Anliker, A. Korthauer, M. Schlaeppi
Dermatology Unit, Canton Hospital of St. Gallen, St. Gallen
Introduction: Ipilimumab is a fully human monoclo-
nal antibody especially against cytotoxic T-lymphocyte antigen-4 (CTLA-4) for treatment in person with
advanced malignant melanoma. The most common
immune-related side effects in using Ipilimumab relate to the skin and gastrointestinal tract. The main
dermatologic reaction is pruritus and generally appears after 2-4 weeks of treatment. Furthermore, as
residual effects are reported injection- site reactions
and vitiligo.
Subject/Method: the 76- year- old man with advanced metastatic malignant melanoma staged
Breslow 6mm, pT4b, pN1 (1/17) M1a stage 4 underwent treatment with four cycles of Ipilimumab with
a dose of 230 mg intraveniously every three weeks.
Allthough he responded well and the PET-CT revealed partial remission he showed signs of fever, elevated CRP and dessiminated vesicules on the trunk
an on the lip. Swabs were analysed for bacteria, for
HSV by PCR an a skin biopsy was performed, staining in HE and with immune histochemical staining
for HSV.
Results: Blood exams showed non damage to other
organs. The skin biopsy showed an folliculitis with
herpes associated cytopathic effect in the epidermal layer, blistering and the presence of multinucleated epidermal cells in the stratum spinosum
Immunostaining was positive positive for herpes
simplex virus type 1 and the swab for HSV1- DNA.
The tests were negative for Bacteria and HSV2. Under treatment with Valacyclovir 2x1000mg/d there
was a complete remission of skin affections in a
week.
Discussion: Allthough a cellular immune deficiency
does not result in Ipilimumab therapy, the importance of CTLA in abrogating the severity of HSV
infections of the cornea in mice has been reported.
Additional skin barrier dysfunction and tumor burden could facilitate the spread of herpes viruses on
the skin. This report highlights the potential risk of
Herpes infection in Ipilimumab- treated patients
one should be aware of, since systemic spread of
HSV can also involve other organs such as the CNS
and heart, if not recognized timely.
Autoren
P51
Stonefish envenomation requiring vacuum-assisted closure therapy and split-skin grafting
C. Blazek, M. Stieger, L. Borradori, N. Pelivani
Stonefish (Synanceiidae family), commonly found
in the shallow waters of the Indo-Pacific region,
are one of the most venomous marine inhabitants. Equipped with 13 dorsal spines provided with
poison glands, they lay perfectly camouflaged under sand or between rocks. Stings occur when unsuspicious inhabitants of tropical coasts as well as
tourists step on the spines, resulting in immediate
evenomation. Despite it rarely kills, Stonefish envenomation causes sudden extreme pain, swelling
and erythema, which can be managed with symptomatic treatment. Immediate recognition of envenomation, early first aid and hot water soaks result in rapid relief of pain and symptoms.
We present a female patient who sustained a single
puncture wound on her left big toe and developed
48
Enbrel . Langfristig frei sein
®
1, 2
Enbrel ®. Anfangen
Enbrel ®. Ankommen
Enbrel ®. Vertrauen
Ab jetzt
zugelass
en
Der erste und einzige TNF- α-Inhibitor 3 – einmalige
Aufbewahrungsoption: bis zu 4 Wochen bei Raumtemperatur 2(15–25 ºC)
(nicht Originalgrösse)
1 Papp KA et al. Long-term, continuous dosing of etanercept in patients with plaque-psoriasis 2011. Expert Rev. Dermatol. 6(4):361–373 2 Fachinformation Enbrel®, aktuelles Arzneimittel-Kompendium der Schweiz 3 Arzneimittel-Kompendium der
Schweiz (www.kompendium.ch)
Gekürzte Fachinformation – Enbrel ® (Etanercept)
Pfizer AG
Schärenmoosstrasse 99
Postfach
8052 Zürich
60003-149-03/12-D
Indikationen: Erwachsene: aktive rheumatoide Arthritis (RA) und Psoriasis-Arthritis (PsA), wenn das Ansprechen auf eine vorhergehende Therapie mit krankheitsmodifizierenden Antirheumatika (DMARD) unzulänglich war. Bei schweren aktiven und
progressiven Formen der RA ohne Vorbehandlung mit Methotrexat. Ankylosierende Spondylitis (AS)/Morbus Bechterew ohne Ansprechen auf konventionelle Therapie. Mittelschwere bis schwere Plaque-Psoriasis (PsO). Kinder und Jugendliche: juvenile
idiopathische Arthritis (JIA) mit polyartikulärem Verlauf ab dem Alter von 2 Jahren, wenn die vorhergehende Methotrexat-Behandlung unzulänglich war. PsO bei Kindern und Jugendlichen ab dem Alter von 6 Jahren, wenn eine andere systemische
Therapie oder Lichttherapie unzulänglich war. Dosierung: Erwachsene: 25 mg 2× wöchentlich s.c. oder alternativ: 50 mg 1× wöchentlich (PsO: alternativ 2× 50 mg wöchentlich initial für 12 Wochen). Kinder und Jugendliche: JIA: 0,4 mg/kg KG (max.
Pfizer AG
25 mg pro Dosis) 2× wöchentlich s.c. PsO: 0,8 mg/kg KG (max. 50 mg pro Dosis) 1× wöchentlich s.c. Kontraindikationen: Überempfindlichkeit gegen den Wirkstoff oder einen der sonstigen Bestandteile. Sepsis oder Risiko einer Sepsis. Die Behandlung
Schärenmoosstrasse 99
sollte bei Patienten mit bestehenden Infektionen nicht begonnen werden. Vorsichtsmassnahmen: Infektionen (inklusive aktive, als auch inaktive [latente] Tuberkulose und HBV), dekompensierte Herzinsuffizienz, allergische Reaktionen, hämatologische
Postfach
Reaktionen und ZNS-Störungen
sowie höheres Risiko für Lymphome und maligne Erkrankungen beachten. Die Anwendung von Enbrel ® bei schwangeren und stillenden Frauen wird nicht empfohlen. Interaktionen: Methotrexat hat keinen Einfluss auf die
8052
Zürich
Pharmakokinetik von Etanercept.
Unerwünschte
Wirkungen: Infektionen (einschliesslich Infektionen der Atemwege und schwerwiegende Infektionen), Malignome, Reaktionen an der Injektionsstelle, Bildung von Autoantikörper u.a. Seit der Markteinführung
wurde über Fälle von Blutbildungsstörungen und ZNS-Demyelinisierungsstörungen berichtet. Packungen: Enbrel® Pulver und Lösungsmittel zur Herstellung einer Injektionslösung: 4 Stechampullen zu 25 mg. Enbrel® Injektionslösung in Fertigspritzen:
4 Fertigspritzen zu 25 mg oder 2 Fertigspritzen zu 50 mg. Enbrel® MyClic (Injektionslösung im Fertigpen): 2 Fertigpen zu 50 mg. Verkaufskategorie B. Zulassungsinhaberin: Pfizer AG, Schärenmoosstrasse 99, 8052 Zürich. Ausführliche Informationen
siehe Arzneimittel-Kompendium der Schweiz. (FI V016)
severe complications including infection and tissue necrosis after a considerable delay in receiving
correct medical care. Improvement was achieved
rapidly by Vacuum-assisted closure therapy, allowing consecutive split-skin grafting four months after
insufficient wound healing.
P52
Are immunoassays an alternative to VDRL in the
management of syphilis ?
L. Fontao1,2, E. Leemans2, C. Fasel-Reymondat2, A. Munoz2, N. Eicher1, M. Michaud1, L. Toutou-Trellu1
1
Department of Dermatology, Geneva
Department of Laboratory Medicine, Geneva
2
The diagnosis of syphilis is often based on the results of serology using assays designed to detect
either nontreponemal (e.g.,VDRL, RPR) or treponema-specific antibodies (e.g. FTA-Abs, TPHA). Nontreponemal tests are used to monitor treatment efficacy. At the University Hospitals of Geneva we have
introduced since 2009 the Abbott Architect Syphilis
TP Immunoassay as screening test for syphilis. This
two-step assay is based on chemiluminescent technology, utilising microparticles coated with three recombinant TP antigens (TpN15, TpN17 and TpN47)
and acridinium labelled anti-human IgG and IgM
monoclonal antibodies as conjugates. Since VDRL
lacks specificity and may produce false positive
in patient suffering of autoimmune diseases or in
pregnant women, we wanted to determine whether
Architect Syphilis TP or EIA-IgM can be used as an
alternative to monitor treatment efficacy
Methods: Sera obtained from 10 patients treated in
our policlinic were tested using, VDRL (Biorad), Architect Syphilis TP (Abbott), TPHA (Dade-Behring),
EIA-IgM (IBL Intl).
Results: We found no clear correlation between Architect Syphilis TP index values and VDRL titers. For
most of the tested patient IgM index values and
VDRL titers show good correlation whereas TPHA titers, as expected, were partially modulated by treatment.
Conclusion: Based on our findings, Architect Syphilis TP should be used only for screening and VDRL
should remain the gold standard to follow treatment efficacy. After a successful therapy, a fourfold
reduction in VDRL titer is expected. In complexes
situations a significant reduction in EIA-IgM index
may help the clinician to assess patient response to
treatment.
P53
P O S T ER S
HIV Infection and skin aging: A retrospective study
in the context of the Lipodystrophy Ambulatory
Program in Geneva
DS. Nikolic1, A. Calmy2, L Toutous-Trellu1
1
2
Infectious Diseases, Geneva University Hospital
Background: HIV-infected individuals are aging under anti-retroviral therapy (ARV) and the incidence
and overall prevalence of non-AIDS age-related
diseases is increasing1,2. Previous reports indicated
that the prevalence of non-AIDS-defining malignancies was increased in older HIV-infected patients
compared to age-related non-infected individuals1.
The overall risk for specific skin cancers development (Kaposi Sarcoma and cutaneous non-Hodgkin
lymphoma) was also described as increased in older
HIV-infected patients3. Precise data on the occurrence of skin epithelial tumors such as basocellular
(BCC) or squamous cell carcinomas (SCC) are unavailable in this population. We sought to determine
whether there was a change in the incidence of BCC
and SCC in a subgroup of HIV+ patients known for
non-AIDS diseases.
Methods: A systematic dermatological evaluation
was proposed during a multidisciplinary day hospital in the Department of Dermatology of the University Hospital of Geneva. The LIPO & Metabolism
Group evaluates and manages HIV+ individuals presenting non-infectious comorbidities associated to
a treated HIV infection. This general database has
been accepted by ethical committee of the University Hospitals of Geneva.
Results: During the period 2008-2012, 150 patients
were admitted with a mean age of 49.5 years. 80.7%
of the patients beneficiated from a dermatological
examination. 93.3% of these patients have been diagnosed for a dermatological condition and 74.3%
of them had access to a dermatological treatment.
Overall, 4 cases of epithelial skin carcinomas have
been diagnosed in this population. The prevalence rate of both BCC and SCC was calculated at
13.3/1000 in this specific subpopulation.
Conclusion: Our data seem to demonstrate that the
overall prevalence of BCC and SCC in a specific subpopulation of HIV-infected patients presenting noninfectious related comorbidities linked to premature
aging is not as increased as expected. More refined
data will be presented and we will also compare between this specific population with a sex and agematched general population control group.
P54
Successful treatment of necrotizing infundibular
crystalline folliculitis with topical ketoconazole
V. Hauser1, W. Kempf2, K. Kerl3, J. Kamarashev3,
S. Nobbe3
Private Dermatology Practice, Rorschach
Histological Diagnostics, Zürich
3
1
2
Necrotizing infundibular crystalline folliculitis (NICF)
is a recently characterized entity of unknown origin.
It is a folliculocentric disorder associated with filamentous crystalline deposits within the partly necrotic follicular ostium and infundibulum. Because
of the association with yeasts and gram-positive
bacteria in the affected follicles, it has been hypothesized that NICF is pathogenetically linked to
these organisms. We present a 19 year old female
patient with multiple waxy umbilicated papules on
her forehead. Clinical and histological findings were
consistend with the diagnosis of NICF. In our case,
mono-therapy with ketoconazole creme was effective and lead to sustained clearance.
50
A unusual presentation of acrodermatitis chronica atrophicans with symmetric involvement of the
lower limbs and extremities
T. Renker, B. Jamnicki, E. Haneke, Th. Hunziker, N. Pelivani, L. Borradori
We here describe a patient presenting with painful
ulcerations and infiltrated lesions on both legs of
apparently 5 months duration.
Clinical examination showed the presence of superficial ulcerations and xantho-granulomatous
plaques on the legs. Furthermore, there was a remarkable skin atrophy with a livid erythema of the
legs and feet. Light microscopy studies of skin biopsy specimens showed an epidermal atrophy with a
dense interstitial lymphocytic infiltrate with numerous plasma cells. The serological tests for Borrelia
infection was strongly positive (presence of specific
IgM and IgG antibodies by ELISA and immunoblot). Based on the clinical picture and serological
findings, the diagnosis of acrodermatitis chronica
atrophicans was made. The patient was started on
doxycyclin 2x100mg/d for 30 days.
Acrodermatitis chronica atrophicans is a late cutaneous manifestation of Borrelia burgdorferi s.l.
infection, that develops years after primary infection. In th e early stage of acrodermatitis chronica
atrophicans, erythema, swelling and erythematous,
plaques develop that usually involve the lower extremities. In the late stage, the skin becomes atrophic, violaceous with a cigarette-paper appearance,
skin ulcerations are present and the underlying
veins become visible. In our case, the presentation
was striking and peculiar, since lesions were distributed symmetrically and of xantho-granulomatous
plaques were present. In the classic form, lesions
exhibit a unilateral involvement and xanthogranulomatous areas are rare.
P56
Cutaneous alternariosis in a pulmonary transplant
patient
N. Saxer-Sekulic, G. Kaya
Background: We describe the case of a 71 year-old
male patient who presented with a rapidly growing
erythematous nodule on his knee, clinically diagnosed as squamous cell carcinoma or an infectious
lesion. 14 years prior, the patient had received a bilateral pulmonary transplant due to emphysema in the
context of an aIpha-1-antitrypsin-deficency.
Methods: Histological slides of paraffin-embedded
biopsy material from the patient mentioned above
have been analyzed on Hematoxylin-Eosin-, Periodic Acid Schiff (PAS)-, Gram- and Giemsa-stained
sections.
Results: Histological examination revealed a pseudocarcinomatous epithelial hyperplasia with associated
suppurative dermatitis characterized by the presence of a dermal inflammatory infiltrate composed
of numerous neutrophils and giant cells, sometimes
with a granulomatous aspect. In the inflamed zones
of dermis, multiple non-pigmented eosinophilic organisms with clear cytoplasmic h alos and double
membrane have been identified. PAS stain showed
round and ovoid organisms ranging from 5 to 10 µm
in diameter. Gram, Ziehl and Giemsa stains were all
negative. A fungal culture of the tissue grew Alternaria species. Species identification was not performed.
Conclusion: Fungi from the genus Alternaria represent fungi belonging to the phaeohyphomycosis
group. The histological features of the skin biopsy
specimen of our patient were typical for cutaneous
alternariosis, described for the first time in 2005 in
transplant patients (1). Most of the cases of cutaneous alternariosis have been reported in immunocompromised hosts. Clinically, these lesions may
present as solitary or grouped papules, plaques or
nodules involving the lower extremities. On histological examination, organisms show a typical double
membrane aspect, better visualized on special stains
for fungal elements. Alternariosis possesses similar
morphological characteristics of cryptococco sis and
blastomycosis. Awareness of clinical and histopathological features is important for the early detection
and treatment of cutaneous alternariosis. We recommend biopsies in each case of unclear infectious lesion of the skin in transplant recipients, completed by
special stains for fungal elements and tissue cultures.
P57
Alopecia areata in HIV positive patients with a restored immunity: about three cases
B. Trigona, D. Nikolic, L. Toutous-Trellu
Introduction: The incidence of alopecia areata (AA) is
20 cases per 100 000 persons per year and a lifetime
risk of 1,7%. AA seems to have an autoimmune etiology. AA has been described in immunosuppressed
HIV positive patients, untreated or at the beginning
of an antiretroviral therapy (1-2). AA in long term
treated patients has not yet been reported.
Observation: Patient 1: a 47-years-old man HIV-positive since 2002 presented in April 2011 patches of
alopecia on the beard. The CD4 lymphocytes count
was 586/mm3 with undetectable viral load. HAART
was unchanged since 2 years. A regrowth of the hair
was observed after 3 months of clobetasol propionate 0,05% then tacrolimus 0,1%.
Patient 2: a 43-years-old man, HIV-positive since
2001, presented in january 2011 patches of alopecia on the scalp. The CD4 lymphocytes count was
586/mm3 with undetectable viral load. HAART was
unchanged since 10 months. After 3 intralesional
injections of triamcinolone ace tonide (Kenacort®),
the patient fully recovered.
Patient 3: a 44-years-old man, HIV-positive since
1999, presented patches of alopecia on the scalp
and beard in 2002 after a voluntary discontinuation
of antiretroviral therapy. However the CD4 lymphocyte count remained stable at 1179/mm3, he recovered after few months of topical tacrolimus 0,1%.
In february 2012 new patches of alopecia were observed. This second episode appeared 4 months after introduction of a new antiretroviral therapy. CD4
lymphocytes count was stable at 580/mm3.
P55
51
Discussion: Without treatment, HIV positive persons
have an altered immunity that leads to infectious
and autoimmune disorders. Since the era of HAART
patients present some common skin disorders with
a more classical presentation and evolution. The restored immunity leads to a better prognosis of their
related disease, however, they remain very susceptible to any changes involving the immune system.
Cutaneous disorders such as AA, may be clinical
signals to treatment modifications or compliance
problem. On the other hand, it is also important to
propose HIV test in the presence of severe alopecia
areata.
P58
Different distribution and clinical patterns in allergic drug reactions vs. reactive/parainfectious
exanthema
M.D. Anliker, P. Fritsche, S. Haltmeier, M. Daschzeren, A.
Surovy, B. Ichters, D. Bühler
POSTERS
Dermatology Unit, Cantonal Hospital of St. Gallen, St. Gallen
Introduction: At first appearance it is difficult to distinguish between drug allergies and exanthemas of
other origin. The aim of the study is to compare distribution and clinical patterns of the two.
Methods: Prospectivly 574 patients with rashes of
the in and outpatient s were examined and the exact drug intake was documented. The body surface
was devided into 74 different fields and skin lesions
were monitored with exact description.
By medical history, skin testing with the possibly
culprit drugs, LTT, oral provocations and histopathologic evaluation patients were devided into allergic
and reactive exanthema groups. With computer
assistance the frequency of distribution in the different fields was displayed similar to thermography
imaging.
Results: 51% were female, 49% male, 47.2% (120)
were allergic 49.2% (125) were reactive and 3% not
applicable. In drug allergy maculopapular rashes
were frequent (62%), SDRIFE 7.5%, vasculitis 6.6%,
eczema 6.6%, AGEP 5.8%, SJS/DRESS 2,5%. Culprit
drugs were antibiotics (43.3%), NSAR (16.6%), contrast media (13.3%), other drugs (20%), not specified
(6.6%). Reactive exanthemas were maculopapular
in 48.6%, papulovesicular in 29.1%, papulonodular
8.6% and vasculitis in 7.8%. Causes were bacterial
infections in 44.8%, viruses 9.4%, fungi 4.7%, toxic
reactions 6.3%, physiologic side effects in 11% and
other causes 32.2%. Clinical distribution differed between the two groups with drug reactions appearing preferably in the skin folds and inner sufaces of
the extremities, axillar and inguinal region, reactive
exanthemas on the outer surfaces of the extremities, flanks, hand and feet.
Discussion: By clinical appearance and exact monitoring of lesions into defined body areas it is possible to differentiate exanthemas of allergic and reactive nature. This is important for the further medical
and therapeutic decisions.
P59
Contact dermatitis to ginkgo biloba – a case report
J. Aschwanden, A. Cozzio, L. Imhof
Objective: We report a case of a 36-year old Japanese woman who, wearing gloves, developed itching erythematous dermatitis on her forearms, but
not the hands, after washing fruits and kernels of
Gonkgo biloba.
Methods: The patient first presented herself at our
emergency unit with several itching, erythematous,
partially excoriated papules and plaques with partly
urticarial aspect on both forearms. Her questioning
revealed that, as in earlier years back in her homecountry Japan, she and her partner had washed
fruits and kernels of Gingko biloba they had collected in a park in Zürich two days previous to the
initial manifestation. We performed a skin biopsy
and started treatment with medium-dosage systemic prednisolone to obtain a relief of the cutaneous symptoms.
Results: With this treatment, the skin lesions improved. The histology showed a skin reaction with
infiltrates reminiscent to eosinophilic dermatitis of
Wells. In literature, there are seve ral substances in
Ginkgo described, which may cause a contact allergy or can even cause skin irritation due to its
acidic character. Ginkgolic acids 1 are aromatic compounds found in the pulpy exterior of the fruit of
ginkgo. There is a close structure between ginkgolic
acids 1 and the components of urushiol 4 (the allergen of poison-ivy). Crossreactions may occur with
the following related plants: cashew nut tree, Indian
marker nut tree, mango tree, lacquer tree, rengas
tree, poison oak, poison sumac, poison dogwood,
Brazilian pepper and poison ivy.
Conclusions: With this case report, we would like to
sensitize dermatologists to the diagnosis of contact
dermatitis to gingko biloba. The increasing cultivation of the female tree in Europe and beyond might
increase the frequency of contact dermatitis to
gingko biloba.
P60
The Effects of a Systematic Instructions Program
on Skin Care and Protection in Patients with Hand
Eczema
M.A. Corti, R. Stirnimann, D. Simon
Background: Hand eczema is a common skin disease with high impact on the patients’ quality of life
as well as socio-economic consequences. An impaired skin barrier due to genetic and/or exogenous
factors plays a key role in the pathogenesis of hand
eczema. Therefore, treatment strategies have to include skin care and protection. For the instruction,
we have developed a systematic program. Here, we
aim to investigate the effect of this program with
special focus on the acceptance and disease severity in patients with hand eczema.
Method: Starting in August 2010, all patients referred for treatment of hand eczema to our depart-
52
Schützen Sie Ihre Risikopatienten
Ohne täglichen Schutz sind gefährdete Menschen dem hellen
Hautkrebs wehrlos ausgesetzt. Daylong actinica ist der
einzige Sonnenschutz mit klinisch nachgewiesener Wirksamkeit
bei Risikopatienten zur Prävention der aktinischen Keratose
und des Plattenepithelkarzinoms.1
Abnahme der Anzahl aktinischer Keratosen
innerhalb von 2 Jahren um 53%1
Nachgewiesene Prävention von NMSC 1
Hervorragende Patientencompliance 2
Korrekte Dosierung dank Dispenser 3
Ulrich C et al. Prevention of non-melanoma skin cancer in organ transplant patients by
regular use of a sunscreen: a 24 month, prospective, case-control study. Br J Dermatol. 161
(Suppl. 3):78 (2009).
2
Ulrich C et al. Sunscreens in organ transplant patients. Nephrol Dial Transplant. 23:1805 (2008).
3
Ulrich C. Genau dosiert mit neuer Pumpe. Derma forum. DA9905 (2010).
Spirig Pharma AG, CH-4622 Egerkingen, www.daylong.com
0212
1
ment were instructed on skin care and protection.
The educational program includes basic knowledge
on skin barrier function, optimal cleaning and care,
adequate use of gloves, practical demonstrations
and hand-outs, occupation-specific procedures.
The instructions that take 15 to 30 minutes for each
patient are given by an experie nced nurse. The effect of this program is evaluated using questionnaires and the Physician Global Assessment (PGA)
score based on the modified Total Lesion Symptom
(mTLSS) score before and 4 to 8 weeks after the instructions.
Results: The evaluation of 30 questionnaires revealed that the majority of patients considerably
changed their behavior resulting in an improvement of clinical signs and symptoms independent
of the concomitant dermatological therapy.
Discussion: Our novel instruction program on skin
care and protection for patients with hand eczema
is well accepted by the patients since praxis-relevant information is provided. Patient educational
programs are valuable and may increase the compliance and thus support therapeutic measures.
P61
Severe skin rash under HCV direct-acting antiviral
agent
L. Feldmeyer1, P. Spring1, M. Joccallaz1, D. Hohl1, D. Moradpour2, M. Gilliet1
1
Department of Gastroenterology, CHUV, Lausanne
P O S T ER S
2
Peginterferon/ribavirin treatment therapy for hepatitis C infection is associated with well-characterized
dermatological adverse events presenting as xerosis, pruritus and eczema. New antivirals like telaprevir and boceprevir have significantly improved the
management of hepatitis C infection but are associated with an increased incidence of dermatological adverse events. Whereas most of the skin rashes
observed on telaprevir triple therapy present in a
similar way to the rashes induced by therapy with
peginterferon/ribavirin, with more than 90% classified as Grade 1 or 2, a few case of severe cutaneous
adverse reactions were observed.
We describe the case of a 51-years-old male patient referred for a rash while receiving telaprevir,
peginterferon alpha 2a and ribavirin. Chronic hepatitis C infection had been diagnosed in 2004. The
patient had no response to a 12-months ribavirin/
interferon alpha therapy. After a hepatic biopsy
showing a progression of liver fibr osis, a triple therapy with telaprevir was initiated. Despite prophylactic skin care with emollients, the patient presented
with a discrete rash on the trunk and extremities
two days after therapy initiation, which resolved
upon local therapy with 0.1% betamethasone valerate unguent. Six weeks later, the cutaneous rash
recurred despite continuous local therapy with
emollients, and progressed further despite reintroduction of the topical steroid therapy, leading to
discontinuation of the HCV therapy one week later.
The patient presented with ill-defined clusters of
coalescing, pruritic, erythematous papules disseminated on the extremities and trunk. Blisters, epidermal detachment, mucosal involvement, fever, blood
eosinophilia or other systemic symptoms were
not present. After discontinuation of the therapy,
the rash resolved slowly. Histologic examination
showed a perivascular and perifollicular lymphohistiocytic inflammation extending to the interface,
with hyperkeratosis and parakeratosis, comparable
to the histological picture described on IFN/ribavirin therapy.
This case illustrates the increasing role the dermatologist play in managing dermatological adverse
events in collaboration with the HCV-treating physicians. Whereas the majority of cutaneous adverse
events on telaprevir triple therapy present as harmless eczematous dermatitis that can be managed
with local therapy and does not require treatment
interruption, potential serious cutaneous reactions
are possible on this therapy.
P62
Severe rhabdomyolysis with adalimumab
P. Fritsche, MD. Anliker
Dermatology and Allergy Unit, Cantonal Hospital of St.
Gallen , St. Gallen
Introduction: There is a broad variety of adverse side
effects linked to the administration of Adalimumab.
Frequently reported side effects of Adalimumab
and other TNF-alpha blockers are infections, exanthema, lupus erythematodes, adverse reactions at
the site of injection and elevation of liver enzymes.
Most side effects of Adalimumab are of minor concern and well manageable.
Patient: A 24 year old healthy male patient with
severe plaque psoriasis was treated prior to Adalimumab with Metothrexate and a short course of
Cyclosporine A. After treatment with Metothrexate
and Ciclosporine Adalimumab was started. Adalimumab was administered with regular doses of initially 80mg s.c., followed by 40mg s.c. every 2 weeks.
There was no other systemic treatment. Topical steroids and Vitamin D Analoga were used during the
whole course of Adalimumab.
Course of therapy with Adalimumab: Previous to
treatment and one month after start with Adalimumab blood count, hepatic, renal parameters and
CK were in range. Eight weeks after the first injection however and two days after the last injection
of Adalimumab AST, ALT and CK were massively
increased (AST 440 U/L, ALT 123 U/L, CK 37`930
U/L, LDH 1514 U/L). Muscle aching but no muscle
weakness was reported by the patient. In order to
prevent crushing of kidneys the patient had been
rehydrated and monitored closely at hospital. Blood
count and renal parameters were in range at all
times. 3 days after initiating emergency treatment
the serum levels of ALT, AST and CK decreased considerably and the patient could be dismissed in a
good state of health.
Discussion: We report on a new severe side effect of
Adalimumab: A combination of severe rhabdomyolysis and increased hepatic parameters. This side
effect is not known for Adalimumab or other TNFalpha inhibitors so far; possibly more incidences
have been overlooked. Therefore we recommend
conducting blood exams a few days af ter drug
application in daily routine; adalimumab-induced
rhabdomyolysis has to be taken into consideration.
54
Skin rash induced by ganitumab: A novel drug reaction
C. Huber, N. Saxer, G. Kaya, B. Cortes
Department of Dermatology, University Hospital Geneva
Introduction: Ganitumab (AMG-479) is a new human monoclonal antibody that targets the type-1
insulin-like growth factor receptor (IGF-1R). Ganitumab is actually used in a phase III trial comparing
AMG-479 versus placebo in association with gemcitabin used as a first-line therapy for metastatic
pancreatic carcinoma. Few data are available about
cutaneous side effects of this treatment. We report
the case of a woman with a recurrent skin rash induced by ganitumab.
Observation: A 51 year-old woman with a history
of metastatic pancreatic carcinoma, presented with
asymptomatic skin rash evolving for several months.
Skin lesions appeared three days after the first treatment of ganitumab, and slowly improved. Nevertheless, the rash reappeared in the same locations
after each new infusion, supporting the imputability of this treatment on the skin reaction. On physical examination, multiple erythematous infiltrated
papules and annular plaques were localized on the
upper trunk, arms and face. A biopsy of a lesion
performed in the right upper extremity showed an
interface dermatitis with lymphocytes, histiocytes
and some eosinophils, consistent with a drug reaction. Class IV topical corticosteroids were prescribed
and improved the rash.
Discussion: Few data are available about side effects
of ganitumab. One phase Ib study assessing the
safety of ganitumab in patients with advanced solid
tumors, reported skin side effects, such as palmoplantar erythrodysesthesia or maculopapular rash.
However, the treatment was combined with targeted agents or cytotoxic chemotherapy. Moreover another phase II study of ganitumab monotherapy did
not confirm these results. Because of the chronology of the rash, the lesions of our patient are most
likely to be attributed to ganitumab.
Conclusion: Our patient presented a peculiar drug
reaction, with relapsing skin lesions on sun-exposed
areas. To our knowledge, this is the first cas e of ganitumab-induced drug rash.
P64
2-methyl-4-isothiazolinone-3-one (MI) : a new epidemic of allergic contact dermatitis ?
P. Piletta, F. Pasche-Koo
2-methyl-4-isothiazolinone-3-one is the emerging
allergen of cosmetics and cleaning products. This
preservative constitutes 1/3 of the methylchloroisothiazolinone / methylisothiazolinone (MCI/MI) mix,
also known as Kathon CG. The polemic about various preservatives, among which the parabens, has
led since 2005 to an increasing use of MI in leaveon care products (creams, wet wipes, etc). We shall
discuss our observations and worries about the increasing number of allergic patients to this preservative.
Results: In 2006, out of 385 patch tested patients 1
had a positive reaction to MCI/MI at 4 days = 0,25%.
2007: 354 patients – 3 positive reactions (++) =
0,84%. 2008: 345 patients – 0 positive = 0 % . 2009:
358 patients – 1 positive = 0,27%. 2010: 371 patients
– 13 patients ++ = 3,5%. 2011: 390 patients – 23 patients ++ to MCI/MI or to MI alone, recently introduced in the preservatives series = 5,9%. 4 patients
reacted to MCI/MI alone, and not to MI, 5 patients
only to MI. 11 patients also reacted to personal
products.
Comments: In 2010 the first observations of MI contact dermatitis were described. Since then, numerous articles have reported similar cases. In 2011 a
Danish study reported that 1,5% of cosmetic products and 16,5% of cleaning products and detergents
contained MI. The results show a major increase in
MCI/MI sensitization. In most situations, these results are clinically pertinent.
Conclusion: The purpose of our study was not only
clinical, but also epidemiological: inform the dermatological community and the concerned authorities
that there is a major problem in relation to the increasing use of MI in the population’s environment.
P65
"EASIdig" – a digital tool to document disease activity in atopic dermatitis
M. Tremp1, I. Knafla2, G. Burg1, B. Wüthrich1, P. SchmidGrendelmeier1
Institute of Psychology, University Hospital Zürich
1
2
Background: Different scoring systems have been
developed to determine the severity of atopic dermatitis (AD); the SCORAD (SCORing Atopic Dermatitis) and EASI (Eczema Area and Severity Index) are
among the best validated scoring systems.
Objective: The aim of this study was to produce a
rational quality control for routine clinical use by using the modern facilities of digital imaging.
Methods: 63 AD patients were scored by a single
person at each visit using the SCORAD & EASI scoring system. Images were taken and rated by two
fully-trained non-dermatologists applying the EASI
score. In addition, blood samples were taken for
determination of total IgE, eosinophilia and eosinophilic cationic protein (ECP).
Results: At all visits the results of SCORAD, EASI and
immunologic parameters correlated significantly
with the EASI score established from the digital images.
Conclusion: Digital evaluation of EASI, hereby name
d "EASIdig", can be learned quickly and is a reliable
tool for the digital assessment of severity and extent
of AD.
Digital evaluation of EASI, hereby name d’"EASIdig",
can be learned quickly and is a reliable tool for the
digital assessment of severity and extent of AD.
P63
55
P66
P67
Hayfever as Christmas gift - by man-planted imported Alder (Alnus spaethii) tree pollen
Atopic Dermatitis in SubSaharan Africa: clinical
and sensitization patterns in Amaxhosa-speaking
patients in Cape Town, Republic of South Africa
M. Gassner1, R. Gehrig2, P. Schmid-Grendelmeier3
Practice for Allergology and Internal Medicine, Grabs
Meteo Schweiz, Section Palynology, Zürich
3
Allergy Unit, Department of Dermatology, University
Hospital Zürich
1
P O S T ER S
2
Background:Long-time studies investigating prevalence of allergic occupational diseases ideally lead
to preventive measurements. Little is known about
the prevalence and time trend of sensitisations to
molecular allergens and relations to the environment. Changing technologies in agriculture and
plantation costumes and trends influence also the
environmental load on allergenic pollens. We investigated the allergenic role of a newly planted alder
species.
Patients and methods: School children of Grabs, a
village in Eastern Switzerland, were surveyed between 1983-2007 (continual repeated cross sectional studies) at the age of 15 years by clinical history
and serological examination: at least 4 spez. IgE.
Sera from 54 pupils in 1986 and 46 pupils in 2006
were reanalysed by a microarray-based determination of IgE to 103 molecular Allergens. Also 12 pupils
with positives specific IgE in 1986 year group were
recalled and reinvestigated in 2010, so 24 years later
at the age of 39 year. Pollen measurement was performed.
Results: During the 24 years observation period the
prevalence of sensitised children in the observation
period increased. Sensitisation against Alder (nAl g
1) was not found in 1986, but was detected in 2006
in 5 out of the 46 not selected “healthy” schoolchildren (10.9%). This increased sensitization was not
seen with other tree pollen allergens such as birch
(Bet v1). Sensitization to Ash pollen was found repeatedly more often than to Birch pollen, during all
24 years.
7 pupils (15.2%) without symptoms in 1986, but
with a clear sensitization to main molecular allergens, had developed symptoms in the next years,
most transiently. From this cohort, 3 show also newly detectable a sensitisation to nAln g1 in 2010.
Alnus pollen were usually measured in relevant
amounts from January to March, but A. spaethii species, planted in 1995-2000, start to flower 2010 and
2011 in December.
Conclusions: This small study shows an increasing
sensitisations to alder, after a 1908 man made species (Alnus spaethii: A. japonica x A. subcordata) was
planted. This alder begins to flourish in December,
before the indigenous species and clearly before
the local pollen season. Thus newly introduced
plant species seem to be able to become a relevant
allergen within a short period as observed on a clinical and molecular level.
Sensitisations to ash pollen are more frequently
than birch pollen, however sometime without the
expected cross-reactivity to olive pollen.
P. Schmid-Grendelmeier1, F. Thawer-Esmail2, H. Carrara3, A. Irvine4, G. Todd2
Allergy Unit, Dept. of Dermatology, University Hospital
Zürich
2
University of Cape Town, Division of Dermatology, Cape
Town, South Africa
3
University of Cape Town, Institute for Biostatistics Cape
Town, South Africa
4
Lady’s Hospital for Sick Children Crumlin, Dublin, Ireland
1
Background: Little is known about atopic dermatitis (AD) in Subsaharan Africa, but recent data show
an increasing prevalence in these regions, mainly
in urbanized area. However, precise data on clinical
features, sensitization patterns and genetic background in this geographic area are still very sparse.
Thus we wanted to evaluate the sensitization patterns in a well defined cohort of AD patients and
controls.
Methods: 102 subjects of Xhosa ethnic background
with AD according to the modified Hanifin Rajka
criteria were recruited (Age range 0-49 years, mean
age 7 years, f/m 50/52), as well as 105 healthy controls from the same population (mean age 29 years,
f/m53/52).. All were clinically examined. Total and
specific IgE levels (ImmunoCAP) for common food
and inhalant allergens were measured and a microarray-based assay to define specific IgE against
103 molecular allergens (ImmunoCAP ISAC) was
performed. Serology against 7 common parasites
and genetic analyses of barrier genes were determined.
Results: AD severity according to EASI was mild in
24 (23.53%), moderate in 44(43.1%) and severe in
34 pts. (33.33%). Total IgE was raised in 91.89% of
AD pts. (mean 2216 kU7l) and significantly higher
than in controls (elevated in 43.8%, mean 80 kU/l).
28.38% of the AD patients had levels >5000 kU/l, of
which 61.9% had severe AD. 89.04% of the patients
had a positive specific IgE to at least one allergen,
significantly more than in controls (32%, p < 0.01).
Most common sensitizations in AD pts.were against
house dust and storage mites and grass pollen. IgE
against food were mostly against egg white (ovalbumin) and - possibly parasite-originating -tropomyosin. There was a strong correlation between
AD severity and IgE-mediated sensitizations. 73.7
% of AD patients showed positive parasite serology
compared to only 43% in controls, mostly towards
Toxocara canis. Barrier genes showed substantial
differences compared to Western population s in
both groups.
Conclusions: IgE levels and sensitizations in these
African Xhosa population are significantly higher
in individuals with AD as compared to controls and
correlate with clinical severity. Thus also in such geographically and socioeconomic different settings
IgE-mediated sensitizations may play an important
role in AD, although allergen spectrum and genetic
background can differ substantially. The higher parasite infestation may be a contributing factor for the
increasing prevalence of AD in urbanized areas.
56
P68
P69
Successful Use of Omalizumab (Anti-IgE-AB, Xolair®) in an Inadequately Controlled Type 2 Diabetic Patient with Severe Insulin Allergy
Severe cutaneous allergic reactions following topical antifungal therapy
Department of Internal Medicine, University Hospital
Zürich
2
Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zürich
3
Department of Endocrinology and Diabetes, University’s
children hospital Zürich
4
Department of Endocrinology, Diabetes and Metabolism,
University Hospital Basel
5
Allergy Unit, Department of Dermatology, University
Hospital Zürich
1
A 62-year old, male patient with type 2 diabetes
for 16 years developed a severe anaphylactic shock
upon intravenous, short acting regular insulin. The
patient’s medical history comprised allergic reactions to an unknown agent as a child as well as injection site reactions, urticaria and dyspnea to subcutaneous insulin injections. The diagnostic work-up
revealed a type 1 IgE-mediated insulin allergy by
positive Skin prick tests (SPT) and elevated specific
IgE levels against insulins of human, porcine and
bovine origin by ImmunoCAP-Assay. The insulins
used were free of proinsulin. SPTs with all solvents
and additives of the insulin solutions were negative.
Genetic sequencing of the patient’s insulin molecule
revealed a normal insulin gene. Because of unsatisfactory glycemic control, specific desensitization
and maintenance therapy with insulin detemir was
performed, but improvement of urticaria and dyspnea was only transient.
As insulin therapy seemed to be indispensable to
control glycemia, treatment with intramuscular injections of 300mg of omalizumab, a monoclonal
antibody against IgE, every 4 weeks was initiated.
A second desensitization therapy with insulin was
successfully performed 6 months later. Insulin detemir was started again and doses were gradually
increased without reappearance of allergic symptoms. Subsequently, glycemia improved. After another 6 months, omalizumab was tapered until urticaria reappeared; currently a dose of 300mg every
8 weeks suffices for full control of allergic symptoms
and adequate glycemia (HbA1c 7.1%).
Insulin allergy is a very rare adverse reaction to insulin1, in the present case to all types of insulins
tested. Desensitization therapy is proposed to treat
patients with disabling allergic symptoms. Omalizumab, an anti-IgE-antibody, has been approved for
severe persistent allergic asthma patients. The rationale to use omalizumab in our patient is supported
by different studies sho wing favorable effects of
omalizumab as treatment before desensitization
therapy in IgE-mediated diseases.
Our report describes for the first time that patients
with severe IgE-mediated insulin allergy can be
treated with omalizumab alone – thus enabling the
use of exogenous insulin.
MM. Tang, MAM. Corti, R. Stirnimann, N. Pelivani, N.
Yawalkar, L. Borrabori, D. Simon
Background: Topical clotrimazole with and without
prednisolone acetate are widely used in the treatment of superficial cutaneous fungal infections.
Both components have been reported to cause contact sensitization.
Objective: To retrospectively analyze and correlate
clinical data and allergen sensitization pattern in patients allergic to topical antifungals
Methods: We report on ten patients presenting with
severe cutaneous allergic reactions following topical application of clotrimazole with/without prednisolone referred to our department between 2008
and 2011. Patch testing was performed in all patients with European standard, antimycotic agent,
corticosteroid, preservative, emollient series, culprit
antifungal and corticosteroid creams used by the
patients.
Results: The cutaneous reactions developed between 7 and 21 days after initiation of antimycotic
therapy. We observed widespread and generalized
eczematous reactions as well as erythematous,
maculop apular, erythema multiforme like and blistering eruptions. Patch tests revealed sensitization
to corticosteroids in five patients, clotrimazole in
two patients, both clotrimazole and corticosteroids
in two patients; as well as exclusively to the culprit
antifungal cream in one patient. The most severe
eruptions were found to be associated with sensitizations to corticosteroids while eczematous reactions were seen in clotrimazole allergy.
Conclusions: Clinicians prescribing antifungal therapy should be aware that severe and generalized allergic reactions may occur. Patch testing is advised
to identify the allergens.
P70
Blue spots on skin and oral mucosa
Z. Spanou, H. Beltraminelli, L. Borradori, D. Simon
A 40-year-old, kidney-transplanted female woman
presented with asymptomatic bluish pigmented. The
lesions, which occurred after either minor trauma or
at sites of injections, were first erythematous and later on progressively turned blue and grayish with no
complete regression. The patient`s past personal history was significant for an insulin- dependent diabetes mellitus, hepatitis C and a nocardia pneumonia.
Because of pulmonary nocardiosis she has been on
treatment with minocycline for over a year.
On examination she had sharply demarcated macular blue-grey pigmentated lesions on the upper and
lower limbs as well as the oral mucosa. Histological
examination revealed pigment granules in the upper and deeper dermis as well as in the subcutaneous fat. Patient’s history, clinical and histopathological features were consistent with the diagnosis of a
minocycline-induced pigmentation.
C. Cavelti-Weder1, B. Muggli1, C. Keller2, A. BabiansBrunner2, A. Biason-Lauber3, MY. Donath4, P. SchmidGrendelmeier5
57
Minocycline is a tetracycline-antibioticum used for
the treatment of numerou s dermatological diseases and infections. The mechanisms of minocyclineinduced pigmentation are not well understood.
Brown granular hyperpigmentation positive for
both iron- and melanin staining within the dermis
are typically found. There are three different types
of hyperpigmentation: type I, with blue-gray pigmentation that appears at sites of inflammation or
scars; type II with blue-gray pigmentation in previously normal appearing skin on the upper and
lower limbs; type III, diffuse grey-brown appearance
at sun-exposed sites (muddy skin syndrome). The
lesions in our case were typical for the type II form.
Regression of minocycline-induced pigmentation
has been rarely observed after discontinuation of
the drug. Laser treatment has been shown effective
in some cases.
P71
Revertant Cutaneous Mosaicism in a Patient with
Poikiloderma with Neutropenia Clericuzio Type
AW. Arnold1, M. Pigors2, R. Happle2, J. Kohlhase3, L.
Bruckner-Tuderman2, C. Has2, P. Itin1
Department of Dermatology, University Medical Center
Freiburg, Germany
3
Center for Human Genetics Freiburg, Germany
1
POSTERS
2
A new syndrome associating poikiloderma and neutropenia was described by Clericuzio et al. in 1991. It
is caused by mutations in the C16orf57 gene, which
encodes a protein with yet unknown function, potentially involved in the control of apoptosis. Here
we report on a 5-year-old boy with poikiloderma
with neutropenia (PN) Clericuzio type caused by the
homozygous mutation c.243G>A, p.W81X in the
C16orf57 gene. He had poikiloderma, mild keratoderma on hands and feet, pachyonychia of the great
toenails, growth delay, hepatosplenomegaly, and
nondescended testes. Blood examinations revealed
a persistent neutropenia leading to many viral and
bacterial infections besides transient thrombocytopenia, elevated LDH and elevated liver enzymes.
Based on the clinical features observed in our patient and on the review of the literature we propose
diagnostic criteria for PN. Recent data suggest that
C16orf57 mutations cause overlapping phenotypes
including PN, Rothmund-Thomson sy ndrome and
dyskeratosis congenita, emphasizing the importance of clinical diagnostic criteria. Interestingly, our
patient presented a normally appearing segmental
skin area on the right leg, contrasting with the otherwise generalized poikiloderma. This suggested
the presence of revertant cutaneous mosaicism. Revertant mosaicism has been observed in several inherited conditions, including epidermolysis bullosa,
a heterogeneous group of blistering skin disorders.
Skin diseases provide a useful model for studying
revertant mosaicism because of the visual and accessible nature of skin. Revertant cell therapy represents a potential ‘natural gene therapy’ because in
vivo reversion obviates the need for further genetic
correction.
Revertant Cutaneous Mosaicism in a Patient with
Poikiloderma with Neutropenia Clericuzio Type.
P72
Junctional epidermolysis bullosa revealed by radiotherapy in an adult
C. Barde1, X-C. Pham1, S. Quenan1, L. Fontao1, T. Zilli2,
G. Kaya1
Policlinic of Dermatology, Geneva University Hospital
Department of Radiooncologie, Geneva University Hospital
1
2
Epidermolysis bullosa (EB) is a rare congenital skin
disease usually diagnosed in early childhood because of blisters appearing on the skin after mildest
trauma. EB is classified into three types depending
on the level of cleavage; intraepidermal blistering
in EB simplex, cleavage within the basement membrane underlying basal keratinocytes either at the
level of lamina lucida in junctional EB, or under the
lamina densa in dystrophic EB. Often EB simplex
type shows mild evolution, while the junctional type
can be associated with internal organ involvement
with a severe outcome and the dystrophic type is
often fatal.
Here we present a case of a 55-year-old man undergoing combined hormone treatment and radiotherapy for prostate cancer who developed skin
blistering on the radiation field. The clinical aspect
suggested a generalized atrophic benign epidermolysis. He was treated with volumetric modulated arc
therapy (VMAT) on the pelvis (50.4 Gy) with a boost
on the pr ostate and the seminal vesicles (24 Gy on
6 fractions of 4 Gy). The first diagnosis was acute
radiodermitis but the radiation doses delivered to
target volumes were around 36 to 40 Gy. The daily
skin dose assessed using in-vivo thermoluminescent dosimetry ranged between 0, 35 to 1, 19 Gy
and the estimated delivered skin doses (from 10, 5
to 35, 7 Gy) were too low to cause skin blistering. A
detailed history revealed that since the age of 3 the
patient had a fragile skin with appearance of blisters
after sun exposure, minor trauma or use of adhesive
dressings. He also reported having fragile teeth with
dental caries and erosions appearing at the age of
7 which led to the implantation of crowns in early
adulthood. Because of the history of the patient and
clinical features, congenital EB was suspected. Biopsies were performed for histology, electron microscopy and direct immunofluorescence microscopy.
Histology showed a cell-poor subepidermal blister
with no inflammatory infiltrate in the dermis. Electron microscopy revealed a split through the lamina
lucida without obvious abnormalities in the number
or the ultrastructure of hemidesmosomes, leading
to the diagnosis of junctional EB. Antigen mapping
performed on patient skin showed normal expression of type VII collagen and laminin-332 as well
as of beta-4 integrin subunit and plectin whereas
BP180 (collagen XVII) expression was reduced compared to normal skin.
Although further investigations are required to
identify the mutated gene in our patient,
58
Successful treatment of benign familial pemphigus (Hailey-Hailey familial acantholytic disease)
by CO2 laser: a 4 cases series and review of the
literature
V. Cattin, M. Gilliet, P. Perrier
Background: Hailey-Hailey disease (HHD) is a very
disabling condition affecting mainly the intertriginous folds with a high psychosocial impact. Prolonged remission or cure may be difficult to obtain
unless undergoing heavy surgical procedures. CO2
laser therapy has been shown to be efficient in very
few publications. We aimed to assess the efficacy of
CO2-laser treatment on histologically documented
HHD with mid-term follow-up and to compare our
results with the existing literature.
Methods: We proposed serial CO2-laser treatments
under local or general anesthesia to two female and
two male HHD patients, documented by skin biopsy,
who had been refractory to conservative approach
for many years. We used the Med X pixel ultrapulse
CO2 laser, at a frequence of 75 Hz and with a pulse
energy of 80 mJ/cm2 (6 W), 2.5 aperture, 2 passes,
with at least 4 weeks intervals.
Results: After four to six treatment sessions, all the
patients showed both subject ive and objective improvement of the disease. Healing was satisfactory
without hypertrophic scars. We observed complete
remission after nine to twelve months follow-up on
the treated areas for three out of four patients. Moreover, all four patients’ quality of life was subjectively
improved. In one patient, the extension of the disease and its very high inflammatory behaviour did
not allow applying properly the above mentioned
protocol and thus failed to reach the expected result unless undergoing general anesthesia. Of note,
several patients showed progression of the disease
around the borders of successfully treated areas.
Discussion: Our observations and literature data indicate that pulsed carbon dioxide laser treatment
provide a prolonged remission on treated areas of
HHD. This simple outpatient procedure avoids extensive multistep skin grafts and related high inpatient costs. Pain following the procedure is a main
issue, as well as prolonged periods of absence from
w ork. Larger series need to be collected, in order to
robustly validate this therapeutic modality for HHD.
P74
Adams-Oliver Syndrome and associated malformations
N. Wolf1, M-C Addor2, S. Christen-Zaech3
Department of pediatrics, CHUV, Lausanne
Division of genetics, CHUV, Lausanne
3
1
2
Adams Oliver syndrome, characterized by aplasia
cutis congenita and terminal transverse limb defects, is extremely rare. It is nevertheless important
for dermatologists and pediatricians to be familiar
with this diagnosis as systemic malformations, including the gastrointestinal tract, the central nervous, ocular, urogenital and cardiovascular system,
may be associated with it. These systemic involvements can be asymptomatic at first and therefore
easily missed.
Here we report a case of a newborn girl with Adams
Oliver syndrome, combining an aplasia cutis congenita, transverse limb defects and ventricular septal defect with patent ductus arteriosus. A review of
the literatur revealed that 22% of Adams-Oliver patients presented cardiac involvement, the valvular
problems being the most common. This highlights
the need for cardiological survey in these children.
P75
Hyperkeratotic cutaneous vascular malformation
associated to cerebral cavernoma with KRIT1 mutation
L. Feldmeyer1, H. Baumann-Vogel2, E. TournierLasserve3, F. Riant3, R. Dummer4, J. Kamarashev4
Department of Neurology, University Hospital of Zürich
3
Assistance Publique Hôpitaux de Paris, Hôpital Lariboisière, Laboratoire de Cytogénétique, Paris,
4
1
2
Familial cerebral cavernous malformations (FCCM)
are vascular malformations inherited as an autosomal-dominant condition. Mutations in three genes
(KRIT1/CCM1, MGC4607/CCM2, PDCD10/CCM3)
have been described so far. Extra-neurological involvement includes retinal and cutaneous vascular
malformations. Cutaneous vascular malformations
are seen in 9% of FCCM patients and present mainly
as hyperkeratotic cutaneous vascular malformation. These malformations are considered specific
for FCCM and are always associated to KRIT1/CCM1
mutations.
We describe the case of a 40-years-old male patient
with multiple cerebral cavernomas presenting with
a skin lesion on the left heel. The lesion presented
clinically as an asymptomatic isolated hyperkeratotic well-demarcated dark-blue plaque of ca. 0.5x1cm
diameter. Histologic examination showed a superficial, verrucous haemangioma with verrucous hyperorthokeratosis, slight papillomatosis and acanthosis
of the epidermis as well as mu ltiple strongly dilated
thin-walled vessels in the superficial dermis.
Based on these findings, we suspected a FCCM and
performed a mutation analysis of the KRIT1 gene
revealed a mutation in the exon 12 (c.1201C>T)
leading to the replacement of a glutamine by a stop
codon at position 401 (p.Q401X), The mutation analysis was followed by genetic counseling; indeed,
the autosomal transmission implies a 50% risk for
the children of the patient to inherit the mutation
and a higher risk to develop cerebral cavernomas
compared to the general population, although the
penetrance is incomplete. A preimplantation genetic testing can be proposed to the affected patients.
This case illustrate the important role the dermatologist can play in identifying discrete but typical
skin changes, leading to identification of the causing mutation.
P73
59
P76
Angiokeratomas like skin lesions for diagnosis of
fucosidosis
F. Poffet1, J. Fluss2, A-M. Calza1, I. Masouye3
1
Institute of pediatry, Geneva University Hospital
2
3
Introduction: We report a case of fucosidosis, a rare
lysosomal storage disease diagnosed through the
presence of angiokeratoma-like lesions with peculiar histology.
Observation: This 14 years old girl is suffering from
severe physic and mental retardation with skin lesions taking the aspect of hyperkeratotic red violaceous little papules on the feet, knees, torso, arms
and inner side of the mouth. She developed herself
normally until the age 5 when she began to slow her
acquisitions and progress towards a severe neurologic and motor degenerative state. Even if there is
consanguinity in the family no one is suffering from
the same symptoms. The mother noticed the first
skin lesions at the age 4 with a slow progression in
number till now. Because of suggestive clinical and
MRI findings the patient was initially diagnosed for
Hallervoden-Spatz syndrome even though she didn’t
present the specific mutation (PANK2) and that no
such angiomatous skin lesions ar e described in this
latter entity. A skin biopsy of a vascular lesion on the
thigh did not show the marked superficial vascular
dilatation suggestive of angiokeratoma but showed
intense and diffuse endothelial cell vacuolisation
leading us towards lysosomial storage diseases. The
collapsed lymphocytic alpha fucosidase activity rate
permitted the right diagnosis.
Discussion: Fucosidosis is due to a-L-fucosidase deficiency [1], resulting in widespread accumulation of
a-L-fucosylated glycoproteins, glycolipids and oligosaccharides in several tissues. This entity was recognized in the late 1960s and up till now, about 100
cases have been reported worldwide. The disease
presents with neurological, skeletal, and cutaneous
findings, including mainly angiokeratoma.
The severity of the neurologic deficiency, the female
sex and the site of angiomatous lesions were not
suggestive here for Fabry disease. Skin histology
showing intense endothelial vacuolisation and the
right en zymatic dosage conducted to reestablish
the right diagnosis after 14 years of evolution of this
severe metabolic disease.
P78
Tunneling hair syndrome: description of a new
entity
S. Quenan, E. Laffitte
P77
Aberrant splicing of the APC gene in benign skin
lesions of genetically confirmed FAP patients
Introduction: We have observed a dermatologic lesion formed by a tunnel of hairs embodied parallel
to the adjacent skin surface. This entity should be
distinguished from the pili migrans and pili incarnati. To our knowledge, this is the first described case
of such a dermatologic lesion, that we designed under the term of "tunneling hair syndrome".
Observation: A 52 year-old Malachi man, presented
to our clinic with a right thoracic sub-mammary
linear asymptomatic lesion, evolving since several
months. This lesion was made of long, black, hard,
and solid hair shaft, embodied parallel to the skin
surface and normally attached by their bulb. These
D.A. Stegmann1, K. Heinmann2, P. Itin3, B. Burger1
Research Group Dermatology, Department of Biomedicine, University Hospital Basel
2
Research Group Human Genetics, Department of Biomedicine, University Children’s Hospital Basel
3
Department of Dermatology, University Hospital Basell
1
P O S T ER S
terized by the early development of polyps and further malignant progression to colorectal cancer. The
disease is caused by germline mutations in the APC
tumor suppressor gene. Until now, several isoforms
of APC have been identified. In its commonest form
the APC protein is encoded by 15 exons resulting in
an 8535bp long transcript.
Benign skin tumors are known extracolonic manifestations of Gardner Syndrome, a phenotypic variant of FAP. As such skin lesions tend to occur significantly earlier than the clinical manifestations of the
colonic polyps, they have been previously discussed
as possible early markers for FAP. Considering the
development of these FAP associated skin lesions
relatively little is known up to now.
We hypothesized these benign skin tumors in FAP
patients develop due to a second mutation (second
hit) on the APC gene according to Knudson’s two h
it hypothesis.
In the present study we investigated APC cDNA in
FAP patients with lipomas, fibromas and epidermal cysts with the aim to reveal intronic mutations.
These intronic mutations are thought to activate a
cryptic splice site and lead to aberrant splicing.
For this, skin samples of 3 lipomas, 9 fibromas and
3 epidermal cysts were taken from 14 genetically
confirmed FAP patients. Total RNA was isolated from
these skin lesions, reverse transcribed to cDNA, and
further amplified with six exon overlapping fragments covering the full length APC gene. PCR products were separated on agarose gels, and aberrant
PCR products were further analyzed by direct sequencing.
For each of the exon overlapping fragments we expected one defined transcript. In addition to these
expected transcripts PCR analyses resulted in 7 additional transcripts already described in literature.
Most of them were expressed in several or even all
FAP patients independent of the type of skin lesion
. Two FAP patients showed a unique fragment pattern. In one patient exon 7 was deleted. In the other
patient the expected bond was lacking. Deletion of
exon 7 in one patient may be interpreted as a cause
of the known germline mutation in the IVS 7 of this
patient. For the other patient influence of the lacking transcript on the pathogenesis of the underlying skin lesion has to be investigated.
Familial adenomatous polyposis (FAP) is an autosomal dominant inherited disease which is charac-
60
Aufgrund der Psoriasis war ein Veloausflug mit der
Familie für ihn eine kaum überwindbare Herausforderung.
Für die meisten von uns selbstverständliche Momente
LEO Pharma Workshop an der
SGDV Jahresversammlung 2012
Psoriasis:
Der Weg zur Patientenzufriedenheit und zum
Therapieerfolg - wie mache ich meinen
Patienten und mir das Leben einfacher?
Chair: Prof. Nikhil Yawalkar, Bern
Dr. Alexander Nast, Berlin
M.A. Cristina Galfetti, Meisterschwanden
Donnerstag, 30. August 2012
17.30 - 18.30, Kursaal Bern, Raum Vivace 2
DAIVOBET® GEL – Wirksamkeit
im wirklichen Leben1 – 3
Den Menschen helfen, mit Psoriasis zu leben.
Referenzen
1. Carroll CL et al. Better medication adherence results in greater improvement in severity of psoriasis. Br J Dermatol 2004; 151(4):895 – 897
2. Zivkovich AH et al. Are ointments better than other vehicles for corticosteroid treatment of psoriasis? J Drugs Dermatol 2009; 8(6):570 – 572
3. Feldman SR et al. Psoriasis: improving adherence to topical treatment. J Am Acad Dermatol 2008; 59(6);1009 – 1016
Gekürzte Fachinformation: DAIVOBET® SALBE / GEL
Zusammensetzung: 1 g Salbe / Gel enthält 0.05 mg Calcipotriol und 0.5 mg Betamethason in Form von Betamethasondipropionat. Indikationen: Psoriasis vulgaris bei Erwachsenen. Dosierung: 1x täglich, max. 100 g/
Woche bzw. 15 g/Tag. Empfohlene Behandlungsdauer: 4 Wochen. Anschliessend wiederholte intermittierende Behandlung unter ärztlicher Kontrolle möglich. Daivobet® Gel vor Gebrauch schütteln. Kontraindikationen:
Überempfindlichkeit gegen Inhaltsstoffe. Anwendung im Gesicht, insbesondere auf augennahen Hautarealen (Kataraktgefahr). Bekannte Störungen des Calciumstoffwechsels. Infektionen mit Viren, Bakterien oder Pilzen,
Hautmanifestationen von Tuberkulose oder Syphilis, Rosazea, periorale Dermatitis, Akne, atrophische Haut, Dehnungsstreifen, erhöhte Fragilität der Hautvenen, Ichthyose, Wunden, perianaler und genitaler Pruritus und
Hautulzera. Erythrodermische, exfoliative und pustulöse Psoriasis. Schwere Niereninsuffizienz und schwere Leberfunktionsstörungen. Keine Anwendung bei Kindern, da noch keine Erfahrungen. Vorsichtsmassnahmen:
Verschleppen ins Gesicht vermeiden, Hände nach Anwendung waschen. Behandlung von >30% der Körperoberfläche vermeiden. Bei einer Dosis von mehr als 100 g/Woche können Hypercalcämien nicht ausgeschlossen
werden. Bei Dosisüberschreitung Kontrolle des Serumcalcium. Während der Therapie mit Daivobet® wird empfohlen, exzessive Bestrahlung mit natürlichem oder künstlichem Sonnenlicht zu begrenzen oder zu meiden.
Eine gleichzeitige Behandlung mit anderen Kortikosteroiden sowie eine grossflächige oder okklusive Anwendung sollten vermieden werden (Suppression endogener Cortisolproduktion). Sorgfältige Therapieüberwachung empfohlen, da die Psoriasistherapie mit Kortikosteroiden ein gewisses Risiko eines Reboundeffektes, einer Toleranzentwicklung und einer Auslösung einer generalisierten Psoriasis pustulosa birgt. Vorsicht bzgl.
Maskierung einer allergischen Reaktion durch das Kortikosteroid. Unerwünschte Wirkungen: Häufig: Pruritus, Hautausschläge, Brennen. Gelegentlich: Hautschmerzen oder Irritation, Dermatitis, Erythem, Exazerbation der
Psoriasis, Follikulitis, Akne, trockene Haut und Augenreizungen. Selten: Pustulöse Psoriasis. Unbekannte Häufigkeit: Reboundeffekt. Interaktionen: Nicht mit salicylsäurehaltigen Zubereitungen mischen, die Salicylsäure
inaktiviert Calcipotriol. Salicylsäure bleibt auf der Hautoberfläche, so dass auch eine zeitlich versetzte Calcipotriol-Anwendung in der Wirkung vermindert sein kann. Packungen: Daivobet® Salbe: Tuben zu 30* und 60*
g (Liste B); Daivobet® Gel: Flaschen zu 60* und 2x60*g (Liste B). Stand der Information: November 2010. *Kassenzulässig. Ausführliche Informationen entnehmen Sie bitte dem aktuellen Arzneimittel-Kompendium der
Schweiz. ©LEO Pharmaceutical Products Sarath Ltd., Eichwatt 5, 8105 Regensdorf. LEO® ©LEO 05 2012 D ALL LEO TRADEMARKS BELONG TO THE LEO GROUP
LEO
Eichw
Tel 0
E-Ma
hairs growing normally penetrate the cutaneous
structures before their shaft crosses again the wall
outside the skin, a few centimeters from their point
of insertion, mimicking by this movement an intracutaneous tunnel.
Discussion: "Pili migrans" or migrating hair, also
known as creeping hair, is a thread-like eruption,
made of a naked hair shaft penetrating as a foreign
body into the epidermis. It has been described in
the Asian population who has dark and thick hair
with a sharp head, typically localized on the neck,
pubis and feet. It mimics the serpiginous parasitic
eruption known as cutaneous larva migrans, but
the diagnosis is easily made by removing the hair
visualized as a shadow through the epidermis. "Pili
incarnati" or ingrown hair is produced either from
a small shaved hair, or a long frizzy hair turning in
a U-shaped direction into the dermis. The continual
growth of this borrowing hair deeply into the dermis
results in a nodular lesion. In our case, the lesion was
made of a bouquet of multiple hairs attached to the
dermal papilla and kept on growing in a linear, horizontal way through the epidermis, making a tunnellike aspect. The strong and thick hair of our patient
follows the normal hair life cycle of growth without
migrating like in pili migrans, or ingrowing like in pili
incarnati. This phenomenon is probably due to the
characteristic of the shaft hair of our patient. To our
knowledge, this is the first description of such a lesion, and to differentiate it from the others, we have
named this entity "tunneling hair syndrome".
P79
Galli-galli disease mimicking more frequent skin
disorders
M. Theiler, J. Kamarashev, S. Goldinger, A. Cozzio
POSTERS
Galli-Galli disease is generally considered an acantholytic variant of Dowling-Degos disease. The disease is inherited in an autosomal dominant manner and probably due to mutations in the keratin 5
gene. The classical presentation consists of slowly
progressive, primarily flexural hyperpigmented reticulate lesions and erythematous papules. A more
widespread variant with pronounced involvement
of the trunk has been described though.
We present two patients with widespread erythematous and hyperpigmented skin lesions lacking flexural involvement, reminiscent of grover’s disease or
urticaria pigmentosa. However, histologic evaluation revealed digitiform elongation of the rete ridges and suprabasal focal acantholysis consistent with
Galli-Galli disease.
We therefore think that Galli-Galli disease should
be considered as a differential diagnosis even when
flexural accentuation is absent, especially in recalcitrant cases of dermatoses mimicking Grover’s disease or urticaria pigmentosa.
P80
Inhibition of hyalurosome in keratinocyte filopodia as a mechanism for corticosteroid-induced
epidermal atrophy
L. Barnes1, F. Ino1, P. Carraux1, JH. Saurat2, G. Kaya1
1
2
Swiss Center for Applied Human Toxicology, Geneva
Topical corticosteroids are largely used in dermatology as anti-inflammatory drugs. A main limitation
for their use is their atrophic effects on the skin.
The mechanism leading to skin atrophy is still not
well understood. We have previously proposed a
membrane organelle, hyalurosome, composed of
molecules involved in hyaluronate (HA) metabolism and cell signaling in the keratinocytes which is
functionally defective in dermatoporosis, a chronic
cutaneous insufficiency/fragility syndrome. In this
study we explored the molecular mechanisms of
the skin atrophy induced by corticosteroids in vitro
and in vivo. We observed an important skin atrophy
and a complete disappearance of hyaluronate (HA),
its main cell surface receptor CD44 and F-actin in
SKH1 hairless mouse skin treated with topical clobetasol propionate (CP), one of the most potent
pro-atrophic corticosteroids. Human keratinocytes
exposed to CP showed an impaired HA secretion
and diminished expression of CD44 an d HA synthase 3 (HAS3) as shown by quantitative PCR. In keratinocytes treated by CP, filopodial structures of the
keratinocytes were abolished together with a redistribution of CD44 and F-actin depolymerization. We
also showed that HA fragments of intermediary size
(HAFi) induced keratinocyte filopodia and protected
them against CP. Topical HAFi induced hyperplasia
in mouse epidermis and prevented the CP-induced
atrophy. Our results suggest that hyalurosome located in the filopodia of keratinocytes is the target
of corticosteroids for their atrophogenic effects.
These observations may lead to the development of
novel treatment and prevention strategies in corticosteroid-induced skin atrophy.
P81
CD44 is crucial for the migration of Lrig1-positive
epidermal stem cells in mouse skin
L. Barnes1, B. Darbellay1, JH. Saurat2, G. Kaya1
1
2
CD44, the main cell surface receptor of hyaluronate
(HA), is a transmembrane protein which contributes to cell motility through its interaction with the
F-actin cytoskeleton via its cytoplasmic domain.
We have previously shown that CD44 is one of the
essential components of hyalurosome located in
keratinocyte filopodia, a cell structure which plays
an important role in epidermal growth factor (EGF)
response. Hyalurosome is likely to be constituted of
CD44, HA synthase 3 (HAS3), EGF receptor (EGFR),
heparin-binding EGF (HB-EGF) and some other molecules (such as hyaluronidase) anchored to the ac-
62
P82
The importance of morphology in dermatopathology – from the histological picture to the dream
(of the diagnosis)
H. Beltraminelli
On this poster the importance of morphology in
dermatopathology is clearly shown. Particular attention is here given to the joy of morphology associated with it. During the perception of forms
spontaneous associations are triggered in our brain.
Where the layman perceives a meaningless round
shape, the expert sees a cystic hidradenoma. Where
the beginner just notice an inflammation, the specialist sees a particular inflammatory cell and therefore has (only) one diagnosis in mind.
Does it need a special talent for perception of
shapes in dermatopathology? Does everybody see
the same? Or does somebody see some parts of a
form better, and therefore understand the meaning of this object differently? The ability to see
needs many requirements: First of all the sense of
vision and enough light. In addition the observer
should recognize something, that means, he/she
should have once seen it before and then again (REcognize), one sees mainly what he/she knows. The
other way round, one should be open to visual surprises: to see also the unexpected and not only that,
what he/she wants to see. One should have an aptitude for art and aesthetics, which means that he/
she should want to see something. In particular, one
must be curious, he/she should want to discover
something, like a child: Children are often good observers, they are not yet marked what they should
see, they just perceive and enjoy. Take a look to the
poster and let the child play in you ... It is about the
art and the dream of/in the science.
P83
Regulation of plectin interaction with intermediate filaments by MAPK-dependent phosphorylation of its carboxy-tail
JE. Bouameur1, Y. Schneider2, P. Lingasamy1, K. Green3,
L. Fontao2, B. Favre1, L. Borradori1
1
3
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago
2
Background: Plectin is a cytolinker of the plakin family. It plays a crucial role in skin resilience by tethering keratins 5 and 14-intermediate filaments (IFs) to
hemidesmosomes. Plectin gene mutations result in
epidermolysis bullosa and/or muscular dystrophy.
The goal of this study was the identification of posttranslational modifications regulating the binding
of plectin to IFs.
Methodology: In silico analysis suggested that
Ser4642, located in the COOH-tail of plectin, could
be a regulatory phosphorylation site. Polyclonal antibodies were raised against the pS4642 phosphopeptide. Interaction of plectin-IF-binding domain
(IFBD) with IFs was assessed by yeast three hybrid
assays, biochemical, cell transfection and immunofluorescence studies. Pathways affecting the level of
pS4642 were identified by treating HeLa cells with
different stimuli and protein phosphatase or kinase
inhibitors.
Results: 1) Plectin-IFBD was phosphorylated on
S4642 in transformed yeas t cells. 2) The interaction
of plectin-IFBD with keratins in yeast was promoted
by replacing S4642 by an unphophorylatable glycine residue. 3) pS4642-plectin-IFBD proteins were
predominantly soluble in extracts from transfected
HeLa cells, in contrast to total recombinant proteins,
which were preferentially associated with the insoluble cytoskeletal fraction. 4) In several cell lines
endogenous plectin was phosphorylated on S4642
and pS4642-plectin was systematically less co-localized to IFs than total plectin. 5) Hemidesmosomes
of keratinocytes either in culture or at the basal
membrane in skin sections contained less pS4642plectin than in other areas. 6) Okadaic acid, EGF and
phorbol esters increased the level of pS4642-plectin
in treated HeLa cells while inhibitors of MAPK pathway prevented this increase.
Conclusion: We have demonstrated that the interaction between plectin and intermediate filaments
is modulated by the phosphorylation of plectin
COOH-tail. This process involves the EGF- and PKCstimulated MAPK pathway, which regulates skin development and homeostasis.
P84
Use of the antimicrobial peptide LL37 for immunotherapy of melanoma
O. Demaria1, M. Singh2, C. Conrad1, M. Gilliet1
MD Anderson Cancer Center, Houston
1
2
Melanoma is a highly aggressive form of skin canDermatologica Helvetica - Volume 24(6) - Juin 2012 POSTERS
tin cytoskeleton and participates in cellular signaling. Hyalurosome works as an autocrine loop, as the
HA secreted by HAS3 binds to CD44 and induces
filopodia. Lrig1 is a negative-feedback regulator of
EGFR and also a marker of an epidermal stem cell
reservoir located in the follicular isthmus.
In this study we explored the expression of HA, Factin and Lrig1, in SKH1 hairl ess CD44 knockout
(CD44KO) mice. These mice displayed a discreet cutaneous phenotype characterized by irregular hairs,
delayed hair growth and slow wound healing.
Our results show that in SKH1 hairless CD44KO mice
the Lrig-1 compartment and HA content are significantly smaller in the hair follicles when compared
to the wild-type mice which show a decreased presence of HA in the follicular and interfollicular zones
where Lrig1 is highly expressed. In addition, in newborn mice, the hair germ was also very small and
poorly positive for Lrig-1. Cells seemed to be unable
to migrate from hair germ downwards to form a hair
follicle and upwards in the interfollicular epidermis.
These observations suggest that Lrig1 might be an
inhibitor of hyalurosome and that CD44 is crucial for
the migration of epidermal stem cells from follicular
isthmus towards interfollicular epidermis or hair follicle in mouse skin.
63
cer. However, the fact that advanced-stage melanoma is relatively resistant to chemotherapy led
to the search of alternative treatment options, including immunotherapy. Melanoma is potentially
immunogenic. However, effective antitumor immune responses are rarely induced spontaneously,
due to the fact that the tumor microenvironment
lacks adequate innate immune activation stimuli
required to initiate strong anti-tumor T cell immunity. Plasmacytoid dendritic cells (pDCs) represent
a dendritic cell subset highly specialized in sensing
viral nucleic acids. During viral infection, pDCs accumulate in infected tissues and are activated to
produce large amounts of type 1 interferons (IFN)
via Toll-like receptors (TLR) 7 and 9. This event is
central to the initiation of protective T cell immunity through activation of myeloid dendritic cells
(mDCs) and the expansion of memory T cells. Our
goal is to mimic this pDC-driven anti-vi ral immune
response to achieve effective anti-tumor immune
T cell responses. Melanoma contain pDCs, which
however are not activated to produce type I IFNs.
We recently found that the anti-microbial peptide
LL37 can induce IFN production by pDCs by forming a complex with DNA released by dying cells and
allowing otherwise no-stimulatory DNA to enter endosomal compartments of pDC and activate TLR9.
Because tumors contain dying cells releasing large
amount of DNA and pDC, but do not express LL37,
we hypothesized that administration of exogenous
LL37 into tumors would lead to formation of LL37DNA complexes that are capable of activating TLR9
in pDCs, causing type I IFN production at the tumor
site and initiating strong and effective anti-tumor T
cell immune responses that may lead at tumor regression. Mice bearing established subcutaneous
B16-OVA melanoma tumors were therefore injected
intratumorally with LL-37. LL-37 was found to induce
IFN-? expression in treated tumors. Furthermor e LL37 induced expansion of OVA-antigen-specific CD8
T cells in draining lymph nodes and their infiltration
at the tumor site. This process was associated with a
delay in tumor growth. Together these findings suggest that intratumoral LL-37 can induce effective
anti-tumor immunity and provide a new promising
strategy for the treatment of advanced-stage melanoma.
polycystic kidneys and accelerated hair depigmentation.
Regulation of apoptosis in lymphocytes is important for development and homeostasis of the adaptive immune system. Calcineurin is a critical factor
in T cell activation but is also involved in the regulation of naïve T cell survival through a modulation of
Bcl-2 expression. Therefore, suppressing calcineurin
might potentiate the pro-apoptotic effect of small
molecule Bcl-2 inhibitors.
Results: We investigated the effect of a blockade of
the calcineurin/NFAT pathway on the pro-apoptotic
potency of ABT-737 in mice and showed that the
reduction in Bcl-2 expression in lymphocytes exposed to inhibitors of the calcineurin/nuclear factor
of activated T cells (NFAT) pathway correlated with
an increased sensitivity to the Bcl-2 inhibitor ABT737 in vitro. Moreover, the calcineurin inhibitor cyclosporine A potentiated the pro-apoptotic effect of
ABT-737 in vivo on one hand on lymphocytes, and
on the other hand on melanocytes: in combination
with cyclosporine A, ABT-737 partially reproduced
the phenotype of Bcl-2 deficient mice, characterized by a generalized fur depigmentation as a result
of melanocyte loss.
Discussion: Survival of melanocyte stem cells depends on Bcl-2. As a result, the physiological hair
graying is accelerated in Bcl-2 deficient mice. The i.p.
application of ABT-737 reproduced this phenotype
by inducing melanocyte depletion and hair depigmentation, dramatically increased in combination
with CsA. The fact that ABT-737 alone was sufficient
to induce hair graying at the site of injection, but that
a combination with CsA was required for a generalized depigmentation, suggests that CsA sensitized
the melanocytic cells to the effect of ABT-737 in a
similar way as we found in lymphocytes. This synergism may be relevant for the development of new
melanoma therapies, particularly in consideration
of previous studies showing an effect of ABT-737 on
melanoma cells. Moreover, the dysplastic alteration
of the hair follicle observed in the long term after
ABT-737 induced melanocyte depletion may represent an innovative model to investigate the role of
melanocyte stem cells in hair follicle biology.
P85
A promising LCM virus based vaccine vector:
mechanisms and efficacy against melanoma
Synergistic Bcl-2 inhibition by ABT-737 and cyclosporine A
L. Feldmeyer1, PE. Cippà2, J. Kamarashev3, S. Segerer4, J.
Chen2, AK. Kraus2, PD. Bardwell5, T. Fehr2
P O S T ER S
1
2
Institute of Physiology and Division of Nephrology, University Hospital Zürich
3
4
Division of Nephrology, University Hospital Zürich
5
Abbott Bioresearch Center, Worcester, USA, Worcester,
USA
Introduction: Bcl-2 (B-cell lymphoma 2) regulates
the mitochondrial apoptosis pathway, and has a
fundamental function in development and regulation of cell survival in different tissues. This is demonstrated by the phenotype of Bcl-2 deficient mice,
characterized by accelerated lymphoid apoptosis,
P86
L. Flatz, S.Olschlager, M. Gilliet
The incidence of malignant melanoma is increasing
at a faster rate than any other cancer and currently
accounts for 4% of all newly diagnosed cancers.
While early-stage lesions are curable with appropriate surgical resection, once melanoma metastasizes
to regional lymph nodes or distant sites, the prognosis is poor. Chemotherapy regimens have thus far
had little impact on overall survival of metastatic
melanoma patients; therefore much effort is being devoted to the search for alternative treatment
options, including immunotherapy. We assessed in
this context the suitability of a recently described
novel replication defective vaccine vector based on
the prototypic arenavirus lymphocytic choriomeningitis virus, which induces potent CD4 and CD8 T
64
P87
Cathelicidin is overexpressed in lesions of
hidradenitis suppurativa
H. Tu, C. Schlapbach, N. Yawalkar, R. Hunger
Hidradenitis suppurativa (HS, acne inversa) is a
chronic inflammatory disorder of apocrine glandbearing skin. The molecular mechanisms leading
to the chronic inflammatory lesions are only poorly
understood. In the current study we investigated
the expression of the antimicrobial peptide (AMP)
cathelicidin on mRNA and protein level in patients
with HS. Seven tissue samples obtained from patients with HS and five normal control skin were
involved in the study. We show that cathelicidin
expression is significantly increased in lesional HS
skin. Using immunofluorescence double staining
we could demonstrate that neutrophils and dendritic cells expressing cathelicidin are present in
the lesions. The high expression of AMPs in HS may
explain the low rate of infections in these chronic
inflamed skin areas. Furthermore, cathelicidins have
been shown to play a key role in wound regeneration through vascularization and in animal experiments it has recently been shown that cathelicidin
gene and / or recombinant protein therapy may be
used for healing of chronic wounds in ulcerative colitis. Theoretically, topical use of cathelicidin may also
be efficient in lesions of HS. Further investigations
are, however, needed to uncover the exact role of
cathelicidin in the inflammatory process in HS.
P88
Spontaneous AD-like symptoms in ft/ft mice appear early after birth
M. Kypriotou, C. Boéchat, M. Huber, D. Hohl
is affected in IV patients, and presence of acanthosis and hyperproliferation in ft/ft epidermis. This is
associated with increased IL1 and TSLP expression,
and Th2-polarization. Consequently, NFkappaB and
Stat pathways were activated, and IL6 mRNA levels were increased. Further, quantitative analysis of
late epidermal differentiation marker revealed high
Sprr2 synthesis. Our data suggest that proinflammatory cytokines are responsible for acanthosis in
ft/ft epider mis, and together with the Th2-derived
cytokines lead to tissue structural changes. We propose the ft/ft mouse model as a appropriate model
to study early AD-like symptoms.
P89
Store Operated Calcium Entry (SOCE)-dependent
Calcium signals control epidermal homeostasis
B. Darbellay1, L. Barnes1, J.H. Saurat2, G. Kaya1
1
2
Cytosolic Ca2+ signals are conducted by Ca2+ influxes from extracellular medium or Ca2+ releases
from the endoplasmic reticulum (ER). Ca2+ releases
depend on the refilling of Ca2+ stores of the ER by
the Ca2+ influx SOCE. Upon the depletion of ER Ca2+
stores, the ER Ca2+-sensor STIM1 opens the plasma
membrane Ca2+ channel Orai1 and activates SOCE
to refill Ca2+ stores.
In this study we investigated the role of SOCE in epidermal homeostasis in mouse and human skin.
We observed an increased human keratinocyte proliferation with SOCE activators, whereas SOCE inhibitors blocked keratinocyte proliferation in vitro. We
then analyzed SOCE during keratinocyte response
to heparin-binding epidermal growth factor (HBEGF). Keratinocyte stimulation with HB-EGF triggers cytosolic Ca2+ signals which depend on Ca2+
releases from the ER, while inhibition of Orai1 impedes HB-EGF-induced Ca2+ signals and prevents
the proliferative effect of HB-EGF. Further experiment s on SKH1 hairless mice showed that topical
application of SOCE modulators controlled the epidermal homeostasis. While Orai1 inhibitor BTP2 and
Orai1 silencing with siRNA decreased the epidermal
proliferation and thickness, SOCE activators CPA,
BHQ and TG showed a contrast effect. Orai1 expression was also decreased in the epidermis of patients
with dermatoporosis, a chronic cutaneous insufficiency/fragility syndrome characterized by extreme
skin atrophy.
Our results suggest that SOCE-dependent Ca2+ signals play an important role in epidermal homeostasis.
Loss-of-function mutations in human profilaggrin
gene have been identified as the cause of ichtyosis
vulgaris (IV), and as a major predisposition factor
for atopic dermatitis (AD). The flaky tail mouse has
been initially described as a model for IV, although
it also presents a predisposition to eczema. In this
study, we realized a characterization of 5-days old
ft/ft pups in order to analyse IV features and to
detect eventual early AD signs. Our data show absence of changes in stratum corneum layer, which
cell responses against a variety of model antigens.
Here we show that it can readily infect human peripheral blood mononuclear cells and thereby activates dendritic cells, which is demonstrated by an
upregulation of CD86. Furthermore, we demonstrate that human CD8 T cells are efficiently primed
in vitro. Heterologous and homologous vaccination
protocols enabled us to improve the induction of T
cells. Recombinantly engineered LCMV based vaccine vectors expressing different melanoma antigens could efficiently control further growth of B16
melanoma in a mouse model by therapeutic vaccination. These findings suggest a potential follow-up
in patients, i.e. a phase 1 clinical trial.
65
P90
Integrin α3 Mutations with Kidney, Lung and Skin
Disease
L. Weibel1, C. Has2, G. Spartà3, A. Moeller4, B. Dekel5, A.
Waters6, I. Hausser7, F. Hildebrandt8, L. Bruckner-Tuderman2, G. Laube3
1
POSTERS
Department of Dermatology, University Children’s Hospital Zürich
2
Department of Dermatology, University Freiburg Medical Center, Germany
3
Department of Nephrology, University Children’s Hospital Zürich
4
Department of Pneumology, University Children’s Hospital Zürich
5
The Paediatric Stem Cell Research Institute and Division
of Paediatric Nephrology, Sackler School of Medicine, Tel
Aviv University, Israel
6
UCL Institute of Child Health and Great Ormond Street
Hospital for Children NHS Trust, London
7
Department of Dermatology, University of Heidelberg ,
Germany
8
Department of Pediatrics, University of Michigan, Ann
Arbor, USA
Introduction: Integrin α3 is a transmembrane integrin receptor subunit mediating signals between
cells and their microenvironment. We identified 3
patients with skin fragility, congenital nephrotic syndrome and interstitial lung disease, with homozygous mutations in the Integrin α3 gene (ITGA3).
Methods, patients and results: Patient 1 was the index case presenting with congenital nephrotic syndrome, interstitial lung disease and increasing skin
fragility from the age of three months. Small blisters
and erosions appeared at areas of mechanical manipulations, healing slowly without scarring. There
was no mucosal involvement. The scalp hair, eyebrows and eyelashes were fine and sparse, the nails
dystrophic. Although the skin fragility was overall
mild, this feature provided the clue to the diagnosis. A homozygous mutation c.1173_1174del in
exon 8 of ITGA3 was confirmed, histologically leading to a loss of Integrin α3 in the kidney, skin and
lung and prof ound abnormalities of the basement
membrane in these clinically affected organs. Subsequently, 2 other children with similar clinical features and ITGA3 mutations were identified. From all
3 patients and their parents the genomic DNA was
extracted from peripheral-blood leukocytes and
the coding region and exon/intron boundaries of
the ITGA3 gene were analysed. Tissue samples were
studied with conventional light microscopy, transmission electron microscopy, immunohistochemistry and -fluorescence microscopy.
Patients 2 and 3 were homozygous for the ITGA3 mutations c.1538-1G>C, in intron 11, and c.1883G>C,
p.Arg628Pro in exon 14, respectively. The ITGA3
mutations in all patients were associated with a
complex phenotype consisting of congenital nephrotic syndrome accompanied with end stage renal
failure, during follow-up worsening epidermolysis
bullosa and severe interstitial lung disease leading
to increasing oxygen consumption. Although patients survived during the neonata l period, severe
multi-organ involvement led to a lethal course.
Conclusions: We identified 3 patients with homozygous mutations of ITGA3-gene associated with
disrupted basement membrane structures clini-
cally leading to nephrotic syndrome, epidermolysis
bullosa and pulmonary disease (NEP-syndrome).
These new mutations reflect the impact and indispensability of Integrin α3 concerning the organization of basement membrane and its clinical impact.
P91
Quantitative and spatial restriction of the proliferation regulator TRAIP in epithelial cells
D. Hohl, C. Chapard, M. Huber
Ubiquitination is a conserved post-translational
protein modification regulating the cellular fate of
proteins and involved in multiple biological functions such as proliferation, differentiation, apoptosis, or inflammation. Addition of ubiquitin moieties
to proteins is carried out by the sequential action of
3 enzymes: E1-activating enzyme, E2-conjugating
enzyme and E3 ubiquitin ligase. E3 protein-ubiquitin ligases determine the substrate specificity.
TRAIP is a RING-type E3 ligase containing a RING domain at its N-terminal end, followed by a coiled-coil
and a leucine-zipper region. TRAIP is conserved in
evolution and expressed in a large number of adult
tissues such as intestine, lung, brain, skin, testes,
thymus and spleen.
TRAIP is necessary for embryonic development
since mutations affecting the Drosophila homolog
of TRAIP are maternal effect-lethal mutants and
TRAIP knock-out mice die in utero due to aberrant
regulation of cell proliferation and apoptosis. Knockdown (KD) of TRAIP in human epidermal keratinocytes (HEK) represses cell proliferation and induces
a block in the G1 phase of the cell cycle, underlining
the tight link between TRAIP and cell proliferation.
To investigate the cellular localization of TRAIP, two
lentiviral vectors (LV) were constructed driving expression of TRAIP-GFP and GFP (Green Fluorescent
Protein) from a CMV promoter. Transduction of HeLa
cells or HEK with TRAIP-GFP or GFP LV followed by
immuno-fluorescence analysis demonstrated that
TRAIP-GFP is localized to the nucleolus. The analysis
of the expression levels of TRAIP-GFP and GFP in stably transduced HeLa cells and HEK revealed that the
TRAIP protein levels were significantly lower than
GFP prote in levels although the mRNA levels were
comparable.
66
DEXERYL
02/2012
vielseitig bei trockenen
Hautzuständen anwendbar:
Psoriasis geht unter die Haut –
auch.1,2
•wirktschnell,starkundlanganhaltend
auf Haut, Kopfhaut, Nägel und Gelenke1-5
•bewährtesSicherheitsprofilseitfast12Jahren6
mehr Lebensqualität für ihre Psoriasis-Patienten.7
* Kein Swissmedic approval für HUMIRA® in juveniler idiopathischer Arthritis.
Referenzen: 1. 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 Feb(2): 241-251. 2. Mease P. 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 May; 68 (5): 702-709. 3. Menter
A. et al. Adalimumab therapy for moderate to severe psoriasis: A randomized, controlled phase III trial. J Am Acad Dermatol 2008; 58:106-115. 4. Thaci D. et al. Adalimumab Treatment of Psoriatic Nail Disease in Moderate to Severe Psoriasis
Including Patients With Hand and/or Foot Psoriasis. Presented as Poster at the Fall Clinical Dermatology Conference, October 27–30, 2011, Las Vegas, Nevada. 5. Navarini A et al. Adalimumab Treatment for Moderate to Severe Psoriasis Substantially Improves PASI Scores As Analyzed by Body Region and Individual PASI Component: Sub-Analysis from the CHAMPION Study. Presented as Poster at the 6th International Congress of Psoriasis: from Gene to Clinic, London, England, 1–3
December 2011. 6. Burmester G. et al. Adalimumab: long-term safety in 23458 patients from global clinical trails in rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriasis arthritis, psoriasis and Crohn’s disease. Ann
Rheum Dis 2012 May 19. [Epub ahead of print]. doi: 10.1136/annrheumdis-2011-201244.* 7. Revicki D et al. Impact of adalimumab treatment on health-related quality of life and other patient-reported outcomes: results from a 16-week randomized
controlled trial in patients with moderate to servere plaque psoriasis. Br J Dermatol. 2008 Mar;158(3): 549-557.
Fachinformation HumiRa® (adalimumab): Z: Wirkstoff: Adalimumab. Fertigspritze oder vorgefüllter Injektor zur subkutanen Selbstinjektion (40 mg). i: Erwachsene Patienten mit aktiver mässiger bis stark ausgeprägter rheumatoider Arthritis, welche ungenügend auf krankheitsmodifizierende Antirheumatika (DMARDs) angesprochen haben, in Monotherapie oder in Kombination mit Methotrexat (MTX) bzw. anderen DMARDs, wobei Kombinationen mit Ciclosporin, Azathioprin
und anderen TNF-alpha-Therapien nicht untersucht worden sind; kürzlich diagnostizierte (< 3 Jahre) MTX-naïve Patienten mit mässiger bis stark ausgeprägter rheumatoider Arthritis, in Kombination mit MTX. Erwachsene Patienten mit Psoriasis-Arthritis, die ungenügend auf DMARDs angesprochen haben, in Monotherapie oder Kombination mit DMARDs. Erwachsene Patienten mit aktiver ankylosierender Spondylitis, die nur unzureichend auf herkömmliche Therapien angesprochen
haben. Erwachsene Patienten mit einem Morbus Crohn 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, chronischer Plaque Psoriasis in Monotherapie, bei denen eine systemische Therapie oder eine PUVA-Therapie angezeigt ist. D: Eine Injektion (40 mg) subkutan alle zwei Wochen. Im Fall einer Verminderung der Wirkung unter Monotherapie bei rheumatoider Arthritis kann eine Erhöhung der Dosierungsfrequenz auf 40 mg Adalimumab einmal wöchentlich von Vorteil sein. Morbus Crohn: 160 mg in
Woche 0, 80 mg in Woche 2 und danach jede zweite Woche 40 mg als subkutane Injektion. Psoriasis: 80 mg in der Woche 0, 40 mg in Woche 1 und danach jede zweite Woche 40 mg als subkutane Injektion. Ki: Überempfindlichkeit gegen
Inhaltsstoffe, aktive Tuberkulose, schwere Infektionen wie Sepsis oder opportunistische Infektionen, mittelschwere bis schwere Herzinsuffizienz (NYHA Kl. III-IV). Relative Ki: Aktive TB, aktive Infektionen, anaphylaktische/schwere allergische
Reaktion, gleichzeitige Gabe von Lebendvakzinen, leichte Herzinsuffizienz, neurologische Ereignisse wie demyelinisierende Erkrankungen. WH: Infektionen, einschliesslich opportunistische Infektionen, TB und Hepatitis B Reaktivierung, allergische Reaktionen, maligne Tumore, Immunsuppression, Impfungen, gleichzeitige Anwendung von TNF-alpha-Inhibitoren und Anakinra, gleichzeitige Anwendung von TNF-alpha-Inhibitoren und Abatacept, hämatologische Ereignisse, AutoAntikörper, Anwendung in der Geriatrie. interak.: keine bekannt/nicht untersucht. uaW: Reaktionen an der Injektionsstelle (Schmerz, Schwellung, Rötung, Pruritus), Infektionen des Respirationstraktes (unterer und oberer Respirationstrakt, Pneumonie, Sinusitis, Pharyngitis, Nasopharyngitis, virale Herpes Pneumonie), Mundinfektionen (Herpes
simplex, oraler Herpes), Genitaltraktinfektionen (vulvovaginale Pilzinfektionen), Haut- und Weichteilinfektionen (Paronychie, Impetigo, nekrotisierende Fasciitis, Panniculitis,
Herpes zoster), systemische Infektionen (Sepsis, Candidiasis), Harnwegsinfektionen (Pyelonephritis), Anämie, Leukopenie (Neutropenie, Agranulozytose), erhöhte Blutfettwerte, Benommenheit, Kopfschmerz, Parästhesien, Husten, Diarrhoe, Motilitätsstörungen, Abdominalschmerzen, Dyspepsie, Mundulzeration, oropharyngeale Schmerzen, Übelkeit, Erhöhung der Leberenzyme, Hautausschlag (schuppender Hautausschlag), Dermatitis (Ekzem), Pruritus, Urtikaria, Haarausfall, Arthritis, muskuloskelettale Schmerzen,
Brustschmerzen, Fieber, Müdigkeit (Asthenie, Unwohlsein), Grippe-ähnliche Symptome. P: Eine gebrauchsfertige Spritze oder ein vorgefüllter Injektor pro Packung. abgabekategorie B. Kassenzulässig, Kostengutsprache nötig. Ausführliche Informationen über Indikationen, Dosierung, Nebenwirkungen und Anwendungseinschränkungen
siehe Arzneimittelkompendium der Schweiz. Vertrieb: Abbott AG, Neuhofstrasse 23, 6341 Baar. Stand der informationen: November 2011. 20120616-PSC-HU-D

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