Search

Background: Rosacea is a common chronic inflammatory facial skin disorder. Standardized evaluation of the severity and extent of rosacea is important for baseline assessment and treatment effect. The currently used Investigator's Global Assessment (IGA) is unspecific and fails to consider subtypes/phenotypes of rosacea and area involvement. The Rosacea Area and Severity Index (RASI) was developed to give a more nuanced evaluation of rosacea features in four facial skin areas adjusted to the relative importance of each area of the face to obtain an overall severity score. Objectives: To validate RASI against the IGA and to assess the inter‐ and intraobserver reliability for RASI. Methods: Sixteen dermatologists evaluated photographs of 60 adult patients with rosacea (3 photographs per patient, one from the front and one from each side). IGA and RASI scores were performed for interobserver reliability assessment. To determine intraobserver reliability, 14 dermatologists evaluated 10 other patients twice with at least 1 week interval. Results: The IGA and RASI correlated well (Spearman correlation coefficient (SCC) = 0.75, 95% confidence interval (CI) = 0.72–0.78). Interobserver reliability was moderate for RASI and poor to moderate for IGA. Reliability was strongest for rhinophyma, followed by papules/pustules and erythema, and rather weak for telangiectasia. For area scores, interobserver reliability was strongest for cheeks, followed by nose, chin and forehead. We found a moderate‐to‐strong intraobserver agreement both for IGA and RASI. Conclusions: We have designed a new practical tool to examine clinical severity of rosacea. RASI proved simple and reliable in scoring clinical severity of rosacea with an agreement comparable to the currently used IGA although RASI will provide a more nuanced view of the current rosacea extent and severity. We suggest that RASI is used in the daily clinical setting as well as in clinical studies assessing the efficacy of rosacea therapies. [ABSTRACT FROM AUTHOR]

Background: Hand eczema is a disease with large variation in clinical presentation and severity. Scoring systems for quantitative severity assessment exist. However, they are observer‐dependent. An objective quantitative tool for scoring of hand eczema would improve categorization of hand eczema. Objective: To investigate the usefulness of multispectral imaging in assessing severity of hand eczema with respect to extent and the different morphological features. Methods: Patients with hand eczema (n = 60) and healthy controls (n = 28) were included. The severity of hand eczema was assessed by a dermatologist using the Hand Eczema Severity Index (HECSI) and a global assessment (Physician Global Assessment [PGA]). Multispectral imaging of the hand was performed on all patients and controls using the VideometerLab Instrument. Results: Areas of the morphological elements identified by multispectral imaging were statistically significantly correlated with the PGA scores. Analyzed by Cohen's kappa, a moderate agreement between imaging‐based severity assessment and PGA was found. The imaging‐based severity assessment was also correlated with HECSI (Spearman rho 0.683, P < .001). Still, the imaging‐based algorithm was not capable of differentiating hand eczema patients from controls. Conclusions: Multispectral imaging allows quantitative measurements of different skin parameters to be performed. In its present form, multispectral imaging cannot replace the clinical assessment of a dermatologist. However, after refinement, this or similar technologies could prove useful. [ABSTRACT FROM AUTHOR]

Background: Same-day discharge of patients undergoing percutaneous coronary intervention (PCI) may challenge preparation of patients for discharge. Objective: The objective of this study was to investigate whether nurse-led telephone follow-up influenced patients' self-management post-PCI. Methods: We performed a randomized study with an allocation rate of 1:1. A standardized nurse-led motivational telephone consultation was conducted between 2 and 5 days after PCI to support adherence to medical therapy, follow-up activities, emotional well-being, and healthy lifestyle. The control group received usual care and discharge procedures. Primary outcome was adherence to use of P2Y12 inhibitor (clopidogrel or ticagrelor) therapy at 30 days of follow-up. Results: We consecutively included 294 elective patients (83%) undergoing PCI and with planned same-day discharge. Adherence to P2Y12 inhibitors was not influenced by the intervention (intervention vs control, 95%vs 93%, respectively; P = .627). However, the proportion of patients readmitted (8% vs 16%, P = .048), as well as self-initiated contacts to general practitioners (29% vs 42%, P = .020),was lower in the intervention group compared with the control group. Patients in the intervention group were more likely to know how to manage symptoms of angina pectoris (90%vs 80%, P = .015), and a higher proportion of patients in the intervention group commenced healthy physical activities (53% vs 41%, P = .043). Conclusion: Nurse-led motivational telephone follow-up did not influence adherence to antiplatelet medical therapy after PCI. However, the intervention positively influenced self-management of angina pectoris and reduced hospital readmissions and self-initiated contacts to general practitioners and hospitals. [ABSTRACT FROM AUTHOR]

According to the material safety data sheet (MSDS) the product consisted of an acrylic polymer-based powder with declared polymethylmethacrylate and a monomer-based liquid with methyl methacrylate (MMA) and ethylene glycol dimethacrylate (EGDMA). 2 Koutis D, Freeman S. Allergic contact stomatitis caused by acrylic monomer in a denture. [Extracted from the article]

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]

The use of nickel in certain consumer goods has been regulated in Denmark since 1990. The aim of this study was to reveal the clinical characteristics of nickel-allergic patients seen in seven private dermatology clinics and to identify current sources of nickel that may elicit nickel dermatitis. During 2006 to 2007, 634 patients with dermatitis aged 17-91 years were patch-tested and completed a questionnaire including a question about the occurrence of dermatitis following skin contact with ear-rings or ear-pins, watches, buttons or metal clasps (i.e. metal dermatitis). χ² tests were applied to test for statistical significant differences. Analysis revealed a lower prevalence of nickel allergy among women in the youngest age group (17-22 years) in comparison with older age groups (23-34 years and 35-46 years) (p<0.03). Most patients experienced metal dermatitis on the first occurrence between 1975 and 1985. No new cases of metal dermatitis were identified after 1985. We conclude that nickel allergy has decreased among young females with dermatitis due to the nickel regulation. [ABSTRACT FROM AUTHOR]

Background The severity of hand eczema is of interest in epidemiological studies. Ideally, as no validated methods of self-assessment exist, a dermatologist should examine all subjects. However, this is very resource intensive. Objectives To examine if severity grading performed by patients with hand eczema using a self-administered photographic guide was in agreement with the assessment performed by a trained dermatologist. Furthermore, to measure the correlation between the severity of hand eczema expressed on a visual analogue scale (VAS) and the clinical severity assessment, using the photographic guide. Methods Fifty-three consecutive outpatients with hand eczema were included, a number based on a prestudy statistical calculation. The patients were asked to grade current severity of their hand eczema by choosing one of four groups of photographs representing differing severities of hand eczema. On the same day all patients were examined by an experienced dermatologist, who graded the severity using the same photographic guide. The photographic guide was a modified version of a validated guide for use by physicians. In addition, the patients rated the severity of their hand eczema on a VAS. Results Fifty-one of the respondents completed the full questionnaire. For 37 of the 51 patients (73%) the clinical severity assessments of patient and dermatologist were identical. The measure of agreement, Cohen's kappa coefficient, was 0.61, indicating good inter-rater agreement. The correlation between the dermatologist-rated severity and the corresponding score by the patients on the VAS was only moderate (Spearman's rank correlation coefficient rho = 0.52). Conclusions The photographic guide for the self-assessment of hand eczema is an easy instrument to use, and for research purposes can be a reliable tool for patients with hand eczema to grade severity. A VAS can only be considered as a mediocre tool for estimation of the dermatologist-rated clinical severity, but should be validated as an independent instrument to assess severity of hand eczema. [ABSTRACT FROM AUTHOR]

The article discusses a study on potential factors related to low quality of life in patients with hand eczema. It highlights materials and methods used including a self-administered photographic guide, skin patch test, and the Dermatology Life Quality Index (DLQI) questionnaires. It reports that hand eczema shows a measurable impact on the quality of life of the patients.

The article presents a case study of a 27-year-old woman who suffered from allergic contact eczema on three different occasions on using nose pads, flip-flops with rubber straps, and watch with rubber straps. A patch testing was performed with high-performance liquid chromatography (HPLC), which concluded that the eczema was caused by drometrizole in all three cases.

The article describes the case of a 62-year-old male patient with a history of keratonic follicular papules, erythematous annular scaly plaques and tinea corporis and who developed Darrier disease (DD) due to cutaneous terbinafine-resistant Tricophyton rubrum infection. The diagnosis was confirmed after performing skin scraping, direct microscopy, Sabouraud agar culture and antifungal susceptibility testing. A discussion on drug resistance in dermatophytes is presented.

A recent Cochrane review evaluated the effect of topical anti-inflammatory treatment for seborrhoeic dermatitis. The authors concluded that topical steroids are an effective treatment and found some evidence of the benefit of topical calcineurin inhibitors. The existing Danish guideline for treatment of seborrhoeic dermatitis prepared on behalf of the Danish Dermatological Society recommends topical antifungal treatment as first-line treatment and anti-inflammatory treatment as adjuvant. The opinion of the authors of this article is that the results of the Cochrane review do not give rise to changes in these recommendations.

Introduction: The aim of the present study was to assess knowledge and therapeutic preferences in the treatment of patients suffering from hand eczema in general practice., Materials and Methods: A questionnaire was mailed to 700 Danish general physicians. Based on the case report of a man suffering from contact eczema on the hands and forearms for 4 months, the general physicians were asked to make a diagnosis, prescribe medication, advise the patient about general skin protection and consider a referral to a dermatologist., Results: 451 (64%) completed the questionnaire. The diagnosis contact eczema was made by almost all respondents (98%). A more potent topical steroid was the most frequently prescribed medication, alternatively in combination with an antibiotic component. A subgroup (16%) wanted to prescribe a less potent topical steroid. Only 20% of the respondents wanted to refer the patient to a dermatologist at the first consultation., Conclusion: Danish general physicians recognise the symptoms of contact eczema. The medical treatment is predominantly in agreement with general recommendations. A minor group would choose a less potent medication which could result in an inferior treatment. Attention should be paid to the fact that patients suffering from contact eczema which lasts more than one month ought to be referred to a dermatologist.