Dermatologie Freiburg

Introduction: Several infectious diseases can present nail manifestations, which may be useful for diagnosis and prognosis, and only a few reports have been made regarding monkeypox (mpox). The objective of this study was to describe the clinical characteristics of nail alterations in patients living with HIV coinfected with mpox. Methods: A prospective, cross-sectional study included patients living with HIV/AIDS, coinfected with mpox. We examined all 20 nails in search of nail plate alterations. Patients were divided into two groups, with and without nail disease, and the CD4 count was noted according to the Centers for Disease Control and Prevention (CDC) classification. A χ2 or Fisher’s exact test for qualitative variables and Mann-Whitney U and Kruskal-Wallis tests with post hoc Bonferroni test for quantitative variables were used to compare them. Data were analyzed with the SPSS Statistics 25 software. Results: Sixty-nine patients were included. The frequency of nail involvement was 58%. Papulonodular lesions were the most frequent type identified, with 21 cases (30.4%). A significant difference was observed between patients with nail disease versus median CD4 count (160 vs. 700/mm3; p = 0.002) and median HIV viral load (45,000 vs. 900/mL; p = 0.009). When comparing the characteristics of the nail lesions with the CDC Classification System for HIV infection by the CD4 count, a significant difference was observed in foot involvement, splinter hemorrhages, papulo-nodular lesions, anonychia, onychomadesis, acute paronychia, and nail bed ulcer-atrophy (p < 0.05). Conclusions: The frequency of nail lesions is high in patients living with HIV coinfected with mpox. In addition, they tend to be more destructive in patients with lower CD4 counts and higher viral loads.

Carcinogenesis and tumor proliferation are characterized by a complex interaction of cancer cells with the tumor microenvironment. In particular, a tumor-promoting effect can be assumed for the stroma and its fibroblasts. An influence of the immune system on non small cell lung cancer (NSCLC) is now also suspected. In our study, we examined 309 sections of squamous cell carcinoma (SCC), a subtype of NSCLC. We determined the cell densities and areas of the different tissues in SCC using the software QuPath. Spearman rank correlation showed a significant positive correlation between the different tumor cell densities and stromal cell densities, and between tumor cell densities and immune cell densities. Overall survival curves by the Kaplan–Meier method revealed a prominent negative curve in cases of low immune cell density. Based on our results, we can assume a positive influence of the tumor microenvironment, especially the stromal cells, on tumor proliferation in SCC. We have also revealed that low density of immune cells is prognostically unfavorable.

This thesis focuses on the optimization of care of a very common form of skin cancer: superficial basal cell carcinoma (sBCC). There are several treatment options for this superficial growing skin cancer. In order to help patients make a personalized treatment decision, a patient decision aid was developed and tested. First, we noticed that all patients had a low level of decisional conflict. This was not significantly lowered by using the decision aid nor was knowledge on treatment options increased. However, patients using the decision aid were more satisfied with their treatment decision afterwards compared to a control group that did not use the decision aid. Furthermore, cost-effectiveness of treatment was evaluated by a systematic literature review. From the few studies that were available, we concluded that, surgical treatment provides value for money compared to alternative treatments for sBCC and that imiquimod cream (a cream that clears tumour by a local immunological reaction) provides value for money compared to other non-surgical treatments.

*Dept Dermatol Inselspital, Univ Bern, Bern, Switzerland; †Private Dermatol Practice Dermaticum, Freiburg, Germany The author has indicated no significant interest with commercial supporters.

HintergrundKunststoffe aus fossilen Rohstoffen (Plastik) werden in großer Menge hergestellt und gelangen bei unsachgemäßer Entsorgung und über weitere Eintragspfade in die Umwelt. Dies kann Auswirkungen auf Flora, Fauna und den Menschen zur Folge haben.Ziel der ArbeitDie vorliegende Arbeit soll Dermatolog*innen einen kompakten Überblick über diese komplexe Thematik und den Zusammenhang zur täglichen ärztlichen Tätigkeit bieten.Material und MethodenEs erfolgte eine selektive Literaturrecherche zu den Themen Mikroplastik und Nachhaltigkeit in der Dermatologie unter Einbezug des Sonderforschungsbereichs 1357 Mikroplastik der Universität Bayreuth.ErgebnissePrimäres und sekundäres Mikroplastik gelangt in großen Mengen in die Umwelt und akkumuliert in aquatischen und terrestrischen Ökosystemen. Dies kann zur Disruption selbiger führen und ökologische Nischen für humanpathogene Spezies schaffen. Menschen und Tiere nehmen Mikroplastik über die Atemwege und die Nahrung zu sich, die gesundheitlichen Folgen sind nicht ausreichend erforscht. Dies liegt v. a. darin begründet, dass Mikroplastik keine einheitliche Stoffgruppe ist und mögliche Effekte von vielen unterschiedlichen Eigenschaften der Partikel abhängen (z. B. Polymertyp, Größe, Form, Additivierung, Oberflächenladung). Die dermatologische Versorgung ist ressourcenintensiv und trägt auf unterschiedliche Weise zur geschilderten Gesamtproblematik bei.DiskussionKunststoffe sind aktuell in vielen Bereichen unverzichtbar. Nichtsdestoweniger haben Ärzt*innen die Verantwortung, negative Folgen für die Gesundheit der Bevölkerung abzuwenden (Vorsorgeprinzip). Es sind daher weitreichende Anstrengungen für mehr Nachhaltigkeit notwendig, dies schließt auch die ärztliche Routineversorgung mit ein.

Eine 81-jährige rüstige Dame wurde mit einer seit zwei Wochen bestehenden, rasch progredienten Schwellung des linken Beines zugewiesen. Ein Leidensdruck bestand zudem auch durch Schmerzen in der Leiste und im Hüftgelenk links.

We describe a sequential multistaining protocol for immunohistochemistry, immunofluorescence and CyTOF imaging for formalin-fixed, paraffin-embedded specimens (FFPE) in the formalin gas-phase (FOLGAS), enabling sequential multistaining, independent from the primary and secondary antibodies and retrieval. Histomorphologic details are preserved, and crossreactivity and loss of signal intensity are not detectable. Combined with a DAB-based hydrophobic masking of metal-labeled primary antibodies, FOLGAS allows the extended use of CyTOF imaging in FFPE sections.