Search

Digital dermatitis (DD) is a polybacterial disease endemic to most UK dairy farms. It poses a major financial and welfare threat and is characterized by high incidence and recurrence rates. We aimed to investigate the association between the UK EBV for resistance to digital dermatitis, the digital dermatitis index (DDI), and the frequency of DD, heel horn erosion (HHE), and interdigital hyperplasia (IH) in a population of Holstein dairy cows. We enrolled and genotyped 2,352 cows from 4 farms in a prospective cohort study. Foot lesion records were recorded by veterinary surgeons for each animal at 4 time points during a production cycle, starting at approximately 2 mo before calving and ending in late lactation. Importantly, these records were not used in the calculation of the DDI. Lesion records were matched to the animal's own DDI (n = 2,101) and their sire's DDI (n = 1,812). Digital dermatitis index values in our study population ranged from −1.41 to +1.2 and were transformed to represent distance from the mean expressed in SD. The relationship between the DDI and the presence of DD was investigated using a logistic regression model, with farm, parity, and a farm-parity interaction fitted as covariates. A multivariable logistic regression model was fitted to evaluate the relationship between HHE and DDI with farm fitted as a covariate. Finally, a univariable logistic regression model with DDI as explanatory variable was used to investigate the relationship between IH and DDI. The odds ratio of an animal being affected by DD was 0.69 for 1 SD increase in the animal's DDI (95% CI = 0.63–0.76). The odds of HHE and IH were 0.69 (95% CI = 0.62–0.76) and 0.58 (95% CI = 0.49–0.68) respectively for 1 SD increase in DDI. The adjusted probability of DD was 32% (95% CI = 27–36%) for cows with mean DDI value of 0, while it was 24% (95% CI = 20–29%) in cows with a DDI value of +1. Sire DDI breeding values were standardized in the same way and then binned into terciles creating an ordinal variable representing bulls of high, medium, and low genetic merit for DD resistance. The daughters of low genetic merit bulls were at 2.05 (95% CI = 1.60–2.64), 1.96 (95% CI = 1.53–2.50), and 2.85 (95% CI = 1.64–5.16) times greater odds of being affected by DD, HHE, and IH, respectively, compared with the daughters of high genetic merit bulls. The results of this study highlight the potential of digital dermatitis genetic indexes to aid herd management of DD, and suggest that breeding for resistance to DD, alongside environmental and management control practices, could reduce the prevalence of the disease. [ABSTRACT FROM AUTHOR]

Background Patch testing is an important investigation when dermatitis is unresponsive to, or worsened by, topical corticosteroid treatment. There is a balance to be struck between testing too many allergens, which is expensive, time consuming and risks causing sensitization, and testing too few, which risks missing the diagnosis. The current British Society for Cutaneous Allergy (BSCA) corticosteroid series comprises eight allergens and was last updated in February 2007. Aim To review and update the BSCA corticosteroid series. Methods We retrospectively analysed data from 16 patch test centres in the UK and Ireland for all patients who were patch tested to a corticosteroid series between August 2017 and July 2019. We recorded the allergens tested, the number and percentage tested to a corticosteroid series and the number of positive results for each allergen. We identified the allergens that test positive in ≥ 0.1% of selectively tested patients. Results Overall, 3531 patients were tested to a corticosteroid series in the 16 centres. The number of allergens tested ranged from 7 to 18 (mean 10). The proportion of patch test patients who were tested to a corticosteroid series ranged from 1% to 99%. Six allergens in the 2017 BSCA series tested positive in ≥ 0.1% of patients. Nine allergens not in the BSCA corticosteroid series tested positive in ≥ 0.1% of patients. Conclusion This audit demonstrates the importance of regular review of recommended series and the significant variations in practice. The new BSCA corticosteroid series that we recommend contains 13 haptens, with the addition of the patient's own steroid creams as appropriate. [ABSTRACT FROM AUTHOR]

Background: Bovine Digital Dermatitis (BDD) is a prevalent infectious disease, causing painful foot skin lesions and lameness in cattle. We describe herein the bovine foot skin microbiota and its associations with BDD using 16S rRNA gene amplicon and shotgun metagenomic sequencing on samples from 259 dairy cows from three UK dairy farms. Results: We show evidence of dysbiosis, and differences in taxonomy and functional profiles in the bovine foot skin microbiome of clinically healthy animals that subsequently develop BDD lesions, compared to those that do not. Our results suggest that taxonomical and functional differences together with alterations in ecological interactions between bacteria in the normal foot skin microbiome may predispose an animal to develop BDD lesions. Using genome-wide association and regional heritability mapping approaches, we provide first evidence for interactions between host genotype and certain members of the foot skin microbiota. We show the existence of significant genetic variation in the relative abundance of Treponema spp. and Peptoclostridium spp. and identify regions in the bovine genome that explain a significant proportion of this variation. Conclusions: Collectively this work shows early changes in taxonomic and functional profiles of the bovine foot-skin microbiota in clinically healthy animals which are associated with subsequent development of BDD and could be relevant to prevention of disease. The description of host genetic control of members of the foot skin microbiota, combined with the association of the latter with BDD development offer new insights into a complex relationship that can be exploited in selective breeding programmes. ApfTUdsqPmkzyTqVTTd38- Video Abstract [ABSTRACT FROM AUTHOR]

Atopic dermatitis is one of the most common conditions managed in the community world-wide. Atopic dermatitis is under intense scrutiny by academic researchers, not to mention drug companies, enabling regular research in the area. Dermatologists have a growing appreciation of the complex causes of this common condition.

Skin fold dermatitis (intertrigo) is an inflammatory process of closely apposing skin surfaces. Extreme conformations towards folded skin in many dog breeds are linked with higher risk. Using anonymised primary-care veterinary data from the VetCompass Programme, this study aimed to report the frequency, demographic risk factors and clinical management for skin fold dermatitis in the UK. Risk factor analysis used random effects multivariable logistic regression modelling. From a study population of 905,553 dogs, the one-year period prevalence in dogs overall was 0.37% (95% CI 0.35–0.39). Diagnosis was supported by laboratory testing in 4.21% cases. Systemic antibiosis was used in 42.30% cases. Compared with crossbreed dogs, the most highly predisposed breeds were English Bulldog (odds ratio [OR] 49.07, 95% CI 37.79–63.70), French Bulldog (OR 25.92, 95% CI 19.62–34.26,) and Pug (OR 16.27, 95% CI 12.20–21.69). The most protected breeds were Yorkshire Terrier (OR 0.14, 95% CI 0.03–0.56), Border Collie (OR 0.31, 95% CI 0.11–0.84), Jack Russell Terrier (OR 0.53, 95% CI 0.30–0.92) and Labrador Retriever (OR 0.57, 95% CI 0.35–0.93). This study adds further evidence to the welfare concerns around high popularity of dog breeds with extreme conformations. The three breeds with by far the highest odds of skin fold dermatitis represent an extreme brachycephalic conformation. [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) relates to skin breakdown from exposure to urine or faeces, and its management involves implementation of structured skin care regimens incorporating appropriate use of skin barrier products to protect the skin from exposure to moisture and irritants. Medi Derma-PRO Skin Protectant Ointment and Medi Derma-PRO Foam & Spray Incontinence Cleanser are part of the Total Barrier Protection™ (Medicareplus International) range indicated for management of moderate-to-severe IAD and other moisture-associated skin damage (MASD). This article summarises the findings of multi-centred patient evaluations of Medi Derma-PRO Skin Protectant Ointment and Medi Derma-PRO Foam & Spray Incontinence Cleanser, and aims to demonstrate the clinical and cost benefits of using these products for the prevention and management of MASD. [ABSTRACT FROM AUTHOR]

Cetacean morbilliviruses (CeMVs) are significant causes of mortality in many cetacean species in epizootics and smaller outbreaks. Despite the prominence of skin lesions in seals and terrestrial animals, including humans, affected by other morbilliviruses, they have not been reported in CeMV-infected cetaceans. Here we report CeMV-associated skin lesions in a fin whale (Balaenoptera physalus) with subacute, systemic CeMV infection that live-stranded in Scotland, UK. Grossly, the skin was sloughing in large sheets, presumed due to autolysis, but histological examination showed syncytia, below the dermoepidermal junction, that were strongly immunopositive for morbillivirus antigen, as were syncytia in other organs. By polymerase chain reaction (PCR), the relative load of CeMV-specific RNA was largest in the liver and urinary bladder, even in formalin-fixed, paraffin-wax embedded samples. Levels were low in skin and only detectable in frozen samples. Genetic comparison of the CeMV revealed close alignment with isolates from fin whales from the North Atlantic Ocean and Mediterranean Sea, but that it was distinct from the porpoise CeMV clade. These findings show skin samples can be used to diagnose CeMV infection in cetaceans, highlighting the potential of ante-mortem sampling for monitoring disease in current populations and assessment of changes in host and pathogen genetics. [ABSTRACT FROM AUTHOR]

Summary: Background: Occupational hand dermatitis poses a serious risk for nurses. Objectives: To evaluate the clinical and cost‐effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses Methods: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first‐year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow‐up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171. Results: Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention‐to‐treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow‐up (12–15 months). When adjusted for baseline prevalence of dermatitis and follow‐up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow‐up in the intervention group relative to the controls were 0·72 (0·33–1·55) and 0·62 (0·35–1·10) for student and ICU nurses, respectively. No harms were reported. Conclusions: There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411–412. What is already known about this topics? Nurses are at high risk of developing hand dermatitis.Educational interventions are only partially successful in preventing hand dermatitis in healthcare workers. What does this study add? The nurse participants in our study had a high level of positive beliefs about good hand care; however, this was not translated sufficiently into their behaviours even when they were provided with access to a behavioural change programme and given ready access to hand moisturizers.The behavioural change programme intervention did not have a significant effect on reducing hand dermatitis among at‐risk nurses. Linked Comment: Brans. Br J Dermatol 2020; 183:411–412. Plain language summary available online [ABSTRACT FROM AUTHOR]

While there is much focus on pressure ulcers (PU), research has shown that the incidence rate of incontinence-associated dermatitis (IAD) in critically ill patients is often higher than for PUs (Bliss et al 2011; Becker et al 2017). The nature of acute illness predisposes this patient population to acute faecal incontinence with diarrhoea (AFID) and they are therefore at higher risk of skin damage to their sacrum. An opportunity was sought to reduce incidences of this type of patient harm. A quality improvement program introduced two clinical-decision support tools; one for the assessment of skin for patients with AFID and a second tool to guide the management of patients' skin, based on the assessment. Extensive consultation followed before a final version was launched across two critical care (CC) units. The CC nurses and healthcare assistants now have evidence-based guidance to assess skin damage caused by incontinence and a clear plan around this aspect of care. The tool can be applied to any person who experiences incontinence and, therefore, at risk of IAD. [ABSTRACT FROM AUTHOR]

Moisture-associated skin damage, especially incontinence-associated dermatitis, continues to present significant health challenges and requires multidisciplinary input to provide effective prevention and treatment. In the absence of mandatory reporting such damage is under- or wrongfully reported, resulting in a lack of accurate data on prevalence and costs of associated care. In March this year, a multidisciplinary team of experts met in the UK to seek to determine measures to improve patient skin care. They aimed to identify activities to increase awareness and education, collect data, and improve prevention and treatment regimes. This article describes that discussion and the conclusions made by the group, such as the key actions required to effect policy changes. [ABSTRACT FROM AUTHOR]

The article discusses the implications of incontinence-associated dermatitis (IAD) for nursing in the context of National Health Service (NHS) England. Topics include the relation of skin function to IAD, the prevention and treatment of IAD, and differences between IAD and pressure ulcers. Risk factors for IAD are noted.

Incontinence-associated dermatitis (IAD) is a defined pathological entity and presents a significant burden for patients and health-care systems. The main objective of this evaluation was to test the efficacy and safety of a skin barrier cream in the management of uncomplicated IAD in elderly patients. Ten incontinent patients with mobility problems that presented with signs of IAD were included in the evaluation. The evaluation took place during a 2-week period. The product’s efficacy was objectively evaluated in each patient with high-frequency ultrasound scans taken from the irritated skin compared with an ultrasound scan taken from normal adjacent (control) skin. Data analysis showed a statistical significance in favour of the capacity of the product to help reduce inflammatory signs. Photographic follow-up allowed correlation of ultrasound findings and clinical signs. The product was effective in treating the skin irritation and preventing further skin breakdown. There were no adverse events during the evaluation. [ABSTRACT FROM AUTHOR]

Purpose: In the United Kingdom (UK) police restraint and control of detainees is undertaken by assorted means. Two types of incapacitant spray (IS) are approved by the UK Home Office for use: CS (o-chlorobenzylidine malononitrile, dissolved in an organic solvent-methyl iso-butyl ketone and pelargonic acid vanillyamide (PAVA). The aim of this study was to document the effects of incapacitant sprays, by symptom assessment and medical examination, within a few hours of deployment. Methods: A detailed proforma was produced to explore the nature of the arrest, the nature of exposure to the incapacitant spray, the type of incapacitant spray, the symptoms experienced and the medical findings. Results: 99 proformas were completed. 74 % were completed by detainees and 26 % were completed by police officers. 88 % were exposed to CS spray, the remainder to PAVA spray. The mean time of assessment after exposure was 2.8 ± 2.33 h (mean ± SD). The most frequent sites of IS contact were the face and scalp ( n = 78), and exposure to the left and right eyes ( n = 32). The most common symptoms were: painful eyes ( n = 68); red eyes ( n = 58); runny nose ( n = 59); lacrimation ( n = 55); nasal discomfort ( n = 52); skin irritation ( n = 49); and skin burning ( n = 45). The most common medical findings were: conjunctival erythema ( n = 34); skin erythema ( n = 21); and rhinorrhea ( n = 20). Conclusions: Symptoms and signs of exposure to IS lasted longer than was expected (a mean of 2.8 h). Approximately 30 % of those exposed had ocular effects and 20 % had skin effects. The findings of this study will enable the guidelines on the expected effects and duration of symptoms resulting from exposure to incapacitant sprays to be reviewed and suggestions for their management to be refined. [ABSTRACT FROM AUTHOR]

The article presents a study based on several case studies related to development of moisture lesions in patients during their stay in intensive care units (ICU) and use of TENA Bed Plus for prevention from these lesions. Topics discussed include reasons for development of these lesions, effect of climate on humidity of the skin, use of virgin fluff pulp in the pads and need of management of these lesions for avoiding painful lesions.

The use of biocidal agents in footbaths for dairy cows as an alternative to antibiotics is becoming standard practice in the UK. However, with numerous biocides available for use in footbaths and varying advice on the frequency with which footbaths should be used, practitioners may refer to the published literature for guidance. The evidence would suggest a variety of biocides are effective at improving bovine digital dermatitis (BDD) lesion score in cows with lesions. However, little published data is available on the protective effective of regular (such as daily) foot disinfection protocols for cows without BDD lesions despite the widespread anecdotal evidence for its efficacy. Formalin and copper sulphate are the most commonly used biocides, both of which should be used with significant precautions. Whichever biocide is used, practical considerations with regard to footbath design and care with making solutions to the correct concentration should be addressed. [ABSTRACT FROM AUTHOR]

The objectives of this study were to 1) identify determinants of poor welfare in commercial broiler chicken flocks by studying the associations between selected resource-based measures (RBM, potential risk factors), such as litter quality and dark period, and animal-based welfare indicators (ABM), such as foot pad dermatitis and lameness, and 2) establish the breadth of effect of a risk factor by determining the range of animal welfare indicators associated with each of the risk factors (i.e., the number of ABM related to a specific RBM). Eighty-nine broiler flocks were inspected in 4 European countries (France, Italy, the United Kingdom, and the Netherlands) in a cross-sectional study. The ABM were contact dermatitis (measured using scores of foot-pad dermatitis and hock burn, respectively), lameness (measured as gait score), fear of humans (measured by the avoidance distance test and the touch test), and negative emotional state (measured using qualitative behavior assessment, QBA). In a first step, risk factors were identified by building a multiple linear regression model for each ABM. Litter quality was identified as a risk factor for contact dermatitis. Length of dark period at 3 wk old (DARK3) was a risk factor for the touch test result. DARK3 and flock age were risk factors for lameness, and the number of different stockmen and DARK3 were risk factors for QBA results. Next, the ABM were grouped according to risk factor and counted. Then, in a second step, associations between the ABM were investigated using common factor analysis. The breadth of a risk factor's effect was judged by combining the number (count) of ABM related to this factor and the strength of association between these ABM. Flock age and DARK3 appeared to affect several weakly correlated ABM, thus indicating a broad range of effects. Our findings suggest that manipulation of the predominant risk factors identified in this study (DARK3, litter quality, and slaughter age) could generate improvements in the related ABM and thereby enhance the birds' overall welfare status. [ABSTRACT FROM AUTHOR]

The article discusses the diagnosis, assessment and treatment of patients with psoriasis. Psoriasis is described as an inflammation of the skin and joints that typically manifest as pink or red scaly plaques. Though its diagnosis is straightforward, it can reportedly develop into unstable pustular or erythrodermic forms. Guidelines on care of psoriasis from the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidance Network (SIGN) are discussed.

The article presents a study which investigates the effect of antibiotic therapy and footrot vaccination on footrot and contagious ovine digital dermatitis (CODD) of sheep in Great Britain. The study incorporates two treatment strategies which consisted of a long-acting amoxicillin injection and intramuscular injection of long-acting amoxicillin. The result of the study suggest a role for infection with Dichelobacter nodosus in the CODD's aetiopathogenesis.

The majority of early-stage breast cancers are treated with breast-conserving surgery followed by adjuvant radiation treatment on the whole breast. Acute dermatitis is a frequent side-effect of adjuvant breast radiotherapy, and this treatment can also impair the long-term cosmetic result. Breast intensity-modulated radiation therapy (IMRT) is a technique that improves the radiation dose distribution in the breast, allowing the avoidance of "hotspots". To review current evidence that breast IMRT provides a patient benefit, a MedLine search was done to identify articles reporting on this technique. A total of 63 manuscripts reporting on breast IMRT were identified. Fifty-six articles present original research data; the majority (80%) reported on physics or dosimetry, a smaller number on clinical outcomes (15%), and on health sciences or radiobiology (5%). Eight articles reported clinical outcomes, with six being single-institution retrospective or prospective cohort from three centers in the USA, and two reporting prospective randomized controlled trials were from the UK and Canada. Combining all these data, the clinical outcomes of nearly 780 patients receiving breast IMRT have been reported and compared with 767 patients receiving standard wedged radiotherapy. There is level 1 evidence that breast IMRT reduces acute dermatitis from a Canadian, multicenter, randomized, double-blinded, clinical trial, and there is level 1 evidence that breast IMRT improves the long-term cosmetic results from a UK randomized clinical trial. [ABSTRACT FROM AUTHOR]

Background Sitting in new chairs or sofas has elicited dermatitis in numerous patients in Finland and in the U.K. since autumn 2006. The cause of the dermatitis seemed to be an allergen in the furniture materials. Objectives To determine the cause of the dermatitis in patients with furniture-related dermatitis. Methods Altogether 42 patients with furniture-related dermatitis were studied. First, 14 Finnish patients were patch tested with the standardized series and with the chair textile material. A thin-layer chromatogram (TLC) strip and an extract made from the same textile material were tested in seven Finnish patients. The test positive spot of the TLC and the content of a sachet found inside a sofa in the U.K. were analysed by using gas chromatography–mass spectrometry. All chemicals analysed were patch tested in 37 patients. Results A positive patch test reaction to the chair textile and to its extract was seen in all patients tested, one-third of whom had concurrent reactions to acrylates. Positive reactions to the same spot of the TLC strip were seen in five of seven patients and dimethyl fumarate was analysed from the spot as well as from the sachet contents. Dimethyl fumarate (0·01%) elicited positive reactions in all the patients. The other chemicals analysed did not elicit positive reactions, but one patient in the U.K. had a positive reaction to tributyl phosphate. Conclusions Sensitization to dimethyl fumarate was seen in all the patients with furniture-related dermatitis. Concurrent sensitization or cross-reactions were common among the sensitized patients. [ABSTRACT FROM AUTHOR]

Background Long-term maintenance treatment with 0·1% tacrolimus ointment for the prevention of flares has been demonstrated to be well tolerated and effective in adults for the treatment of atopic dermatitis (AD) but its impact on health-related utility has not been reported. Objectives The purpose of this study was to estimate utility changes associated with the use of tacrolimus ointment in the maintenance treatment of adults with AD. Methods Data were collected from a clinical trial investigating long-term maintenance treatment with 0·1% tacrolimus ointment in adults with AD. All patients were treated with twice-daily tacrolimus ointment during an open-label period (OLP) of up to 6 weeks, with subsequent randomization to a double-blind disease-control period (DCP) of 12 months comparing tacrolimus ointment, used twice weekly as maintenance treatment, vs. the emollient vehicle as standard treatment. Health-related utility (EQ-5Dindex) was estimated by Monte Carlo simulation from SF-12 responses by application of a published response mapping algorithm and the U.K. tariff for EQ-5D responses and SF-6D responses, respectively. Results Evaluable data were available for 257 patients stratified into mild, moderate or severe AD with a median age at screening of 28 years [interquartile range (IQR) 22–38] and 40% male. At screening the median EQ-5Dindex across the strata was 0·848 units (IQR 0·704–0·882) for mild cases, 0·796 (0·737–0·876) for moderate cases, and 0·760 (0·661–0·823, P < 0·001) for those with severe disease. At the end of the OLP, mean utility improvement across all strata was 0·027 [95% confidence interval (CI) −0·011 to 0·065, P = 0·165] for mild cases, 0·046 (95% CI 0·015–0·064, P = 0·002) for moderate cases and 0·076 (95% CI 0·035–0·118, P < 0·001) for those with severe disease. At the end of the blinded DCP, repeated measures analysis showed an age- and sex-adjusted mean change of 0·045 units ( P < 0·001) for subjects treated with tacrolimus ointment over those treated with emollient vehicle. Conclusions Patients with AD of all severities showed considerable decrements in health-related utility. However, treatment with 0·1% tacrolimus ointment was associated with clinically significant improvement in health-related utility for patients with moderate and severe AD, which was sustained over a 12-month maintenance period compared with those using standard treatment with an emollient vehicle. [ABSTRACT FROM AUTHOR]

The article focuses on atopic eczema, an inflammatory condition of the skin characterized by lesions with varying degrees of exudate and scaling. Management guidelines and recommendations in children aged 12 and below commissioned by the National Institute for Health and Clinical Excellence(NICE) is presented. The role of primary care in the management of eczema in adults and children is discussed.

Bodily bumps in early modern England were not simply collections of humors that needed to be lanced and drained. Diagnosis, prognosis and treatment of skin swellings comprised a deeply rich semiotics that both patients and healers read according to a range of biographical factors, incidents, sensations, observations and experiences. Using diaries and case histories in seventeenth-century surgical texts, this article explores how both patients and healers read and treated bodily bumps. It then looks at patients and healers together during medical encounters in order to show how both parties' interpretations and observations of the body created a collaborative interpretation of health. The article shows that, long before the development of physical diagnosis in the nineteenth century, surgeons were pressing and prodding patients' bodies to discern the nature and severity of external ailments. Thus, in addition to the patient narrative, touching and manipulating the body were often significant aspects of medical diagnosis and practice in the early modern period. [ABSTRACT FROM AUTHOR]

The article presents research summaries related to dermatitis in Great Britain. According to a study, it has found out that the new fungicide could be the allergen responsible for sofa dermatitis. Another study examines the use of hair dye and the frequency and nature of reported adverse reactions and the risk factors. Furthermore, a study stresses the need for education of all users of epoxy resins in regard to the skin hazard in the workplace and using proper protective equipment.

This article reviews the clinical guideline on the management of atopic eczema in children up to the age of 12 years published by the National Institute for Health and Clinical Excellence (NICE) in Great Britain. Patients are advised to identify potential trigger factors for eczema which include irritants, skin infections and contact allergens. A categorization of eczema based on severity and its impact on quality of life and psychosocial well-being is presented. Medications for the condition include corticosteroids and calcineurin inhibitors.

Background Atopic dermatitis (AD) has a wide spectrum of dermatological manifestations and despite various validated sets of diagnostic criteria that have been developed over the past decades, there is disagreement about its definition. Nevertheless, clinical studies require valid diagnostic criteria for reliable and reproducible results. Objective To summarize the evidence concerning the validity of diagnostic criteria for AD. Methods All data sources were identified through searches on Medline, Embase and Cochrane databases. The Quality Assessment of Diagnostic Accuracy tool (QUADAS) was used. Results are presented in a receiver operating characteristic (ROC) plot. Results Out of the 20 articles that met the criteria, 27 validation studies were identified. In two studies concerning Hanifin and Rajka diagnostic criteria sensitivity and specificity ranged from 87·9% to 96·0% and from 77·6% to 93·8%, respectively. Nineteen validation studies of the U.K. diagnostic criteria showed sensitivity and specificity ranging from 10% to 100% and 89·3% to 99·1%, respectively. Three validation studies concerning the Schultz-Larsen criteria showed sensitivity from 88% to 94·4% and specificity from 77·6% to 95·9%. In one article concerning the criteria of Diepgen, the sensitivity ranged from 83·0% to 87·7% and the specificity from 83·9% to 87·0%. One article studied the Kang and Tian criteria and reported 95·5% sensitivity and 100% specificity. One article validating the International Study of Asthma and Allergies in Childhood (ISAAC) criteria showed a positive and negative predictive value of 48·8% and 91·1%, respectively. Conclusion With this systematic review of the existing sets of diagnostic criteria for AD a varying number of validation studies with varying methodological quality was found. The U.K. diagnostic criteria are the most extensively validated. However, improvement of methodological design for validation studies and uniformity in well-validated and applicable diagnostic criteria are needed to improve future intervention studies and to compare study results. [ABSTRACT FROM AUTHOR]

A brief summary of the currently accepted aetiology and pathogenesis of footrot and interdigital dermatitis in sheep in Great Britain is presented together with a description of the transmission dynamics of Dichelobacter nodosus. Approaches that may be successful for control or elimination of the disease are proposed and areas of uncertainty in current knowledge highlighted. Research and practice in Great Britain is Compared with that from other countries and the proposal made that the environment and]or carrier (non-diseased) sheep may assist 'persistence of footrot. [ABSTRACT FROM AUTHOR]

Background Chromium and cobalt (and their compounds) are well recognized as being important causes of occupational contact dermatitis (OCD), particularly of the hands, although their exact contribution to occupational hand dermatitis varies between different studies. In some European studies, cases of chromium-related dermatitis have decreased following the addition of ferrous sulphate to cement to reduce the amount of available chromium. Objectives To examine, using data from the U.K. occupational skin surveillance schemes, the proportionate reported incidence and changing trends in OCD considered to be related to chromium and cobalt for the 11-year period from February 1993 to December 2004. Methods Surveillance data collected by the two British occupational health surveillance schemes, EPIDERM and OPRA, from February 1993 to December 2004 were studied. These are occupational health surveillance schemes in the U.K. to which physicians voluntarily and anonymously report new cases of skin disease suspected to be work related. Results Over the 11-year period, dermatologists reported 22 184 cases of OCD, comprising 77% of all types of occupational skin diseases that were disclosed. Chromium was recorded as being thought to play a role in 1226 (6%) of these, with cobalt identified as being likely to be implicated in 823 (4%). The numbers fluctuated on a year-on-year basis but there were no overall trends during the period of study. The male/female ratio was 5 : 1 for chromium and 1 : 1 for cobalt. Overall, the male/female ratio for OCD was 1·4 : 1. The rates of dermatitis believed to be related to both metals generally increased with age. In women, the highest rate for chromium was seen in the > 60 years age group, whereas conversely, for cobalt the rate decreased with age. For chromium-related OCD the most common occupations were builders and building contractors, bricklayers, construction workers and plasterers. For cobalt-related OCD, the commonest occupations were hairdressers/barbers, builders/building contractors, retail cash/checkout operators, machine operatives and domestic cleaners. Occupational physicians reported 15 016 cases of OCD (82% of all occupational skin diseases reported by them) for the period May 1994–December 2004. Of these, only 38 cases were thought to be related to chromium and 30 to cobalt (25 of the latter were processing labourers). Conclusions In this series, chromium was reported by dermatologists as potentially being involved in 6% of all cases of OCD in the U.K., and cobalt in 4%. Our data support the view that chromium-related dermatitis has an onset in later working life and often affects those in the building trades, whereas cobalt-related dermatitis seems to have an earlier onset and may affect a wide range of employments. [ABSTRACT FROM AUTHOR]

Here we describe a pathological osteoderm from the crocodylomorph Diplocynodon hantoniensis (Bouldnor Formation, earliest Oligocene, Isle of Wight, United Kingdom). The specimen bears a porous, erosive branching channel that distorts the surface ornamentation and periosteum over 60% of the preserved dorsal surface area. We diagnose this condition as necrotizing dermatitis: a surficial bacterial or fungal infection that can penetrate the dermal layers to affect the underlaying penosteum of osteoderms. This condition has been previously reported for an extant tortoise and caiman; however, this is the first reported occurrence in the fossil record. [ABSTRACT FROM AUTHOR]

During 2005, 31 UK veterinary practices participated in a survey of flea infestation, during which 2653 dogs and 1508 cats were examined for evidence of flea infestation and skin disease compatible with flea allergy dermatitis (FAD). The prevalence of flea infestation in the cats was 21-09 per cent, significantly (P<0.001) higher than in the dogs (6.82 per cent). The prevalence of skin lesions compatible with FAD in the cats (8.02 per cent) was also significantly (P<0.001) higher than in the dogs (3.32 per cent). Flea infestations were more common in households with cats and with more than one pet. Of 467 fleas identified from the cats, 462 (98.93 per cent) were Ctenocephalides fells, one was Ctenocephalides canis, one was Archaeopsylla erinacei, two were Pulex irritans, and one was Spilopsyllus cuniculi. Of 336 fleas identified from the dogs, 313 (93.15 per cent) were C fells, five were C Canis, 12 were A erinacei, five were P irritans, and one was Ceratophyllus (Nosophyllus) fascIatus. Almost half of the owners of the dogs and cats were unaware of their pet's flea infestation. The overall prevalence of fleas and/or skin lesions that could potentially be compatible with FAD was 7-46 per cent in the dogs and 22-28 per cent in the cats. [ABSTRACT FROM AUTHOR]

Background Photoallergic contact dermatitis can be difficult to diagnose if not appropriately investigated. Currently, the most common U.K. photoallergens appear to be sunscreen chemicals. The investigation of choice is photopatch testing (PPT), which is probably underused. In part, this is due to differences in methodology and results interpretation. Objectives To conduct PPT using a group of sunscreen chemicals, defined indications and a standardized methodology including interpretation and relevance of reactions in patients attending for investigation at 17 centres across the U.K., Ireland and the Netherlands. Methods Patients ( n = 1155) who fulfilled the inclusion criteria were investigated with PPT using sunscreen chemicals in addition to suspected topical products. Readings were taken at 24, 48 and 72 h following standardized ultraviolet A irradiation (5 J cm−2). The clinical relevance of any reaction was recorded. Results Of the 1155, 130 had allergic reactions (11·3%). Of these, 51 had photoallergy (PA) (4·4%), 64 had contact allergy (CA) (5·5%), and 15 patients had combined PA and CA (1·3%). Multiple PA was seen in some. The most common photoallergen was benzophenone-3 (27 reactions; 21%). Most reactions (60%) were clinically relevant. The most common indication for testing in patients found to have PA was a history of reacting to a sunscreen (41%). The other 59% had an exposed-site dermatitis/skin problem or a photodermatosis. Some centres ( n = 8) performed readings after the standard 48-h reading, and an extra 32 PA and 22 CA reactions were detected, which were not evident at 48 h. A new photoallergen (octyl triazone) was detected in two patients. Conclusions Sunscreen PA and CA are probably equally uncommon. Most reactions, of both reaction types, were relevant clinically. A large proportion of patients (59%) found to have PA was unaware of reacting to a sunscreen chemical, suggesting that PA should be considered as an explanation in any exposed-site dermatitis. Although this study focused on reactions at 48 h postirradiation, readings performed up to 96 h, while inconvenient, add value by detecting additional relevant responses. A previously unknown photoallergen was found, highlighting the need for awareness of novel photoallergens in the marketplace. A standardized PPT method not only encourages more use of this investigation, but also facilitates comparison of results between centres and so will improve our understanding of PA. [ABSTRACT FROM AUTHOR]

The misery of living with atopic eczema (syn. dermatitis, AD) cannot be overstated for it may have a profoundly negative effect on the health-related quality of life (HRQoL) of children and their family unit in many cases. As it is one of the commonest chronic relapsing childhood dermatosis (UK lifetime prevalence 16–20% by 20 years), with increasing worldwide prevalence, this has major social and financial implications for individuals, healthcare providers and society as a whole. This review explores the impact of AD on the lives of children and their family units and the use of some of the recently developed HRQoL measures, which have enabled investigation and categorisation of the physical, psychological and psycho-social effects of childhood eczema across all aspects of life. These effects include symptoms of itching and soreness, which cause sleeplessness in over 60%. Sleep deprivation leads to tiredness, mood changes and impaired psychosocial functioning of the child and family, particularly at school and work. Embarrassment, comments, teasing and bullying frequently cause social isolation and may lead to depression or school avoidance. The child's lifestyle is often limited, particularly in respect to clothing, holidays, staying with friends, owning pets, swimming or the ability to play or do sports. Restriction of normal family life, difficulties with complicated treatment regimes and increased work in caring for a child with eczema lead to parental exhaustion and feelings of hopelessness, guilt, anger and depression. The hidden costs involved in eczema management can be significant and have particular impact on lower income families. The impairment of quality of life caused by childhood eczema has been shown to be greater than or equal to other common childhood diseases such as asthma and diabetes, emphasising the importance of eczema as a major chronic childhood disease. HRQoL measures are proving to be valuable tools for use in the clinical setting, as outcome measures for pharmaceutical studies, for health economics and audit purposes. It is therefore recommended that in future, they should be used in conjunction with objective measures of severity, as part of the assessment process of a child with atopic eczema. Lack of information on eczema and treatments heightens parental anxiety. Education of all individuals involved in the care of children with eczema is fundamental in the management of AD and it is essential to provide simple clear, unambiguous information on treatment and disease management in order to reduce the negative impact on HRQoL. [ABSTRACT FROM AUTHOR]

Early life factors and, in particular, the fetal environment have been suggested to programme risk of allergic disease in later life. Diversion of nutrients away from immune organs towards the brain, a process termed brain sparing, has been proposed as a mechanism underpinning this association. The study population was a group of 256 seven-year old children from the UK recruited from two general practitioner surgeries. Historical anthropometric data from birth to age three and current anthropometry were assessed as predictors of parent-reported wheeze and eczema. Eczema at seven years was not related to any anthropometric indices at birth or during infancy. A smaller head circumference at 10–15 days of age was noted in children with current wheeze at age 7 years ( P = 0.018) and this relationship persisted after adjustment for current anthropometry and confounders. Comparison of children with head circumference over 36.5 cm at 10–15 days with those with head circumference under 35.5 cm, showed reduced odds for wheeze at 7 years (OR 0.12, 95% CI 0.03–0.44, Ptrend = 0.009).These data suggest that factors that determine fetal growth may be associated with wheeze in childhood and support the developmental origins of health and disease hypothesis. Brain sparing does not appear to play a role in this early life programming. [ABSTRACT FROM AUTHOR]

Background Allergic contact dermatitis (ACD) increases with age, and a prevalence of between 13·3% and 24·5% has been reported. Patch testing infants may be particularly difficult, and false-positive reactions may occur. Objectives The purpose of this retrospective study was to determine whether the site of primary dermatitis in children could predict a diagnosis of ACD. The current frequency of sensitization in children was also evaluated and the main sensitizing substances among children were verified. Methods Between 1995 and 2004, 500 children were patch tested and entered on to the patch test database at Leeds General Infirmary. Analysis of the database included identifying the presenting patterns of eczema and reviewing the patch test results for each child. Results Of the children, 133 (27%) had one or more positive patch test result. The effect of age on the likelihood of a positive patch test was highly significant ( P < 0·001). Girls were significantly more likely to have a positive patch test compared with boys: odds ratio for a positive test 0·62 (95% confidence interval 0·41–0·95; P = 0·029). Type IV allergy to nickel (33%) was the most frequent finding. Reactions to fragrance mix (18%), cobalt (11%), mercapto chemicals, Myroxylon pereirae and p-phenylenediamine (each 8%) were the next most common. No statistical significance was found in the relationship between the site of primary dermatosis and a positive patch test result. Conclusions The pattern of presenting dermatitis in children should not determine referral for patch testing. Any child with persistent eczema should be referred for patch testing. [ABSTRACT FROM AUTHOR]

The article presents the summaries of papers related to paediatric dermatology. Atopic dermatitis (AD) accounts for at least 15% of referrals to secondary care dermatology, often requiring multiple visits and occupying much valuable time and resources. The researchers audited the usefulness of two quality-of-life measures, the Infants Dermatitis Quality of Life index (IDQOL) and Dermatitis Family Impact (DFI), which are easy to use in a routine clinical setting. A retrospective study on allergic contact dermatitis in children was conducted in Great Britain. 503 children were identified who had undergone patch testing consecutively in the reserchers' department between the years 1995 and 2004. This represents the largest study of children who have undergone patch testing in Great Britain.

Summary. Porcine circovirus 2 (PCV-2) is implicated as the causative agent of post-weaning multisystemic wasting syndrome (PMWS) and is also associated with porcine dermatitis and nephropathy syndrome (PDNS). The recent emergence of epidemic PMWS in the United Kingdom was predated by sporadic cases of PDNS dating back to the early 1980’s. The aim of this study was to investigate whether PCV-2 DNA was present in archival tissues, and if so, to investigate the relatedness of these viruses with contemporary strains of PCV-2. DNA extracted from paraffin wax-embedded tissue blocks (n = 68), was subjected to a TaqMan® polymerase chain reaction (PCR) targeting a fragment of ORF1 of PCV-2. Positive results were obtained from 41% (9/22), 31% (4/13) and 32% (8/25) of submissions from the 1990’s, 1980’s and 1970’s respectively. The presence of PCV-2 antigen in some of these tissues was confirmed by immunohistochemistry (IHC). A PCR targeting ORF2 was used to obtain sequence data for phylogenetic analysis. Sequences from 5 archival tissues were unique but showed high genetic identity to PCV-2 sequence obtained from a 2000 PDNS case. These data demonstrate that similar isolates of PCV-2 have been present in the UK pig population for more than 30 years. [ABSTRACT FROM AUTHOR]

There is strong evidence that the incidence and prevalence of atopic diseases is increasing. However, estimates of the prevalence of atopic dermatitis (AD) have varied greatly in the U.K. and most parts of the developed world. The aim of the study was to estimate the prevalence and incidence of AD between the ages of 0 and 42 months in children born in the 1990s in a defined population in the U.K. We used data from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), a large population-based study in the U.K. that enrolled all pregnant mothers who were resident in Avon and had their delivery date falling between 1 April 1991 and 31 December 1992. Since then ALSPAC has collected a wide range of data from the newborns and their parents. Data reported here were collected at 6, 18, 30 and 42 months using parental reports in a postal questionnaire. Of the 14 009 children originally enrolled 8530 provided information on AD in each of the four follow-up questionnaires. We defined AD as a report of rash in at least two of the four questionnaires. Incidence risk was defined as the percentage of new cases of AD between follow-up questionnaires, out of the total number of children whose parents had not reported that they had AD by the time of the previous follow-up. Period prevalence of 21·0%, 25·6%, 23·2% and 19·9% were observed at ages 0–6, 6–18, 18–30 and 30–42 months, respectively. The corresponding incidence risks were 21·0%, 11·2% and 3·8%, at 0–6, 6–18 and 18–30 months, respectively. There were no gender differences in either the incidence or prevalence of the disease. Results from this large, prospective study are consistent with recent reports of increased incidence and prevalence of AD. Health planners can use our estimates of incidence and prevalence to project the number of children likely to suffer from AD during infancy and early childhood, and thus to determine the human and financial resources required. [ABSTRACT FROM AUTHOR]

A self-completion questionnaire sent to 2600 Nottinghamshire members of the Graphical Paper and Media Union elicited a 62% response. Forty one per cent of respondents reported suffering a skin complaint at some time and 11% had a current skin problem on the hand. This paper reports the validation stage of the study. Samples of 45 ‘cases’ of self-reported dermatitis and 60 ‘controls’, who reported they had never suffered a skin complaint, were clinically examined. All 45 self-reported cases were clinically confirmed as dermatitis. Occupationally related irritant contact dermatitis (ICD) was diagnosed in 20 (44%); 26 (58%) complaints were thought to be induced or exacerbated by occupation. Of the controls, 21 (35%) were also diagnosed with a skin complaint, the majority being mild, with an occupational association in 17, the majority (15) being ICD. Sixteen ICD cases were patch tested resulting in positive reactions to colophony, neomycin, nickel and potassium dichromate (2 of each). Two cases of basal cell carcinoma on the face were also identified, of which the participants were unaware. Although there was no false positive self-reporting there was a considerable number of false negatives, demonstrating the importance of clinical validation of questionnaires relating to industrial skin disease. This study has highlighted the need for improvement in skin care provision in the printing industry. [ABSTRACT FROM AUTHOR]

For more than 100 years, it has been widely held that of all the Primula species to cause allergic contact dermatitis, P.obconica is the most likely culprit, particularly in Northern Europe. The main sensitizer is primin, but other sensitizers are reported. Other species are rarely implicated, but we suspect from our discussions with Primula growers that this is probably a consequence of under-reporting. Moreover, cutaneous reactions to other hardy Primula species and cultivars would appear to be milder and may sometimes be associated with a state of tolerance after repeated handling. With the co-operation of members of the Midland and West Section of the National Auricula and Primula Society of the UK, 462 questionnaires were sent out to members and 316 replies were returned (response rate 68.4%) with data on 320 growers. 84 out of a total of 320 (26.25%) attributed a cutaneous reaction to Primula species, whereas 236 (73.75%) reported no reaction. Of the 84 who reported reactions, 48 suspected P.auricula, 34 P.obconica, 10 P.vulgaris, 5 P.allionii,3P.marginata and 2 P.forrestii. 19 believed that they had reacted to 2 or more species of Primula. Our study suggests that Primula species other than P.obconica may elicit dermatitis more frequently than previously recorded. Key words: allergic contact dermatitis; hardy primula species; primin; farina; P.auricula; plants; airborne; occupational; horticulture; gardening. [ABSTRACT FROM AUTHOR]

Since February 1993 the EPIDERM surveillance scheme has collected data on occupational skin disease from consultant dermatologists in the UK. Reporting by occupational physicians to the scheme began in May 1994 and was superseded in January 1996 by the Occupational Physicians Reporting Activity (OPRA). The schemes currently receive reports on incident cases from 244 dermatologists and 790 occupational physicians. An estimated total of 9937 cases of contact dermatitis reported by dermatologists was calculated from surveillance data; 8129 contact dermatitis cases were estimated from reports by occupational physicians. The annual incidence of occupational contact dermatitis from dermatologist reports was 6.4 cases per 100,000 workers and 6.5 per 100,000 from reports by occupational physicians, an overall rate of 12.9 cases per 100,000 workers. Manufacturing industries account for the greatest number of cases seen by both sets of reporting physicians, with health care employment second. Reports from dermatologists also indicate high rates of dermatitis in the personal service industries (mainly hairdressers and barbers) and in agriculture. With the exception of an increase in cases seen in nurses in both schemes, the numbers and proportions of cases of contact dermatitis within occupations have remained fairly constant over the 6-year reporting period. Agents accounting for the highest number of allergic contact dermatitis cases were rubber (23.4% of allergic cases reported by dermatologists), nickel (18.2), epoxies and other resins (15.6), aromatic amines (8.6), chromium and chromates (8.1), fragrances and cosmetics (8.0), and preservatives (7.3). Soaps (22.0% of cases), wet work (19.8), petroleum products (8.7), solvents (8.0), and cuffing oils and coolants (7.8) were the most frequently cited agents in cases of irritant dermatitis. The national scope of the data, together with the parallel structure by which both dermatologists and occupational physicians report incident cases, is useful in determining the extent of skin hazards in UK industry and may help in better targeting efforts to reduce the burden of skin disease at work. [ABSTRACT FROM PUBLISHER]

Background: The environment plays an important part in the aetiology of atopic eczema, but specific causes are unknown. Exposure to hard water is thought to be a risk factor for eczema. We undertook an ecological study of the relation between domestic water hardness and the prevalence of eczema among Nottinghamshire schoolchildren.Methods: Questionnaire details of 1-year period and lifetime prevalence of eczema were obtained from parents of 4141 randomly selected primary-school children and 3499 secondary-school children in southern Nottinghamshire. Geographical information systems (GIS) were used to link the geographical distribution of eczema prevalence with domestic water-hardness data (four categories). Adjustment was made for potential confounding by sex, age, socioeconomic status, and access to health care.Findings: Among the primary-school children there was a significant direct relation between both 1-year period and lifetime prevalence of eczema and water hardness, both before and after adjustment for confounders. The 1-year period prevalence was 17.3% (261/1509) in the highest water-hardness category and 12.0% (94/786) in the lowest (adjusted odds ratio 1.54 [95% CI 1.19-1.99] p for trend <0.001). The corresponding values for lifetime prevalence were 25.4% (384/1509) and 21.2% (167/786; adjusted odds ratio 1.28 [1.04-1.58], p for trend=0.02). Eczema prevalence trends in the secondary-school population were not significant (adjusted odds ratio for highest compared with lowest hardness category for 1-year prevalence 1.03 [0.79-1.33], p for trend=0.46; for lifetime prevalence 0.99 [0.83-1.23], p for trend=0.93). Eczema prevalence in primary-school children increased in relation to chlorine content of water, but the trend across four chlorine-content categories was not independently significant after adjustment for confounders.Interpretation: Exposure to hard water in the home may increase the risk of eczema in children of primary-school age. [ABSTRACT FROM AUTHOR]

The article presents abstracts of a symposium held at Robinson College, Cambridge, Great Britain from December 14-16, 1994. Functional heterogeneity of human mast cells was discussed during the symposium. Mast cells heterogeneity is well defined in the rodent, where two distinct phenotypes have been identified. Releasability is a term that has been applied to several notable features of the response of human basophils and mast cells to receptor-mediated stimulation. Interest in this area comes from several directions. These include interest in whether differences in cellular sensitivity to simulation.

Focuses on the development of urticaria in Great Britain. Implication of the concept of neurosis for the function of vasomotor nerves supplying the small blood vessels; Role of mast cells as the source of mediators in urticaria; Relationship between urticaria and thyroid disease.

Reports on the representation of the role of the several classes of candidate mediators of inflammation in human skin based from a study in Great Britain. Capacity of inflamed tissues to retain their vitality enabling development of the classical features of inflammation; Contribution of the tissue mast cell and subsequent realization that it was a source of important molecular mediator to the pharmacological research in inflammation; Role of histamine as a chemical mediator in the inflammatory response.

The article presents the case of 9 beauticians working in a high-end luxury health spa in Great Britain. The beauticians had dorsum in their hands and fingers and in some cases, there was spread to wrists and forearms. It was found that the dermatitis was caused by use of essential oils. The allergy has been recognized as an occupational hazard.

The article focuses on various aspects of rehabilitation of cases of industrial dermatitis in Great Britain. The successful rehabilitation of people suffering from occupational or industrial dermatitis is often observed to depend on their obtaining different employment or upon alteration being made in the methods, materials, or exposures of the work they had been performing. After analyzing documents of the Ministry of National Insurance, the authors found that there was no case where the patient had recovered fully or had been able to resume his original occupation without further trouble.

Presents cases related to the studies in dermatology from the North British Dermatological Society in Great Britain. Identification of lichen planus in an infant; Examination of a 68 years old woman with morphoea bullosa; Methods used in investigation of a farmer with reticulosis.