S1 Guideline onychomycosis

Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German‐Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence‐based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review

Candidose der Haut

Seebacher C, Abeck D, Brasch J, et al. Candidose der Haut. Journal der Deutschen Dermatologischen Gesellschaft (JDDG). 2006;4(7):591-596

Tinea der freien Haut

Seebacker C, Korting HC, Abeck D, et al. Tinea der freien Haut. Journal der Deutschen Dermatologischen Gesellschaft (JDDG). 2005;3(11):921-926

Onychomykose

Seebacher C, Brasch J, Abeck D, et al. Onychomycosis. Journal der Deutschen Dermatologischen Gesellschaft (JDDG). 2007;5(1):61-66.Dt. Version erschienen u.d.T.: Onychomykose ([https://doi.org/10.1111/j.1610-0387.2007.06134_supp.x]( https://doi.org/10.1111/j.1610-0387.2007.06134_supp.x)

Tinea of glabrous skin

Seebacher C, Korting HC, Abeck D, et al. Tinea of glabrous skin. Journal der Deutschen Dermatologischen Gesellschaft. 2010;8(7):549-554

Orale candidiasis

Reinel D, Plettenberg A, Seebacher C, et al. Orale Candidose. Journal der Deutschen Dermatologischen Gesellschaft. 2008;6(7):593-597

Tinea Capitis

Seebacher C, Abeck D, Brasch J, et al. Tinea Capitis. Journal der Deutschen Dermatologischen Gesellschaft (JDDG). 2006;4(12):1085-1091

S1 Guideline onychomycosis

Nenoff P, Reinel D, Mayser P, et al. S1-Leitlinie Onychomykose. Journal der Deutschen Dermatologischen Gesellschaft. 2023;21(6):678-694.Die Onychomykose ist eine Pilzinfektion des Nagelorgans und betrifft sowohl Finger- als auch Zehennägel. Sie wird in Europa vor allem durch Dermatophyten verursacht. Die Diagnostik erfolgt mittels direktmikroskopischer, kultureller und/oder molekularer Methoden aus Nagelmaterial (Nagelspäne). Eine Lokaltherapie mit antimykotischem Nagellack wird bei leichten oder mäßig ausgeprägten Nagelinfektionen empfohlen. Bei mittelschwerer und schwerer Onychomykose wird empfohlen – falls keine Kontraindikationen bestehen – stets oral (systemisch) zu behandeln. Eine antimykotische Kombinationstherapie – oral und topisch – sollte dabei angestrebt werden. Ziel dieser Aktualisierung der deutschen S1-Leitlinie ist es, Auswahl und Durchführung von geeigneter Diagnostik und Therapie zu vereinfachen. Die Leitlinie wurde unter Berücksichtigung aktueller internationaler Leitlinien und den Ergebnissen einer Literaturrecherche durch die Experten der Leitlinienkommission erstellt. Die Leitlinienkommission besteht aus Mandatsträgern der Deutschen Dermatologischen Gesellschaft (DDG), des Berufsverbandes der Deutschen Dermatologen (BVDD), der Deutschsprachigen Mykologischen Gesellschaft (DMykG), der Deutschen Gesellschaft für Hygiene und Mikrobiologie (DGHM), der Deutschen Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ), der Arbeitsgemeinschaft pädiatrische Dermatologie (APD) und der deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI). Methodisch wurde die Leitliniengruppe durch die Division of Evidence-based Medicine (dEBM) begleitet. Die Leitlinie wurde nach einem umfangreichen internen und externen Review durch die beteiligten Fachgesellschaften freigegeben

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline