Antimicrobial susceptibility testing of dermatophytes - Comparison of the agar macrodilution and broth microdilution tests

Fifty dermatophyte strains, recently obtained from clinical material, belonging to 4 different species were examined for their susceptibility to 5 systemic or topical antimycotic agents using both an agar macrodilution and a broth microdilution test. Antimycotics compared were griseofulvin, itraconazole, sertaconazole, terbinafine and ciclopiroxolamine. A comparison of the minimum inhibitory concentrations (MIC) clearly showed differences between the two test methods applied. For all 5 antimycotics, MIC data were three- to seventyfold lower in the microdilution test system. These differences, depending on the test method, have to be taken into account when comparing MIC data in the literature or when relating the in vitro data to the tissue concentrations determined in vivo

The role of androgens and estrogens in Hidradenitis Suppurativa – a Systematic Review

Hidradenitis suppurativa (HS) is an inflammatory skin disease. Several observations imply that sex hormones may play a role in its pathogenesis. HS is more common in women, and the disease severity appears to vary in intensity according to the menstrual cycle. In addition, parallels have been drawn between HS and acne vulgaris, suggesting that sex hormones may play a role in the condition. The role of androgens and estrogens in HS has therefore been explored in numerous observational and some interventional studies; however, the studies have often reported conflicting results. This systematic review includes 59 unique articles and aims to give an overview of the available research. Articles containing information on natural variation, severity changes during menstruation and pregnancy, as well as articles on serum levels of hormones in patients with HS and the therapeutic options of hormonal manipulation therapy have all been included and are presented in this systematic review. Our results show that patients with HS do not seem to have increased levels of sex hormones and that their hormone levels lie within the normal range. While decreasing levels of progesterone and estrogen seem to coincide with disease flares in premenopausal women, the association is speculative and requires experimental confirmation. Antiandrogen treatment could be a valuable approach in treating HS, however randomized control trials are lacking.</p

Self-inflicted skin lesions: A review of the terminology

The current literature on the management of self-inflicted skin lesions points to an overall paucity of treatments with a high level of evidence (randomized controlled trials, controlled trials, or meta-analyses). In order to improve the communication between dermatologists and mental health professionals, the European Society for Dermatology and Psychiatry (ESDaP) recently proposed a classification of psychodermatological terms in order to establish a coherent use of terms across the medical fields involved.We reviewed current and previous psychodermatological diagnoses in order to clarify how the previous plethora of terms is covered by the new classification.This may aid physicians and mental health professionals in understanding how the new classification relates to the prior plethora of psychodermatological diagnoses and thereby facilitate the future use of the new classification.</p

Hidradenitis suppurativa is associated with higher heart rate but not atrial fibrillation: A comparative cross-sectional study of 462 individuals with hidradenitis suppurativa in Denmark

Hidradenitis suppurativa (HS) is a chronic inflammatory dermatological disease with inflammatory mechanisms overlapping those of psoriasis, and both diseases have been associated with cardiovascular risk factors i.e. smoking and metabolic syndrome. Two studies have recently linked psoriasis with Atrial Fibrillation (AF). AF is the most frequently occurring cardiac arrhythmia in the general population and is typically accompanied by increased heart rate. Both AF and heart rate are linked with inflammation.The aim of the study was to investigate a potential association between HS and increased heart rate as well as AF.We performed a comparative cross-sectional study using digital measurements of heart rate and resting 12-lead electrocardiography (ECG) in combination with self-reported information when diagnosing AF.Our study comprised 32 individuals with HS from the hospital (the hospital HS group), 430 from the general population HS group (the population HS group), and 20,780 controls. Age and sex adjusted analysis demonstrated a significantly higher heart rate in the HS groups vs. controls (15% (range: 8-23%) higher for the hospital HS group and 4% (2-5%) higher for the population HS group). We found no association between HS and AF (P=0.1670). </p

In-vivo-Darstellung einer Sarcoptes-scabiei-Infestation mittels optischer Kohärenztomographie

&lt;b&gt;&lt;i&gt;Hintergrund: &lt;/i&gt;&lt;/b&gt;&lt;i&gt;Sarcoptes scabiei&lt;/i&gt; kann mit Hilfe verschiedener Darstellungsverfahren sichtbar gemacht werden. Mit der optischen Kohärenztomographie (OCT) lassen sich möglicherweise die bei Skabies-Infestation auftretenden Veränderungen der Hautmorphologie charakterisieren und der Parasit darstellen. &lt;b&gt;&lt;i&gt;Methoden:&lt;/i&gt;&lt;/b&gt; Fünf Patienten aus der Klinik für Dermatologie am Klinikum Augsburg und am Roskilde Hospital in Roskilde, Dänemark, wurden mit der optischen Kohärenztomographie (OCT; VivoSight®; Michelson Diagnostics Ltd., UK) untersucht. Der Nachweis der Milben erfolgte mittels Epilumineszenz; zur Bestätigung der Diagnose wurde eine lichtmikroskopische Untersuchung durchgeführt. &lt;b&gt;&lt;i&gt;Ergebnisse:&lt;/i&gt;&lt;/b&gt; Die OCT wies in vivo bei allen Patienten &lt;i&gt;S.-scabiei&lt;/i&gt;-Milben nach. Milben und Gänge wurden sichtbar gemacht und Einzelheiten des Ganginhalts dargestellt. &lt;b&gt;&lt;i&gt;Schlussfolgerung:&lt;/i&gt;&lt;/b&gt; Die OCT kann &lt;i&gt;S.-scabiei&lt;/i&gt;-Milben in vivo sichtbar machen, was dafür spricht, dass die OCT zur Untersuchung der Biologie der Milbe in vivo eingesetzt werden kann und eine frühzeitige Beurteilung einer gegen Krätzmilben wirkenden Therapie ermöglicht. Die OCT ist in der Lage, Strukturen in der Haut mit einer Auflösung von 8 µm darzustellen. Somit könnte dieses Verfahren eine rasche, nichtinvasive, In-vivo-Diagnose und -Untersuchung von Infestationen ermöglichen.</jats:p

The road to biologics in patients with hidradenitis suppurativa: a nationwide drug utilization study

Background: Prolonged systemic antibiotic treatment is often a part of management of hidradenitis suppurativa (HS). Although biologic therapies are now available, the patient's treatment journey leading to biologic therapy is unclear. Objectives: To examine treatment patterns and duration of systemic treatment use in patients with HS preceding biologic therapy. Methods: We identified all patients with HS receiving treatment with biologics in the Danish National Patient Registry from 2010 to 2018 and extracted their entire prescription history of specific systemic treatments from the Danish National Prescription Registry since its inception in 1995. The patients' treatment journeys are graphically displayed through Sankey diagrams and box plots generated to show temporal distributions. Descriptive patient characteristics were presented as frequencies with percentages for categorical variables and as means with SDs or medians with interquartile ranges (IQRs) for continuous variables. Results: A total of 225 patients with HS were included. Patients had most frequently been treated with penicillin (n = 214; 95·1%), dicloxacillin (n = 194; 86·2%), tetracycline (n = 145; 64·4%) and rifampicin/clindamycin (n = 111; 49·3%), as well as the retinoids isotretinoin and acitretin, and dapsone. Prior to biologic therapy, patients received a mean of 4·0 (SD 1·3) different systemic therapies, across a mean of 16·9 (SD 11·3) different treatment series. The mean time from first systemic therapy until biologic therapy was initiated was 15·3 (SD 5·1) years [8·2 (SD 5·9) years when excluding penicillin and dicloxacillin]. Conclusions: Patients with HS who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS. Delay in the initiation of biologic therapy may represent a missed opportunity to prevent disease progression. What is already known about this topic? The treatment journey leading to biologic therapy in patients with HS has not previously been investigated. What does this study add? Our data from 225 patients with HS illustrate that patients who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS

Physiology and pathology of eosinophils: Recent developments: Summary of the Focus Workshop Organized by DGAKI.

Over the last century, eosinophils have been regarded ambiguously either as 'friends' or 'foes'. Recent developments have greatly enhanced our understanding of the role and function of eosinophils in health and disease. Pathogenic eosinophilic inflammation can lead to severe diseases in various organs, such as the gastrointestinal tract, airways, heart and skin. In a 2-day focus workshop of the German Society for Allergology and Clinical Immunology (DGAKI), the state of the art was discussed and practical recommendations for diagnosis and treatment of eosinophilic diseases, with a particular focus on new biologics, such as anti-interleukin 5 and anti-interleukin 5R, were derived

Hidradenitis suppurativa is associated with higher heart rate but not atrial fibrillation: A comparative cross-sectional study of 462 individuals with hidradenitis suppurativa in Denmark

Hidradenitis suppurativa (HS) is a chronic inflammatory dermatological disease with inflammatory mechanisms overlapping those of psoriasis, and both diseases have been associated with cardiovascular risk factors i.e. smoking and metabolic syndrome. Two studies have recently linked psoriasis with Atrial Fibrillation (AF). AF is the most frequently occurring cardiac arrhythmia in the general population and is typically accompanied by increased heart rate. Both AF and heart rate are linked with inflammation.The aim of the study was to investigate a potential association between HS and increased heart rate as well as AF.We performed a comparative cross-sectional study using digital measurements of heart rate and resting 12-lead electrocardiography (ECG) in combination with self-reported information when diagnosing AF.Our study comprised 32 individuals with HS from the hospital (the hospital HS group), 430 from the general population HS group (the population HS group), and 20,780 controls. Age and sex adjusted analysis demonstrated a significantly higher heart rate in the HS groups vs. controls (15% (range: 8-23%) higher for the hospital HS group and 4% (2-5%) higher for the population HS group). We found no association between HS and AF (P=0.1670). </p

A position paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI

Background: For the preventive treatment of the 2019 coronavirus disease (COVID-19) an unprecedented global research effort studied the safety and efficacy of new vaccine platforms that have not been previously used in humans. Less than one year after the discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral sequence, these vaccines were approved for use in the European Union (EU) as well as in numerous other countries and mass vaccination efforts began. The so far in the EU approved mRNA vaccines BNT162b2 and mRNA-1273 are based on similar lipid-based nanoparticle carrier technologies; however, the lipid components differ. Severe allergic reactions and anaphylaxis after COVID-19 vaccination are very rare adverse events but have drawn attention due to potentially lethal outcomes and have triggered a high degree of uncertainty. Methods: Current knowledge on anaphylactic reactions to vaccines and specifically the new mRNA COVID-19 vaccines was compiled using a literature search in Medline, PubMed, as well as the national and international study and guideline registries, the Cochrane Library, and the Internet, with special reference to official websites of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), Robert Koch Institute (RKI), and Paul Ehrlich Institute (PEI). Results: Based on the international literature and previous experience, recommendations for prophylaxis, diagnosis and therapy of these allergic reactions are given by a panel of experts. Conclusion: Allergy testing is not necessary for the vast majority of allergic patients prior to COVID-19 vaccination with currently licensed vaccines. In case of allergic/anaphylactic reactions after vaccination, allergy workup is recommended, as it is for a small potential risk population prior to the first vaccination. Evaluation and approval of diagnostic tests should be done for this purpose

The road to biologics in patients with hidradenitis suppurativa - a nationwide drug utilization study

Background Prolonged systemic antibiotic treatment is often a part of management of hidradenitis suppurativa (HS). While biologic therapies are now available, the patient’s treatment journey leading to biologic therapy is unclear. Objectives To examine treatment patterns and duration of systemic treatment use in HS patients preceding biologic therapy. Methods We identified all HS patients receiving treatment with biologics in the Danish National Patient Registry from 2010 through 2018 and extracted their entire prescription history of specific systemic treatments from the Danish National Prescription Registry since its inception in 1995.The patients’ treatment journeys were graphically displayed through Sankey diagrams, and generated box-plots to show temporal distributions. Descriptive patient characteristics were presented as frequencies with percentages for categorical variables and as means with standard deviations (SDs) or medians with interquartile ranges (IQRs) for continuous variables. Results A total of 225 HS patients were included. Patients had most frequently been treated with penicillin (n=214; 95.1%), dicloxacillin (n=194; 86.2%), tetracycline (n=145; 64.4%) and rifampicin/clindamycin (n=111; 49.3%), as well as the retinoids isotretinoin and acitretin, and dapsone. Prior to biologic therapy, patients received a mean of 4.0 (SD 1.3) different systemic therapies, across a mean of 16.9 (SD 11.3) different treatment series. The mean time from first systemic therapy until biologic therapy was initiated was 15.3 (SD 5.1) years (8.2 [SD 5.9] years when excluding penicillin and dicloxacillin). Conclusion HS patients who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS. Delay in the initiation of biologic therapy may represent a missed opportunity to prevent disease progression