Biologika zur Behandlung des Melanoms

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Ergänzend zum letzten Blog-Beitrag („Biologika in der Dermatologie“), der im Wesentlichen den Einsatz biotechnologisch hergestellter Arzneimittel (Biologika) zur Behandlung der Psoriasis behandelte, möchten wir in diesem Beitrag auf Biologika zur Therapie des Melanoms eingehen.

Zwei mechanistische Ansatzpunkte

In der Behandlung des Melanoms kommen mit den Checkpoint-Inhibitoren Biologika zum Einsatz. Dabei gibt es zwei mechanistische Ansatzpunkte:

Behandlung des Melanoms

Zum anderen kann die antitumorale Immunantwort durch Hemmung des PD-1-Signalweges gefördert werden (Abb. 1), wodurch ebenfalls die Anzahl aktivierter T-Zellen erhöht wird.

Dies ist möglich, da über den PD-1-Signalweg die Apoptose regulatorischer T-Zellen reduziert und die Apoptose Antigen-spezifischer T-Zellen ausgelöst wird.

Inhaltsverzeichnis

Abb. 1: Hemmung des PD-1-Signalwegs; modifiziert nach 1

Aktuelle Wirkstoffe - Biologika

Folgende Biologika stehen aktuell (Stand: September 2021) zur Behandlung des Melanoms zur Verfügung:

Mehr Informationen: KV-Quoten-Check zu Biologika auf dem DeutschenArztPortal

Autor

Rp. Institut / DeutschesArztPortal.de info@rpinstitut.com

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Literaturverzeichnis

  1. Lyons TG und Ku GY. Chin Clin Oncol 2017; 6 (5): 53

Olive oil skin care

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The origin of the olive tree goes back to the beginnings of recorded human history. For example, archaeological finds show that the wild form of the tree was used in Syria in the 4th century BC. The olive tree was considered a tree of life and the olive branch was used as a sign of peace, not only in the biblical story of Noah's Ark, but also among the ancients.

What is the structure of olive oil?

Olive oil ingredients

Olive oil is mainly composed of glycine-linked fatty acids - the triglycerides. In particular, these include oleic acid, palmitic acid, linoleic acid, and small amounts of stearic acid and palmitoleic acid. In addition, it contains low levels of phospholipids, carotenoids, and vitamins A and E, two very important vitamins for the skin.

The properties and effects of vitamins A and E will be discussed in detail in a separate article. Natural olive oil (native and untreated) also contains the antioxidants Oleocanthal and Oleuropein.

Prevention of inflammation

Oleocanthal is a naturally-occurring, non-selective inhibitor of cyclooxygenase, a key enzyme for the regulation of inflammation and pain.

Messengers such as prostaglandins, which are responsible for pain transmission and inflammatory spread, cannot be formed in the presence of oleocanthal, thus preventing the inflammatory response (1). This mechanism is similar to the action of the drug ibuprofen.

Health aspects of olive oil

Cancer inhibitory effect

Oleuropein also has special properties. Data obtained from a scientific panel indicates that oleuropein, both alone and in combination with a chemotherapeutic agent, has an in-vitro (i.e., in cultured cells) anticancer effect in high-metastatic osteosarcoma (a type of bone cancer) (2).

Protection against UVB-induced skin cancer

Another study, published in 2017, demonstrated antioxidant protection against cell death of keratinocytes (cells of the upper skin layer) that were exposed to UVB radiation. This suggests that intake of native olive oil may help prevent UVB-induced skin cancer (3).

Olive oil - more than just skincare and protection

Skin structure

Between the cells of the horny layer of the skin are intercellular lipids (fats) that surround the keratinocytes. These lipids consist of ceramides, free fatty acids, and cholesterol. This creates a water-repellent and fat-liking border zone that reduces the permeability of our skin.

Skin care

Due to its chemical structure, olive oil can penetrate the horny layer and improve its smoothness and protection capabilities. The fatty acids are ideal carriers for fat-soluble substances, including the vitamins A and E. The other therapeutic ingredients contained within olive oil penetrate through the protective layer and can exert their effects deep within the skin.

Creams for the ideal skin care

The direct use of pure oils as skin care can be more comedogenic, thereby causing blemishes. More suitable is a mixture of different fats in a cream that combines the beneficial qualities of olive oil with optimal solubility.

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Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Beauchamp GK, Keast RS, Morel D, Lin J, Pika J, Han Q, Lee CH, Smith AB, Breslin PA.: Ibuprofen-like activity in extra-virgin olive oil. Nature, 2005, S. 45.
  2. Przychodzen P, Wyszkowska R, Gorzynik-Debicka M, Kostrzewa T, Kuban-Jankowska A, Gorska-Ponikowska M. Anticancer potential of oleuropein, the polyphenol of olive oil, with 2-methoxyestradiol, separately or in combination, in human osteosarcoma cells. Anticancer Res. 2019 Mar;39(3):1243-1251.

  3. Salucci S, Burattini S, Buontempo F, Martelli AM, Falcieri E, Battistelli M. Protective effect of different antioxidant agents in UVB-irradiated keratinocytes. Eur J Histochem. 2017 Sep 18;61(3):2784.

Biologika in der Dermatologie

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Biologika - was ist das? Bei Biologika handelt es sich um biotechnologisch hergestellte Arzneimittel, die in der Gesundheitsversorgung zunehmend an Bedeutung gewinnen. Biologika wirken Fehlregulationen des Immunsystems durch das Hemmen bestimmter Rezeptoren und Immunzellen entgegen.

Somit eignen sich die Eiweißsubstanzen zur Behandlung von dermatologischen Erkrankungen, zu denen unteranderem Psoriaris und rheumatoide Arthritis zählen.

In Deutschland steigt der Umsatz mit Biologika in den vergangenen Jahren jeweils um etwa 1 Milliarde Euro und erreichte ein Volumen von 12,4 Milliarden Euro im Jahr 2018.1

Inhaltsverzeichnis

Biosimilarfähiger Markt in Deutschland

Betrachtet man den Umsatz des biosimilarfähigen Marktes in Deutschland, lässt sich ein Anstieg des Biosimilar-Anteils von 32,2 % im Dezember 2018 auf 48,2 % im Januar 2020 beobachten (Abb. 1).1 Bis Dezember 2020 stieg der Biosimilar-Anteil weiter auf 51 %.2

Abb. 1: Dynamik des deutschen Biosimilar-fähigen Marktes; modifiziert nach 1

Biosimilar-Anteil in der Dermatologie

Der Biosimilar-Anteil ist auch bei den für die Dermatologie relevanten Wirkstoffen vergleichsweise hoch:

Der Umsatz mit Biosimilars nahm im Dezember 2020 bei Infliximab einen Anteil von 78,2 %, bei Etanercept von 71,6 % sowie bei Adalimumab von 55,6 % ein.2

Biologika zur Behandlung der Psoriasis

Pathogenese der Psoriasis

Im Folgenden wird näher auf die Pathogenese der Psoriasis eingegangen, da die Biologika zur Behandlung hier eingreifen, indem sie einzelne Zytokine hemmen.

Was löst Psoriasis Schübe aus?

An der Pathogenese der Psoriasis sind sowohl angeborene als auch adaptive Immunprozesse beteiligt (Abb. 2). Nach Aktivierung durch bestimmte Triggerfaktoren (z. B. Pathogene, Medikamente) setzen Keratinozyten Mediatoren der angeborenen Immunabwehr frei. Dabei kann es sich beispielsweise um antimikrobielle Peptide oder Chemokine handeln.

Adaptive Immunprozesse

So kann das antimikrobielle Peptid Cathelicidin LL-37 dendritische Zellen aktivieren, wodurch adaptive Immunprozesse ausgelöst werden. Dendritische Zellen setzen nach Aktivierung insbesondere TNF-α und IL-23 frei.

Die Freisetzung von IL-23 fördert die Differenzierung von naiven T-Zellen in Th17-Zellen, die eine Schlüsselrolle in der Pathogenese der Psoriasis einnehmen. Th17-Zellen produzieren nach Aktivierung verschiedene proinflammatorische Zytokine, wie z. B. IL-17A, IL-17F, IL-22 und TNF-α.

Zytokine Psoriasis

Diese Zytokine fördern die Einwanderung weiterer Immunzellen und die Hyperproliferation der Keratinozyten. Dendritische Zellen sorgen zudem durch Freisetzung von IL-12 für eine Differenzierung von naiven T-Zellen in Th1-Zellen, die unter anderem IFN-γ produzieren.3,4

Abb. 2: Hauptachse der Psoriasis-Pathogenese; modifiziert nach 3

Aktuelle Wirkstoffe

Welche Biologika gibt es? Folgende Wirkstoffe stehen aktuell (Stand: September 2021) zur Verfügung:

Verordnungsvorgaben der Kassenärztlichen Vereinigungen zur Behandlung der Psoriasis

Um Arzneimittelausgaben zu senken, wird das Verordnungsverhalten zunehmend durch Zielquoten der Kassenärztlichen Vereinigungen (KVen) reguliert. Bei der Behandlung der Psoriasis mit Biologika sind insbesondere Biosimilar-Mindestquoten zu berücksichtigen.

Die meisten KVen haben Biosimilar-Mindestquoten für die Gesamtgruppe der TNF-alpha-Inhibitoren festgelegt. Diese liegen im Jahr 2021 beispielsweise in Nordrhein für Dermatologen bei 80 % und in Sachsen bei 67,5 %.5,6 Im Saarland gilt für Dermatologen eine Biosimilar-Mindestquote für Adalimumab in Höhe von 80 %.7

Mehr Informationen: KV-Quoten-Check zu Biologika auf dem DeutschenArztPortal

Autor

Rp. Institut / DeutschesArztPortal.de info@rpinstitut.com

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Literaturverzeichnis

  1. IQVIA: Newsletter Fokus Biosimilars; Mai 2020
  2. IQVIA: Fokus Biosimilars; März 2021
  3. Albanesi C et al. Front Immunol 2018; 9: 1549
  4. Ogawa E et al. J Dermatol 2018; 45 (3): 264–272
  5. Kassenärztliche Vereinigung Nordrhein: Arzneimittelvereinbarung 2021
  6. Kassenärztliche Vereinigung Sachsen: Arzneimittelvereinbarung 2021
  7. Kassenärztliche Vereinigung Saarland: Arzneimittelvereinbarung 2021

What does proper nipple care look like?

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In this article we celebrate the challenges and joys of breastfeeding. The World Health Organization recommends starting breastfeeding within the first hour of a baby's life and continuing as often and as much as the baby wants. However, the initial period of breastfeeding may be challenging.

What are the advantages of breastfeeding?

Weight loss

Breastfeeding reflexively activates contractions of the uterus, which encourages it to shrink back to its normal size. This contraction of the uterus is due to the release of hormones, specifically the hormone oxytocin. In addition, there are several studies that prove that breastfeeding mothers lose more weight than those who do not breastfeed (1).

Breast cancer risk reduction

Moreover, exclusive breastfeeding among parous women reduces the risk of breast cancer compared with parous women who do not breastfeed exclusively (2).

Child health

Regarding the infant, breastfeeding provides a multitude of benefits to the child, including fewer episodes of diarrhea, ear infections, and lower rates of respiratory infections as well as a lower risk of sudden infant death, diabetes, asthma, and childhood obesity (3).

Why can breastfeeding be challenging?

Since the practice of breastfeeding is done approximately every two hours, especially at the beginning, proper nipple care should work to emulate the missing hydrolipid film.

Constant suction can lead to trans-epidermal water loss, which stresses the skin barrier. It can also cause sore nipples. This condition is characterized by dry, painful nipples with redness, flaking, and cracking of the skin.

What does optimal nipple care look like?

Gentle cleaning of the breast

In general, women should wash their breasts only with water and let them air dry. Applying breast milk can help heal damaged nipples before and after feeds, as well as frequently changing nursing positions.

Topical treatment

Concerning topical treatment, nipples need special care, which means that the ointment base should be oily. Good nipple care contains plenty of fats. Natural products like shea butter and cocoa butter are very suitable because they contain many valuable fats which mimic those produced by our bodies, therefore keeping the nipples smooth and supple. Ingredients like Aloe vera and Portulaca olearacea may also have beneficial effects on nipple fissures (4).

Lanolin

However, the star ingredient is lanolin. A balm containing ultra-pure lanolin, a natural product obtained from sheep’s wool, moisturizes and supports healing. Therefore, the application of sheep’s wool, so called “healing wool”, containing this valuable fat on the nipples also has healing properties.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Sámano R1, Martínez-Rojano H, Godínez Martínez E, Sánchez Jiménez B, Villeda Rodríguez GP, Pérez Zamora J, Casanueva E. Effects of breastfeeding on weight loss and recovery of pregestational weight in adolescent and adult mothers. Food Nutr Bull. 2013 Jun;34(2):123-30.
  2. Unar-Munguía M, Torres-Mejía G, Colchero MA, González de Cosío T. Breastfeeding Mode and Risk of Breast Cancer: A Dose-Response Meta-Analysis. J Hum Lact. 2017 May;33(2):422-434.
  3. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep) 2007;153:1–186.
  4. Niazi A. A Systematic Review on Prevention and Treatment of Nipple Pain and Fissure: Are They Curable? J Pharmacopuncture. 2018.

Treatments with botulinum toxin by the dentist

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Botulinum toxin injection is an effective method for teeth grinding, also known as bruxism. The drug can be used outside the known approvals under the so-called off-label use for wrinkle treatment.

Mechanism of action of botulinum toxin

Botulinum toxin is a neurotoxin, a nerve-active substance that temporarily blocks the transmission of neurotransmitters in the nerves. This occurs due to a strong binding of botulinum toxin to the nerve endings, whereby these are blocked and no more impulses can be transmitted to the muscle fibres. As a result, the muscle can no longer move and becomes flaccid.

Therapies with botulinum toxin

Botulinum toxin treatment can be used for various medical conditions and aesthetic procedures. These include eye tremors, strabismus, migraine, swallowing spasms muscle or vascular spasms and excessive sweating.

The sympathetic nerves regulate the amount of sweating, with acetylcholine transmitting the impulses to the sweat glands. This is where botulinum toxin acts to stop increased sweating. As a result, the transmission of nerve impulses to the sweat glands is blocked for about 3-6 months.

Can a dentist inject botulinum?

Whether treatment with botulinum toxin may be performed by a dentist depends on whether the intervention is the practice of medicine. If this is the case, it must be clarified whether this treatment falls within the scope of dentistry.

Dental Health Act

The practice of dentistry is defined by Section 1 (3) of the Dentistry Act (ZHG). According to this, the practice is defined by the detection and treatment of dental, oral and maxillofacial diseases. If wrinkles in more distant regions are to be injected, such as on the eyes or in the forehead area, these body regions no longer fall within the scope of dentistry and may therefore not be treated by the dentist.

Botulinum in healing science

The term "healing science" is defined by the healers law (German law on non-medical practitioners) and is used to determine, cure or alleviate pain. Since the purely aesthetic injection of wrinkles does not correspond to these guidelines in the first place, the term was expanded here and also includes treatments that require medical expertise and can cause damage to health. The treatment with botulinum toxin requires anatomical knowledge and is accordingly a medical treatment.

Side effects

Treatment with botulinum toxin can have side effects, such as minor bruising or nerve dysfunction. Allergies or hypersensitivity, for example to the medication or the anesthetic, can also occur.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Artikel in DZW „Zahnarzt-verliert-Approbation-nach-Botoxbehandlungen” Tim Oehler
  2. Sommer, B., G. Sattler: Botulinumtoxin in der ästhetischen Medizin 2006 Georg Thieme Verlag KG, Stuttgart
  3. S1-Leitlinien Definition und Therapie der primären Hyperhidrose der Deutschen
  4. Artikel Lex medicorum „Dürfen Zahnärzte Botox spritzen“ von 2011

Dermatoscopy of nevus cell nevi

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With the aid of a dermatoscope, a so-called reflected-light microscope, skin lesions can be magnified and viewed in greater detail. This is usually done at 10x magnification of the skin finding. In dermoscopy, not only nevus cell nevi but also various other skin findings can be assessed and diagnosed. These include, for example, scabies, lichen ruber planus or seborrheic keratoses.

What are nevus cell nevi?

Nevus cell nevi are benign, melanocytic skin tumours. The number of moles increases steadily until the 3rd decade of life, with genetic predispositions and UV exposures playing a major role. Acquired nevi are well circumscribed, round to oval, with regular diameter of 2-5mm.

Depending on their location, three types are distinguished. Junctional nevus is located epidermally and usually has a solid medium to dark brown coloration. The compound nevus is located epidermodermally and is lighter pigmented than the junctional nevus.

And last but not least, the dermal nevus, which is located exclusively dermally, is usually raised and has a lighter coloration than the compund nevus.

Diagnosis of nevus cell nevi

Dermoscopy is used for the diagnosis and evaluation of skin tumour and nevi. Skin tumours include benign and malignant neoplasms characterized by autonomous growth. Nevi, on the other hand, are characterized by malformation with abnormal tissue composition and enlarge according to body growth.

Reliable assessment of the skin lesion is crucial for timely detection of malignant skin tumours. The most dangerous is malignant melanoma also known as black skin cancer, whereas tumours known as white skin cancer are much more common.

Evaluation by dermatoscope

Evaluation of a nevus cell nevus is performed during inspection with a dermoscope using the ABCDE rule. A malignant skin lesion should be suspected if A= asymmetric changes, B= border is irregular, C= colorite is irregular, D= diameter over 5mm, and E= elevation above the skin level.

These atypical changes are seen in dysplastic nevi, which are markers for the development of malignant melanoma. These nevi typically have a diameter of 5-15mm, are indistinctly circumscribed and variably pigmented. Their localization is usually on the trunk.

Conclusion

Patients with many nevi should undergo annual follow-up, and if there is evidence of atypical changes, these nevi should always be excised and examined histologically.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Thieme Kurzlehrbuch Dermatologie, 2. Auflage, Wolfram Sterry, 2011

Botulinum toxin injections against the appearance of scars

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Pathological scarring, i.e. hypertrophic scars and keloids, can be reduced by injecting botulinum toxin A, according to the latest studies. The effect of improving the appearance of scars here underlies the theory of chemoimmobilization.

Mode of action of botulinum toxin A

The musculature surrounding the wounds tends to become hyperactive as a result of microtrauma and, accordingly, the inflammatory phase is increased and prolonged, with cytokines and growth factors being released.

The injection of botulinum toxin A into the muscles surrounding the wound causes the neurotoxin to now paralyze this muscle in a dose-dependent manner. This inhibits the growth of fibroblasts and thus the formation of scars. 

Evidence-based medicine

In order to determine the exact dosing of botulinum toxin A, Chen et al. (2021) investigated the influence of different doses on surgical scars in a randomized study with 24 participants of different genders in middle age. For this purpose, the drug was injected intradermally into scars after tumour excisions without muscle involvement.

Here, different doses were injected into each half of the surgical wound closure following surgery. On the one hand a lower dose with 4 Botox units per injection point at a distance of one centimeter and on the other hand a higher dose with 8 Botox units per injection point. 

Dosage of the preparation

The result of this study showed significantly better mSBSES scores and VAS scores in the scar half with the higher botulinum toxin dosage than the other half with the lower dosage.

Thus, it can be concluded that immediate injection of botulinum toxin A can improve the appearance of surgical scars, although it should be noted that a uniform treatment regimen should not be used due to differences in tissue composition and other individual factors. 

Conclusion

A major disadvantage of botulinum toxin A injections in scars is only the high cost and the lack of evidence whether the preparation is also effective in keloids. 

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Ärzte Zeitung, Dermatologie „Mit Botulinumtoxin gegen Narben“, Marie Fahrenhold 09.01.2020, 12:35 Uhr
  2. Scientific reports, “The effect of botulinum toxin injection dose on the appearance of surgical scar”, Z. Chen et all, 2021

Milia - treatments against skin gravel

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Milia are cysts of keratin about 1-3 mm in diameter which occur due to the obstruction of a sweat duct or hair follicle. They can be classified into primary milia, which develop spontaneously with no clear etiology, and secondary milia, which appear after traumatic events on the skin, for example.

Influencing factors

This condition usually manifests in middle-aged women in regions of the head and neck and around the eyes or nose (1). Predisposing factors include heavy moisturizers, poor face hygiene (sleeping with makeup on, for example), the use of topical corticosteroids, and sun damage.

Why do some babies develop milia?

The first few weeks after birth present major changes for a baby. During pregnancy, it was supplied with important nutrients via the mother’s bloodstream. Along with these nutrients, maternal hormones can enter the baby’s blood.

Immediately after birth, when the child is “disconnected” from the mother’s bloodstream, these hormones suddenly drop. In response to the hormonal change, various skin changes can occur including milia, newborn acne, and seborrheic dermatitis, among others.

All of these skin conditions occur around the 3rd week of life and disappear again as soon as the baby’s organism has regained balanced of its hormonal status (2).

What treatment options are available?

Can milia disappear on their own?

The answes is yes - milia can disappear on their own.  In infants, this means that the best treatment is no treatment. Squeezing is generally contraindicated, as it irritates the skin and may lead to hyperpigmentation due to the associated inflammation.

Cosmetic treatment

Nevertheless, in adults with persistent milia that remain longer than expected without receding, it is possible to visit a facialist or dermatologist who can scratche the milia with a fine needle and gently evacuate the cyst content (3).

Dermatologist procedure

In the case of large milia, an experienced dermatologist can remove them with a 2-3mm punch under local anesthesia.

How can I prevent milia?

The key is using gentle products on the skin that do not cause inflammation. This is why irritant cosmetic products should be avoided. Moreover, soft exfoliation can be performed. The goal of this treatment lays in the removal of skin impurities, which result in skin that is toned, cleaner, and visibly refreshed

Mechanical peeling

At home, a mild mechanical peeling can be performed regularly at a rate of once or twice a week. When choosing a scrubbing cream for personal use, it is important to look for a cosmetic formulation that uses organic exfoliation particles and contains moisturizing ingredients in order to prevent unnecessary skin irritation.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. de Wet J, Jordaan F, Akad M, Visser W. Bilateral malar milia en plaque as primary presentation of discoid lupus erythematosus. JAAD Case Rep. 2017 Mar; 3(2): 106–109.
  2. Jean L. Bolognia , Julie V. Schaffer , Lorenzo Cerronia. Dermatology. 4th Edition. Elsevier.
  3. Thami GP et al. (2002) Surgical Pearl: Enucleation of milia with a disposable hypodermic needle. J Am Acad Dermatol 47: 602-603
  4. Vemula S, Maymone MBC, Secemsky EA, Widjajahakim R, Patzelt NM, Saade D, Vashi NA. Assessing the safety of superficial chemical peels in darker skin: A retrospective study. J Am Acad Dermatol. 2018 Sep;79(3):508-513.e2.

Cream or serum?

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The skin has always held an important position within medicine. Even the writings of Hippocrates contain formulas for the elimination of "traces of aging". The skin, as the largest organ of the human body, occupies a special position in the aging process of humans (1). Nowadays, almost everyone uses a hydrating cream daily. But which daily routine is the best one?

What is the difference between a lotion and a serum?

The difference lies in the galenic formulation. The galenic formulation deals with the principles of preparing and combining medicines in order to optimize their absorption. The term ‘galenic’ is named after Claudius Galen, a second century Greek physician who codified the preparation of drugs using multiple ingredients.

He described numerous cosmetic preparations, an example being his famous cold cream (unguentum refrigerans), which was very popular among Roman women of his time who wanted to alleviate the effects of aging (2). These so-called "cold creams" are unstable water in oil emulsions that break on the skin and segregate. Thus, shortly after application of the cold cream, there is an increased release of water from the preparation.

Effectiveness through the overall formulation

A well-formulated and skin condition-based foundation has been proven to have many beneficial effects on the skin, while a too rich foundation applied to seborrheic skin can lead to breakouts, defined as acne cosmetica. In addition, the efficacy of many skincare agents is strongly dependent on the overall formulation.

When considering a water-in-oil emulsion or Vaseline, only a moderate penetration of vitamin E into the skin can be achieved. Using a micro or nano-emulsion, for example, can significantly improve its effectiveness (3). This is why not every face cream is the same, even if one is advertised to contain the same main ingredients.

Serums for face care

A formula that allows carrying of a high concentration of active ingredients is the so-called serum, a low-viscosity gel. In addition, a serum provides a great deal of moisture and thus absorbs quickly. The cushioning effect of anti-aging serums is therefore immediately visible. However, serums contain hardly any moisturizing ingredients.

Skin care through the combination of serum and cream

Skincare products designed to increase the skin's moisture content are among the best-selling skincare products. The use of moisturizing agents is not only an essential principle of the moisturizing and rehydrating care of dry skin, but also of the treatment and preventative care of aged skin.

These agents complement the natural barrier of the skin, protect against dehydration, and can smooth fine lines through discrete swelling of the upper layer of the skin, known as the stratum corneum (4).  For this reason, a skincare routine based on the application of a serum and then hydration with a cream is recommended.

Table of Contents

Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema, is one of the most common chronic skin conditions. It presents predominantly in childhood and tends to...

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Bibliography

  1. Kerscher M. Dermatokosmetik. Steinkopff Verlag. 2009.
  2. Pai-Dhungat JV, Parikh F. Claudius Galen (130-201 A.D.). J Assoc Physicians India. 2015 Mar;63(3):21-2.
  3. Martine MC, Bobin MF (1984) Role des micro- émulsions dans l-absorption percutanée de l’alpha-tocophérole. J Pharm Belg 39:348–354
  4. Böni R, Burg G. Altershaut: physiologische Grundlagen, prophylaktische Maßnahmen und Therapieansätze. Schweiz Med Wochenschr 2000. 130:1272–1278

Dermatoskopie von Nävuszellnävi

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Mit Hilfe eines Dermatoskop, einem sogenannten Auflichtmikroskop, können Hautveränderungen vergrößert und genauer betrachtet werden. Dies erfolgt meist bei 10-facher Vergrößerung des Hautbefundes. In der Dermatoskopie können nicht nur Nävuszellnävi, sondern auch verschiedene andere Hautbefunde beurteilt und diagnostiziert werden. 

Was sind Nävuszellnävi?

Nävuszellnävi sind gutartige, melanozytäre Hauttumore. Die Anzahl an Muttermalen nimmt bis zum 3. Lebensjahrzehnt stetig zu, wobei genetische Prädispositionen und UV-Expositionen eine große Rolle spielen. Erworbene Nävi sind gut umschrieben, rund bis oval, mit regulärem Durchmesser von 2-5mm. Je nach Lage wird zwischen drei Typen unterschieden.

Der Junktionsnävus befindet sich epidermal und weist meist eine einfarbige mittel- bis dunkelbraune Färbung auf. Der Compund-Nävus befindet sich epidermodermal und ist heller pigmentiert als der junktionale Nävus. Und zu guter Letzt der dermale Nävus, der sich ausschließlich dermal befindet, meist erhaben ist und eine hellere Färbung als der Compund Nävus aufweist.

Diagnose der Nävuszellnävi

Für die Diagnose und Beurteilung von Hauttumor und Nävi kommt die Dermatoskopie zum Einsatz. Zu den Hauttumoren zählen benigne und maligne Neoplasien, die sich durch ein autonomes Wachstum auszeichnen. Nävi dagegen sind durch eine Fehlbildung mit abnormaler Gewebezusammensetzung gekennzeichnet und vergrößern sich entsprechend des Körperwachstums.

Die sichere Einschätzung der Hautveränderung ist entscheidend, um maligne Hauttumore rechtzeitig erkennen zu können. Am gefährlichsten ist das malige Melanom auch als schwarzer Hautkrebs bekannt, wohingegen Tumore die als weißer Hautkrebs bezeichnet werden, deutlich häufiger sind.

Beurteilung mittels Dermatoskop

Die Beurteilung eines Nävuszellnävus erfolgt bei der Inspektion mit einem Dermatoskop anhand der ABCDE Regel. Der Verdacht auf eine maligne Hautveränderung sollte aufkommen bei A= asymmetrischen Veränderungen, B= Begrenzung ist unregelmäßig, C= Colorit ist unregelmäßig, D= Durchmesser über 5mm und E= Elevation/ Erhabenheit über das Hautniveau.

Diese atypischen Veränderungen sind bei dysplastischen Nävi zu beobachten, die Marker für die Entwicklung eins malignen Melanoms darstellen. Diese Nävi haben typischerweise einen Durchmesser von 5-15mm, sind unscharf begrenzt und unterschiedlich pigmentiert. Ihre Lokalisation ist meist am Stamm.

Therapie

Patienten mit vielen Nävi sollten einer jährlichen Kontrolle unterzogen werden und bei Hinweisen auf atypische Veränderungen sollten diese Nävi immer exzidiert und histologisch untersucht werden.

Literaturverzeichnis

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Literaturverzeichnis

  1. Thieme Kurzlehrbuch Dermatologie, 2. Auflage, Wolfram Sterry, 2011