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The terminology, classification, diagnosis and treatment of self-inflicted dermatological lesions are subjects of open debate. The present study is the result of various meetings of a task force of dermatologists, psychiatrists and psychologists, all active in the field of psychodermatology, aimed at clarifying the terminology related to these disorders. A flow chart and glossary of terms and definitions are presented to facilitate the classification and management of self-inflicted skin lesions. Several terms are critically discussed, including: malingering; factitious disorders; Miinchausen's syndrome; simulation; pathomimicry; skin picking syndrome and related skin damaging disorders; compulsive and impulsive skin picking; impulse control disorders; obsessive compulsive spectrum disorders; trichotillomania; dermatitis artefacta; factitial dermatitis; acne excoriée; and neurotic and psychogenic excoriations. Self-inflicted skin lesions are often correlated with mental disorders and/or pathological behaviours, thus it is important for dermatologists to become as familiar as possible with the psychiatric and psychological aspects underlying these lesions. [ABSTRACT FROM AUTHOR]

Chronic pruritus is a common symptom and there is an urgent need to test new anti-pruritic substances in highquality clinical trials. However, no widely accepted standardized and validated method for objectively measuring pruritus is yet available. A special interest group of the International Forum for the Study of Itch has been established to assess scoring methods and questionnaires for use in clinical trials. This paper presents our current recommendations. The set of measures we recommend includes pruritus intensity scales, instruments for assessment of scratch lesions, chronic pruritus course, quality of life and patient benefitsen. [ABSTRACT FROM AUTHOR]

Chronic hand eczema places a heavy burden on patients, often affecting their ability to work. This paper compares the cost-of-illness and treatment approaches for patients with refractory chronic hand eczema, in relation to whether the disease was occupational or unrelated to work factors. Data from 2 surveys, comprising 310 patients with chronic hand eczema insured by German statutory health insurance (SHI) (including work-impaired patients, work-unaffected patients and non-working patients) and known work-related chronic hand eczema insured by occupational health insurance (OHI). Annual healthcare costs of managing work-impaired patients (SHI) and patients with work-related chronic hand eczema (OHI) were €3,164 and €3,309, respectively, approximately double the costs of managing non-working and work-unaffected (SHI) patients. This analysis shows that the costs associated with chronic hand eczema are affected by the correlation of chronic hand eczema with work, with costs being higher for occupational patients with chronic hand eczema. [ABSTRACT FROM AUTHOR]

Since they were first administered to patients with anti-body deficiency disorders over 50 years ago, human intravenous immunoglobulin preparations have been used successfully to treat a rapidly increasing number of auto-immune and inflammatory disorders, among which are a series of cutaneous autoimmune and inflammatory diseases. These include dermatomyositis, Kawasaki's disease, a number of autoimmune bullous diseases, severe adverse drug reactions, and other autoimmune and/or allergic conditions, such as atopic dermatitis. Although only a minority of these indications (dermatomyositis, Kawasaki's disease) are officially registered or based on double-blind, placebo-controlled clinical studies, the observed efficacy and safety profile of currently available intravenous immunoglobulin sometimes makes this a treatment of choice for initiation of therapy or for replacement of more toxic alternatives, such as systemic immunosuppressive medications. The increasing use of intravenous immunoglobulin has been associated with further understanding of its mechanism(s) of action, clinical manipulation and associated side-effects, as well as the introduction of improved or new types of intravenous immunoglobulin. This paper reviews the current knowledge of the mode of action of intravenous immunoglobulin, its reported therapeutic effects in cutaneous disease, its mode of administration and safety profile, and compares the currently available intravenous immunoglobulin preparations. [ABSTRACT FROM AUTHOR]

An allergy workup is done in many children with atopic dermatitis but its pratical benefit on disease management remains largely unproven. This paper emphasizes the need of a global assessment of the young patient, including compliance to previous treatments and disease severity. Allergy testing should be considered as a second line option, integrated to global management. True food allergy is found in one third of patients with moderate/severe disease, and avoidance diets in such patients help reducing topical corticosteroids consumption. Apart a better delineation of the indication of the tests, there is a need to make allergy workups simplier, and a better standardization of tests is needed. [ABSTRACT FROM AUTHOR]

In a multicentre study consecutively patch-tested dermatitis patients were tested simultaneously with 1.0% and 2.0% (w/v) formaldehyde in aqua applied with a micropipette (15 μl) to the filter paper disc in Finn Chambers (0.30 mg/cm2 and 0.60 mg/cm2, respectively). A total of 2,122 dermatitis patients were patch-tested. In all, 77 (3.6%) patients reacted positively to formaldehyde; 37 reacted only to 2.0%, 35 reacted to both concentrations and 5 patients reacted only to 1.0%. Significantly more patients were thus diagnosed with contact allergy to formaldehyde with 2.0% compared to 1.0% (p < 0.001) without causing more irritant reactions. The detected number of isolated allergic reactions to the 2 formaldehyde- releasers in the Swedish baseline series and not to formaldehyde itself raises the question whether quaternium-15 1.0% and diazolidinyl urea 2.0% should be present in the Swedish baseline series. [ABSTRACT FROM AUTHOR]

Dermatoscopy increases the accuracy of diagnosis of melanoma. An atypical vascular pattern may be an indicator of cutaneous malignant melanoma (CMM). During dermatoscopy of certain CMMs numerous ruby droplets of blood appear when the dermatoscope is pressed firmly against the lesion. The aim of this paper was to examine the histopathological background for this observation. CMMs from 8 patients showing the poppyfield sign, i.e. squirts of ruby blood droplets, were paired with 8 CMMs of equal Breslow thickness not showing this sign. The 16 CMMs were placed in an unsystematic sequence and presented to two dermato-pathologists who assessed the lesions independently for confirmation of Breslow thickness, Clark level, ulceration and presence of dilated tumour vessels. There was no disagreement between the pathologists' assessments. Age of the patients and Breslow thickness of the cutaneous malignant melanoma were similar in the two groups. All 8 poppyfield CMMs had dilated tumour vessels compared with 25% (2/8) of the non-poppyfield CMMs (p< 0.007). Histological ulceration was observed in all poppyfield CMMs and none of the non-poppyfield CMMs (p< 0.001). The poppyfield bleeding sign is a dermatoscopic clue to dilated tumour vessels. It may be a dermatoscopic reflection of increased vascular density described in primary CMMs compared with adjacent skin and may also reflect the presence of primitive vessels in CMMs displaying increased fragility. [ABSTRACT FROM AUTHOR]

The article focuses on the research work group International Forum for the Study of Itch (IFSI) and also offers brief historical information about the group. It informs that the goal of IFSI is to conduct clinical and experimental studies related to itch. It also informs that several IFSI members are contributing into the projects of the World Health Organization.

Hyperreactivity on re-exposure of previous allergic con- tact dermatitis skin areas has been previously demonstrated. This study aimed to investigate in methyldibromoglutaronitrile (MDBGN) allergic patients whether skin with previous allergic dermatitis from MDBGN showed an augmented response on re-exposure by both a patch test challenge and a use test with a liquid soap preserved with MDBGN. MDBGN dermatitis was elicited on the back and arms of sensitized individuals. One month later the previously eczematous areas were challenged with MDBGN. On the back, the test sites were patch-tested with a serial dilution of MDBGN and a use test was performed on the arms with an MDBCN-containing soap. A statistically significant increased response was seen on the areas with previous dermatitis on the back. Eight of the nine patients who developed dermatitis on the arms from the MDBGN-containing soap had an augmented response on areas with prior allergic contact dermatitis. Even though the allergic dermatitis appeared to be healed, an increased reactivity to allergen re-exposure was demonstrated both by patch test and use test challenge. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin disorder characterized by hyperproliferative keratinocytes and immune cell infiltration into the skin, often accompanied by itch. Histamine, acting via histamine 1-4 receptors, is known to modulate immune responses in the skin and to induce itch. The aim of this study was to test the role of histamine 2 receptors and histamine 4 receptors in the imiquimod-induced psoriasis-like skin inflammation model. BALB/c mice were treated intraperitoneally with amthamine (histamine 2 receptor agonist), JNJ-39758979 (histamine 4 receptor antagonist), a combination of both, or vehicle twice daily in a preventive manner. Imiquimod was applied once daily onto the back skin for 10 consecutive days. Stimulation of histamine 2 receptors and blockade of histamine 4 receptors ameliorated imiquimod-induced skin inflammation. The combination of amthamine and JNJ-39758979 reduced skin inflammation even more, diminished epidermal hyperproliferation, and inhibited spontaneous scratching behaviour. A combination of histamine 2 receptor agonist and histamine 4 receptor antagonists could represent a new strategy for the treatment of psoriasis. [ABSTRACT FROM AUTHOR]

Carvone (l-carvone), a mint flavour in spearmint oil, is considered a mild skin sensitizer. Carvone-sensitization may be linked to oral/perioral signs and oral lichen planus, but studies are sparse. The prevalence of patch test reactions to carvone and relevant findings from the positive group were investigated. Records for patch-tested patients at the Malmö clinic, for the period 1996 to 2016, were studied. Carvone-positive and carvone-negative patients were compared regarding patch test data from baseline series and dental series. Dental series-tested carvone-positive patients were also compared with a matched group. A total of 147 out of 4,221 referred patients had a positive patch test to carvone. Sensitized patients had higher mean age and were primarily women; 73% had oral signs and 57% had oral lichen. Concomitant patch test reactions to gold, nickel and mercury were common. In the matched group-comparison carvone-positive patients had a higher frequency of oral lichen, but no difference was found in sensitization to gold and mercury. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) is characterized by heterogeneous activity, evolution, associated comorbidities and response to treatment. The aim of this study was to identify prognostic factors in patients with CSU that predict disease course and response to standard treatments. An observational retrospective study was conducted in a cohort of 549 patients with CSU, comparing patients with isolated CSU and those with CSU with concomitant inducible urticaria (CSUCIndU). The factors associated with a worse prognosis in terms of duration and/or CSU activity and its episodes were: multiple episodes of CSU (19.2% had more than one lifetime episode of CSU), late-onset (63.6% of patients developed first onset of CSU after the age of 45 years), concomitant CIndU (20.2%) and functional serum autoreactivity. Patients with CSU-CIndU required more frequent therapy after 5 years and higher doses of 2nd-generation H1-antihistamines. Of patients with a baseline Urticaria Activity Score 7 (UAS7) between 16 and 42, 84.6% required cyclosporine or omalizumab to achieve symptom control, compared with 15.4% of patients with a baseline UAS7 between 0 and 15 (p = 0.0013). Baseline CSU activity is the only factor found to be predictive for refractoriness to treatment with H1-antihistamines. [ABSTRACT FROM AUTHOR]

Ultraviolet B (UVB) irradiation affects epidermal cells, which respond via a cascade of inflammation markers. After initial in vitro and ex vivo experiments, this study used cutaneous microdialysis to generate a kinetic profile for 16 cytokines and 4 prostanoids in human skin in vivo. Skin areas 9 cm2 were irradiated with UVB (2× minimal erythematous dose) 16 h after catheter placement in the dermis of the volar forearms of healthy volunteers. Dialysates were collected at 4-h intervals up to 64 h and analysed for 5- and 8-iso-PGF2α, 9α,11α-PGF2α and PGE2 by gas chromatography-mass spectrometry (GC/MS). Dialysates were also analysed for interleukin (IL)-1β, IL-2, IL-3, IL-4, IL-5, IL-6, IL-8, IL-10, tumour necrosis factor (TNF)-α, Fas ligand (FasL), interferon-γ- inducible protein-10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), RANTES, eotaxin, and granulocytemacrophage colony-stimulating factor (GM-CSF) using a multiplex-based cytometric-bead-array. In conclusion, 3 peaks with synchronic release of T helper (TH) 1-directed inflammatory cytokines and prostanoids could be detected post-UVB: an early phase (4-12 h), an intermediate phase (16-24 h) and a late phase (32-40 h). A TH2- directed cytokine response was detectable at intermediate and late phases. [ABSTRACT FROM AUTHOR]

Over the last decades, Life Course Research (LCR), predominantly the domain of sociology, has been increasingly applied in health research, as Life Course Epidemiology (LCE). The latter is concerned with disease patterns over time, accumulation of exposures over time, critical time periods and patterns of risk. We argue that concepts from LCR and LCE could be widely applied in dermatology, in general, and, more precisely, in the study of chronic inflammatory skin diseases, e.g. atopic eczema and psoriasis. The life course approach can generally be applied in two different ways. It may be used in the more traditional manner, in which the disease and its patterns over time are examined as the outcome variable. Conversely, it can examine life course as the outcome variable, which is dependent on the disease course, the treatments administered, and other physical or psychosocial environmental exposures. In dermatology, this second application of the LCR concepts is both promising and relevant because of the notable impact of chronic skin diseases on the patients' quality of life. In particular, we argue how LCR may be conducive to a better understanding of the concept of 'Cumulative Life Course Impairment', which is increasingly gaining acceptance. This approach helps identifying not only individuals at risk and particularly vulnerable patients but also critical periods for optimising interventions in order to avoid life course impairment. It also may facilitate more appropriate treatment decisions in clinical practice. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a common disease in childhood and an important risk factor for the later development of other atopic diseases. Many publications on childhood AD use questionnaires based on information obtained in adulthood, which introduce the possibility of recall bias. In a prospective cohort study, recall bias was evaluated in 1,501 unselected schoolchildren (mean age 14 years) evaluated for the first time in 1995 with a standardized questionnaire combined with a clinical examination and repeated in 2010. The lifetime prevalence of AD was 34.1% including data obtained both during school age and 15 years later, compared with 23.6% including data only from adulthood. The most important factors for remembering having had AD in childhood were: (i) long duration of dermatitis in childhood; (ii) adult hand eczema; and (iii) concomitant atopic disease. Recall bias for childhood AD affected the results of logistic regression on adult hand eczema and is a significant problem in retrospective epidemiological questionnaire studies evaluating previous AD as a risk factor for development of other diseases. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) occurs in approximately 2-3% of adults. The aim of this study was to develop and validate the self-administered Atopic Dermatitis Burden Scale for Adults (ABS-A). Patients were enrolled consecutively from those attending the Station Thermale Avène for a diagnosis of AD. ABS-A was developed using standard methodology, and consisted of 3 phases: exploratory, development, and validation. Internal consistency (Cronbach's a), concurrent validity (Spearman's correlation between ABS-A, SF-12 and Dermatology Life Quality Index [DLQI)]), and discriminant validity, were analysed. A total of 128 adults (68.8% females) completed the ABS-A, consisting of 18 items grouped into 4 domains. ABS-A showed good internal coherence (Cronbach's α, 0.89) and was correlated with both SF- 12 components [r = -0.36, p < 0.0001 (Physical); r = -0.52, p < 0.0001 (Mental)] and DLQI (r = 0.78; p < 0.0001). The ABS-A score varied significantly according to AD severity. To our knowledge, ABS-A is the first specific tool for assessing AD burden in adult patients. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is an inflammatory disease characterized by painful skin ulcerations with undermined and erythematous borders. The etiology of PG is not well understood, but it is generally considered to be an aberrant immune response characterized by a dermal neutrophilic infiltrate. Given the existence of only a few PG clinical trials, treatment options are largely based upon anecdotal data and small case studies. In addition to classic immunosuppressive medications, PG has been reported to respond well to the anti-TNF agents, infliximab, etanercept, and adalimumab. Newer biologics such as ustekinumab (anti-IL-23), ixekizumab (anti-IL-17) and brodalumab (anti-IL-17R) are promising given the effect of IL-17 on neutrophil migration. However, the effectiveness of these newer agents remains to be rigorously evaluated. Multi-drug regimens have not been well described in the literature but are an excellent alternative for patients with refractory disease. Herein, we provide a comprehensive review of the pathophysiology of PG and of the different treatments available for managing PG patients, including the theoretical benefit of initiating multidrug regimens. We also provide one possible treatment algorithm for patients with refractory disease and give examples of refractory PG cases successfully treated with multidrug regimens. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is the most common chronic inflammatory disease among children in industrialised countries. Many factors influence this disease in a negative way and contact allergy is one such factor. The aim of the study was to examine the frequency of contact allergy among children with the diagnosis atopic dermatitis. Contact allergy was found in 22/82 children (26.8%), the most common from Amerchol L101 (11.0%), potassium dichromate (7.3%), and nickel sulfate (4.9%). A statistically significant difference in contact allergy frequency was demonstrated for those with hand and/or foot eczema compared to those without. Children with atopic dermatitis who suffer from hand and/or foot dermatitis should always be patch-tested to evaluate whether they have a relevant contact allergy and thus allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

The individual prognosis of infants with atopic dermatitis (AD) is important for parents, healthcare professionals, and society. The aim of this study was to investigate predictors for remission of infant AD until school age. A systematic review was carried out of clinical and epidemiological studies investigating the effect of filaggrin gene (FLG) loss-of-function mutations, sex, exposure to pets, topical anti-inflammatory treatment, disease severity, and atopic sensitization during infancy on complete remission of infant-onset AD until 6-7 years of age. Systematic electronic searches until September 2013, data abstraction, and study quality assessment (Newcastle- Ottawa Scale) were performed. From 3,316 abstracts identified, 2 studies of good study quality were included. Parental allergies and sex did not significantly affect remission. For non-remission of AD, the included articles reported an association with any atopic sensitization at 2 years old (adjusted odds ratio [aOR] 2.76; 95% confidence interval (CI) 1.29-5.91), frequent scratching with early AD (aOR 5.86; 95% CI 3.04-11.29), objective severity score at 2 years old (aOR 1.10; 95% CI 1.07-1.14), and exposure to pets (cat OR 2.33; 95% CI 0.85-6.38). It is largely unknown which factors predict remission of infant AD. This is a highly relevant research gap that hinders patient information on the prognosis of infant-onset AD. [ABSTRACT FROM AUTHOR]

The preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a well-known sensitiser and present in most baseline series since at least 20 years. The proportions of MCI/MI are 3:1. MI alone has been used as a preservative in occupational and household products, and cosmetics since less than 10 years. MCI/ MI tested at 100 ppm fails to detect a significant percentage of contact-allergic reactions to MI. Our aim was to investigate whether a separate test preparation with MI picks up additional cases of contact allergy to MI not detected with MCI/MI 200 ppm. MI was inserted into the baseline series of the Malmö clinic in 2003 starting at 475 ppm, then 900 ppm, then 1,000 ppm, 1,500 ppm and finally 2,000 ppm. In 5,881 consecutively tested dermatitis patients the contact allergy rate for MI varied between 0.5 and 6.5%, with a marked increase in recent years. The contact allergy rate to MI 2,000 ppm alone, not traced by MCI/MI 200 ppm, varied between 0 and 1.9%. In conclusion, due to the increase of contact allergy to MI not traced by MCI/MI 200 ppm, MI in water at 2,000 ppm should be tested in a baseline series. Independent of patch test technique a dose of 60 μg/cm2 should not be exceeded to avoid adverse reactions and particularly patch test sensitisation [ABSTRACT FROM AUTHOR]

Internationally approved guidelines for the diagnosis and management of Malassezia-related skin diseases are lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspices of the Danish Society of Dermatology undertook a data review and compiled guidelines for the diagnostic procedures and management of pityriasis versicolor, seborrhoeic dermatitis and Malassezia folliculitis. Main recommendations in most cases of pityriasis versicolor and seborrhoeic dermatitis include topical treatment which has been shown to be sufficient. As first choice, treatment should be based on topical antifungal medication. A short course of topical corticosteroid or topical calcineurin inhibitors has an anti-inflammatory effect in seborrhoeic dermatitis. Systemic antifungal therapy may be indicated for widespread lesions or lesions refractory to topical treatment. Maintenance therapy is often necessary to prevent relapses. In the treatment of Malassezia folliculitis systemic antifungal treatment is probably more effective than topical treatment but a combination may be favourable. [ABSTRACT FROM AUTHOR]

Skin microdialysis is an established method for in vivo sample collection from the extracellular fluid space. This method has been extensively used in studies of inflammatory reactions in the skin of animals and humans. Skin microdialysis consists of the implantation of semi-permeable probes into the upper dermis, perfusion with a physiological buffer, and the recovery of the substances that diffused from the skin into the perfusion fluid. Microdialysis allows the simultaneous assessment of the temporal variations of inflammatory mediator release in the skin as well as the monitoring of vascular and sensory functions. By the aid of this technique, potential associations can be found between functional changes and a variety of substances and mediators released at the site of interest. This allows further insights into the possible mechanisms underlying physiological and pathophysiological events in the skin, including cutaneous inflammation. This review provides a comprehensive but not exhaustive review of the use of microdialysis in studies of experimental and clinical inflammatory reactions in the skin in animals and humans. [ABSTRACT FROM AUTHOR]

New treatment modalities are needed in atopic dermatitis. We evaluated the pharmacokinetics, safety, tolerability, and efficacy of topical cis-urocanic acid (cis-UCA) cream in randomised vehicle-controlled double-blinded clinical trials. The subjects received 5% cis-UCA emulsion cream and control vehicle on volar forearms after right–left randomisation. Study 1: 16 healthy subjects received one dose on the skin and, a week later, on DMSO-irritated skin. Study 2: 16 healthy subjects received 2 daily doses for 10 days. Study 3: 13 patients with mild to moderate disease were treated on selected skin lesions twice daily for 28 days. Study treatments were well tolerated. cis-UCA remained close to endogenous levels in plasma and urine. cis-UCA reduced transepidermal water loss (TEWL) both in healthy subjects and in the patients. Eczema area severity index and physician’s global assessment improved from baseline with both treatments. cis-UCA cream improved skin barrier function and suppressed inflammation in the human skin. [ABSTRACT FROM AUTHOR]

Urticaria, defined by the presence of wheals and/or angioedema, is a common condition in children, prompting parents to consult physicians. For its successful management, paediatric-specific features must be taken into account, regarding the identification of eliciting triggers and pharmacological therapy. This review systematically discusses the current best-available evidence on spontaneous acute and chronic urticaria as well as physical and other urticaria types in children. Potential underlying causes, namely infections, food and drug hypersensitivity, autoreactivity and autoimmune or other conditions, and eliciting stimuli are considered, with practical recommendations for specific diagnostic approaches. Second-generation antihistamines are the mainstay of pharmacological treatment aimed at relief of symptoms, which require dose adjustment for paediatric use. Other therapeutic interventions are also discussed. In addition, unmet needs are highlighted, aiming to promote research into the paediatric population, ultimately aiming at the effective management of childhood urticaria. [ABSTRACT FROM AUTHOR]

Epidemiological data on chronic pruritus (> 6 weeks) in the general population are sparse. We aimed to provide data on the incidence and prevalence of chronic pruritus, and identify its determinants based on crosssectional and longitudinal analyses. A cohort of 1,190 participants from a cross-sectional baseline-study (response rate: 57.8%) was followed up after one year. The questionnaire assessed occurrence of chronic pruritus, medical, lifestyle and psychosocial variables. Incident chronic pruritus was defined as reported chronic pruritus at follow-up in those subjects free-of-the-symptom at baseline. Cross-sectional analyses of data from the follow-up assessments addressed potential associations of medical, lifestyle and psychosocial factors with prevalent chronic pruritus. Longitudinal analyses examined sociodemographic factors as potential predictors of incident chronic pruritus. The follow-up response rate was 83.1%. The mean age of subjects was 56 years, and 58% were female. The 12-month cumulative-incidence equalled 7.0% (95% confidence interval (95% CI) 5.2-9.2%. Lifetime prevalence was 25.5% (95% CI 21.8-27.8%). Incidence was significantly associated with age. Determinants of prevalent chronic pruritus in multivariable analyses were: liver disease, asthma, eczema and dry skin within the medical domain, an elevated body mass index within the lifestyle domain and higher anxiety scores within the psychosocial domain. Findings suggest a considerable 12-month incidence and lifetime prevalence and provide important directions for future research. [ABSTRACT FROM AUTHOR]

The aim of this double-blinded, vehicle-controlled study was to test the antipruritic efficacy of topical strontium to relieve a nonhistaminergic form of itch that would be clinically relevant for chronic pruritic diseases. Itch induced with cowhage is mediated by PAR2 receptors which are considered to play a major role in itch of atopic dermatitis and possibly other acute and chronic pruritic conditions. The topical strontium hydrogel formulation (TriCalm®) was tested in a head-to-head comparison with 2 common topical formulations marketed as antipruritics: hydrocortisone and diphenhydramine, for their ability to relieve cowhage-induced itch. Topically-applied strontium salts were previously found to be effective for reducing histamine-induced and IgE-mediated itch in humans. However, histamine is not considered the critical mediator in the majority of skin diseases presenting with chronic pruritus. The current study enrolled 32 healthy subjects in which itch was induced with cowhage before and after skin treatment with a gel containing 4% SrCl2, control vehicle, topical 1% hydrocortisone and topical 2% diphenhydramine. Strontium significantly reduced the peak intensity and duration of cowhage-induced itch when compared to the control itch curve, and was significantly superior to the other two over-the-counter antipruritic agents and its own vehicle in antipruritic effect. We hereby show that a 4% topical strontium formulation has a robust antipruritic effect, not only against histaminemediated itch, but also for non-histaminergic pruritus induced via the PAR2 pathway, using cowhage. [ABSTRACT FROM AUTHOR]

Pruritus is a major symptom of numerous skin and systemic diseases and causes a substantial burden on patients' quality of life (QoL). We report here the validation of the German version (GerItchyQoL) of the first pruritusspecific QoL instrument ItchyQoL. GerItchyQoL was created from the original version following standard protocols. It was completed by 308 patients with chronic pruritus of different origin and tested for validity, reliability and responsiveness. Factor analysis of GerItchyQoL revealed the 4 domains symptoms, functioning, feelings, and self-perception. Reliability was demonstrated by good internal consistency of all domains. We confirmed convergent validity by comparing the instrument with itch severity, as measured with a visual analogue scale (VAS 0-10), and with the Short-Form-12 (SF-12), a widely used generic health-related QoL instrument. Concurrent validity was shown by the ability to discriminate between patient groups of different itch severity. Changes in GerItchyQoL scores correlated with changes in itch severity (VAS), suggesting responsiveness of the German tool. This study provides preliminary evidence of validity, reliability and responsiveness of GerItchyQoL and also shows a high impact of chronic pruritus on QoL. Further translations of ItchyQoL into additional languages will enable large-scale international, multilingual trials. [ABSTRACT FROM AUTHOR]

Despite an increasing knowledge of dandruff and seborrbeic dermatitis (D/SD), the pathophysiological understanding is still incomplete but suggests a role of Malassezia yeasts in triggering inflammatory and hyper-proliferative epidermal responses. The objective of this report is to review published literature from in vivo studies of D/SD populations to provide a more complete description of overall scalp health. New biomolecular capabilities establish a depth of pathophysiological understanding not previously achievable with traditional means of investigation. Biomarkers representing inflammation, hyper-proliferation and barrier function are all perturbed by the D/SD condition and robustly respond to therapeutic resolution. These biomarkers can be sampled noninvasively, enabling their use in routine clinical evaluations as either surrogate endpoints or complementary ones to classical signs/symptoms to broaden the etiological learning. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess the associations between chronic spontaneous urticaria (CSU), Helicobacterpylori infection and small intestinal bacterial overgrowth. Forty- eight patients with CSU were studied by scoring the urticaria activity and assesing the quality of life. Patients with H. pylori infection (n=11) or small intestinal bacterial overgrowth (n=13) were specifically treated for one week and clinically evaluated both before and 4 weeks after the eradication therapy. Eradication of H. pylori infection led to a significant improvement in CSU (p<0.002). In contrast, eradication of small intestinal bacterial overgrowth was not associated with any clinical improvement in CSU, despite the fact that these patients had statistically significant more urticaria activity at baseline. Thus there is no evidence to support the eradication of small intestinal bacterial overgrowth in CSU, but eradication of H. pyiori infection may result in an improvement of the disease. [ABSTRACT FROM AUTHOR]

Infection with Staphylococcus auras is common in all forms of eczema. Production of super antigens by S. auras increases skin inflammation in eczema; antibacterial treatment is thus pivotal. Poor patient compliance is a major cause of treatment failure; combination preparations that contain an antibacterial and a topical steroid and that work quickly can improve compliance and thus treatment outcome. Fusidic acid has advantages over other available topical antibacterial agents - neomycin, gentamicin, clioquinol, chlortetracycline, and the antifungal agent miconazole. The clinical efficacy, antibacterial activity and cosmetic acceptability of fusidic acid/corticosteroid combinations are similar to or better than those of comparator combinations. Fusidic acid/steroid combinations work quickly with observable improvement within the first week. Studies have shown that short-term (2 weeks) use of fusidic acid/corticosteroid combinations does not increase the development of resistance. A new formulation of fusidic acid with betamethasone valerate in a lipid cream also addresses xerosis in eczema. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the clinical and microbiological effect on Propionibaclerium acnes of oral tetracycline plus topical adapalene vs. oral isotretinoin in moderate to severe acne vulgaris. Male and female acne patients with moderate or severe inflammatory disease were enrolled and assigned randomly to 6 months of treatment with oral tetracycline hydrochloride plus topical adapalene, or oral isotretinoin, in a controlled, open study. After cessation of oral treatment the antibiotic-treated group received topical adapalene for the 2-month follow-up period. Clinical and microbiological assessments were performed. Skin samples for microbial identification and quantification were taken at baseline, after 2, 4 and 6 months of treatment, and 2 months after cessation of treatment. Patients treated with isotretinoin showed pro-longed significant remission compared with the other group. The density of resistant propionibacteria did not change significantly in any of the groups and there was no correlation between resistant P. acnes and the clinical response in any of the regions investigated. Antibiotic treatment was found to be a good alternative to isotretinoin, regardless of the presence of antibiotic-resistant P. acnes, although isotretinoin had a better effect, with prolonged remission after treatment. [ABSTRACT FROM AUTHOR]

In the last few decades an increasing understanding of the pathomechanisms involved in urticaria has highlighted the heterogeneity of different subtypes. According to the new European Academy of Allergology and Clinical Immunology/Global Allergy and Asthma European Network/European Dermatology Forum (EAACI/GA2LEN/EDF) guidelines, urticaria subtypes can be grouped into spontaneous urticaria, which includes acute urticaria and chronic urticaria, the physical urticarias, and other urticaria disorders, including, for example, contact urticaria. Clarity of nomenclature is required not only to choose the correct measures in diagnosis and management, but also to compare data from different studies. Urticaria has a profound impact on quality of life and performance. Effective treatment is thus required in all cases where avoidance of eliciting factors is not feasible. For symptomatic relief, non-sedating H1-antihistamines are the first choice in most subtypes of urticaria; however, double-blind controlled studies have shown that the dosages required may exceed those recommended for other diseases, e.g. allergic rhinitis. The current guidelines therefore suggest increasing the dosage up to four-fold, whereas alternative treatments should be reserved as add-on therapy for unresponsive patients. [ABSTRACT FROM AUTHOR]

Sebum production is thought to play a major role in acne vulgaris in adolescents. Psychological stress may exacerbate acne; however, it is not known whether the perceived association between stress and acne exacerbation is due to increased sebum production. The aims of this study were to determine: (i) if psychological stress in adolescents is associated with increased sebum production; and (ii) if stress is associated with increased acne severity independent of, or in conjunction with, increased sebum production. Ninety-four secondary school students in Singapore (mean age 14.9 years) were enrolled in this prospective cohort study. During a high stress condition (prior to mid-year examinations) and a low stress condition (during the summer holidays), the following were evaluated: (i) self-reported stress level using the Perceived Stress Scale; (ii) sebum level at baseline and at 1 h; and (iii) acne severity. The prevalence of self-reported acne in this study population was high (95% in males and 92% in females). Most subjects had mild to moderate acne. Sebum measurements did not differ significantly between the high stress and low stress conditions. For the study population as a whole, we observed a statistically significant positive correlation (r=0.23,p=0.029) between stress levels and severity of acne papulopustulosa. In adolescents, psychological stress does not appear to affect the quantity of sebum production. The study suggests a significant association between stress and severity of acne papulopustulosa, especially in males. Increased acne severity associated with stress may result from factors other than sebum quantity. [ABSTRACT FROM AUTHOR]

Making a differential diagnosis between early mycosis fungoides (MF) and parapsoriasis is often difficult at the clinical and histological level. The aim of this study was to explore markers that could help in this process. A total of 88 patients were included in 2 categories: large plaque parapsoriasis and digitiform parapsoriasis. A histological examination was performed for each patient, and expression of the antigen My7 (CD13), which is lacking in cutaneous T-lymphomas (CTCL) (but not in inflammatory lesions) and rearrangement of the T-cell receptor gene were analysed. A histological aspect of epidermotropic CTCL was observed in 23.5% of cases of large plaque parapsoriasis and 15% of cases ofdigitiform parapsoriasis. A disappearance of My7 antigen was noted in the 2 forms of parapsoriasis, more frequently when there was CTCL histology. A cutaneous clone was observed in 10.3% of cases of large plaque parapsoriasis, but not of digitiform parapsoriasis. For 3 patients, a cutaneous clone and a disappearance of My7 were associated with a non-specific histology. Considering these histological, immunological and molecular biological data, it appears that My7 antigen combined with T-cell clone may help the dermatologist to confirm the diagnosis of early ME Moreover, further studies will determine whether CD13 is an early prognostic marker of evolution of a parapsoriasis to MF. Finally, these results demonstrate that digitiform parapsoriasis can be an early stage of MF. [ABSTRACT FROM AUTHOR]

Systemic immunosuppressive agents are recommended for patients with atopic eczema in whom disease activity cannot be controlled adequately with topical treatments. Guidelines do not give clear advice which agents to prefer. We systematically reviewed clinical trials on systemic treatment for severe atopic eczema to provide evidence-based treatment recommendations. Standardized literature search, independent standardized assessment of eligibility and data abstraction was performed by 2 reviewers. Twenty-seven studies totalling 979 patients were included. Eleven studies consistently showed effectiveness of cyclosporine. Cyclosporine is recommended as first option for patients with atopic eczema refractory to conventional treatment. Evidence from randomized controlled trials also exists for interferon-7 and azathioprine. Although frequently used in clinical practice, systemic glucocorticosteroids have not been assessed adequately in studies. Mycophenolate mofetile showed effectiveness in 2 small uncontrolled studies. Intravenous immunoglobulins and infliximab are not recommended based on published data. [ABSTRACT FROM AUTHOR]

Patients with suspected cutaneous adverse drug reactions are often referred to allergy clinics or departments of dermatology for evaluation. These patients are selected compared with patients identified in prospective and cross-sectional studies of hospital populations. This explains the observed variation in prevalence of specific reactions and of eliciting drugs. This study investigated the prevalence of cutaneous adverse drug reactions in a university hospital department of dermatology that is specially focused on allergy. An 8-month survey was carried out during the period April-December 2003. Consecutive patients suspected of having cutaneous adverse drug reactions during this period were examined by dermatologists and investigated. Drug imputability was assessed in the 194 patients included; 33.5% had an exanthema with certain or likely drug imputability. Urticaria and local reactions at injection sites were the most frequent reactions (25% and 18.8%, respectively). β-lactam antibiotics, extracts for desensitization and insulins were the main drug groups involved, and accounted for 22.8%, 17.1% and 14.2%, respectively, of the reactions. Extracts for desensitization and insulins elicited more reactions than expected. This probably reflects the referral pattern to an allergy clinic. [ABSTRACT FROM AUTHOR]

Propionibacterium acnes is often discussed as a contributing pathogenic factor in the aetiology of acne lesions. The aim of this study was to test which porphyrin patterns are synthesized by P. acnes in vivo in untreated acne patients and during standard acne regimens. These photosensitive compounds are potential targets for photodynamic therapy of acne and need to be better characterized in the skin. Using high-performance liquid chromatography coproporphyrin III was the main porphyrin identified in all patients. Coproporphyrin I and protoporphyrin were found at considerably lower concentrations. When the porphyrin concentration of individual patients receiving isotretinoin was analysed repeatedly over time, clinical improvement was associated with lowered levels of porphyrins. Statistical analysis demonstrated a significant reduction in the porphyrin fractions only in the isotretinoin group which was associated with clinical improvement 2 months after starting therapy. [ABSTRACT FROM AUTHOR]

The in vitro activity of a new triazole R126638 against Malassezia yeasts was compared with that of ketoconazole. With the agar dilution technique, minimal inhibitory concentrations were lower for R126638 compared with ketoconazole against Malassezia globosa, M. obtusa, M. slooffiae, M. restricta and two strains of M. sympodialis. On human stratum corneum in vitro, both R126638 and ketoconazole were very effective in reducing the production of hyphae from 15% to 1% with R126638 and to 2% with ketoconazole. Scanning electron microscopy did not reveal obvious surface differences between untreated cultures and cultures exposed to ketoconazole or R126638 in the concentration range 0.01–1 μg/ml. However, transmission electron microscopy showed partial to complete necrosis of the cytoplasmic organelles of Malasseziayeasts. The combined scanning electron microscopy and transmission electron microscopy findings confirm earlier observations of the ‘mummifying’ effect of azoles against Malassezia spp. In conclusion, R126638 is an interesting new triazole with high activity against the Malassezia yeasts, which are involved in pityriasis versicolor and seborrhoeic dermatitis. [ABSTRACT FROM AUTHOR]

Atopy patch testing with Japanese cedar pollen extract has been used to investigate patients with atopic dermatitis whose condition is exacerbated by contact with Japanese cedar pollen. Comparative atopy patch testing, scratch tests, and assays for total IgE and specific IgE were performed in 74 patients with atopic dermatitis, 5 patients with Japanese cedar pollinosis and 15 control subjects. A skin biopsy was performed on any sites that were positive to Japanese cedar pollen patch test. The results after 48 h of atopy patch testing were compared with the patient's history, skin scratch test and specific IgE. Twenty-two of the 74 patients (30%) had a history of exacerbation every spring after contact with Japanese cedar. Of these patients 68% showed a positive reaction to Japanese cedar pollen extract, as did 21% of patients with atopic dermatitis without a history of exacerbation by Japanese cedar pollen, 20% of patients with Japanese cedar pollinosis without eruption and 7% of control subjects. A histological examination revealed eczematous changes and infiltration of lymphocytes and eosinophils in atopy patch testing positive sites. In conclusion, atopy patch testing with Japanese cedar pollen extract is a useful method for investigating trigger factors for eczematous skin lesions in a subgroup of patients with atopic dermatitis. [ABSTRACT FROM AUTHOR]

Combined exposure to different irritants in the workplace may lead to irritant contact dermatitis, which is the main type of occupational dermatitis among bakers and confectioners. Following previous work on 'tandem irritation', a panel of healthy volunteers was exposed twice daily for 4 days to the organic fruit acids: citric, malic, and lactic acid, either alone or in tandem application with 0.5% sodium lauryl sulphate (SLS) in a repetitive irritation test. Irritant cutaneous reactions were quantified by visual scoring and non-invasive measurement of transepidermal water loss and skin colour reflectance. Twice daily application of either citric or malic acid alone did not induce a significant irritant reaction. Combined exposure to one of the fruit acids and SLS caused marked barrier disturbance, hut the latter irritant effect was smaller than that obtained by combined exposure to SLS abovementioned fruit acids and SLS did not enhance cumulative skin irritation. [ABSTRACT FROM AUTHOR]

Systemic contact dermatitis may occur in contact-sensitized individuals when they are exposed to haptens orally, transcutaneously, intravenously or by inhalation. We report the case of a woman developing a diffuse skin eruption after the topical use of Rhus toxicodendron alcoholic extract and the oral introduction of a homeopathic preparation of the same substance for herpes treatment. An open test, performed with the Rhus toxicodendron tincture, showed an erythemato-oedematous response at 48 h and vesicular reaction at 96 h that was still present after 7 days. Patch test with 65% ethyl alcohol gave negative results. The open test performed, as control, in eight healthy informed subjects revealed negative responses to Rhus tincture application. The result is interesting because in Italy, allergic contact dermatitis to Rhus is uncommon and this case increases the understanding of the pathogenetic mechanism leading to systemic contact dermatitis development. [ABSTRACT FROM AUTHOR]

Patients infected with human immunodeficiency virus are highly susceptible to adverse dermatological reactions to specific medications. Severe cutaneous conditions such as Stevens-Johnson syndrome and toxic epidermal necrolysis are associated with high morbidity and, notably for toxic epidermal necrolysis, high mortality. Although overall mortality from human immunodeficiency virus has dramatically declined owing to highly active antiretroviral therapy, these antiretroviral regimens have been associated with a wide spectrum of severe cutaneous reactions. We reviewed case reports and clinical trials in the English literature on Medline® (1966 to 2001) and Aidsline® (1980 to 2000) to determine the prevalence of Stevens-Johnson syndrome and toxic epidermal necrolysis attributable to the current FDA approved antiretroviral medications. We identified a total of approximately 50 patients who had Stevens-Johnson syndrome and/or toxic epidermal necrolysis associated with the use of 5 antiretroviral medications: 2 nucleoside reverse transcriptase inhibitors, zidovudine (2 patients) and didanosine (1 patient); 1 non-nucleoside reverse transcriptase inhibitor, nevirapine (42 patients); and 2 protease inhibitors, indinavir (1 patient) and amprenavir (an unspecified number within the 1% of over 1400 patients experiencing severe life-threatening reactions). Of the reports that specified the onset time of adverse reaction after initiation of treatment, 86% (19/22) of patients experienced reactions within 4 weeks. Ten of the approximately 50 patients were diagnosed with StevensJohnson syndrome or toxic epidermal necrolysis, due to specific antiretroviral medication, or a combination of medications identified by either resolution upon withdrawal, consistent biopsy findings or a positive rechallenge. The remainder of the identified patients were reported in articles lacking data regarding drug administration, reaction history or other details. [ABSTRACT FROM AUTHOR]

The preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a well-known sensitiser and present in the Swedish baseline series since the 1980s. The proportions of MCI/MI are 3:1. MI alone has been used as a preservative since less than 10 years. This study was conducted on behalf of the Swedish Contact Dermatitis Research Group to evaluate inclusion of MI in the Swedish baseline series since the preparation of MCI/MI might fail to detect contact-allergic reactions to MI alone. Patients with suspected allergic contact dermatitis at 5 Swedish dermatology departments were consecutively patch-tested with MI 2,000 ppm aq and MCI/MI 200 ppm aq. The number of cases with exclusive contact allergy to MI varied between 0.8-4.2%. In total, 1.9% reacted exclusively to MI and not to MCI/MI. Due to the considerable frequency of contact allergy to MI not traced by MCI/MI, MI 2,000 ppm aq is included in the Swedish baseline series from January 2014. This corresponds to a dose of 60 μg/cm². [ABSTRACT FROM AUTHOR]

Topical corticosteroids are the mainstay of treatment in inflammatory skin diseases. Corticosteroids penetrate human skin, especially when the penetration barrier is damaged. Whether long‐term application of topical corticosteroids can lead to alteration of immune responses is not clear. We sought to examine the impact of topical corticosteroids on immune responses in patients using long‐term topical corticosteroids. Peripheral blood mononuclear cell proliferation in response to tetanus toxoid and tuberculin stimulation was studied, and tetanus toxoid‐specific antibodies were examined with ELISA. The results showed that, compared with the control group, the stimulation indices of patients' peripheral blood mononuclear cell to tetanus toxoid and tuberculin stimulations were lowered, which was especially significant in the tetanus toxoid group. No significant decrease was found in serum levels of tetanus toxoid‐specific antibody. The results suggest that topical corticosteroids can suppress cell‐mediated immune response in patients using long‐term topical corticosteroids. [ABSTRACT FROM AUTHOR]

Perfluoropolyethers (Fomblin[sup ®] HC products) are chemical nonreactive polymers with special physico-chemical properties that recently showed promise as protective preparations in the prevention of irritant contact dermatitis. We evaluated the efficacy of a new class of perfluoropolyethers (perfluoropolyether phosphate, Fomblin[sup ®] HC/P2) in the prevention of experimentally induced cumulative irritant contact dermatitis if applied prior to irritation. A panel of 20 healthy volunteers was tested with a repetitive irritation test using 4 standard irritants (sodium lauryl sulphate of highest purity, sodium hydroxide, lactic acid and toluene) in a randomized double-blind study. Application sites were assessed clinically and by the use of bioengineering techniques (transepidermal water loss and chromametry). Three gel preparations each containing 5% perfluoropolyether phosphate showed significant efficacy against irritation due to sodium lauryl sulphate and sodium hydroxide, while one test preparation containing 2% showed inferior benefit, indicating a dose-related effect. Preparations containing perfluoropolyether phosphates can be recommended for workplaces with water-soluble irritants. Further studies under real workplace conditions are indicated. [ABSTRACT FROM AUTHOR]

Hyperkeratotic dermatitis of the palms - also called eczema keratoticum - is a chronic, sometimes disabling condition in middle-aged persons. We carried out a single-blind, placebocontrolled study using acitretin in 29 patients. Fourteen patients received active therapy (30mg acitretin daily) and 15 placebo. All had hyperkeratotic changes of the palms with painful fissures and most had involvement of the volar aspects of their fingers. Approximately half of the patients had similar plantar changes. A semi-quantitative score of six parameters was used: hyperkeratosis, fissuring, scaling, itch, redness and vesicle count. After 4 weeks of treatment, a 51 % reduction of all symptoms was observed among patients receiving acitretin (p < 0.01) compared with a 9 % reduction in the placebo group (p > 0.05). No further improvement was seen over another 4 weeks of treatment. There were no changes in blood biochemistry, including serum lipids. No patients discontinued therapy because of side effects. We conclude that 30mg of acitretin is efficacious and safe to use in patients with hyperkeratotic dermatitis of the palms. [ABSTRACT FROM AUTHOR]

Examines the clinical response to gold sodium thiosulfate as a circulating contact allergen. Development of eczematous flare-up of existing dermatitis; Nature of the flare-up; Presence of toxicoderma-like rash and transient fever.

The article presents a case study of 4-generation Chinese family from Fujian, China with acne inversa (AI). It highlights the characterization of a novel mutation in the NCSTN Gene following the observed recurrent inflammatory papules, painful nodules and abscesses in their skins. It also emphasizes the effect of mutation p.A315V for developing AI in the family.

The article describes the case of a six-month old boy with iatrogenic Cushing's syndrome after treatment with a topical corticosteroids prescribed for dermatitis. It discusses the symptoms experienced by the patient, results of the patient's physical examination, the patient's medical history and treatment given to the patient.