SummaryIt is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30 % of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20 % of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri-and postoperative pain management is briefly outlined. This article addresses:  The fundamentals of the classification and neurophysiology of pain;  Standards for pain documentation in children and adults;  General standards for pharmaceutical pain management;  Current specific treatment options for postherpetic neuralgia, leg ulcers, and pyoderma gangrenosum in conjunction with the expanded WHO analgesic ladder.

We report the use of a 577-nm wavelength high-power optically pumped semiconductor laser (HOPSL) to treat 12 patients with multiple recalcitrant non-genital warts that had not responded to conservative and invasive treatment. The patients were treated weekly using a 577 nm HOPSL connected to a scanner device. Ten patients with warts showed complete clearance after treatment. One patient had partial clearance and one did not respond at all. Slight to medium pain (visual analog scale, VAS=2–6) was reported during treatment. After treatment there was no evidence of scarring. After the 6-month follow-up there was no recurrence of the completely cleared warts.

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We report on a 73-year-old male patient with granulomatosis with polyangiitis (Wegener's granulomatosis) who developed increasingly growing lesions of actinic keratosis (AK) and squamous cell carcinoma (SCC) of the scalp under systemic immunomodulatory therapy with azathioprine for more than 8 years. The patient underwent a first-line surgical therapy resulting in histologically confirmed R0 resection status followed by topical imiquimod treatment and cryotherapy. However, recurrence of AK/SCC progression could not be stopped sufficiently. Therefore, due to the difficult localization of the lesions at the head and the limitation of further surgical procedures, the patient was presented to our laser medicine department in order to consider complementary therapy options. The therapy approach was combining photodynamic therapy (PDT) with laser-assisted drug delivery (LADD). PDT has been successful in treating field cancerization for decades, but it has limitations in the treatment of hyperkeratotic lesions. Pre-treatment with LADD can be used to optimize the penetration depth of the prodrug 5-aminolevulinic acid (BF-200 ALA, Ameluz) and significantly increase the bioavailability as well as inducing an inflammatoric reaction. Following this therapeutic approach, we were able to achieve a stable disease over a follow-up period of 2 years after six sessions of combined LADD + PDT.