Issue 2016.1

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 The subject of the cutaneous manifestations of hyperthyroidismis is a significant subject for dermatologis. The methods are  appropriate.  This clinical study is interesting and important.   Ass. Prof. Katarzyna Borowska (Poland)  

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 It is well known that the DLE can evolve into SLE ( the scarring lesions can be just the symptom of SLE) – that is why all patients with DLE lesions have to be examined carefully according the SLICC (Systemic Lupus International Collaboration Clinics) criteria. If the diagnose could be established based on “old” (since 1982 – completed in 1997) American College of Rheumatology (ACR) criteria, the SLE had to be diagnosed in described case (even without immunological criteria, if the photosensitivity the oral ilcers could be confirmed by the physician). But the conclusion concerning the DLE/SLE cannot be done in case of described patient based on SLICC, because not all immunological criteria were checked – what about the antiphospholipid antibodies, the C3 and C4 concentration, the total CH50 activity, as well as the direct Coombs’ test? It is possible that one of them will be positive and the SLE diagnose can be confirmed for sure. The interesting thing is that the oral ulcers were included in between positive clinical criteria (they should be confirmed by the doctor, but they did not exist during the examination; can the doctor be sure that those oral ulcers were not just aphthae or recurrent symptoms of Herpes Virus infection?), but the photosensitivity was not included (it was also just in anamnesis). Also the other reasons of non-scarring alopecia had to be checked ex. androgenic, caused by medicaments, associated with iron deficiency ect. In my opinion it is good to realise that the sensitivity of SLICC criteria is higher than ACR (93.2% vs 85.6%), but the specificity is lower (84% vs 96%). This means that some patients not fulfilling the ACR criteria can be diagnosed based on SLICC (there were the publication confirming that more than 60% of patient not fulfilling the ACR criteria had fulfilled SLICC criteria). That is why to diagnose SLE both classifications should be considered in parallel.   Ass. Prof. Małgorzata Sokołowska-Wojdyło MD, PhD, MSc (Poland)  

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 It is an interesting clinical case that brings knowledge of an entity sometimes little conisderada. Pity that noes too good radiogáfica image. Also it would be interesting to know if it has Realize CT injuries and if there is progress monitoring, especially of the images associated with 2.6 and 2.7.   Dr José López López (Spain)  

 Gorlin Syndrome represent a rare disease, wich can affect not only the skin, but also multiple systems, like the skeletal system, the genitourinary system, and the central nervous system. For these reasons, Gorlin syndrome requires a multidisciplinary approach. According to Kimoni et al, the  the clinical diagnosis is based on two major criteria or one major and two minor. In these article, the authors present a well documented case, with four major criteria and one minor. Thank you for this interesting case.   Dr Ana Maria Draganita (Romania)    

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 The subject of the cutaneous manifestations of hyperthyroidismis is a significant subject for dermatologis. The methods are  appropriate.  This clinical study is interesting and important.   Ass. Prof. Katarzyna Borowska (Poland)  

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 The article in this issue by Uwe Wollina, Birgit Heinig, and Andreas Nowak deserves special awareness. They try to condense medical knowledge on the use of leeches over almost 25 centuries and in many cultures – ever since their first documented use in Egypt around 1400 B.C. to modern evidence-based medicine with a first systematic review of 2014. It may therefore be assumed that leeching is one of the underlying human experiences to create medicine. The amazing properties of the up to 200 different compounds identified so far in the saliva of leeches may contribute to the different areas of indications that the authors describe separately. It has been until the 1970ies that their possible use in plastic surgery was discovered. This article e.g. gives an excellent overview of the role of leeches in salvaging flaps. As written by dermatologists, these indications are clearly predominantly. For those more involved with musculosceletal pain, osteoarthritis might be the predominant indication. For any interest, practical aspects of their use, tolerability and reported adverse effects are thouroghly mentioned. For the conventional pharmacologist, therapies with animals might be a nightmare, as they object to standardization and put heavy problems on quality control, down to mix of species as mentioned here. All this does not seem to prevent their worldwide appr. onemillionfold medical use every year.     Rainer Stange, MD, PhD (Germany)