Renal transplant recipients (RTR) have a 50-200-fold higher risk for nonmelanoma-skin cancer (NMSC) causing high rates of morbidity and sometimes mortality. Cohort-studies gave evidence that a sirolimusbased immunosuppression may inhibit skin tumor growth. This single-center, prospective, assessorblinded, randomized trial investigated if switching to sirolimus treatment inhibits the progression of premalignancies and moreover how many new NMSC occur compared to continuation of the original immunosuppressive therapy. Forty-four RTR (mean age 59.9 years, mean duration of immunosuppression 229.5 months) with skin lesions were randomized to sirolimus or continuation of their original immunosuppression. Blinded dermatological assessment at month 6 and 12 by the same dermatologist evaluated the clinical change compared to baseline. Biopsy was performed in suspected malignancy. Already the 6-month-assessment showed significant superiority of sirolimus-therapy: a stop of progression, even regression of preexisting premalignancies (p < 0.0005). This effect was increased at month 12 (p < 0.0001). Nine patients developed histologically confirmed NMSC: one in the sirolimus group, eight in the control group, p = 0.0176. Sirolimus-based immunosuppression in RTR, even when established many years after transplantation, can delay the development of premalignancies, induce regression of preexisting lesions and decelerate the incidence of new NMSC.

Mycetoma is a chronic putrid infection of the cutaneous and subcutaneous tissue concerning predominantly the feet, and more rarely other body parts. Mycetoma can be caused by both fungi (eumycetoma) and bacteria (actinomycetoma). Mode of infection is an inoculation of the causative microorganism via small injuries of the skin. The clinical correlate of both forms of mycetoma is tumescence with abscesses, painless nodules, sinuses and discharge. The latter is commonly serous-purulent and contains grains (filamentous granules) which can be expressed for diagnostic purposes. Distinctive for both eumycetoma and actinomycetoma, are the formation of grains. Grains represent microcolonies of the microorganism in vivo in the vital tissue. The most successful treatment option for eumycetomas offers itraconazole in a dosage of 200 mg twice daily. This triazole antifungal is considered as 'gold standard' for eumycetomas. Alternatively, the cheaper ketoconazole was widely used, however, it was currently stopped by the FDA. Actinomycetomas should be treated by the combination of trimethoprim-sulphamethoxazole (co-trimoxazole 80/400 to 160/800 mg per day) and amikacin 15 mg/kg body weight per day. Mycetomas are neglected infections of the poor. They are more than a medical challenge. In rural areas of Africa, Asia and South America mycetomas lead to socio-economic consequences involving the affected patients, their families and the society in general.

Rosazea ist eine häufige, entzündliche, vornehmlich das Gesicht betreffende Dermatose vorzugsweise des Erwachsenenalters. Die Erkrankung zeichnet sich durch einen chronischen, schubhaften Verlauf aus, wobei klinisch-morphologisch unterschiedliche Schweregrade abgegrenzt werden können. Im Initialstadium können flüchtige Erytheme im Gesicht auftreten, welche später persistieren. Weiterhin sind Teleangiektasien -hauptsächlich an den Wangen -sehr häufig. Papeln und Papulopusteln sind für den Schweregrad II typisch. Auch an das Gesicht angrenzende Hautareale wie Hals, Brust, Rücken und Kopfhaut können betroffen sein. Andere Formen sind durch ein Lymphödem und eine diffuse Hyperplasie des Bindegewebes und der Talgdrüsen, sogenannte Phyme, gekennzeichnet. Diese können mit den anderen Hautveränderungen vergesellschaftet sein oder auch unabhängig von diesen auftreten. Die Erkrankung betrifft häufig auch die Augen. Das klinische Erscheinungsbild der Rosacea papulopustulosa kann dem der Akne ähneln, es fehlen jedoch Komedonen und die Patienten sind deutlich älter als typische Aknepatienten. Auch wird bei Rosazea noch diskutiert, ob es sich um eine primär follikuläre Erkrankung handelt.Es liegen nur wenige größere Studien zur Epidemiologie der Rosazea vor. In einer aktuellen Studie aus Großbritannien wurde eine Inzidenz von 1,65/1 000 Personenjahren (Definition der Inzidenz: X neue Fälle/100 000 Einwohner/Jahr, d. h. 165/100 000 Einwohner/Jahr) festgestellt, mit jährlich 4 000-5 000 neu diagnostizierten Fällen [1]. Die Prävalenz der Rosazea wurde in verschiedenen Studien untersucht, allerdings bestehen zwischen den Ergebnissen erhebliche Diskrepanzen. So ermittelte eine deutsche Studie in einer Kohorte mit 90 880 Personen eine Prävalenz der Rosazea von 2,3 % [2], eine in Schweden durchgeführte Studie, in der 809 Arbeiter untersucht wurden, hingegen eine Prävalenz von 10 % [3]. In einer estnischen Studie wurde bei 348 Angestellten eine Prävalenz von sogar 22 % festgestellt, allerdings war die untersuchte Zielgruppe 30 Jahre oder älter, was die Prävalenz automatisch erhöht, da die Erkrankung gewöhnlich erst im höheren Lebensalter auftritt [4]. Tatsächlich erfolgt in 80 % der Fälle die Diagnose einer Rosazea im Alter von 30 Jahren oder später [1]. Interessanterweise zeigen sich bezüglich der betroffenen

(. 10 240, 47). Treatment failures were reported in at least 6 of 151 cases (4%). Conclusions: Atypical clinical and serological courses of syphilis were observed in HIV infected patients. Ulcerating secondary syphilis with general symptoms ("malignant syphilis") was 60 times more frequent than in historic syphilis series. Neurosyphilis was found in one sixth of those with active syphilis. Therefore lumbar puncture should be considered a routine in coinfections with HIV and syphilis. Treatment efficacy should be monitored carefully.

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BackgroundThere is an unmet need for general population‐based epidemiological data on rosacea based on contemporary diagnostic criteria and validated population survey methodology.ObjectiveTo evaluate the prevalence of rosacea in the general population of Germany and Russia.MethodsGeneral population screening was conducted in 9–10 cities per country to ensure adequate geographic representation. In Part I of this two‐phase study, screening of a representative sample of the general population (every fifth person or every fifth door using a fixed‐step procedure on a random route sample) was expedited with use of a questionnaire and algorithm based on current diagnostic criteria for rosacea. Of the subjects that screened positive in the initial phase, a randomly selected sample (every third subject) t`hen underwent diagnostic confirmation by a dermatologist in Part II.ResultsA total of 3052 and 3013 subjects (aged 18–65 years) were screened in Germany and Russia respectively. Rosacea prevalence was 12.3% [95%CI, 10.2–14.4] in Germany and 5.0% [95%CI, 2.8–7.2] in Russia. The profile of subjects with rosacea (75% women; mean age of 40 years; mainly skin phototype II or III, majority of subjects with sensitive facial skin) and subtype distribution were similar. Overall, 18% of subjects diagnosed with rosacea were aged 18–30 years. Over 80% were not previously diagnosed. Within the previous year, 47.5% of subjects had received no rosacea care and 23.7% had received topical and/or systemic drugs. Over one‐third (35% Germany, 43% Russia) of rosacea subjects reported a moderate to severe adverse impact on quality of life.ConclusionRosacea is highly prevalent in Germany (12.3%) and Russia (5.0%). The demographic profile of rosacea subjects was similar between countries and the majority were previously undiagnosed.

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SummaryAlthough there is presently no cure for rosacea, there are several recommended treatment options available to control many of the symptoms and to prevent them from getting worse. In addition to self-help measures like avoidance of trigger factors and proper skin care, rosacea management should include topical medications as one of the first-line choices for patients with erythematous and mild to severe papulopustular rosacea. Since mixed forms of characteristic rosacea symptoms are more common, medical treatment must be symptom-tailored for each individual case and will often involve a combination therapy. Approved topical agents for the major symptoms of rosacea encompass brimonidine for erythema and ivermectin, metronidazole or azelaic acid for inflammatory lesions, all of which have shown their efficacy in numerous valid, well-controlled trials. In addition, there are several other, not approved topical treatments which are possible options that require further validation in larger well-controlled studies.