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Biomedical subjects

E J van Zuuren

Publications and source records attributed to E J van Zuuren.

13 recordsLinked to original sources
PubMed2005

Interventions for rosacea.

BACKGROUND: Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved. Frequently it can be controlled, but it is not clear which treatments are most effective. OBJECTIVES: To assess the evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY: We searched the Skin Group Specialised Register (February 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February 2005), EMBASE (1980 to February 2005), BIOSIS (1970 to March 2002) and the Science Citation Index (1988 to February 2005). Reference lists of trials and key review articles were searched. Relevant manufacturers and experts were contacted. SELECTION CRITERIA: Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the authors to have seriously flawed methodology were excluded. DATA COLLECTION AND ANALYSIS: Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent authors. Disagreements were resolved by discussion and consensus. MAIN RESULTS: The evidence provided by twenty-nine included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea were included. Pooled data from two trials involving 174 participants indicated that according to the participants, topical metronidazole is more effective than placebo (odds ratio (OR) 5.96, 95% confidence interval (CI) 2.95 to 12.06). Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group; the rates of treatment success were approximately 70 to 80% versus 50% to 55% (OR 2.45, 95% CI 1.82 to 3.28). A within-patient trial of azelaic cream versus placebo could not be pooled with the other three studies, but also showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians, tetracycline was effective (OR 6.06, 95% CI 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study. AUTHORS' CONCLUSIONS: The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. Good RCTs looking at these treatments are urgently needed.

Dermatologic Agents↗
PubMed2005

[Drug rash with eosinophilia and systemic symptoms (DRESS) attributed to the oral skin-care supplement Imedeen].

In a 56-year-old woman, 'drug rash with eosinophilia and systemic symptoms' (DRESS) was diagnosed. She had been admitted to hospital twice in two months because of fever and skin rash. Further studies revealed that in addition to the skin rash, the woman also suffered from eosinophilia, lymphadenopathy and a temporary liver-function disorder. After infectious and malignant causes had been excluded, the DRESS syndrome was diagnosed. The syndrome was attributed to the oral skin-care supplement Imedeen. She had stopped using this preparation previously, after which the symptoms decreased markedly. Now she was treated with corticosteroids and methotrexate and recovered completely after almost four months. The DRESS syndrome is characterised by skin rash, fever, lymphadenopathy and haematological abnormalities, especially eosinophilia and/or atypical lymphocytosis. Single or multiple organ involvement, especially of the liver, kidney, lungs and/or heart, is also common. The syndrome is associated with a number of different drugs.

Chemical and Drug Induced Liver Injury↗
PubMed2004

Interventions for rosacea.

BACKGROUND: Rosacea is a common skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often also involved. The cause of rosacea is unclear. It is a chronic disease, which can be controlled in most cases with appropriate treatment. Numerous treatments are in use although it is unclear which are best, and which are most appropriate for the different types of rosacea. OBJECTIVES: To assess and summarise current evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY: We searched the Skin Group Specialised Trials Register (March 2002), Cochrane Central Register of Controlled Trials (CENTRAL, March 2002), MEDLINE (from 1966 to March 2002), EMBASE (from 1980 to March 2002), Biosis (from 1970 to March 2002) and the Science Citation Index (from 1988 to March 2002). Reference lists of trials and key review articles were also searched. Relevant manufacturers and experts were contacted. SELECTION CRITERIA: Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the reviewers to have seriously flawed methodology were excluded. DATA COLLECTION AND ANALYSIS: Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent reviewers. MAIN RESULTS: The evidence provided by twenty-two included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea could be included. Pooled data from two trials involving 174 participants indicated that topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95 to 12.06). Data from a between-patient trial (114 patients) and a within-patient trial (33 patients) of azelaic cream versus placebo were not pooled, but both showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians' ratings, tetracycline was effective (odds ratio 6.06, 95% confidence interval 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study. REVIEWER'S CONCLUSIONS: The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid cream have a therapeutic effect. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. As many of these treatments are used for rosacea, good RCTs are urgently needed.

Humans↗
PubMed2003

Recalcitrant atopic dermatitis due to allergy to Compositae.

Atopic dermatitis is often complicated by allergic contact dermatitis, although patch testing may reveal positive reactions of uncertain relevance. We report a case of a 35-year-old woman with recalcitrant atopic dermatitis, with a positive patch-test reaction to Compositae mix (CM). Initially, sensitization appeared to be of past relevance only, due to use of calendula. However, it turned out that she followed a self-devised diet consisting largely of food products of the Compositae family. On excluding these food products her skin condition improved quickly. This case report underscores the difficulty in determining the relevance of positive patch tests, and shows that thorough analysis of positive patch tests, by both patient and physician, may reveal unexpected or less common sources of contact allergens.

Adult↗
PubMed2003

Diffuse neurofibroma on the lower back.

Diffuse neurofibroma is an uncommon form of neurofibroma, which occurs principally in children and young adults. This tumor presents most often in the head and neck region. We have seen a young girl with a diffuse neurofibroma on the lower back that was successfully excised.

Back↗
PubMed2002

[Allergic reactions and hypopigmentation due to temporary tattooing with henna].

Skin tattooing with henna seems a safe alternative to permanent skin tattooing. Contact dermatitis due to henna is rare. Most of the reactions are due to additives, especially paraphenylenediamine, which is added to speed up the process of skin dyeing and to give a darker brown to black colour ('black' henna) instead of the otherwise reddish brown henna colour. Paraphenylenediamine is a well-known strong sensitizer, particularly due to its use as a hair dye. Three patients, two boys aged 8 and 10 years and a 30-year-old woman, developed allergic contact dermatitis after skin painting, after which hypopigmentation remained. Patch tests with paraphenylenediamine were strongly positive in all three patients. This positive reaction means that they will never be able to dye their hair and that they have an increased risk of cross-reactions with other dyes, but also with local anaesthetics, sulfonamides, para-aminoazobenzoic acid or para-aminosalicylic acid.

Adult↗
PubMed2001

[Diagnostic image (40). Scurvy].

In a 17-year-old woman with anorexia nervosa, scurvy was diagnosed as the cause of fatigue, abdominal pain, vaginal bleeding and several distinctive skin lesions.

Adolescent↗
PubMed2001

Psychosocial impact of acne vulgaris. evaluation of the relation between a change in clinical acne severity and psychosocial state.

BACKGROUND: Although knowledge concerning the impact of acne vulgaris on quality of life has increased in recent years, relatively few studies have assessed the effect of a change in clinical severity on psychosocial state. OBJECTIVE: Assessment of the effect of a change in clinical acne severity on psychosocial state. METHODS: This was investigated by means of questionnaires and clinical assessments by acne patients and dermatologists. Fifty females with mild to moderate facial acne were seen before and after a 9-month treatment with oral contraceptives. RESULTS: The results showed a great variability in psychosocial impairment between individuals. After 9 months, a significant reduction in clinical severity was seen overall which did not relate to the significant improvements in self-esteem, stability of self-esteem and acceptance of appearance. CONCLUSION: Perceived psychosocial impairment is individually based, is greater in women who subjectively overrate their acne and does not relate to clinical improvement.

Acne Vulgaris↗
PubMed2000

Basal cell carcinoma on the dorsum of the hand: report of 11 cases.

BACKGROUND: Basal cell carcinoma (BCC) is the most common cutaneous malignancy, although the appearance on the dorsum of the hand appears to be rare. OBJECTIVES: The purpose of this study was to identify and describe patients with BCC of the dorsum of the hand in a large cohort of BCC patients and to provide a review of the literature. METHODS: Eleven patients with a BCC on the dorsum of the hand were identified. Information on age at diagnosis, sex, treatment and follow up, presence of additional malignancies, etc., was gathered from medical records. RESULTS: Between January 1985 and December 1995, 2990 BCCs were registered, of which 11 were located on the dorsal aspect of the hand (0.37%). Nine patients were male and most patients had a history of multiple skin malignancies. Most of the BCCs were nodular or had a nodular component. Solar elastosis was frequently seen. The percentage of 0.37% compares well with BCC located on the dorsum of the hand in other studies, but also with other parts of the body per skin surface area (except the face and neck area). CONCLUSIONS: The density of BCC on the dorsum of the hand is much lower than in the face and neck area but compares well with other parts of the body.

Adult↗
PubMed1995

Treatment of recurrent squamous cell carcinoma of the hand in immunosuppressed patients.

Since 1981, 14 patients with kidney transplants have been treated for recurrent squamous cell carcinoma of the skin of the dorsum of the hand by total skin resection. Frozen sections of the base of the tumor sites were carried out and the denuded area was resurfaced with split-skin grafts harvested from non-sun-exposed areas on the buttock and upper thigh. During follow-up examinations, no recurrence was seen in the grafted areas. The appearance was good and hand function was satisfactory.

Adult↗
PubMed1994

Resurfacing the back of the hand as treatment and prevention of multiple skin cancers in kidney transplant recipients.

BACKGROUND: Skin cancer is a serious problem in renal transplant recipients. In some patients numerous skin cancers develop on the back of the hand. Instead of repeated excisions, a more radical procedure may be necessary. For these patients a new surgical therapy is available: resurfacing the back of the hand. OBJECTIVE: Our purpose was to clinically evaluate this new procedure. METHODS: Eleven kidney transplant recipients who underwent resurfacing of the back of the hand were analyzed in a retrospective follow-up study. With this surgical procedure the skin of the entire dorsum of the hand is excised and split-skin grafts harvested from thigh and buttock skin are then placed. Information was gathered from the medical records and questionnaires, and by physical examination. RESULTS: The mean follow-up time was 4.7 years. No recurrences of skin cancer were observed in the transplanted skin. The cosmetic appearance was acceptable, and there were few side effects. CONCLUSION: Resurfacing the back of the hand can be a successful treatment for carefully selected patients with multiple skin cancers on the back of the hand and can be used prophylactically in patients with severely actinically damaged skin.

Adult↗