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Biomedical subjects

G B Jemec

Publications and source records attributed to G B Jemec.

At least 37 records · Page 2Linked to original sources
PubMed1999

An assessment of anxiety and dermatology life quality in patients with atopic dermatitis.

Anxiety is a prevalent psychological factor associated with atopic dermatitis (AD). AD patients generally suffer from a high anxiety level, and psychological treatment documents a positive effect on the anxiety level, as well as the course and management of the disease. The Dermatology Life Quality Index (DLQI) has been suggested as a relevant clinical measure in AD. This study investigated the relationship between the severity of AD, dermatological life quality and anxiety. Thirty-two adults suffering from AD were examined using the Severity Scoring of AD Index (SCORAD), the DLQI and the Spielberger State-Trait Anxiety Index (STAI). Twenty-two healthy controls were examined using the DLQI and STAI. Results showed that the AD group had higher anxiety and lower dermatological life quality than the control group. In the AD group a significant positive correlation was found between SCORAD and DLQI and between DLQI and STAI. However, no correlation was found between SCORAD and STAI. The results suggest that: (i) both severity of eczema and anxiety are important for dermatological life quality; (ii) psychological inferences should not be made from the severity of eczema, but from the psychological measures, and vice versa; and (iii) both dermatological and psychological assessment is important in AD.

Adolescent↗
PubMed1999

Correlation between the greasiness and the plasticizing effect of moisturizers.

Moisturizers are used as cosmetics and as adjuvant therapy in dermatology. The strength or relative efficacy of moisturizers is poorly described and thus advising patients is difficult. It has been suggested that lipidization of the skin by moisturizers and the changes in skin mechanics following the application of a moisturizer may be useful measures of outcome. The aim of this study is to describe the relative efficacy of 5 different moisturizers, a barrier cream and a gel in terms of changes in skin mechanics and electrical capacitance before and after application. Assessment of the greasiness or absorption of the cream was made by standardized blotting of unabsorbed residue. Lipid-rich creams (Vaseline, Locobase and Decubal creme) caused increased skin distensibility, while no differences were found in hysteresis changes. In contrast, the relative efficacy in increasing skin capacitance was significantly greater in the moisturizers with a lower lipid content (Clinique, Nivea) and gel. The results suggest that lipidization is of major importance to the plasticity of the skin. When moisturizers are used to improve skin plasticity it is suggested that lipid-rich formulations be used. Cosmetically more acceptable creams and gel were however better at increasing skin capacitance which has been interpreted as a measure of skin hydration. The difference may reflect a design adaptation of these creams to a specific outcome measure and our results raise the question of appropriate outcome measures and our results raise the question of appropriate outcome measures in future moisturizer studies.

Adult↗
PubMed1999

The diagnostic accuracy of Danish GPs in the diagnosis of pigmented skin lesions.

BACKGROUND: The GP often has a primary function in assessing pigmented skin lesions in Denmark. No data are available on the diagnostic accuracy of this process. OBJECTIVE: We aimed to study the sensitivity, specificity and positive prognostic value of the diagnosis made by 27 trained or trainee GPs. METHOD: We tested the diagnostic accuracy of the viewing of colour slides of pigmented skin lesions under standardized conditions at a seminar on skin cancer. Diagnostic accuracy was determined only for the clinically relevant diagnosis of benign or malignant. RESULTS: The median diagnostic accuracy (sensitivity) for the group as a whole was 0.75 (95% CI 0.65-0.80), the specificity was 0.70 (95% CI 0.68-0.79) and the positive predictive value 0.70 (95% CI 0.62-0.77). CONCLUSION: These values are comparable with previously published figures for trainee dermatologists, and it is therefore concluded that ongoing interest rather than basic training is the major determinant for clinical acumen.

Adult↗
PubMed1999

Giant solitary trichoepithelioma.

The giant solitary trichoepithelioma is a rare trichogenic tumor with potential for local recurrence. Only nine cases have been previously described in the literature, and one additional case without recurrence during the first 3.5 years of observation is presented stressing that the rate of recurrence is low.

Hair Follicle↗
PubMed1998

[Prevalence of hidradenitis suppurativa in Denmark].

The morbidity of hidradenitis suppurativa can be considerable, but little is known about its epidemiology. Our purpose was to describe the one-year and point prevalences of hidradenitis suppurative and its potential precursor lesions. We obtained the histories and examined an unselected sample (599 persons) of the general population (one-year prevalence), and we performed physical examination for a consecutive sample of 507 persons undergoing screening for sexually transmitted diseases (point prevalence). The point prevalence was 4.1% (95% confidence interval [CI] = 3.0-6.0) on the basis of objective findings. The one-year prevalence of hidradenitis was 1.0% (CI = 0.4-2.2) on the basis of subject recollection only. The patients in the sample on which the point prevalence is based were younger than those in the unselected sample of the general population (p < 0.001). Hidradenitis was significantly more common in women (p = 0.037), which may result from a female preponderance of genitofemoral lesions (odds ratio [OR] = 5.4; CI = 1.5-19.3). No sex difference was found in the prevalence of axillary lesions. Hidradenitis suppurativa is significantly more common than hitherto estimated. A female preponderance of patients is confirmed, except for patients with axillary lesions. Additional longitudinal studies are necessary to assess the importance of potential precursor lesions such as non-inflamed nodules or comedones.

Adult↗
PubMed1998

Relationship between keratinocyte adhesion and death: anoikis in acantholytic diseases.

Loss of attachment to the substratum may trigger apoptosis in epithelial cells (anoikis). It is less clear whether apoptosis may be triggered by disruption of cell-cell contacts, as happens in acantholytic diseases. Biopsy specimens were obtained from the border of skin lesions from four patients with pemphigus vulgaris (PV), four patients with pemphigus foliaceus (PF), three patients with Darier's disease (DD), two patients with Darier's-type Grover's disease (GD), and two patients with benign familial pemphigus Hailey-Hailey disease (HH). Control skin was obtained from five healthy volunteers. TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling) and confocal laser scanning microscopy was employed to detect the nuclei containing fragmented DNA in apoptotic cells. In PV and PF, TUNEL-stained apoptotic keratinocytes were abundantly present in the regions of acantholysis and in the cohesive epidermis below the blisters. Apoptotic keratinocytes had pyknotic, condensed nuclei. In DD, GD and HH, the number of TUNEL-stained keratinocytes was lower, apoptotic keratinocytes were confined to the regions of dyskeratosis and acantholysis, and pyknosis was absent. In conclusion, disruption of cell-cell contacts in acantholytic skin disorders may in some cases cause apoptosis of keratinocytes. Further studies are needed to determine whether the observed differences in the pattern of apoptosis are due to targeting of different junctional elements (adherens junctions in PV and PF versus desmosomes in DD, GD and HH).

Apoptosis↗
PubMed1998

Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa.

BACKGROUND: Antibiotics are often used to treat hidradenitis, but only topical clindamycin has been shown to be effective in a randomized controlled trial. The paucity of these trials may be the result of difficulties in disease assessment. OBJECTIVE: We compare topical clindamycin with systemic tetracycline in the treatment of hidradenitis suppurativa, and study clinical disease assessment. METHODS: A total of 46 patients with stage 1 or 2 hidradenitis suppurativa were treated in a double-blind, double dummy controlled trial. RESULTS: No significant difference was found between the two types of treatment. Patients' global assessment of disease was significantly worse than physician's assessment in 3 of 5 evaluations (P = .0096 to .015), but the correlation between patients' and physicians' assessments was satisfactory after only one visit (rs = .761 to .895). Soreness was the key factor in patients' overall assessment of the disease. CONCLUSION: Systemic therapy with tetracyclines did not show better results than topical therapy with clindamycin. Subjective factors, particularly soreness, appear to be a key factor in patients' assessment of the disease and should, therefore, be included as an outcome variable in future therapy studies.

Administration, Cutaneous↗
PubMed1998

Quantitative evaluation of chronological ageing and photoageing in vivo: studies on skin echogenicity and thickness.

Skin ageing is divided into chronological ageing and photoageing due to the cumulative effects of solar ultraviolet radiation. It is, however, difficult to measure the degree of photoageing and chronological ageing in humans in vivo. Here, we have evaluated the usefulness of ultrasonography for measurement of chronological ageing and photoageing in vivo. Twenty megahertz ultrasonography was performed in 90 individuals (29 men, 61 women, age 18-94) to describe age-related changes in sun-exposed regions with different levels of sun exposure (dorsal and ventral forearm, forehead, ankle) and non-exposed buttock skin. Skin thickness and skin echogenicity in different layers of the dermis were measured in ultrasound images. Additionally, cutaneous photodamage was scored clinically. Age-related changes were dependent on body site as well as layer of the dermis. A progressive, age-related decrease in echogenicity of the upper dermis was found in sun-exposed regions (dorsal forearm, forehead), but not in moderately exposed regions (ventral forearm, ankle). In the buttock an increase in echogenicity was observed. The echogenicity of the lower dermis increased in all examined sites. Skin thickness increased with age in the forehead and buttock, but decreased in the extremity skin. Our findings show that photoageing causes a decrease in echogenicity in the upper dermis. In contrast, chronological ageing is associated with an increase in echogenicity in the lower dermis. Although both increases and decreases in skin thickness were observed in different anatomical regions, there was no general relationship between skin thickness and age. Dermal echogenicity was deemed valuable for in vivo study of chronological ageing and photoageing.

Adolescent↗
PubMed1998

Evidence-based dermatologic out-patient treatment.

OBJECTIVE: To determine the evidence base for routine therapeutic decisions in dermatologic out-patients. DESIGN: A retrospective review of a random sample of primary therapy and literature. SETTING: University hospital, dermatologic out-patient clinic in Copenhagen MATERIAL: A random sample of the case notes from 115 out-patients. METHOD: The evidence base of therapy prescribed when the diagnosis was ascertained was studied in literature searches in MEDLINE and EMBASE. Evidence was structured into primary evidence consisting of randomized controlled trials, and secondary evidence consisting of follow-up studies or the application of trial results between diseases with pathogenic or clinical similarities, e.g. atopic and seborrheic dermatitis. RESULTS: Randomized controlled trials could be found describing 38% (95% confidence interval: 30-47) of all treatments. Secondary evidence was found for 33% (24-41), while no evidence was found for 23% (16-31) of the given treatments. CONCLUSIONS: Approximately three-quarters of dermatologic out-patient therapy is based on scientific evidence ranging from randomized controlled trials to logical deduction from analogous clinical situations. The proportion of evidence-based medicine in dermatologic therapy therefore appears to be comparable with that of internal medicine and may thus be above expectations.

Adolescent↗
PubMed1997

Pincer nails and alopecia as markers of gastrointestinal malignancy.

Nail abnormalities may be markers of non-dermatologic disease. We present a case in which pronounced pincer nails and universal alopecia developed in association with a metastasising adenocarcinoma of the sigmoid colon. It is suggested that this association represents a new ectodermal paraneoplastic syndrome.

Adenocarcinoma↗
PubMed1997

The homogeneity of hidradenitis suppurativa lesions. A histological study of intra-individual variation.

Recent data suggest that hidradenitis suppurative is a disease of the follicle, but the histological homogeneity of findings over time and in different anatomical regions has not been verified. Its description may help towards a better classification of the follicular diseases. Correct classification provides both knowledge by interference and a way of generalizing with respect to the significance of specific findings. The intra-individual variation of hidradenitis was described through classification of specimens taken from patients with multiple simultaneous or consecutive excisions. A total of 51 specimens from 11 patients were examined; of these 30 were from synchronous biopsies, and 21 from consecutive biopsies (range 2 months to 6 years). The majority of specimens (44/51) contained poral occlusion, sinus tracts or cysts. This pattern was present in 50-85% of the specimens from any given patient with hidradenitis. No primary apocrine involvement was seen. Fibrosis occurred often (33/51 specimens), and eccrine involvement was seen more often than apocrine involvement (10 vs 7 specimens). The homogeneous histology of hidradenitis supports its reclassification as a follicular disease. The reproducibility of the findings further suggests that the changes are specific and that hidradenitis is therefore a definite disease entity within the spectrum of follicular diseases. Additional functional studies may help classify hidradenitis more precisely in relation to other follicular diseases.

Adult↗
PubMed1997

Sebum excretion in hidradenitis suppurativa.

BACKGROUND: Clinical and histological similarities between hidradenitis suppurativa and acne have been pointed out. The possible role of sebaceous glands in hidradenitis has not previously been investigated. Acne treatment, in particular is however not effective in hidradenitis. No previous information was found on regional sebum excretion in hidradenitis. OBJECTIVE: Investigate the sebum excretion (SE) and markers of cutaneous virilization in hidradenitis patients. METHODS: Sebutapes and scores of acne, hirsutes and alopecia in 16 women with hidradenitis suppurativa were compared with 16 healthy controls. RESULTS: The SE and the number of active glands followed a similar pattern in both groups (face > axillae/genitofemoral fold, p < 0.0001) but no significant differences were seen between the two groups. No differences were seen in the median Body Mass Index, number of obese persons in either group or any of the clinical markers of virilization studied. CONCLUSION: No significant axillary, genitofemoral or facial seborrhea was found in hidradenitis. It is suggested that SE is not an important factor in the development of hidradenitis, and this may help explain the generally unsatisfactory therapeutic effect of retinoids in this disease. The results further suggest that general cutaneous virilization is not a feature of hidradenitis.

Acne Vulgaris↗
PubMed1997

The applicability of clinical scoring systems: SCORAD and PASI in psoriasis and atopic dermatitis.

The lack of standard systems for assessment of disease severity poses a problem for the introduction of rational quality control in dermatology. The scoring systems often involve assessment of the same aspects of disease, and it may therefore be conceivable that one system could potentially be applied to routine clinical work and form the basis of disease quantification in dermatology. This study was undertaken to compare PASI (Psoriasis Area and Severity Index) and SCORAD (SCOring index of Atopic Dermatitis) scoring systems, to assess disease severity in patients with atopic dermatitis and psoriasis. Patients with psoriasis (14) and atopic dermatitis (14) were scored with both systems, and correlation coefficients and multiple regression coefficients were calculated. A significant correlation between SCORAD and PASI was found (rs = 0.66). Correlation coefficients were highest (rs = 0.87) when only atopic patients were studied, and lowest (rs = 0.57) when only psoriatic patients were studied. Assessments of area and erythema are suggested as candidates for a generalised scoring systems for dermatological disease. The results suggest that in spite of the overlap between the two score systems, significant diagnosis-specific differences exist, and neither PASI nor SCORAD is an optimal general dermatological scoring system for disease severity. Additional methodological developments are necessary.

Adolescent↗
PubMed1997

Ultrasound examination of hair follicles in hidradenitis suppurativa.

OBJECTIVE: To describe the in vivo skin echostructure, hair follicle shape, and dermal thickness in hidradenitis suppurativa. DESIGN: Qualitative and quantitative assessment of high-frequency (20-MHz) B-mode ultrasound images of lesional and paralesional skin. SETTING: University hospital. PATIENTS: Age- and sex-matched outpatients with hidradenitis suppurativa (n = 15) and healthy control subjects (n = 13). Median age was 34 years (range, 31-38). RESULTS: Clinically normal paralesional hair follicles in hidradenitis have an abnormal shape. The follicles appear to be wider in the deep dermis, the difference being statistically significant in the genitofemoral region (P = .007). Patients with hidradenitis have larger follicles in the axilla than controls (P = .002). Mature acne and hidradenitis lesions are indistinguishable, but both are different from epidermal cysts. Mean axillary and genitofemoral skin was significantly thicker in patients than in controls. CONCLUSIONS: In vivo ultrasonography shows characteristic differences in the shape of hair follicles in hidradenitis. The general underlying abnormalities appear to occur in the deep part of the follicle. The mature lesions are indistinguishable from acne, but are clearly different from epidermal cysts. A thickened skin may play a pathogenic role in the development of hidradenitis.

Adult↗