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PubMed1992

[Response to a series of carbon dioxide baths].

The authors investigated 28 patients, mean age 43.6 years, during their stay in spa Dudince. The patients had a daily carbon dioxide bath, thermally indifferent, for a period of 20 minutes. During the first, tenth and twentieth bath the humoral circulatory and renal response was assessed. During every bath a standard reaction developed (decline of plasma renin activity and of the aldosterone level, increased excretion of water and minerals, changes of the blood pressure and heart rate). The influence of the series of baths was manifested by a gradual increase of the diuresis, natriuresis, a more permanent drop of the blood pressure and at the end of the series also of the heart rate. The other investigated parameters did not change significantly during the series of baths, as compared with the reaction to a single bath. The attained results justify the conclusion that a series of carbon dioxide baths had a gradually improving effect which is favourable, in particular in the treatment of cardiovascular diseases.

Adult↗
PubMed2006

Preoperative bathing or showering with skin antiseptics to prevent surgical site infection.

BACKGROUND: Surgical site infections (SSIs) are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower incidence of surgical site infection. OBJECTIVES: To review the evidence for preoperative bathing or showering with antiseptics for the prevention of hospital-acquired (nosocomial) surgical site infection. SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE (January 1966 to December 2005) and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials comparing any antiseptic preparation used for preoperative full-body bathing or showering with non-antiseptic preparations in patients undergoing surgery. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for selection, trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Six trials involving a total of 10,007 participants were included. Three of the included trials had three comparison groups. The antiseptic used in all trials was 4% chlorhexidine gluconate (Hibiscrub). Three trials involving 7691 participants compared chlorhexidine with a placebo. Bathing with chlorhexidine compared with a placebo did not result in a statistically significant reduction in SSIs; the relative risk of SSI (RR) was 0.91 (95% confidence interval (CI) 0.80 to 1.04). When only trials of high quality were included in this comparison, the RR of SSI was 0.95 (95%CI 0.82 to 0.10). Three trials of 1443 participants compared bar soap with chlorhexidine; when combined there was no difference in the risk of SSIs (RR 1.02, 95% CI 0.57 to 1.84). Two trials of 1092 patients compared bathing with chlorhexidine with no washing. No difference was found in the postoperative SSI rate between patients who washed with chlorhexidine and those who did not wash preoperatively (RR 0.70, 95% CI 0.19 to 2.58). AUTHORS' CONCLUSIONS: This review provides evidence of no benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.

Anti-Infective Agents, Local↗
PubMed2006

Meta-analysis of preoperative antiseptic bathing in the prevention of surgical site infection.

BACKGROUND: Preoperative bathing with an antiseptic solution is widely used to prevent surgical site infection, but trial results are conflicting. METHODS: Trials were identified by searches of Medline, Embase and the Cochrane controlled trials register. Studies were eligible if they compared an antiseptic solution used in preoperative bathing with a non-antiseptic washing agent or with no bathing and if they reported data on surgical site infection. RESULTS: Six trials with a total of 10 007 patients were included; all of them used 4 per cent chlorhexidine gluconate. Three trials with 7691 patients compared chlorhexidine with placebo. Bathing with chlorhexidine did not reduce surgical site infection rate; the relative risk (RR) was 0.91. Including only trials of high quality, the RR was 0.95. Three trials with 1443 patients compared bar soap with chlorhexidine; no differences in the surgical site infection rates were detected, and the RR was 1.02. Two trials of 1092 patients compared bathing with chlorhexidine with no washing. The surgical site wound infection rate in the two groups was similar, and the RR was 0.70. CONCLUSIONS: The evidence does not support preoperative bathing with chlorhexidine as a means of reducing surgical site wound infection.

Anti-Infective Agents, Local↗
PubMed1996

Influences of bathing and hot weather on the pharmacokinetics of a new transdermal clonidine, M-5041T.

The influences of bathing and hot weather on plasma concentrations of clonidine were examined during application of a new transdermal clonidine system, M-5041T, in eight healthy volunteers. An M-5041T patch containing 6 mg of clonidine was applied on the right chest for 96 hours during winter with or without bathing (40 degrees C for 5 minutes) and also during summer without bathing. Plasma concentrations and urinary excretion of clonidine were determined for a 160-hour period after application. Plasma concentrations of clonidine in the winter trials did not differ significantly with or without bathing. Plasma drug concentration as a whole was significantly higher in the summer trial than in the winter trial, however. The maximum plasma concentration (Cmax), area under the plasma concentration-time curve (AUC), and urinary excretion (Ae) of clonidine also tended to be higher in the summer trial. These results suggest that plasma levels of clonidine are higher after application of M-5041T during hot weather. Although the period of bathing used in this study was short, the influence of bathing seems to be negligible.

Administration, Cutaneous↗
PubMed1994

Cardiovascular effects of Atenolol, scopolamine and their combination on healthy men in Finnish sauna baths.

Indicators of cardiovascular strain were studied in 12 healthy young men under the influence of drugs affecting the autonomic nervous system during the course of taking a sauna bath. There were four bath sessions: one without a drug (control) and three with drug pretreatment (Atenolol 50 mg or Scopolamine 0.3 mg or their combination taken orally 2 h before the bath). The time spent in the hot room depended on the subjective rating of heat stress. Its mean duration at a temperature of 88 degrees C (dry bulb) was 22 (range 14-33) min and did not differ significantly among the sessions. In the Atenolol experiment the mean resting heart rate before the bath was significantly lower (P < 0.001, ANOVA of repeated measures) than in the other experiments. The increase in heart rate per minute of heat exposure was significantly lower (P < 0.001) in the Atenolol experiment and higher (P = 0.017) in the Scopolamine experiment than in the other experiments. The systolic blood pressure increased more slowly (P = 0.004) and the diastolic pressure decreased less (P = 0.02) in the Atenolol experiment than in the other experiments. Heart rate and blood pressure returned to their initial levels during the 30-min recovery after the heat exposure. The plasma noradrenaline concentrations increased approximately twofold during all of the bath sessions, whereas the plasma adrenaline and serum thromboxane B2 concentrations showed no consistent alterations. A small oral dose of Scopolamine alone or in combination with Atenolol produced no marked cardiovascular strain in healthy men during a sauna bath.

Administration, Oral↗
PubMed1996

Treatment of psoriasis with polyethylene sheet bath PUVA.

BACKGROUND: Bath PUVA has been shown to be an effective alternative treatment for psoriasis with fewer systemic side effects than oral methoxsalen (8-MOP). The cost of 8-MOP and the need for a bath unit have prevented wider use of this treatment. OBJECTIVE: We investigated the safety and efficacy of sheet bath PUVA by restricting the volume of the psoralen/bath water solution to 10 L with the aid of a polyethylene sheet. METHODS: Fifty-eight patients with chronic plaque-type psoriasis were treated with bath PUVA in a concentration of 0.5 mg of 8-MOP per liter of water. RESULTS: The group required a median of 17 baths (95% confidence interval [CI], 14-20) for clearance. Total UVA dose for the entire group was 26 J/cm2(95% CI, 18-47). CONCLUSION: Sheet bath PUVA is safe, efficient, and easy. This regimen can significantly reduce the amount of 8-MOP required, thereby resulting in a favorable cost/benefit ratio.

Administration, Cutaneous↗
PubMed1999

Cancer incidence among Finnish psoriasis patients treated with 8-methoxypsoralen bath PUVA.

BACKGROUND: Long-term oral 8-methoxypsoralen (8-MOP) and UVA (PUVA) therapy increases the risk of nonmelanoma skin cancer and possibly also of cutaneous malignant melanoma. Topical application of 8-MOP PUVA induces malignant tumors in rodent skin, but little is known about its carcinogenicity in human skin. OBJECTIVE: Our purpose was to investigate the carcinogenicity of 8-MOP bath PUVA in humans. METHODS: This was a cohort study of 158 patients with psoriasis, for whom 8-MOP bath PUVA had been initiated during 1979 to 1992. The average number of 8-MOP bath PUVA treatments was 36 (range, 6 to 204) and the mean cumulative UVA dose was 92 J/cm2 (range, 3 to 884 J/cm2) by the end of 1995. The patients were not treated with any other forms of PUVA. Cancer incidence subsequent to 8-MOP bath PUVA up to the end of 1995 was determined by linking the cohort with the records of the Finnish Cancer Registry. The standardized incidence ratios (SIR) were calculated for skin cancer and some common internal cancers, using the expected numbers of cases based on the regional cancer incidence rates. RESULTS: There was one case of basal cell carcinoma, but no cases of other types of skin cancer. A total of 6 noncutaneous cancers were observed (SIR, 1.3; 95% confidence interval, 0.5 to 2.8). CONCLUSION: No association between cutaneous cancer and 8-MOP bath PUVA was found, but the statistical power of this study alone is not adequate to warrant definite conclusions. The results can be used in a meta-analysis as soon as other studies on the carcinogenicity of 8-MOP bath PUVA are published.

Administration, Cutaneous↗
PubMed2001

Warm tub bathing during labor: maternal and neonatal effects.

AIM: To study possible detrimental maternal and neonatal effects of immersion in warm water during labor. DESIGN: Prospective randomized controlled bathing during first stage of labor vs no bathing. SETTING: Obstetrical departments at a university hospital and two central hospitals. PRIMARY END-POINT: Referral of newborns to NICU. MATERIAL AND METHODS: Randomization took place by means of sealed opaque envelopes at each delivery unit. Preconditions for participation in the study were: singleton parturient wishing to bathe, a gestational duration of at least 35 weeks+0 days, a planned vaginal delivery, normal admission test, regular contractions and cervix dilated to at least 3-4 cm. Parturients randomized to the 'no bath' control group were allowed to use a shower. Rupture of the membranes was not a contra-indication to participation. Those excluded from randomization were women with intra-uterine growth retardation, meconium-stained amniotic fluid, or in the event that the tub was occupied by another randomized parturient. MAIN RESULTS: On average, parturients stayed in the tub for 50-60 min. No significant difference was seen regarding the referral rate to NICU among 612 cases vs 625 controls, OR 0.8; 95% CL 0.2, 3.1. The OR for epidural analgesia was 1.0; 95% CL 0.8, 1.3. Nor was any significant difference seen in the rate of perineal tear grade III-IV (OR 1.3), instrumental delivery (OR 1.1), cesarean section (OR 1.8), or maternal post partum stay on the ward. During the neonatal period, no significant difference was seen in the number of newborns with Apgar <7 at 5 min (4 vs 5), neonatal distress (OR 2.2) or tachypnéa (OR 1.0). CONCLUSION: In the present study no negative effects of bathing during labor could be discerned. The results indicate that expectant mothers wishing to bathe during labor may do so without jeopardizing their own, or their newborns' wellbeing after birth.

Adult↗
PubMed2000

Does smoking influence the efficacy of bath-PUVA therapy in chronic palmoplantar eczema?

Bath-PUVA therapy has been described as successful treatment for palmoplantar eczema. However, our own observations showed that patients with palmoplantar eczema of the dyshidrotic or hyperkeratotic type responded only partially to bath-PUVA therapy. In order to evaluate environmental influences possibly having an impact on the efficacy of this therapy, smokers and non-smokers suffering from palmoplantar eczema treated with bath-PUVA therapy were compared. A retrospective study was conducted involving 62 patients, 39 non-smokers and 23 smokers, with palmar and/or plantar eczema resistant to local corticosteroids. Bath-PUVA therapy was performed according to the European standard regimen for oral PUVA therapy. The total number of treatments and the cumulative UVA-dose were similar in smokers and non-smokers (smokers 24+/-17.7 (mean+/-SD) and 67.6+/-51.3 J/cm2 vs. non-smokers 25.7+/-16.3 and 68.5+/-49.3 J/cm2). In the group of non-smokers, 31% showed complete remission (CR; 100% clearance), 33% partial remission (PR; more than 50% clearance) and 36% no change after treatment (NC; less than 50% clearance). In contrast, the group of smokers showed only 13% CR and 22% PR, whereas 65% exhibited NC. The differences regarding complete or partial remission between the groups were statistically significant (Student t-test for paired samples; P<0.05). Regarding the different type of eczema, bath-PUVA proved to be more successful in the dyshidrotic type of eczema as compared to the hyperkeratotic type in non-smokers (P<0.05). In the group of smokers no CR was achieved in patients suffering from the dyshidrotic form of eczema. Smoking is likely to be a reason for the failure of bath-PUVA therapy in the treatment of chronic palmoplantar eczema, in particular regarding smokers with eczema of the dyshidrotic type where no complete remission was achieved.

Adult↗
PubMed2005

Effect of bathing on skin flora of preterm newborns.

OBJECTIVE: To assess the effect of bathing with water only or with mild pH neutral soap and water on skin flora of preterm newborns. METHOD: Randomized blinded clinical trial that enrolled 73 preterm newborns whose gestational age was between 28 and 35 weeks and birth weight between 800 and 1800 g. At the age of 3 days the infants were randomly assigned to a group that was given daily baths either with water only, or with soap and water for 7 or more days. Antibiotic treatment delayed onset of the trial in some preterm infants. On the final day of bathing axillary bacterial cultures were obtained before and 30 minutes after bathing. RESULTS: At the time of axillary culturing, the mean age of the newborns was 19 days. Coagulase-negative Staphylococcus was the most prevalent microorganism in both groups. No significant difference was found in the count of microorganism colonies between both groups. The comparison of the number of bacterial colonies between the time before and after bath, carried out by repeated-measures ANOVA showed a significant difference over time in the two groups, without a significant difference between the two groups. CONCLUSIONS: Bathing preterm newborns with water only or with soap and water produces similar effects on skin colonization of a preterm neonate. Both are effective to decrease the number of colonies of Gram-positive and Gram-negative bacteria.

Baths↗
PubMed2001

Concentration-dependent phototoxicity in trimethylpsoralen bath psoralen ultraviolet A.

BACKGROUND: Long-term use of topical trimethylpsoralen (TMP) psoralen bath plus ultraviolet A (bath PUVA) is considered safe with regard to the risk of skin cancer. However, the potential for severe phototoxicity limits its use. OBJECTIVES: To study the effect of dilution of the TMP bath on the minimal phototoxic dose (MPD). METHODS: Fifteen volunteers participated in the study. The MPD tests were performed for three TMP concentrations: 0.33 mg L-1, 0.1 mg L-1 and 0.033 mg L-1 at 2-week intervals. Geometric UVA dose series increasing by a factor of radical2 were used for the testing on the previously unexposed buttock skin. The MPD72 h was assessed at 72 h from the bath. RESULTS: For the highest TMP concentration of 0.33 mg L-1, the median MPD72 h was 0.14 J cm-2 (95% confidence interval (CI), 0.10-0.14 J cm-2). For the diluted TMP bath concentration of 0.1 mg L-1, the median MPD72 h increased to 0.29 J cm-2 (95% CI, 0.2-0.41 J cm-2) and for 0.033 mg L-1 to 0.81 J cm-2 (95% CI, 0.57-1.15 J cm-2), respectively. Thus, diluting the labelled concentration of 0.33 mg L-1 1 : 10 increased the median MPD72 h 5.6-fold. CONCLUSIONS: With regard to the safety and practicality of the TMP bath PUVA, the lower concentrations of TMP may be of clinical importance, and this needs to be validated in future controlled clinical trials.

Adult↗
PubMed2001

Shared bathing and drowning in infants and young children.

OBJECTIVE: A study was undertaken to look at possible risks of shared bathing in early childhood. METHODS: Autopsy databases were searched at the Women's and Children's Hospital and State Coroner's Office, Adelaide, Australia, from January 1963 to December 1999, the Victorian Institute of Forensic Medicine, Melbourne, Australia, from January 1991 to December 1999, and the Children's Hospital-San Diego, San Diego, USA, from January 1990 to December 1999, for all cases registered as drowning in children aged 2 years and under who were in a bath with another child around the time of death. RESULTS: A total of 17 cases were found. The age range of the victims was 8-22 months (average=11.8 months), with a male to female ratio of 10:7. The surviving children (who were all siblings) were significantly older, with an age range of 19-48 months (average=30.4 months), and a male to female ratio of 12:5. (The survivors were on average 18.5 months older than the victims, range=11-32 months). In every case the children had been left unsupervised for variable periods of time. CONCLUSIONS: These cases represented a significant component -- between 22 and 58% -- of bath drownings in the 2 years and under age group. It would appear that shared bathing for young children and infants may only acceptable if adult supervision is constant, and that a young sibling is not an appropriate person to look after an infant or toddler in the bath. While the risk of leaving an infant in a filled bath may be exacerbated if an older child is also present, further population-based studies are required to examine this hypothesis.

Age Distribution↗
PubMed2000

Effects of bathing immediately after birth on early neonatal adaptation and morbidity: a prospective randomized comparative study.

OBJECTIVE: Because the risks and benefits of early bathing of newborn infants are not well established, we investigated the effects of bathing immediately after birth on rectal temperature, respiratory rate, heart rate, blood pressure, percutaneous arterial blood oxygen saturation (SpO2) and early neonatal morbidity. METHODS: The study was designed as a randomized prospective comparative study in the neonatal care unit of a university hospital. A total of 187 healthy term and near-term newborn infants, who were delivered vaginally without asphyxia, between January and December 1997 were the study subjects. We compared findings in newborns who were bathed 2-5 min after birth (n = 95) with those of a control group (n = 92) who received dry care instead. Groups were comparable with respect to gestational age, birthweight, male: female ratio, Apgar score and umbilical blood pH. Rectal temperature was measured with an electronic thermometer immediately before the intervention bathing or dry care and at 30 min and 1, 2, 3, 8 and 12 h after birth. Heart rate, respiratory rate, systolic and diastolic blood pressure and SpO2 were measured at 1, 2, 8 and 12 h after birth. The incidence of early neonatal morbidity, including hyperbilirubinemia and gastrointestinal and respiratory problems, was also compared. RESULTS: Rectal temperature changed over time postnatally in both groups (P < 0.0001, ANOVA) and there was a significant difference in rectal temperature between groups (P< 0.0001, ANOVA). Mean (+/- SEM) rectal temperature at 30 min after birth (i.e. approximately within 20 min after intervention) was significantly higher in the bathed group than in the control (dry care) group (37.30 +/- 0.06 is 37.00 +/- 0.05 degrees C, respectively; P = 0.000022). Respiratory rate, heart rate, blood pressure and the ratio of the number of infants with SpO2 90-94% and 95-100% did not differ significantly between the two groups. The incidence of early neonatal morbidity, including vomiting, acute gastric mucosal lesion, polycythemia, need for tube feeding, phototherapy and oxygen therapy, also did not differ between the two groups. CONCLUSIONS: Early bathing, minutes after birth, did not appear to adversely affect the adaptation of healthy full-term and near-term newborn infants.

Age Factors↗
PubMedDate not supplied

Infant's physiological response to short heat stress during sauna bath.

Thermoregulatory response to Finnish sauna bath was investigated in 47 infants (age 3 - 14 month). Before taking a short sauna bath lasting 3 min, the infants stayed in a swimming pool for 15 min. Under these conditions sauna bathing did not increase the rectal temperature. Unexpectedly rectal temperature even decreased by 0.2 degrees C (p < 0.05) probably due to redistribution of cold peripheral blood into the core of the body. Mean systolic and diastolic arterial blood pressure and mean heart rate remained unchanged after sauna bathing. The blood pressure amplitude decreased significantly after the swimming period from 47 mm Hg to 38 mm Hg (p < 0.05) and rose again after sauna bathing to 42 mm Hg. All infants tolerated short heat exposure in the sauna without side effects. The circulatory adjustment was efficient. Even young infants were able to cope with the acute circulatory changes imposed by heat stress. Adequate thermoregulatory and cardiovascular adaptive responses to sauna bathing could be shown for the first time in infants between 3 and 14 months of age.

Age Factors↗
PubMed2000

Assessment of airborne exposure to trihalomethanes from tap water in residential showers and baths.

This study evaluates airborne concentrations of common trihalomethane (THM) compounds in bathrooms during showering and bathing in homes supplied with chlorinated tap water. Three homes in an urban area were selected, each having three bedrooms, a full bath, and approximately 1,000 square feet of living area. THMs were concurrently measured in tap water and air in the shower/bath enclosure and the bathroom vanity area using Summa canisters. Chloroform (TCM), bromodichloromethane (BDCM), and chlorodibromomethane (CDBM) were quantified using U.S. Environmental Protection Agency (EPA) Method TO-14. Air samples were collected prior to, during, and after the water-use event for 16 shower and 7 bath events. Flow rate and temperature were measured, but not controlled. The increase in average airborne concentration (+/- standard error) during showers (expressed as microg/m3 in shower enclosure or bathroom air per microg/L in water) was 3.3+/-0.4 for TCM, 1.8+/-0.3 for BDCM, and 0.5+/-0.1 for CDBM (n = 12), and during baths was 1.2+/-0.4 for TCM, 0.59+/-0.21 for BDCM, and 0.15+/-0.05 for CDBM (n = 4). The relative contribution of each chemical to the airborne concentrations was consistent for all shower and bath events, with apparent release of TCM > BDCM > CDBM. The results are therefore consistent with their relative concentration in tap water and their vapor pressures. When the shower findings for TCM are normalized for water concentration, flow rate, shower volume, and duration, the average exposure concentrations in these urban residences are about 30% lower than those reported by other investigators using EPA analytical methods. This difference is likely attributable primarily to greater air exchange rates in residential shower/bath stalls compared to more "airtight" laboratory shower chambers. This appears to be the first field study to thoroughly evaluate THM exposures from residential showers and baths, and can be used to validate previously published models of tap water volatile chemical transfer to indoor air.

Adult↗
PubMed1992

The effects of rice bran broth bathing in patients with atopic dermatitis.

We determined the effects of rice bran broth bathing therapy in 17 outpatients with atopic dermatitis. The rice bran broth used in this study was made in our hospital and distributed to the patients who dissolved it in the bathtub as a medicinal bath. In the case of one patient, redness and itching of the skin increased just after bathing. The patient subsequently discontinued therapy. We followed the other 16 patients who performed rice bran broth bathing for 2-5 months and examined their skin symptoms once a month. The efficacy of this therapy in alleviating skin symptoms was excellent in four of the 16 evaluated patients, good in seven, slightly effective in four, and ineffective in one. None of the 16 patients experienced negative effects of treatment. Recurrence of initial symptoms was not detected in any patient during rice bran broth bathing. Rice bran broth bathing therapy appears to be safe and clinically useful.

Adolescent↗
PubMed2006

Bath transfers in older adult congregate housing residents: assessing the person-environment interaction.

OBJECTIVES: To examine environmental feature utilization (EFU) and the types and prevalence of performance difficulties during a videotaped bath transfer and to determine the personal characteristics associated with total EFU and performance difficulties. DESIGN: Cross-sectional analysis. SETTING: Two congregate housing facilities in southeastern Michigan. PARTICIPANTS: Eighty-nine older adults who reported independence in bathing. MEASUREMENTS: Trained video coders recorded EFU (defined as upper extremity contact with features in the environment) and rated performance difficulties (defined as lack of fluid movement or difficulty negotiating the environment). EFU was measured by determining whether features used were safe (i.e., designed for use as a transfer support) or unsafe and by total EFU (i.e., number of environmental features used during the transfer). Personal characteristics included self-reported medical conditions, bath transfer difficulty, functional mobility, lower extremity strength, range of motion functional impairment, and falls efficacy. RESULTS: For participants with a tub-shower, safe EFU was higher than unsafe EFU (85% vs 19%; P<.001). Participants with shower stalls had the same rate of safe and unsafe EFU (71%). In multiple regression analysis, self-reported bath transfer difficulty was associated with total EFU (P=.01). One-third of the sample had performance difficulties. In multivariate analysis, range of motion functional impairment (odds ratio (OR)=13.49, 95% confidence interval (CI)=1.11-163.53) and lowest quartile in falls efficacy scores (OR=5.81, 95% CI=1.24-27.41) were associated with performance difficulties. CONCLUSION: Unsafe EFU and performance difficulties were common in independently bathing older adults. Self-reported bath transfer difficulty appears to be a good indicator of high total EFU and may be used as a screening question for clinicians. Important strategies to reduce unsafe EFU and to increase falls efficacy include removing shower sliding glass doors and training older adults in safe transfer techniques.

Activities of Daily Living↗
PubMed2005

PUVA-gel vs. PUVA-bath therapy for severe recalcitrant palmoplantar dermatoses. A randomized, single-blinded prospective study.

BACKGROUND/PURPOSE: In order to avoid unwanted effects of systemic psoralen and ultraviolet A (PUVA) therapy, various topical PUVA treatment modalities have been developed and are being increasingly used. However, up to now very few controlled studies comparing the therapeutic efficacy of different topical photochemotherapy modalities are available. Thus, the aim of our study was to compare the clinical efficacy of conventional PUVA-bath therapy to topical PUVA-gel therapy in patients with recalcitrant dermatoses of the palms and soles. METHODS: Twenty patients with severe palmoplantar dermatoses or localized psoriatic plaques were enrolled in our observer-blinded, randomized half-sided study. The treatment modalities compared were: (i) aqueous 8-methoxypsoralen (8-MOP)-containing gel plus broadband UVA irradiation (PUVA-gel therapy) and (ii) 8-MOP bath of the hands and/or feet plus broadband UVA (PUVA-bath therapy). RESULTS: On the body half, which was randomized to PUVA-gel therapy, the median Area and Severity Index for palmoplantar dermatoses (ASIppd) decreased from 28 (range 6-56) to 1.5 (range 1-37, P = 0.00) after a median 33 (13-49) irradiations compared with a reduction from 26.5 (range 6-52.5) to 1.5 (range 0-38, P = 0.00) for PUVA-bath therapy. Both improvements of ASIppd scores were found to be statistically significant, with no significant difference between PUVA-gel and PUVA-bath therapy. Severe phototoxic reactions such as strong erythema, blistering and/or pain were not observed in any patient. CONCLUSION: PUVA-gel therapy seems to be an effective therapeutic alternative to conventional PUVA-bath therapy in treating localized dermatoses of the palms and soles. The advantage of PUVA-gel therapy is reduced organizational efforts and expenses.

Adult↗