Download Medical services and specialized outpatient clinics

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Specific activities in Bern at the beginning of the 21 century: the search for high quality
evaluation, diagnosis and care as a tertiary referral centre
Under the chairmanship of Prof Borradori, the department has made a major effort to provide a wide
range of specialised clinics to ensure excellent patient evaluation and care. The goal is to serve as a
tertiary referral centre for high quality medical care and as a respected teaching centre for the future
generation of dermatologists. Clinics for melanocytic and non-melanoma skin cancers,
dermatosurgery, psoriasis, allergic and atopic dermatitis, acne together with hidradenitis suppurativa,
autoimmune skin and connective tissue diseases represent the core of the department’s activities. The
latter are complemented by clinics for paediatric dermatology, chronic wounds, phlebology, cutaneous
lymphomas, trichology, nail disorders, as well as interventional aesthetic dermatology and laser
treatments. Some of these clinics are supervised by external part-time consultants, who are national
or international experts in their field.
Pigment lesion and melanoma clinic (Prof Robert Hunger)
The incidence of malignant melanoma is growing rapidly. The current incidence rate in Switzerland is
one of the highest in the world. A melanoma and pigmented skin lesions clinic provides follow up to
patients with melanoma and enhances early recognition of tumours; patients with atypical moles and
melanoma also receive clinical follow-up. Subjects at risk are regularly evaluated using a digital
dermatoscopic system (Fotofinder) and confocal laser microscopy.
The names of all melanoma patients since 1996 have been put into an inter-departmental database
(dermatology, plastic surgery, pathology, nuclear medicine, oncology) which currently comprises over
1400 patients and which is used to identify prognostic factors and impact management and
therapeutic intervention (sentinel lymph node dissection) on disease-free survival and prognosis.
The non-melanoma skin cancers (NMSC) clinic (Dr Patrick Oberholzer, Prof Robert Hunger)
The importance of NMSC such as basal cell carcinoma and squamous cell carcinoma and thus of
dermatosurgery is steadily increasing. This is related firstly to the increase of skin cancers (4 – 8% in
Europe per year) due to life style (sun exposure) and population ageing. Since the Inselspital is one of
the Swiss reference sites for organ transplantation, we are implicated in managing skin tumours in this
high-risk organ-recipient population. The NMSC provides multidisciplinary skin tumour consultations,
dermatologic surgery, with particular focus on Mohs micrographic surgery (see below) as well as
alternate therapeutic approaches, like radiotherapy (in collaboration with the department of
radiotherapy), photodynamic therapy (PDT), cryosurgery, non-invasive topical immunomodulatory
therapies.
Micrographic surgery clinic (Dr Rocco della Torre, Dr André M. Skaria)
Mohs micrographic surgery is a technique which combines the surgical act with an immediate
intraoperative histopathological examination of the excised tumour. The major part of treated tumours
is mostly of epidermal nature but a modified technique called slow Mohs surgery also allows the
treatment of certain forms of skin sarcomas and melanomas. Our department has been one of the first
centres in Switzerland to provide Mohs surgery and was introduced in Bern by Dr A.M. Skaria, who
has been director of the dermatosurgery committee of the SSGV for many years.
Psoriasis clinic (Prof Nikhil Yawalkar)
Psoriasis is a common inflammatory skin disease of variable severity with profound psychosocial
implications and morbidity. Recent insights into the immunopathogenesis of psoriasis have provided
exciting new therapeutic opportunities, e.g. with biologic treatments. In our specialised clinic we
provide topical and systemic treatments including phototherapy, traditional systemic agents and
tumour necrosis factors inhibitors (etanercepts, infliximab, adalimumab) are routinely used. We
provide interdisciplinary courses of medical education for affected patients (dermatologists,
psychologist, nutritionists). Clinical activities are complemented by clinical research studies with
testing of novel biologic treatments, and participation in phase 3 trials a well as by basic investigative
studies.
Drug reaction clinic (Prof Nikhil Yawalkar)
The skin is commonly affected by adverse drug reaction, the severity of which can be mild to lifethreatening. In close collaboration with the allergology unit of the Inselspital under the leadership of
Prof Werner Pichler we have a specific clinical and research expertise in cutaneous drug reactions.
Patient evaluation and assessment include skin testing (prick, intradermal and patch tests),
lymphocyte transformation tests and basophil activation tests. We have performed basic investigative
studies aimed at the characterisation of the pathomechanisms of cutaneous drug reactions (see
research below).
Autoimmune skin disease clinic (Prof Luca Borradori)
We have a specific interest in the management of patients with autoimmune blistering diseases, such
as bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa, and pemphigus. Our clinic is
involved as a referral centre for patients from all over the country. Bullous pemphigoid represents one
of the most frequent disease groups which requires hospital admission and makes up to 10% of our
in-patient diagnoses. In addition to clinical management, we have been involved in clinical multicentre
European studies aimed at characterising the clinical course and prognostic markers in affected
patients as well as in investigator-driven therapeutic trials (e.g. intravenous immunoglobulins,
rituximab, anti-IL-5 antibodies).
Dermatopaediatric clinic (Dr Kristin Kernland)
Our department is in tight collaboration with the University Children’s Hospital in Bern for the
evaluation of children with genetic, infectious, metabolic and endocrine diseases and skin
manifestations. There are two major areas of interest and expertise: 1) vascular malformations
evaluated in the context of an interdisciplinary hemangioma board; 2) evaluation and management of
patients with inherited skin blistering disorders such as epidermolysis bullosa (EB) within the so
called EB-Insel centre. We offer a specialised interdisciplinary evaluation of affected EB patients
involving paediatricians, gastroenterologists, dentists, plastic surgeons, and dietitians/nutritionists as
well as a diagnostic genetic workup in collaboration with various leading European molecular-genetic
laboratories. We have a specialised team ensuring appropriate wound dressing care and
physiotherapy of affected patients. Finally, we provide information to people living with these
disorders as well as their family members and friends.
Laser clinic (Dr Nathalie Dietrich)
Our laser centre led by Dr N. Dietrich in close collaboration with Dr Nathalie Irla is equipped with
most of the state of the art laser devices (e.g. Cynergy lasers). Cooperation with specialists from
other departments (angiology, paediatrics, paediatric surgery) allows interdisciplinary clinical
management. Efforts are made to improve therapy algorithms by the use of lasers for a number of
skin disorders, such vascular malformations, pigmentary disorders, tattoos, psoriasis, and sun
damage. The laser clinic treats both in- and out-patients and tightly cooperates with two experienced
consultants to provide high standard clinical care taking advantage of their extensive database with
more than 95,000 patients. The activities in this area have taken greatly advantage from the teaching
and support of Dr Maurice Adatto, (Geneva), and Dr Klaus Fritz (Lindau, Germany), two international
experts who have been both presidents of European Society of Laser Dermatology (ESLD).
Atopic eczema clinic (Prof Dagmar Simon)
Eczematous skin diseases concern over 20% of dermatologic patients. Atopic dermatitis affects
approximately 10% of children at the age of 6-7 years. Irritant and allergic contact dermatitis are
common in adults often as occupational eczema. We provide all diagnostic and therapy facilities for
patients with eczematous skin diseases. Diagnostic tests comprise blood and skin tests (patch tests,
skin prick tests, atopy patch tests, provocation tests) to identify exogenous and endogenous
pathogenic factors. The treatment includes an adequate anti-inflammatory therapy including systemic
therapy, skin care, skin protection, psychological advices, and pathogenic trigger avoidance
strategies, including changes in occupational life. Furthermore, we offer medical education courses for
atopic dermatitis patients.
Trichology clinic (Dr Pierre de Viragh)
We provide a specialised evaluation and care of patients with complex diseases of the scalp and hair.
Expert evaluation and individualised therapy are mandatory when hair loss, hair structure alteration or
scalp inflammation are treatment-resistant or when scarring occurs. To analyse in detail the features
of the disease, a number of exams are carried out; trichogramscanning electron microscopy
stereotactic photography and computer-assisted digital imaging (trichoscan), dermoscopic scalp
evaluation. Scalp biopsies for examination by light microscopy and immunohistochemistry. Dr. P. de
Viragh, who acts as consultant has an outstanding clinical expertise in hair disorders with a solid
background in basic investigative studies and dermatopathology in this complex field.
Nail disease clinic (Prof Eckart Haneke)
In a dermatological practice, 10 to 15% of the patients present because of nail disorders. Little is
known about the management of nail patients since until recently little could be done for many nail
diseases. The diagnosis of nail diseases is further hampered by the fact that very few
dermatopathologists and pathologists are experienced with nail biopsies, since most physicians are
afraid to biopsy a nail organ. Finally, some nail diseases require a specific surgical approach for
treatment evaluation with both conservative and surgical management is offered for inflammatory,
infectious, tumoral and congenital nail diseases. Bern is proud to have been able to provide an almost
unique consultation in Europe led by an international expert, Prof E. Haneke, who combines clinical
expertise with surgical skills in this complex area.
Phlebology (Dr Albert-Adrien Ramelet, Dr Urs Büttiker)
Our department is able to provide clinical evaluation, clinical investigation (plethysmography, cwDoppler and colour duplex) as well as in both the conservative (compression, venoactive drugs,
physiotherapy) and surgical (sclerotherapy, echo-guided sclerotherapy, surgery) treatment of CVD.
Management of chronic wounds is another speciality in our department with several specialised
nurses for wound care. Our phlebology clinic benefits from the expertise of an internationally known
phleblologists, Dr dr h.c. A.A. Ramelet. The latter past vice-president of the International Union of
Phlebology, is an author of several standard textbooks in this field.
Chronic wounds clinic (Prof Thomas Hunziker, Dr Nedzmidin Pelivani)
Our department has a large out-patient clinic dealing with evaluation and management of recalcitrant
skin wounds with specialised nurses, providing the entire offer of conservative (with all kind of the
novel wound dressings) and surgical treatments (such as conventional skin grafting, complex grafting).
The clinic is at the leading edge in the development of biotechnologically developed treatments,
including tissue-engineered skin equivalents (with development of autologous epidermal skin
equivalent derived from hair taken from affected patients).