ZusammenfassungHintergrund: Früher galt die Koexistenz von Psoriasis vulgaris und atopischer Dermatitis (¹Mischformenª) als extrem selten. Aufgrund eigener klinischer Befunde wurden in dieser Studie die ¹Mischformenª erneut analysiert. Patienten und Methodik: 1520 Patienten wurden mittels anerkannter Atopiekriterien und speziell für die Studie zusammengestellter Psoriasis-Kriterien untersucht. Auûerdem wurden der HLA-Typ und das Gesamt-IgE bestimmt. Ergebnisse: Die Häufigkeit der ¹Mischformenª lag in der vorliegenden Studie bei 5,3 %. Klinisch waren sie sowohl durch Atopiezeichen, wie Pruritus, Dermographismus albus, Dyshidrose und Wolleunverträglichkeit, als auch durch Psoriasiskriterien, wie Psoriasisphänomene, psoriatische Nagelverän-derungen und Psoriasisarthritis, charakterisiert. 43 % der Patienten hatten erhöhte Gesamt-IgE-Werte (> 120 kU/l). Die erstmalig bei ¹Mischformenª untersuchten HLA-Muster ergaben Psoriasisassoziierte Antigene (B27, B57, Cw2, Cw6). Die bei den Patientinnen gefundene erhöhte Homozygotierate von HLA-DRB1 und -DRB4(DR53) könnte auf eine geschlechtsabhängige Begünsti-gung der Manifestation von ¹Mischformenª hinweisen. Schlussfolgerung: ¹Mischformenª können häufiger auftreten, als bis jetzt angenommen worden ist, und bedürfen eines speziellen Therapieplanes. Bei unklarer Zuordnung der beiden Erkrankungen sollte auf ¹Mischformenª geprüft werden. AbstractBackground: In previous reports the coincidence of Psoriasis vulgaris and Atopic dermatitis were considered extremly infrequent. Due to antagonistic clinical results the occurrence of ¹mixed formsª will be analysed again in a representative group. Patients and Methods: 1520 patients were diagnosed by established ¹atopic criteriaª and by psoriasis criteria especially created for this study. Additionally, the HLA type and the entire-IgE concentration were tested. Results: ¹Mixed formsª occurred in a frequency of 5.3 %. Clinically they were characterized by atopic markers, such as pruritus, xerosis, dermographismus albus and dyshidrosis, and by criteria of psoriasis, such as psoriatic phenomena, psoriatic alterations of the nails and psoriatic arthritis. 43 % of patients showed increased concentration of entire IgE (> 120 kU/l). In this study for the first time investigated HLA pattern revealed increased frequencies of psoriasis-associated antigens (B27, B57, Cw2, Cw6). The finding of an increased rate of females homozygous for HLA-DRB1 and -DRB4(DR53) suggests a genderrelated predominance of ¹mixed formsª. Conclusions: ¹Mixed formsª occurred more frequently than formerly reported. A special therapeutical concept is important. In case of any indistinct diagnosis of both diseases the ¹mixed formsª should be kept in mind.

An erythrodermic skin disease occurring in a patient with an already existing erythroderma of different cause is a rare phenomenon. A 13 year old girl with congenital lamellar ichthyosis suffered from both erythroderma and generalized scaling. Probably at the age of 11, a clinically not recognized psoriatic erythroderma appeared associated with a pustular palmoplantar psoriasis of the Barber-Königsbeck type as well as a psoriatic osteoarthropathy. The identification off such overlapping disorders is of great importance for proper therapy.

A 79-year-old patient presented with an asymptomatic scalp tumor which had grown over the past 9 months. Based on clinical, histological and immunohistochemical staining, we made the diagnosis of an atypical fibroxanthoma (AFX). AFX is a rare tumor, but important in the differential diagnosis of other scalp tumors. The routine histological staining allows one to identify a malignant fibrous histiocytoma, while a spindle-cell malignant melanoma can be excluded with immunohistochemical staining. An anaplastic squamous cell carcinoma cannot always be separated with completed certainty from atypical fibroxanthoma. AFX is a low-grade malignant tumor and most cases behave in a benign fashion. After complete excision, we recommend follow-up for a number of years because of the possibility of local recurrence.

A 37 year old woman presented with a 4-month history of "plaques opalines" of the oral mucosa complaining of a rough feeling in her mouth and burning when swallowing. On the basis of clinical, histological and serological details and especially the presence of generalized indolent lymphadenopathy, the diagnosis of secondary syphilis was made. Although plaques opalines are a relatively rare manifestation of secondary syphilis, they can occasionally be the only sign and are important in the differential diagnostic considerations of gray-white mucosal lesions, especially with current continuing rise of syphilis incidence in Central Europe.

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