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In total, 256 patients with bacteriologically verified impetigo contagiosa were included in three double-blind, parallel group, randomized, multi-centre trials, where the efficacy of hydrogen peroxide cream (Microcid) was compared with that of fusidic acid cream/gel (Fucidin). The trials were performed at 47 centres in three countries, Sweden, Germany and UK, and the results are compiled in the present report. During the course of the 3-week treatment period, 92 patients out of 128 (72%) in the Microcid group were classified as healed, compared to 105 patients out of 128 (82%) in the Fucidin group. This difference was not statistically significant. The reduction in composite sign severity score (the sum of the score for erythema, vesiculation/bullae, weeping and crusting divided by four) in each separate study was 73%, 78% and 84% in the Microcid group and 85%, 85% and 84% in the Fucidin group. No statistically significant differences were found in the separate studies or when compiling the studies in a meta-analysis. When the patients had been classified as healed, beta-haemolytic streptococci were eliminated in all patients treated with Microcid cream. Since treatment started before the result of the bacteriology was known, another 135 patients with negative skin culture were enrolled in the trials, i.e. 391 patients were included in the safety analysis. Out of these, 23 patients reported the occurrence of adverse events, mainly classified as mild. In conclusion, Microcid cream has been documented as a topical alternative to fusidic acid in the treatment of impetigo.

Patients with nickel allergy and different types of eczema with and without atopy were given a single oral dose of nickel sulfate. Blood levels and urinary excretion were determined by atomic absorption spectrophotometry. Urinary excretion of nickel was found to be dependent on age, decreasing with increasing age. When difference in age between the eczema groups was taken into account, the level of nickel in urine was significantly (p < 0.005) higher in the two atopy groups compared to the controls. This may indicate a higher intestinal absorption of nickel in atopic skin disease.

Chronic leg ulcer is a disease of long duration, occurring predominantly in elderly people. Traditionally, little interest has been devoted to the study of the impact of this disease on life quality. In the present study the Nottingham Health Profile (NHP) was used to assess disease influence on six areas of daily life, namely: pain, physical mobility, sleep, energy, emotional reactions and social isolation. Standard questionnaires were distributed to patients with chronic leg ulcers of venous, arterial or mixed venous-arterial origin, treated at the Department of Dermatology. Complete data were obtained from 125 patients. The disease had a marked impact on the patient's subjectively perceived health. Males exhibited remarkably elevated scores, compared to the normative scores for men, especially in the areas of pain, emotional reactions, social isolation and physical restrictions. For women the impact of leg ulcer disease, although obvious, seems much less marked than for males. An exceptionally long median duration of leg ulcer disease was found among shop-assistants. It is possible that preventive measures should be undertaken in this group. The duration of leg ulcer disease did not seem to influence the quality of life. Patients with long disease duration in fact reported fewer problems than those with shorter duration, suggesting adaptive mechanisms. This study indicates that male leg ulcer patients should be more closely observed for symptoms of emotional stress, pain, social isolation and impaired physical mobility. More efforts should be made to alleviate pain. Above all this study underlines the importance of considering not only the ulcer but the whole patient.

By means of a questionnaire sent to all medical units in Malmö, including primary care, homes for the elderly, and industrial health clinics, 275 patients with leg and foot ulcers were identified. With a population of 232,908 in Malmö, this corresponds to a prevalence of 0.12%, which is lower than reported by others. Since the response rate was high (88% total, Primary Care: 100%), the prevalence of 0.12% is, however, believed to be real and might be explained by the urban area investigated, with easy access to care and proximity to one somatic hospital. 50% of the patients with leg and foot ulcers were treated in Primary Care, and 30% of the leg ulcer patients were treated at the Department of Dermatology. 88% of leg and foot ulcer patients were over 75 years of age. Median age was 79.5 years, with 80 for women and 76.5 for men. In Primary Care the median age was 82. There was a predominance of women in the study population with an overall sex ratio of 3:1. A higher proportion of patients living alone was found in Primary Care. The etiology of the ulcers was considered to be "unknown" or "other" or else no statement was given in 36% of the leg ulcer- and 22% of the foot ulcer patients. This might reflect an overall uncertainty about the underlying etiological cause. Medially and laterally located leg ulcers were reported equally often, but there was also a great proportion of wholly or partially circumferential ulcers. 76% of the foot ulcers were located on the toes.(ABSTRACT TRUNCATED AT 250 WORDS)

Delayed hypersensitivity retest reaction 3 and 6 weeks after induction of allergic and irritant inflammation, was studied in 13 females with known hypersensitivity to nickel. An increased retest reaction compared to controls was observed only in sites of earlier specific allergic inflammation. Also a general down-regulation of the degree of hypersensitivity was observed at retesting.

Questionnaires concerning nursing care of leg and foot ulcer patients in three major care-giving sectors of the national health service, namely the Department of Dermatology, general hospital wards/clinics, and primary care, have been analysed. The overall response rate was 88% (primary care: 100%). Forms regarding 193 patients with leg ulcers and 64 patients with foot ulcers were analysed. Substantial differences in nursing care were noted between the three sectors. In 55% of the leg ulcers and 45% of the foot ulcers fibrin slough was present in the ulcer. Black, necrotic tissue was present in 8% of the leg ulcers and 22% of the foot ulcers. Profuse ulcer-exudation was most commonly reported for leg ulcer patients treated at the Department of Dermatology, while the majority of foot ulcers had only a mild exudation. Frequency of dressing changes varied between 1.4 times/week for leg ulcers at the Department of Dermatology and 9.2 times/week (foot ulcers 11.6) at general hospital clinics. Local wound dressings were exclusively chosen by physicians at the Department of Dermatology, mainly by physicians at general hospital clinics, and equally often by physicians and nurses in primary care. Time since last evaluation of the ulcer by a physician varied. At the general hospital clinics, 89% of the patients with leg ulcers had been seen by a physician within the last 2-month period. At the Department of Dermatology, 89% and in primary care 61% of the patients were examined within this period. 11% of the patients in primary care had never consulted a physician for their ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)

Salpeter-induced calcium deposits in ten patients showed a close clinical and histopathological similarity to the lesions of pseudoxanthoma elasticum. By electron microscopy and selected area diffraction analyses of the calcium deposits we find the changes indistinguishable from the changes previously described in involved skin of patients suffering from PXE. Clinically our patients were compared with the fourteen patients with traumatic calcification previously described.

The flare-up reaction of old patch test sites following oral intake of antigen have been shown to be site and antigen specific reactions. Using enzyme and immunohistochemistry, the morphology of 6- to 8-week-old patch test sites, before and after oral challenge with nickel, was investigated. Before oral challenge, small scattered perivascular cell infiltrates consisting of macrophages, mast cells, T-lymphocytes, and OKT6+ dendritic cells were found in old patch test sites. In early and strong flare-up reactions combined with systemic toxicoderma-like reactions, polymorphonuclear leukocytes and lysed granular fragments from these cells were prominent. In slower flare-up reactions with little systemic involvement, T-lymphocytes predominated. We conclude that cells, probably macrophages, which are able to secrete inflammatory mediators promoting chemotaxis for polymorphonuclear leukocytes and/or T-lymphocyte proliferation, may play an important role in initiation of the flare-up reaction.

In the present study we produced allergic, irritant, ultraviolet and liquid nitrogen inflammation in human volunteers. Biopsies were taken from each test site and adjacent normal skin as control 4-5 weeks later. The monoclonal antibodies OKT 6 and HLA-DR were used for light microscopic detection of Langerhans' cells (LC). At all 4 post-inflammatory test sites the number of epidermal LC (OKT 6 positive as well as HLA-DR positive) were significantly increased compared to normal skin. Also, the density of dermal dendritic cells was increased in post-inflammatory test sites. The increased number of epidermal LC seems to be a result of inflammation and not a specific event strongly related to certain cutaneous inflammatory disorders. The present investigation supports the theory that epidermal LC play a role in skin homeostasis.

Two cases with recurrent annular lesions of similar clinical appearance and course are described. The histopathological investigations showed in both cases dense and diffuse infiltrates mainly of polymorphonuclear neutrophilic leucocytes in the mid dermis. No fever, leucocytosis or elevated ESR were observed. Systemic corticosteroid treatment controlled symptoms but recurrence after treatment was withdrawn occurred in both cases. It is discussed if we are dealing with a variant of Sweet's syndrome or a new entity.

In subjects hypersensitive to nickel we have investigated local and systemic effect of whole body exposure of cumulative suberythema UVB doses as well as solarium-UVA exposure. UVB possesses both locally and systemically a suppressive effect on human allergic contact dermatitis, but UVA has no such effect. The systemic suppressive effect of UVB might be of therapeutic importance in patients with severe chronic dermatitis of the hands when adding this effect to a local suppressive effect. Also, patch testing should not be performed during UVB and/or overt sun exposure.

Cutaneous lesions clinically similar to and histopathologically indistinguishable from pseudoxanthoma elasticum have been observed in the cubital folds of nine elderly farmers. In all cases the skin lesions were ascribed to exposure to salpeter during fertilization on a single occasion decades previously. Signs of systemic pseudoxanthoma elasticum were absent.

The effect of local as well as whole body irradiation with UVB was investigated in patients with chronic hand eczema not responding to conventional topical treatment. UVB irradiation of the hands was significantly more effective than placebo. Whole body UVB irradiation combined with additional irradiation of the hands proved to be even more effective than local treatment in clearing chronic hand eczema. Due to the relatively fast relapse of the hand eczema after the UVB treatment period maintenance treatment is warranted. This could possibly be carried out by the patients at home, but under surveillance by a dermatologist.

Ultraviolet radiation has been stated to inhibit afferent as well as efferent phases of allergic contract dermatitis. In this controlled study 17 female patients with nickel allergy were studied by three different protocols after an initial determination of their degree of hypersensitivity. They were patch tested with nickel sulfate immediately after UVB, 4-6 days after UVB, or immediately after external PUVA. Neither depressing nor enhancing of the allergic reaction was observed when compared to non-irradiated controls. The role of Langerhans cells as antigen-presenting cell playing an important role in the elicitation phase of allergic contract dermatitis is discussed and questioned.