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PubMed1997

Effects of the calcium antagonist felodipine on renal haemodynamics, tubular sodium handling, and blood pressure in cyclosporin-treated dermatological patients.

BACKGROUND: Deterioration of renal function and rise in blood pressure are clinically important side-effects of cyclosporin (CsA) treatment. Calcium antagonists may have a renoprotective effect against CsA nephrotoxicity. PURPOSE: To investigate the effect of the dihydropyridine calcium-channel blocker felodipine on renal haemodynamics, tubular sodium handling, and blood pressure in CsA-treated patients with no primary renal disease, 18 patients with various CsA-treated dermatological diseases were allocated to receive either felodipine 5 mg (extended release tablets) once daily for 4 weeks followed by placebo for 4 weeks, or vice versa, in a prospective, randomized, double-blind study. The patients were investigated before treatment and at the end of each treatment period. RESULTS: After felodipine, both glomerular filtration rate (GFR) and renal plasma flow (RPF) were significantly higher compared to placebo (89.4 +/- 17.5 (mean +/- SD) vs 79.0 +/- 15.9 ml/min and 412.0 +/- 107.6 vs 326.1 +/- 78.0 ml/min respectively, P < 0.001 for both), and filtration fraction (FF) was lower (0.22 +/- 0.03 vs 0.25 +/- 0.03, P < 0.001). Both systolic and diastolic blood pressure were lower after felodipine compared to placebo (116 +/- 11/71 +/- 7 vs 133 +/- 18/83 +/- 10 mmHg, P < 0.001 for both). Furthermore, proximal output of sodium, i.e. fractional excretion of lithium, was higher after felodipine (26.9 +/- 7.3% vs 20.4 +/- 5.5%, P < 0.001) as well as total sodium excretion (0.33 +/- 0.19 vs 0.19 +/- 0.08 mmol/min, P < 0.001). CONCLUSIONS: It is concluded, that felodipine 5 mg once daily for 4 weeks increased GFR, RPF, and sodium excretion in cyclosporin-treated dermatological patients with no primary renal disease. Furthermore, felodipine lowers blood pressure in these patients. The effects of felodipine may be due to an antagonizing effect against CsA-induced nephrotoxicity.

Adolescent↗
PubMed1983

The diagnostic use of monoclonal antibodies in a variety of dermatologic conditions.

Monoclonal antibodies have been used to characterize subpopulations of lymphocytes in a variety of dermatologic conditions by immunofluorescence and immunoperoxidase staining. Various clinical presentations of cutaneous T-cell lymphoma have been shown to be neoplastic expansions of helper T-lymphocytes. Immunoperoxidase studies using subset-specific monoclonal antibodies have allowed the differentiation of patients with cutaneous T-cell lymphoma from lymphocytoma cutis and B-cell lymphomas secondarily involving the epidermis. Increased numbers of OKT-6 positive Langerhans' cells in the dermal infiltrates of patients with cutaneous T-cell lymphoma may be another immunocytological marker of this disease. Studies done on circulating lymphocytes of patients with psoriasis and pemphigus vulgaris have shown normal ratios of T-cell subsets in patients with psoriasis and an expansion of the helper T-cell subset in an untreated patient with pemphigus. Immunofluorescence and immunoperoxidase techniques used in conjunction with highly specific monoclonal antibodies have been shown to be valuable for histopathologic study of dermatologic diseases.

Antibodies, Monoclonal↗
PubMed2000

Dermatologic manifestations of infectious diseases in pregnancy.

Several pathogens that have been identified as teratogenic or fetotoxic have associated dermatologic changes when active infection is present. Viral and bacterial teratogenic pathogens include herpes simplex virus 1, herpes simplex virus 2, varicella-zoster virus, cytomegalovirus, human papilloma virus, human parvovirus B19, rubella, viral hepatitis, syphilis, and gonorrhea. This article focuses on the characteristic dermatologic manifestation of these diseases in pregnancy; diagnostic strategies; interpretation of maternal and fetal laboratory test results; treatment of the pregnant woman, fetus, and newborn; and congenital outcomes of treated and untreated infection. Emphasis is placed on vaccination and prevention of transmission of infection to pregnant women.

Adult↗
PubMed1991

Neurologic disorders and dermatologic manifestations in HIV-infected children.

Cutaneous manifestations of HIV infections in childhood are common but are not the dermatologic lesions associated with HIV infection in adults. For example, Kaposi's sarcoma, a common finding in adults with AIDS, is rare in children. Other cutaneous manifestations, including bacterial and fungal lesions and viral exanthems, are common in children with AIDS and can be atypical and severe. Because 90% of the pediatric AIDS population acquires the virus via maternal transmission to the fetus, a dysmorphic syndrome associated with intrauterine infection has been described. Physicians caring for and evaluating pediatric patients at risk for AIDS should be aware of these dermatologic manifestations, so that early detection and treatment can be instituted to reduce the morbidity of the complication of HIV infection.

HIV Infections↗
PubMed1989

Evaluation of antibacterial sensitivity testing methods for methicillin-resistant Staphylococcus aureus in a dermatology outpatient population.

Over a period of one year, 1986-1987, 116 strains of Staphylococcus aureus were isolated from patients attending two outpatient dermatology clinics in Houston, Texas. The purpose of this study was to evaluate the adequacy of routine antibiotic sensitivity testing methods for detecting methicillin-resistant Staphylococcus aureus (MRSA). The Kirby-Bauer disk diffusion method was compared with a commercially available screening medium containing 6 micrograms/ml of oxacillin and 4% NaCl. The minimal inhibitory concentration (MIC) of methicillin, oxacillin, and oxacillin with 4% NaCl to S aureus using the agar dilution method was also determined. Approximately 90% of S aureus strains produced beta-lactamase and were resistant to penicillin and ampicillin. By disk diffusion, no strains were resistant to methicillin, though diameters of zones of inhibition were between 10 and 14 mm in seven strains. All strains proved to be sensitive to methicillin by MIC determinations and on the oxacillin-NaCl screening medium. The MIC of methicillin was 2.5 micrograms/ml for the majority of strains of S aureus, between 0.16 and 0.31 microgram/ml for oxacillin, and 0.08 to 0.16 microgram for oxacillin with 4% NaCl. We concluded that the incidence of MRSA in an outpatient dermatology population is low, and a combination of disk diffusion and oxacillin-NaCl screening is adequate for testing sensitivity.

Adolescent↗
PubMed1986

Dermatological screening.

Occupational skin diseases are the most frequently reported occupational diseases in the US today. In addition, nonoccupational skin diseases are also prevalent among workers. Dermatological screening examinations may be performed to detect conditions that place the worker at increased risk, so that risk might be reduced; detect early signs of specific occupational diseases; or systematically record cutaneous abnormalities so that increases in prevalence or incidence associated with workplace exposures can be identified. Some of the available dermatological screening methods will be discussed, with attention to ways in which the effectiveness of screening may be enhanced. Conditions for which such procedures may be useful include dermatitis, acne, chloracne, pigmentary changes, melanoma, and nonmelanoma skin cancer. The importance of biological monitoring in relation to cutaneous exposure is also discussed.

Dermatitis, Occupational↗
PubMed1994

Opportunities for research in dermatologic epidemiology.

This report is based on a number of papers presented at the March 1993 Scientific Workshop on the Epidemiology of Skin Diseases, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. It focuses on opportunities in dermatologic epidemiology identified at the workshop and discusses these opportunities in the context of health maintenance organizations as sites for data collection, problems to be expected, and the potential contribution of dermatologic epidemiology.

Health Maintenance Organizations↗
PubMed2004

Advances in optical coherence tomography imaging for dermatology.

Optical coherence tomography (OCT) is a non-invasive imaging technique, which has previously demonstrated potential for use in dermatology. The purpose of this study is to demonstrate how improvements in image quality, speed, and functionality enable qualitative and quantitative information to be obtained from in vivo human skin. We developed a portable fiber-optic based OCT imaging device that requires only 1 second to simultaneously provide high-resolution images of skin structure, collagen birefringence, and blood flow. Images of normal human skin were acquired in vivo, and features compared with clinical and histologic observations. The layered structure and appendages of skin were apparent in conventional OCT images, and correlated well with corresponding histology. Polarization-sensitive OCT images simultaneously revealed birefringent regions within the dermis corresponding to the location of collagen fibers, as confirmed with polarized light microscopy. Properties of collagen-rich tissues including tendon and scar tissues were quantified. Location of blood flow was also displayed alongside structural and polarization-sensitive images. Significant improvements in OCT technology have been made since its early application in dermatology. In particular, combining the previously described structural and Doppler imaging functions with polarization-sensitive imaging increases the utility of the technique for rapid, non-invasive investigations in the skin.

Cicatrix↗
PubMed2005

Translating the science of quality of life into practice: What do dermatology life quality index scores mean?

This study's aim was to determine the relationship between Dermatology Life Quality Index (DLQI) scores and a Global Question (GQ) concerning patients' views of the overall impairment of their skin-related quality of life (QoL), and to express this relationship by identifying bands of DLQI scores equivalent to each GQ descriptor. A DLQI questionnaire and the GQ were mailed to 3834 adult general dermatology outpatients. There were 1993 (52%) responses: male 841; female 1152. Mean DLQI score = 4.86 (range 0-30, standard deviation (SD) = 5.83). Mean GQ score = 1.22 (range 0-4, SD = 1.20). The mean, mode, and median of the GQ scores for each DLQI score were used to devise several sets of bands of DLQI scores, and kappa coefficients of agreement calculated. The set proposed for adoption is: DLQI scores 0-1 = no effect on patient's life (GQ = 0, n = 754); DLQI scores 2-5 = small effect on patient's life (GQ = 1, n = 611); DLQI scores 6-10 = moderate effect on patient's life (GQ = 2, n = 327); DLQI scores 11-20 = very large effect on patient's life (GQ = 3, n = 242); DLQI scores 21-30 = extremely large effect on patient's life (GQ = 4, n = 59); kappa coefficient 0.489. Banding of the DLQI will aid the clinical interpretation of an individual's DLQI score and allow DLQI scores to inform clinical decisions.

Adolescent↗
PubMed2006

Educational and dermatological aspects of secondary individual prevention in healthcare workers.

Healthcare workers (HCW) have an increased risk of suffering from occupational skin diseases (OSDs). Therefore, we established special prevention and skin protection courses for HCW. Medical aims are to optimize diagnostic procedures and individual therapy, educational aims are to improve individual skin protection/skin care habits of the patient and also to influence the participants' attitudes towards health. Participants are patients that have been suspected to suffer from an OSD and are insured with the German Accident Prevention Insurance Association for Health Care Workers (BGW). Teaching units mainly focus on the texture and functioning of the skin, general aspects of OSDs, general information concerning skin protection, instructions about the correct use of skin cleansing and skin protection products. Besides, every participant is clinically examined by a dermatologist and a precise patient's history is obtained. Individually adapted skin protection strategies are developed. Patients can ask the dermatologist questions in confidence. 504 patients (mean age: 36.9 years, SD = 11.7) participated in the skin protection courses. 94.6% (n = 477) suffered from hand eczema frequently caused by a mixture of atopic, irritant and allergic contact dermatitis, but irritant contact dermatitis was the most frequent diagnosis (55.4%, n = 279). The participants rated the course as good to excellent. Health education and advisory services in occupational dermatology are still fragmentary. Prevention of OSD and maintenance of health through education are important complementary measures for dermatological care. In the future, similar educational programmes should be offered for employees of other professions with an increased risk for OSD.

Adult↗
PubMedDate not supplied

Skin diseases in Chinese children at a pediatric dermatology center.

Understanding the pattern of disease referrals is important in the delivery of a service. We followed 331 new referrals at a pediatric dermatology clinic over 12 months. Fifty percent of the patients were female; 293 patients (88.5%) had a single diagnosis and 36 (10.9%) had two diagnoses. Three leading causes for referrals accounted for 60% of the 371 skin diseases encountered: 124 diagnoses (33%) were of eczema, 73 diagnoses (20%) were of nevi, and 22 diagnoses (6%) were of viral warts. The nevi seen included melanocytic, epidermal, sebaceous, and vascular nevi. Skin biopsies were performed in 23 patients (6.9%), and microscopy and culture for fungal infections in 11 patients (3.3%). Forty-one patients (12%) were referred to the laser clinic for assessment of their nevi or pigmented skin lesions. Topical steroids were prescribed in 47% of patients during their follow-ups. Follow-up appointments were offered to 90% of patients. Eczema required the most frequent follow-up. Gender disparity in referrals was evident only in endogenous eczema (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.04-2.60 in males; p = 0.033). Girls were more likely to be referred to the laser clinic than boys (OR 2.31, 95% CI 1.10-4.92; p = 0.026). Most dermatologic diagnoses were made on clinical grounds and moderately potent topical corticosteroids were the most commonly prescribed medication. Since chronic skin disorders prevailed in the referrals, repeated follow-up appointments were required.

Asian People↗
PubMed2006

Digital camera images obtained using a light-emitting diode illuminator and their dermatological applications.

BACKGROUND/PURPOSE: Although digital cameras have powerful macrocapabilities, flash macrophotographs are often unsatisfactory. The aim of this study was to develop a light-emitting diode (LED) illuminator for macro digital photography that allows colorimetric investigations of the skin. METHODS: We devised an LED illuminator suitable for acquiring super-macro digital images of the skin. Reference CIELAB color chart values were compared statistically with computed values from digital images in order to obtain equations for real CIELAB values. Using these, we acquired and analyzed images of various dermatological conditions using an LED illuminator. RESULTS: The images obtained with the devised LED illuminator were more reproducible than flash-assisted photographs. With proper camera settings, the devised LED illuminator and the color analysis method developed during this study provided digital skin images containing colorimetric information. CONCLUSION: A digital camera equipped with an LED illuminator is a useful tool for dermatological research and clinical practice.

Colorimetry↗
PubMed1993

Inadequate size of 'negative' clinical trials in dermatology.

Fifty-eight clinical trials with negative conclusions, published in three British dermatological journals over the last 4 years, were reviewed to determine the risk of their having missed an effective treatment. All but one of the 44 evaluable trials had a greater than 1 in 10 risk of missing a 25% relative treatment difference (median risk 81%), and 31 of the trials (70%) were so small that they had a greater than 1 in 10 risk of missing a 50% relative treatment difference (median risk 42%). The 'negative' trial result was compatible (within 95% confidence limits) with a 25% beneficial relative treatment effect in 36 studies (82%), and a 50% treatment benefit in 22 studies (50%). Only one study used confidence intervals to describe the main findings, and only three studies (7%) mentioned the basis for sample size estimation at the outset of the study. Of particular concern was that in half (23/44) of the studies there was an incorrect interpretation of the findings. It is worrying to observe such a profusion of clinical trials in dermatology which are too small to answer the questions being posed, especially when this is coupled with misreporting of results. Apart from ethical concerns, many treatments compatible with a considerable treatment benefit may have been erroneously discarded as a result of such studies. We recommend the use of confidence intervals to summarize clinical trial findings, so that readers can quickly decide whether clinically important treatment effects are plausible.

Humans↗
PubMed2004

Do dermatology outpatients value a copy of the letter sent to their general practitioner? In what way and at what cost?

Dermatology services are largely outpatient based. Time for satisfactory patient communication is limited, with an average of around 15 min per new patient. The amount of new information that can be retained after verbal communication alone is limited during such consultations. One way to reinforce such information is to send patients a copy of the hospital specialist's letter to the general practitioner. Before advocating this unreservedly, it is important to explore the value patients attach to receiving such a letter and to estimate the cost of this practice. In order to explore patients' views of copy letters more fully, all patients attending dermatology outpatients at Queen's Medical Centre, Nottingham during a week in October 2001 were sent copy letters and later interviewed by telephone using a structured questionnaire that gathered information on content, usage, clarity and perceived usefulness. Direct costs were also calculated. Of 70 patients invited to participate, 59 (85%) could be contacted by telephone at the 2-week follow-up period. Of those 59 patients contacted by telephone, surprisingly only 46 (78%) had actually received a copy letter at 14 days post-consultation. Of the 46 patients receiving a copy letter, 45 (98%) thought the information in the letter was consistent with their consultation; the letter was read a mean number of two times; nine patients (20%) understood most and 36 (78%) all of the letter; 25 (54%) found it useful and a further 21 (46%) found it very useful. Patients' views as to the value in receiving the letter included improved communication, recall and a sense of increased involvement in health care decisions. The direct total cost of sending a copy letter was 25.3 pence per patient. Consultants who participated in the exercise did not perceive any additional difficulties in implementing this practice. This small study found that 100% of patients receiving a copy letter found it useful. The fact that around one-fifth of patients did not receive such copy letters within 2 weeks as intended is worrying, and requires further investigation. Sending a copy letter involves a relatively trivial cost for a practice which patients view as a valuable resource.

Ambulatory Care↗
PubMed2004

Significance of the cytokine interferon gamma in clinical dermatology.

Interferon (IFN)-gamma is considered a key cytokine of innate and adaptive immunity playing pivotal roles in host defence against microbial pathogens and tumours, and exerts profound antiproliferative and antifibrotic effects. In this review we discuss applications and perspectives of IFN-gamma in clinical dermatology, such as papillomavirus and bacterial infections, tumours, atopic dermatitis, and fibrotic conditions such as scleroderma and postradiation fibrosis. Moreover, we give a summary of the pharmacologic properties including main side effects and potential risk factors of IFN-gamma therapy. Although former enthusiasm for IFN-gamma (e.g. in atopic dermatitis) has subsided, this cytokine might remain a promising tool (and target) in clinical dermatology, due to its central immunobiologic functions, better characterization of its kinetics in diseases facilitating optimized treatment schedules, and successful applications in fibrotic conditions such as scleroderma, idiopathic pulmonary and skin postradiation fibrosis.

Humans↗
PubMed2004

Prevalence of dermatological disorders in Thai HIV-infected patients correlated with different CD4 lymphocyte count statuses: a note on 120 cases.

BACKGROUND: Skin disease is one health problem among human immunodeficiency virus (HIV)-seropositive patients. Several dermatological findings in HIV-infected patients have been investigated. In this study, the skin lesions of 120 HIV-infected patients with different CD4 count statuses in Bangkok, Thailand, are studied. METHODS: This study was performed as a cross-sectional descriptive study. All subjects had a complete physical examination to detect their dermatological disorders and carried out the necessary diagnostic procedures by consultation with the dermatologist. RESULTS: Eighty percent of all patients were observed to have one or more skin disorders. Xerosis (73.33%) and oral candidiasis (54.17%) were the most common skin disorders, followed by seborrheic dermatitis (46.67%), pruritic papular eruption (36.67%), oral hairy leucoplakia (12.50%), folliculitis (11.67%), herpes zoster (9.17%), and alopecia (6.67%). CONCLUSION: Although the pattern of cutaneous lesions was comparable with previous reports, the strikingly lower prevalence of skin tumor and drug eruption was reviewed. Patients with advanced HIV infection were found to have significantly more skin disorders than those with early stage HIV.

AIDS-Related Opportunistic Infections↗
PubMed2003

Photography in dermatology: comparison between slides and digital imaging.

BACKGROUND: Clinical photography is an essential tool for any medical speciality, such as dermatology, wherein accurate records are required of pre, intra and postoperative findings, plus quick access to these records for comparison and evaluation purposes. Clinical photography is important not only to the surgeon, but also to the patient, so that a realistic objective assessment of improvement may be made. Conventional emulsion film-based prints from negatives and positive colour transparencies revolutionised clinical records when they first appeared. Now the appearance and rapid development of digital photography is bringing about yet another revolution. AIM: To compare conventional with digital photography from the standpoints of cost-effectiveness, ease of archiving and ease of retrieval. The quality of the imaging was not dealt with. METHODS: A professional clinical photographer took images using: Nikon F3 (conventional emulsion based photography); FotoFinder Derma (digital photography). RESULTS: Although traditional emulsion-based photographs are quicker to take, digital imaging provides an almost immediately available image and is much swifter to use for classification, later retrieval and comparison between serial images. CONCLUSIONS: Despite the initial expense of acquiring digital equipment compared with traditional photographic apparatus, when examined over a five-year period, both formats cost approximately the same. Digital photography offers advantages in ease of archiving and storage, savings in time and space, extremely quick retrieval and very easy comparison of images. Digital photography is very much the way of the future in dermatological clinical imaging.

Journal Article↗
PubMed2004

Body dysmorphic disorder and cosmetic dermatology: more than skin deep.

Body dysmorphic disorder (BDD) is relatively common in cosmetic practise, yet it remains under-recognized. BDD patients are unnaturally concerned with minimal or non-existent flaws, most commonly in the skin (e.g. facial acne or scarring) and hair (e.g. hair loss). Many patients develop social avoidance and suffer occupational or academic impairment. More severely ill patients may become housebound or even attempt suicide. Despite the minimal or non-existent nature of the perceived appearance flaws, patients with BDD may request dermatological treatments such as isotretinoin or dermabrasion. Although treatment outcome has received little investigation, it appears that most patients are dissatisfied with dermatological treatment and, even if the outcome is objectively acceptable, they do not worry any the less about their appearance afterwards. In contrast, a majority of patients respond to serotonin reuptake inhibitors or cognitive behavioural therapy. Treatment of these patients is best given by an experienced health professional. This may be a mental health professional or a dermatologist with an interest in psychological medicine.

Journal Article↗