摘要:cqvip:Background: Atopic dermatitis, nummular eczema, chronic hand dermatitis, palmar plantar psoriasis, and xerotic eczema are common inflammatory skin conditions. They may be refractory to conventional topical and even systemic treatment.Little evidence is available that demonstrates the benefits of aggressive topical treatment of patients with these disorders. Objective: To describe a simple, inexpensive, effective topical treatment with an accompanying patient educational sheet.Design: A retrospective study of 28 patients referred to a tertiary care center for refractory chronic pruritic eruptions. Intervention with a plain water 20-minute soak followed by smearing of midstrength to high-strength corticosteroid ointment led to clearing or dramatic improvement. Results: Objective and symptomatic improvement was obtained from aggressive topical treatment. It was well accepted in this group of referral patients. Conclusions: Hydration for 20 minutes before bedtime followed by ointment application to wet skin and alteration of cleansing habits is an effective method for caring for several common skin conditions. Prospective studies are needed to further validate these findings.
摘要:cqvip:Background: We previously reported the effects of finasteride on scalp hair weight and count over a 2-year period in men with androgenetic alopecia (AGA). Objective: Our purpose was to evaluate the effects of finasteride on hair weight and count over 4 years in men with AGA. Methods: Men with AGA were randomized to receive finasteride (1 mg/d) or placebo for 192weeks. Results of the second (weeks 96- 144) and third (weeks144- 192) extension periods are reported. Results: Finasteride increased hair weight at 144 and 192 weeks (week 192: finasteride,21.6% increase from baseline; placebo, 24.5% decrease from baseline; net increase in hair weight for finasteride vs placebo = 46.0% , P < .001). Hair count also increased with finasteride at 144 and 192 weeks (week 192: finasteride, 7.2% increase from baseline; placebo, 13.0% decrease from baseline;net increase in hair count for finasteride vs placebo = 20.3% , P< .05). Finasteride was generally well tolerated. Limitations:Because this study was extended from its original 48- week duration to nearly 4 years, the sample size available for analysis decreased with time. Conclusion: Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs,such as increased growth rate (length) and thickness of hairs,contribute to the beneficial effects of finasteride in treated men.
摘要:cqvip:Background: Prurigo pigmentosa (PP) is a rare inflammatory disease of the skin typified by recurrent, pruritic erythematous macules and papules that resolve leaving behind net like pigmentation. Objective: PP is diagnosed most commonly in Japanese women. Preponderance of the disease in other ethnic populations has yet to be identified. Methods: We conducted a clinicopathologic case study in 4 Iranian women. Results:The clinical diagnosis of PP was confirmed by typical histopathologicfindings, elucidating the morphologic spectrum of the disease. Limitations: The small number of patients in this study is a limitation. Conclusion: We suspect that PP may have a proclivity in the Iranian population.
摘要:cqvip:Atopic eczema (AE) is a major risk factor for hand eczema. In Scandinavian population-based studies, the occurrence of AE in childhood has often been assessed by the question ‘ Have you had childhood eczema?’ In the present study, this question was validated. A questionnaire was sent to 600 cases with AE and 600 controls without eczema or allergic disease, identified in school medical records from the 1960s. The response rate was 70.5% , and the mean age of the respondents was 36.7 years. The specificity of the question was 70.7% and the sensitivity 89.9% . The sensitivity was higher and the specificity lower in a subgroup with current hand eczema compared with a group without hand eczema. The results showed that the question overestimated the prevalence of AE in childhood by a factor of 1.6. When used for risk assessment, the question provided a better estimate of the risk of current hand eczema as compared with the lifetime risk of hand eczema. In conclusion, the validated question overestimated prevalence of childhood AE and may overestimate AE as a risk factor for hand eczema in adult population surveys.
摘要:cqvip:Sporadic cases of contact allergy to white petrolatum, which is used as a vehicle in patch test preparations, have been reported. The quantitative relevance of the phenomenon remains yet to be elucidated. Methods: Retrospective analysis of patch test data of the Information Network of Departments of Dermatology (IVDK, http://www.ivdk.org) between 1992 and 2004. Results: Analysis of 79 365 patients patch tested with pure petrolatum yielded 27 ‘ + ’ (0.03% ) and 2 ‘ + + + ’ (0.003% ) reactions. The majority of non-negative reactions (0.3% ) was interpreted as doubtful (235) or mild irritant (32). The negative reaction index (RI) (- 0.8), and the high positivity ratio (PR) (93% ) especially a lack of concordance with patch test preparations containing ≥ 99% petrolatum indicate that many of the ‘ positive’ (+ ) reactions have to be considered as irritant. There were 2 ‘ + + + ’ reactions. In 1 case, an ‘ angry back reaction’ was confirmed. The other case is probably a reading or documentation error, as the majority of patch test reactions to preparations containing petrolatum remained negative in this case also. Conclusions: True allergic patch test reactions to white petrolatum are extremely rare and probably due to an individually increased susceptibility to allergens and/or irritants. This is in agreement with considering petrolatum as a non-sensitizer.
摘要:cqvip:The risk of actively sensitizing a patient in connection with diagnostic patch tests exists. This risk, however, is extremely low, especially from standard allergens, and if the test is carried out according to internationally accepted guidelines. This retrospective study investigates the clinical consequences in cases of possible patch test sensitization. Among 7619 consecutively tested eczema patients in a 14- year period 26 (0.3% ) were identified in the database as having had a late patch test reaction, which may be an indication of patch test sensitization. 9 of these cases were not suitable or available for the follow-up investigation and 3 patients were not traceable. Among the 14 remaining patients 1 had a reaction to gold sodiumthiosulphate, which was assessed to be a persistent reaction and not a late reaction, and in 2 patients a clear relevance for the late reacting allergen was found. For the remaining 11 patients we could not rule out that they were patch test sensitized, and they were investigated further. 1 was diseased and 10 were interviewed regarding the possible consequences of the alleged patch test sensitization. 9 had not experienced any dermatitis problems, and 1 could not exclude the possibility that the alleged patch test sensitization had aggravated her dermatitis problems, although we find it unlikely based on the full clinical history. Even though the patient material is small and the limitations inherent in such a retrospective study, the results and the literature indicate that development of clinical contact dermatitis following patch test sensitization is very rare.
摘要:cqvip:Contact with metal working fluids (MWF) is an important factor in the development of occupational hand dermatitis in patients working in the metal processing industry. Biocides are added to MWF as preservatives and are known sensitizers. We analysed 318 patch test reactions to N,N-methylene-bis-5-methyl-oxazolidine 1% in petrolatum (5-methyloxazolidine, Grotan OX , CAS no. 66204- 44- 2, a formaldehyde releasing biocide) present in coolant oils in patients exposed to MWF and with suspected occupational dermatitis (OD). Positive allergic reactions were noted in 15 (4.7% ) cases. In 7 (47% ) cases, we were able to confirm relevance by examining the material safety data sheets and these showed that N,N-methylene-bis-5-methyloxazolidine was present in the oils used by the patients. No certain relevance could be proved in 8 cases, but in these instances, further information on the biocides used in the oils could not be obtained. Positive reactions to formaldehyde were seen in 11 (73% ) patients. Sensitization either to this biocide and/or formaldehyde allergy was considered to have been likely to have made a contribution to the workers’ dermatitis.
摘要:cqvip:Mercaptobenzothiazole (MBT) compounds are well known contact allergens. To detect rubber allergic patients we use both MBT (2% in petrolatum) and a mercapto-mix with 4 constituents of 0.5% each in our standard series. In this article the EECDRG presents data of in total 32 475 consecutive tested patients attending the respective contact dermatitis clinics from 11 centres in Europe to determine if the mix and MBT detected the same allergic patients. We found 327 patients positive to the mix or MBT, or to both. 261 were positive to the mix and 254 to MBT. MBT was negative in 73 patients who were positive to the mix. If the mix had not been in the standard series, on average 22% of patients allergic to a mercapto-compound would have been missed, for MBT this would have been on average 20% . All clinics would have missed a significant number of positive reactions if both compounds had not been tested. We conclude, that both the mercapto mix and MBT are required in the standard series.
摘要:cqvip:Background: Alopecia areata (AA) is a polygenic immunemediated disorder affecting the hair follicle for which an association with human leukocyte antigen HLA-DRB1 11 has been described. Objective: Two parameters including age of onset and extent of the disease (patchy AA and AT/AU forms)- were correlatedwith the presence or absence of HLA-DRB1 11 and its alleles in 88 severe AA patients. Methods: Patients and healthy controls were typed for HLA-DR and - DQ by molecular method. Results: Among AA patients, 37.5% (a proportion rising to 72% when taking patients who began their first patch before the age of 20 years) were positive for HLADRB1 11 compared to 21.2% healthy controls (p = 0.004, RR = 2.1). DRB1 11-positive status was associated with earlier development of the first AA patch, at the mean age of 16 years compared to 27 years (p = 0.003) in DRB1 11-negative patients. Among the DRB1 11 alleles, the presence of DRB1 1104was associated with the earliest occurrence of AA. Conclusion: Our data indicate that the HLA system largely through DRB1 1104 allele influences AA onset rather than extension considering patchy AA and AT/AU.
摘要:cqvip:An easy-to-use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index (OHSI) was developed for this purpose and the interobserver reliability investigated. The clinical severity was evaluated on the basis of the extension or clinical characteristics of six morphological characteristics. For the validation of the OHSI, hand eczema in 28 patients was investigated independently by one dermatologist and 2 occupational physicians. The agreement between the observers was determined by using kappa values, Kendall’ s coefficient of concordance, the intraclass correlation coefficient (ICC) and the 95% limits of agreement. The ICC for the total OHSI was 0.80 and the estimated limits of agreement (- 3.6 and 3.0) were sufficiently small to expect that ratings according to OHSI performed by independent observers of different medical specialities should produce similar results. It could be demonstrated that the use of the OHSI is simple and practicable. The interobserver reliability for the summary score is good. OHSI seems a reliable tool for assessing the severity of occupational hand eczema.
摘要:cqvip:Background and Objective: The objective of this study was to evaluate the relationship between Jessner’ s lymphocytic infiltration of the skin (JLI) and lupus erythematosus (LE), which has been the subject of debate since its initial description in 1953. Material and Methods: This is a retrospective study including all patients with a histopathologically ascertained diagnosis of JLI performed at the Laboratoire d’ Histopathologie Cutan′ ee of the Strasbourg University Hospital between 1993 and 2003. Information about patient characteristics and follow-up data were retrieved between 2004 and 2005. Special attention was paid to features indicative of LE. Results: 210 consecutive patients (102women and 108 men) with a mean age 42 years were diagnosed with JLI in the reference period. 175 patients (83% ) had multiple lesions and 32 patients (15% ) had only a single lesion at the time of diagnosis (data not available in 3 patients). The head, neck and upper part of the thorax were involved in 171 patients (81% ). An annular or arciform configuration and/or arrangement were present in 111 patients (53% ). Lesions consisted of red (100% ) papules or plaques (98% ). Mean follow-up was 4 years. Sixteen patients (7.6% ) had proven LE. Only 2 patients (1% ) developed >4 ACR criteria of systemic LE. Furthermore, 1 patient had antiphospholipid antibody syndrome and 2 patients had rheumatoid arthritis. Conclusions: This high frequency of patients with typical features of LE strongly argues that JLI could be a dermal variant of LE and not an autonomous entity. It might be the cutaneous marker of a subset of LE patients with excellent prognosis.
摘要:cqvip:Background: Noncultured epidermal cell transplantation in vitiligo permits the coverage of relatively large areas without culturing cells. Objective: To investigate the effectiveness of noncultured epidermal cell transplantation in treating stabilized vitiligo using objective and subjective evaluationmethods. Methods: Noncultured autologous melanocytes and keratinocytes were grafted in a hyaluronic-acid-enriched suspension on superficially laser-abraded vitiligo lesions in 40 patients with refractory stable vitiligo (30 with generalized and 10 with localized vitiligo). The repigmentation was evaluated 3- 12 months after grafting using a digital image analysis system. Furthermore the treatment was evaluated from the patients’ point of view with the DLQI (Dermatology Life Quality Index) and a ‘ global assessment’ . Results: The mean percentage of repigmentation, evaluated at the last follow-up visit,was 72% (median 84% ), and a repigmentation of ≥ 70% was observed in 62% of patients. The best results were achieved in the neck and the presternal region. A subjective evaluation was performed in half of the subjects. The mean DLQI score at inclusion (6.95, SD = 6.68, n = 20) was significantly decreased after treatment (p = 0.013, mean 3.85, SD = 4.13, n = 20). The patients were satisfied with the achieved result, found it worthwhile to undergo the treatment and would choose it again. Conclusion: According to both subjective and objective evaluation methods, noncultured epidermal cell transplantation is promising in patients with stable vitiligo.
摘要:cqvip:We herein report 2 cases of multiple lobular capillary hemangiomas after scalding. The patients exhibited papules and nodules on the scalded areas after healing. Histopathological examination of the lesions showed capillary proliferation in the upper dermis with edematous stroma containing inflammatory infiltrates predominantly composed of neutrophils. Biopsy tissue and secretion specimens from lesions of case 1 were cultured for bacteria, and both grew Enterobacter cloacae. Ultrastructural examination revealed features typical of a lobular capillary hemangioma and viral inclusion bodies in the epidermis of case 1. Multiple lobular capillary hemangiomas after scalding are rarely reported. Trauma may play an important role in the development of this rare condition. Accumulation of similar cases and its precise observation is needed to confirm the associations and to establish an etiological link between the disease and the pathogens.
摘要:cqvip:Kaposi’s sarcoma (KS) is an angio proliferative neoplasia associated with human herpesvirus 8 (HHV-8) infection. HHV-8 generates KS by means of the secretion of vascular endothelial growth factor (VEGF) and up-regulation of VEGF receptor, KDR, in endothelial cells. We report a case of KS in a 72-year-old male with a renal transplant who had received immunosuppressant drugs including sirolimus, mycophenolatemofetil, tacrolimus and steroids. KS developed 11 months after transplantation, in relation to deep venous thrombosis and withdrawal of sirolimus due to toxicity. Multiple purple papules and nodules were observed exclusively in the limb affected by thrombosis. Diagnosis of KS was confirmed by biopsy. Progressive withdrawal of prednisone was accompanied by full remission of the tumour. The thrombosis and withdrawal of sirolimus may have acted as cofactors in the development of KS, favouring the activation of the VEGF/KDR autocrine loop. Our experience contributes to further evidence that sirolimus may protect against KS.
摘要:cqvip:A 71-year-old man exhibited an acute acneiform rash affecting the face and the upper trunk about 2 weeks after starting cetuximab, an epidermal growth factor (EGF) receptor antagonist treatment for metastatic colon cancer. The skin eruption faded after stopping cetuximab and applying topical corticosteroids. The reexposure to cetuximab 3 weeks later provoked a more extended relapse of the skin rash, which then clinically and histologically corresponded to transient acantholytic dermatosis. While the acneiform cutaneous side effects of the EGF receptor antagonists are interpreted as a result of the direct interference with pilosebaceous follicle homeostasis, in this case an acrosyringium-related pathogenesis might be postulated. Applying topical corticosteroids and emollients, the cetuximab therapy could be pursued.
摘要:cqvip:Background: Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous eruption which is often provoked by drugs. Case Report: We report 2 cases of AGEP which showed rapidly spreading pustular eruptions accompanied by malaise, fever and neutrophilia after the administration of systemic prednisolone (corticosteroid of group A, hydrocortisone type). The histological examination showing neutrophilic subcorneal spongiform pustules was consistent with the diagnosis of AGEP. In both cases the rash cleared within a week upon treatment with topical steroids (corticosteroid of group D1, beta-methasonediprop-ionate type and corticosteroid of group D2, hydrocortisone-17-butyrate type). Three months after recovery, the sensitization to corticosteroids of group A was confirmed by epicutaneous testing and positive lymphocyte transformation tests. Conclusion: These cases show that systemic corticosteroids can induce AGEP and demonstrate that epicutaneous testing and lymphocyte transformation tests may be helpful in identifying the causative drug. Our data support previous reports indicating an important role for drug-specific T cells in inducing neutrophil inflammation in this disease.
摘要:cqvip:Background: We present two cases of Toxicodendron dermatitis, one acquired in the United States but presenting in the United Kingdom (UK), the other a recurrent dermatitis following importation of the plant to the UK. Poison ivy, poison oak and poison sumac are native to North America and belong to the genus Toxicodendron. This group of plants is of interest to the dermatologist because they contain a mixture of potent sensitisers which cause a severe allergic contact dermatitis. Conclusions: The dermatitis can present to the dermatologist in Europe after an individual has been in contact with the plant whilst visiting an endemic area. The plants have the potential to grow in Europe and it is therefore possible for an individual to be sensitised and subsequently to develop the rash without leaving the continent.
摘要:cqvip:Background: Although papulopustular lesions are one of the diagnostic criteria for Behcet’s disease, controversy exists as to the nature of these lesions. Specific vessel-based papulopustular lesions as well as nonspecific follicular lesions may be seen in patients with Behcet’s disease. Some authors suggest that papulopustular lesions should be considered a positive criterion only if they exhibit a vessel-based neutrophilic reaction. Objective: To determine whether specific vessel-based papulopustular lesions can be differentiated clinically from nonspecific follicular lesions in patients with Behcet’s disease. Methods: Twenty-three papulopustular lesions in 20 patients with Behcet’s disease were initially examined clinically by two dermatologists blind to each other’ s diagnosis. Biopsies taken from these lesions were examined by a pathologist unaware of the patient data. Results: Leukocytoclastic vasculitis or perivascular infiltration was observed in 10 lesions, perifollicular and perivascular infiltration was noted in nine lesions, and perifollicular inflammation was seen in four biopsy specimens. Most of the lesions interpreted clinically as specific papulopustular lesions of Behcet’s disease had predominantly perivascular infiltration or leukocytoclastic vasculitis; however, three papulopustular lesions evaluated by both observers as specific papulopustular lesions had only perifollicular inflammation, and one lesion diagnosed clinically as a nonspecific follicular eruption revealed perivascular neutrophilic reaction. Inter observer variance was noted in three papulopustular lesions. Conclusions: Clinical examination may not be sufficient to predict the dermatopathologic pattern in all lesions. Papulopustular lesions with no specific clinical and histopathologic features may create problems in the diagnosis of Behcet’s disease.
摘要:cqvip:Introduction: Cutaneous leishmaniasis is a common parasitic disease in Iran, especially in Isfahan. First line treatment for this disease is antimonial compounds; however, owing to the intermittent failure of this treatment and its significant sideeffects alternative therapeutic measures have been advocated. Objective: Evaluating the efficacy of pentoxifylline plus glucantime in the treatment of cutaneous leishmaniasis. Methods: This double-blind, randomized, controlled clinical trial with simple sampling was performed on 64 patients with cutaneous leishmaniasis referred to the Skin Diseases & Leishmaniasis Research Center from an endemic foci of L. major in Isfahan. The patients randomlywere divided into two groups. One group was treated with systemic Glucantime (20 mg pentavalent antimony/kg/day) combined with pentoxifylline (400 mg three times daily) and the other group were treated with Glucantime (20 mg pentavalent antimony/kg/day) plus placebo (three tablets daily) for 20 days. Follow up lasted 3 months. Response to treatment was grouped as complete improvement (lesions had been flattened, no induration, and epidermal creases had appeared), partial improvementr (eduction in lesion size, but without the appearance of epidermal creases) and poor response (no reduction in lesion size). Results: Of 64 participants, 32 patients in the trial group and 31 patients in the control group were followed for 3 months. One patient in group B discontinued with drew. After this time, complete improvement, partial improvement and poor response to treatment were 81.3% , 12.5% and 6.2% in the trial group and 51.6% , 29% and 19.4% in the control group, respectively. We also observed no adverse effect resulting from pentoxifylline. Discussion: The result obtained by two therapeutic methods indicates that combined therapy with Glucantime and pentoxifylline is more effective than Glucantime alone (P < 0.05).
摘要:cqvip:Background: Modifications in social habits together with the increase of emigration have contributed not only to increased dermatophytoses but also to an altered etiology. During the last few years, Braga has suffered a radical change from a rural to a cosmopolitan life-style. Methods: A statistical study of dermatophytoses and the etiology of their causative agents was performed by a retrospective survey carried out among patients of Hospital de S o Marcos, Braga, Portugal, from 1983- 2002. In this study, a total of 10- 003 patients were analyzed. Results: Over this period the frequency of dermatophytoses, as defined by the recovery of a dermatophyte in culture, was found to be 23.6% , whereas nondermatophytic infections accounted for 7.0% . Analysis of the clinical form s and the isolated fungi supports that the dermatophyte species have a predilection for certain body areas (P ≤ 0.01). Age is a very important factor regarding the occurrence of dermatophytoses (P ≤ 0.0001), with a correlation between increasing age and infection, positive for Trichophyton rubrum and negative for Microsporum canis. Overall the gender of the patients is not an association factor for the development of dermatophytoses; however, significant differences were detected in the distribution of some etiologic agents (P ≤ 0.05). Conclusions: The results showed the main etiologic agent of dermatophytoses to be Trichophyton rubrum (37.4% ). Moreover, dermatophytoses are both decreasing and showing a new profile in Braga, and a pronounced decrease of Trichophyton megninii was observed throughout the study.
摘要:cqvip:A 14-year-old boy was referred to the Dermatology Clinic of the Medical University of Mashhad, Iran,with numerous cutaneous telangiectasias on the face, ears, lips, and back of the hands, with lesions in the temporal region being the first to appear (Figs 1- 3). His mother stated that the lesions had been present for 10 years with an increase in the past 6 months. He had no history of bleeding from the nose, mouth, gastrointestinal tract, and other mucosal surfaces, and there was no sign of organ involvement. On inspection, no lesions were detected on the nasal mucosa, external ear, over the tympanic membrane, or mouth. The patient is one member of a family of six. His mother is healthy, but similar lesions were seen in his father, sister and one of his brothers with similar distributions. Lesions were also seen in his aunt and paternal grandmother, showing disease distribution in six members of this family from three generations. The oldest brother is 20 years of age and mentioned the onset of disease from the age of 10 years. The sister is 18 years of age and lesions started to appear 7 years ago; she claims that the lesions regress during her menstrual period. The youngest brother is 4 years of age and shows no sign of cutaneous lesions as yet. The parents are not consanguineous. Generalized telangiectasia with a predominant distribution on light-exposed skin, an autosomal dominant inheritance, and no sign of systemic or mucosal involvement and bleeding disorders indicates a diagnosis of hereditary benign telangiectasia. Our patient did not consent to biopsy.
摘要:cqvip:Background: Rosacea is a skin problem not uncommonly encountered world-wide. There is a need for an effective and well-tolerated treatment for this disease. Objective: To evaluate the efficacy and side-effects of zinc sulfate in rosacea in a randomized, controlled, double-blind trial. Patients and methods: Patients with rosacea who attended the outpatient Clinic of Dermatology and Venereology in Baghdad Teaching Hospital were recruited into this study between October 2002 and August 2004. A disease severity score was calculated for each patient. The patients were randomly allocated to receive either zinc sulfate 100 mg or identical placebo capsules three times per day. Zinc sulfate and placebo capsules were given in a double blind manner. Following 3 months of starting the treatment, the patients crossed over, i.e. patients on placebo crossed over to zinc sulfate and those on zinc sulfate crossed over to placebo. Results: Twenty-five patients with rosacea were included in this study: 16 (64% ) females and nine (36% ) males. Nineteen patients completed the study: 11 (58% ) females and eight (42% ) males. Patient age ranged from 21 to 64 years with a mean ± SD of 48.2 ± 9.3 years. Duration of the disease ranged from 1 to 14 years with a mean ± SD of 4.4 ± 3.2 years. In the group started on zinc sulfate, the score before therapy ranged from 5 to 11 with a mean ± SD of 8 ± 2.0. The mean started to decrease directly after the first month of therapy with zinc sulfate to a significantly lower level. After shifting to placebo treatment, the mean started to rise gradually in the fifth month but remained significantly lower than the levels before therapy. In the group started on placebo, the score before therapy ranged from 5 to 9 with a mean ± SD of 7 ± 1.3. The mean remained high in the first 3 months of therapy while the patients were on placebo. After shifting to zinc sulfate, the mean started to decrease after the fourth month to significantly low levels. No important side-effects were reported apart from mild gastric upset in three (12% ) patients on zinc sulfate. Conclusion: Zinc sulfate was found to be a good option in the treatment of rosacea, as it was safe, effective and lacking important side-effects.
摘要:cqvip:Pyoderma gangrenosum (PG) is an uncommon cutaneous disease of unknown etiology. In 50 percent of affected patients, PG is associated with systemic disease including inflammatory bowel disease, arthritis, and hematologic malignancies. Diagnosis of PG is based on clinical presentation, histopathology and on the exclusion of other diseases that can produce clinically similar lesions, e.g. infection, vasculitis, malignancy, collagen vascular diseases, diabetes, and trauma. Four variants of PG have been described: ulcerative, pustular, bullous, and vegetative. We report a woman with renal failure who developed PG in the absence of any obvious triggering trauma in a distinctive unilateral crop just distal to an arteriovenous dialysis shunt.
摘要:cqvip:Aim: To determine the quantitative effect and technique of use of the anodal current for the treatment of palmoplantar hyperhidrosis on local areas of the palms and soles. Methods: Twelve patients (four males and eight females) with idiopathic palmoplantar hyperhidrosiswere enrolled in this study. Having determined the initial sweat intensities of both hands using the pad glove method, direct electrical current (d.c.) treatment was applied to the palms of the patients using a complete regulated d.c. unit for which the current and potential ranges were 0- 30 mA and 0- 90 V, respectively. Electrodes were placed into two separate water plates, and covered with pad made from gauze and cotton material. The pads were moisturized with tap water for current conduction. The anodal current was applied to the right hands of six patients (group I) and to the left hands of the remainder (group II). After seven treatments had been completed for the palms, the final sweat intensities of the hands were measured. Results: In both groups, the final sweat intensities of the hands subjected to the anodal current were significantly decreased in comparison with the initial values, regardless of whether the anodal current was applied to the right or left hand (P 0.05). Conclusions: It can be concluded that the anodal current is more effective in reducing sweating on the palms when applied either to the right or left hand. In the treatment of palmoplantar or localized hyperhidrosis, the anodal current should be referenced first to treat the sweatier hand or foot, or a local hyperhidrotic area of the skin. The selection of the anodal current for one hand for the first five or seven sessions appears to be more effective than the use of polarity changes for each session.
摘要:cqvip:We evaluated the clinical characteristics of sirolimus-induced acne in 80 recipients of renal transplantation. It developed in 36 of 48 (75% ) men and 2 of 32 (6% ) women. Lesion locations and clinical, bacteriologic, and histologic features differentiated sirolimus-induced acne from acne vulgaris, but therapeutic management was similar. The main limitation for this study was the absence of a control group without sirolimus. Epidermal growth factor inhibition by sirolimus is a plausible explanation for this acne.
摘要:cqvip:Background: Chronic disease can have physical and psychological effects which affect social functioning. These effects can be better understood from the perspective of parent and child by the use of health-related quality of life (HRQL) measures. Various HRQL measures are now available, of which generic health measures have been the most widely used. These permit comparison between different diseases and also the normal population. Objectives: To cross-validate a new generic HRQL proxy measure for children, the Children’ s Life Quality Index (CLQI), with an established speciality-specific dermatological questionnaire, the Children’ s Dermatology Life Quality Index (CDLQI), in a group of children with chronic skin diseases. The impairment of HRQL in the same group of children with skin disease was then compared with that associated with other common chronic childhood diseases using the CLQI. Methods: The CDLQI was completed by 379 children aged 5- 16 years with skin disease of more than 6 months’ duration. Their parents (n = 379) and parents of 161 children aged 5- 16 years with other chronic diseases were also asked to complete a proxy measure, the CLQI. Results: Using linear regression analysis, the CLQI and the CDLQI scores showed a strong linear association (rs = 0.72, P < 0.001) and on a Bland-Altman plot, reasonably good agreement (expressing scores out of 100, the 95% limits of agreement were from - 25.5/100 to 26.7/100). In the child’ s opinion psoriasis and atopic dermatitis (AD) caused the greatest impairment (CDLQI scores of 30.6% and 30.5% ), followed by urticaria (20% ) and acne (18% ). Using the generic CLQI (scored 0- 36), from the parental perspective the highest score was for AD (33% ), followed by urticaria (28% ), psoriasis (27% ) and alopecia (19% ). Comparing this with children with other chronic diseases, those with cerebral palsy had the highest score (38% ), followed in descending order by those with generalized AD (33% ), renal disease (33% ), cystic fibrosis (32% ), urticaria (28% ), asthma (28% ) and psoriasis (27% ). Diseases such as epilepsy (24% ) and enuresis (24% ) scored higher than diabetes (19% ), localized eczema (19% ), alopecia (19% ) and acne (16% ). Conclusions: Using the CLQI we have shown that HRQL impairment in children with chronic skin disease is at least equal to that experienced by children with many other chronic diseases of childhood, with AD and psoriasis having the greatest impact on HRQL among chronic skin disorders and only cerebral palsy scoring higher than AD. Cross-validation of the CLQI with the CDLQI in the group of children with skin disease demonstrates a strong linear association and good agreement between the two.
摘要:cqvip:Background: Severe variants of psoriasis, such as erythrodermic psoriasis, may be associated with serious morbidity and mortality. Current treatment options for erythrodermic psoriasis are limited, unsatisfactory and potentially associated with organ-specific toxicity. Recently, a new class of agents, targeted biological therapies, has emerged. Etanercept is a recombinant human fusion protein acting as a competitive inhibitor of tumour necrosis factor-α . The safety and efficacy of etanercept have been widely demonstrated in psoriatic arthritis and moderate to severe plaque-type psoriasis. Objectives: To assess the efficacy and tolerability of etanercept in the treatment of erythrodermic psoriasis over a period of 24 weeks. Methods: Ten patients, eight men and two women, were selected to receive etanercept 25 mg subcutaneously twice weekly. The Psoriasis Area and Severity Index (PASI) score, ranging from 0 to 72, was used to assess the severity of disease. Results: Etanercept was well tolerated and led to a significant reduction in the severity of disease over the period of treatment. After 24 weeks, the mean PASI score decreased from 39.1 (baseline) to 5.1. At week 12, five of 10 (50% ) patients achieved an improvement of PASI score from baseline exceeding 75% . At week 24, six of 10 patients (60% ) achieved or maintained an improvement of PASI score from baseline exceeding 75% while two patients (20% ) maintained an improvement of between 50% and 75% . Conclusions: In this study, etanercept has been demonstrated to be an effective treatment for erythrodermic psoriasis, providing a safe and convenient alternative to current therapies.
摘要:cqvip:Background: Infliximab, a mouse-human chimeric monoclonal antibody directed against tumour necrosis factor-α , has been shown to be effective for moderate to severe psoriasis, but there are few data published on its use in recalcitrant, treatment-resistant resistant disease or in combination with other antipsoriatic therapies. Objectives: To report our experience with infliximab in the treatment of patients attending a tertiary referral service with severe recalcitrant disease. Methods: All patients attending a tertiary referral service for severe psoriasis who were treated with infliximab between 2002 and July 2005 were entered into a prospective, open-label study. Details on disease phenotype, clinical course and adverse events were recorded together with measures of disease severity [Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index, clinical photography] at baseline, weeks 2 and 6, and then at 2-monthly intervals throughout the treatment period. Results: Twenty three patients were treated with infliximab during the study; one patient had pustular psoriasis and was therefore excluded from statistical analysis. All had severe disease (baseline PASI 26.5 ± 6.7, mean ± SD, n = 22) and had received at least two systemic therapies for psoriasis in the past; 16 were taking one or more concomitant therapies at the time of treatment initiation. At week 10, 95% had achieved a 50% or greater improvement in baseline PASI (PASI 50), and 77% had achieved a 75% or greater improvement (PASI 75). Efficacy was sustained in the longer term, with eight of 10 patients on treatment for more than 11 months maintaining at least a PASI 50. Only one patient had treatment withdrawn due to lack of efficacy, two suffered severe systemic infections including extrapulmonary tuberculosis (splenic abscess) and cellulitis, and six have discontinued due to adverse effects including infusion reactions (two), severe thrombocytopenia (one), hepatitis (one) and malignancy (two). Conclusions: Data from this open-label study suggest that infliximab is a rapidly effective treatment for patients with severe, treatment-resistant disease, although approximately 25% of patients had to discontinue therapy due to the development of serious adverse effects. Long-term follow-up, continued pharmacovigilance, and further controlled comparative studies will be required to evaluate fully the risks associated with infliximab in the context of this already difficult to treat population.
摘要:cqvip:Background: Efalizumab (anti-CD11a), a humanized monoclonalantibody, blocks multiple T-cell-dependent functions implicated in the pathogenesis of psoriasis, including T-cell activation, migration to the skin, reactivation in psoriatic skin and interactions with keratinocytes. Objectives: This multinational, randomized, double-blind, placebo-controlled, parallel-group trial was designed to evaluate the safety and efficacy of subcutaneous efalizumab 1.0 mg kg-1 once weekly for 12 weeks compared with placebo in a population that included high-need patients, defined as those for whom at least two systemic therapies were unsuitable because of lack of efficacy, intolerance or contraindication. Patients/methods: Patients with moderateto- severe plaque psoriasis [involvement of ≥ 10% of total body surface area and Psoriasis Area and Severity Index (PASI) ≥ 12.0 at screening] were randomized in a 2:1 ratio to receive efalizumab or placebo. The primary efficacy endpoint was the proportion of patients achieving ≥ 75% PASI improvement (PASI- 75 response) at week 12 in the intention-to-treat population; secondary endpoints included changes in PASI, static Physician’ s Global Assessment, Physician’ s Global Assessment of change from baseline and percentage of body surface area affected. Results: We enrolled 793 patients (529 received efalizumab and 264 placebo), including 526 high-need patients (342 received efalizumab and 184 placebo). Week 12 PASI- 75 rates were 29.5% for efalizumab compared with 2.7% for placebo among high-need patients (P < 0.0001) and 31.4% for efalizumab compared with 4.2% for placebo in the full study population (P < 0.0001). Results for all secondary efficacy endpoints showed superiority of efalizumab over placebo in both the high-need and the full populations. Efalizumab demonstrated a favourable safety profile, without evidence of systemic toxicity, in both the high-need group and the overall study population. Conclusions: The efficacy and safety of efalizumab therapy were comparable between high-need patients and themore general moderate-to-severe psoriasis patient population. In view of its demonstrated efficacy and safety profile, efalizumab represents a valuable option for the treatment of adult patients with moderate-to-severe plaque psoriasis, including high-need patients.
摘要:cqvip:Background: Familial cylindromatosis is a rare genetic disorder, giving rise to neoplasms of the skin appendages. We have recently shown that loss of the cylindromatosis tumour suppressor gene leads to activation of NF-κ B, a transcription factor having antiapoptotic activity. This provides a possible explanation for the deregulated growth of cylindromas. In cell-based assays, salicylate can prevent NF-κ B activation caused by loss of the cylindromatosis gene, suggesting that salicylic acid application might be a potential treatment for cylindromatosis. Objectives: To assess the effectiveness of topical application of salicylic acid on familial cylindromas. Methods: Cylindromas in five patients from four different cylindromatosis families were treated with twice daily and then once daily topical salicylic acid. Clinical response was determined by serial tumour measurements. Results: In total 17 cylindromas in five patients were studied: 12 target lesions and five control lesions. The median size of the cylindromas was 1.0 cm (range, 0.6- 2.8 cm). Two of the 12 cylindromas showed a complete remission. Another eight lesions showed some response, but not sufficient to qualify as partial remission. The control lesions remained stable or increased in size. Conclusions: Salicylic acid is a well-tolerated and potential new treatment for cylindromatosis.