Search PubMed⌕ Search

Biomedical subjects

T L Diepgen

Publications and source records attributed to T L Diepgen.

At least 19 recordsLinked to original sources
PubMed2006

[Tick bites and borreliosis in children attending forest kindergarten: a challenge for prevention].

AIM: The aim of this study was to analyse the influence of preventive measures on the risk of being bitten by a tick and of suffering from borreliosis in children attending so-called 'forest kindergartens' (nurseries located in forested areas where children spend all-season full-time outdoors), compared to children attending regular kindergartens. In addition, we aimed to analyse sources of information and the risk of being bitten more than once. METHODS: 53 kindergartens (25 forest kindergartens, 28 regular kindergartens) in the state of Baden-Württemberg, Germany participated in this study and protective parental behaviour was recorded. In a prospective cohort study, the numbers of tick bites and cases of borreliosis were recorded monthly (March to October 2004) using a questionnaire. The influence of preventive measures was estimated using multivariate log-binomial regression. RESULTS: Altogether, 1707 children of 'forest kindergartens' (506 children) and regular kindergartens (1201 children) were included. Parental protective behaviour was significantly better in forest kindergartens compared to regular kindergartens. There were no substantial differences between effect estimates after stratification for parental protective behaviour. For children attending a 'forest kindergarten, the adjusted risk ratio of being tick bitten was 2.6 (3.3-3.0) which was only slightly different from the unadjusted risk, ratio. CONCLUSION: Although protective parental behaviour in 'forest kindergarten' children was significantly better compared to regular kindergarten, children in forest kindergartens are at a considerable risk of tick bites and borreliosis. Implementing effective preventive measures against borreliosis represents a public health challenge.

Borrelia↗
PubMed2006

Atopic dermatitis and cancer risk.

BACKGROUND: Epidemiological studies have provided growing evidence of a link between atopy and cancer risk. OBJECTIVES: To review the evidence from case-control studies and cohort studies on a possible association between atopic dermatitis (AD) and cancer risk, with particular attention to the case definition of AD. METHODS: Studies with quantitative data on the association between AD (eczematous disease) and cancer risk were obtained from MEDLINE in combination with a review of cited references. RESULTS: In 23 publications, AD was implicated in the risk of haematological [childhood leukaemia (n = 3), adult leukaemia (n = 3), non-Hodgkin lymphoma (NHL; n = 4) and different haematological cancers (n = 1)], pancreatic (n = 5), skin (n = 2) and brain malignancies (n = 5). The overall picture of the results of these studies shows that a history of AD may be associated with a decreased risk of pancreatic cancer, brain tumour and childhood leukaemia, although in most instances the findings were not statistically significant. No consistent associations were observed for skin cancer or NHL. The definition of AD had varying quality, and was imprecise in the majority of publications. CONCLUSIONS: The findings of the epidemiological studies tend to support a lower risk of cancer among persons with a history of AD. Although a more careful definition of AD is needed, these epidemiological studies could provide an estimate of the background cancer risk in patients with AD when the long-term effects of treatments for AD are assessed.

Brain Neoplasms↗
PubMed2006

Pruritus as a leading symptom: clinical characteristics and quality of life in German and Ugandan patients.

BACKGROUND: Pruritus is the most frequent and distressing symptom associated with dermatoses and various internal and neurological diseases. OBJECTIVES: To investigate two different populations of patients with pruritus, one in Germany and one in Uganda, with a particular focus on clinical characteristics, aetiology and quality of life. METHODS: We investigated by questionnaire 132 patients (59 men, 73 women, mean age 54.5 years) who were referred to the Department of Dermatology at the University Hospital of Magdeburg, Germany, with the diagnosis of pruritus as a leading symptom. The questionnaire was also applied in 84 patients who consulted the Dermatology Clinic at Mbarara, Uganda for pruritus. The questions referred to personal data and disease history of the individual, history and present occurrence of concomitant diseases, present and past therapy, quality, frequency and triggers of itching and scratching, other disorders and complaints, quality of life and impact on work and disability. RESULTS: Seventy-five (57%) of the German patients had pruritus due to dermatoses, 47 patients (36%) had pruritus due to a systemic disease and in 10 patients (8%) pruritus was of unknown origin. Most had a history of pruritus of several months up to years. Pruritus associated with dermatoses mostly affected the whole body and was permanent with an undulatory character. Affective reactions such as aggression and depression occurred more frequently in dermatological patients compared with those with systemic pruritus. The former group felt that pruritus had a greater impact on their lives. Almost all Ugandan patients had pruritus due to dermatoses except for three patients with pruritus of unknown origin. Eczema and prurigo were the most frequently observed dermatoses in both German and Ugandan patients. Patients with pruritus in both populations showed an impaired quality of life. There was no pronounced difference between the populations with regard to feelings of depression and suicidal thoughts. CONCLUSIONS: A great deal of helpful information in this complex group of patients can be obtained using this questionnaire. Pruritus has a major impact on quality of life and especially impairs those patients with pruritus associated with dermatoses and pruritus of unknown origin.

Adolescent↗
PubMed2005

[Pruritus in pregnancy. A frequent diagnostic and therapeutic challenge].

Pruritus is the leading dermatological symptom during pregnancy. Besides preexisting or acquired dermatoses, there are a number of pregnancy-specific dermatological diseases such as PEP (polymorphic eruption of pregnancy, previously named PUPPP), pemphigoid (herpes) gestationis, and pruritus gravidarum that are accompanied by severe itching and scratching. Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration. The use of topical and systemic treatments depends on the underlying aetiology of pruritus and the stage and status of the skin. In general, emollients, topical anti-pruritics and topical corticosteroids appear to be the safest options for localised forms of pruritus in pregnancy whereas systemic treatments and/or UV phototherapy are adequate for generalized pruritus. Systemic corticosteroids and a restricted number of antihistamines may be administered in severe cases. This paper highlights the major aetiologies of pruritus during pregnancy and points out the cornerstones of antipruritic therapy in recognition of our own clinical experiences and the current literature.

Administration, Topical↗
PubMed2005

[Evidence-based evaluation of the effect of Type IV Allergies on the reduction of fitness for work. Survey of occupational skin diseases].

Evidence-based guidelines about the distribution of type IV allergens of the European standard series in different professions and its occupational relevance are missing. Based on published data, epidemiological investigations, work related knowledge about industrial processes, and allergen specific properties, recommendations are given about the clinical impact in the working environment for the following allergens: acrylates/methacrylates, epoxy resins, dichromate, cobalt, nickel, formaldehyde, (chlor-)methylisothiazolone, p-phenylendiamine, colophony, thiurame, mercaptobenzothiazole, dithiocarbamate, n-isopropyl-n'-phenyl-p-phenylendiamine, fragrance mix, composite mix, and neomycinsulfate. These recommendations might improve the clearance rate and allergological evaluation of the occupational relevance of different delayed type sensitizations or allergens.

Allergens↗
PubMed2005

[Evidence-based medicine and the Cochrane Skin Group].

The concept of evidence based medicine (EBM) has represented a paradigm shift in medical thinking and practise in the last decade. However, we seem to be stuck with the phrase, yet it is a term that is frequently abused and misunderstood. Therefore, the purpose of this article is to clarify what evidence based dermatology (EBD) is and what it is not. Some guidance on the four key steps in practising EBM in dermatology will be given. The central role of systematic reviews will be elaborated and the Cochrane skin group introduced. Finally, the limitation of EBD will be discussed.

Clinical Trials as Topic↗
PubMed2005

[Therapy of hand eczema. What can we learn from the published clinical studies?].

Hand eczema is a very common skin disease, which can be induced by different causes. Although many interventions ranging from topical corticosteroids and UV therapy to oral cyclosporine and retinoids are available, the treatment of hand eczema can be very difficult and frustrating. The objective of our study was to assess the external evidence of different treatment modalities for hand eczema. Electronic databases (Cochrane, MEDLINE, Embase, Pascal, Jicst-Eplus, Amed) were systematically searched for clinical trials on therapy for hand eczema. Additionally, four general medical journals (BMJ, JAMA, Lancet, NEJM) and 17 specialists dermatological journals were hand searched from 1977 to August 2004. A total of 100 studies were found and 31 identified as randomised clinical trials (RCTs) dealing with different interventions. Due to the poor quality of most of these RCTs, they are inadequate as a guide to clinical practice. There is a need for high-quality RCTs on therapy for hand eczema regarding established as well as new treatment options taking different subgroups of hand eczema into consideration.

Adrenal Cortex Hormones↗
PubMed2005

[Rehabilitation after work related skin diseases].

The high incidence rates of occupational contact dermatitis, its poor prognosis, and the high social and economic impact of the disease for the affected individuals as well as for the medical insurance companies indicates a need to strive for the target of "rehabilitation instead of retirement". Here, we highlight the need and effectiveness of rehabilitation measures in individuals with work related skin diseases (mainly contact dermatitis and hand eczema). We discuss the measures for secondary individual prevention as well as tertiary prevention, which have been established in our department together with the state medical insurance companies, mainly the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BWG: Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Service). The results of the multicentre study "Optimisation and Quality Assessment of Tertiary Prevention of Occupational Dermatoses" are presented and discussed. Both, the secondary as well as tertiary prevention measures have been successful, which has resulted in a decrease in the total annual rehabilitation costs to the BGW. A reason for this success story is the fact that in Germany these organisations are, in contrast to the health insurance companies, responsible for both acute treatment and the rehabilitation.

Dermatitis, Contact↗
PubMed2005

Monitoring the European standard series in 10 centres 1996-2000.

A 5-year retrospective study of the frequency of sensitization to the 25 allergens of the European standard series (ESS) was conducted in 10 centres in 8 European countries. Included were the results of 26 210 patients. The range in sensitivities differed moderately between the centres. Combining results of different centres and drawing conclusions on incidences can be done only with great care. The information on the ranking of the allergens and their sensitization incidence in the clinics are useful for decisions on the future composition of the standard series. The ESS is still a valid screening tool, and no substances should be deleted.

Allergens↗
PubMed2005

Is atopy a protective or a risk factor for cancer? A review of epidemiological studies.

OBJECTIVE: There is an ongoing debate whether there is a link between a history of atopy and cancer risk. The purpose of this paper is to review the published epidemiological studies on the association between atopy and the risk of cancers. METHODS: Through an electronic search (January 1986-April 2004) with an additional review of cited references, we identified studies with quantitative data on the relation of atopy (irrespective of its definition or subtype) to cancer (different cancer sites). RESULTS: The protective effect of atopy in colorectal cancer has been observed consistently in the case-control studies, but not in cohort studies. A consistent inverse association between self-reported atopy and glioma risk has been shown, but there is absence of such an association for meningioma. In most studies, the risk of leukaemia, in particular childhood leukaemia, tends to be lower among people with a history of atopy. Studies, which looked at, the association between atopic diseases and risk of cancers of pancreatic, breast, lymphoma showed varying outcomes. Most studies on the atopy-pancreatic cancer relation suggested an inverse association. For lymphoma, most studies have shown no substantial association. Overall evidence indicates an increased risk of lung cancer among persons with a history of asthma. CONCLUSION: Despite the mixed results, the emerging picture from most of the currently available epidemiological data indicate that atopic disease is associated with a reduced risk for cancer. Further research should focus on a more carefully defined 'atopy' status and manifestation of different atopic diseases, to advance our understanding of the role that allergies might play in the risk of developing cancer.

Epidemiologic Studies↗
PubMed2004

[Skin cancer and occupational disease].

Although it is universally accepted that UV light exposure can cause malignant skin tumors, UV-induced skin cancers are not recognized as an occupational disease in Germany. Exposure to natural or artificial UV light occurs in many work places, so that the induction of occupational skin cancers is certainly plausible. In recent years, a special clause in the occupational disability rules has recognized some cases of UV-induced skin cancers. We discuss the nature of occupational UV exposure, explore preventative measures and review the data regarding occupational UV-induced skin tumors. After evaluating recent publications, we conclude that for squamous cell carcinoma the epidemiological proof of an at least doubled risk (RR >2) due to occupational UV radiation can be given. The clear dose response relationship supports these epidemiological findings. For the individual risk assessment, an attributive UV radiation >40% due to occupational factors must exist. Under those circumstances, squamous cell carcinoma should be recognized and compensated as an occupational disease.

Basal Cell Carcinoma↗
PubMed2004

[Internet and occupational dermatology. Quality criteria and useful links].

The World Wide Web (WWW) offers physicians as well as their patients a huge resource of health information, which can be attained within minutes. Nevertheless it is difficult to select the needed information out of the mass of provided data and their quality is often poor with many unproven statements. Occupational dermatologists can especially benefit from the internet as they need a wide range of data from many sources. Much of this data can already be obtained via internet. To facilitate their search for information, this article presents a selection of German websites. The quality of the websites has been assessed using criteria such as design, search function, provided links and medical information. The results revealed deficiencies in the transparency of the data, e.g. often it is not apparent who is responsible for the information or when they were updated.

Dermatitis, Occupational↗
PubMed2004

[Quality of life of patients with occupationally-induced hand eczema].

In recent years quality of life has been studied in a growing number of different dermatological diseases. Internationally validated questionnaires such the RAND-36 (identical to the SF-36) do not contain enough questions which are relevant for skin diseases. There is no publication on quality of life issues in occupational skin diseases, and only one short report gives data on quality of life in hand eczema. The widely used skin specific instrument DLQI has only 2 questions that indirectly refer to employment issues. A quality of life questionnaire on occupational skin diseases (mostly hand eczema) should ideally include questions on work-related impairment of both physical functioning and interaction with colleagues.

Activities of Daily Living↗
PubMed2004

[Developments in chromate allergy in the German construction industry].

For decades potassium dichromate has been the most important allergen in the construction industry. In Scandinavian countries the prevalence of potassium dichromate sensitization declined following the introduction of low-chromate cement. In contrast, analysis of our register in Northern Bavaria and the data of workers compensation board show no significant decline in potassium dichromate sensitization in the German construction industry during the 1990s. In 1993, German legislation provided an Approved Code of Practice and the cement manufacturers committed themselves to reduce the level of water-soluble chromates to less than 2 ppm in bag cement. Since 2000 this agreement has also included ready-mixed concrete. It remains to be seen, if sensitization against potassium dichromate will decline in the upcoming years. Based on our data, it would be desirable if only low-chromate cement was used in the construction industry in Germany as in Scandinavia.

Adolescent↗
PubMed2004

[Hydroxyethyl starch-(HES)-induced pruritus as secondary complication of an occupational accident].

A 29-year old employee (controller in the textile industry) had an occupational accident leading to a femoral fracture. After surgery, he developed acute respiratory distress syndrome (ARDS) necessitating intensive care treatment. Three weeks after the accident, he developed generalized severe itching on a daily basis unresponsive to systemic and topical treatments. After one year, the itching had decreased to approximately 50% of its initial intensity. Hydroxyethyl starch (HES)-induced pruritus was diagnosed, based on the typical history and clinical features, the proven administration of HES and its cutaneous tissue storage by electron microscopy. Drug-induced pruritus caused by the plasma expander hydroxyethyl starch can be a secondary consequence of an occupational accident and thus an issue in accident compensation claims.

Accidents, Occupational↗
PubMed2004

[Pruritus in childhood. A diagnostic and therapeutic challenge].

From the clinician's point of view, pruritus in children is quite frequent. It mainly occurs along with dermatoses but rarely with systemic diseases such as renal and liver failure or with genetic disorders. Mostly, it appears in the setting of atopic dermatitis (AD). Other frequent differential diagnoses comprise e.g. scabies, impetigo, varicella, tinea, urticaria, mastocytosis and psoriasis. In children, pruritus is most often associated with severe scratching leading to artefacts. This group of patients requires a therapeutical regimen of its own. The use of topical and systemic treatments depends on the underlying aetiology of pruritus and the stage and status of the skin. The physician has to consider that topically applied drugs may cause intoxication due to the different body volume/body surface proportion, especially in newborns and infants. The dosages of systemic drugs need to be adapted in children and UV phototherapy should be performed with caution due to possible longterm photo damage of the skin. Physicians feel more insecurity treating pruritus in children, especially when systemic treatments are taken into consideration. We want to highlight the major aetiologies of pruritus in children and point out the cornerstones of antipruritic therapy in this challenging group of patients in recognition of our own clinical experiences and the current literature.

Adolescent↗