87Á5% of patients in both the 1% and 2% GPB formulation groups, and this reached statistical significance (P < 0Á03 vs. pooled placebo). Onset of action was already shown on Day 2 with statistical significance compared with baseline. Similar to the findings in other studies, 3,4 we also observed a high placebo rate, probably due to the complex nature of HH. Comparison of pre-and post-treatment (Day 14) Hyperhidrosis Disease Severity Scale (HDSS) values showed a clear reduction in the severity of the HH after treatment with the 1% and 2% GPB creams (Figure 1b), while effects with the 0Á5% were less pronounced. A reduction in HDSS to a value of 1 was achieved in 100% of patients with the 2% GPB cream, in 75% with the 1% GPB cream and 37Á5% with the 0Á5% GPB cream. There was no evidence of a dose-related change from baseline of Dermatology Life Quality Index. In the ATMOS-1 (n = 344) and ATMOS-2 (n = 353) trials with glycopyrronium tosylate, 5,6 50% sweat reduction was observed in 72Á1% of patients, but local skin reactions, including erythema, burning/stinging and pruritus were common (> 5%, up to 17%). 6,7 Based on the risk-benefit profile and the results of this study, the 1% GPB cream was selected for further clinical development. A phase III clinical trial (n = 500) has been started to confirm these initial results. Acknowledgments Medical writing was provided by Dr Alexander Boreham (co.medical, Berlin, Germany). C.M., M.S., A.K., U.K. and C.A. were employees of the Dr. August Wolff GmbH & Co. KG Arzneimittel at the time of the study. U.K. and C.A. are named as inventors on a patent application claiming glycopyrronium salt-containing oil-in-water emulsions.

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Background: Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus (S.) aureus strains represent an increasing problem in Germany. Although there have been several outbreaks at day care centers and in urban communities in recent years, there are currently no diagnostic algorithms or treatment recommendations for these particular infections in Germany. Methods:We performed a literature search in the PubMed/MEDLINE database with the goal of developing an algorithm for diagnosis and treatment of these infections. National and international recommendations were also considered.Results: Panton-Valentine leukocidin (PVL) is a pore-forming protein produced by certain S. aureus strains. Both methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) strains may carry the lukS-lukF gene responsible for PVL production. The clinical presentation of infections caused by PVL-positive S. aureus ranges from isolated recurrent abscesses to extensive furunculosis. Despite adequate treatment of primary infections, approximately 40 % of patients develop recurrent disease. The choice of treatment regimen is guided by the clinical presentation of the infection. In addition, some scientific literature recommends bacteriological screening of patients and their contacts, followed by decolonization of affected individuals. Conclusions:The present article focuses on the pathogenesis and risk factors of recurrent mucocutaneous infections caused by PVL-positive S. aureus strains and proposes a diagnostic and therapeutic algorithm for optimal patient care.

Hintergrund: Rezidivierende mukokutane Infektionen durch PVL-positive Staphylococcus (S.) aureus-Stämme stellen in Deutschland ein zunehmendes Problem dar. In den letzten Jahren wurden Ausbrüche in Kindertagesstätten und Kommunen beschrieben. Dennoch liegen zurzeit keine diagnostischen Algorithmen oder Therapieempfehlungen für die entsprechenden Infektionen in Deutschland vor. Methode: Eine Literaturrecherche in der Datenbank PubMed/MEDLINE erfolgte mit dem Ziel, einen diagnostischen und therapeutischen Algorithmus zu erarbeiten. Zudem wurden nationale und internationale Empfehlungen berücksichtigt. Ergebnisse: Panton-Valentine Leukozidin (PVL) ist ein porenbildendes Protein, das von bestimmten S. aureus-Stämmen produziert wird. Sowohl Methicillin-sensible (MSSA) als auch Methicillin-resistente S. aureus (MRSA)-Stämme können das für die PVL-Produktion verantwortliche Gen lukS-lukF besitzen. Das klinische Bild der durch einen PVL-positiven S. aureus verursachten Infektionen erstreckt sich von einzelnen rezidivierenden Abszessen bis hin zu einer ausgedehnten Furunkulose. Bei etwa 40 % der Patienten kommt es zu Rezidiven der Beschwerden trotz einer konsequenten Behandlung der Erstinfektion. Die Therapie variiert je nach klinischem Bild der jeweiligen Infektion. Zudem wird in der Literatur eine Screeninguntersuchung der Patienten und ihrer engen Kontaktpersonen sowie eine bakterielle Dekolonisation der Betroffenen empfohlen. Schlussfolgerungen: Diese Arbeit fokussiert auf die Pathogenese und Risikofaktoren der rezidivierenden mukokutanen Infektionen durch PVL-positive S. aureus-Stämme und versucht einen diagnostischen und therapeutischen Algorithmus zur optimalen Patientenversorgung vorzuschlagen. SummaryBackground: Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus (S.) aureus strains represent an increasing problem in Germany. Although there have been several outbreaks at day care centers and in urban communities in recent years, there are currently no diagnostic algorithms or treatment recommendations for these particular infections in Germany. PathogenesePanton-Valentine Leukozidin (PVL) ist ein porenbildendes Protein, das von bestimmten S. aureus-Stämmen produziert wird. Sowohl Methicillin-sensible (MSSA) als auch Methods: We performed a literature search in the PubMed/MEDLINE database with the goal of developing an algorithm for diagnosis and treatment of these infections. National and international recommendations were also considered.