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Diagnosis and treatment of chronic actinic dermatitis.

Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis and/or a pseudolymphomatous eruption. Abnormal photosensitivity to ultraviolet (UV) and often visible radiation is a feature. Many patients also have multiple contact allergens. Histopathologic features vary, with a spectrum from mild dermatitis to pseudolymphomatous (reticuloid) features. The essential tests to make the diagnosis and to guide advice on avoidance of the responsible wavelengths and any contact allergens are phototesting and patch testing. Chronic actinic dermatitis can be regarded as a disorder of increased susceptibility, for reasons that remain uncertain, to develop delayed-type allergic responses to both endogenous photoallergens and exogenous allergens. Treatment consists of detailed advice on sunlight and allergen avoidance (guided by the results of investigations), topical corticosteroids, and emollients. When these measures are insufficient alone, systemic immunosuppressives may be considered: systemic prednisolone for acute exacerbations or azathioprine if systemic treatment is required for more than a few weeks.

Chronic Disease↗

Therapeutic options for chronic hand dermatitis.

Hand dermatitis is a common skin condition that often has a chronic and/or relapsing clinical course. Several clinical forms of hand dermatitis have been described, including contact (i.e., allergic and irritant), hyperkeratotic (i.e., psoriasiform or tylotic), frictional, nummular, atopic, pompholyx (i.e., dyshidrosis), and chronic vesicular hand dermatitis. In the present review, therapeutic options for these types of hand dermatitis are discussed in detail, focusing on treatments for recalcitrant hand dermatitis.

Chronic Disease↗

Effects of diaper types on diaper dermatitis associated with diarrhea and antibiotic use in children in day-care centers.

Infants and toddlers in day-care centers have a relatively high frequency of diarrhea and/or oral antibiotic use, and may be at increased risk of developing diaper dermatitis when diapered. A six-month, prospective, double-blind study was conducted in day-care centers in Houston, Texas, to determine the frequency of diarrhea, antibiotic use, and diaper dermatitis in infants and toddlers wearing conventional (cellulose-only core) disposable diapers or disposable diapers with a core of absorbent gelling material (AGM) and cellulose. A questionnaire was administered weekly to the day-care staff to gather health information, and weekly visual examinations were made of children for diaper dermatitis. The frequency of diarrhea was 1.9 episodes per child-year and that of antibiotic use was 3.3 courses per child-year. Infants diapered in disposable diapers with AGM had a significantly (P 0.032) lower mean grade of diaper dermatitis during diarrhea episodes and a lower (P 0.054) mean grade during antibiotic use, compared to those diapered in conventional disposable diapers. There was no significant difference between groups with regard to isolation of Staphylococcus aureus or Candida albicans from superficial skin cultures of the diapered area. The results indicate that diarrhea and antibiotic use occur frequently in children in day-care centers, and that the severity of diaper dermatitis is less in children wearing AGM disposable diapers than those wearing conventional disposable diapers in that setting.

Anti-Bacterial Agents↗

Association of skin wetness and pH with diaper dermatitis.

The strength of the association between diaper dermatitis and measurements of skin wetness and skin pH was evaluated by statistical analysis of four diaper trials involving 1601 infants. Although the strength of the association between skin wetness and diaper dermatitis was greater than that between skin pH and diaper dermatitis, increases in wetness and pH were both significantly associated with elevated mean grades for diaper dermatitis. The skin environment least likely to be associated with diaper dermatitis is one in which increases in both skin wetness and skin pH are minimized.

Body Water↗

Risk factors associated with the prevalence of interdigital dermatitis in sheep from 1999 to 2000.

As part of an investigation into improving the treatment and control of lameness in sheep flocks in England and Wales, a postal survey was conducted in November 2000. Farmers were asked to estimate the prevalence of footrot and interdigital dermatitis in their flocks. In the ewes the prevalence of interdigital dermatitis remained relatively stable throughout the year, but there was a large increase in lambs during late spring and early summer. Logistic regression models were used to assess statistically significant risk factors associated with prevalences of the condition of 5 per cent or more in ewes and 10 per cent or more in lambs. Factors that increased the risk in ewes were 'sometimes/never' catching lame sheep compared with 'always' farm land 100 m or less above sea level and renting-in winter grazing; factors that increased the risk in lambs were a prevalence of 5 per cent or more of footrot in ewes, 'sometimes/never' catching lame ewes compared with 'always', 'sometimes/never' treating ewes with footrot with parenteral antibiotics compared with 'always', showing sheep at agricultural events, farm land 100 m or less above sea level, and a prevalence of 5 per cent or more of interdigital dermatitis in ewes. Turning sheep on to a field which had been free from livestock for at least two weeks after footbathing decreased the risk of interdigital dermatitis in lambs. Footbathing without the use of a clean field compared with not footbathing did not significantly affect the prevalence of the interdigital dermatitis.

Animals↗

Frequency of radiation recall dermatitis in adult cancer patients.

BACKGROUND: The re-occurrence of an inflammatory skin reaction which is limited to previously irradiated areas after the administration of a promoting agent is called radiation recall dermatitis. Despite a number of case reports no systematic analysis about the frequency of the phenomenon exists. Therefore we performed an observation study in order to obtain information about this phenomenon in clinical practice. PATIENTS AND METHODS: 142 patients who underwent palliative radiotherapy were included in the study. The skin reaction at the day of completion of radiotherapy was documented and the patients were followed until cytotoxic chemotherapy was administered or at least 6 months. RESULTS: 91 patients received different types of chemotherapy. In 8 patients a radiation recall dermatitis was observed, corresponding to a frequency of 8.8%. The radiation skin reactions occurred within 6 weeks after the completion of radiotherapy which corresponded to the time-period most of the chemotherapies were applied in. The grade of observed radiation recall dermatitis ranged from a mild erythema to a severe exfoliative dermatitis. CONCLUSION: The radiation recall dermatitis is a reaction of moderate frequency among adult cancer patients. Its possible severity as well as consecutive therapeutic consequences argue for its consideration in clinical settings.

Adult↗

Evening primrose oil (Epogam) in the treatment of chronic hand dermatitis: disappointing therapeutic results.

BACKGROUND: Hand dermatitis is a common therapeutic challenge with limited and unsatisfactory therapy modules. A possible beneficial role of oral evening primrose oil needs to be investigated. OBJECTIVE: Pharmacological doses of gamma-linolenic acid (GLA) could improve the water permeability barrier of the epidermis in chronic hand dermatitis. Clinical improvement, changes in the lipogram and epidermal lipid composition could define functional improvement of the skin. Electron-microscopic evaluation of the epidermal lipid bilayer could underline the efficacy of essential fatty acids in chronic hand dermatitis. METHODS: Thirty-nine patients with chronic (> 1 year), stable hand dermatitis entered a 24-week double-blind placebo-controlled trial. Patch test with the European standard of allergens, haematogram and serum IgE values were determined before commencement of the study. Active therapy (600 mg/day of GLA) was administered to half the patient group. Medication was given for 16 weeks and observations continued for another 8 weeks. Patients were assessed clinically, using a visual analogue scale at 4-week intervals. Plasma and red blood cell lipograms, as well as skin biopsies, were taken before therapy, after the 16-week supplementation period and at week 24. Tissue was used for histological evaluation, electron-microscopic assessment and epidermal lipid analysis. RESULTS: Improvement in clinical parameters was present in the Epogam and placebo groups, but no statistical difference could be confirmed between the groups. Haematogram, blood and epidermal biochemistry were normal at baseline. No change in the lipid composition of plasma red cells or epidermis could be detected during the trail. Ultrastructurally skin specimens showed no change during the study period. CONCLUSION: The study indicates that the therapeutic value of orally administered GLA for chronic hand dermatitis is not superior to that of placebo.

Administration, Oral↗

Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer.

PURPOSE: The effectiveness of nonsteroid topical agents for the prevention of acute dermatitis during adjuvant radiotherapy for breast carcinoma has not been demonstrated. The goal of this study was to compare the effectiveness of calendula (Pommade au Calendula par Digestion; Boiron Ltd, Levallois-Perret, France) with that of trolamine (Biafine; Genmedix Ltd, France), which is considered in many institutions to be the reference topical agent. PATIENTS AND METHODS: Between July 1999 and June 2001, 254 patients who had been operated on for breast cancer and who were to receive postoperative radiation therapy were randomly allocated to application of either trolamine (128 patients) or calendula (126 patients) on the irradiated fields after each session. The primary end point was the occurrence of acute dermatitis of grade 2 or higher. Prognostic factors, including treatment modalities and patient characteristics, were also investigated. Secondary end points were the occurrence of pain, the quantity of topical agent used, and patient satisfaction. RESULTS: The occurrence of acute dermatitis of grade 2 or higher was significantly lower (41% v 63%; P <.001) with the use of calendula than with trolamine. Moreover, patients receiving calendula had less frequent interruption of radiotherapy and significantly reduced radiation-induced pain. Calendula was considered to be more difficult to apply, but self-assessed satisfaction was greater. Body mass index and adjuvant chemotherapy before radiotherapy after lumpectomy were significant prognostic factors for acute dermatitis. CONCLUSION: Calendula is highly effective for the prevention of acute dermatitis of grade 2 or higher and should be proposed for patients undergoing postoperative irradiation for breast cancer.

Acute Disease↗

Prevalence and correlates of hand dermatitis among nurses in a Japanese teaching hospital.

BACKGROUND: Although hand dermatitis represents a common occupational disease among hospital nurses, epidemiologic studies of this nature are comparatively rare in Japan. METHODS: We recruited a complete cross-section of nurses from a teaching hospital in central Japan. Data was gathered by means of a self-reported questionnaire, with hand dermatitis symptoms and evaluation criteria drawn from previously validated research. Participants were categorised according to their hospital department during the analysis. RESULTS: A total of 305 questionnaires were successfully completed and returned (response rate: 84%). There were statistically significant differences in hand dermatitis prevalence between the departments (p < 0.05), ranging from 6% in psychiatry to 48% in the surgical unit and averaging 35% across the entire group. A history of allergic disease was shown to increase the risk of hand dermatitis (odds ratio = 3.7, 95% confidence interval: 2.1 - 6.6). Washing their hands more than 15 times per work shift also increased the risk (odds ratio = 2.0, 95% confidence interval: 1.2 - 3.4). CONCLUSION: This study has shown that hand dermatitis prevalence varies among Japanese nurses depending on their hospital department, and is generally quite high when compared to other reports.

Adult↗

Psoriasiform acral dermatitis. Report of three cases.

The authors report 3 patients affected by psoriasiform acral dermatitis, a distinctive clinical entity characterized by a chronic dermatitis of the terminal phalanges, associated with marked shortening of the nail beds of the affected fingers. The skin biopsy showed in all cases the pathological features of a subacute spongiotic dermatitis. X-ray examination of affected fingers showed no bone or soft tissue changes. Differential diagnosis of psoriasiform acral dermatitis included psoriasis, atopic or contact dermatitis and corticosteroid-induced distal phalangeal atrophy.

Acrodermatitis↗

[Experimental survey of a new topical anti-oxidant based on furfuryl palmitate in the treatment of child's and baby's dermatitis with eczema: results from a multicenter clinical investigation].

In this paper we present the preliminary results of a multi-center clinical investigation carried out on a new topical product (Triderm(R) Lenil+) containing Superoxidodismutase (SOD), 18-beta glycyrrethic acid, Vitamin E, alpha bisabolol and a new patented antioxidant molecule, Furfuryl palmitate. These active agents altogether protect skin from cell damages that promote the inflammatory syndrome; their action is furthermore sustained by agents such as phytosphingosine and phytosterols that act to repair the skin barrier. Furfuryl palmitate is an ester with a strong quenching ability towards the singlet oxygene (1O2) and with a high permeability potential through the biological membranes, thanks to its lipophylic formula. Further than being among the main responsible for skin ageing, the 1O2 is involved in the genesis of many topical pathologies such as allergic and irritant dermatitis, atopic dermatitis, inflammation, psoriasis and sunburns. The product has been extensively tested for its effectiveness and skin tolerability on a selected population of 60 children and babies with age ranging from 2 months to 14 years, suffering mainly with atopic dermatitis and irritant dermatitis. The topical use of the product caused a significant improvement of the inflammatory skin conditions, with evident and fast inflammation and eczema reduction in all the investigated pathologies, as shown in the present study. The product has been formulated in order to avoid any sensitisation risk and did not show any relevant side effect. It is particularly suitable in the treatment of pediatric dermatitis with symptoms like eczema, itching, desquamation and xerosis.

Administration, Topical↗

A clinical trial to assess the use of sodium hypochlorite and oxytetracycline on the healing of digital dermatitis lesions in cattle.

The increased frequency of diseases, especially those of the hoof, cause economic losses, such as premature culling of affected animals, decreased milk production, weight loss, reduced fertility, and the high costs of treatment. A great variety of hoof conditions may affect cattle, one of them is digital dermatitis. These conditions are probably due to multiple factorial diseases and present with similar clinical signs. Bovine lameness is typically treated by foot trimming and debridment of the lesions, coupled when necessary with systemic antibiotics and therapeutic footbaths, which results in a clinical cure in the majority of the cases. The objective of this study was to evaluate the topical action of sodium hypochlorite associated with the systemic use of oxytetracycline for the treatment of wounds clinically diagnosed as bovine digital dermatitis. One hundred and twenty Holstein cattle varying ages from 1 to 9 y and presenting the clinical signs of digital dermatitis, were used in this study. Group 1 (G1) received topical treatment with a 1% sodium hypochlorite footbath twice a day for 30 d and 4 treatments of parenteral oxytetracycline (10 mg/kg bodyweight, IM, q48h). Group 2 (G2) received only the topical treatment with 1% sodium hypochlorite, as described for G1. Group 3 (G3) received only with parenteral oxytetracycline, as described for G1. Group 4 (G4) was treated exclusively with a dicloro divynil pirrolidona, ortoiododimetil, para-nitofenil-fosforotioato in a vegetal tar-based ointment, immediately after the surgery. After 45 d, the recovery rates were as follows: G1, 86.67%; G2, 73.33%; G3, 56.67%; and G4, 50%. The surgical treatment of digital dermatitis with subsequent treatment with oxytetracycline systemically and 1% sodium hypochlorite topically was the most effective for the convalescence of cattle bearing wounds similar to digital dermatitis.

Administration, Topical↗

[Side effects of oral retinoid Ro 10-9359 on the unaffected skin of psoriatic patients: retinoid dermatitis].

Dermatitis occurring as a side effect in psoriatic patients during oral administration of the retinoid acid derivative Ro 10-9359 is described. This so-called retinoid dermatitis exhibits a characteristic disseminated pattern. Sites of predilection are the face, the exterior surface of the upper and the interior surface of the lower arms, the superior thoracic aperture, the back of the hands and the flanks. The lesions present as follicular papules and/or vesicles. The histological picture is that of acute non-specific dermatitis. This retinoid dermatitis was observed in 9 our of 23 patients (39%) treated with Ro 10-9359. Other side effect such as erythema, desquamation, itching and, rarely, a burning sensation showed the same distribution. The characteristic dermatitis, as well as the other side effects mentioned, occur dose-dependently within the normal therapeutic range of Ro 10-9359 for psoriasis (0.5--1 mg/kg bodyweight daily).

Administration, Oral↗

Perioral dermatitis: an uncommon condition?

To document the persistence of perioral dermatitis at dermatology clinics at University Hospital, Saskatoon, we reviewed the charts of all patients with the condition seen between January 1983 and March 1985. Patients with rosacea referred to the clinics during the same period were used as a comparison group. A total of 80 patients with perioral dermatitis and 117 patients with rosacea were seen during the study period; most were female. Those with perioral dermatitis were significantly younger and had a significantly shorter mean duration of the eruption before presentation than those with rosacea (p less than 0.001). The distribution of the lesions was different in the two groups. Sixty-eight (85%) of the patients with perioral dermatitis and 45 (38%) of those with rosacea had used topical corticosteroids, a postulated risk factor for perioral dermatitis; the use of potent topical corticosteroids was frequent in both groups. Despite continuing medical education on the dangers of chronic use of these agents for eruptions on the face, physicians continue to prescribe them.

Adrenal Cortex Hormones↗

Etiology and pathophysiology of diaper dermatitis.

Common diaper dermatitis is a group of skin disorders that result from attack of the skin by physical, chemical, enzymatic, and microbial factors in the diaper environment. The integrity of healthy skin is compromised by the very nature of the diaper environment, and normal intact skin therefore remains an elusive goal of current diapering practices. Moist occlusion promotes miliaria, and causes an increase in the coefficient of skin friction. Skin hydration and an increase in skin pH result in impaired barrier function, and fecal enzymes begin to attack the skin, further degrading its normal ability to cope with its environment. Skin in this weakened state is susceptible to a variety of biological, chemical, and physical insults that can cause or aggravate diaper dermatitis. These include attack of the skin by fecal enzymes and other irritants in urine and feces, mechanical abrasion, and infection by C. albicans. Diapering is unquestionably an effective and convenient way of localizing an infant's excreta. Unfortunately, infant skin was not designed to operate continuously in the resulting environment, and is frequently unable to weather this assault. However, by improving the inherently adverse relationship between diapers and diapered skin, one can have a significant effect on the incidence and severity of diaper dermatitis. A diaper that keeps skin drier will result in skin that is less permeable to irritants, supports less microbial growth, is less susceptible to chafing damage, and has less contact with irritants in urine and feces. A diaper that maintains the environment closer to the normal acidic pH of skin will promote skin that is less permeable to irritants, and reduce the irritancy of fecal enzymes. Finally, a diaper that limits the mixing and spreading of urine and feces will result in less potentiation of enzyme activity and less contact of the skin with fecal irritants. Diaper dermatitis, by definition, cannot exist in the absence of diapers. Moreover, diaper dermatitis will become less troublesome for the infant population to the degree that diapered skin can be provided an environment closer to that of undiapered skin.

Diagnosis, Differential↗

Actinic reticuloid via persistent light reaction from photoallergic contact dermatitis.

Photoallergic contact dermatitis developed in a patient who had used deodorant soaps containing tribromsalan. He persistently reacted to light, since the dermatitis persisted long after cessation of contact with the causative chemical. During this period, he experienced generalized, eczematous dermatitis on several occasions. On testing, the patient showed extremely severe photosensitivity extending through the ultraviolet to the visible spectrum. At that time, a skin biopsy specimen showed the microscopic findings of eczematous dermatitis. A diagnosis of actinic reticuloid was first made histologically nine years after the initial examinations, when the patient was 56 years old. This long-term follow-up study may support the view that photoallergic contact dermatitis, persistent light reaction, and actinic reticuloid could constitute various phases of a single disease.

Chronic Disease↗

Diaper dermatitis: current concepts.

Diaper dermatitis may result from prolonged skin contact with wetness and bacteria. Ammonia plays no apparent role in the generation of diaper dermatitis. Candida albicans frequently contaminates a diaper dermatitis and should be considered present in any diaper dermatitis and should be considered present in any diaper dermatitis known to be present for longer than three days. Topical fluorinated glucocorteroids, boric acid, and mercury-containing preparations should be avoided in the diaper area because of their toxicity.

Ammonia↗

[Diaper dermatitis. Classification, occurrence, causes, prevention and treatment].

Diaper dermatitis is a multifactorial dermatological disorder characterized by inflammation in the diaper area. About half of all babies and old people in need of care experience light dermatitis, while 20% have moderate and 5% severe dermatitis. Friction from the diaper, occlusion, irritation from faeces, ammonia, detergents, candida albicans, proteolytic and lipolytic enzymes and moisture deposited on the epidermis cause damage at the stratum corneum layer of the epidermis. Diaper dermatitis is caused by a combination of mostly irritant effects. Compounds that infiltrate the skin can aggravate the reaction to the damaged epidermis. The barrier function of epidermis must be restored in order to prevent and treat diaper dermatitis.

Aged↗