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PubMed1999

Nongenital dermatologic disease in HIV-infected women.

BACKGROUND: Dermatologic disease in HIV-infected women has not been adequately characterized. OBJECTIVE: The main purposes of this study were to characterize nongenital dermatologic disease in HIV-infected women and correlate these diagnoses with CD4 lymphocyte count to compare these findings with those in published reports of men. METHODS: This study was a retrospective chart review of female patients with dermatologic diagnoses followed up at an HIV clinic in New York City, seen by either a dermatologist (49 patients) and/or a primary care practitioner (114 patients). CD4 lymphocyte count was recorded if available within 6 months of diagnosis; mean CD4 count was calculated for all disorders with 5 or more diagnoses. RESULTS: Oropharyngeal candidiasis, drug eruption, dermatophytosis, rash (not otherwise specified), nongenital herpes simplex, herpes zoster, and seborrheic dermatitis were the most prevalent diagnoses made by primary care providers. Itchy red bump disease, acne, atopic dermatitis, xerosis, seborrheic dermatitis, nongenital warts, and molluscum contagiosum were the most prevalent diagnoses made by the dermatologist. Mean CD4 lymphocyte count was lowest in itchy red bump disease, nongenital warts, nongenital herpes simplex, xerosis, and drug eruptions. CONCLUSION: There appears to be no appreciable difference in the spectrum or prevalence of dermatologic disease in HIV-infected women versus HIV-infected men, except for a lower prevalence of Kaposi's sarcoma, oral hairy leukoplakia, and possibly onychomycosis in women. The degree of immunosuppression associated with various dermatoses in HIV-infected women is similar to that in men, except perhaps for molluscum contagiosum, which may appear earlier in women.

Adult↗
PubMed1999

Dermatologic disease accounts for a large number of hospital admissions annually.

BACKGROUND: Severe skin disease uncommonly requires hospitalization. The number of patients hospitalized for skin disease annually in the United States has never been reported. OBJECTIVE: We evaluated the number of patients admitted for skin disorders. METHOD: Using data from 2 national databases, the Healthcare Cost and Utilization Project-3 Nationwide Inpatient Sample (HCUP-3 NIS) 1992-1994 and Medicare Provider Analysis and Review (MEDPAR) 1990-1996 file, we evaluated the total discharges, total charges, and reimbursement of the dermatology-specific (272, 273, 283, and 284) and -related (263, 264, 265, 266, 271, 277, 278, and 279) diagnosis-related groups (DRGs). RESULTS: In 1994, the HCUP-3 NIS data showed that a total of 468,014 discharges were classified under Dermatology DRGs, whereas in 1996 MEDPAR data gave a figure of 183,310 discharges with a total Medicare reimbursement of $892 million. In both data sets, dermatology-specific DRGs show a decrease over time, although dermatology-related DRGs generally showed an opposite increasing pattern. The top 10 states reimbursed by Medicare in 1996 for the discharges grouped under the DRGs mentioned above were New York, California, Pennsylvania, Florida, Texas, Ohio, Illinois, Michigan, New Jersey, and Massachusetts. CONCLUSION: Many patients are admitted annually for skin disease. The minority are admitted by dermatologists.

Hospitalization↗
PubMed1998

Dermatologic lupus: Hopkins Lupus Cohort.

Dermatologic manifestations are among the most common signs of systemic lupus erythematosus (SLE). The Hopkins Lupus Cohort study is a prospective study in which patients with SLE are seen on a quarterly basis for measurement of disease activity, laboratory tests, and assessment of morbidity and quality of life. This cohort has allowed unique insights into the epidemiologic factors of SLE, the presentation of dermatologic lupus, and morbidity, all of which are presented in this report. In addition, the dermatologic signs of antiphospholipid antibody syndrome (APS) are reviewed. Approaches to treatment of dermatologic lupus and APS are discussed.

Adult↗
PubMed2004

Occurrence of Malassezia species in healthy and dermatologically diseased dogs.

The presence of Malassezia spp. yeasts was investigated in dermatological specimens of 224 dogs, 164 dermatologically diseased and 60 normal dogs. Subjects included in the study were of different breed, age, sex and habitat. Malassezia spp. positive cultures were obtained in 142 (63.4%) specimens: 67.6% from dermatologically diseased subjects and 51.6% from healthy dogs. Malassezia pachydermatis, either as a pure culture or in association with lipid-dependent species, was identified in 138 (97%) specimens. Malassezia furfur was identified in 69 (48.6%) specimens and was associated with other Malassezia species in 68 dogs, as a pure culture in one subject: at the best of our knowledge, this species was identified before as the sole species from canine dermatitis. Malassezia sympodialis was identified in 11 (7.7%) specimens, always in association with other species: it was never isolated from kennel dogs. Statistical analysis of data showed a very significant difference (P < 0.01) in the prevalence of isolation of Malassezia spp. between animals with and without dermatological signs, and in the distribution of cultural burden between diseased and healthy dogs. A statistically significant difference (P<0.05) was also detected in the group of animals between 1- and 5-years of age. No significant difference was found between male and female dogs.

Animals↗
PubMed1999

Dermatology in general practice.

A significant percentage of the workload of a general practitioner is dermatological. This study has analysed the cases seen by one partner in a semirural practice over a 5-year period. Of a total of 11,191 patients seen, 2386 had a dermatological diagnosis (21%). There was a preponderance of females (1604, 67%) and the most common skin diseases seen were viral warts, eczema and benign tumours. Surgical intervention was carried out in 707 cases, an atypical situation for most general practitioners. It was only because of additional training as a hospital practitioner in dermatology that the partner treated both benign and malignant tumours where she felt confident to do so. The incidence of skin cancer was 3% and 22 patients were referred to a dermatology outpatient department.

Eczema↗
PubMed2000

Adverse effects of herbal drugs in dermatology.

Herbal treatments are becoming increasingly popular, and are often used for dermatological conditions. Thus dermatologists should know about their potential to cause adverse events. This review is aimed at addressing this area in a semisystematic fashion. Some agents, particularly Chinese herbal creams, have been shown repeatedly to be adulterated with corticosteroids. Virtually all herbal remedies can cause allergic reactions and several can be responsible for photosensitization. Some herbal medicines, in particular Ayurvedic remedies, contain arsenic or mercury that can produce typical skin lesions. Other popular remedies that can cause dermatological side-effects include St John's Wort, kava, aloe vera, eucalyptus, camphor, henna and yohimbine. Finally, there are some herbal treatments used specifically for dermatological conditions, e.g. Chinese oral herbal remedies for atopic eczema, which have the potential to cause systemic adverse effects. It is concluded that adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation.

Complementary Therapies↗
PubMed1998

Dermatology in southwestern Ethiopia: rationale for a community approach.

BACKGROUND: Skin diseases represent one of the most frequent causes of morbidity in developing countries; however, little is known about the dermatologic needs of the population. The prevalence of skin disease in two different rural communities in southwestern Ethiopia was determined using descriptive epidemiologic techniques. METHODS: A household survey, designed to ascertain demographic information and dermatologic needs, was given to all households in both communities (827). The point prevalence of skin diseases was determined after examination by dermatologists of 768 self-selected individuals (40% of individuals were invited to attend dermatologic examination, either those self-reporting skin disease or identified as positive cases during the household survey); an individual survey form was given to all of these patients. RESULTS: Although 47% (S/UO) and 59% (Kishe) of the households in the two communities reported skin symptoms, the true dermatologic needs of these settlements were far greater than the expressed values, as examination by dermatologists of randomly selected households revealed that 67% of householders not reporting dermatoses had significant skin disease. During the point prevalence study, the commonest complaints were parasitic (scabies, pediculosis, and onchocerciasis) infestations (46% of diagnoses), followed by bacterial and fungal infections (33%); other conditions included endemic nonfilarial elephantiasis. Overcrowding was the main risk factor for infection. Thirty-two per cent (S/UO) and 39% (Kishe) of examined individuals had received previous treatments, which were ineffective in 74% and 63% respectively. CONCLUSIONS: Subsistence farmers spend a high proportion of their limited cash income on ineffective treatment. Simple schemes of management for the most common dermatoses, which local health workers could be trained to recognize and manage, could do much to redress the burden of skin disease in this population.

Adolescent↗
PubMed2004

[Four years of quality assurance of dermatologic procedures: report from the ABD clearing institution].

BACKGROUND: Expert dermatologic evaluation is the most relevant tool for secondary prevention in occupational dermatology in Germany. If there is a possibility of a work-related skin disorder in an employee, dermatologists may conduct the relevant diagnostic procedures (e.g. patch-and prick-tests, serology) at the expenses of the public employers' liability insurance fund (UVT). Most dermatologists make careful use of this unparalleled privilege, which is also an obligation. However, recently, with an increasing number of dermatologist's reports submitted, there have been occasional complaints by the UVT concerning overly extensive testing. In 1999 the Task Force on Occupational and Environmental Dermatology (ABD) of the German Dermatological Society established a clearing procedure. Two experienced occupational dermatologists will--separately--give their expert opinion on dermatologist's reports which have been forwarded anonymously by the UVT for expert review. RESULTS: Thus far, from May 1999 to May 2003 155 dermatologist's reports have been submitted to the clearing procedure. The complaints were in > 95% of cases considered justified by the experts. Their criticism was primarily directed towards excessive testing procedures and failure to provide sufficient clinical information. CONCLUSIONS: The UVT does not undertake such extensive preventive efforts for any other occupational disease. Therefore, quality management of the dermatologist's procedure--conducted by dermatologists and providing transparency--is essential to maintain and develop this effective tool of secondary prevention for the benefit of workers and employers.

Germany↗
PubMed2003

Dermatologic surgery in the demented patient.

BACKGROUND: Dementia is an organic mental disorder that is characterized by a general loss of intellectual abilities involving impairment of memory, judgment, and abstract thinking as well as changes in personality. Demented patients are a growing subgroup within the practice of dermatologic surgery and especially in Mohs surgery. These patients often have other medical and social concerns in addition to their dementia. OBJECTIVE: Demented patients require specific knowledge of their problems to care for them properly, especially in cases in which prolonged procedures are required such as Mohs surgery. METHODS: A review the literature is given regarding this subgroup of patients and how to best prepare and care for them before, during, and after dermatologic surgery. RESULTS: Demented patients often have other medical concerns and therefore have associated medications, medical ailments, postsurgical care, and social and mental challenges. CONCLUSION: The dermatologic surgeon needs to be aware of the special concerns of demented patients, especially in prolonged and potentially complicated surgeries. Not only do they have mental challenges, but they often have other medical and social challenges that need to be specifically accounted for before, during, and after dermatologic surgery.

Caregivers↗
PubMedDate not supplied

Dermatology life quality index: data from Danish inpatients and outpatients.

The aim of the present study was to provide data on the reliability and validity of a Danish translation of the Dermatology Life Quality Index (DLQI), a short measure of the impact of dermatological diseases on quality of life. The DLQI was administered to 200 outpatients and 100 hospitalized patients suffering from a range of dermatological diseases and to 100 sex- and age-matched healthy controls. Mean scores, internal consistency and test-retest reliability were comparable to the results reported for the original English version. Hospitalized patients reported greater impairment of disease-related quality of life than outpatients, and patients with atopic dermatitis and psoriasis exhibited greater scores than patients suffering from other dermatological diseases. Discriminant, construct and predictive validities of the Danish translation of the DLQI were satisfactory, as indicated by significant associations between DLQI scores and physician-rated disease severity, disease duration and the time patients were willing to spend each day on a hypothetical effective treatment. The results also suggest that the emphasis Danish patients place on various aspects of disability covered by the questionnaire is similar to that of English patients. In conclusion, the Danish translation of the DLQI showed satisfactory reliability and the preliminary results indicate that this version is a valid measure, which can be used in both research and clinical settings.

Adolescent↗
PubMed2004

To follow dermatological treatment regimens--patients' and providers' views.

Adherence to long-term therapy for chronic illness is on average 50%. However, regarding adherence to dermatological treatment the existing literature is limited. The aim of the study was to acquire an understanding of issues associated with adherence to dermatological therapy. Focus group interviews were used in two types of fora: patients with chronic dermatological diseases and health care providers, including doctors, nurses and pharmacists working in dermatological care. Results reveal the providers' view of a suboptimal rate of adherence. According to both providers and patients, factors affecting adherence were patients' expectations and experiences of therapeutic effect, possibilities for the patient to take active part in treatment decisions, as well as mode of administration and type of medication. Suggested strategies for improvement are individualized patient education, continuous treatment support with assessment of medication-taking behaviour and enhanced communication skills among the providers.

Adult↗
PubMed2003

Mycophenolate in dermatology.

Originally used to treat psoriasis nearly three decades ago, mycophenolic acid, reformulated as mycophenolate mofetil (MMF), has been rediscovered by the world of dermatology. As a relatively well-tolerated immunosuppressive used in organ transplant recipients, MMF has recently been reported to show promise for several dermatologic conditions, including psoriasis, pemphigus vulgaris, pyoderma gangrenosum, bullous lichen planus, and even connective tissue diseases such as lupus erythematosus and dermatomyositis. Although not intended to be exhaustive, this review discusses MMF with regard to its basic pharmacology, its side effects, and its reported efficacy in a variety of dermatologic indications. Relevant literature was retrieved by a Medline search combining the terms "mycophenolate" or "mycophenolic acid" and "skin" or "skin disease" or a number of specific conditions ("psoriasis", "dermatitis", "eczema", "pemphigoid", "pemphigus", "vasculitis", "pyoderma gangrenosum", "Crohn's disease", "graft-versus-host disease", "lichen planus"). As MMF has only been recently re-introduced for dermatologic application, the nature of much of the literature is admittedly that of case reports or case series. Nevertheless, the results are sufficiently promising to warrant further larger, control studies.

Dose-Response Relationship, Drug↗
PubMed2006

Dermatological findings in 3 generations of a family with a high prevalence of human T cell lymphotropic virus type 1 infection in Brazil.

BACKGROUND: Dermatologic manifestations are quite common in patients with adult T cell leukemia and lymphoma and patients with myelopathy and/or tropical spastic paraparesis associated with human T cell lymphotropic virus type 1 (HTLV-1). The aim of this study was to investigate dermatological findings presented by 30 members of a Brazilian family, half of whom are infected with HTLV-1 (as confirmed by enzyme-linked immunosorbent assay and Western blot). METHODS: The subjects underwent dermatologic examination and laboratory assessment, which included the search for the HTLV-1 genome in peripheral blood mononuclear cells (PBMCs) by qualitative and semiquantitative polymerase chain reaction (PCR) and in skin samples by nested qualitative PCR and immunofluorescence assay. RESULTS: We found that cases of xerotic dermatological alterations, including 3 cases of acquired ichthyosis, were more frequent among the infected patients (7 cases vs. none among the uninfected individuals; P=.0063). Other lesions observed in this group included impetigo, scabies, epidermal nevus, herpes zoster scar, rosacea, and juvenile acne. One HTLV-1-infected individual presented with concurrently acquired ichthyosis, impetigo, scabies, dermatophytosis, and seborrheic dermatitis. The PCR performed on PBMCs and skin samples from 24 patients confirmed the serological results in all cases. Additionally, the HTLV-1 proviral load was higher in patients with >1 skin lesion. Finally, HTLV-1 could be identified in the skin by immunofluorescence assay, which, by use of PCR as the gold standard, showed a sensitivity and specificity of 61.5% and 100%, respectively. CONCLUSIONS: Altogether, these clinical and laboratory findings point to an HTLV-1 tropism toward the skin, even in HTLV-1 carriers without adult T cell leukemia/lymphoma or HTLV-1-associated myelopathy and/or tropical spastic paraparesis.

Adult↗
PubMed1986

Patterns of dermatology referrals in a general hospital.

A survey of 500 patients hospitalized in non-dermatology wards and referred for dermatological opinion is reported. In approximately 50%, the skin lesions were related to the presenting illness; in 36.6% of these patients the skin condition contributed substantially to the diagnosis of the systemic disease. This study emphasizes the considerable interface between cutaneous and systemic disease and the need for close co-operation between medical and dermatology departments. The implications for postgraduate education are highlighted, since such patients are infrequently seen in a dermatology out-patient setting.

Aged↗
PubMed1995

Dermatology in the intensive care unit.

We report our experience, and review the literature, concerning 'intensive care dermatology'. Over a period of 14 months, 27 patients who had significant cutaneous problems were seen in the intensive care unit. These included primary dermatological conditions, multisystem disorders with cutaneous signs, complications of dermatological therapy, and skin conditions developing as complications of intensive care. We discuss the diagnosis and management of dermatological problems in the intensive care unit.

Adult↗
PubMed2005

A prospective study of the incidence of complications associated with dermatological surgery.

BACKGROUND: Dermatological surgery is a relatively new and expanding subspecialty within dermatology. Little information is available about complications in this kind of surgery in the European setting. OBJECTIVES: The aim of this study was to assess the incidence of anaesthetic, haemorrhagic and infectious complications in dermatological surgery and to highlight the factors associated with these complications. METHODS: Data were collected prospectively over a 3-month period for all surgical procedures performed by a network of dermatologists (n = 84 dermatologists) in France, including the excision of all benign or malignant tumours but excluding sebaceous cysts and pyodermas. Information was collected regarding dermatologists, patients, procedures and complications. RESULTS: A total of 3788 surgical procedures were available for review; 236 complications, mostly minor, occurred in a total of 213 surgical procedures (6%), bleeding being the most common (3%). Vaso-vagal syncope was the main anaesthetic complication (51 of 54). Infectious complications occurred in 79 patients (2%). Superficial suppuration accounted for 92% of surgical site infections. Only one patient had a systemic infection. Complications requiring additional antibiotic treatment or repeat surgery accounted for only 22 cases of 3788 (1%). No statistically significant correlation was found with the characteristics of the dermatologists, especially with respect to their training or amount of surgical experience. Similarly, no link could be established between complications and surgical conditions. Multivariate analysis showed that anaesthetic or haemorrhagic complications were independent factors for infectious complications. Sex, administration of an anticoagulant or immunosuppressant, type of procedure performed and duration exceeding 24 min were independent factors for haemorrhagic complications. CONCLUSIONS: This study shows a low rate of complications associated with dermatological surgery performed by dermatologists under local anaesthesia on an outpatient basis.

Adolescent↗
PubMed2005

Does enough quality of life-related discussion occur during dermatology outpatient consultations?

BACKGROUND: Dermatologists' assessments of how their patients' lives are affected by the skin disease are of importance for informing clinical decisions. However, there is no information about how often quality of life (QoL) issues are discussed in outpatient consultations. OBJECTIVE: To examine the relationship between the extent of QoL-related discussion during dermatology outpatient consultations, and the current impact of the disease on patients' lives. PATIENTS AND METHODS: A total of 238 consultations were observed in a teaching dermatology outpatient department for QoL-related discussion initiated by either the clinician or the patient. Following the consultation, all patients were posted a Dermatology Life Quality Index (DLQI) questionnaire to complete and return within 1 week. RESULTS: QoL discussion was absent in 40% of consultations. Consultants initiated the fewest QoL discussions with patients, and nurses the most (P < 0.0001). One hundred and twenty-eight (54%) patients returned the DLQI, 114 (48%) of which were evaluable. The mean score was 5.6, SD +/- 6.6, median 3, range 0-29. The mean DLQI score for the patients with whom there was no QoL discussion was 4.0 +/- 4.7, n = 55, compared with the mean DLQI score for patients with whom QoL was discussed 6.8 +/- 7.2, n = 59 (P < 0.001). CONCLUSION: This study demonstrates that little information concerning QoL is elicited during dermatology outpatient consultations.

Adolescent↗
PubMed2006

The effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with atopic dermatitis.

BACKGROUND: The prevalence of atopic dermatitis (AD) is increasing worldwide, and many patients present to secondary care in adult life. This is a significant contribution to the workload of all dermatology departments. There are no studies investigating the impact of a dermatology consultation within secondary care. OBJECTIVES: To examine the effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with AD. METHODS: This prospective observational study recruited new adult patients with AD referred from primary care. Eczema severity was assessed using the SCORAD (Severity Scoring of AD) index and subjective good or poor clinical outcome. The Dermatology Life Quality Index (DLQI) was used to quantify the impact of AD on adult patients. Patients were assessed at initial consultation (T1), 6 weeks (T2) and 3 months (T3). Statistical analysis was performed using independent t-tests, repeated-measures analysis of variance, correlation coefficients and Bonferroni post hoc comparisons. RESULTS: Sixty-three patients were recruited (37 women, 26 men) with a mean age of 34 years. Mean SCORAD at T1 was 48.2 and the majority (51%) had severe eczema (objective SCORAD>40). Mean SCORAD reduced by 52% from T1 to T2 (P<0.001) but there was no significant change in SCORAD from T2 to T3. A subjective good clinical outcome was validated by a decrease in SCORAD of >20 (P<0.001). Patients in the good clinical outcome group were significantly older than those in the poor clinical outcome group (38 vs. 27 years, P<0.05). The mean age at presentation of women was significantly younger than men (29 vs. 43 years, P<0.01). Women's mean SCORAD improved over all three visits, while men's mean SCORAD improved from T1 to T2 but worsened from T2 to T3 (P<0.001). The mean DLQI reduced over all three visits, from 9.5 at T1 to 8.8 at T2 and 7.0 at T3, and was significantly correlated with SCORAD at T1 and T2 (P<0.01). Patients accurately self-scored their eczema on a body map as shown by a significant correlation between these scores and SCORAD at T1 and T2 (P<0.001). CONCLUSIONS: We have shown that within the first 3 months of referral to secondary care, new adult patients with AD have the greatest improvement in AD, measured by SCORAD, after their initial appointment. Quality of life, as measured by DLQI, continued to improve over all three visits.

Adolescent↗