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Notes: A case of erythema annulare centrifugum-type psoriasis in a 58-year-old white woman with a history of chronic plaque psoriasis is described. Initial failure of antipsoriatic treatments and an untypical histology complicated the diagnosis. After several trials acitretin at a low maintenance dose combined with oral fish oil and topical calcitriol led to sustained long-term remission. The spectrum of clinical differentiation of this rare disease, the histological characteristics and its nosological classification are discussed. It is suggested that this dermatosis represents a variant of acute psoriasis, rather than a variant of pustular psoriasis.

Notes: A case of digital gangrene in a patient with systemic lupus erythematosus without secondary antiphospholipid syndrome is reported. The acute onset of the necrotizing acrovasculitis occurred without a history of Raynaud’s phenomenon. Preceding symptoms of the systemic lupus erythematosus were arthritis, photosensitivity, alopecia and anorexia. Despite the seriousness of the acute episode the patient achieved an excellent outcome.

Notes: Malignant spiradenoma is an exceedingly rare adnexal tumour clinically characterized by rapid enlargement of a pre-existing, long-standing benign spiradenoma. Microscopic examination typically reveals a continuum between benign spiradenoma and areas of malignant transformation. Biological behaviour is unpredictable and it should be regarded as a potentially lethal neoplasm. Treatment recommendations require radical surgical excision. The reported case of a 23-year-old female illustrates the malignant transformation of a 1.5 cm nodule within a large linear spiradenoma almost covering the frontal aspect of the lower leg. In reviewing the literature, malignant transformation seems to occur slightly more often in multiple than in solitary spiradenomas. It is unclear whether excision restricted to the malignant area is an advisable treatment option in comparison to total excision of all spiradenoma nodules. In the presented case, the transformed area was excised. The patient is free of recurrence after 2 years.

Notes: Background and objective The increasing urbanization and the decrease in the numbers of farms in southern Germany might be associated with an increasing prevalence of allergic diseases. We compared the prevalence of allergic diseases in farmers, and rural, suburban and urban residents in the small geographical area of Augsburg in southern Germany.Methods In a cross-sectional survey adults, aged 25–75 years selected from the community population register were investigated. Rural, suburban and urban residents were defined by community size and farmers by occupation. Allergic respiratory disorders were assessed by self-administered questionnaires and specific IgE antibodies to five common aeroallergens.Results In comparison to rural residents the urban population had an increased risk of allergic rhinitis (OR = 1.5; 95% CI: 1.2–1.9), atopic sensitization (OR = 1.2; 95% CI: 1.0–1.4) and sensitization against pollen (OR = 1.5; 95% CI: 1.2–1.9). There was no difference in the risk of asthma (OR = 1.0; 95% CI: 0.6–1.6) and a decreased risk in the sensitization against house dust mite (OR = 0.8; 95% CI: 0.7–1.0). The suburban residents did not differ from urban residents. Farmers had lower risks in allergic rhinitis, atopic sensitization, sensitization against pollen and mites (OR = 0.63; 0.86; 0.51 and 0.80, respectively) than rural non-farming residents, however, these differences were statistically not significant. Reported allergic rhinitis with sensitization to pollen was 2.5 times (95% CI: 1.8–3.6) more prevalent in urban than in rural residents.Conclusion A farming environment and rural lifestyle might be associated with unknown protective factors impacting the prevalence of allergies.

Notes: Background The increase in allergic diseases is still unexplained. It was hypothesized that the intake of unsaturated fatty acids is a contributing cause of this development. We investigated the relationship between serum cholesterol levels, intake of polyunsaturated fatty acids (PUFA) and manifestations of atopy in a population-based setting.Methods A nested case–control study was performed within the population of the 3rd MONICA survey in Augsburg (Germany). The serum levels of total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol of 1537 adults (aged 28–78 years, response 61.4%) and the estimated intake of PUFA in a subset of 139 men were compared with the frequency of a doctor's diagnosis of asthma, allergic rhinoconjunctivitis (AR), atopic eczema (AE) and allergic sensitization as measured by skin prick and Radio Allergo Sorbent Test.Findings In bivariate analyses, we obtained a negative linear association between total and LDL cholesterol levels and the frequency of AR and sensitization, which was no longer significant after adjustment for important confounders. In contrast, positive linear associations were found between HDL cholesterol levels and AR and AE and, furthermore, between the intake of PUFA and allergic sensitization in men (P〈0.01). After adjustment, an increasing risk for atopic diseases with increasing levels of HDL cholesterol and an increasing risk for allergic sensitization with increasing intakes of PUFA remained statistically significant.Interpretation There is indication that HDL cholesterol also plays a role in the complex interaction of fat intake, metabolism and the manifestation of atopy in adults. These findings may contribute to the understanding of time trends and regional differences of allergies.

Notes: Background Atopic diseases develop on a genetic background and are modulated by environmental factors among which some infectious diseases are thought to have a protective influence.Objective The aim of this study was to determine the influence of infectious diseases in younger ages, bacterial and viral, on atopic diseases and sensitization to aero- and foodallergens in adults.Methods A population-based sample of 4262 subjects aged 25–74 years were interviewed concerning their history of infectious disease within the first 18 years of life. Information about allergic disease, including atopic eczema, allergic rhinitis (AR), and asthma was obtained. A blood sample was drawn and analysed for allergen-specific IgE antibodies against food- and aeroallergens.Results Multiple logistic regression analyses identified viral infection to be associated with AR (adjusted odds ratio (OR)=1.39; 95% confidence interval (95% CI): 1.13–1.72) and sensitization to aeroallergens (OR=1.21; 95% CI: 1.05–1.41). Bacterial disease was a negative predictor for atopy development in the subgroup of patients sensitized to nutritional allergens with concomitant atopic eczema (OR=0.34; 95% CI: 0.11–0.99), AR (OR=0.67; 95% CI: 0.42–1.07), or asthma (OR=0.41; 95% CI: 0.19–0.87). Influences of viral and bacterial infection on AR differed with regard to family history of atopic disease.Conclusion In our study population, history of viral infection was consistently positively associated with AR. Our data suggests that bacterial infections might be preventive for specific subgroups of atopy.

Notes: Background Prevalence data for atopic eczema based on a dermatological examination have not so far been available for East and West Germany. Possible differences in the proportions of extrinsic and intrinsic types of eczema, and how far these could explain differences in the prevalence of eczema, need to be clarified. Objectives To compare the prevalence of atopic eczema in pre-school children between different locations in East and West Germany, and over a period of 7 years, at three time points. Additionally, to determine the proportions of intrinsic and extrinsic types of eczema by taking skin prick test reactivity into account. Methods Repeated cross-sectional studies in 1991, 1994 and 1997 in 5–6-year-old pre-school children at five different locations in West Germany (n = 2075) and six in East Germany (n = 1926) were carried out. Individuals with eczema were identified by an examination performed by physicians of the Department of Dermatology. In addition, a skin prick test and a standardized questionnaire were used. Results The overall prevalence of atopic eczema in these children was 10·4%. At all three times of investigation (1991, 17·5% vs. 11·2%; 1994, 12·6% vs. 8·7%; 1997, 11·2% vs. 4·5%) and in the total group (12·9% vs. 8·2%), the prevalence was significantly higher in East than in West Germany. After controlling for influences of sex, parental history of atopic diseases, observer and socio-economic status in multiple logistic regression analyses, these differences remained significant for 1991, 1994 and for the overall group (odds ratio, OR 1·78, 95% confidence interval, CI 1·43–2·21). Girls (OR 1·56, 95% CI 1·27–1·92) and children whose parents had a higher level of school education (OR 1·17, 95% CI 1·00–1·37) were affected more frequently. Of all children, 26·6%, and of those with eczema, 41·9% exhibited at least one reaction in the prick test (OR 2·21, 95% CI 1·75–2·80; sensitization in eczema vs. no eczema). Whereas 50·4% of the children with eczema in West Germany were sensitized, only 36·5% of the diseased children in East Germany reacted positively in the prick test (OR 1·77, 95% CI 1·12–2·79). Conclusions These results are in accordance with findings regarding allergic sensitization and hay fever and might indicate that factors other than allergy are responsible for the higher prevalence of atopic eczema in East Germany.