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Abstract

Allergologie select, Vol. 5/2021 (260-264)

Anti-inflammatory topical medication – new developments in the treatment of atopic dermatitis

Johannes Wohlrab¹,², Burkhard Kreft¹, and Luisa Sophie Scholz²

¹University Hospital Halle (Saale), Clinic for Dermatology and Venereology, and ²Institute for Applied Dermatopharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
Atopic dermatitis is a chronic inflammatory disease that arises from polygenic disposition, a dysfunction of the physicochemical epithelial barrier, a cutaneous dysbiosis, and a faulty neurosensory activity and shows a highly individual acuity due to epigenetic factors. An essential component of therapeutic management is the application of anti-inflammatory topical medication. Currently, topical glucocorticoids and topical calcineurin inhibitors are routinely used in reactive and proactive therapy. In recent years, the development of molecular medicine has identified several new therapeutic targets that have enabled the development of innovative therapeutic approaches. In addition to phosphodiesterase-4 inhibitors and aryl hydrocarbon receptor modulators, it is mainly Janus kinase inhibitors with different selectivity that are emerging as new effective and safe options for topical therapy. The current data suggests that in the coming months and years representatives of the above-mentioned substance classes will be approved for topical use.Correspondence to:
Prof. Dr. Johannes Wohlrab, Klinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, Halle (Saale), Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 6/2022 (18-26)

Contact allergies to topical antibiotic applications

Burkhard Kreft and Johannes Wohlrab

University Hospital Halle (Saale), Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
Despite limited evidence on clinical efficacy and increasing resistance problems, topical antibiotics are still used in everyday clinical practice. However, topical antiseptic agents such, as octenidine and polyhexanide, often have a broader efficacy spectrum. They also have a broader target tropism because of their non-specific cellular mechanisms of action. Repeated use of topical antibiotics also carries the risk of contact sensitization, which could limit potential subsequent use as systemic antibiotics. Contact allergy is a clinically relevant problem, particularly in patients with barrier-damaged skin, pre-existing dermatosis, or occupational exposure. It can be concluded that with the use of modern antiseptics, topical antibiotic therapy is rarely indicated and should be avoided, not only because of the risk of contact sensitization but also because of the unfavorable and potentially consequential resistance problem.Correspondence to:
Burkhard Kreft, MD, University Hospital Halle (Saale), Department of Dermatology and Venereology, Martin Luther University HalleWittenberg, Ernst-Grube-Str. 40, D-06120 Halle (Saale)
Email: [email protected]

Abstract

Allergologie select, Vol. 10/2026 (101-106)

Cefazolin as an alternative in patients with a history of penicillin or β-lactam antibiotic allergy: A case overview

Burkhard Kreft, Johannes Wohlrab, and Cord Sunderkötter

Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Germany
Many patients with suspected or confirmed allergy to penicillin or β-lactam antibiotics are unnecessarily denied all β-lactam antibiotics (BLA) and instead given a less effective antibiotic with more side effects. However, cefazolin, a first-generation cephalosporin, is a safe and effective treatment option for these patients in most cases. Recent studies show that immunological cross-reactions among BLAs are primarily caused by structural similarities in the side chains and not by the common β-lactam ring. Cefazolin has unique R1 and R2 side chains that largely rule out cross-reactivity with other BLAs. In a case series, 21 patients with a history of alleged or confirmed allergy to BLAs were exposed to cefazolin under real-life conditions, and all but 1 patient (who developed an uncomplicated maculopapular rash) showed no reaction. Therefore, the use of cefazolin is acceptable under clinical supervision in cases of a previous uncomplicated delayed-type reaction. However, in cases of reported or documented clinical reactions to BLA that are indicative of a type I allergy (such as urticaria, angioedema, anaphylaxis), prior to (titrated) administration of cefazolin under appropriate monitoring measures, a diagnostic evaluation in accordance with guidelines, including a negative skin test for cefazolin, is advisable. This procedure avoids the use of less suitable reserve antibiotics and ensures effective treatment without incalculable risk for anaphylaxis.Correspondence to:
Dr. med. Burkhard Kreft, Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
Email: [email protected]

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