Search

Atopic Dermatitis (AD) is a common inflammatory skin disease characterized by skin and systemic inflammation, and barrier dysfunction. Herein, we investigate the proteomic profile of AD skin barrier to identify a unique signature with an easy-performed sampling approach. We enrolled 8 moderate-to-severe AD patients and 8 age- and gender-matched healthy controls. Swabs were obtained from non-lesional skin of retroauricular area and antecubital fold. Peptide mixtures obtained through protein precipitation and in-solution digestion were analysed using NanoLC-MS/MS. Label-free quantification and statistical analysis were conducted in MaxQuant and Perseus. Bioinformatics analysis was performed using Gene Ontology and STRING. We identified 908 proteins and 35 differentially expressed proteins were selected (fold change 2, FDR

Objective: To understand the status quo of PICC Catheter-associated Skin Impairment (CASI) in some hospitals at all levels in Jingzhou city, and to explore the risk factors for PICC Catheter-associated Skin Impairment. Methods: From June 2019 to July 2020, a self-made questionnaire for CASI status was used to facilitate the extraction of CASI patients in PICC in some hospitals at all levels in Jingzhou city. Local skin lesions were collected and classified during PICC maintenance, and the damage types, occurrence frequency and related influencing factors of CASI were counted to identify independent risk factors. Results: In this study, there were 173 cases of CASI in PICC’s patients including local infection 56.1% (97/173), exudation at the puncture site 16.8% (29/173), irritant dermatitis 21.4% (37/173), allergic dermatitis 4.6% (8/173), and tension injury 1.2% (2/173). After univariate analysis, there were statistically significant differences between CASI occurrence type and duration of catheter wear, age, underlying disease, skin moisture and hyperhidrosis, PICC maintenance as required, hospital grade maintenance and intermittent chemotherapy (P < 0.05). Then, disordered multiple Logistic regression analysis was performed, and exudation at the puncture site was used as the reference group. The results showed that patients with PICC were more likely to have CASI if they were aged, long catheter time, had diabetes, had moist and sweaty skin, and were in the intermittent stage of chemotherapy. Conclusion: The incidence of CASI is high in patients aged 70 - 79 years, and local infection is the most common. PICC’s patients with diabetes are at high risk of CASI. PICC’s patients with excessive sweating are more likely to have CASI. The intermittent stage of chemotherapy is the excessive CASI; time with tube affects CASI occurrence.

Objetivo: apresentar os métodos utilizados para promover a prevenção de ocorrência de Lesão por Pressão (LPP) durante quatro meses de atuação no setor clínica médica. Metodologia: O presente estudo descritivo de abordagem qualitativa, do tipo relato de experiência, durante nossa atividade como enfermeiras residentes no setor clínica médica de um Hospital Federal na cidade do Rio de Janeiro, no período do curso de Pós-Graduação em nível de especialização em Clínica Médica e Cirúrgica, sob a forma de treinamento em serviço, no período de julho a outubro do ano de 2020. Resultados: o estudo evidenciou que o dimensionamento pessoal da equipe de Enfermagem afeta diretamente a incidência e prevalência da LPP. O estudo reforça que a aplicação da Escala de Risco de Braden permite a tomada de decisão e direcionamento das intervenções de enfermagem para cada paciente. Considerações Finais: é essencial a interação com protocolos e realizar ajustes nas ações previstas que têm impacto ou ação direta no comprometimento da pele do paciente. Entende se como fator importante para a confecção do curativo ideal com cobertura adequada, contudo torna-se primordial a manutenção da prevenção das lesões por pressão. Assim fazem os enfermeiros e suas equipes da Unidade de Internação Clínica desta Instituição.

Atopic dermatitis is a clinical syndrome that affects both people and animals. Dogs closely mimic the complexity of the human skin disease, and much progress has been made in recent years in terms of our understanding of the role of skin impairment and the identification of new treatments. Cats and horses also develop atopic syndromes which include both cutaneous and respiratory signs, yet studies in these species are lagging. It is now recognized that atopic dermatitis is not a single disease but a multifaceted clinical syndrome with different pathways in various subgroups of patients. Appreciating this complexity is clinically relevant as we develop more targeted treatments which may work well in some patients but not in others. Different phenotypes of atopic dermatitis have been described in dogs, and it is possible that phenotypes related to breed and age may exist in other animals similar to how they are described in people. The awareness of different mechanisms of disease leads to the desire to correlate different phenotypes with specific biomarkers and responses to treatment. In this review, the current understanding and updated information on atopic syndrome in animals are described, highlighting opportunities for further studies in the future.

Although there has been an increase in the use of skin high frequency ultrasound for the evaluation of dermal thickness and skin impairment in systemic sclerosis, its role is still under debate and its use has not yet been fully validated. Herein we discuss the recent data from research and clinical practice on methods for sonographic evaluation of dermal thickness in systemic sclerosis.

Background One of the characteristics of systemic sclerosis (SSc) is an increase in dermal thickness (DT) (1-3). Although the standard method to evaluate the extent of skin involvement is the modified Rodnan skin score (mRSS) (3,4), high frequency ultrasounds (US) and the plicometer skin test (Plicometry) (5-8) are now being used in SSc patients. Objectives The aim of this study was to determine any correlations between mRSS, US and Plicometry during the evaluation of skin impairment in SSc patients. Methods A total of 63 SSc patients (mean age 64±13SD years, mean SSc duration 7±6 years) and 63 healthy subjects (HS) (mean age 64±12SD years) were enrolled. The three methods (mRSS, US and Plicometry) were used to evaluate skin impairment in the seventeen areas of the skin usually evaluated by mRSS (face, fingers, dorsum of hands, forearms, arms, chest, abdomen, thighs, legs and feet) and the total score was calculated, as previously reported (1,3,4,8). Intra-rater reliability of the three techniques was assessed by having the same rater performing 2 consecutive measurements at each skin site. Statistical evaluation was performed by non-parametric tests. Results A significant positive correlation was observed between the three methods used to evaluate DT in the SSc patients (mRSS vs US r=0.64, p 0.05). The intraclass correlation coefficients for mRSS was 0.95, 0.97 for US and 0.96 for Plicometry. Data collection for mRSS took almost 10 minutes, 15 minutes for Plicometry and 20 minutes for US. Conclusion This study demonstrates a significant relationship between mRSS, US and Plicometry in the DT evaluation of SSc patients. The SSc patients had statistically significantly higher values than HS when the 3 techniques were used to evaluate the seventeen skin areas. References [1] Cutolo M, et al. Best Pract Res Clin Rheumatol. 2016;30:670-687. [2] Ruaro B, et al. Arthritis Rheumatol 2015; 67 (suppl 10). [3] Clements P, et al. J Rheumatol 1995;22:1281-5. [4] CzirjakL, et al. Ann Rheum Dis. 2007; 66: 966-9. [5] Hesselstrand R, et al. Rheumatology 2008;47:84-7. [6] Kaloudi O, et al. Ann Rheum Dis. 2010;69:1140-3. [7] Ruaro B, et al. Microvasc Res. 2018;115:28-33. [8] Parodi MN, et al. Br J Rheumatol. 1997;36:244-50. Disclosure of Interests None declared

To our knowledge this is the first systemic review that provides an overview of the cutaneous paraneoplastic syndromes (CPS) (i.e., clinical manifestations, pathomechanisms, and treatment modalities) occurring in stomach cancer. CPS are caused by substances produced by stomach cancer and may precede, coincide with, or follow the diagnosis of this malignancy. More than 20 possible CPS in association with stomach cancer have been identified. CPS mostly compromises the patient's quality of life by skin impairment plus discomfort and are often associated with a dismal prognosis on survival. Studies of these CPS not only in stomach cancer have partially contributed to the understanding of pathomechanism and since CPS may be the presenting sign of an occult cancer, cognizance of their features and clinical implications are of considerable importance. Patients with these syndromes should have an appropriate work-up for a possibly occult malignancy with consecutive successful early treatment.

Objective: The aim of this study was to identify any correlations between microvascular damage, assessed by nailfold videocapillaroscopy and skin impairment, evaluated by three different methods, the modified Rodnan skin score (mRSS), skin high-frequency ultrasound (US) and the plicometer skin test (PST) in systemic sclerosis (SSc) patients. Methods: Sixty-three SSc patients and 63 healthy subjects were enrolled. Nailfold videocapillaroscopy (NVC) was used to assess the nailfold capillaroscopy pattern ("Early", "Active" or "Late"), according to the Cutolo classification. All subjects were assessed by mRSS, US and PST to evaluate their dermal thickness (DT) in the seventeen skin areas of the body usually evaluated by mRSS (zygoma, fingers, hands, dorsum of hands, forearms, arms, chest, abdomen, thighs, legs, feet). Statistical evaluation was performed by nonparametric tests. Results: All the three methods demonstrated progressively higher values of skin impairment in patients with "Early", "Active" or "Late" pattern of nailfold microangiopathy (for mRSS p < 0.01, US p < 0.02 and PST p < 0.02). A positive correlation was also observed in SSc patients between the three methods used to evaluate skin involvement (mRSS vs US, mRSS vs PST, PST vs US, p < 0.0001 respectively). Conclusions: This study demonstrates that there is a correlation between two of the most important aspects to classify and monitor the SSc patients, i.e. microvascular damage progression (evaluated by NVC) and skin damage (assessed by mRss, US and PST).

The most common source of occupational skin disease is contact dermatitis, an inflammation caused by exposure to an allergen. Whenever possible, the evaluating physician should rely on objective evidence such as lichenification, excoriation, and hyperpigmentation rather than subjective complaints. Patch testing, biopsy, and sensory discrimination tests are reliable tools at the evaluating physician's disposal. Disfigurements of the face are rated using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, Section 11.3, The Face, and Chapter 8, The Skin, is used for all other skin impairments. The evaluating physician records the history of the injury, evaluates the patient, and, in consultation with Table 8-3, notes any objective clinical studies to diagnose the pathology. The functional history, physical examination findings, and diagnostic test findings values then are assigned using Table 8-2; the functional history acts as the key factor and determines the patient's impairment class, physical examination, and diagnostic test findings, each acting as non-key factors, or modifiers. Finally, the non-key factors are used to modify the impairment rating from its default value within its impairment class, and the result is the final skin impairment rating expressed as whole person impairment. Chapter 8 is used only rarely in impairment rating in workers’ compensation cases, and examiners should study the chapter carefully before using it.

Summary Background Skin scoring systems have to meet specific demands depending on their particular settings and indications, e.g. occupational screenings vs. clinical examinations, evaluating progress of treatment or supervision of preventive strategies. Until now, most scoring systems have been developed for severe cases of hand eczema. A validated quantitative scoring system for early hand eczema is still missing. Objectives The present cross-sectional study was aimed at assessing the practical value of a quantitative hand eczema score for occupational screenings (HEROS) at the workplace and its potential for identifying individuals at increased risk of work-related skin disease. Methods Both hands of 800 male metal workers were examined for characteristic morphological patterns of hand dermatitis and quantified with HEROS. The score was validated by testing inter- and intraobserver reliability in random samples. Results of validation were compared with three already validated skin scores for distinct hand eczema (Osnabruck hand eczema severity index, hand eczema severity index, Manuscore). Results The score values ranged from 0 to 82 (theoretical maximum 2260), reflecting the skin condition of healthy, fit-for-work subjects. Inter- and intraobserver reliability was good to excellent. Results for reliability of the HEROS were in line with all three validated scores for hand eczema. The predictive value for identifying persons at increased risk for developing hand eczema was low. Conclusions The HEROS seems to be an adequate tool for observer near-independent assessment of early hand eczema, especially for quantifying minimal skin impairment. Therefore, we propose the implementation of this scoring system for quantifying early hand dermatitis in occupational screenings.

Objectives Assessing plant size-related differences based on self-reported working conditions and their influence on perceived symptoms at workplace. Methods A total of 799 metal workers from 9 small-sized enterprises (SE) and 10 medium-sized enterprises (ME) German metal working plants were interviewed in 2007/2008. Inclusion criteria were "wet work" and willingness to participate (response rate: 58% in ME, 67.7% in SE). Results Workers in SE complained more often of hand eczema (20.2% vs 13.8%) whereas workers in ME more frequently reported breathing problems (4.2% vs 0.9%). Work safety was higher in ME. Conclusions The higher rate of skin impairment in SE might be explained by a lower level of work safety. However, the higher frequency of perceived respiratory symptoms in ME seems to contradict this assumption and except plant size there might exist another potential confounder, especially for breathing impairment.

Autoantibodies are important in the diagnosis of dermatomyositis. They can be divided in two different groups: myositis-associated autoantibodies (MAA) prevailing in overlap syndromes, and myositis-specific autoantibodies (MSA), with diagnostic specificity exceeding 90%. Our purpose was to detect retrospectively the prevalence of the most common MSAs in a group of 19 adult DM patients (13 women, 6 men). A severe DM (SDM), with extensive cutaneous and muscular manifestations, dysphagia, and sometimes pneumopathy, was detected in ten cases. Three patients had a mild DM (MDM), with little muscle and skin impairment, and a short course. Four patients suffered from amyopathic DM (ADM), two from paraneoplastic DM (PDM). Each serum was tested for ANA, ENA, MAAs, MSAs. Myositis-specific autoantibodies were detected in 15 cases. The most frequent was anti-TIF1γ, associated with SDM or PDM in four out of seven cases. Anti-MDA5 antibodies were recorded in a SDM and in a ADM with lung fibrosis. Anti-Mi2 and anti-SRP antibodies were both detected in a MDM and in a SDM, whereas anti-SAE1 in a amyopathic form. Other antibodies (anti-NXP2, -Jo1, -PL7, -PL12, -OJ) were found in single patients with SDM. Our series confirmed that specific autoantibodies could be helpful to classify different clinical subsets, particularly in the case of paraneoplastic forms or association with pneumopathy. Moreover, they can help in predicting the disease evolution and influence therapeutic strategies. A greater number of cases should be useful to highlight the clinical and pathogenic role of these antibodies, and develop a homogeneous protocol for diagnosis and treatment.

Atopic dermatitis (AD) is a common skin disease that affects humans and animals. Skin impairment has been described in human and canine AD. Equine AD is recognized in practice but little is known about its pathogenesis. As remarkable similarities exist across species in terms of cutaneous manifestations of AD, it was speculated that skin abnormalities may also exist in atopic horses. This case report describes the ultrastructure of the stratum corneum of two normal and two atopic horses. Biopsies were taken from sites predisposed to AD and examined using electron microscopy. Stratum corneum in normal samples was compacted with organized lipid lamellae while in atopic samples disorganized lipid lamellae, retained lamellar bodies and amorphous lipids were found. These changes are very similar to what reported in AD in other species. It is currently unknown whether these abnormalities in atopic horses are primary or secondary and their importance in allergen penetration.

Elastin makes up 2–4 % of the dry weight of the human skin dermis, yet despite its relatively low abundance, it serves major structural, mechanical, and cell-signaling roles (Fig. 5.1) (Vrhovski and Weiss 1998). The integrity of the elastic fiber network is a strong determinant of the skin’s elasticity, resilience, quality, and texture (Kielty 2006; Roten et al. 1996). Its importance is particularly exemplified by the severity of skin impairment in various genetic disorders that affect elastin expression in the dermis, such as cutis laxa and pseudoxanthoma elasticum (Kielty 2006).

Background – Cutaneous impairment plays a crucial role in atopic dermatitis (AD). Transepidermal water loss (TEWL) measurement is an indirect assessment of skin barrier function and correlates with disease severity in humans. Skin impairment also exists in canine AD; however, concerns exist regarding variability and reliability of TEWL measurements in dogs. Hypothesis/Objectives – The purposes of this retrospective study were twofold: first, to investigate the correlation between severity of dermatitis [measured by Canine Atopic Dermatitis Extent and Severity Index (CADESI)] and TEWL; and second, to evaluate whether increased TEWL at a young age correlates with disease severity later in life. Methods – Data from atopic beagles and dogs with natural AD were analysed. Transepidermal water loss was measured in atopic beagles (n = 24) with an open chamber and in dogs with naturally occurring AD with a closed chamber device (two studies, with n = 14 and n = 18). Pearson product–moment correlation was used for analyses. Transepidermal water loss of the inguinal region, axilla, antebrachial flexure and pinna was analysed. Correlations were investigated for each study, separately first and then jointly. They included CADESI and TEWL of individual regions, total CADESI and total TEWL of all measured regions, and total CADESI and TEWL of key regions. Results – In atopic beagles, TEWL measured at 1 year of age pre- and post-allergen challenge was correlated with CADESI at 1, 3 and 6 years of age. Overall, low correlation coefficients were found; therefore, a biologically relevant connection could not be demonstrated. The main significant positive correlation was found between TEWL in the pinna and total CADESI. Conclusions and clinical importance – It is concluded that TEWL does not correlate with disease severity.

The purpose of this study is to develop new standards for the disability evaluation with reference to existing laws and other study reports regarding disabilities for the rational evaluation of the diverse kinds of disfigurement in appearance and skin. Three plastic surgery specialists and 3 dermatology specialists developed a new standard for the disability evaluation which is appropriate for circumstances in Korea. Disability rate does not take into account the social occupation, gender or age of the patient, but instead, evaluate the Activity of Daily Living and the social adaptability of the appearance and skin disfigurement regardless of the balance between different disabilities. We tried to include most cutaneous disorders and categorized them into 3 types; congenital (Type 1), acquired (Type 2) as well as any permanent skin impairment sequelae of disease, trauma or treatment process (Type 3). For type 3 disorders, we tried to rate the score according to the size of involved skin lesion. The disability rate is determined by dividing the disability class into 8 steps based on the seriousness of each type of disability.

Advanced practice nurses and staff nurse skin-care team members provided the necessary expertise and information to integrate AHCPR recommendations in a protocol for patients at risk for skin impairment. Regular practice monitoring and education regarding skin management have proven to be successful strategies. A skin-impairment management protocol is provided.

f you or a loved one has ever been a patient in a hospital or nursing home and developed a pressure sore, call 1800-555-SORE. You are entitled to cash awards for unnecessary pain and suffering from this preventable illness. Call now and talk with an attorney at no cost to you. We get paid when you get paid. " That pitch, delivered in a television commercial for a local law firm, certainly got my attention. As an orthopedic nurse clinician, I'm very much concerned with skin and wound care, since my patients are at high risk for skin impairment. I knew that hospitals were beginning to see lawsuits involving pressure sores. But when this appeal by lawyers to potential litigants was broadcast into my living room, I knew that my practice and those of my fellow nurses were under scrutiny.