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]

Climatotherapy (CT) is a treatment with immediate high clearance rate for chronic psoriasis, but evidence of long‐term effects is scarce. Assessment of the impact of a single CT treatment on disease activity and quality of life was carried out at 4‐ to 6‐month follow‐ups. A prospective study of patients with psoriasis undergoing 4 weeks of CT in Israel describes long‐term outcomes of CT. Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores were assessed before CT and at an average of 5 months after return. Assessment of the eligibility for CT takes place twice a year. A total of 49 patients (28/21 M/F) participated. Pretreatment PASI was 2.6 to 18.7 (mean 8.1 ± 3.8) vs control PASI 0 to 16.9 (mean 5 ± 2.8), (P <.0001). Mean ΔPASI was 3.2 (39.5% reduction). PASI 75 was achieved by 11/49 patients; 10/49 had increased PASI. The mean DLQI score was 16.1 (range 2‐30); 10.6 at follow‐up (range 0‐28), and 33 patients achieved DLQI minimal clinically important difference (P <.0001). Age, sex, number of previous CT, and duration of observation period did not affect endpoints. CT and unmonitored self‐treatment induces PASI 75 in one‐fifth patients at follow‐up 4 to 6 months later. Six of 10 patients report a clinically important improvement of patients' quality of life as measured by DLQI. [ABSTRACT FROM AUTHOR]

Methotrexate (MTX) has been used in the treatment of psoriasis and other dermatological diseases for more than 50 years. However, there is limited evidence regarding its effect, dose and monitoring, and a lack of consensus regarding how the drug should be used in daily practice. Although the use of MTX is governed by guidelines, such as the European S3-Guidelines and the National Institute for Health and Care Excellence (NICE) guideline, it is important to discuss and adjust these guidelines to national standards. An expert meeting was held in Denmark at the end of 2014, in order to reach consensus regarding the use of MTX in dermatological practice in Denmark. Participants included dermatologists, hepatologists, paediatricians, clinical biochemists and a rheumatologist. Topics discussed were: liver disease monitoring, teratogenic effects of MTX, risk of cancer, and use of MTX in children. We report here the conclusions of this expert meeting regarding use of MTX in dermatological practice. [ABSTRACT FROM AUTHOR]

The use of a validated screening questionnaire to identify individuals with chronic leg ulcers allows large-scale population-based studies to be conducted that measure and monitor the prevalence of the disease. The aim of this study was to design and validate such a screening questionnaire to identify patients with chronic leg ulcers. A simple 3-item questionnaire was developed at the Department of Dermatology, University Hospital of Zealand, Denmark. In total, 90 patients attending the department’s outpatient clinic for dermatological diseases and chronic wounds were included in this study. All included participants completed the questionnaire and were subsequently examined by dermatologists. We found that the constructed 3-item questionnaire in this study had a sensitivity and specificity of 95% and 93% and a positive predictive value and negative predictive value of 78% and 95%, respectively. Moreover, we found that the use of the 3-item questionnaire, as compared with a single question, in which the participants were asked whether they currently have a leg ulcer, resulted in significantly higher positive predictive value (+11.6%, P = .035) and specificity (+5.6%, P = .046) of the diagnostic test. Future studies are merited to investigate the diagnostic accuracy of the questionnaire in other populations and settings. [ABSTRACT FROM AUTHOR]

Rosacea is a field within dermatology with new insight within immunological research and new treatment-algorithm. Patient education on rosacea and appropriate treatments is an important aspect in helping patients succeed with therapy. Treatment should be tailored to each individual patient, taking into account: symptoms, trigger factors, patients' wishes, most bothersome symptoms, psychological aspect, individual needs. A combination of clinical therapies to treat different symptoms concomitantly may offer the best possible outcomes for the patient. In this review article we describe these aspects. [ABSTRACT FROM AUTHOR]

Cutis laxa is a rare disease characterized by abnormal skin wrinkling and laxity, due to decreased elastin synthesis or structural extracellular matrix defects. We have explored elastin metabolism in a case of adult onset cutis laxa localized to the upper body of a woman. For this purpose, we obtained skin biopsies from affected and unaffected skin areas of the patient and analyzed these with microscopy, polymerase chain reaction, western blotting and cell culture experiments. Skin from the affected area lacked elastin fibers in electron microscopy but had higher mRNA expression of elastin and total RNA. Levels of an apparent tropoelastin degradation product were higher in the affected area. Fibroblast cultures from the affected area were able to produce elastin and showed higher proliferation and survival after oxidative and UVB stress compared to fibroblasts from the unaffected area. In conclusion, we report a case of acquired localized cutis laxa with a lack of elastic fibers in the skin of the patient's upper body. The lack of elastic fibers in the affected skin was combined with increased mRNA expression and protein levels of elastin. These findings indicate that elastin synthesis was increased but did not lead to deposited elastic fibers in the tissue. [ABSTRACT FROM AUTHOR]

Background Interferon-γ has been suggested as causal therapy in both hyper-IgE syndrome and severe atopic dermatitis. Aim To investigate the therapeutic effect of short-term, low-dose interferon-γ both as monotherapy and in combination with topical treatment, in a patient with a variant of the hyper-IgE syndrome. Method Interferon-γ was administered subcutaneously (50 μg/m2 × 3 d/w) for 4 weeks. Three regions were studied: hands, flank and feet. The hands were treated with betamethasone-17-valerate cream and the feet with mupirocin ointment, while the flank was treated only with a moisturizer. Results All regions showed significant reductions of the clinical scores (0.0001 < P < 0.0280), but hands and feet showed significantly greater reduction than hank (P < 0.004). Conclusions The results suggest that short-term, low-dose interferon-γ treatment is a potentially useful therapy in hyper-lgE syndrome dermatitis when used in combination with topical mupirocin or a steroid. [ABSTRACT FROM AUTHOR]

Key Clinical Message Papillomatosis cutis lymphostatica is a benign, usually asymptomatic and underreported condition resulting from primary lymphedema or damage of lymphatic vessels due to diabetes. Cases have only been published sporadically. The presented image may help future colleagues to establish the diagnosis. [ABSTRACT FROM AUTHOR]

Cites a study to discuss daily use of crude coal tar (CCT) in the treatment of plaque psoriasis. Methods used in the treatment with CCT; Comparison of baseline scores for the body site being treated; Side effects of implementing CCT treatment.