Professor Höller Obrigkeit

• laser treatment of haemangiomas, angiomas, telangiectasias, keratoses and more;
• treatment of age-related skin changes with botulinum toxin and hyaluronic acid preparations;
• use of the YAG laser to treat benign pigmented spots, age-related (seborrhoeic) warts, scars and precursor stages of certain forms of skin cancer, as well as to remove wrinkles;
• use of the carbon dioxide laser to remove wrinkles and smooth the skin;
• use of the Aurora laser to remove fine capillaries and «spider veins», as well as couperose;
• use of the krypton laser to remove haemangiomas, small dilated veins, «spider veins» and angiomas;
• use of IPL combined with radiofrequency to remove unwanted hair on the face, underarms, back, legs and bikini area;
• laser correction of scars and scarring;
• microdermabrasion;
• mesotherapy;
• radiofrequency skin rejuvenation;
• cold laser peeling of the face and décolletage;
• FT deep laser facial rejuvenation;
• laser remodelling of the face and décolletage;
• use of the PicoSure laser to remove tattoos and permanent make-up, pigmentation, scars, post-acne marks, stretch marks and wrinkles.

• treatment of autoimmune rashes, including severe forms of autoimmune bullous dermatosis;
• treatment of hereditary and autoimmune diffuse connective tissue diseases (collagenoses), including scleroderma and dermatomyositis;
• treatment of vasculitis;
• treatment of severe forms of inflammatory skin disease (psoriasis, pyoderma gangrenosum, granulomatous dermatosis);
• treatment of mastocytosis;
• treatment of the most severe autoimmune systemic diseases (polymyositis, systemic lupus erythematosus, etc.);
• treatment of viral acanthoma;
• treatment of skin neoplasms, including melanomas and lymphomas (malignant melanoma, basal cell carcinoma, squamous cell carcinoma, lymphoma);
• skin cancer prevention;
• treatment of cutaneous manifestations of graft-versus-host disease.

• rapid hyposensitisation;
• allergen-specific immunotherapy - ASIT (inpatient and outpatient);
• treatment of severe, life-threatening drug intolerance reactions;
• treatment of severe forms of atopic dermatitis (also known as diffuse eczema or neurodermatitis);
• treatment of chronic urticaria and chronic angio-oedema.

• treatment of severe forms of bacterial infection of the skin and soft tissue (bullous necrotising erysipelas, phlegmon, carbuncles);
• treatment of viral skin diseases (eczema herpeticum, herpes zoster (known as shingles), chickenpox in adults,
• highly active antiretroviral therapy (HAART) for HIV-positive patients, as well as therapy for opportunistic and concomitant conditions);
• treatment of deep or systemic mycoses (fungal skin diseases);
• treatment of gonococcal sepsis and neurosyphilis.

• treatment of ulcers that respond poorly to therapy;
• treatment of chronic wounds;
• treatment of venous diseases of the lower limbs;
• dermatological proctology;
• treatment of hyperhidrosis (excessive sweating);
• balneophototherapy of skin diseases;
• treatment of hair and scalp disorders;
• photodiagnosis and photodynamic therapy of various inflammatory and malignant skin diseases;
• dermatological surgery, including vascular surgery.

Treating psoriasis is a very difficult task — nevertheless, with a systematic approach, doctors at German clinics are able to achieve good results (lasting remission).

At specialised dermatology clinics in Germany, treatment is always preceded by comprehensive diagnostics aimed at identifying the «triggers» of the disease, that is, the factors that set the pathological processes in motion.

German clinics treat psoriasis using combinations of different methods, including:

Topical treatment:

• salicylic acid preparations;
• baths with exfoliating additives;
• salt baths;
• vitamin D analogues, for example calcipotriol;
• topical corticosteroids at the lowest effective potency, for example, 0.1% tacrolimus ointment;
• dithranol-containing preparations, topical retinoids

Ultraviolet treatment:

• narrowband UVB 311 phototherapy;
• broadband UVB phototherapy;
• SUP (selective phototherapy);
• systemic PUVA therapy;
• PUVA creams.

Laser treatment:

treatment of the affected areas with the excimer laser 308 (compared with ultraviolet therapy, fewer sessions are required for the same effect).

Systemic therapy

with systemic immunosuppressants or immunomodulating drugs (for example methotrexate, ciclosporin, a TNF-alpha inhibitor):

• retinoids;
• antibiotics to treat the underlying streptococcal infection;
• methotrexate;
• ciclosporin A;
• fumaric acid derivatives;
• biologics – monoclonal antibodies, "biologicals" (for example alefacept).

Innovative monoclonal antibodies in the treatment of psoriasis

The drug treatment of psoriasis has been transformed by the arrival of the new biologics – monoclonal antibodies. However, data from long-term (three-year) clinical follow-up of patients receiving innovative biological agents – interleukin inhibitors – have shown that taking them does not remove the need for older medicines such as steroids (corticosteroids) or courses of phototherapy.

Biological treatment regimens for psoriasis that include at least one biologic can and should therefore be supplemented with topical steroids or phototherapy, since monoclonal antibodies do not eliminate the need for corticosteroids in psoriasis.

As for monoclonal antibodies, those prescribed most often were:

• adalimumab (Humira, AbbVie);
• etanercept (Enbrel, Amgen);
• ustekinumab (Stelara, Janssen);
• infliximab (Remicade, Janssen);
• secukinumab (Cosentyx, Novartis);
• ixekizumab (Taltz, Eli Lilly).