http://www.medicaljournals.se/acta/ Acta Dermato-Venereologica is an international peer-review journal for clinical and experimental research in the field of dermatology and venereology. http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1936
Abstract is missing (Quiz)]]> 2014-08-27 Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1937
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Abstract is missing (Short Communication)]]> 2014-08-27 Shortcom http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1929
Abstract is missing (Short Communication)]]> 2014-08-19 Shortcom http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1938
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Abstract is missing (Short Communication)]]> 2014-09-09 Shortcom http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1974
Mutations in genes encoding for desmosomal components are associated with a broad spectrum of phenotypes comprising skin and hair abnormalities and account for 45–50% of cases of arrhythmogenic right ventricular cardiomyopathy. Today, more than 120 dominant and recessive desmoplakin (DSP) gene mutations have been reported to be associated with skin, hair and/or heart defects. Here we report on 3 cases with yet unreported DSP mutations, c.7566_7567delAAinsC, p.R2522Sfs*39, c.7756C>T, p.R2586*, c.2131_2132delAG and c.1067C>A, p.T356K, that were associated with variable woolly hair or hypotrichosis, palmoplantar keratoderma, and cardiac manifestations. In addition, we review and summarise the clinical features and DSP mutations of the patients described in the literature, which illustrates the complexity of this group of disorders and of their genotype-phenotype correlations, which cannot be easily predicted. Early diagnosis is crucial and cardiac examinations have to be performed on a regular basis.]]> 2014-10-02 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1921
The efficacy and safety of acitretin was evaluated retrospectively in a cohort of 46 patients with moderate to severe plaque psoriasis (Psoriasis Area and Severity Index (PASI) range 10–42). Patients were treated at an initial dose of 10 mg/day acitretin, which was then gradually increased until the best therapeutic effect with the fewest adverse effects was reached (< 50 mg/day) and later decreased and maintained at the lowest effective dosage. Efficacy measures were: (i) PASI75 (75% improvement) and PASI50 between 10 and 16 weeks; and (ii) PASI75 even after 16 weeks of treatment. At weeks 10–16, PASI75 and PASI50 were achieved by 47.8% and 87% of the patients, respectively. Overall, 67.3% reached PASI75. Adverse events occurred in 18 patients (39.1%); among these, 4 (8.7%) discontinued acitretin. Our findings suggest that acitretin at an initial low, gradually escalating dose, and subsequently maintained at the minimal effective dose, is a suitable treatment option for plaque psoriasis as it provides clear-cut improvement in most treated patients while minimizing the risks of side-effects]]> 2014-08-27 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1928
Pityriasis rubra pilaris (PRP) is an uncommon cutaneous disease with disorder of keratinisation. Up to now, systemic retinoids like acitretin or isotretinoin seem to be the most effective therapeutic agents. However, no large trials on this rare disease have been published and no standardised treatment has been established so far. Recently, single case reports demonstrate beneficial effects of alitretinoin (9-cis retinoic acid) in patients with PRP. We performed a retrospective observational analysis of type I adult-onset patients with PRP (n = 5) treated with systemic alitretinoin in our department. Alitretinoin was highly effective in the treatment of PRP in 4 of 5 cases. PASI score was reduced significantly in the alitretinoin responders. We assume that alitretinoin could serve as an additional effective systemic treatment option for type I adult-onset PRP.]]> 2014-09-09 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1955
Moderate to severe ichthyosis is known to have a significant impact on quality of life. A French national survey was performed to describe in more detail how ichthyosis impacts the patients’ lives. A questionnaire specifically dedicated to ichthyosis was distributed to patients followed in hospital expert centres or members of the French association of patients. A total of 241 questionnaires were completed and returned (response ratio: 29% for children and 71% for adults). A negative impact of ichthyosis was obvious in terms of domestic life (skin care, housework, clothing, etc.), educational/professional lives (rejections by other children, workplace discrimination, absenteeism, etc) and for leisures/sports activities. The patient’s economical resources were also heavily impacted by ichthyosis with important out-of-pocket expenses.]]> 2014-09-17 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1940
This study aims to assess the impact of childhood vitiligo on the psychological status and quality of life of their parents, and to determine how this varies according to their children’s disease condition. The study included 50 families of children with vitiligo (a total of 75 participants) and 50 families of normal children (a total of 79 participants). The psychosocial impact of the disease on parents was measured using the Self-rated Health Measurement Scale (SRHMS) and the Dermatitis Family Impact Questionnaire (DFI). SRHMS scores for parents of children with vitiligo were significantly lower than for parents with normal children. In addition, women had lower scores than men in the study group. The mean DFI score in affected families was higher than in unaffected families. Parents of children with vitiligo have significant psychological problems, and their quality of life is poorer than for parents of normal children. In conclusion, parents of children with vitiligo need as much care and attention as their affected children.]]> 2014-08-27 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1939
The aim of this study was to investigate the impact of climate therapy on self-management in people with psoriasis. This was a prospective study of 254 adults with chronic psoriasis who participated in a 3-week climate therapy (CT) programme. The 8-scale Health Education Impact Questionnaire (heiQ) was completed at baseline, after 3 weeks of CT, and 3 months later. Change was assessed using paired sample t-tests mean (95% confidence interval) change scores (range 1–4). All heiQ scales showed statistically significant improvement after 3 weeks of CT. The greatest improvement was in Health-directed activity, followed by Emotional distress, and Skill and technique acquisition. At the 3-month follow-up, only the Emotional distress scale remained improved. In addition, disease severity (self-administered PASI; SAPASI) improved significantly from before CT to 3 weeks and 3 months after CT. This study suggests that CT provides a range of benefits that are important to people with psoriasis, particularly in the short term. A challenge is how to achieve long-term benefits.]]> 2014-09-30 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1920
The aim of this study was to evaluate the associations between chronic inflammatory skin conditions and patients’ emotional state and quality of life. The following self-rated questionnaires were used: Emotional State Questionnaire, a self-report scale assessing depression and anxiety symptoms; Dermatology Life Quality Index (DLQI); and RAND-36, a measure of health-related quality of life. The study group comprised 40 patients with psoriasis, 40 with eczema, 40 with acne, 15 with seborrhoeic dermatitis and 40 healthy controls. Patients with chronic skin diseases had lower DLQI and lower RAND-36 physical functioning scores, more perceived physical limitations and pain, and lower emotional well-being and general health ratings compared with the control group. In conclusion, chronic skin diseases are associated with symptoms of emotional distress, in particular insomnia and general anxiety.]]> 2014-08-27 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1925
Bullous pemphigoid (BP) is a common blistering disease caused by antibodies directed against hemi-desmosomal proteins BPAG1 and BPAG2. The disease is characterised by intense pruritus and blistering of the skin. The systemic treatment with the highest level of evidence for BP is systemic glucocorticoids. However, since the disease often occurs in the elderly patients, and since the most common co-morbidities are diabetes and neurological diseases, glucocorticoid-sparing drugs are often introduced. We retrospectively identified all BP patients admitted to our tertiary clinic over a 7-year period in order to register demography, treatment and co-morbidities. The most common steroid-sparing drugs were azathioprine (87%) and methotrexate (11%). Less than 2% were treated with dapsone, rituximab and cyclosporin A. As expected, we found a relatively high rate of neurological disorders, diabetes, and malignancies, but surprisingly we also found an increased rate of cardiovascular diseases compared to the Danish population in general.]]> 2014-08-18 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1950
The prevalence of melanocytic naevi in children correlates with sun exposure and may serve as an objective population risk indicator of future melanoma incidence. The aim was to investigate if mobile teledermatology could offer a valid methodology compared with standard manual, face-to-face counting of naevi on the back of children. Ninety-seven children aged 7–16 years were enrolled. One dermatologist performed manual naevi counting and imaging of the child’s back using an iPhone 4S comprising a safe-coded mobile application. Two other dermatologists independently counted naevi from the images. Cohen’s weighted kappa (κw) coefficient demonstrated substantial agreement for both dermatologists: κw = 0.69 (0.57–0.81 [95% confidence intervals]) and κw = 0.78 (0.70–0.86), compared with the manual assessment. Inter-rater reliability was also substantial (κw = 0.80 [0.73–0.87]). Use of mobile teledermatology proved valid for estimating naevi prevalence on the back and could provide a more feasible methodology following trends in sun exposure in children.]]> 2014-09-09 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1901
A possible association between use of snus (Swedish moist snuff) and hand eczema was studied. 27,466 individuals responded to questions regarding hand eczema, tobacco use and other life style factors in a Swedish Public Health Survey in 2006, response rate 58%. Of these persons, 12.2% reported daily snus use (men 22.0%, women 4.3%), 15.5% daily smoking (men 14.4%, women 16.5%). Of snus users 7.5 % reported hand eczema (men 6.5%, women 11.8%), of smokers 11.7% (men 8.6%, women 13.6%) and of non-tobacco-users 9.7% (men 7.9%, women 11.0%). In multivariate analysis hand eczema was significantly less common in snus users, in total prevalence proportion ratio (PPR)?=??0.813, in men PPR =??0.820, but significantly more common in smoking women, PPR?=?1.238. Physical exercise was a confounder; gender an effect modifier. No positive association was demonstrated between snus use and hand eczema in contrast to the positive association found between smoking and hand eczema in women.]]> 2014-07-23 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1881
Acute symptoms of atopic dermatitis (AD), such as erythema, oedema/papulations and excoriations, respond quickly to topical corticosteroid treatment. Conversely, lichenification is regarded as a troublesome non-acute symptom of chronic AD which can take months of treatment before any improvement is seen. However, very little data actually support this opinion. Here, we analyse lichenification scores in 3 multicentre, short-term studies of nearly similar design. Two of these studies were active comparator dosage trials administered with either fluticasone propionate cream or ointment once or twice daily, the third study was a placebo control. In each of these 4-weeks studies lichenification was measured weekly. For the evaluation of the lichenification score over time a random-coefficients regression model was used. In all active treatments lichenification significantly improved (p < 0.005) within one week. Improvement continued afterwards, with > 80% of patients scoring no, very mild or mild lichenification after 4 weeks. We developed a model in which the lichenification score drops off linearly with the square root of time. The resulting convexly shaped downward time trend of lichenification was significant during all treatments and was significantly stronger during active treatment than with placebo. Fluticasone propionate can improve moderate to severe lichenification in a relative short period of time.]]> 2014-10-06 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1933
The objective of this study was to examine the subgroup of patients with chronic pruritus with dysesthetic subqualities for the presence of psychiatric comorbidities and to evaluate whether anxiety and depression make a difference in perception of somatosensory stimuli in quantitative sensory testing (QST). Forty-nine patients underwent routine diagnostics, a standardised QST testing battery, a psychosomatic evaluation for psychic comorbidities and filled out 2 questionnaires: the Patient Health Questionnaire for the assessment of depressive mood and the State Trait Anxiety Inventory. Twenty-seven (55.1%) of the sample had at least one psychiatric comorbid diagnosis. QST parameters were not correlated to anxiety and depression levels. We conclude that psychosomatic evaluation should become part of routine diagnostics of these patients in order to detect and treat psychiatric comorbidity. However, research on somatosensory aspects in these patients seems not to be affected by the levels of anxiety and depression.]]> 2014-09-04 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1958
Mycosis fungoides (MF) and Sézary syndrome (SS) belong to the group of primary cutaneous T-cell lymphomas (CTCL). Regardless of the stage of the disease, patients with MF and SS can suffer from chronic pruritus. The aim of the study was to investigate the correlation between the interleukin 31 (IL-31) serum level, the degree of pruritus and CTCL severity; and to compare the frequency of IL-31 gene polymorphisms between patients and the control group, and between patients at different stages of the disease. Pruritus affected 67.7% of patients with MF and SS in our study. The IL-31 serum level was significantly higher in CTCL patients than in the control group but there were no positive correlation between IL-31 serum level and pruritus. A statistically significant difference in allele frequencies for IL-31 IVS2+12 gene polymorphisms between early and advanced stages was detected; GAG haplotype was more frequent and AGA was less frequent in stage IA patients compared with patients in the other stages of the disease.]]> 2014-09-11 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1918
Cold contact urticaria is the second most common subtype of physical urticaria. Cold stimulation standardized tests are mandatory to confirm the diagnosis. The aim of this study is to define the utility of determining thresholds (critical time and temperature) in assessment of the clinical course of typical acquired cold contact urticaria. Nineteen adult patients (10 women and 9 men; mean age 45 years) were included in the study and the diagnosis was confirmed with the ice-cube test and TempTest 3.0. Patients were treated continuously for 1 year with 20 mg/day rupatadine (anti-H1). Thresholds measurements were made before and after treatment. Improvements in temperature and critical time thresholds were found in the study sample, demonstrating the efficacy of continuous treatment with rupatadine. In most cases association with a clinical improvement was found. We propose an algorithm for the management of acquired cold contact urticaria based on these results.]]> 2014-08-21 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1944
Debridement is essential in wound treatment to remove necrotic tissue and wound bacteria but may lead to bacteria spread by aerosolization. This study investigated the wound bacterial reduction and bacterial transmission induced by debridement using curette, plasma-mediated bipolar radiofrequency ablation (Coblation®) or hydrodebridement (Versajet®). Full thickness dermal wounds in porcine joint specimens inoculated with S. aureus were debrided with curette, Coblation, Versajet, or were left untreated. During and after debridement, aerosolized bacteria were measured and to assess wound bacterial load, quantitative swab samples were taken from each wound. Only Coblation was able to reduce the bacterial load of the wound significantly. Versajet debridement resulted in a significant bacterial aerosolization, but this was not the case with Coblation and curette debridement. This study shows that Coblation is a promising wound debridement method, which effectively reduces the wound bed bacterial load without the risk of bacterial aerosolization.]]> 2014-08-27 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1949
The complex nature and difficult-to-establish aetiology of chronic pruritus (CP) makes it challenging to provide medical care for patients with CP. This challenge can only be met with a multidisciplinary approach. The first multidisciplinary Itch Centre in Germany was established at the University of Münster in 2002 to meet the needs of this patient population. More than 2,500 outpatients and 400 inpatients are diagnosed and receive treatment each year. To ensure evidence-based medical care, an electronic system for medical documentation and patient-reported outcomes was established. Automated data transfer to a research database enables comprehensive data analysis. Our translational research has characterized peripheral and central itch mechanisms, provided novel clustering of CP patients, and identified novel target-specific therapies (e.g. neurokinin 1 receptor-antagonist). The multidisciplinary approach, combined with basic, clinical and translational research, enables comprehensive medical care of patients as well as implementation of high-quality experimental and clinical studies.]]> 2014-09-04 Special http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1959
In clinical practice, the term “paraneoplastic itch” is used to describe itch in patients with cancer. Patients with hematological or solid tumor malignancies can be affected. In general, paraneoplastic itch is considered a rare disorder. However, paraneoplastic itch in hematological malignancies such as polycythemia vera and lymphoma are relatively frequent while other forms of paraneoplastic itch are in fact extremely rare. The true frequency of this symptom is unclear, epidemiological data in this field are limited. Itch in malignant disease may additionally impair patients’ quality of life. A population-based cohort study showed that chronic itch without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies. Paraneoplastic itch is rather resistant to treatment. In 2012, an interdisciplinary interest group of physicians and researchers was founded, aiming to generate a clear definition of paraneoplastic itch. In this paper we briefly review the current knowledge and aim to define what can be summarized under the term “paraneoplastic itch”.]]> 2014-09-10 Special http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2037
Abstract is missing (Commentary)]]> 2015-01-08 Commentary