Dermatologica Helvetica

Transcription

D
ermatologica
Helvetica
90
90. Jahresversammlung der SGDV
90 e Réunion annuelle de la SSDV
4 - 6 September / Septembre 2008
LAUSANNE
Dieses Heft wurde für die Fortbildung der Schweizer
Dermatologen dank einer Hilfe der folgenden Firma
realisiert :
Ce numéro à été réalisé grâce à une aide pour la formation continue des dermatologues suisses de la firme :
6 / 2008
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INFO SPIRIGCH
WWWSPIRIGCH
Dermatologica
ANZEIGENREGIE / RÉGIE DES ANNONCES
Carine HERRERAS Tél : +41 79 667 32 48
Fax: +41 22 372 94 60
Helvetica
E-mail : derm.helv@bluewin.ch
RUBRIKEN DER DERMATOLOGICA HELVETICA
RUBRIQUES DE DERMATOLOGICA HELVETICA
Weiterbildung / Formation continue
Redaktionsbüro / Bureau éditorial
J.-H. Saurat
Hauptschriftleitung
Editeur en chef
Schriftleitung
Editeur en chef adjointe
M. Harms
S. Kuenzli
Schriftleitung Westschweiz
Editeur député pour la Suisse
romande
T. Hofer
Schriftleitung Deutschschweiz
Editeur député pour la Suisse
alémanique
C. Mainetti
F. Pelloni
Schriftleitungen Tessin
Editeurs députés pour le Tessin
e-mail : derm.helv@bluewin.ch
Journal-Klub / Journal-Club
Fokus / Focus
J.-H. Saurat Redaktionsbüro / Bureau éditorial
derm.helv@bluewin.ch
Klinische Fälle / Cas cliniques
Universitätskliniken und praktizierende Ärzte
Les cliniques universitaires et les praticiens
Fragen und Antworten / Questions et réponses
A.-A. Ramelet, Lausanne
aaramelet@hin.ch
Neues aus dem Fachgebiet / Nouvelles
professionnelles
Forum des Präsidenten der SGDV / Tribune du
Président de la SSDV
T. Hofer
thomas.hofer@sec.hin.ch
Neues aus der SGDV / Nouvelles de la SSDV
M. Pongratz
e-mail: sgdv-ssdv@hin.ch
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
Freies Forum / Tribune libre
Humorvolles und Launiges / Billet d’humour et d’humeur
J.P. Grillet
Neues aus der Industrie / Nouvelles de l’industrie
Druck / Impression
Atar Roto Presse SA, Vernier
ISSN : 1420-2360
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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
Neues aus der SGDV
Nouvelles de la SSDV
Provisorische Traktandenliste der 90. Generalversammlung der SGDV
Ordre du jour provisoire de la 90e Assemblée Générale de la SSDV
Lausanne - Palais de Beaulieu
Freitag, 5. September von 17.00 bis 18.45 Uhr – Vendredi 5 septembre de 17 h à 18 h 45
Provisorische Traktandenliste
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
4
Einführung durch den Präsidenten
Genehmigung der Traktandenliste
vom 5. September 2008
Wahl der Stimmenzähler
Genehmigung des Protokolls
der 89. Generalversammlung der SGDV 19. Oktober 2007
Jahresbericht des Präsidenten SGDV
Berichte der Präsidenten der ständigen
SGDV-Kommissionen
Berichte der Präsidenten der SGDV-Arbeitsgruppen
Bericht aus der FMCH
Preise/Unterstützungen:
9.1. Stiftung Spirig Pharma AG
9.2. Prof. U. W. Schnyder - Posterpreis
9.3. SGDV-Posterpreis
Mutationen SGDV
10.1. Mitglieder
– Neumitglieder
– Statusänderungen der Mitglieder der SGDV
im Jahr 2008
10.2. Ernennungen
– Ehrenmitglieder
– Korrespondierende Mitglieder
10.3. Wahlen
– Präsident elect
– Quästorin
Gründung neuer Arbeitsgruppen
11.1. Skincare
11.2. Organtransplantation
Medien SGDV (Dermatologica Helvetica –
Dermatology – www.derma.ch)
DermArena
Projekt e-learning der DDG
CIRS
Nationaler Hautkrebstag 2008
Planung 2009-2011
Weiter- und Fortbildung
17.1. Schwerpunkt Dermatopathologie
17.2. Logbook - Weiterbildungsprogramm
17.3. Weiterbildungsstätten Weiterbildungskonzepte
17.4. Fortbildungskontrolle 2005-2007
Bericht der Quästorin, Dr. Carmen Laetsch
18.1. Jahresrechnung per 31. Dezember 2007
18.2. Jahresrechnung per 31. Dezember 2007
der Stiftung der Gesellschaft zur Bekämpfung von
Geschlechtskrankheiten
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Bericht der Rechnungsrevisoren, Dr. Rolf INGOLD und
Dr. Martin Kägi
Genehmigung
20.1. der Jahresrechnung 2007
20.2. des Berichts der Rechnungsrevisoren
Entlastung des Vorstands für das Geschäftsjahr
2007-2008
Abstimmung über eine EADV-Mitgliedschaft
Festlegung des Mitgliederbeitrags 2009
23.1. ROKO
Budget 2009, Dr. Carmen Laetsch
Genehmigung Budget 2009
Genehmigung der Reglemente 2009 der SGDV
26.1. Mitgliederbeitragsreglement
26.2. Spesenreglement
26.3. Gebührenreglement
26.4. Beitrittsreglement
Agenda SGDV 2008-2009
27.1. SGDV Frühjahrskolloquium in Zürich
11.-12. Juni 2009
27.2. Jahresversammlung 2009 in Basel
3.-5. September 2009
Varia
Dr. Thomas Hofer
Präsident SGDV
Ordre du jour provisoire
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Introduction du Président
Adoption de l’ordre du jour du 5 septembre 2008
Désignation des scrutateurs
Adoption du procès-verbal de la 89ème Assemblée
Générale de la SSDV du 19 octobre 2007 à Berne
Rapport annuel du Président de la SSDV
Rapports des Présidents des commissions
permanentes
Rapports des Présidents des groupes de travail
Rapport de la FMCH
Prix/Bourses :
9.1. Fondation Spirig Pharma SA
9.2. Prof. U.W. Schnyder – Prix Poster
9.3. Prix Poster SSDV
Mutations SSDV
Neues aus der SGDV
11.
12.
13.
14.
15.
16.
17.
18.
10.1. Membres
– Nouveaux membres
– Mutations des membres de la SSDV en 2008
10.2. Nominations
– Membres d’honneur
– Membres correspondants
10.3. Elections
– Président élect
– Trésorière
Nouveaux groupes de travail
11.1. Skincare
11.2. Transplantation d’organes
Media SSDV (Dermatologica Helvetica – Dermatology –
www.derma.ch)
DermArena
Projet e-learning de la DDG
CIRS
Journée nationale du cancer de la peau 2008 planification 2009 - 2011
Formation postgraduée et continue
17.1. Formation approfondie Dermatopathologie
17.2. Logbook Programme de formation postgraduée
17.3. Etablissement de formation postgraduée –
concepts de la formation postgraduée
17.4. Contrôle de la formation continue 2005-2007
Rapport de la Trésorière, Dr. Carmen Laetsch
18.1. Comptes au 31 décembre 2007
18.2. Comptes au 31 décembre 2007 de la Stiftung der
Gesellschaft zur Bekämpfung von Geschlechts krank
heiten
Nouvelles de la SSDV
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Rapport des vérificateurs des comptes,
Dr. Rolf Ingold & Dr. Martin Kägi
Adoption
20.1. des comptes 2007
20.2. du rapport des vérificateurs des comptes
Décharge au Comité pour la gestion de la Société
de l’année 2007-2008
Affiliation à l’EADV - Votation
Fixation de la cotisation 2009
23.1. ROKO
Budget 2009, Dr. Carmen Laetsch
Adoption du Budget 2009
Adoption des réglements 2009 de la SSDV
26.1. Réglement des cotisations
26.2. Réglement des indémnités
26.3. Réglement des émoluments
26.4. Réglement d’admissions des nouveaux
membres
Agenda SSDV 2008 -2009
27.1. Colloque de printemps SSDV à Zürich du 11 au
12 juin 2009
27.2. Réunion annuelle 2009 à Bâle,
du 3 au 5 septembre 2009
Varia
Dr. Thomas Hofer
Président SSDV
Ankündigungen – Annonces
4. Internationaler Dermatoskopie-Kurs
der Schweizerischen Gesellschaft für Dermatologie und Venerologie (SGDV)
Donnerstag,/Jeudi 28. August 2008, 09.00 - 17.00 Uhr
Grosser Hörsaal NORD 1 D, Universitätsspital Zürich
Programm auf / Programme sur www.derma.ch
Berufspolitisches Seminar SGDV im Rahmen der Jahresversammlung der SGDV
Freitag, 5. September 2008 von 16.00 -16.30 Uhr
Séminaire de politique professionnelle de la SSDV lors de la réunion annuelle de la SSDV
Vendredi 5 septembre 2008 de 16h à16h30
Dr. Jacques de Haller
"La vision de la FMH pour l’avenir, et les réseaux de soins"
5
90e Réunion annuelle de la SSDV
Lausanne 4 - 6 September / Septembre 2008
Speziell danken möchten wir folgenden
Firmen für Ihre grosszügige Unterstützung
(Stand 15. Mai 2008)
Nous remercions spécialement les firmes suivantes de leur généreux support (jusqu’au
15 mai 2008)
Hauptsponsoren - Sponsors principaux
Abbott AG, Baar
Galderma AG, Cham
Sponsoren - Sponsors
Allergan AG, Pfäffikon
Banque Cantonale Vaudoise, Lausanne
Emil Frey SA, Crissier
Geistlich Pharma AG, Wolhusen
A. Menarini AG, Zurich
Merz Pharma (Schweiz) AG, Allschwil
Nikon Instruments AG, Egg b. Zürich
Organogenesis Switzerland GmbH, Zoug
Olympus Suisse SA, Le Mont-sur-Lausanne
Sources minérales Henniez SA, Henniez
Liste der Aussteller / Liste des exposants
Wir danken folgenden Firmen herzlich für ihr Interesse
und ihre Beteiligung
Nous remercions vivement pour leur participation et leur
intérêt les firmes suivantes
Abbott AG
Allergan AG
Allergomed / Allergopharma
AllergyCare AG
Association Ichtyose Suisse
Astellas Pharma
Bauerfeind AG
B. Braun Medical SA – OPM
Beiersdorf AG – Division Eucerin
Biocam GmbH
Biogen-Dompé AG
Marcel Blanc & Cie SA
Bluemedic S.à r.l.
Bristol-Myers Squibb SA
Clinique Cosmetics
6
Baar
Pfäffikon
Therwil
Kilchberg
Bargen
Wallisellen
Oberrohrdorf
Sempach
Volketswil
Regensburg (Allemagne)
Zoug
Le Mont-sur-Lausanne
Paudex
Baar
Zürich
Conrex Pharmaceuticals – Sesha
Cosmétique Active (Suisse) SA
Dermapharm AG
Erbe Swiss AG
Essex Chemie AG – Dpt Pharma / Remicade
Esthetic-Med GmbH
Pierre Fabre (Suisse) SA
Galderma AG
Ganzoni & Cie SA Sigvaris
Gebro Pharma AG
Martigny
Neuenhof
Hünenberg
Winterthur
Lucerne
Dübendorf
Allschwil
Cham
Saint-Gall
Liestal
Globopharm AG
Egg b. Zürich
Hermal Reckitt Benckiser Healthcare
Zoug
Huco Vision SA
Saint-Blaise
IBSA AG
Pambio-Noranco
Iromedica AG
Saint-Gall
Johnson & Johnson AG
Spreitenbach
KCI Medical GmbH
Nyon
Krebsliga Schweiz
Bern
Lasermed AG
Roggwil
Leo Pharmaceuticals Products Sarath Ltd
Regensdorf-Watt
Ligue suisse contre le cancer
Berne
Meda Pharma
Wangen-Brüttisellen
Medic Service AG
Tagelswangen
Merck (Schweiz) AG
Zoug
Merz Pharma (Schweiz) AG
Allschwil
Mölnlycke Health Care
Dietikon
Nikon Instruments AG
Egg b. Zurich
NMS-Bio-Medical
Praroman
Novartis Pharma Schweiz AG
Berne
Olympus Suisse SA
Le Mont-sur-Lausanne
Organogenesis Switzerland GmbH
Zoug
Permamed AG
Therwil
Qualicare AG
Bâle
Quantel Derma – Wavelight Aesthetic GmbH
Erlangen (Allemagne)
Salzmann Medico / Venosan
Saint-Gall
Sanofi Pasteur MSD AG
Baar
Schweizerische Psoriasis und Vitiligo Gesellschaft
Berne
Skinepil S.à r.l.
Prez-vers-Noréaz
Smith & Nephew AG
Soleure
Spirig Pharma AG
Egerkingen
Trimedal AG
Brüttisellen
Unilabs Management & Services SA
Genève
Laboratoires dermatologiques d’Uriage
Courbevoie (France)
Laboratoires Viollier AG
Bâle
Waldmann Lichttechnik Gmb
Küttingen
Louis Widmer SA
Schlieren
Wyeth Pharmaceuticals AG
Zoug
Carl Zeiss AG
Feldbach
Willkommen in Lausanne / Bienvenue à Lausanne
Liebe Kolleginnen und Kollegen,
Mesdames, Messieurs, chers Collègues,
Ein herzliches Willkommen zur 90. Jahresversammlung unserer Gesellschaft,
ein wichtiger Geburtstag. Wir haben deshalb an ein wichtiges Thema gedacht,
nämlich "Die klinisch-pathologische Korrelation in der Dermatologie". Es ist
nicht zufällig, dass wir dieses Thema ausgewählt haben, denn die Dermatopathologie ist integraler Bestandteil unseres Faches und Gegenstand langjähriger Verhandlungen. Wir möchten hiermit zeigen, dass eine klinische Evaluation
ohne histopathologische Untersuchung nicht möglich ist und umgekehrt, dass
eine ausgezeichnete Dermatopathologie von klinischen Faktoren und Informationen abhängig ist. Eben diese Interdependenz möchten wir aufzeigen.
Als Neuheit schlagen wir vor, dass nach jedem Hauptvortrag eine histopathologische Präsentation folgt, somit ergibt sich keine künstliche Trennung der
Dermatopathologie von der Klinik. Wir begrüssen ebenfalls unsere Kollegen
Pathologen, die sich unserem Kongress anschliessen.
Mit Freude haben wir auch festgestellt, dass fast alle Arbeitsgruppen SGDV
zu einem Workshop am Donnerstag nachmittag am Kongressort zusammenkommen.
Zum ersten Mal treffen wir uns nicht mehr im CHUV, sondern im Palais Beaulieu. Wir sind überzeugt, dass Sie und auch unsere Industriepartner die räumlichen Verhältnisse auf einem Stockwerk schätzen werden, auch betr. Workshops und Posteraustellung, sowie die gute Zugänglichkeit mit öffentlichen
und privaten Verkehrsmitteln.
Wir freuen uns, Sie zahlreich in Lausanne begrüssen zu dürfen und senden
Ihnen, liebe Kolleginnen und Kollegen, unsere besten Grüsse.
Nous vous souhaitons une cordiale bienvenue à la 90ème assemblée annuelle
de notre Société. C’est un anniversaire important et, pour le célébrer dignement, nous avons choisi comme sujet principal " La confrontation anatomoclinique en dermatologie ". Nous ne nous sommes pas arrêtés sur ce thème
par hasard, mais bien parce que la dermato-pathologie fait partie intégrante
de notre spécialité et s’impose comme sujet de discussion depuis quelques années. Nous aimerions démontrer qu’une évaluation clinique sans investigation
histo-pathologique n’est pas possible, et que l’excellence en dermato-pathologie dépend aussi de facteurs et d’informations cliniques. C’est cette interdépendance que nous aimerions souligner. Nous aimerions également introduire
une nouveauté : chaque conférence principale sera suivie d’une présentation
de cas histo-pathologique en vue d’éviter toute séparation artificielle entre la
dermato-pathologie et la clinique. Nous saluons aussi ici nos collègues pathologues qui participent à cette manifestation.
C’est avec plaisir que nous constatons que presque tous les groupes de travail
SSDV peuvent se réunir le jeudi après-midi au même endroit.
Finalement, pour la première fois, nous ne nous réunissons plus au CHUV,
mais au Palais de Beaulieu qui offre davantage d’espace aux exposants réunis
sur un étage, toute la place nécessaire pour les ateliers et l’exposition des
posters, mais aussi une bonne accessibilité tant avec les transports publics qu’en
voiture.
Nous nous réjouissons de vous rencontrer nombreux à Lausanne et vous
adressons, Mesdames, Messieurs, chers Collègues, nos meilleures salutations.
Renato G. Panizzon
Paul Bigliardi
Gisèle Maradan
Mitarbeiter/innen der Klinik
Renato G. Panizzon
Paul Bigliardi
Gisèle Maradan
Les collaboratrices et collaborateurs du service
Grusswort des Präsidenten der SGDV / Message de bienvenue du Président de la SSDV
Liebe Kolleginnen
Chères et chers collègues,
"Zeit ihres Bestehens sind Kenntnisse in Dermatopathologie integraler Bestandteil des dermatologischen Fachwissens… Situationsgegeben bietet
die Haut dem Facharzt für Dermatologie die Möglichkeit des Studiums von
klinischer und histologischer Pathologie in Personalunion… Die Schaffung
eines "Schwerpunktes Dermatopathologie" soll dazu dienen, dieses in der
Vergangenheit reichlich wissenschaftlich ausgeschöpfte Potential auch für die
Zukunft, zu Gunsten der Patienten, zu erhalten."
Dies ist ein Auszug aus der Präambel des "Schwerpunktes Dermatopathologie", dessen heute vorliegende Variante nach einigen Jahren harter Verhandlungen mit der Schweizerischen Gesellschaft für Pathologie am 13. März
von der KWFB ohne Gegenstimme akzeptiert worden ist. Es gilt nun noch die
Hürde der nächsten Aerztekammersitzung zu nehmen! Mit anderen Worten:
die Zeugung ist geglückt, die Eltern sind bereit, zu ihren kommenden, neuen
Verpflichtungen zu stehen, die Schwangerschaft verläuft zur Zeit komplikationslos und das Thema der diesjährigen Jahresversammlung bietet, von den
Organisatoren, denen unser aller Dank gilt, perfekt geplant, die passende Ambiente für die – so hoffen wir alle inbrünstig – Ankündigung der glücklichen
Geburt dieses Wunschkindes: Unserer SGDV zum 90-jährigen Jubiläum ein den
heutigen Bedürfnissen entsprechendes, qualitativ hochstehendes, strukturiertes WBP in "Dermatopathologie" zu übergeben, wäre doch ein wunderschönes Geschenk! Vorfreude ist erlaubt. Und sollte doch noch etwas dazwischen
kommen, so würde das auf keinen Fall die Vorfreude auf das uns erwartende
Fortbildungsprogramm schmälern. Der einzige, wohl nicht vermeidbare, heute
leider schon erkennbare Wermutstropfen in unserer Vorfreude entweicht dem
Umstand, dass Prof. Renato Panizzon uns wohl zum letzten Mal als Gastgeber
zu einer Jahresversammlung nach Lausanne einlädt. Doch ist nicht gerade dies
der "Motivationshype", in Scharen ins Palais Beaulieu zu pilgern?
Mit herzlichen Grüssen
" Depuis le début de l’existence de la dermatopathologie, les connaissances en
cette matière font partie intégrante du savoir spécifique d’un dermatologue...
Du fait des circonstances, la peau offre au médecin spécialiste en dermatologie la possibilité de l’étude de la pathologie clinique et histologique dans une
union du personnel... La création d’une " Formation approfondie dermatopathologie " doit servir à conserver, à l’avenir encore et pour le bien des patients,
ce potentiel très largement exploité précédemment au plan scientifique".
Ceci est un extrait du préambule de la " Formation approfondie dermatopathologie ", dont la variante à disposition aujourd’hui a été acceptée sans opposition par la CFPC en date du 13 mars, après quelques années de dures négociations avec la Société suisse de pathologie. Il s’agit maintenant de franchir
l’obstacle de la prochaine séance de la Chambre des médecins! Autrement dit:
l’enfant a été conçu, les parents sont prêts à faire face à leur prochaines obligations nouvelles, la grossesse se poursuit actuellement sans complications
alors que le thème de l’assemblée annuelle 2008 offre – et toute notre reconnaissance va en cela aux organisateurs qui ont prévu la chose à la perfection – le cadre idéal pour l’annonce, que nous espérons tous avec ferveur, de
l’heureuse naissance de cet enfant désiré: remettre à notre SSDV à l’occasion
de son 90e anniversaire un programme de formation postgraduée " dermatopathologie " répondant aux besoins actuels, de haute qualité et structuré
serait bien un superbe cadeau! Il vous est permis de vous réjouir. Et si quelque
chose devait encore venir faire office de contretemps, cela ne diminuerait en
aucun cas notre réjouissance face à ce programme de formation postgraduée
qui nous attend. Le seul petit bémol à notre joie, et ceci est certes inévitable
mais malheureusement perceptible aujourd’hui déjà, réside dans le fait que le
Prof. Renato Panizzon nous invite pour la dernière fois en qualité d’hôte à une
assemblée annuelle à Lausanne. Mais n’est-ce pas là précisément la " motivation hype " pour se déplacer en masse au Palais de Beaulieu?
Je vous adresse à toutes et à tous mes salutations cordiales,
Thomas Hofer
Präsident SGDV
Thomas Hofer
Président SSDV
7
Präsidenten der Schweizerischen Gesellschaft für
Dermatologie und Venereologie
Présidents de la Société Suisse de Dermatologie et
Vénéréologie
1913-1914
1914-1915
1915-1919
1919-1920
1920-1921
1921-1922
1922-1923
1923-1924
1924-1925
1925-1926
1926-1927
1927-1928
1928-1929
1929-1931
1931-1932
1932-1935
1935-1938
1938-1941
1941-1945
1945-1948
1948-1951
H. Oltramare, Genève
J. Jadassohn, Berne
H. Dind, Lausanne
B. Bloch, Zurich
F. Lewandowski, Bâle
H. Oltramare, Genève
G. B. Antonietti, Lugano
M. Winkler, Lucerne
B. Bloch, Zurich
O. Nägeli, Berne
E. Ramel, Lausanne
W. Lutz, Bâle
Ch. du Bois, Genève
R. Chable, Neuchâtel
H. Stauffer, Aarau
W. Lutz, Bâle
G. Miescher, Zurich
E. Ramel, Lausanne
W. Lutz, Bâle
A. Lassueur, Lausanne
P. Robert, Berne
1951-1954
1954-1955
1955-1957
1957-1960
1960-1963
1963-1966
1966-1969
1969-1972
1972-1975
1975-1978
1978-1981
1981-1984
1984-1987
1987-1990
1990-1993
1993-1996
1996-1999
1999-2002
2002-2005
2005-2007
2007-
W. Jadassohn, Genève
H. Fuchs, Bâle
H. Stauffer, Aarau
R. Paillard, Genève
W. Burckhardt, Zurich
E. Tenchio, Bellinzona
H. Kuske, Berne
F. Favre, Bienne
R. Schuppli, Bâle
P. Bigliardi, Ermatingen
J. Delacrétaz, Lausanne
R. Mazzi, Locarno
A. Krebs, Berne
A.A. Ramelet, Lausanne
T. Rufli, Bâle
H. Perroud, Fribourg
J.-P. Gabbud, Berne
R.G. Panizzon, Lausanne
F. Gueissaz, Neuchâtel
P. Itin, Bâle
T. Hofer, Wettingen
Kongresse der Schweizerischen Gesellschaft
für Dermatologie und Venereologie
Congrès de la Société Suisse de Dermatologie
et Vénéréologie
1913
1914
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1940
8
Genève
Berne
Lausanne
Zurich
Bâle
Genève
Lugano
Lucerne
Zurich
Berne
Lausanne
Bâle
Genève
Neuchâtel
Neuchâtel
Aarau
Bâle
Lausanne
Lucerne
Zurich
Berne
Genève
Bâle
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
Lucerne
Lausanne
Zurich
Berne
Montreux
Genève
Bâle
Lausanne
Zurich
Berne
Genève
Bâle
Lausanne
Zurich
Berne
Genève
Bâle
Lausanne
Zurich
Berne
Genève
Bâle
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
Lausanne
Zurich
Berne
Bâle
Genève
Lausanne
Zurich
Bâle
Genève
Berne
Lausanne
Zurich
Bâle
Genève
Berne
Lausanne
Zurich
Bâle
Genève
Berne
Lausanne
Zurich
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Bâle
Genève
Lausanne
Zurich
Bâle
Genève
Berne
Lausanne
Zurich
Bâle
Genève
Berne
Lausanne
Zurich
Bâle
Genève
Berne
Lausanne
Bâle
Zurich
Genève
Berne
Traiter les champs de cancérisation:
la nouvelle perspective thérapeutique
dans la kératose actinique
admis par les caisses
Aldara® 5% Crème (Imiquimod): immunomodulateur. Indications: traitement topique de l’adulte. 1. Condylomes acuminés externes dans la zone génitale et périanale. 2. Carcinomes basocellulaires superficiels
multiples (confirmés par biopsie; diamètre tumoral maximal 2 cm) au niveau du tronc (à l’exclusion de la région anale et génitale), au niveau du cou ou aux extrémités (à l’exclusion des mains et des pieds),
lorsqu’une excision chirurgicale n’est pas indiquée et que le suivi est garanti. 3. Kératoses actiniques, non hyperkératosiques, non hypertrophiques, cliniquement typiques, localisées sur le visage et la tête.
Posologie: appliquer respectivement avant le coucher. Condylomes acuminés externes: appliquer une couche mince 3 x/semaine (au maximum 16 semaines); la crème doit rester 6–10 h au contact de la
peau. Carcinome basocellulaire superficiel: pendant 6 semaines, 5 x/semaine; la crème doit rester 8 h au contact de la peau. Kératose actinique: pendant 16 semaines 3 x/semaine; la crème doit rester 8 h au
contact de la peau. Contre-indications: hypersensibilité au principe actif ou à un excipient. Traitement des enfants et adolescents. Précautions: Ulcères ouverts, plaies ouvertes, interventions chirurgicales:
uniquement après cicatrisation complète. Pas de pansement occlusif, contact des yeux avec la crème et effet du soleil sur la peau traitée. Possible aggravation des manifestations cutanées inflammatoires.
Prudence en cas de traitement du prépuce chez l’homme non circoncis. Déconseillé en cas de condylomes acuminés internes de la région génitale. Pendant grossesse et allaitement: uniquement en cas
de nécessité absolue. Recommandations concernant les rapports sexuels et la contraception en cas de condylomes acuminés, et autres mises en garde et précautions d’emploi selon les indications: voir le
Compendium. Effets indésirables: Très fréquent: réactions au site d’application (jusqu’à 40%). Fréquent: prurit, douleurs, brûlures au site d’application. Infections, céphalées, fatigue, myalgies. (EI 1%: voir
le Compendium). Interactions: Non étudiées. Interactions improbables avec les principes actifs administrés de façon systémique. Présentation: EO de 12 sachets à usage unique. (A). Admis par les caisses
maladie. Informations détaillées: notice d’emballage, Compendium suisse des médicaments ou MEDA Pharma GmbH, 8602 Wangen-Brüttisellen. Mise à jour de l’information: février 2006.
Donnerstag 4. September 2008 - Jeudi 4 septembre 2008
09.00 - 11.00
Erweiterter Vorstand SGDV / Comité SSDV élargi
11.00 - 13.00
Dermarena
12.00 - 14.00
Registrierung / Enregistrement
14.00 - 17.00
Workshops / Ateliers ( s. Detailprogramm / voir programme détaillé) :
Andrologie
Dermatochirurgie
Dermato-esthétique et corrective
Dermatopathologie
Dermatopädiatrie / Dermatopédiatrie
SCDRG – Allergologie
Transplantation
Trichologie
09.00 - 17.00
Pflegefachgruppe / Infirmières
Freitag 5. September 2008 - Vendredi 5 septembre 2008
07.30 - 09.00
Registrierung, Poster-Installation
Enregistrement, pose des posters
09.00 - 09.15
Eröffnung der Jahresversammlung
Ouverture de la Réunion annuelle
09.15 - 09.35
Dr M. Geiges :
"Die Tradition der klinisch-pathologischen Korrelation in der SGDV"
09.35 - 10.05
Key Lecture 1
Prof. Martin C. Mihm Jr.
"Clinical Pathological Spectrum of Interface Dermatitis"
10.05 - 10.15
Histologie: Fallpräsentationen / Présentation de cas d’histologie - Basel
10.15 - 10.35
Fallvorstellung / Présentation de cas - Aarau
10.35 - 11.00
Pause, Industrie-Ausstellung, Poster-Besuch
Pause, Visite de l’exposition de l’industrie et des posters
11.00 - 11.30
Key Lecture 2
Dr S. Fraitag
" Confrontation anatomo-clinique en dermatopédiatrie "
11.30 - 11.40
Histologie: Fallpräsentationen / Présentation de cas d’histologie - Lausanne
11.40 - 12.00
Fallvorstellung / Présentation de cas - Saint-Gall
10
12.00 - 12.30
Key Lecture 3
Dr R. Cerio
"Life Threatening Dermatoses"
12.30 - 12.40
Histologie: Fallpräsentationen / Présentation de cas d’histologie - Bern
12.40 - 13.50
Ausstellung
Lunch, Industrie
Lunch, visite de l’exposition de l’industrie et des posters
12.45 - 13.45
Company sponsored Meetings
13.50 - 14.00
Freie Mitteilung / Communication libre 1 - Genève
14.00 - 14.30
Key Lecture 4
Dr W. Kempf, PD
"Die Lymphome der Haut"
14.30 - 14.40
Histologie: Fallpräsentationen / Présentation de cas d’histologie - Zürich
14.40 - 14.50
Freie Mitteilung / Communication libre 2- Triemli
14.50 - 15.20
Key Lecture 5
Dr F. Rongioletti
" Les tumeurs cutanées non mélanomes "
15.20 - 15.30
Histologie: Fallpräsentationen / Présentation de cas d’histologie - Friedrichshafen/Viollier
15.30 - 16.00
Fallvorstellung / Présentation de cas - Bern
16.00 - 16.30
Guest Lecture – Standespolitik / Politique professionnelle
Dr J. de Haller « La vision de la FMH pour l’avenir et les réseaux de soins »
16.30 - 17.00
Pause, Industrie-Ausstellung, Poster-Besuch
Pause, visite de l’exposition de l’industrie et des posters
17.00 - 18.45
Generalversammlung SGDV / Assemblée générale de la SSDV
18.45 - 19.30
Apéritif (Palais de Beaulieu)
20.00
Gala-Diner / Dîner de gala (Hôtel Palace - Lausanne)
Samstag 6. September 2008 - Samedi 6 septembre 2008
08.00 - 08.30
Registrierung / Enregistrement
08.30 - 09.00
Fallvorstellung / Présentation de cas - Basel
09.00 - 09.30
Key Lecture 6
Prof. M. Dahl
"Recents developments in immunopathology of the skin"
09.30 - 09.40
Histologie: Fallpräsentationen / Présentation de cas d’histologie - Genève
09.40 - 09.50
Freie Mitteilung / Communication libre 3 - Bern
09.50 - 10.00
Freie Mitteilung / Communication libre 4 - Basel
10.00 - 10.30
Fallvorstellung / Présentation de cas - Zürich
11
10.30 - 11.00
Pause, Industrie-Ausstellung und Poster-Besuch
Pause, visite de l’exposition de l’industrie et des posters
11.00 - 11.30
Key Lecture 7
Prof. H. Kerl
"Die melanozytären Hauttumoren"
11.30 - 11.40
Histologie: Fallpräsentationen / Présentation de cas d’histologie - Prof. Büchner / Dr. Kempf PD
11.40 - 12.00
Fallvorstellung / Présentation de cas - Bellinzona
12.00 - 12.30
Key Lecture 8
Prof. H.-A. Lehr
"The pathologist’s view"
12.30 - 13.00
Lunch, Industrie-Ausstellung
Lunch, visite de l’exposition de l’industrie
13.00 - 14.00
Poster-Diskussion
Visite de l’exposition des posters avec discussion
14.00 - 14.30
Fallvorstellung / Présentation de cas - Genève
14.30 – 14.40
Freie Mitteilung / Communication libre 5 - Zürich
14.40 - 15.10
Fallvorstellung / Présentation de cas - Triemli
15.10 - 15.20
Freie Mitteilung / Communication libre 6 - Lausanne
15.20 - 15.50
Fallvorstellung / Présentation de cas - Lausanne
15.50 - 16.00
Verleihung der Poster-Preise / Remise des prix posters
16.00
Schluss der Jahresversammlung und Aperitif
Clôture de l’Assemblée annuelle et apéritif
Für mehr Lebensqualität
Metoject
®
Methotrexat Fertigspritzen
zur Selbstinjektion
bei Psoriasis
sicher
einfach
kassenzulässig
7.5 mg
10 mg
15 mg
20 mg
25 mg
Metoject (Methotrexat-Dinatrium):
I: Schwere, aktive rheumatoide Arthritis bei erwachsenen Patienten. D: individuell dosieren KI: Überempfindlichkeit gegenüber Methotrexat oder einem
der Hilfsstoffe, Leberinsuffizienz, Alkoholabusus, Niereninsuffizienz, Vorbestehende Blutdyskrasie, Schwere, akute oder chronische Infektionen, Ulzera
der Mundhöhle und bekannte Ulzera des Magen-Darm-Traktes, Schwangerschaft, Stillzeit. Gleichzeitige Impfung mit Lebendimpfstoffen. IA: Alkohol,
hepatotoxische, hämatotoxische Arzneimittel, Orale Antibiotika, Probenecid,
schwache organische Säuren, Pyrazole und nicht-steroidale Antiphlogistika,
Arzneimittel mit unerwünschten Wirkungen auf das Knochenmark, Arzneimittel die Folatmangel verursachen, Andere Antirheumatika, Sulfasalazin,
Protonenpumpeninhibitoren, Koffein- oder Theophyllin-haltige Getränke.
UW: Stomatitis, Dyspepsie, Übelkeit, Appetitlosigkeit, Anstieg der Transaminasen Leukozytopenie, Anämie, Thrombozytopenie, Kopfschmerzen, Müdigkeit, Benommenheit interstitielle Alveolitis/Pneumonitis, Ulcerationen
der Mundschleimhaut, Diarrhoe, Exantheme, Erytheme, Pruritus. Swissmedic Liste A. Ausführliche Angaben entnehmen Sie bitte dem Arzneimittelkompendium der Schweiz. Gebro Pharma AG, Liestal
®
DERMATOPATHOLOGIE
2nd ESDP / SGDP Joint Meeting
Coordinateur :
Dr Gürkan Kaya, PD
Slide viewing
Pause-café
Principles and
Character of Modern
Dermatopathology
(H. Kerl - Graz)
SGDP Meeting
DERMATO-CHIRURGIE
Coordinateur :
Prof. J. Hafner,
Dr D. Salomon, PD
Biologie des kutanen
SCC
(J. Hafner und
D.Salomon)
Anatomopathologie
und Grading des SCC
(P. Häusermann und
Mitarbeiter)
Hochrisiko-Tumore
und Risikoprofil
für Metastasierung
(D. Salomon und
Mitarbeiter)
Pause-café
Spezifische Formen
von spinozellulären
Karzinomen
(A. Skaria und
M. Adatto)
Sarkomatoides
Karzinom
(der Glazenregion)
C. Mainetti und
S. Läuchli)
Peniskarzinom (Service
d’Urologie, CHUV)
Ein Plädoyer für die
mikrographische
Chirurgie beim SCC
(M. Möhrle und
Mitarbeiter)
Apéritif
14.00
15.00
15.45
16.15
17.00
17.30
Apéritif
Welcome and
Introduction
(G. Kaya - Geneva)
Salle Turin A-B
Salle Lausanne
Apéritif
Pause-café
Andrologische
Fallbeispiele
(interaktiver Workshop)
Die Vielzahl der
andrologischen
diagnostischen Tests
ANDROLOGIE
Coordinateur :
Dr Christian Sigg
Salle Turin C
Salle Londres C-D
Die Behandlung des
alternden Gesichtes –
ein interaktiver Dialog
(B. Noël)
Pause-café
Einführung
(D. Fuchs)
Hyaluronsäure - Was ist
es und welches Produkt
wähle ich für was?
(C.Boudny)
Welchen Laser soll ich
mir kaufen?
(W. Thürlimann)
Das obere Gesichtsdrittel
– BotulinumtoxinInjektionspunkte
für Anfänger
(B. Schlagenhauff)
Das untere
Gesichtsdrittel – wie
behandelt man am
besten (n.n.)
Apéritif
Apéritif
Zukünftige
Zusammenfassung und
Entwicklungen
Take Home Message
(laufende Studien, neue
(U. Büttiker)
Medikationsregimes)
Databanken Organtransplantierte,
Klinische Fälle,
Medikamentennebenwirkung
Pause-café
Klinische Fälle
Hautkrebs
Progression von in
situ zu invasivem
spinozellulärem
Karzinom. Allelisches
Ungleichgewicht und
enzündliches Inflitrat
Organtransplantation
Klinische
Fälle – Infektion
Richtlinien /
Empfehlungen
Haut und Organtransplantation
TRANSPLANTATION
DERMATO-ESTHÉTIQUE
Coordinateur :
ET CORRECTIVE
Dr Günther Hofbauer PD
Coordinateur :
Dr Oliver Philip Kreyden
Salle Londres A-B
Apéritif
Case presentations :
L. Weibel, USZ
A. Cozzio, USZ
S. Christen, CHUV
M. Lurati et D. Hohl,
CHUV
Update on ESPS 2010
(S. Christen et
D. Hohl)
" What’s new " from
the ESPD 2008?
(J. Izakovic und M. Lacour)
" What’s new " from
the SPD 2008?
(D. Hohl)
Pause-café
DERMATOLOGIE
PÉDIATRIQUE
Coordinateur :
Prof. Daniel Hohl
Salle Turin F
Apéritif
Kasuistiken
Pause-café
Dynien
Differentialdiagnosen
Ekzeme im
Genitoanal-bereich :
Allergische Kontaktekzeme
Nichtallergische
Ekzeme
SCDRG - ALLERGOLOGIE
Coordinateurs :
Drs Dagmar Simon, PD,
et Rita Sigg
Salle Turin D
Apéritif
Pause-café
Cellules souches,
microenvironnement
et morphogénèse des
follicules pileux
(M. Brouard, Lausanne)
Behandlung der Alopecia
areata mit Methotrexat
(P. de Viragh, Lausanne
et Berne)
Dermatoskopie von
Haarkrankheiten
(R. Trüeb und I. Kolm,
Zürich)
La greffe de cheveux
sur homme et femme
(A. Friedli, Genève)
TRICHOLOGIE
Coordinateur :
Dr Pierre de Viragh et
Prof. Ralph Trüeb
Salle Turin E
90e Réunion Annuelle de la Société Suisse de Dermatologie et Vénéréologie
Lausanne, Palais de Beaulieu, 4 - 6 septembre 2008
ATELIERS PRATIQUES / WORKSHOPS – Jeudi 4 septembre 2008
Apéritif
Mme Rosaria de Lorenzo
Présidente de l’Association
Suisse de Dermatologie
Tél: 061 328 74 27
delorenzor@uhbs.ch
Information
Rôle spécifique
de l’infirmière en
dermatologie
(9 h-17 h)
Programm/e :
www.derma.ch
Pause-café
Mme Rosaria de Lorenzo
Präsidentin der
Schweizerischen
Pflegefachgruppe
Tel: 061 328 74 27
delorenzor@uhbs.ch
Information
Rôle spécifique
de l’infirmière en
dermatologie
(9 h-17 h)
Programm/e :
www.derma.ch
INFIRMIÈRES
Coordinatrice :
Mme Valérie Champier
Salle Turin C
Allgemeine Informationen
f
/ Informations générales
Präsident der SGDV / Président de la SSDV
Ortspräsident / Président local
Wissenschaftlicher Sekretär / Secrétaire scientifique
Dr Thomas Hofer
Prof. Renato G. Panizzon
Dr Paul Bigliardi, PD
Ort der Jahresversammlung / Lieu de réunion
Palais de Beaulieu, avenue des Bergières 10, 1000 Lausanne 22, www.beaulieu.org
Kongresskosten / Frais du congrès
Mitglieder SGDV, OA und Assistenten / Membres SSDV, CDC et assistants
Gratis / Gratuit
Mitglieder SGPath / Membres SSPath
CHF 120.–
Mitglieder SGPath (1 Tag) / Membres SSPath (1 jour)
CHF 50.–
Mitglieder SGPath (1/2 Tag) / Membres SSPath (1/2 jour)
CHF 25.–
Nichtmitglieder SGDV / Non-membres SSDV / SGPath
CHF 750.–
Nichtmitglieder (1 Tag) SGDV / Non-membres SSDV (1 jour) / SGPath
CHF 300.–
Nichtmitglieder SGDV (1/2 Tag) Non-membres SSDV (1/2 jour) / SGPath
CHF 150.–
Bitte überweisen Sie den obenstehenden Betrag bis zum 31. Juli 2008 auf folgendes Konto :
Merci de verser le montant ci-dessus d’ici au 31 juillet 2008 sur le compte :
« Colloque SSDV Dermatologie » no A.T 5006.20.98 (BCV - Case postale 300 - 1001 Lausanne - CCP n° 10-725-4
Clearing : 767 - BIC/SWIFT : BCVLCH2LXXX - IBAN : CH31 0076 7000 T500 6209 8).
Freie Mitteilungen / Communications libres
8 Minuten + 2 Minuten Diskussion / 8 min + 2 min discussion
Poster
Postergrösse / Format des posters
Höhe / Hauteur : 160 cm
Breite / Largeur : 120 cm
Vortragsvorbereitung / Conference Preview
Die Referenten sind gebeten sich mind. 60 Min. vor der Präsentation beim Kongress-Sekretariat zu melden. /
Les conférenciers s’annoncent au plus tard 60 minutes avant la présentation au secrétariat du congrès.
Unterkunft / Logement
Wird vom Teilnehmer übernommen / Doit être pris en charge par le participant.
Office du tourisme : + 021 / 613 73 73 – www.lausanne-tourisme.ch
Allgemeine Informationen / Informations générales
Madame Gisèle Maradan
Service de Dermatologie et Vénéréologie
1011 Lausanne – CHUV
Tél. : +41 79 607 99 35
Fax : +41 21 314 03 82
E-mail : Gisele.Maradan@chuv.ch
Tel. Kongress / Tél. Congrès : 0041 21 643.32.70
Fax Kongress / Fax Congrès : 0041 21 643 33.05
14
Anfahrtsplan / Plan d’accès
C on gr ès S SDV
Î
Zug / Train
Das Kongresszentrum Beaulieu erreichen Sie mit dem Bus in 10 Minuten ab Bahnhof SBB Lausanne.
Buslinie 3 : Bahnhof SBB – Beaulieu oder Bellevaux
Le centre de congrès de Beaulieu se trouve à 10 minutes de la gare CFF de Lausanne en empruntant le bus.
Ligne 3 : Gare CFF – Beaulieu ou Bellevaux
Vom Seeufer her / Si vous venez des bords du lac
Buslinie / Ligne 2 : Bellerive – Ouchy – Saint-François – Beaulieu - Désert
Tageskarten TL / Cartes journalières TL
Tageskarten für den Busbetrieb können zu CHF 7.60 (mit Halbtax zu CHF 5.70) bei Frau Maradan bis zum 31. Juli 2008 bestellt werden
bei : / Il y a possibilité de bénéficier de cartes journalières pour les bus TL au prix de CHF 7.60 (CHF 5.70 avec l’abonnement CFF demitarif). Ces cartes journalières peuvent être commandées d’ici au 31 juillet 2008 auprès de :
Madame G. Maradan (Tél. 079/607 99 35 – E-mail : Gisele.Maradan@chuv.ch) .
Auto / Voiture
Zufahrt von Autobahn / Accès voiture par autoroute :
Ausfahrt / Sortie : Lausanne – Blécherette
Parking
Das Kongresszentrum Beaulieu verfügt über 600 Parkplätze. 24 Stunden kosten CHF 18.–. Tageskarten können bis zum 31. Juli 2008
bestellt werden bei : / Le parking de Beaulieu dispose de 600 places. Le coût est de CHF 18.– par 24 heures. Des cartes journalières peuvent être commandées auprès de :
Madame G. Maradan (Tél. 079/607 99 35 – E-mail : Gisele.Maradan@chuv.ch) d’ici au 31 juillet 2008.
15
ANMELDEFORMULAR / BULLETIN D’INSCRIPTION
WORKSHOPS – ATELIERS PRATIQUES
Name, Vorname / Nom, prénom :. -------------------------------------------------------------------------------------------------------------------------------Adresse (Stempel / Timbre):
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Ich melde mich für folgenden Workshop an:
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2nd ESDP
(European Society of Dermatopathology)
SGDP
(Swiss Group of Dermatopathology)
Joint Meeting
04.09.2008 - 14.00 - 17.30
Palais de Beaulieu - Salle Turin A-B
LAUSANNE
Program
14.00 - 15.30
Slide viewing
15.30 - 16.00
Coffee break
16.00 - 16.05
PD Dr. G. Kaya (Switzerland):
Welcome and Introduction
16.05 - 16.35
Professor Helmut Kerl (Austria):
Principles and Character of Modern Dermatopathology
16.35 - 16.45
Discussion
16.45 - 17.30
SGDP meeting
Entrance free for congress members / CHF 30.– for non-members
SSDV
Swiss
Society of
Dermatology and
Venereology
c
WORKSHOP ADC/GDC
DC Dermatochirurgie
DC Dermato-Chirurgie
DC Dermatochirurgia
der Arbeitsgruppe für Dermatochirurgie
du groupe de travail de Dermatochirurgie
Präsident - Président : A.M. SKARIA
04.09.2008 - 13.30h - 16.30h
Palais de Beaulieu - Salle Lausanne
LAUSANNE
Thema – Thème
Spinozelluläres Karzinom (SCC) der Haut
Carcinome spinocellulaire (CSC) cutané
Organisation : Prof Dr J. Hafner, PD Dr D. Salomon
Chairmen : A. Skaria, M. Adatto
Programm - Programme
13.30 – 14.00
14.00 – 14.30
14.30 - 15.00
15.00 - 15.30
15.30 – 16.15
16.15
Anatomopathologie und Grading des SCC
Anatomopathologie et " Grading " des CSC
(P. Häusermann und Mitarbeiter)
Hochrisiko – Tumore und Risikoprofil für Metastasierung des SCC
Profil de risque des carcinomes spinocellulaires cutanés
(D. Salomon, A. Campanelli)
Pause
Sarkomatoides Karzinom (der Glatzenregion)
Carcinomes sarcomatoïdes
(C. Mainetti, S. Lauchli)
Ein Plädoyer für die mikrographische Chirurgie beim SCC
Un plaidoyer pour la chirurgie micrographique des CSC
(M. Möhrle und Mitarbeiter)
Ende der Veranstaltung, Apéritif
Fin de la session, apéritif
19
Freie Mitteilungen
Oral Presentations
Das Jahrhundert der klinisch-histopathologischen Korrelation in der Schweizer
Dermatologie
M.L. Geiges
Dermatologische Klinik, Universitätsspital Zürich
Als die Schweizerische Gesellschaft für Dermatologie und Syphilographie 1913 gegründet wurde, hatte sich die histopathologische Beurteilung
von Hautveränderungen als Hilfsmittel zur Beurteilung und Diagnostik von Hautkrankheiten bereits durchgesetzt. In der Dermatologischen Lehre gehörten histologische Zeichnungen genauso
zum Unterricht wie Moulagen. Streiflichter aus
dem 19. Jahrhundert, z.B. auf die Arbeiten von
Jacob Henle (nicht nur die Erstbeschreibung der
Demodexmilbe1847 im „Beobachter der östlichen Schweiz“) illustrieren die zunehmende
Einbindung der Dermatohistopathologie in die
dermatologische Systematik. Beispiele aus den
Versammlungen der SGDV im 20. Jahrhundert
zeigen, wie die Histopathologie selbstverständlich zum dermatologischen Denken gehörte.
Daran änderte auch der Wandel vom morphologischen über den funktionellen hin zum heute
immunbiologischen Zugang zu den Hautkrankheiten nichts. Die Gründung der International
Society of Dermatophathology 1979, also über
100 Jahre, nachdem die Histopathologie elementarer Bestandteil der Dermatologie geworden war, ist Ausdruck des immer breiteren und
tieferen Wissens, welche zur Spezialdisziplin
innerhalb der Dermatologie und Pathologie
geführt hat. Die Gründung von Gesellschaften,
Arbeitsgemeinschaften und Kommissionen, auch
innerhalb der SGDV, ist aber auch Ausdruck einer
völlig neuartigen politischen Diskussion, welche
die Notwenigkeit einer unmittelbar verflochtenen
mikroskopischen Analyse mit dem vitalen makroskopischen Befund am Patienten in Frage stellt.
Key lectures
KL1
Clinical Pathological Spectrum of Interface Dermatitis
M. C. Mihm Jr
Massachusetts General Hospital, Boston, USA
KL2
Clinical-pathological correlations in pediatric dermatology
S Fraitag-Spinner
Hôpital Necker-Enfants malades, Paris, France
Clinical-pathological correlations are crutial in
dermatology, particularly in pediatric dermatol20
Communications libres
ogy in which pitfalls are numerous. To illustrate
them we use a quiz-like presentation with various short examples of inflammatory diseases
cases, genodermatoses as well as tumoral cases
with many demonstrating features showing clinical and pathological findings.
KL 3
Life Threatning Dermatoses
R. Cerio
Royal London Hospital, London, UK
KL 4
Melanocytic proliferations
H. Kerl
Department of Dermatology, Medical University of Graz, Austria
In the field of melanocytic tumors specific diagnosis may be extraordinarily difficult in the
absence of an appreciation of clinical nuances.
By presenting the real patient or clinical digital
images of melanocytic lesions of the patient at
the same time as the histological evaluation of
the slide is performed, a maximum amount of
information can be obtained. This leads to an
enormous increase of the quality of diagnosis.
With this in mind, lessons from patients will be
presented.
KL 5
Rare non melanocytic skin tumors
F. Rongioletti
Section of Dermatology, DISEM, University of
Genova,Italy
The rare skin tumors are quite numerous and
include those neoplasms whose incidence is
less than 2 per 100.000. The low incidence of
these tumors and the difficulty to collect in only
one centre a sufficient number of cases to have
enough experience and results, makes difficult
both their clinical and histopathological recognition and their prognostic evaluation and treatment. This lecture will deal with two types of rare
non melanocytic skin tumors: rare skin tumors as
a markers of syndromes and rare skin malignant
tumors.
KL 6
Recents developments in immunopathology
of the skin
M.V. Dahl
College of Medicine, Mayo Clinic Arizona
Immunopathology utilizes fluorescein-labeled
antihuman antibodies to various substrates. In
direct immunofluorescence, these are used as
simple stains. In indirect immunofluorescence,
they are used to mark in site of in vitro antibody
fixation to normal substrates. Although the techniques are old and well-known, applications and
usefulness have changed. This lecture will emphasize new diseases and subtypes of diseases
and their immunopathology, new serologic tests
(often ELISA tests) and their correlations with
older immunofluorescence ones, new insights
into sites for biopsies, and uses of salt-split skin
to aid diagnosis by indirect immunofluorescence.
To keep the lecture interesting, I will also highlight new understandings of how these antibodies work to produce disease.
KL 7
Cutaneous lymphomas
W. Kempf
Dermatologische
Zürich
Klinik
Universitätsspital
Diagnosis of cutaneous lymphomas (CL) is challenging due to a significant overlap in clinical,
histological and immunphenotypic features of
cutaneous lymphomas. As a consequence, the
final diagnosis of CL should always be based on
a synthesis of clinical, histological, immunophenotypic and molecular features as well as the
results of staging examinations.
In early stages of mycosis fungoides (MF) and
in Sézary syndrome, histological findings may
be subtle and distinction from eczema or drug
eruption may be difficult. Thus, careful clinical
examination is crucial for the diagnostic process.
Pheno- and genotypic features such as loss of
T-cell antigens and detection of clonal T-cells
may be adjunctive diagnostic findings. Among
primary cutaneous CD30+ lymphoproliferative
disorders, lymphomatoid papulosis (LyP) exhibits a broad spectrum of histological manifestations and can be misinterpreted as a reactive
inflammatory process. On the other hand, several inflammatory and infectious skin disorders
can harbor CD30+ activated lymphocytes thus
simulating LyP. Clinical features are essential to
establish correct final diagnosis and to avoid inappropriate treatment.
The expression of certain proteins and/or presence of genetic alterations such as translocations
have diagnostic implications. Expression of bcl-2
in cutaneous follicular B-cell infiltrates often indicates secondary cutaneous involvement of a
nodal follicular lymphoma.
Correlation of phenotypic markers with prognosis has been demonstrated for some forms
of CTCL and CBCL. Among subcutaneous T-cell
lymphomas, expression of alpha/beta T-cell receptor (TCR) is linked to an indolent course with
favorable prognosis, whereas gamma/delta TCRpositive forms exhibit a poor prognosis. In CBCL,
loss or decreased expression of p16 in diffuse
large B-cell lymphoma of leg type represents a
marker of infavourable outcome.
The biology and prognosis of CL differ signifi-
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anti-âge
P
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cantly from those of nodal lymphomas with the
same cytomorphologic or phenotypic profile. This
has an important impact not only on classification, but in particular on the treatment of CL. In
early disease stages of the most common CTCL,
mycosis fungoides (MF), treatment results in
transient response, but does usually not induce
long-standing remission. It is still a matter of debate which therapy is adequate in early stages of
MF and if intense and aggressive therapy in early
disease stage is able to prevent disease progression. For more advanced stages, various strategies are employed including interferon-alpha,
retinoids such as bexarotene, chemotherapy, denileukin diftitox, alemtuzumab (anti-CD52), and
experimental approaches such as adenovirus-IFNgamma-vectors. For MF and Sézary syndrome,
evidence-based guidelines for treatment have
recently been published by the EORTC Task Force
Cutaneous Lymphomas.
KL 8
The pathologist’s view
H.-A. Lehr
Insitut für Pathologie, Johannes GutenbergUniversität, Mainz, DE
Free Communications
FC 1
Ebselen is a depigmenting agent that inhibits melanin synthesis, melanosomal
transfer, and alters melanosome dispersion in keratinocytes
B. Kasraee, P. Carraux, L. Fontao, O.
Sorg, JH Saurat
Clinique de Dermatologie, Hôpital Cantonal
Universitaire de Genève
We introduce the glutathione peroxidase mimic
ebselen as a novel skin-depigmenting agent with
three different mechanisms of action. Ebselen in
non-cytotoxic concentrations (50 µM) inhibited
melanin synthesis in cultured B16 melanocytes.
In three-dimensional epidermal reconstructs
(Melanoderm™), a 0.5% ebselen topical formula decreased the amount of melanin to 50%
of that of control after two weeks of treatment
with no cytotoxicity against melanocytes or keratinocytes. In vivo, ebselen (0.5%) produced skin
depigmentation after 12 days of topical application on black guinea pig skin and significantly
reduced the amount of epidermal melanin without altering the number of DOPA-positive melanocytes. Histochemical, immunohistochemical
and quantitative analyses through electron microscope studies performed on melanocyte-keratinocyte co-cultures, as well as black guinea pig
skin, confirmed that, independently of its melanogenesis inhibiting property, ebselen significantly reduced the rate of melanosomal transfer
22
from melanocytes to neighbouring keratinocytes.
Finally, ebselen inhibited melanosomal dispersion in keratinocytes and caused the eventually
transferred melanosomes to cluster and to form
melanosomal aggregates in the keratinocyte cytoplasm in vivo. Melanosomal re-distribution is
a well-known mechanism for tegument colour
changes in low vertebrates, and the glutathione
peroxidase mimic ebselen appears to be the first
molecule capable modulating this process in
mammalian skin.
FC 2
Martorell’s hypertensive ischemic leg ulcer must not be confounded with pyoderma gangrenosum
J. Hafner, S. Nobbe, H. Partsch, S.
Läuchli, D. Mayer, B. Amann-Vesti, R.
Speich, L.H.G. Burg, L. E. French
Dermatologische Klinik, Universitätsspital
Zürich
Introduction : Martorell’s hypertensive ischemic
leg ulcer (HYTILU) has become one of the leading
causes of leg ulcers at the Department of Dermatology, University Hospital of Zurich. Despite its
frequency, the majority of patients are initially
misdiagnosed as pyoderma gangrenosum (PG).
Treatment strategy of HYTILU and PG are completely different.
Objective : To outline the characteristics of HYTILU and the therapeutic consequeces.
Methods : A consecutive series of 31 patients
with HYTILU were subjected to a thorough retrospective analysis. Clinical features, suspected
diagnosis at initial presentation, cardiovascular
risk factors, vascular examination, histology,
revised diagnosis after completed assessment,
specific surgical management and outcome were
analyzed after a standardized protocol. Results
31/31 Patients presented with one or multiple
painful necrotic skin ulcers at the laterodorsal
leg, bilateral in 16/31 instances (52%). 16/31
(52%) were referred under the suspicion of PG
and 12/31 (39%) were under systemic immunosuppression. All patients had arterial hypertension (100%) and 18/31 (58%) diabetes. All
patients showed a histology of subcutaneous
stenotic arteriolosclerosis, in 22/31 (71%) with
medial calcification. Peripheral arterial disease
was diagnosed and confirmed by angiography in
14/31 (45%). After establishing the diagnosis of
Martorell’s HYTILU, 29/31 (94%) underwent debridement and split skin grafting, in 12/31 (39%)
at repeated occasions. Only 2/31 (6%) healed by
conservative means. Three (9%) patients died
from sepsis, two of them under immunosuppression for supposed pyoderma gangrenosum.
Conclusions : Martorell’s HYTILU is a clearly
defined entity that can easily be overlooked and
confounded with pyoderma gangrenosum. Diagnosis involves clinical and vascular assessment,
and a large and deep biopsy from the wound
border. Treatment is based on surgical measures,
specifically debridement, vacuum-assisted negative pressure wound treatment, and split skin
grafts, often at repeated occasions. Antibiotic
treatment is often necessary. Immunosuppression is not warranted and may expose patients
to the risk of sepsis.
FC 3
Partial reconstitution and subclinical remodeling of cutaneous microvessels in
long term survivors after allogeneic bone
marrow transplantation
P. Haeusermann, E. Kump, A. Rovó, A.
Tichelli, P. Itin, A. Gratwohl, B.C. Biedermann
Klinik für Dermatologie, Universitätsspital Basel
Graft-versus-Host Disease (GVHD) is one of the
major complications after allogeneic hematopoietic stem cell transplantation (aHSCT) and skin
is one of the key target organs involved in its
acute and chronic form. Immune mediated vessel attack and subsequent microvessel loss in
skin has been observed in patients with chronic
GVHD after aHSCT and endothelial derived von
Willebrand factor (vWF) has been shown a useful biomarker for chronic GVHD. In this study,
we wished to test whether long-term survivors
of aHSCT without clinical and histological characteristics of cutaneous GVHD show signs of
persistent vascular remodeling. Skin biopsies
of a cohort of 32 recipients of allogeneic bone
marrow transplants without any clinical signs
of cutaneous GVHD (including 5 of those who
were currently classified as having chronic GVHD
other than skin involvement) were obtained on
average 17 years (range 11-26) after aHSCT.
Microvessels in skin were histomorphometrically
assessed and quantified by two different, independent methods. We found no significant difference in average microvessel density and size distribution of microvessels in long term survivors
compared to healthy controls. Moreover, neither
past experience of acute or chronic GVHD nor
current status of chronic GVHD had an impact
on both parameters. In contrast, patients with
chronic cutaneous GVHD of sclerotic type and
patients with lichen sclerosus have microvessel
loss in the superficial microvascular plexus of the
skin. In conclusion, the complex therapy of aHSCT including procedures such as chemotherapy,
pretransplant conditioning, total body irradiation
and posttransplant experience of GVHD had no
sustained effect on the microvascular architecture of long term survivors after aHSCT without
clinical and histological evidence of cutaneous
GVHD. Our histomorphometrical investigations
do not give evidence, or, are not appropriate to
suggest that subclinical GVHD is present in skin,
even in those patients who experience current
GVHD without skin involvement. Microvascular
remodeling as observed during chronic GVHD is
caused by ongoing immune mediated injury and
Freie Mitteilungen
recovers completely after resolution of chronic
cutaneous GVHD.
FC 4
Interaktive Wundstimulation mit Wachstumsarretierten menschlichen Keratinozyten und Fibroblasten in einer Fibrinmatrix:
Allox, ein allogenes Tissue EngineeringProdukt der zweiten Generation zur Behandlung chronischer Hautwunden
R. Goedkoop, E. Rolland, T. Hunziker
Universitätsklinik für Dermatologie, Inselspital
Bern
Allox, ein allogenes Tissue Engineering-Produkt
einer neuen Generation bestehend aus wachstumsarretierten menschlichen Keratinozyten und
Fibroblasten und appliziert in einer Fibrinmatrix
mittels Spray, zeigte in einer multizentrischen,
randomisierten, doppelblinden, placebokontrollierten Phase-II-Studie bei therapierefraktären
chronischen venösen Beinulzera eine Zunahme
der Wirkung in Abhängigkeit von Zellzahl und
-ratio, welche mit Versuchen zur Zytokinfreisetzung in vitro korrelierte. Die praeklinische und
klinische Testung dieses neuartigen Produkts belegt, dass im Tissue Engineering mit allogenen,
nicht proliferativen Zellen Dosisfindungs-Studien
sowie eine langfristige Kryokonservierung möglich sind. Das Aufsprayen erlaubt eine einfache,
berührungsfreie Applikation.
In a multicenter, randomized, double-blind, placebo controlled phase II study in recalcitrant
chronic venous leg ulcers Allox, a new generation allogeneic tissue engineering product consisting of growth-arrested, human keratinocytes
and fibroblasts delivered in a fibrin matrix by a
spray device, showed increasing efficacy that
correlated with cell number and ratio dependent
in vitro data on cytokine release. The development of this novel product illustrates that using
allogeneic, non-proliferative cells brings additional benefit compared to other tissue engineering products by allowing preclinical and clinical
dose-finding studies as well as long-term storage in a frozen state. Spray application results in
an easy, non-touch use.
FC 5
Juvenile dermatomyositis: nailfold capillaroscopy changes, baseline predictors and
disease course over 36 months
S. Christen-Zaech, R. Seshadri, J. Sundberg, A.S. Paller, L. M. Pachman
Service de Dermatologie et Vénéréologie,
CHUV
Methods : Duration of untreated disease, NFC,
Disease activity scores (DAS), Tumor necrosis factor-α-308 allele, DQA1*0501, and disease
course were analysed in 61 initially untreated
children with JDM over 36 months. Regression
analysis modelled the variation within and between each patient.
Results : At diagnosis, shorter duration of untreated disease (p=0.05) and a lower DAS skin
(p=0.035) were associated with a unicyclic
disease course. Over 36 months, end-row loop
(ERL) regeneration was associated with lower
DAS skin (p<0.001) but not DAS muscle (p=0.9);
ERL regeneration (p=0.04) and decreased bushy
loops (BL) (p=0.04) were associated with a
shorter duration of untreated disease. At 36
months, increased ERL regeneration (p=0.007)
and improvement of DAS skin (p<0.001) and
DAS muscle (p=0.025) were associated with a
unicyclic disease course
Conclusion : Early treatment of JDM may lead
to a unicyclic disease course in 40% of cases.
The non-unicyclic disease course is usually a
reflection of continuing skin involvement with
persistent NFC changes. More attention needs to
be given to the optimal treatment of cutaneous
findings in JDM.
Objectives: To determine in children with juvenile dermatomyositis (JDM), the association of
nailfold capillaroscopy (NFC) changes with clinical findings and genotype in order to identify differences in disease course.
Ihr Beratungsgespräch beginnt im Wartezimmer.
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Posters
Malignant and benign tumours
P1
Primary Cutaneous follicular B-cell Lymphoma
Y. Lechleitner, S. Christen-Zaech, R.G.
Panizzon, D. Hohl
Service de Dermatologie et Vénéréologie, CHUV
Cutaneous B-cell lymphomas are a distinct and very
important group of extranodal lymphomas. They
represent 22.5 % of all lymphomas arising within
the skin. We present a 37-year-old Caucasian man
with a several months history of two asymptomatic,
firm, nodules, which developed on the parieto-occipital scalp, and on the scar of a previously removed
intradermal naevus of the chest. Histopathologic
and immunohistolchemical analyses were positive
for CD20, CD10 and Bcl6, and negative for Bcl2,
and partly positive for MIB-1. No CD43 coexpression from B-cells was found. B monoclonality PCR
research was positive on frozen skin material.There
was no particular translocation t(14;18) Bcl2-JH
at bone marrow analyses. These facts allowed to
establish the diagnosis of a primary cutaneous follicular B-cell lymphoma. An extracutaneous involvement was excluded by computer tomography scan.
Both cutaneous nodules were excised with security margins. However, subsequently a new nodule
developed within 6 months on the parietal scalp.
Renewed histoimmunochemical analysis confirmed
the same diagnosis. A treatment with intralesional
a-2a Interferon was initiated, leading to a current
remission.
P2
Cutaneous T-cell lymphoma: Significance of
the size of a dominant T-cell clone detected
by PCR
B. Niklaus, J. Benhattar, N. Kunzle, F.
Burri, C. Bricod, W. Kempf, R.G. Panizzon
Patients with cutaneous T-cell lymphoma (CTCL)
present clonal T-cell receptor gamma (TCR-y) gene
rearrangements detectable by polymerase chain
reaction (PCR). We focused on the correlation of
the estimated abundance of various T-cell clones at
initial diagnosis and in the sequel of time with the
development of CTCL. Forty-one patients were followed retrospectively over a mean period of 31.6
months (1-71 months), and investigated for clinical
, histopathologic, immunophenotypic, and molecular genetic features. The only entering criterion was
detection of a dominant T-cell clone by PCR on fresh
frozen tissue. Among these 41 patients, 33 (80%)
24
developed a well characterized CTCL. At initial diagnosis the estimated size of the T-cell clone was
small in 51% of cases and a CTCL was confirmed
in 67% of them. A medium-sized T-cell clone was
observed in 22% and a CTCL was proven in all of
them. Large T-cell clones (27%) indicated CTCL in
91%. A constant feature was the reproducibility of
the same T-cell clone in all cases during follow-up.
We conclude that the incidence of CTCL increases
with medium and large dominant T-cell clones, respectively, and that already small T-cell clones are
suspect of CTCL and may, even in early stages of
CTCL simulating inflammatory tissues, indicate a
lymphoproliferative disorder.
P3
Cutaneous T-cell lymphoma : dendritic cells
are increased in dermal infiltrates and are in
close contact with CD4+ tumor cells
R.E. Hunger, A. Ochsenbein, U. Kaelin,
N. Yawalkar
Department of Dermatology, Inselspital Bern
Primary cutaneous T-cell lymphoma (CTCL) represents a heterogeneous group of extranodal nonHodgkin lymphomas of which mycosis fungoides
and Sézary syndrome, are the most common types.
Dendritic cells (DC) are professional antigen-presenting cells. They have the ability to induce primary immune responses and their functional and
phenotypic properties profoundly influences the
outcome of an immune response. Two different
subsets of DC have been described. Plasmacytoid
DC expressing the surface markers BDCA-2 are
found under normal conditions mainly in the circulating blood. Myeloid DC are predominantely situated in the peripheral tissues. The aim of this study
was to analyze the distribution and frequency of
DC in lesions of CTCL. We therefore analyzed by a
computer-based image analysis system immunohistochemically stained tissue sections from lesional
and as a control from non-lesional skin of patients
suffering from CTCL. Both DC subsets, plasmacytoid
and myeloid, were clearly increased in lesional skin
as assessed by the immunohistochemical markers
for CD303 (BDCA-2), CD1a, CD206 (mannose receptor), CD207 (langerin), CD209 (DC-sign) and
CD11c. Immunofluorescence double stainig with
CD4 and CD1a antibodies demonstrated a close
contact of tumor cells with DC. This results suggest
that myeloid and plasmacytoid DC play an important role in tumor progression of CTCL.
P4
T-cell lymphoma mimicking PLEVA: a case
report
D. Mahler, C. Brun del Re, L. Zala, T.
Hunziker, R.E. Hunger
A 51-year-old man with a long standing history of
sprue lost weight and complained of night sweat
for half a year. In the same time multiple partly
ulcerative papules and plaques developed on his
entire skin. Moreover there were oral and genital
ulcers. A extensive examination exhibited multiple
ulcerations in the esophagus, stomach and duodenum as well as multiple nodular pulmonary infiltrates. Initial skin biopsy was consistent with PLEVA, further histological examinations including PCR
analysis showed T-cell-receptor clonality indicating
T-cell lymphoma.
P5
Specific Cutaneous Infiltrates Of B-cell
Chronic Lymphocytic Leukemia At The Site
Of Influenza Vaccination
X.-C. Pham, C. Prins, C. Barde, I. Masouyé
Clinique de Dermatologie, Hôpital Cantonal Universitaire de Genève
Specific cutaneous infiltrates of B-cell chronic
lymphocytic leukemia (B-CLL) at sites of infectious skin diseases (herpes simplex, herpes zoster,
Borrelia burgdorferi) or primary cutaneous epithelial neoplasms (basal cell carcinoma, squamous
cell carcinoma) are rare. We present a case of a
75-year-old woman with B-CLL since 1999, who
developed over 3 weeks an ulcerative plaque at
the site of an influenza vaccination given 1 month
before. The patient was receiving her 6th chemotherapy course since 1999 because of exacerbation
of leukemia and was treated with chlorambucil. A
skin biopsy revealed a dense, diffuse infiltrate of
small lymphocytes throughout the entire dermis.
The lymphocytes showed an aberrant phenotype
CD20+/CD5+ consistent with B-CLL. The lesion
was treated by excision. Leukemic infiltration of the
skin at sites of preexistent skin diseases are rare but
well documented and similarities exist with the socalled Köbner phenomenon. Previous reports suggested that this phenomenon may be a response
to antigenic stimuli. To our knowledge, this is the
first description of influenza vaccination-induced
cutaneous infiltrates of B-CLL.
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Posters
P6
Unifocal Langerhans cell histiocytosis of the
oral mucosa
I. Hitz Lindenmüller, M. Oberholzer, I.
Raineri, J.T. Lambrecht, S.K. Fistarol
Dermatologische Universitätsklinik Basel
An otherwise healthy 24-year-old man presented
with a two-week history of pain on the left upper
jaw. Clinical examination showed a 10mm ulceration of the buccal gingiva 26/27. Radiographs
revealed no osseous radiolucencies. Teeth 26 and
27 were not loosened and reacted vital. A biopsy
disclosed a mixed nodular infiltration predominantly composed of atypical histiocytes, immunohistochemically staining positive with CD1a/S100,
revealing the diagnosis of Langerhans cell histiocytosis (LCH). Clinical examination of skin and lymph
nodes, complete blood count, liver function studies, chest X-ray, abdominal ultrasonography and
technetium diphosphonate bone scan showed no
evidence of further manifestations of the disease.
The diagnosis of LCH restricted to the oral mucosa
was established. The complete oral lesion including
the gingival mucosa, the periost and the adjacent
bone was ablated by CO2-laser and treated subsequently topically with triamcinolone acetonide. The
patient is still in remission after 1 year of follow-up.
Oral lesions often represent a very early sign of LCH
and may predate systemic manifestations. Exclusive affection of the oral cavity is rare and usually
originates from a bony lesion. We describe a patient
with oral LCH limited to the mucosa without bony
involvement. This rare manifestation of LCH may
delay diagnosis. Our case reminds to include LCH in
the differential diagnosis of oral mucosal ulcers.
P7
Prognostische Relevanz von Lysyl Oxidase
bei Plattenepithelkarzinomen im Bereich der
Mundhöhle und des Oropharynx (OSCC).
A. Albinger-Hegyi, S. Stoeckli,M. Storz,
S. Schmid, H. Moch, I. Hegyi
Einleitung : Da die Hypoxie im Tumorgewebe, unabhängig von der Therapiemodalität, mit einer ungünstigen Prognose bei OSCC-Patienten assoziiert
ist, haben wir in der vorliegenden Studie die prognostische Relevanz des hypoxieregulierten Proteins
Lysyl-Oxidase (LOX) bei Plattenepithelkarzinomen
der Mundhöhle und des Oropharynx untersucht.
Patienten und Methode: Das Primärtumorund Lymphknotenmetastasengewebe von 92
Lymphknoten-negativen und 160 Lymphknotenpositiven Patienten haben wir mittels Gewebearraytechnologie (TMA) immunhistochemisch unter26
sucht. Als etablierter Hypoxiemarker wurde die Carboanhydrase IX (CAIX) verwendet. Die Expression
wurde semiquantitativ mittels IRS-Score ermittelt.
Resultate : Die Expression von LOX im Tumorgewebe korrelierte signifikant mit der Expression des
Hypoxiemarkers CAIX. Ausserdem wiesen Patienten
mit hoher Expression von LOX im Tumorgewebe
ein ungünstiges Gesamtüberleben auf. Interessanterweise haben wir ausserdem eine hohe LOXExpression in den Lymphknotenmetastasen in 60%
(79/130) der Lymphknoten-positiven Patienten.
Schlussfolgerung : Die LOX-Expression korreliert
signifikant mit der Expression des Hypoxiemarkers
CAIX. Eine starke LOX-Expression bei Patienten mit
Plattenepithelkarzinomen im Bereich der Mundhöhle und des Oropharynx ist mit einer verkürzten Überlebensrate assoziiert. In der multivariaten
Analyse stellt neben dem T- und N-Stadium auch
die starke LOX-Expression einen unabhängigen
negativen prognostischen Faktor (p = 0,038) für
das Gesamtüberleben dar. Die Bestimmung der
LOX-Expression kann als prognostischer und diagnostischer Marker verwendet werden. Individuelle
Expressionsmuster erlauben die Zuordnung der Patienten in unterschiedliche Risikogruppen.
P8
Unusual presentation of a rapidly progressing giant melanoma
Massimo C.R. Lurati, Stéphanie Christen-Zaech, Olivier Michielin, Renato G.
Panizzon
An 88-year-old woman presented with a rapidly
expanding violet-black cranial plaque which had
previously been biopsied and diagnosed as angiosarcoma. Due to an atypical clinical and histopathological presentation the patient was referred
to our institution for a second opinion and further
investigations. Renewed histopathological analysis
as well as radiological imaging revealed extensive
locally metastatic melanoma of unknown primary
as well as an isolated unclassified melanoma of the
right cheek. The diagnostic workup and therapeutic
options are discussed in the setting of this extremely advanced locally invasive melanoma.
P9
The Role of In-vivo Reflectance Confocal
Mircoscopy in the Diagnosis of Melanoma
I. Kolm , J. Hafner, R. Dummer, M. Oliviero, L.E.French, A.A. Marghoob, H.
Rabinovitz, R.P. Braun
Klinik für Dermatologie, Universitätsspital Zürich
Background : In vivo reflectance confocal micros-
copy (RCM) is a new promising tool for the non-invasive diagnosis of pigmented and non-pigmented
skin lesions. RCM criteria for the diagnosis of melanoma have been described. Melanomas are mostly
characterized by epidermal architectural disarray
and pagetoid cells in the epidermis, non-edged papillae, and cellular atypia at the dermal-epidermal
junction, and atypical nests and bright nucleated
cells in the upper dermis (92% sensitivity, 69%
specificity. In: Pellacani et al. JID 2007).
Objectives: To evaluate the usefulness of RCM for
the diagnosis of melanoma and melanoma recurrence.
Methods : Patients with clinical and /or dermoscopic suspicious pigmented lesions were evaluated with RCM (Vivascope 1500; Lucid Inc, Rochester,
NY). Moreover, we used the RCM for lesions where
we suspected local recurrence of melanoma (for example monitoring Lentigo maligna melanoma after
treatment with radiotherapy).
Results : RCM improves the sensitivity in diagnosis
of melanoma and can be helpful as a noninvasive
technique for the early diagnosis of local melanoma
recurrence.
P 10
5 cases where In-vivo Reflectance Confocal
Microscopy changed my mind
R.P. Braun, I. Kolm, M. Oliviero, J.
Hafner , L.E.French, A.A. Marghoob,
H.Rabinovitz
Klinik für dermatologie, Universitätsspital Zürich
Background : In-vivo reflectance confocal microscopy (RCM)is a new non invasive method for the
in vivo diagnosis of melanoma. It bridges the gap
between dermoscopy and histopathology because
it provides at the time a horizontal overview like
dermoscopy and allows at the same time the evaluation at a cellular level like histopathology. Objectives : To evaluate the usefulness of RCM for the
diagnosis of equivocal pigmented lesions
Methods : We present cases where this new tool
clearly changed our mind and where confocal microscopy allowed to predict the true histopathological diagnosis. There were cases where dermoscopy examination was totally benign and the lesion
turned out to be melanoma or vice versa
Results : We present 5 cases where confocal microscopy overruled dermoscopy diagnosis and predicted the histopathological outcome.
Posters
P 11
POEMS Syndrome: case presentation and review of peculiar dermatological findings
B.Pernus, P. Itin, P. Häusermann
Dermatologie Universitätsspital Basel
We report the case of an 74-year old patient
who was diagnosed with POEMS Syndrome. He
presented with axillary, inguinal and mediastinal
lymphadenopathy, organomegaly with hepato-and
splenomegaly, sclerotic bone lesions, peripheral
neuropathy, endocrinopathy with hypothyroidism,
hypercortisolisme and low serum-testosterone,
monoclonal gammopathy and finally characteristic
skin changes including multiple angiomas. Further
histological work up revealed glomeruloid haemangiomas. POEMS syndrome is a complex and rare
paraneoplastic syndrome secondary to a plasma cell
dyscrasia. We aim to review the published dermatological findings with focus on vascular lesions.
P12 - P14
Free Slots
P 15
Eruptive inflamed melanocytic nevi resembling halo nevi
T. Schneiter, H. Nievergelt, R.E. Hunger,
D. Simon
Klinik für Dermatologie und Venerologie; Universität Bern
A rare case of eruptive melanocytic nevi resembling
clinically and histologically halo nevi is presented.
Although there are case reports on eruptive melanocytic nevi in the literature, inflamed variants
have not been reported yet. This 57-year-old Caucasian man with fair skin suddenly developed dozens
of small tumours on the trunk after sunbathing in
Marokko. These dome shaped lesions had a diameter of 4-7 mm, a light brown to red colour, and
were surrounded by a small hypopigmented rim.
The histological examination as well as immunohistochemistry of three lesions revealed melanocytic
tumours with a dense lymphocytic infiltrate resembling halo nevi.
P 16
Syringomes éruptifs
A.-M. Thielen, I. Masouyé, X.-C. Pham,
F.-A. Le Gal
28
Les syringomes sont des tumeurs annexielles bénignes dérivant de la partie épidermique de l’épithélium canalaire de la glande eccrine. Ils sont
fréquents sur les paupières inférieures (0.6% de
la population) où ils se présentent sous forme de
papules dermiques uniques ou multiples, molles,
translucides, de couleur chair ou discrètement jaunâtres. Notre patient de 16 ans, aux antécédents
de dermatite atopique et de dermatose plantaire
juvénile, a développé progressivement depuis l’âge
de 8-9 ans de multiples petites lésions papuleuses,
non prurigineuses, de couleur chair à brun clair, sur
le tronc et plus récemment sur les cuisses, et le cou.
L’analyse histologique a permis le diagnostic de syringome. Le syringome éruptif est une forme rare de
syringome, avec moins de 100 cas décrits dans la
littérature. L’origine du syringome éruptif est actuellement controversée: processus prolifératif annexiel
primaire ou réponse hyperplasique du canal eccrine
à une pathologie inflammatoire? Les syringomes
éruptifs font partie du diagnostic différentiel des
dermatoses papuleuses éruptives généralisées, particulièrement dans les deux premières décades.
rencontrées sont la limitation des activités physiques, l’ulcération et les sur-infections. Il n’y a pas
de dégénérescence maligne car il ne s’agit pas d’un
ostéochondrome typique avec un cartilage hyalin et
du périchondre mais d’une exostose avec un cartilage fibrocartilagineux. Le traitement se fait par
excision chirurgicale après avulsion de la tablette
unguéale. Les récidives sont fréquentes (10%) et
sont dues à des excisions incomplètes. En conclusions, devant toute modification douloureuse d’un
ongle chez le jeune il faut penser à une exostose
sous-unguéale même si les signes unguéaux sont
discrets. Le diagnostic de l’exostose sous-unguéale
est aisé et repose sur la radiologie.
P 17
L’exostose sous-unguéale: une tumeur à
évoquer devant toute modification douloureuse d’un ongle
Une patiente de 48 ans, sans antécédent d’acné,
présentait depuis 9 mois des lésions acnéiformes
prurigineuses des deux joues. L’examen anatomopathologique et l’immunohistochimie évoquaient le
diagnostic de lymphome ou de pseudolymphome B.
La sérologie et la PCR borréliennes (sur tissu fixé
et inclus en paraffine) étaient négatives malgré un
antécédent de morsure de tique. Un traitement systémique de doxycycline secondairement associé à
un traitement topique de tacrolimus 0.1% ont induit une régression complète des lésions cutanées.
L’absence de réarrangement clonal des gènes des
immunoglobulines et la résolution complète et durable des lésions ont permis de retenir le diagnostic
de pseudolymphome B. Il s’agit donc d’une présentation clinique rare de cette entité mimant une
dermatose courante. Ce cas illustre la nécessité de
remettre en cause le diagnostic d’acné devant des
lésions atypiques et tardives.
A. Campanelli, L. Borradori
L’exostose sous-unguéale est une tumeur ostéocartilagineuse bénigne concernant l’enfant et le jeune
adulte. Elle touche généralement la phalange distale du gros orteil et pourrait être liée à une anomalie congénitale ou un défaut du périchondre. Une
fille de 12 ans, sans antécédent médical, consulte
en raison d’un nodule douloureux de l’hallux droit
évoluant depuis 3 mois. Le diagnostic de verrue a
été posé par plusieurs médecins qui ont prescrits
de nombreux traitements anti-verruqueux topiques
sans amélioration. L’examen clinique est celui d’un
nodule charnu érosif du bourrelet latéral du gros
orteil réalisant en regard une onycholyse et une
destruction unguéale. La radiographie conventionnelle met en évidence une excroissance osseuse
rattachée au dos de la phalangette sans rupture de
la corticale ni autre anomalie, image caractéristique
d’une exostose sous-unguéale. L’examen histologique de la résection tumorale montre un os trabéculaire mature couvert d’un tissu fibrocartilagineux.
L’exostose sous-unguéale est souvent confondue
avec les verrues sous-unguéales, l’onychomycose,
le fibrome digital, la tumeur glomique, le botriomycome sur ongle incarné, le kyste mucoïde et le mélanome amélanique. Les erreurs diagnostiques ne
sont pas rares et peuvent mener à des traitements
inadéquats. Les complications les fréquemment
P 18
Pseudolymphome B cutané imitant une
acné
A.-M. Thielen, X.-C. Pham, G. Kaya, F.-A.
Le Gal
P 19
Pseudolymphoma of the nose associated
with occupational metallic particle projections
Maxime Vernez, Bernard Noël, Renato
G. Panizzon, Emmanuel Laffitte
Service de dermatologie et vénéréologie, CHUV
We report a case of pseudolymphoma following
the projection of stainless steel particles into the
nasal tissue in a 50-year-old metal worker. Clinically the patient presented with an erythematous,
infiltrated, and focally purulent lesion. Skin biopsy
demonstrated a dermal predominantly lympho-
Prix Galien 2008
Der quadrivalente
Impfstoff gegen
Zervixkarzinome zur
Prävention eines breiten
Spektrums an Erkrankungen* und
für einen früh spürbaren Nutzen
*
Zervixkarzinome, zervikale intraepitheliale Neoplasien höheren Grades, vulväre intraepitheliale Neoplasien höheren Grades
und Genitalwarzen, die durch humane Papillomaviren der Typen 6, 11, 16, 18 verursacht werden.
Gardasil®
Z: Eine Impfdosis (0.5 ml) Impfstoffsuspension enthält ca. 20 μg HPV-Typ 6 L1-Protein, 40 μg HPV-Typ 11 L1-Protein, 40 μg HPV-Typ 16 L1-Protein, 20 μg HPV-Typ
18 L1-Protein. I: Prävention von hochgradigen Dysplasien der Zervix (CIN 2/3), Zervixkarzinomen, hochgradigen dysplastischen Läsionen der Vulva (VIN 2/3) sowie
von äusseren Genitalwarzen (Condylomata acuminata), die durch die Typen 6, 11, 16 und 18 des humanen Papillomavirus (HPV) verursacht werden. D:
Grundimmunisierung: 3 Einzeldosen zu je 0.5 ml, die gemäss Impfschema 0, 2, 6 Monate verabreicht werden. Der Impfstoff ist intramuskulär anzuwenden. Die
Anwendung von Gardasil bei Kindern unter 9 Jahren wird nicht empfohlen. KI: Überempfindlichkeit gegen die Wirkstoffe oder gegen einen der sonstigen Bestandteile.
VM: Wie bei allen injizierbaren Impfstoffen sollten für den Fall seltener anaphylaktischer Reaktionen nach Gabe des Impfstoffs geeignete Behandlungsmöglichkeiten
unmittelbar zur Verfügung stehen. UW: Fieber, Erythem, Schmerzen, Schwellung. P: Fertigspritze (1 Impfdosis) mit Nadelschutzvorrichtung und zwei separat eingeblisterten Nadeln. Packungen mit 1 und 10 Fertigspritzen. (Liste B) Stand der Information: 11/2006. Sanofi Pasteur MSD AG, Gulmmatt, 6340 Baar
Posters
cytic infiltrate with several associated plasmocytes,
consistent with the diagnosis of pseudolymphoma.
Direct immunofluorescence was negative. B and
T cell clonality assays were negative. Serology for
borreliosis was negative. A metallic foreign body
was visualized by conventional radiography and
CT imaging. EDX X-ray spectrophotometry showed
the presence of nikel, iron and chromium containing metallic particles in the skin biopsy. Therapy by
topical steroids and oral doxycyclin associated with
dye laser treatment resulted in excellent clinical response. The association between an occupational
metallic particle projection and pseudolymphoma
has insofar never been reported. It is essential for
dermatologists to be aware of this entity and its occupational health and insurance aspects.
in the general environment of human beings, has
rarely been reported as an etiological agent of superficial skin and nail infections in immunocompetent hosts. We report three brothers with underlying ichthyosis who developed cutaneous Geomyces
pannorum infection. Therapy with oral terbinafine
and topical ketoconazole resulted in complete resolution, although all three developed recurrent disease. Superimposed fungal infections may be more
common and atypical in appearance in patients
with ichthyosis, which was the likely predisposing
factor in these brothers.
Microbiologie/Allergologie/Immunologie
A. Campanelli, D. Viero
P 21
Pets as the main source of two zoonotic species of the Trichophyton mentagrophytes
complex in Switzerland, Arthroderma vanbreuseghemii and Arthroderma benhamiae.
S. Drouot, B. Mignon, M. Fratti, P.
Roosje, M. Monod.
In cases of highly inflammatory dermatophytosis
in humans, it is important to identify the possible
source of animal transmission in order to prevent
recurrence, family outbreaks or rapidly progressing epidemics. A survey of dermatophytes in pets
during a 14 month period in Switzerland revealed,
in addition to Microsporum canis, two different
species of the Trichophyton mentagrophytes complex, Arthroderma benhamiae and Arthroderma
vanbreuseghemii, all causing inflammatory dermatophytoses. Arthroderma benhamiae was only
but frequently found on guinea pigs. Arthroderma
vanbreuseghemii was found mainly on European
short hair cats, but also on dogs and in one case
on a pure-bred cat. Ninety-three percent of the cats
carrying A. vanbreuseghemii were identified to be
hunters and all had skin lesions. In contrast, cats
that were strictly indoors with skin lesions were
found to be almost exclusively infected by M. canis.
Therefore, it can be suspected that infection with A.
vanbreuseghemii occurred during hunting and that
the natural source of this dermatophyte is soil or an
animal other than the cat, most probably a rodent.
P 22
Recurrent cutaneous Geomyces pannorum
infection in three brothers with ichthyosis
S. Christen-Zaech, S. Patel, A. J Mancini
Geomyces pannorum, a geophilic fungus present
30
P 23
Le panaris herpétique: un diagnostic oublié
Une femme de 28 ans, nous est adressée pour évaluation d’un panaris récidivant et douloureux du
majeur droit. Elle a développé de nombreux épisodes de lésions vésiculo-bulleuses et érythémateuses
survenant sur la face palmaire du 3e doigt droit associé à des douleurs intenses avec des états fébriles
jusqu’à 39°C. Elle se rend à 7 reprises aux urgences
où, à chaque fois, elle bénéficie d’incisions et de
drainages du doigt et de la gaine du tendon fléchisseur. Après chaque intervention, elle reçoit des
traitements antibiotiques systémiques et oraux.
De nombreux prélèvements bactériologiques, mycologiques et mycobactériologiques reviennent
systématiquement négatifs. L’immunofluorescence
directe pour la recherche d’herpès s’avère négative.
Une culture virale met alors en évidence la présence
d’herpes simplex virus de type 2. Après introduction
de valaciclovir oral 500 mg 2 fois par jour pendant
5 jours, le panaris guérit rapidement avec disparition des douleurs. Le panaris herpétique est une infection à herpes simplex virus récurrente qui touche
habituellement les enfants et les jeunes adultes et
résulte d’une auto-inoculation. Il peut aussi résulter, chez le personnel médical en particulier, d’une
contamination auprès de patients atteints d’herpès
labial. Le panaris herpétique peut être cliniquement
difficile à distinguer d’un panaris bactérien. Il peut
y avoir présence de pus ainsi qu›une lymphangite
avec adénopathie épitrochléenne et axillaire. Toute
présence de panaris récidivant ou ne répondant pas
favorablement à un traitement antibiotique, doit
faire évoquer la possibilité d’une étiologie herpétique même en l’absence de classiques vésicules
groupées en bouquet.
P 24
HIV-associated papular pruritic eruption in a
rural environment in sub-saharan Africa
A.A. Navarini-Meury, M. Stoeckle, S.S.
Navarini-Meury, M. Mbata, E. Mossdorf, P. Kibatala, M. Tanner, C. Hatz, P.
Schmid-Grendelmeier
Dermatologische Klinik Universitätsspital Zürich
In tropical countries, HIV patients commonly suffer
from papular pruritic eruption (PPE). This skin disease involves the trunk, limbs and often the face.
It has a high disease burden because of disfigurement and carries social stigma because of its high
predictive value for HIV infection of up to 80%.
In addition, it results in sleep and concentration
problems due to constant itching. Pruritic papules
are thought to result from immunologic reactions
against residual mosquito antigens in the dermis. In
a HIV cohort in rural Tanzania with 12% prevalence
of PPE, we have retrospectively analysed response
of PPE-patients to available treatments. Oral promethazine ameliorated subjective itching (p<0.001)
and objective clinical scores (p<0.032) significantly
more than topical steroids. PPE-Scores did not correlate with CD4 counts or antiviral medication.
P25
Dermite de contact allergique aux chaussures due à la colophane
G. Marazza, O. Sorg, P. Zimmerli, P. Piletta
Introduction : La dermite de contact allergique aux
chaussures est une dermatose fréquente, favorisée
par un effet synergique entre différentes substances allergisantes et un environnement propice à la
pénétration des allergènes. Les allergènes fréquemment rencontrés sont le caoutchouc et les produits
utilisés pour sa fabrication, les différentes colles et
produits adhésifs ainsi que le cuir par le biais des
sels de chrome, utilisés pour le tannage.
Observation : Nous décrivons le cas d’une patiente
de 39 ans, qui nous a consultés pour des lésions
eczématiformes des pieds. Les tests épicutanés ont
objectivé à 96h00 une sensibilisation au chrome
(+++), au cobalt (++), à la colophane (++) et à
2 paires de chaussures de la patiente (++). Le diagnostic d’une dermite de contact aux chaussures
a été retenu. Nous avons ensuite procédé à une
analyse chimique (HPLC) à la recherche de chrome
ou colophane, qui à permis de mettre en évidence
la présence de colophane au niveau des semelles
des deux paires de chaussures et étonnamment
Acne vulgaris
Überzeugend in der Wirkung:
ACNE CREME PLUS
LIPO SOL LOTION
Für die lokale Behandlung von
Acne vulgaris. Durch die Kombination
von Benzoylperoxid mit Miconazol
ist die ACNE CREME PLUS optimal
wirksam und sehr gut verträglich.
Milde, nicht schälende
Reinigungslotion als sinnvolle
Therapieergänzung.
Wirkt talgauflösend und
antibakteriell.
ACNE CREME PLUS Widmer
Zusammensetzung: Benzoylis peroxidum 50 mg, Miconazoli nitras 20 mg. Indikation: Acne vulgaris. Kontraindikation: Bekannte
Überempfindlichkeit gegenüber einem Bestandteil des Produktes. Vorsichtsmassnahmen: Kontakt mit Augen und Schleimhäuten
vermeiden. Unerwünschte Wirkungen: Benzoylperoxid kann vor allem zu Beginn der Therapie Reizungen wie Brennen, Rötung der
Haut mit Abschuppung und Austrocknung hervorrufen. Tube zu 30 ml. Liste C. Kassenzulässig.
LIPO SOL LOTION Widmer
Zusammensetzung: Triclosan 2 mg. Indikationen: Reinigung und Desinfektion der Haut bei allen Formen von Akne und Seborrhoe.
Vorsichtsmassnahmen: Kontakt mit Augen und Schleimhäuten vermeiden. Flasche zu 150 ml. Liste D. Kassenzulässig.
Ausführliche Informationen entnehmen Sie bitte dem Arzneimittel-Kompendium der Schweiz.
Louis Widmer AG, CH-8952 Schlieren
DER HAUT ZULIEBE
LOUIS WIDMER AG, Rietbachstrasse 5, 8952 Schlieren-Zürich
www.louis-widmer.com
Ichthyosen, Hyperkeratosen
Das Therapieangebot
CARBAMID
+VAS 0.03 CREME
CARBAMID
CREME NEUE FORMEL
CARBAMID
EMULSION
BAIN
EXTRA-DOUX
CARBAMID + VAS 0.03 CREME Widmer: Zusammensetzung: Tretinoinum 0,3 mg, Ureum 120 mg, Dexpanthenolum 10 mg. I: Schwere Fälle von Ichthyosis vulgaris und
congenitalis. Erythrodermia ichthyosiformis congenitalis. Follikuläre Hyperkeratosen. Palmar- und Plantarhyperkeratosen. D: 1–2 x tgl. auftragen. KI: Rosacea, akute Dermatitiden,
bekannte Überempfindlichkeit. VM: Kein Kontakt mit Augen und Schleimhäuten, übermässige Sonnenbestrahlung vermeiden. UW: Selten Hautreizungen. Tuben zu 30 ml und
100 ml. Liste B. Kassenzulässig.
CARBAMID CREME NEUE FORMEL Widmer: Zusammensetzung: Ureum 120 mg. I: Behandlung von trockener spröder Haut, Erythema craquelé (Xerosis) sowie Hyperkeratosen
und leichteren Formen der Ichthyosis vulgaris. Unterstützende Behandlung bei kongenitalen Ichthyosen. D: 1–2 x tgl. auftragen. KI: Bekannte Überempfindlichkeit. VM: Kontakt mit
Augen und Schleimhäuten vermeiden. UW: Selten Hautreizungen. Tube zu 100 ml. Liste D. Kassenzulässig.
CARBAMID EMULSION Widmer: Zusammensetzung: Ureum 80 mg. I: Trockene und schuppende Dermatosen (leichte Hyperkeratosen). Sehr raue, trockene und ekzematöse
Haut. Langzeitbehandlung und Rückfallprophylaxe der Ichthyosis und Neurodermitis. D: 1–2 x tgl. auftragen. KI: Bekannte Überempfindlichkeit. VM: Kontakt mit Augen und
Schleimhäuten vermeiden. UW: Selten Hautreizungen. Flasche zu 150 ml. Liste D. Kassenzulässig.
BAIN EXTRA-DOUX Widmer: Zusammensetzung: Ichthyol® hell 30 mg, Extractum chamomillae 10 mg, Guajazulenum 0,25 mg. I: Badezusatz für die Behandlung trockener,
rauer, ekzematöser Haut. Bei Ichthyosis, Hyperkeratosen, Psoriasis, Neurodermitis, Pruritus, Prurigo. D: 2–3 Bäder pro Woche. VM: Kein Kontakt mit Augen und Schleimhäuten,
übermässige Sonnenbestrahlung vermeiden. UW: Selten Hautreizungen. Flasche zu 250 ml. Liste D. Kassenzulässig.
Ausführliche Informationen entnehmen Sie bitte dem Arzneimittel-Kompendium der Schweiz.
Louis Widmer AG, 8952 Schlieren
DER HAUT ZULIEBE
Posters
l’absence de chrome.
Discussion : La colophane est une résine d’origine
naturelle chimiquement complexe, extraite de certaines variétés de pins. Elle est utilisée dans la fabrication du papier, de colles, d’adhésifs et de produits
d’imprimerie. Son imputabilité dans les dermites de
contact aux chaussures a été rapportée. Elle est le
plus souvent utilisée comme adhésif au niveau des
semelles, (produisant des lésions qui prédominent
sur les plantes des pieds) mais aussi lors du processus de tannage du cuir (lésions au dos des pieds).
Conclusion : La colophane est un produit très répandu dans l’environnement mais rarement impliqué dans le développement de dermites de contact
allergiques aux chaussures. La découverte d’une
sensibilisation à la colophane chez un patient avec
eczéma des pieds devrait être considérée comme
pertinente et systématiquement recherchée.
P 26
Patch test flare up
B. Theler, C. Bucher, L.E. French, B.
Ballmer Weber, G.F.L. Hofbauer
Introduction : The persistence of an allergen and
immunocompetent cells in sites of healed contact
dermatitis as well as flare up reactions triggered by
patch testing and after systemical provocation with
the concerning allergen are well-known phenomena. We report to our knowledge the first flare-up
of a previous patch test site following cutaneous
application of nickel in an individual with latent
nickel sensitization.
Case report : Patch testing in a 23-year old female
patient was performed for dermatitis following application of various gels and adhesive bandages:
positive delayed type hypersensitivity reactions
were noted for nickel sulfate and potassium chloride. The patient had never noticed skin reactions
to nickel-containing items. Three weeks following
these patch tests, the patient wore earrings which in
the past had been well tolerated. She subsequently
developed dermatitis of both earlobes within hours,
and dermatitis at the site of nickel patch testing
within a day.
Discussion : Nickel exposure for 48 hours in a small
patch test area under occlusion is sufficient to prime
a previously unresponsive individual to subsequent
exposure with the previously tolerated antigen.
Nickel patch testing should thus be employed cautiously as it may unmask a clinically silent contact
sensitization.
P 27
Contact sensitivity to metals: evidence of irritant tests in metal implant patients
P. Häusermann, K. Scherer, E. Kump, A.J.
Bircher
Allergologie, Dermatologie Universitätsspital Basel
TEXT :
Introduction : Contact sensitivity to metals is often
suspected in patients with a variety of symptoms
from metal implants. We evaluated the prevalence
of positive patch tests to a large series of metals in
a patients with complications from knee and hip
protheses and osteosynthesis.
Patients and Methods : Eighteen consecutive patients with metal implants associated with pain,
swelling or dermatitis (11 females, 56 years)
were included. All were patch tested with the
German standard and an extended metal series
(Chemotechnique, Hermal, Hospital pharmacy).
Readings were done at day 2 and 3 according to
the ICDRG guidelines. In 6 patients test reactions
with an irritant pattern were examined with conventional and immune histochemistry. Results In
metal implants patients 12/18 (66%) were positive
to metals particularly nickel, cobalt, chromium and
manganese, vanadium and rhodium. Some were
morphologically allergic reactions, with a crescendo
evolution, others particularly to manganese were
irritant reactions with pustules and a decrescendo
evolution. Histology revealed a mixed inflammatory
pattern, immune histochemistry showed CD 3, , 8
and CD 163 positive cells.
Discussion : We found an unexpected high prevalence of positive patch tests to metals in implant
patients. There was a high prevalence to the classical metals nickel, cobalt and chromium. The majority of the positive reactions, however, could be
related neither to exposure nor to symptoms. Irritant reactions may present a problem particularly
with manganese, vanadium and rhodium. Metal
contact sensitivity may play a contributing role in
symptomatic metal implants, however non irritant
test concentrations are mandatory.
P 28
Recombinant allergens as diagnostic tool in
mould allergy
S. Nobbe, B. Simon-Nobbe, M. Breitenbach, P. Schmid-Grendelmeier
Background : Cladosporium herbarum (Cla h),
together with Alternaria alternata (Alt a) are two
of the most important allergenic moulds. For diagnostic skin tests, usually extracts purified from raw
material are used. However with such extracts, only
a limited standardization and purity is achievable.
Recombinant allergens were found to be a very
specific, reliable and safe tool for the diagnosis of
mould allergic diseases.
Patients and methods : We investigated in a clinical trial of 29 mould allergic patients the use of
selected recombinant mould allergens (rAltNTF,
rClaNTF, rAltMtDH, rClaMtDH, rAlta1, rClaTcTPEn)
in skin prick tests (SPT), in comparison with natural
mould allergen extracts and defined also specific
IgE against these allergens by ELISA.
Results : SPT with the recombinant allergen rAlta1
were highly specific and detected more patients
than the skin tests with the allergen extracts. The
other recombinant allergens showed only in a very
limited number of patients positive SPT and seem
to be of lower importance. The correlation between
SPT and specific serum IgE was very high.
Conclusion : Our findings support the use of recombinant proteins in the diagnostic work up,
especially for Alt a1 - related allergies. In spite of
the large number of allergens in Alt a, it is likely
that a combination of Alta1 with a small number
of other recombinant allergens is sufficient to diagnose Alt a - sensitised patients with high sensitivity
and specificity. Recombinant allergens will allow a
more precise diagnosis and possibly also a highly
efficient specific.
P 29
Chronic Urticaria: Cognitive flexibility influences the course of urticaria
B. Töndury, P. Bures, B. Mühleisen, S.
Büchi, B. K. Ballmer-Weber
Chronic Urticaria : Cognitive flexibility influences
the course of urticaria A consultation for urticaria
patients has been established at the Department
of Dermatology of the University Hospital of Zurich since January 2007. Correlation between patient’s history and type/cause of urticaria, impact of
a positive autologous serum skin test (ASST) and
of psychological factors on the course of urticaria
were investigated. 98 patients with a mean age of
39 years (range: 11-77 years) and chronic or acute
intermittent urticaria were recruited from January till December 2007. Patients were interviewed
on suspected trigger factors of their urticaria and
their cognitive flexibility was assessed using a Pictorial Representation of Illness and Self Measure
(PRISM). ASST and physical tests (for pressure, cold,
etc.) were performed. Patient’s history correlated in
fourteen patients with the identified type of urticaria (14,3%). Food allergy was suspected to cause
urticaria by 32 patients (32,7%), physical triggers
by 59 patients (60%), but could be only confirmed
in five and four patients, respectively. The ASST
33
Posters
was positive in thirty-five cases (54%). 65 patients
(66,3%) demonstrated in PRISM analysis to have
a cognitive flexibility, i.e. to be able to see a variation in the intensity and frequency of their symptoms. Thirty-nine of those patients (60%) showed
a favourable course, i.e. a reduction of days with
urticaria symptoms of 25%. Fifteen patients had no
cognitive flexibility and only five of those (33,3%)
showed a favourable course. However, there was
no correlation between the outcome of ASST and
the course of the urticaria. In conclusion: patient’s
history did not correlate with the clinical test results. More importantly, however, there is an indication that cognitive flexibility could be a predictive
marker for the course of chronic urticaria.
P 30
Galvanic urticaria
G. Vanini, C. Mainetti
Servizio di Dermatologia, ORBV, Bellinzona
A 25-year-old woman presented to the dermatology department with a 3 year history of excessive
sweating from the feet and axillae. She was otherwise well, had no medical history of note and
was on no regular medication. We decided to treat
hyperhidrosis with aluminium chloride hexahydrate
solution witch was poorly tolerated. Iontophoresis
was administered to feet without addition of an
anticholinergic agent in room temperature water.
Direct current at a maximum of 30 mA was used.
After 10 min, an itchy eruption appeared and persisted for 1 h. Examination revealed urticaria. Only
areas immersed in the iontophoresis chamber were
involved. Urticarias occuring secondary to an environmental stimulus is known as physical urticarias.
Physical urticarias are responsible for approximately 15% of urticarias. Cholinergic (by an increase in
core body temperature), aquagenic, heat, vibratory
urticarias were ruled out by appropriate diagnostic tests. Heat, cold, sunlight, pressure, water and
vibration have been described in association with
urticaria; however, the development of urticaria following the administration of an electrical current
(galvanic urticaria) is extremely rare.
P 31
Iodine is rarely the elicitor in hypersensitivity reactions to contrast media
pathomechanism is not clear, contradictory results
with a very low up to a 70% prevalence of positive
IDT have been reported. In DT reactions, delayed
positive patch and IDT tests, and ICM-specific Tcells suggest a T cell-mediated mechanism. In both
the role of iodine has not been clarified so far. Since
occasionally positive skin tests to iodine containing drugs are observed, such patients are often
falsely labelled as being “allergic to iodine”. We
investigated the presence of a hypersensitivity to
iodine in patients with a history of hypersensitivity reactions to ICM. Methods 16 patients (7 male,
9 female, mean age: 61.6 years) with a history of
IT-(group A, n=6) or DT- (group B, n=8) hypersensitivity reactions to ICM/iodine were investigated.
Depending on the clinical reaction, skin prick tests,
IDT and patch tests (PT) with several ICM and different iodine formulations were done. After exclusion of contraindications and obtaining informed
consent, all underwent oral provocation with pure
iodine solutions. Results In group A, positive skin
tests to 2 ICM were observed. One patient with
completely negative skin tests reacted twice to oral
iodine with an urticarial exanthem. In group B, a T
cell-mediated sensitization to one or more ICM was
identified in the skin tests in 8/8. In 5/8 patients
additional contact sensitizations to one or more iodine formulations was found, Oral provocation with
iodine was negative in 6/8 patients. Two patients
developed an exanthem after oral provocation with
iodine. Three patients experienced a transient nausea and dizziness during oral provocation.
Conclusion : We have previously demonstrated in
a patient with iodine mumps that oral challenge
with Lugol’s solution is in principle a valid means
to elicit a hypersensitivity reaction to iodine. In 13
patients we were able to show that in the majority
iodine is not the eliciting agent in hypersensitivity
reactions to ICM. Therefore, in these cases more
likely the ICM molecules and not iodine are the
eliciting structures. One patient with an IT reaction
to an ICM and an urticaria to iodine did not have
a detectable sensitization to an ICM. Two patients
with DT reaction and broad sensitization to all ICM
tested reacted to oral iodine.
P 32
Apoptosis in cutaneous cytotoxic GVHD and
correlation to cytotoxic- and regulatory T
cells
K. Scherer, T. Harr, S. Bach, A.J. Bircher
E. Kump, B. Biedermann, P. Itin, P.
Häusermann
Background : Hypersensitivity reactions to iodinated contrast media (ICM) are either immediate
reactions (IT) occurring typically within one hour, or
delayed reactions (DT), which typically occur after
several hours to one or 2 days. In IT reactions, the
We study lymphocyte involvement and apoptotic
events in the cytotoxic dermatoses cytotoxic-type
GVHD (acute and late acute GVHD, lichenoid
chronic GVHD), idiopathic lichen planus and benigne solitary lichenoid keratosis. We aim to identify
34
and quantify the relative contribution of lymphocyte subsets in the induction of apoptosis of keratinocytes and correlate those to cellular cytotoxic
and regulatory events. Using immunofluorescence
assays on paraffin sections of skin biopsies from
large patient databases, we screen for presence,
localization and activity of cytotoxic T-cells (CTLs)
(CD3+CD8+), inflammatory CTLs (CD8+TIA-1+),
T-helper cells (CD3+CD4+) and regulatory T-cells
(CD4+FoxP3+). On parallel slides, we detect corresponding apoptotic events by using the TUNEL
assay and assess the target cell types based on
their subtissue localization. This study is a starting
project with focus on the further elucidation of the
pathogenesis of cutaneous GVHD.
P 33
Treatment-induced localized pemphigus of
the lower lip: first manifestation of pemphigus vulgaris or treatment-induced transient
pemphigus-like disease?
Gex-Collet C, Scherer K, Itin P, Häusermann P
We report the case of a 76-year old female patient
who was treated for actinic cheilitis with CO2 laser
treatment and subsequently developed the clinical
picture of erosive cheilitis. The further histopathological and serological work up including direct
immunofluorescence studies revealed a clear cut
formal diagnosis of pemphigus vulgaris without
any further manifestations. Systemic and topical
glucocorticoids were successfully administrated and
could be tapered within few weeks. We discuss the
potential mechanisms of treatment induced pemphigus and try to propose criterias to delineate autoimmune bullous pemphigus vulgaris. Finally, we
review the literature with focus on laser-induced
pemphigus-like skin diseases.
P 34
B cells depletion for therapy-resistant cutaneous manifestations in systemic lupus erythematosus (SLE)
G.L Vanini, J-F. Balavoine, C. Chizzolini,
L. Borradori
Background: Skin involvement is one of the most
common manifestations of SLE. While cutaneous
lupus erythematosus (CLE) is not life-threatening,
it may result in considerable morbidity. CLE may
be difficult to manage with both topical and systemic therapies. B-cell depletion using anti-CD20
monoclonal antibody (rituximab) is currently in-
Posters
vestigated in the management of autoimmune diseases. Rituximab may induce remission in SLE, its
value in controlling CLE is, however, unclear. Aim
and intervention: To test the efficacy of rituximab
in two patients with long-lasting SLE with CLE
manifestations refractory to a variety of topical and
systemic therapies (steroids, calcineurin inhibitors,
antimalarials, immunosuppressants). Both patients
received four weekly infusions of 375mg/m2 of
rituximab. The usual immunosuppresive therapy
was continued. Results: In both cases, B cell depletion led progressively to a significant improvement
of their skin manifestations. Furthermore, prednisone dosage could be reduced (from 20 to 2.5
mg/d and from 30 to 10 mg/d, respectively). During
the period of B depletion, no serious side effects
were observed. In one case, 17 months after antiCD20 treatment a relapse was observed, which
occurred concomitantly with the reconstitution of
B cell numbers. Two additional doses of rituximab
(375mg/m2, at 1 week of interval) controlled her
skin involvement. At present both patients show no
or weak cutaneous activity, seven and six months
after the last infusion, respectively. Conclusion: Our
results suggest that B cells depletion represents a
viable option for the treatment of therapy-resistant
cutaneous involvement in LES.
Our patient has not developed any underlying malignancy so far, but she will be followed closely.
Vesiculobullous Sweets is a rare variant of this syndrome, and a review of literature has shown that
it is most frequently associated with myelogenous
leukaemia.
P 36
A case of Erythema Elevatum Diutinum associated with an IgG kappa stage III multiple
myeloma.
:
P. Perrier, A. Christinat, B. Noël, AK.
Lapointe, D. Hohl
Erythema Elevatum Diutinum (EED) is a rare, chronic
neutrophilic dermatosis histologically characterized
by leukocytoclastic vasculitis. We report the case of
a 71 years old woman with an IgG kappa stage
III multiple myeloma, diagnosed one month before
she was referred to our dermatological clinic. Before
initiation of chemotherapy, she presented symmetrical painful violaceus-yellowish nodulo-pustular lesions of the extensor faces of elbows, of the dorsal
metacarpo-phalangeal joints and lateral sides of
both 2nd fingers, and on the anterior face of the
right leg. Skin biopsy revealed necrotic epidermis,
massive neutrophilic infiltration of the entire dermis
and vascular damage. Immunofluorescence showed
granular deposits in vessel walls. EED was diagnosed based on clinical and histopathological findings. Dapsone therapy was prescribed and 5 days
later myeloma chemotherapy (Thalidomide, Melphalan, Prednisolone) was initiated. Dapsone was
taken during 3 weeks with a rapid improvement of
the lesions and then stopped in order to avoid neuropathy in association with Thalidomide. 6 weeks
after onset of lesions and 4 weeks after initiation
of anti-cancer therapy, serum IgG were normalized
and b2-microglobulin significantly decreased. Concomitantly, nodules had flattened, and only violaceous hyperkeratotic residual macules were seen.
There is low consensus about therapeutical modalities for EED, although Dapsone seems to be more
successful than other drugs. This case illustrates a
rapid resolution of early EED lesions under Dapsone
and effective anti-cancer therapy.
P 35
Bullous Sweet syndrome with no associated
malignancy
M. Vernez, R.G. Panizzon, S. ChristenZaech
Sweet›s syndrome is an acute febrile neutrophilic
dermatosis characterized by erythematous plaque,
arthralgias, myalgias, and leukocytosis, which is
often associated with infections, malignancies, inflammatory bowel disease, autoimmune disorders,
drugs or pregnancy. We report a 44-year-old women, who presented with fever, malaise, arthralgia
and a recent eruption of numerous, erythematous,
painful plaques on the face, trunk, arms and thighs
that evolved rapidly into bullous lesions. Mucous
membranes were not involved. Laboratory results
revealed a slight leucocytosis with neutrophilia,
a discrete thrombocytopenia and an increased creactive protein. Histopathologic examination of
the superficial dermis showed a dense neutrophilic
infiltrate and a massive oedema confirming our
clinical diagnosis of bullous Sweet syndrome. Underlying etiologies were excluded by microbiologic
exams, whole body computer tomography scan,
gastrointestinal investigations, drug review, laboratory screening for autoimmune disorders and hematopathies. Therapy with oral prednisone, 50 mg
once a day for 5 days, and topical corticosteroids
creams resulted in a prompt relief of all symptoms.
Fortes démangeaisons?
35
Posters
P 37
Erythema induratum Bazin: endemische und
nicht endemische Infektion
M.A.M. Rezzonico Corti1, P. Michalopoulos1, I. Masouyé2, C. Mainetti1
1. Servizio Cantonale di Dermatologia, ORBV,
Bellinzona
2. Clinique de Dermatologie, Hôpital Cantonal
Universitaire de Genève
Unter dem Begriff vom Erythema induratum Bazin
versteht man eine allergisch-hypererge Reaktion
nach hämatogener Streuung von Tuberkelbakterien
oder ihren Bestandteilen aus einem tuberkulösen
Fokus. Zwei klinische Fälle, eine 50-jährige Patientin balkanischer Herkunft und ein 63-jähriger Tessiner, werden diskutiert. Die erste Patientin erhielt
eine antituberkulöse Therapie gemäss den Richtlinien der schweizerischen Lungenliga. Der zweite
Patient erhielt wegen einer Leberinsuffizienz eine
modifizierte antituberkulöse Therapie. Der klinische
Verlauf beider Patienten war erfolgreich und komplikationslos. Das Erythema induratum Bazin stellt
gelegentlich eine diagnostische Herausforderung
dar. Auch in nicht endemischen Tbc-Gebieten lohnt
es sich, ein Tbc-Screening durchzuführen. Weiterhin sollten die Ergebnisse des Mantoux-Tests, eine
PCR-Untersuchung auf Tbc-DNA des betroffenen
Gewebes und eventuell ein Interferon-gamma Bluttest in die Diagnostik einfliessen.
General Dermatology
P 40
Actinic lichen planus : report of a case with
melasma-like-features
E. Khelifa, S. Abraham, P. Chavaz, I.
Masouyé, L. Borradori
Actinic lichen planus (ALP) (synonyms: lichen planus
tropicus, lichenoid melanodermatitis, lichen planus
atrophicus annularis) is a chronic benign disease. It
is a distinct variant of lichen which often occurs on
light-exposed areas with racial predilection for Orientals. We describe a patient presenting with diffuse melasma-like hyperpigmentation on the face
first diagnosed as cutaneous lupus erythematosus
(LE). Observation: A 32-year-old woman of Moroccan origin progressively developed hypermelanotic
patches on her face, assuming a melasma-like appearance as well as erythematous lesions with
slight-to-moderate scaling. Her medical history was
otherwise unremarkable. Microscopic examination
of a skin biopsy specimen revealed vacuolar degen36
eration of the basal cell layer. A band-like lymphohistiocytic infiltrate was present in the upper dermis
with pigmentary incontinence. Discussion: ALP is
typically characterized by the presence of pruritic
violaceous papules most commonly located on the
extremities of young and middle-aged adults. It
may be accompanied by oral and genital mucous
membrane lesions as well as hair and nail involvement. A chloasma/melasma-like form of ALP has
also been rarely described in females. Although the
similarity to melasma is striking, the histopathologic picture with presence of an interface dermatitis is
distinctive. ALP should be considered in the differential diagnosis of cutaneous LE and melasma-like
lesions in all patients originary from Middle East,
North Africa and India.
P 41
Linear morphea follows Blaschko’s lines
L. Weibel, J. Harper
Background : The aetiology of morphea (or localized scleroderma) remains unknown. It has previously been suggested that lesions of linear morphea may follow Blaschko’s lines and thus reflect
an embryological development. However, the distribution of linear morphea has never been accurately
evaluated.
Objectives : We aimed to identify common patterns
of clinical presentation in paediatric patients with
linear morphea and to establish whether linear
morphea follows the lines of Blaschko.
Methods : A retrospective chart review of 65 children with linear morphea was performed. According to clinical photographs the skin lesions of these
patients were plotted onto standardized head and
body charts. With the aid of Adobe Illustrator a final
figure was produced including an overlay of all individual lesions which was used for comparison with
the published lines of Blaschko. Results : Thirty-four
(53%) patients had the en coup de sabre subtype,
27 (41%) presented with linear morphoea on the
trunk and/or limbs and 4 (6%) children had a combination of the two. In fifty-five (85%) children the
skin lesion were confined to one side of the body,
showing no preference for either left or right side.
By comparing the overlays of all body and head lesions with the original lines of Blaschko there was
an excellent correlation.
Conclusions : Our data indicates that linear morphea follows the lines of Blaschko. We hypothesize
that in patients with linear morphea susceptible
cells are present in a mosaic state and that exposure to some trigger factor may result in the development of this condition.
P 42
Pediatric Morphea (Localized Scleroderma):
Review of 136 Patients
S. Christen-Zaech, M.D. Hakim, F.S. Afsar, A.S. Paller
Background : Morphea is an autoimmune inflammatory sclerosing disorder that may cause permanent functional disability and disfigurement. Objectives : Determine the clinical features of morphea in
a large pediatric cohort.
Methods : Retrospective chart review of 136 pediatric patients with morphea from one center,
1989-2006.
Results : Most children showed linear morphea,
with a disproportionately high number of Caucasian
and female patients. Two patients with rapidly progressing generalized or extensive linear morphea
and arthralgias developed restrictive pulmonary
disease. Initial oral corticosteroid treatment and
long-term methotrexate administration stabilized
and/or led to disease improvement in most patients
with aggressive disease.
Conclusions : These data suggest an increased
prevalence of morphea in Caucasian girls, and
support methotrexate as treatment for problematic forms. Visceral manifestations rarely occur; the
presence of progressive problematic cutaneous disease and arthralgias should trigger closer patient
monitoring.
P 43
Primary atrophic solitary morphea profunda
E. Khelifa, I. Masouyé, P. Chavaz, H.
Hauser, J.-P. Grillet, L. Borradori
Localized scleroderma, also known as morphea, is
a cutaneous disorder of unknown origin. We report
here an unusual case of solitary morphoea profunda (SMP), a form of morphea rarely mentioned and
discussed in the literature that presented with isolated non-inflammatory lesions mimicking localized
lipoatrophy. Primary atrophic scleroderma had already been reported, but to our knowledge, there is
no description of primary atrophic solitary morphea
profunda. Besides, in contrary of other reports of
SMP, having clinical signs of epidermal involvement
(atrophy, purplish colour, depigmentation…), our
patient had no superficial changes of skin colour or
texture. Because of the rarity of the condition, there
are no well established therapeutic approaches for
localized morphea and morphea profunda.
Posters
P 44
Zincdermatitis–like erythroderma as a precursor of systemic lupus erythematodes
S. Haug, J. Bäte J., C. Pournaras, M.D.
Anliker
Clinic of Dermatology, St. Gallen
Introduction : Causes for an erythroderma can vary
widely and therefore always pose a challenge for
the dermatologist in charge. Besides quite common
skin alterations like atopic or seborrheic eczema or
psoriasis, more rarely skin diseases like T-cell lymphoma, zinc deficiency syndrome or manifestation
of a form of systemic or cutaneous lupus have also
to be considered. Skin manifestations of the zinc
deficiency syndrome are typically alterations of
the orifices and distal extremities and commonly
becomes infected with bacteria and yeast. Cutaneous lupus erythematosus is a chronic inflammatory
autoimmune disease with multiple forms of cutaneous manifestations and a broad spectrum of clinical
manifestations. Therefore the diagnose sometimes
can be hard to make.
Patient/methods : The female, 85 years old, did not
have any systemic symptoms prior to the development of a widespread erythrodermic eczematous
dermatitis resembling a psoriasis guttata or zinc
deficiency dermatitis. The skin alterations were resisting to treatment with topical steroids, systemic
Acitretin combined with systemic steroids and Cycolsporine with topic and systemic steroids under
the presumption of a psoriasis guttata. Amelioration could only be reached by the treatment with a
combination of Plaquenil, Imurek and Prednison. A
skin biopsy included direct immunfluoreszenz technic also as mycological investigations and laboratory tests were performed. Weeks later this patient
developed a severe anaemia Hb 117 g/l and was
hospitalised for 4 days. A source for internal bleeding was not found.
Results : The skin biopsy revealed an eczematous
reaction resembling a photosensitive dermatosis or
a subacute cutane lupus erythematodes. All laboratory findings were normal besides an elevated titer
for ANA (1:640) and SS-A/Ro IgG. Therefore first the
diagnosis of a SCLE was made. After the anaemia ,
which had to be corrected by two blood bottles the
diagnosis of a systemic lupus was discussed versus
drug side effects of Imurek.
Discussion : Sometimes atypical skin lesions can
lead the way to the diagnosis of a systemic lupus
erythematodes. As we did not stop Imurek medication after the anaemic event and still find the
patients under good conditions, the proof for the
diagnosis is very probable. The patient is currently
under diagnostic procedure to exclude more organ
manifestations of a systemic lupus erythematodes.
P 45
Revival or long forgotten: Features in zinc
deficiency
AUTEURS :
J. Bäte, M.D. Anliker
Clinic of Dermatology, St. Gallen.
Zinc deficiency is known to cause or to contribute
to skin diseases, acrodermatitis enteropathica probably being the most well known one. Some other
dermatologic conditions appear to be associated
with decreased blood levels of this trace element:
non-healing leg ulcers, xerotic acrodermatitis, asteatotic eczema, cheilitis angularis, blepharitis angularis, psoriasiform dermatitis, acneiform folliculitis,
alopecia of diffuse pattern, nail dystrophy, nails’
Beau-lines, clinical picture of necrolytic migratory
erythema. A decrease in alkaline phosphatase will
confirm zinc deficiency, if the patient does not present the typical clinical picture. Genetic disorders,
malnutrition, malabsorption and organism’s high
demand can cause serum zinc deficiency. Number
Information professionnelle abrégée de Protopic®
C: Principe actif: tacrolimus. Protopic® pommade à 0,03% et Protopic® pommade
à 0,1% contiennent respectivement: tacrolimus 0,3 mg et 1 mg, excipients ad
unguentum pro 1 g. I: Protopic® est indiqué pour le traitement d‘exacerbations
aiguës de la dermatite atopique modérée à sévère, pour le traitement de
seconde intention au cas où le traitement conventionnel ne serait pas assez
efficace ou s‘il survenait des effets secondaires. Pos: Adultes: enduire 2 fois par
jour les lésions cutanées d‘une mince couche de pommade à 0,03% ou 0,1%.
Enfants dès deux ans et adolescents: enduire 2 fois par jour les lésions cutanées
d‘une mince couche de pommade à 0,03%. Le traitement doit être limité aux
seules lésions cutanées. Une utilisation continue à long terme devrait être évitée. CI: Protopic® est contre-indiqué chez les patients ayant une hypersensibilité
connue au tacrolimus ou à I‘un des excipients de la pommade. Préc: La pommade Protopic® n‘a pas été evaluée chez I‘enfant de moins de 2 ans. Pendant
toute la durée du traitement, I‘exposition excessive de la zone traitée aux rayons
UV (UVA ou UVB), par exemple soleil et solarium, doit être evitée. Des méthodes
de protection solaire appropriées doivent être recommandées par le médecin
traitant. Des préparations émollientes peuvent être utilisées simultanément à
Protopic®, en respectant un délai de 2 heures entre les applications des deux
produits sur la même zone. Grossesse et allaitement: Catégorie de grossesse C.
El: Irritations cutanées au site d’application: sensation de brûlures, prurit, sensation de chaleur, érythème, douleur, irritation, folliculite, acné, intolérance à
l’alcool, infections à herpès virus, paresthésies et dysesthésies. I: Le tacrolimus
n’étant pas métabolisé par la peau, il n‘y a pas de risque d‘interaction percutanée qui pourrait affecter le métabolisme du tacrolimus. Prés: Pommade 0,1%
10 g, 30 g et 60 g, Pommade 0,03% 10 g, 30 g et 60 g. Catégorie de vente B,
admis aux caisses-maladie. Avant la prescription, veuillez consulter le Compendium Suisse des Médicaments.
APCHPRTIN0508f
Références
1. Hanifin, J.M. et al.: Efficacy and safety of tacrolimus ointment treatment for
up to 4 years in patients with atopic dermatitis. JAAD 2005; 53(2): S186-S194
2. Paller, A.S. et al.: Tacrolimus ointment is more effective than pimecrolimus
cream with a similar safety profile in the treatment of atopic dermatitis: results
from 3 randomized, comparative studies. JAAD 2005; 52(5): 810-822 3. Hanifin,
J.M. et al.: Tacrolimus ointment for the treatment of atopic dermatitis in adult
patients: part I, efficacy. JAAD 2001; 44(1): S28-S38 4. Paller, A. et al.: A 12-week
study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric
patients. JAAD 2001; 44(1): S47-S57
Astellas Pharma SA
Grindelstrasse 6, CH-8304 Wallisellen
Tél. +41 (0)43 233 60 20
Fax +41 (0)43 233 60 30
office@ch.astellas.com, www.astellas.ch
Astellas_Ins_Protopic_210x148_f_1 1
Calme l’eczéma!
• Forte efficacité1, 2
• Bonne tolérance1, 2
• Démangeaisons sous contrôle3, 4
14.5.2008 10:53:34 Uhr
Posters
of patients at risk are increasing due to gastric
banding and bowel bypass operations, inflammatory diseases of the GI tract and eating disorders.
Lack of zinc is associated with other symptoms:
diarrhoea, hypoproteinaemia, impaired cellular immunity. Zinc needs to be substituted orally for three
months. In case of malnutrition patients should receive nutritional education. Zinc tablets are a drug
with potential side-effects: erythroderma, copper
and iron deficiency and subsequent anaemia (blood
count after 1.5 months recommended); it appears
to increase the risk of urinary-genital infections in
smokers. In persistant zinc deficiency following adequate substitution and genetic abnormality missing, a gastrointestinal work-up is advised. We will
present a few cases with clinical pictures.
P 46
Keratosis pilaris atrophicans faciei (Ulerythema ophryogenes): A case report
AUTEURS :
Nedzmidin Pelivani, Robert E Hunger,
Nikhil Yawalkar, Ivan Hegyi, Thomas
Hunziker
Department of Dermatology, University hospital
Bern
We report on a 27-year-old woman referred to our
clinic with scarring alopecia and midfacial erythema
suggestive for lupus erythematosus. Further findings were loss of lateral eyebrows with erythema,
follicular papules and hyperkeratosis. This clinical
picture as well as histology was consistent with ulerythema ophryogenes, a rare hereditary disorder
with altered follicular keratinization.
P 47
Martorell’s hypertensive ischemic leg ulcer
must not be confounded with pyoderma
gangrenosum - a review on 31 consecutive
cases
J. Hafner, S. Nobbe, H. Partsch, S. Läuchli, Mayer Dieter, R. Speich, Huber Lars, B.
Ammann-Vesti, G. Burg, L.E. French
Background : Martorell’s hypertensive ischemic
leg ulcer (HYTILU) has become one of the leading
causes of leg ulcers at the Department of Dermatology, University Hospital of Zurich. Despite its
frequency, the majority of patients are initially misdiagnosed as pyoderma gangrenosum (PG). Treatment strategy of HYTILU and PG are completely
different.
Objective : To outline the characteristics of HYTILU
and the therapeutic consequeces. Patients and
Methods: A consecutive series of 31 patients with
HYTILU were subjected to a thorough retrospective
38
analysis.
Results : 31/31 Patients presented with one or multiple painful necrotic skin ulcers at the laterodorsal leg, bilateral in 16/31 instances (52%). 16/31
(52%) were referred under the suspicion of PG and
12/31 (39%) were under systemic immunosuppression. All patients had arterial hypertension (100%)
and 18/31 (58%) diabetes. All patients showed a
histology of subcutaneous stenotic arteriolosclerosis, in 22/31 (71%) with media calcification. Peripheral arterial disease was diagnosed in 14/31 (45%).
For treatment, 29/31 (94%) patients underwent
debridement and split skin grafting, in 12/31 (39%)
at repeated occasions. Only 2/31 (6%) healed by
conservative means. Three (9%) patients died from
sepsis, two of them under immunosuppression for
supposed pyoderma gangrenosum.
Conclusions : Martorell’s HYTILU is a clearly defined
entity that can easily be overlooked and confounded
with PG. Diagnosis involves clinical and vascular assessment, together with histological confirmation.
Treatment is based on surgical measures, specifically debridement, vacuum-assisted negative pressure wound treatment, and split skin grafts, often
at repeated occasions. Antibiotic treatment is often
necessary. Immunosuppression is not warranted
and may expose patients to the risk of sepsis.
P 48
Blue toe syndrome revisited, or: 9 conditions
leading to a blue toe
M.D. Anliker, J. Bäte, S. Haug, C. Pournaras
Clinic of Dermatology, St. Gallen
Introduction : The blue toe syndrome is referred to
in the case of cholesterine embolism, but can be a
sign of other diseases with great impact. The intention was to collect cases of blue toes of any cause.
Patients/methods : Subsequently 14 patients with
blue toes of any genesis were examined in an outpatient clinical setting over a course of 6 years.
Clinical clues and known internal diseases could
sometimes lead to an obvious diagnosis, some
times the cause was revealed by specific serologic
examinations, but in the majority of cases biopsy
for histopathological examination was essential in
diagnosis. Only 4 of the patients in the end were
diagnosed having cholesterine embolism, in the
other cases blue toes were the result of sarcoidosis,
systemic lupus erythematodes, borreliosis, paraneoplastic cryoglobulinemia and others more.
Discussion : Causes of a blue toe can differ greatly
and its recognition can lead to the finding of a systemic disease; often the histopathological analysis
is essential.
Treatment
P 49
A case for Mohs Surgery: when to do slow
Mohs and when frozen section Mohs
S. Läuchli, J. Hafner, L. French
Mohs Surgery is a technique allowing histological visualization of the complete surgical margins.
For many skin tumors, it is the treatment of choice,
aimed at achieving the highest possible cure rate
whilst preserving as much healthy tissue as possible. This is especially true for tumors with an invasive growth pattern, such as sclerosing BCC or
DFSP, and/or tumors in difficult anatomical locations. Mohs surgery using frozen sections became
popular in the USA in the 1970’s following publications by Mohs and Tromovitch. Many European
centers prefer an alternative method in the form of
slow Mohs which involves embedding the specimens in paraffin and reading the slides the next
day. At the University Hospital in Zurich, the practice of frozen section Mohs has been implemented
parallel to slow Mohs two years ago. The comfort
of reaching tumor free margins within a few hours
and the efficiency of frozen section Mohs has led
to its quick acceptance. In some instances, slow
Mohs is still preferred, appreciated for its accuracy
in detecting tumor cells in the margins, especially in
tumors such as DFSP and Lentigo Maligna, and for
its feasability with very large tumors. Presenting a
few cases for both methods, their advantages and
disadvantages are discussed.
P 50
Schmerzarme photodynamischen Therapie
PDT durch die Vorbereitung mit 0,075%
Capsaicin Crème.
E.E. Küng, L.S. Steinmann.
Einleitung und Problemstellung: Obwohl die photodynamische Therapie (PDT) schon seit mehreren
Jahren in vielen Spielarten zur Anwendung kommt,
ist sie als Methode noch weit von einer Standardisierung entfernt. Insbesondere die teils ausgeprägten, brennenden Schmerzen während der Beleuchtung sind ein riesiges (Akzeptanz-)Problem bei den
Patienten. Material und Methode: Seit 07/2004
wurden an unserer Praxis gegen 500 Patienten
(Durchschnittsalter 66 J) mit Methyl-Aminolävulinsäure (MALA, Metvix®), ab 02/2005 mit 5-Aminolävulinsäure-Nanokolloidgel (5-ALA) zumeist
wegen aktinischen Keratosen mit dem Aktilite®
CL 128 LED System behandelt. Seit 02/2007 haben
wir begonnen, bei der 5-ALA zur Penetrationsförderung der 5-ALA die Haut vor Auftragen des Gels
mit Wundbenzin zu entfetten. Zusätzlich wurde zur
Seborrhoisches Ekzem
Steroidfrei im Trend
EFALITH® CREME
(Lithiumsuccinat + Zinksulfat)
Die lokale Behandlung mit antimykotischer
und antibakterieller Wirksamkeit.
Rasch, anhaltend und gut verträglich.
Simulation
EFALITH® CREME Widmer.
Zusammensetzung: Wirkstoffe: Lithii succinas 80 mg, Zinci sulfas 0,5 mg. Excipiens ad unguentum pro 1 g. Eigenschaften/Wirkungen:
EFALITH® CREME Widmer eignet sich für die topische Behandlung der seborrhoischen Dermatitis. EFALITH® CREME Widmer ist eine farblose
Wasser-in-Öl-Crème. Die beiden Wirkstoffe Lithiumsuccinat und Zinksulfat haben antiinflammatorische und antipruriginöse Eigenschaften.
Lithiumionen in der Form des Lithiumsuccinats sind wirksam gegenüber Hautentzündungen. Lithium hat bakteriostatische und antimykotische
Eigenschaften. Zinksulfat ist bekannt für seine Wirkung bei entzündlichen Hautläsionen. Indikationen: Seborrhoische Dermatitis. Dosierung/
Anwendung: EFALITH® CREME Widmer wird zweimal täglich, morgens und abends, auf die befallenen Hautstellen aufgetragen und leicht
einmassiert. Die Behandlung wird solange fortgeführt, bis eine Besserung eintritt, normalerweise innerhalb von vier Wochen. Indem EFALITH®
CREME Widmer weniger häufig oder in Intervallen aufgetragen wird, kann der verbesserte Hautzustand längerfristig erhalten werden. Nach jeder
Anwendung sollen die Hände gut gewaschen werden. Nicht bei Kindern und Jugendlichen unter 15 Jahren anwenden. Kontraindikationen:
Bekannte Überempfindlichkeit gegenüber den Wirkstoffen oder einem der Inhaltsstoffe gemäss Zusammensetzung. Vorsichtsmassnahmen:
Kontakt mit Augen und Schleimhäuten ist zu vermeiden. Nicht bei Psoriasis verwenden (unter oraler Lithiumtherapie wurden Exacerbationen
einer Psoriasis beschrieben). Schwangerschaft/Stillzeit: Schwangerschaftskategorie C. Unerwünschte Wirkungen: Leichte und vorübergehende Reizungen an Haut und Augenlidern wurden häufig beobachtet. Packungen: Tube zu 20 ml (B). Stand der Information:
Dezember 2004. Louis Widmer AG, CH-8952 Schlieren.
DER HAUT ZULIEBE
Trockene, raue Haut, Juckreiz und Ekzeme
BAIN EXTRA-DOUX
DERMATOLOGIQUE
Widmer
Zusammensetzung:
Ichthyol® hell 30 mg,
Extractum chamomillae 10 mg,
Guajazulenum 0,25 mg.
Indikationen:
Badezusatz für die
Behandlung trockener,
rauer, ekzematöser Haut.
Bei Ichthyosis, Hyperkeratosen,
Psoriasis, Neurodermitis,
Pruritus, Prurigo.
Dosierung:
2–3 Bäder pro Woche.
Vorsichtsmassnahmen:
Kein Kontakt mit Augen
und Schleimhäuten, übermässige Sonnenbestrahlung
vermeiden.
Packungen:
Flasche zu 250 ml. Liste D.
Kassenzulässig.
Ausführliche Informationen
entnehmen Sie bitte dem
Arzneimittel-Kompendium
der Schweiz.
Louis Widmer AG,
8952 Schlieren
BAIN EXTRA-DOUX
DERMATOLOGIQUE
Der Badezusatz zum Wohle Ihrer Haut
Für die gezielte Behandlung von trockener, rauer Haut und
Juckreiz. Mit rückfettenden, antiseptischen, juckreiz- und
entzündungshemmenden Eigenschaften.
DER HAUT ZULIEBE
Posters
Schmerzdämmung zwischen jeweils 10-30 Minuten
vor der Beleuchtung ein Lidocaingel 2% aufgetragen. Es zeigte sich, bei im Übrigen vergleichbaren
Resultaten, eine deutliche Verbesserung der Schmerzen, allerdings für eine gute Patientenakzeptanz
immer noch nicht genügend. Wir haben deshalb
ab 12/2007 bei allen neuen Patienten zusätzlich
eine 0,075% Capsaicin-Crème (in Excipial Crème)
in der ersten Woche 4/d, in der zweiten Woche 3/d
für zwei Wochen Gesamtanwendungszeit vor dem
Beleuchtungstermin durch die Patienten selber als
Therapievorbereitung auf die zu behandelnden
Stellen mit einem Randsaum von 1-2 cm auftragen
lassen. Resultate: In den ersten Tagen gaben die
Patienten erwartungsgemäss ein leichtes Brennen
nach dem Auftragen der Capsaicin Creme an. In
allen der mittlerweile über 50 Fälle zeigte sich eine
starke Absenkung der Schmerzhaftigkeit während
und nach der PDT, teilweise wurde die Behandlung
sogar nahezu schmerzfrei. Die Aufnahme des Lichtsensibilisators 5-ALA und die erreichten klinischen
Resultate der Behandlungen wurden in keiner Art
und Weise eingeschränkt (Fluoreszenzkontrolle und
klinische Nachkontrollen nach 2 - 3 Monaten). Konklusion: Die Anwendung von Capsaicin 0.075 %
2 Wochen vor PDT löst das Problem der starken
neuropathischen Schmerzen elegant und wird von
den Patienten gut toleriert. Bei richtiger Anwendung ist das Verfahren einfach und sicher.
P 51
MAL-Photodynamic Therapy : Efficacy and
Safety
M.A.M. Rezzonico Corti, C. Mainetti
Servizio Cantonale di Dermatologia, Ospedale
Regionale Bellinzona e Valli
Photodynamic therapy (PDT) is a treatment modality mainly used for nonmelanoma skin cancers
(NMSC) and their precursors. This study evaluates
the efficacy and the safety of methyl-aminolaevulinate (MAL)-PDT in our clinic. During a three months
period ending January 2008, we enrolled 46 patients affected with 120 actinic skin precanceroses
or NMSCs treated with MAL-PDT. The outcome of
the therapy was checked 8 weeks after the end of
the treatment. The healing rate was 88.0% (73 of
83 lesions) for actinic keratoses, 100% (9) for Bowen diseases and 88.9% (16 of 18) for basocellular carcinomas; 65% of the treated lesions had no
side effects after PDT and 90% of them healed. The
most frequent cosmetic discomfort was skin discoloration. MAL-PDT can be considered efficient and
safe. According to our results, the profile of the patient with the highest relapse risk is: a man, treated
on the scalp or on the back of the hands in a field
cancerisation area. Similary to literature, 35% of
the patients presented at least one permanent side
effect independently from localization or gender.
P 52
MAL-Photodynamic Therapy: Pain, Phototoxic Reaction and Patient Satisfaction
M.A.M. Rezzonico Corti, C. Mainetti
Servizio Cantonale di Dermatologia, Ospedale
Regionale Bellinzona e Valli
Photodynamic Therapy (PDT) can cause pain and
a phototoxic reaction (PTR) resulting in erythema,
edema and crusting. These conditions are considered transitory side effects and the resulting discomfort is often underestimated. We describe our
experiences with 46 patients affected with 120
lesions treated with MAL-PDT, all of whom were
treated in our clinic and enrolled between November 2007 and January 2008. We interviewed each
patient about pain, grade of PRT and personal satisfaction after 8 weeks of treatment. As expected,
pain is higher during irradiation then during curettage or after irradiation. Twenty-seven lesions
(22.5%) reported very high pain during irradiation
and 54% of lesions reported pain after irradiation
for an average time of 19 hours. Approximately
80% of the lesions reported light or no PTR; 90%
of the patients showed a good or very good final
satisfaction for the executed PDT. Overall, we found
that pain generated by topical MAL-PDT causes a
remarkable discomfort. Lesions on the head (scalp
and forehead) or field cancerisations areas are risk
factors for high pain or for a strong or medium
PTR.
P 53
Pyogenic granuloma treated with pulsed
Nd:YAG (1064nm) laser - a case series
C. Gex-Collet, P.H. Itin, K. Scherer.
Introduction : Pyogenic granuloma (PG) is a common, benign vascular tumour of the skin or mucosa.
A variety of therapeutic approaches such as surgical
excision, curettage, shave excision with or without
cautery, cryotherapy, scleroytherapy, imiquimod or
different laser therapies are available. Considering
the benign character treatment options with a good
“cost-effectiveness” especially in view of expenditure
and scarring should be preferred. We present a series of patients treated with the pulsed Nd:YAG laser.
Patients and methods : We present 15 patients
with solitary PGs on the acres (7), on the face (4),
the extremities (2) and on the trunk (1). All patients
were treated with the pulsed Nd:YAG laser at 1064
nm with an average fluence of 120J/cm2, spotsize
of 5-7mm and pulselenght of 20-30ms. Results: In
14/15 patients treatment with Nd:YAG-laser was
successful. Repeated pulses were applied. On average, 1.6 treatment sessions were needed. Scarring
has only been noted in one patient.
Conclusion : A variety of options exist for the treatment of PG with more or less significant side effects.
No single treatment can be reasonably applied for
all sizes and locations. Nd:YAG laser therapy is a
valid and valuable option in the therapeutic armament of PG.
P 54
Life-threatening or organ impairing HenochSchönlein Purpura: Plasmapheresis may save
lives and limit organ damage
D. Donghi, U. Schanz, A. Fontana, R.M.
Trüeb, L.E.French, J. Hafner
Adult onset Henoch-Schönlein purpura tends to
become chronic-relapsing, however rarely leads to
organ impairment, e.g. due to chronic glomerulonephritis. Bed rest, compression and non-steroidal
antiinflammatory drugs are usually sufficient to
control the active phases. We report on two cases
of adulthood Henoch-Schönlein Purpura with an
unusually severe evolution. One patient required intense care treatment for hypovolemic shock caused
by hemorrhagic pancolitis, the other had progressive and extremely extensive vasculitic leg ulcers.
Both were refractory to common immunosuppression with systemic corticosteroids (oral and pulse)
and additive steroid-sparing immunsuppressive
drugs. Only after introduction of plasmapheresis
both patients showed a dramatic improvement of
the disease, with rapid and almost complete healing. Plasmapheresis is an exceptional therapeutic
tool in the treatment of severe HSP, but the growing
literature on its highly beneficial effect underlines
the potential usefulness.
P 55
Successful treatment of recalcitrant palmoplantar pustular psoriasis with sequential
use of infliximab and adalimumab
N. Yawalkar, R. Hunger
Bern
Palmoplantar pustular psoriasis is characterized by
recurrent crops of sterile intraepidermal pustules,
erythema, fissuring, and scaling. The disease causes
considerable physical disability and treatment regimes often remain unsatisfactory. Although some
case reports indicate that TNF inhibitors may be
helpful in the treatment of pustular psoriasis, other
reports have also described paradoxical induction
of pustular psoriasis by TNF inhibitors and have
cautioned the use of these agents in PPP. We re41
Posters
port a case of successful treatment of recalcitrant
palmoplantar pustular psoriasis with two different
TNF inhibitors in a 48-year-old woman unresponsive to other treatment modalities including different topical preparations, phototherapy, acitretin
and methorexate. The patient also suffered from
psoriatic arthritis. Rapid improvement was initially
achieved after three infusions of infliximab. In correlation with clinical improvement histological
and immunohistochemical analysis of skin lesions
demonstrated a marked reduction of the proinflammatory infiltrate and TNF-α. After discontinuation of infliximab due to an infusion related
reaction remission was obtained with treatment of
adalimumab. This case demonstrate that infliximab
may represent a useful therapeutic option to obtain
rapid relief of recalcitrant palmoplantar psoriasis
and that switching from infliximab to adalimumab
is feasible.
P 56
The mTOR inhibitor Rapamycin significantly
improves facial angiofibroma lesions in a tuberous sclerosis patient
F.L..Günther, A. Hofbauer, A. MarcolloPini, A. Corsenca, D. Andreas D. Kistler,
L.E. French, R.P. Wüthrich, A.L. Serra
Tuberous sclerosis patients present with typical
skin changes such as ash-leaf-like hypopigmented
macules, Shagreen patch, molluscum pendulum,
forehead fibrous plaque, confetti-like macules,
Koenen tumors and facial angiofibromas Facial angiofibroma is probably the most vexing skin change
for tuberous sclerosis patients. Here we report on
a patient with tuberous sclerosis who underwent
a renal transplantation. Initial immunosuppressive
treatment with tacrolimus was later switched to rapamycin, a specific mTOR inhibitor with anti-angiogenic potential. Subsequently, we observed great
improvement of facial angiofibroma following rapamycin introduction, suggesting a pivotal role for
mTOR in the formation of angiofibroma. We present the first clinical case for the effect of rapamycin
on facial angiofibroma as proof-of-concept in man.
Our patient demonstrated an impressive reduction
of facial angiofibroma in response to rapamycin
treatment. The hamartin-tuberin complex regulates the activity of the downstream kinases mTOR,
p70S6kinase, 4E-BP1 and ribosomal S6 proteins.
mTOR pathway proteins are upregulated in TSC tumor cells. Rapamycin specifically inhibits mTOR and
has therefore been identified as a potential therapeutic agent This case provides proof of concept
that development of facial angiofibromas can be
stopped and dramatically reversed under therapy
42
with the mTOR-inhibitor rapamycin.
P 57
Facelift for reconstruction of large facial defects
AUTEURS :
B. Noel, R.G. Panizzon
Reconstruction of large facial defects after excision
of cutaneous malignancies may represent a challenge for dermatologic surgeons. We demonstrate
that facelift can be used as an advancement flap
for the reconstruction of large facial defects. The
procedure is performed under local tumescent anesthesia. The redundant skin of the lower face is
mobilized with extensive subcutaneous undermining. To improve skin mobilization and reduce suture
tension it is important to mobilize the subcutaneous musculoaponeurotic system (SMAS) which
lies just deep to the subcutaneous fat. Release of
mandibular, platysma and zygomatic ligaments give
additional skin mobilization. The SMAS is plicated
with a posterosuperior vector by means of two
purse-string sutures firmly fixed to the zygomatic
arch. Skin excess is excised to adjust the wound
edges. Interrupted sutures are used for skin closure.
Controlateral facelift can be performed for cosmetic
reasons if necessary. Large cheek and temporal defects can be easily closed with this procedure. Excellent functional and cosmetic results are obtained.
Basic Research
P 60
NLR activity in contact hypersensitivity: a
role of Langerhans cells and/or Keratinocytes
H. Watanabe , E. Contassot, S. Roques,
A. Caillon, L.E. French, O. Gaide
We have previously shown that contact hypersensitivity (CHS) due to dinitrochlorobenzene, is dependent on the inflammasome. We found that the importance of the inflammasome is mainly restricted
to the sensitization phase of CHS. At this stage,
Langerhans cells and bone marrow dendritic cells
are thought to play a more important role than T, B,
NK and Mast cells. We set to determine which cells
require an inflammasome to prime T cells in CHS, using both in vitro studies on primary cells, and in vivo
studies in mice. We found that neither Langerhans
cells lines nor primary dendritic cells can activate
IL-1b in response to contact sensitizers. However,
both cells responded well to classic LPS containing
the NLR activator muramyldipeptide. Conversely,
keratinocytes secreted significant amounts of IL-1b
in response to contact sensitizer but not LPS. Similarly, UV irradiation, another inflammasome-trigger,
induced significant response in keratinocytes only.
Taken together, these data may suggest that keratinocytes are the main target of CS. To further refine
this question, we have generated chimeric mice
that either contain an inflammasome-deficient
bone-marrow or skin. CHS responses in these mice
suggest that radio-resistant skin resident cells are
the major source of inflammasome-driven IL-1b.
P 61
Antimicrobial Proteins in Acne Inversa
C. Schlapbach, N. Yawalkar, R.E. Hunger
Bern
Acne inversa (hidradenits suppurativa) is a chronic
inflammatory disorder of the apocrine gland-bearing
skin. Its pathogenesis is still poorly understood and
the role of the immune system in the maintenance or
even genesis of the disease is controversial. Recent
studies showed varying expression of antimicrobial
peptides (AMPs) by the innate immune system in
other chronic inflammatory diseases of the skin. We
therefore investigated the expression of AMPs in
acne inversa using real time PCR analysis and immunohistochemical staining. mRNA levels of AMPs
were found to be significantly increased in acne inversa. This result was confirmed for psoriasin on the
protein level, which was located in the epidermis.
Interestingly, the protein expression of hBD-2 in the
epidermis of acne inversa lesions was decreased,
but a large number of macrophages expressing
hBD-2 were found in the dermis. We conclude that
AMPs are highly overexpressed in acne inversa lesions as compared to normal skin. However, the site
of the major expression seems to depend on the
particular AMP. Psoriasin is overexpressed in epidermal keratinocytes whereas hBD-2 seems to be
produced mainly by dermal macrophages.
P 62
Cutaneous squamous cell carcinoma progression is associated with increased inflammation: Immunosuppression reduces
CD123+ and FOXP+ cells
B. Mühleisen, I. Petrov, T. Gächter, M.
Kurrer, L. Schärer, R. Dummer, Lars E.
French, Günther F.L. Hofbauer
The immune system fights atypical keratinocytes
in the progression to squamous cell carcinoma of
the skin (SCC). Drug-induced immunosuppression
in organ transplant recipients (OTR) dramatically in-
Posters
creases cutaneous carcinogenesis 60- to 100-fold.
We analyzed local inflammation in the paired biopsies of intraepithelial and invasive SCC in immunocompetent patients and OTRs. We studied
peritumoral SCC inflammatory infiltrate assessing
diameter, density and phenotype (CD3, 4, 8, FOXP3,
CD123, STAT1) by immunohistochemistry. Immunocompetent patients’ lesions were compared
to OTRs’ lesions. Considerable inflammation was
observed in all intraepithelial SCC (inflammatory
infiltrate diameter 2.80 mm ±2.21 immunocompetent pts, 2.15 mm ±2.95 OTRs). Inflammation was
more pronounced in invasive SCC of immunocompetent patients (4.60 ±4.67 mm) and OTRs (3.30
±5.90 mm) respectively (p<0.005). The density of
peritumoral inflammatory infiltrates increased from
intraepithelial to invasive SCC (p=0.005). Compared to immunocompetent patients, OTRs show
a lower density of peritumoral inflammatory infiltrate (p=0.041). OTRs also show reduced CD3+
and CD8+ cell proportions in intraepithelial SCC
(p=0.025 and 0.027, respectively). FOXP3+ cell
proportions in OTRs’ invasive SCC are markedly diminished (p=0.048). CD123+ cells increase in the
progression from intraepithelial to invasive SCC in
immunocompetent patients (p=0.040). CD123+
cells are reduced in all SCC of OTRs (p=0.036).
Intraepithelial SCC is accompanied by pronounced
inflammation both in immunocompetent patients
and OTRs. Invasive SCC is associated with further
increased inflammation overall. Here, OTRs show
compromised quantity and quality of inflammation, in particular reduced proportions of FOXP3+
regulatory T cells and CD123+ pDCs. This distinct
inflammatory infiltrate may contribute to the increased cutaneous carcinogenesis and more aggressive behavior of SCC in OTRs.
P 63
Increased expression of IL-12p70 and IL-23
by multiple dendritic cell and macrophage
subsets in plaque psoriasis
:
A. Hassan, G. Tscharner, R. Hunger, N.
Yawalkar
Bern
Psoriasis is an immunologically mediated disease
with T cells exhibiting a type 1 cytokine pattern in
lesional skin. Previous reports indicate that various
cytokines including IL-12 and IL-23 play a critical
role in inducing and maintaining psoriatic skin lesions. However, the relative contributions of IL-12
and IL-23 in inducing inflammation and the cellular
source of these cytokines have not been thoroughly
analyzed so far. We sought to investigate the expression of IL-12p70 and IL-23 in plaque psoriasis and to characterize the dendritic cell (DC) and
macrophage subsets responsible for the production
of these cytokines. Skin biopsy specimens were
obtained from 11 patients with plaque psoriasis.
Immunohistochemistry using monoclonal antibodies targeting IL-12p70 and IL-23 was performed
on serial cryostat sections using the avidin-biotin
complex/alkaline phosphatase method. Colocalization of IL-12 and IL-23 with different dendritic cell
(CD1a, CD11c) and macrophage cell (CD14, CD32)
markers was performed using double immunofluorescence staining. Increased immunoreactivity for
both IL-12p70 and lL-23 was detected in psoriatic
skin lesions. IL-12p70 and lL-23 were readily detected in CD11c+, CD14+, CD32+ cells. IL-12p70
and to a lesser extent lL-23 were also found in
some CD1a+ dendritic cells. An enhanced expression mainly of lL-23 was also observed in keratinocytes. In conclusion, IL-12p70 and lL-23 are highly
expressed in psoriasis and both cytokines may play
crucial role in the pathogenesis of this disease. Different DC and macrophage subsets are important
sources of IL-12 and lL-23 which could be valuable
therapeutic targets in the treatment of psoriasis.
P 64
On the search for ligands and biological
functions of LY6/PLAUR proteins in the epidermis
B. Favre, L. Plantard, B. Riederer, D.
Hohl
Lymphocyte antigen 6/plasminogen activator urokinase receptor (LY6/PLAUR) proteins are extracellular
protein-protein interaction modules. Our previous
studies have demonstrated that several LY6/PLAUR
proteins are expressed in the epidermis, suggesting
that they play a role in skin homeostasis. To identify
the ligand and biological function of the LY6/PLAUR
LY6D, LYNX1B, LYPD2 and SLURP1 we tested several
approaches. Tagged and secreted constructs of LY6/
PLAURs were expressed in transfected 293T cells.
Conditioned medium was then used in binding experiments on keratinocytes in culture and human
skin sections and co-immunoprecipitation experiments, but negative results indicated that anti-tag
antibodies were not sensitive and specific enough
for these applications. Therefore, we expressed
recombinant LY6/PLAURs in bacteria and raised
polyclonal antibodies against the purified proteins.
Affinity columns were prepared to purify polyclonal
antibodies and to isolate potential LY6/PLAUR ligands. Highly specific affinity-purified antibodies
are presently used for analysis of the expression of
LY6/PLAURs in human skin and co-immunoprecipitation studies. Since LYNX1B and SLURP1 are more
abundant in the suprabasal layers of the epidermis
than the basal layer, we investigated the effect of
secreted LY6/PLAUR conditioned medium on differentiation of cultured keratinocytes. Western blotting
analysis revealed a higher expression of keratins
1 and 10 in cells incubated with LYNX1B.
P 65
Role of the TRAF interacting protein (TRIP) in
keratinocyte proliferation
S. Almeida, N. Zosso, S. Chevalley, D.
Hohl, M. Huber
We have recently shown that the tumor suppressor
CYLD can interact with the TRAF interacting protein
TRIP/TRAIP. TRIP has been identified as a RING-type
E3 ubiquitin ligase. TRIP can inhibit NF-kappaB
activation mediated by TNFalpha. Moreover, TRIP
knockout was associated with early embryonic lethality in mice. Our goal is to investigate the role
of TRIP in epidermal homeostasis. Primary keratinocytes derived from human foreskin were cultured in
low-calcium serum free medium and keratinocyte
differentiation was induced after supplementation
of medium with 1.2 mM calcium. We found that
TRIP expression was significantly diminished four
days after calcium-shift. Moreover, puromycinselectable lentivirus expressing small hairpin RNA
(shRNA) directed against TRIP mRNA was used to
knock-down TRIP in cultured primary keratinocytes.
Preliminary evidence showed that TRIP knock-down
was associated with arrest of proliferation. These
results suggest that TRIP has an important role in
the regulation of proliferation/ differentiation in
keratinocytes.
P 66
CD1d gene expression and function in human epidermal keratinocytes after UVB exposure.
S. Ryser, M. Vihanto, D. Hohl, A.M.
Moodycliffe
Human epidermal keratinocytes (KC) are important
components of the skin immune system. During
inflammation, they produce a variety of cytokines
that recruit inflammatory cells and skin-homing
lymphocytes to the site of cutaneous tissue injury,
and express class I and II MHC molecules that
present antigen to T-cells. CD1d is a specific class I
MHC-like molecule, which has the ability to present
glycolipids to natural killer T (NKT) cells. In epidermal tissues, the activation of NKT cells by CD1dglycolipids has an important role in the regulation
of innate and adaptive immune responses. Recent
findings suggest in addition that CD1d could also
function in a NKT-cell independent manner. In this
study we investigated whether keratinocyte CD1d
directly regulates the innate immune function of
43
Posters
human KC in response to UVB exposure. We analyzed the release of pro-inflammatory cytokines in
normal and CD1d-deficient KC after exposure to
different doses of UVB radiation. Gain-of-function
studies were also performed using lentiviral vectors
expressing wt or mutant CD1d to assess its role in
regulating cytokine production and as a pro-survival factor after UVB exposure. In summary this work
will help to define the physiological role of CD1d in
human skin and contribute to our understanding of
the role of CD1d in the etiology of UV-induced skin
pathologies.
P 67
Skin ageing in Chinese women correlated to
photoexposure
M. Bigliardi-Qi1, F. Bonté2, V. Nollent2,
Chen Zhiqiang3, P.L Bigliardi1
1. Departments of Dermatology, CHUV Hôpital,
Lausanne,
2. LVMH recherché, St Jean de Braye, France
3. Chinese Academy of Medical Science, Institute
of Dermatology, Nanjing, China
There exist not many studies correlating the morphological and Immunohistochemical changes
of ageing skin between photoexposed and notexposed skin of the same patient. There exist even
less data In the asian population. For the production of skin care products It will be Important to
have these Informations. Therefore we designed
a clinical study to compare sun-exposed skin and
unexposed skin in Chinese women from different
age groups. The volunteers were recruited in the
south of China, the region of Nanjing. All volunteers signed a confidential disclosure agreement
and the volunteers had to fill out a questionnaire
and photos were taken from the skin before the biopsies. A total of 30 healthy Chinese women, aged
between 22 and 63 years were recruited and divided into young and old group (for each age group
6 volunteers 20-29 years/30-39 years/40-49 years/
50-59 years and 60-69 years). Skin punch biopsies
(3 mm) were taken from the anterior surface of
the upper arm (protected area) and the posterior
surface of the forearm (exposed area). The samples
were fixed in formaldehyde and embedded in paraffin for further analysis. The epidermal and stratum
corneum thickness at exposed area is thinner than
unexposed area. The thickness increases with age
and peak the highest between 40-60 and decrease
afterwards This hypertrophy is probably a sign for
physical protection of the skin from UV light. As expected, the sun-exposed skin expressed in general
significantly more melanine than the non-exposed
skin areas, however this overexpression of Melanin
was only significantly increased in the age group
60-70. In addition, further investigation was conducted on caveolin-1, principle structural compo44
nent on caveolae. Caveolin-1 in epidermis is related
with differentiation and in dermis related to senescence phenotype in fibroblasts. In epidermis, the
caveolin-1 expression is increased after photoexposure in keratinocytes (especially for younger group),
but decreased with age only in the photoexposed
skin. In dermis, no significant changes in photoprotected zone were observed. However, in photoexposed zone, the caveolin-1 expression decreased
with age. Caveolin-1 expression decreases with age
in epidermis and dermis under UV influence. Therefore Caveolin-1 expression could be an indicator
for UV-induced senescence in skin.The expression
of different opioid receptors in skin was measured
and showed interesting correlation to the abovementioned results. The opioid receptor expression is
changed with age, but not with photoexposure.
P 68
Comparison of the depigmenting properties
of retinoic acid and retinaldehyde
B. Kasraee, O. Sorg and JH Saurat
:
We used various in vitro and in vivo models to
compare the depigmenting activities of retinoic
acid (RA) and retinaldehyde (RAL). In cultured
murine B16 melanocytes, the non-cytotoxic concentration of 1 µM of RA and RAL decreased the
melanin content by 61% and 77%, respectively.
The genomic analysis by qPCR showed no modulation of the genes involved in melanin synthesis
and melanosome maturation, such as tyrosinase,
TRP1, dopachrome tautomerase, and pmel17. Topical application of RA and RAL 0.05% on mouse
tail skin for 3 weeks decreased the melanin content
by 50% and 80%, respectively, and decreased the
density of active melanocytes by 50% and 75%,
respectively, as shown by the ability of melanocytes
to convert DOPA to melanin. When applied to the
ears of black guinea pigs, 0.01% RAL decreased
epidermal melanin by 50%; electron microscopy
analysis showed that the density of melanosomes
in keratinocytes was decreased by 62%, whereas
the density of melanosomes in melanocytes was
unchanged. Thus RAL, the natural precursor of RA,
which is less irritating when applied on human skin,
showed better depigmenting properties than RA in
various models. This indicates that RAL should be
considered as a key partner in topical depigmenting
preparations.
P 69
First identification of hydroxylated polychlorinated dibenzodioxins as metabolites
of TCDD in human
O. Sorg, M. Zennegg, P. Schmid , R. Fedosyuk, R. Valikhnovsky, V. Kniazevych,
J.H. Saurat
We have performed various prospective investigations to follow-up the routes of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) elimination in a patient
suffering from severe TCDD poisoning. Based on
TCDD analyses of the known routes of elimination (faeces, skin lesions and sweat), only 40% of
the amount estimated from the decrease of TCDD
in the fat compartment over a period of one year
could be recovered mainly in the faeces. In order
to identify possible TCDD metabolites which may
account for this difference, faeces and urine were
analyzed using gas chromatography high resolution mass spectrometry (GC/HRMS). We identified
a monohydroxy-tetrachlorodibenzo-p-dioxin (OHTCDD) in faeces and in urine (where TCDD was
likewise undetectable), and a monohydroxy-trichlorodibenzo-p-dioxin (OH-TriCDD) only in faeces.
The total of the faecal concentrations of these two
metabolites was similar to the faecal concentration
of unmetabolized TCDD, and accounted for another
40% of the total TCDD elimination from the body.
This is the first identification of TCDD metabolites in
humans. If humans are indeed able to hydroxylate
TCDD any intervention supporting such a pathway
could decrease the long TCDD half-life, which represents the major problem in the treatment of patients intoxicated with TCDD.
P 70
Identification of function of RAIDD in UVinduced skin tumor formation
S. Roques, A. Caillon, J. Tschopp, O.
Gaide
PIDD is a recently identified protein that forms a
signaling complex triggered by UV-induced genotoxic stress. PIDD activation has been suggested
to induce, sequentially, two opposing effects. It
activates the protein RIP-1 and the survival factor
NF-kB and then recruits and activates caspase-2 via
the adaptor protein RAIDD and induces apoptosis.
The balance between these life and death signals
has been proposed to act as a DNA damage/repair
checkpoint. However, this assumption is based on
in vitro studies and little is known on the role of
this signaling complex in vivo. As the skin is the pri-
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Posters
mary organ affected by UV-induced DNA damage,
we have generated RAIDD deficient mice in the hairless albinos mouse strain, in order to observe their
response to UV treatment. Surprisingly, we found
that, after 20 weeks of irradiation at 80mJ of UVB
thrice a week, mice deficient for RAIDD had significantly less tumor (squamous cell carcinoma: 10.8 vs
1.8) then their littermate controls. Taken together,
these results suggest that the RAIDD caspase-2 signaling pathway does not lead to apoptosis, which
is consistent with the observation that apoptosis is
not affected in caspase-2 deficient mice.
Genetics
P 72
Buschke-Ollendorff Syndrome: Genetics in a
three generation family and a brief review
of the literature
B. Burger, J. Galambos, P. Itin
Klinik für Dermatologie, Universitätsspital Basel :
Buschke-Ollendorff syndrome (BOS, OMIM
#166700) refers to the association of connective
tissue nevi and osteopoikilosis (OPK), a benign
sclerosing skeletal dysplasia, characterized by
widespread foci of osteosclerotic trabeculae radiologically showing small rounded or linear opacities.
BOS is a rare disorder (incidence is thought to be
about 1 : 20’000), inherited in a pleiotropic autosomal dominant mode with variable penetrance
and considerable phenotypic heterogeneity. Both
OPK and connective tissue nevi may also occur as
uncommon isolated familial conditions, and are also
characterized by an autosomal dominant mode of
inheritance. The first case of BOS was described by
Buschke and Ollendorff in 1928. In 2004 heterozygous loss-of-function mutations in the LEMD3 gene
were discovered in both BOS and OPK. In 2007 a
mutation in the same gene was found in a family
with isolated connective tissue nevi (without OPK).
Since then 22 germline mutations in the LEMD3
gene were described causing different phenotypes
with skin and/or bone involvement, i.e. OPK, BOS,
and familial connective tissue nevi. We present a
three generation BOS, caused by a novel mutation
in the LEMD3 gene and discuss possible genotypephenotype correlations reviewing the described
mutations in the literature.
P 73
A new homozygous KIND1 mutation in a
Swiss family with KS and recurrent actinic
keratoses
P. Itin, L. Bruckner-Tuderman, C. Has
Kindler syndrome (KS) is a rare, autosomal recessive
46
skin fragility disorder characterized by blistering in
infancy, followed by photosensitivity and progressive poikiloderma. In addition, progressive skin
atrophy and premature aging, severe periodontal
disease, colitis and occasionally carcinogenesis may
occur. KS is caused by loss-of-function mutations in
the KIND1 gene which encodes kindlin-1, an actin
cytoskeleton-focal contact-associated protein predominantly expressed in keratinocytes. We report
on a new Swiss family with KS. The index patient is
a 62-year-old male patient with neonatal blistering,
photosensitivity with poikiloderma, ectropion and
conjunctivitis on both eyes, atrophic skin on hands
and feet, numerous actinic precanceroses, severe
periodontal disease and urethral stenosis. Recurrent
precancerosis started ten years ago in sun exposed
skin and was treated with cryosurgery, imiquimod
and topical 5-fluorouracil. The patient has three
sisters, one died soon after birth because of severe
blistering disease. The second sister has also skin
blistering associated with sclerodermiform lesions.
The third sister is unaffected. Mutation analysis of
the index patient showed a homozygous mutation
in exon 3 of the KIND1 gene on codon 110 which
results in an exchange of arginine and leads to a
stop codon. This finding represents a new mutation
in KIND1 which leads to a complete phenotype of
KS. To the best of our knowledge, our patient is the
oldest to be definitely diagnosed with KS by genetic analysis. Among the around 100 patients with
known KIND1 mutations, 4 patients were reported
to have SCC, or actinic keratoses. Further investigations will aim to the question why these patients
develop actinic precancerous lesions and epithelial
malignancy.
P 74
An In Vitro Model for Epidermolytic Hyperkeratosis
M. Obarzanek-Fojt, B. Favre, M. Huber,
D. Hohl
Service de dermatologie et vénéréologie, CHUV :
Epidermolytic hyperkeratosis (EHK) is an autosomal-dominant skin disorder, which is characterized
by erythroderma and blistering early in life and the
development of hyperkeratotic lesions with age.
Mutations responsible for EHK occur in keratin 1
(KRT1) or keratin 10 (KRT10) gene. To study the mechanism underlying the disease we established an
in vitro model. For this purpose we used a lentivirus
system for expression of a mutated form of KRT10.
The missense mutation (R156H) in the rod domain
of keratin 10, reported to cause a severe phenotype
in patients, was introduced in KRT10. Primary keratinocytes infected with lentiviruses carrying wild type
Myc-KRT10 or mutated Myc-KRT10 were cultured
in serum free condition and differentiated in high
Ca2+. Exogenous wild type keratin 10 formed in-
termediate filaments with endogenous keratin 1.
However keratinocytes expressing mutated keratin
10 showed collapse of intermediate filaments. To
increase the severity of the phenotype, we applied
20 % stretch to cells growing on silica membranes.
Alterations in stress response in keratinocytes, expressing wt-KRT10 versus mutated-KRT10 is being
analysed.
P 75
Ectodyplasin A as a treatment for XLHED,
new lessons from the dog model
O. Gaide, M.L. Casal, J.R. Lewis, E.A.
Mauldin, A. Tardivel, K. Ingold, M. Favre, F. Paradies, S. Demotz, P. Schneider
P
Loss of function mutations in ectodysplasin A (EDA)
results in X-linked hypohidrotic ectodermal dysplasia (XLHED). We have previously shown that a
recombinant soluble form of EDA has the potential
to revert the disease in mice. Maximal efficacy was
achieved when the protein was administered to
the developing embryo. This raised concern as to
the feasibility of the treatment in humans, as regulations agencies limited a potential human trial
to post-natal treatment. We therefore assessed the
potency of the molecule in newborn dogs suffering
from the disease. We found that, after treatment
with EDA, significant normalization of lacrimation
and resistance to eye and airway infections and improved sweating ability was achieved in all XLHED
dogs. Importantly, whereas primary dentition was
not salvaged by the treatment, adult dentition was
corrected in four of five treated dogs. This suggest
that post-natal treatment may positively impact on
the most significant clinical aspect of the disease,
suggesting that the therapeutic window is wider
than expected from the mouse study. Hence, we
provide further proof of concept necessary for a
human trial and demonstrate an unexpected postnatal role of EDA in the development of secondary
dentition.
Protection solaire pour
peaux intolérantes et allergiques
La gamme blanche de lÉau thérmale Avène
•
•
•
•
•
100% protection minérale (TiO2 + ZnO)
Sans parfum
Protection cellulaire active avec Pré-tocophéryl
Certificat de conformité pour UVA
Riche en Eau thérmale Avène apaisante
Indications
Allergie aux filtres chimiques • peaux atopiques • cicatrices récentes •
photosensibilité médicamenteuse • bébés et enfants de moins de 3 ans
LES LABORATOIRES DERMATOLOGIQUES AVÈNE
sont partenaires de la
Renate K., aus Mönchaltdorf
Mit Freude wieder Bürofachfrau
Mehr als nur Symptomlinderung
Umfassende Therapie
bei Psoriasis*
Der einzige humane TNF␣-Rezeptor 1
Langanhaltende, starke Wirksamkeit 2
Weltweit Nr. 1 – meistverschriebenes Biologic 3
bei entzündlichem Rheuma und Psoriasis*
Because ordinary is not enough.
Referenzen:
1 Enbrel® Fachinformation (www.kompendium.ch) 2 Stephen Tyring et al. Long-term safety and efficacy of 50 mg of Etanercept twice weekly in patients with psoriasis. Arch Dermatol. 2007; 143: 719-726. 3 IMS 2007
Gekürzte Fachinformation: Enbrel® (Etanerceptum)
Indikation: *Aktive rheumatoide Arthritis (RA), Psoriasis-Arthritis (PsA) und juvenile chronische Arthritis (JCA), wenn das Ansprechen auf eine vorhergehende Therapie mit krankheitsmodifizierenden Antirheumatika (DMARD)
unzulänglich war, bei Erwachsenen mit schweren aktiven und progressiven Formen der RA ohne Vorbehandlung mit Methotrexat, bei Ankylosierender Spondylitis (AS) / M. Bechterew ohne Ansprechen auf konventionelle Therapie
sowie bei Erwachsenen mit mittelschwerer bis schwerer Psoriasis (Pso). Dosierung: Erwachsene: 25 mg 2 x wöchentlich s.c. RA, AS und PsA alternativ: 50 mg 1 x wöchentlich. Kinder und Jugendliche
(4 – 17 Jahre): 0.4 mg / kg KG (max. 25 mg pro Dosis) 2 x wöchentlich s. c. Pso: Alternativ 2 x 50 mg initial für 12 Wochen. Kontraindikationen: Überempfindlichkeit gegen den Wirkstoff oder einen der sonstigen Bestandteile.
Sepsis oder Risiko einer Sepsis. Die Behandlung sollte bei Patienten mit bestehenden Infektionen nicht begonnen werden. Vorsichtsmassnahmen: Infektionen, dekompensierte Herzinsuffizienz,
allergische Reaktionen,hämatologische Reaktionen und ZNS-Störungen sowie höheres Risiko für Lymphome und maligne Erkrankungen beachten. Schwangerschaft / Stillzeit: Die Anwendung
von Enbrel® bei schwangeren und stillenden Frauen wird nicht empfohlen. Unerwünschte Wirkungen: Infektionen (einschliesslich Infektionen der Atemwege & schwerwiegende Infektionen),
Malignome, Autoantikörper. Seit Markteinführung wurde über Fälle von Blutbildungsstörungen und ZNS-Demyelinisierungsstörungen berichtet. Reaktionen an der Injektionsstelle. Interaktionen:
Wyeth Pharmaceuticals AG
Methotrexat hat keinen Einfluss auf die Pharmakokinetik von Etanercept. Packungen: 4 Fertigspritzen zu 25 mg** oder Stechampullen zu 25 mg**. 2 Fertigspritzen zu 50 mg** oder Stechampullen
Grafenauweg 10, 6301 Zug zu 50 mg**. Lagerung bei 2 – 8 ° C. Verkaufskategorie B. ** Kassenzulässig. Ausführliche Informationen siehe Arzneimittel-Kompendium® der Schweiz oder www.documed.ch.

Dermatologica Helvetica

Transcription

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