Differenzialdiagnostische Fallstricke aus der Dermatochirurgie

Abstract

Evaluation of skin diseases can be challenging for non-dermatologists. Even obvious well-characterized skin pathologies might be misleading and thus treatment can fail. Particularly the differentiation of surgical treated entities is important, for example the management of a wound healing disturbance profoundly differs from that of a pyoderma gangrenosum. This article outlines several easily mistaken pairs of dermatologic entities on one hand and surgical on the other. For example, a livedo vasculopathy can be confused with a leg ulcer, a nail melanoma with a simple hematoma and finally a hidradenitis suppurativa with an axillary abscess. Typical clinical signs and anamnestic data may often lead to the right diagnosis also assisted by the simple fact to “keep it in mind“.

Für Nicht-Dermatologen ist es oftmals gar nicht so leicht, Hauterkrankungen differenzialdiagnostisch richtig einzuschätzen. Insbesondere Entitäten, die vermeintlich bekannte Charakteristika aufweisen, werden nicht selten verkannt und dann unter Umständen falsch behandelt. So unterscheidet sich z. B. die Therapie einer vermeintlichen Wundheilungsstörung fundamental von der eines postoperativen Pyoderma gangraenosum.

Schlüsselworter

Livedovaskulopathie - Nagelmelanom - postoperatives Pyoderma gangraenosum - Acne inversa - inguinaler/axillärer Abszess

Key words

livedovasculopathy - subungual melanoma - postoperative pyoderma gangrenosum - hidradenitis suppurativa - inguinal/axillary abscess

• Literatur

• 1 George T. Livedovaskulopathie, Pathogenese, Diagnostik und Therapie des Hautinfarktes. Hautarzt 2011; 62: 627-636
• 2 George T, Sunderkötter C. et al. Livedoid vasculopathy in a pediatric patient with elevated lipoprotein (a) levels: prompt response to continuous low-molecular-weight heparin. Arch Dermatol 2010; 146 (08) 927-928
• 3 Becker A, Stoffels-Weindorf M, Schimming T. et al. Rezidivierende Ulzerationen bei Livedovaskulopathie. Erfolgreiche Behandlung mit niedermolekularem Heparin. Dtsch Med Wochenschr 2013; 138: 1458-1462
• 4 Kerk N, Drabik A, Luger T. et al. Rivaroxaban prevents painful cutaneous infarctions in livedoid vasculopathy. Br J Dermatol 2013; 168: 898-899
• 5 Meiss F, Marsch W, Fischer M. Livedoid vasculopathy. The role of hyperhomocysteinemia and its simple therapeutic consequences. Eur J Dermatol 2006; 16 (02) 159-162
• 6 Wollina U, Nenoff P, Haroske G. et al. The Diagnosis and Treatment of Nail Disorders. Dtsch Arztebl Int 2016; 113 (29) 509-518
• 7 Haneke E. Malignant nail tumors. Hautarzt 2014; 65 (04) 312-320
• 8 Mohrle M, Hafner HM. Is subungual melanoma related to trauma?. Dermatology 2002; 204 (04) 259-261
• 9 Stern DK, Creasey AA, Quijije J. et al. UV-A and UV-B penetration of normal human cadaveric fingernail plate. Arch Dermatol 2011; 147 (04) 439-441
• 10 Blum A. Onychomycosis with onychodystrophy or acrolentiginous melanoma with onychomycosis and onychodystrophy?. Hautarzt 2012; 63 (04) 341-343
• 11 Moehrle M, Metzger S, Schippert W. et al. “Functional” surgery in subungual melanoma. Dermatol Surg 2003; 29 (04) 366-374
• 12 Trémezaygues L, Schmaltz R, Vogt T. et al. Management des Pyoderma gangraenosum. Hautarzt 2010; 61: 345-355
• 13 Su WP, Davis MD, Weenig RH. et al. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2004; 43 (11) 790-800
• 14 Born S, Marsch WC. Das postoperative Pyoderma gangraenosum. Chirurg 2001; 72: 1043-1047
• 15 Reichrath J, Bens G, Bonowitz A. et al. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. J Am Acad Dermatol 2005; 53 (02) 273-283
• 16 Canoui-Poitrine F, Revuz JP, Wolkenstein P. et al. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol 2009; 61: 51-57
• 17 Alikhan A, Lynch PJ, Eisen D. Hidradenitis suppurativa: A comprehensive review. J Am Acad Dermatol 2009; 60: 539-541
• 18 Rompel R, Petres J. Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa. Dermatol Surg 2000; 26: 638-643
• 19 von Laffert M, Stadie V, Ulrich J. et al. Morphologie of pilonidal sinus disease: some evidence of its being a unilocalized type of hidradenitis suppurativa. Dermatology 2011; 223: 349-355
• 20 Jansen T, Altmeyer P, Plewig G. Acne inversa (alias hidradenitis suppurativa). J Eur Acad Dermatol Venereol 2001; 15: 532-540
• 21 Zouboulis CC, Bechara FG, Fritz K. et al. S1-Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa. J Dtsch Dermatol Ges 2012; 10 (05) 1-31