DefinitionSchwitzen ist ein physiologischer, lebensnotwendiger Prozess, bei dem aus den ekkrinen Schweißdrüsen ein wässriges Sekret abgegeben wird. Durch die rasche Verdunstung des Schweißes wird dem Körper Wärme entzogen, so dass der Organismus vor Überhitzung geschützt wird. Die hierzu erforderliche Schweißmenge kann mehrere Liter pro Tag erreichen. Im Gegensatz dazu bezeichnet der Begriff Hyperhidrose, ein Übermaß an Schwitzen, welches über die Erfordernisse der Wärmeregulation hinausgeht. Hyperhidrose wird daher nicht anhand der Schweißmenge, sondern aufgrund der Fehlfunktion des Schwitzens definiert. Diese Fehlfunktion kann zu erheblichen sozialen und beruflichen Einschränkungen führen und damit eine ausgeprägte Verminderung der Lebensqualität hervorrufen.

Chronic ulcerative stomatitis (CUS) has recently been described as a new disease entity characterized by chronic ulceration of oral mucosa which responds to treatment with hydroxychloroquine. It has a particular type of stratified epithelium-specific, antinuclear autoantibody as an immunological marker. Twelve cases have been reported in the literature. We present a 40-year-old woman with an 11-year history of chronic oral ulcerations. Other dermatological diseases, including oral lichen planus, pemphigus vulgaris and cicatricial pemphigoid, as well as bullous lupus erythematosus, were excluded. The clinical diagnosis of CUS was confirmed on the grounds of the immunological and ultrastructural findings. The lesions initially responded to high doses of systemic corticosteroids but relapsed promptly after dose reduction. Dapsone was ineffective. Hydroxychloroquine, given at a dosage of 200-400 mg/day, led to a complete and long-lasting remission.

Clear cell hidradenoma was diagnosed in a girl at 3(1/2) years of age. Only one case of hidradenoma has been documented in the first decade of life, although it remains unclear whether it was clear cell hidradenoma. This case demonstrates that clear cell hidradenoma is a rare differential diagnosis of cutaneous tumors even in young children, which is of special interest, because malignant transformations can occur.

Focal hyperhidrosis can have a considerable impact on social and occupational activities and be associated with significant impairment in quality of life. Primary (idiopathic) hyperhidrosis is neither caused by systemic disorders nor by external factors. It usually occurs in areas characterized by a high density of sweat glands such as the axillae and hands. The diagnosis of focal hyperhidrosis is based on history and clinical findings. Supplementary diagnostic tests include gravimetry (measurement of the amount of sweat) and the iodine starch test (which shows the area of sweating). Treatment options consist of topical agents, botulinum toxin A injections, iontophoresis, treatment with radiofrequency, microwaves, or ultrasound as well as surgical procedures (axillary suction curettage, sympathectomy). Systemic agents such as anticholinergics may also be used. Selection of the most appropriate therapeutic approach depends on the site affected, prior treatment as well as the patient's requests.

Satisfactory to good performance of the GlucoDay monitor was observed, indicating the device to be suitable for routine clinical use. In particular, however, the discomfort experienced during wearing requires further improvements in its usability.

Brooke-Spiegler syndrome is characterized by the development of multiple trichoepitheliomas and cylindromas. In addition, multiple spiradenomas have been observed in this autosomal-dominant inherited disease. We report a 53-year-old woman with multiple cylindromas on the head and neck and multiple trichoepitheliomas on the face. Additionally, she had had since birth a plaque on the right side of her neck containing two nodules with features of both cylindroma and trichoepithelioma. Immunohistochemical investigations revealed in the basaloid cells of trichoepithelioma an expression of CK 5/6, CK 14, CK 17, CK 19 and vimentin. The cells of the cylindroma lacked vimentin but expressed additionally CK 7, CK 8 and CK 18. The occurrence of cylindroma and trichoepithelioma in a single nevoid plaque from a patient with Brooke-Spiegler syndrome implies an alteration in the stem cells of the folliculosebaceous-apocrine unit and could be characteristic of the disorder.

Four patients with systemic scleroderma and 1 patient with localized scleroderma were treated with ciclosporin (CS) given in daily doses between 2.2 and 5.6 mg/kg body weight for 3–26 months. Under this medication clinical improvement was observed in 4 patients with partial regression of cutaneous sclerosis and inflammation, healing of fingertip ulcerations or leg ulcers and improvement of articular mobility. However, in 1 patient with rapidly advancing systemic scleroderma a short-term therapy with CS in low doses (2–3 mg/kg body weight) resulted in arterial hypertension and renal dysfunction. Therefore careful selection of patients and close-meshed controls are indicated when CS is considered as anti-inflammatory treatment in scleroderma.

Zusammenfassung Die fokale Hyperhidrose kann zu erheblichen sozialen und beruflichen Einschränkungen und damit zu einer ausgeprägten Verminderung der Lebensqualität führen. Der primären Hyperhidrose liegen keine internistischen Erkrankungen oder externen Ursachen zugrunde. Sie tritt vor allem im Bereich von Arealen mit einer großen Schweißdrüsendichte wie den Achseln und den Händen auf. Die Diagnose der Hyperhidrose basiert auf der Anamnese und der Klinik. Unterstützt wird die Diagnostik durch Gravimetrie (die Schweißmengenmessung) und den Iod‐Stärke‐Test (der das vom Schwitzen betroffene Areal definiert). Zur Behandlung der primären Hyperhidrose stehen eine Reihe von Verfahren wie die topische Therapie, die Injektionstherapie mit Botulinumtoxin A, die Leitungswasser‐Iontophorese, die Therapie mit Radiofrequenz, Mikrowellen oder Ultraschall bis hin zu den operativen Interventionen wie der axillären Saugkürettage oder der Sympathektomie zur Verfügung. Auch systemische Therapeutika (vor allem Anticholinergika) kommen zur Anwendung. Die Auswahl der geeigneten Behandlungsmaßnahmen sollte individuell auf die Lokalisation, die vorangegangen Behandlungen und die Wünsche des Patienten abgestimmt werden.