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PubMed2001

Skin diseases in children in rural Kenya: long-term results of a dermatology project within the primary health care system.

BACKGROUND: Following an epidemiological study on skin diseases in 5780 pupils from 13 schools in rural western Kenya in 1993, a dermatology project within the primary health care system was established in 1994 by the German non-government organization (NGO) 'Doctors in Aid of Children with Skin Diseases in Africa'. Within this project trained community health workers carried out regular visits to schools and nurseries and treated children with hydrocortisone acetate 1% cream for dermatitis, gentian violet 1% solution for bacterial skin infections, Whitfield's ointment for dermatophytoses and benzylbenzoate emulsion 25% for scabies. OBJECTIVES: To assess the impact of this intervention. METHODS: In 1999, after a 5-year period, 4961 pupils from the same 13 schools were re-examined and the prevalence rates were compared. RESULTS: Non-infective dermatitis had a prevalence of 1.7% in 1993 as well as in 1999; among the communicable diseases bacterial infections declined from 12.7% to 11.3% (not significant), fungal infections rose from 10.1% to 13.9% (P < 0.05) and arthropod infections (mainly scabies) remained at similar levels of 8.3% in 1993 and 8.0% in 1999. A distinctive reduction could only be found for tropical ulcers (0.1% in 1999 compared with 1.2% in 1993). CONCLUSIONS: The prevalence of dermatoses in children in rural Africa does not only depend on treatment schemes within the primary health care system, but on the socio-economic conditions available.

Adolescent↗
PubMed2001

["De morbis qui in superficie corporis videntur" (St. Isidore of Seville, 621 A.D.) the first dermatology text in Europe].

San Isidoro of Sevilla (562-636) was a learned Spaniard of the early Middle Ages. His principal work, the Etymologies, is an encyclopedic treatise which analyzes the origin and meaning of about 5,500 terms corresponding to the different knowledge of his era. Liber IV of the Etymologies is dedicated to Medicine, and one of his chapters, titled De morbis qui in superficie corporis videntur (The diseases that are seen on the skin surface), studies 32 terms corresponding to skin diseases, so that this chapter represents the first text dedicated specifically to Dermatology in Europe. At the same time, according to the general plan of the work that includes each term with its origin and its definition, Liber IV (De Medicina) would be the oldest medical terminology dictionary known.

Dermatology↗
PubMed2001

Investigation of the allergenicity of a refined peanut oil-containing topical dermatologic agent in persons who are sensitive to peanuts.

We determined if a topical oil containing 0.01% fluocinolone and refined peanut oil (Derma-Smoothe/FS topical oil), among other ingredients, included materials to which peanut-sensitive individuals were sensitized. No immediate (15-min) or delayed (72-h) skin test reactivity was demonstrated in any of the 14 subjects tested. These results suggest that this refined peanut oil-containing dermatologic preparation is safe to use, even in persons who are sensitive to peanuts.

Administration, Topical↗
PubMed2001

Dermatologic surgery into the next millennium, part II.

This is the second article in a 4-part series on dermatologic surgery. This section provides detailed information about filling agents and botulinus toxin A. The filling agents discussed here are frequently used in our office. It is emphasized that meticulous technique and patient selection predict a good cosmetic result. To select the right agent, patient safety must be a priority.

Botulinum Toxins, Type A↗
PubMed1994

[Anton Nyström: the first practitioner in dermatology in Sweden and the controversy about his book on skin disorders].

Anton Nyström (1842-1931), practitioner and author, was at the end of the nineteenth and the beginning of the twentieth century a well-known but also controversial personage in Swedish cultural and intellectual life. The posterity remembers him mainly for having introduced the philosophical system of Auguste Comte and founded a Society for Positivism in Sweden as well as having founded an institution ("Arbetarinstitutet") in Stockholm with the purpose to give an all-round education to the working classes through lectures by leading personalities in the world of culture and science. In numerous publications he treated besides medical topics also religious, cultural, social, political and historical themes. Immediately after his medical graduation in May 1868, he went abroad to study dermatology and stayed for this purpose for nearly one and a half years in Vienna, Paris and London. Back in Sweden in the autumn of 1869, he began writing a book with the title "Theoretical and practical essays on skin disorders." This book is for us today interesting because it illustrates the different views of that time on skin diseases held by Hebra in Vienna, Bazin and Hardy in Paris and Wilson and Tilbury Fox in London. In Paris Nyström had been fascinated by Bazin's and Hardy's theories on constitutional diseases and diathetic states and had, as he says, "embraced the doctrines of Bazin". In Vienna, however, he had disapproved of Hebra's way to reject speculations on internal etiology for skin diseases and to look upon them as having mainly an external cause and of his method to treat skin diseases preferably with local remedies. In London he was on very friendly terms with Tilbury Fox, who to his satisfaction also sympathized with the opinions held by Bazin. ...

Dermatology↗
PubMed2001

Adapalene gel 0.1% is effective and well tolerated in acne patients in a dermatology practice setting.

The US Food and Drug Administration has approved adapalene gel 0.1% for use in the treatment of acne vulgaris. The objective of our study was to evaluate the efficacy and tolerability of adapalene gel 0.1% in the treatment of acne vulgaris in a clinical practice. We used a 12-week, multicenter, open-label, noncomparative phase 4 study of adapalene gel 0.1%. The study involved approximately 600 dermatologists in the United States and included 2,545 healthy men and nonpregnant women older than 14 years who had mild or moderate acne vulgaris. Of the patients enrolled, 75% completed the study and most of them (89%) showed an improvement in their acne (clear of acne or marked, definite, or minimal improvement) from baseline. Most patients (69%) were satisfied or very satisfied with adapalene therapy, and most (80%) wished to continue treatment. Only 3.7% of patients enrolled reported treatment-related adverse events (n=94), the most common being skin irritation (2.2%). We conclude from this open-label trial in a dermatology practice setting that adapalene gel 0.1% was effective and well tolerated and had a favorable safety profile. Furthermore, compliance with once-daily application of adapalene was rated as high by 92% of patients who responded to a self-assessment questionnaire.

Acne Vulgaris↗
PubMed2001

The use of therapeutic moisturizers in various dermatologic disorders.

Moisturizers can serve as important adjunctive therapeutic modalities for patients with various dermatologic disorders, including acne vulgaris, rosacea, retinoid-induced irritant dermatitis, atopic dermatitis, psoriasis, and the skin dryness that appears to occur with intrinsic and extrinsic aging. Therapeutic moisturizers, defined as those proven in clinical trials to be both compatible with topical therapies and biocompatible with the skin, not only improve the signs and symptoms of dry skin but also, as research has demonstrated, help maintain hydration and overall integrity of the stratum corneum. The type of humectants and emollients contained in a therapeutic moisturizer can affect the overall tolerability of the formulation. Dermatologists should recommend therapeutic moisturizers that are noncomedogenic, devoid of irritant ingredients, and compatible with many therapeutic regimens.

Biomechanical Phenomena↗
PubMed2002

Common sense dermatological drug suggestions for women who are breast-feeding.

Use of medications by breast-feeding mothers is not uncommon. When prescribing a medication to a nursing mother, the physician must weigh the potential risk of exposing the infant to the medication or the risks of not breast-feeding against the benefits of the medication to the mother. Information regarding the safety of common dermatological medications during lactation will be reviewed. Based on this information, treatment recommendations will be made.

Adult↗
PubMedDate not supplied

[Profile of skin diseases observed in a department of dermatology (1995-2000)].

OBJECTIVE: The aim of this retrospective study was to determine the nature and frequency of skin diseases observed at the Dermatology Department (Hôtel-Dieu de France University Hospital) between January 1st, 1995 and December 31, 1999, and to compare them according to age and sex. PATIENTS AND METHODS: All the patients who presented to the consultation were enclosed in the study. Their file included sex, age, one or several diagnoses, the number of visits for each disease. Only new diagnoses were taken into account. Data were handled by Epilnfo program. RESULTS: 6822 patients (59.01% women, 40.99% men, average age 31 years) were seen with 8552 diagnoses. Fungal infections represent the most frequent disease (14.6%), followed by acne (14.1%), eczema (8.56%), viral infections (7.9%) and skin tumors (7.28%). Women consulted more often than men for acne, rosacea, eczema, hair loss, melasma and stretch marks; whereas men consulted more often for fungal and viral infections, and alopecia areata. DISCUSSION: The most frequent skin diseases (all ages merged), were fungal infections, acne and eczema. The same three diagnoses were found before as the most frequent in a previous Lebanese study. The profile of skin diseases in Lebanon turns out very close to observations made in developed countries, but it differs from the Western profile on two fundamental points: absence of leg ulcers and rarity of skin tumors. This profile seems, besides, very remote from the Middle-Eastern and Arabic context especially because of the absence of some endemic diseases such as tinea capitis, leprosy and leishmaniosis.

Adult↗
PubMed2002

[Dermatology in private practice in France in 2000].

OBJECTIVES: Data regarding French dermatological practice are scarce. Our objective was to identify the skin disorders most commonly diagnosed by office-based dermatologists. We also documented the severity of these skin disorders, as reflected by the repercussions on patient's everyday life, and the way physicians managed patients. DESIGN: We carried out a one-day survey of visits to a randomly selected sample of 900 French office-based dermatologists. The randomization was stratified according to the five French different dialing area codes. RESULTS: Office-based dermatologists saw 6411 patients with 7839 skin disorders during the survey. The daily number of visits to French dermatologists was estimated at 47 000 and the annual number between 12 and 14 millions. Office-based dermatologists mostly managed warts, acne, nevus, dermatitis, malignancies and pre-malignancies, fungal infection and psoriasis. Repercussions on patients'everyday life were assessed by physicians as important or very important in 28 p. 100 of cases. Half of the patients received topical treatment, 20.5 p. 100 a systemic drug and 40 p. 100 a minor surgical procedure (including cryotherapy). CONCLUSION: Although dermatologists frequently see benign skin disorders such as warts or nevus, more severe diseases represent an important part of their activity.

Dermatology↗
PubMed2002

A retrospective study on the characteristics of androgenetic alopecia among Asian races in the National Skin Centre, a tertiary dermatological referral centre in Singapore.

OBJECTIVE: To study the characteristics and psychosocial impact of androgenetic alopecia among Asian races. METHODOLOGY: A retrospective telephone interview study of patients managed for androgenetic alopecia in 1997 in a tertiary dermatological referral centre in Singapore. RESULTS: Two hundred and fifty-six patients (111 females and 145 males) were included in the study. Their mean age at presentation was 33.7 years. There were no significant statistical mean age differences among the different races (Chinese, Malay and Indian). The mean duration of disease before consultation was 31.2 months; 33.2 months for males and 28.9 months for females (ns). Almost all patients (96.4%) were socially embarrassed and "unhappy" about their androgenetic alopecia. Most (90.5%) sought treatment for "cosmetic" reason. Slightly more males sought treatment for cosmetic reason than female (P = 0.01). 7.5% were worried about an underlying systemic disease as a cause of their alopecia. A positive family history of androgenetic alopecia was recorded in 58.9% (151/256). Male patients tend to have higher proportion of having a father or male sibling with similar problem, whereas female patients tend to have higher proportion of having a mother or females sibling with androgenetic alopecia. The predominant balding patterns for males were a combination of frontal, bi-temporal recession and vertex thinning (43%, 45% and 55%, respectively). Whereas in females, the predominant presentation was vertex thinning (60%) and, infrequently, frontal and bi-temporal thinning (19% and 15%, respectively). Diffuse pattern was also more predominant in females (28%) compared to males (10%). CONCLUSIONS: Most patients presented in their thirties with females presenting earlier than males and almost all patients presented for treatment for cosmetic reasons. Patients are generally unhappy about their appearance as a result of their alopecia. A strong positive family history appears to suggest that the disorder may be acquired through an autosomal dominant trait. Male patients tend to have a father or male sibling with similar condition and female patients tend to have a mother or female sibling with similar condition.

Adaptation, Psychological↗
PubMed2002

[Publications of French dermatology professors from 1996 to 1998].

INTRODUCTION: The number and level of the publications reflect the scientific activity of physicians. The assessment of this activity is required for nomination and for the internal promotion of University Professors--Hospital Practitioners (UP-HP). We present the results of such an assessment. MATERIAL AND METHODS: The list of the individual publications of 62 UP-HP was established from research on the Medline on the PubMed website. We eliminated the journals without an Impact Factor and the articles of continued medical training. A score was obtained for each of the authors on each of their publications. This was calculated by multiplying the rank coefficient of the author by the coefficient of the type of publication (letter, clinical case or article) and by the coefficient of the journal (ranging from 1 to 4). The global score of a UP-HP was the sum of the scores per publication. The mean score of each UP-HP was assessed by dividing their global score by the number of their publications. RESULTS: One thousand thirty-one scientific publications in 3 years was divided into 502 articles, 316 clinical cases and 213 letters. The yearly number of publications per UP-HP was a mean of 5.5 (+/- 4.2) ranging from 0 to 17.3. The publications were mainly written in English (p=10(-2)). There were more articles than clinical case reports and letters (p=10(-1)). The yearly number of publications was greatest among those aged 46-55. No difference was noted in gender, function (head of a department or not) or the size of the town. The UP-HP working in a team including other UPs had written a greater number of publications (p=10(-2)). The global scores did not significantly differ between the 3 age ranges considered; conversely, the mean score decreased significantly with age (p=0.04). The UP-HP working in teams including several UPs had significantly higher global score (p=0.03). DISCUSSION: These results show the heterogeneity of the "publishing" activity. The method used in this study for the scientific assessment could be subject to improvement; its principle is indisputable, but its methods of use remain to be specified. The best "publication structure" of young UP-HP may be related to age, demonstrating a decline in scientific activity during the working life, or a cohort-effect--i.e., the progressive improvement in recruitment conditions and scientific activity over the past 20 years. The better performance of the UP-HP working in a team including several UP-HP must be interpreted with care; however, it may help to define a geographical policy of Dermatology.

Dermatology↗
PubMed2002

Website discussion forums: results of an Australian project to promote telecommunication in dermatology.

Discussion forums on the Internet allow doctors to discuss issues of interest in a rapid, convenient and educational manner. In March 2002, the department of dermatology at the St George Hospital in Sydney launched a national Website with an online discussion forum for dermatologists. Features of the Website forum include the ability to moderate the discussion boards, a choice of public or private discussions and receipt of automatic email notifications. Over three months, three dermatologists posted a total of 13 messages on three different topics. The low rate of participation by dermatologists may have been due to lack of time or familiarity with the technology. Increased promotion to and education of dermatologists who are most likely to use the discussion forum may improve utilization of this means of communication.

Australia↗
PubMed2003

[Quality of life in dermatology: Tunisian version of the Skindex-29].

The skin situated in the interface between the body and the outside world, is a zone privileged by the interactions between the individual and the society. The objective of our work was to study the quality of life in dermatology, while elaborating a Tunisian version of the Skindex-29 scale. For that we questioned 60 patients, among them 20 are affected by psoriasis, 20 are affected by vitiligo and 20 are affected by onychomycosis. The evaluation of the psychometric properties of the questionnaire was satisfactory. The chronic dermatosis altered the quality of life of the patients. This deterioration touches by order descending the patients affected by psoriasis, vitiligo, and onychomycosis. The patients were particularly sensitive when uncovered zones were reached, particularly the face. These results are in conformity with the data of the literature relating to the subject. The validation of this version is necessary.

Adult↗
PubMed2003

[Classification of dermatologic manifestations in lupus erythematosus].

Various dermatologic manifestations are observed in the different lupus subsets. Lupus lesions are characterized by a dermo-epidermal dermatitis. Other lesions, vascular or non vascular, are essentially present in association with systemic lupus erythematosus. Acute, subacute and chronic lupus erythematosus are distinguishable according to their clinical aspects, pathological features and evolution. Acute lesions are either localized to the midface or widespread. Subacute lesions may be annular or psoriasiform. Chronic lupus erythematosus includes localized or widespread discoid lupus, lupus tumidus, chilblain lupus and panniculitis. Therapy of cutaneous lupus is mainly based on antimalarials and avoidance of sun irradiation. In refractory cutaneous lupus, no universal guidelines are currently available. Except for acrosyndromes and urticaria-like lesions, vascular lesions may be due to vasculitis or thrombosis. An accurate diagnosis is absolutely necessary since therapy is different in thrombosis and vasculitis. Non vascular and non lupus lesions are numerous, some of them require special treatment such as dapsone for bullous lupus.

Acitretin↗
PubMedDate not supplied

Potential future dermatological indications for tacrolimus ointment.

Tacrolimus ointment is a steroid-free topical immunomodulator developed for the treatment of atopic dermatitis, a common, chronic inflammatory skin disease. By inhibiting T-cell activation and cytokine production, topically applied tacrolimus modulates inflammatory responses in the skin. Numerous clinical trials have shown that it is effective and well tolerated for the treatment of atopic dermatitis, its licensed indication. In addition, numerous publications suggest that tacrolimus ointment may provide effective treatment for a variety of other inflammatory skin disorders, many of which are very difficult to manage with standard therapy. This paper reviews currently available evidence regarding the use of tacrolimus ointment in a range of dermatological disorders, including psoriasis, lichen planus, pyoderma gangrenosum, lichen sclerosus, contact dermatitis, leg ulcers in rheumatoid arthritis, steroid-induced rosacea and alopecia areata. It also provides recommendations for future clinical studies with tacrolimus ointment.

Adjuvants, Immunologic↗