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=10.2340/00015555-1645
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The main purpose of this study was to compare the effect of the 2 minimally invasive surgical techniques for treating axillary hyperhidrosis: superficial tumescent suction curettage and curettage only. A total of 22 patients diagnosed with axillary hyperhidrosis received one type of treatment at each side, randomized. Examinations were performed pre-operatively and at 3, 6 and 12 months following treatment. Sweating was measured by gravimetry and a new skin conductance method. Subjective rating of sweating was assessed by a visual analogue scale. Skin conductance was recorded during a stress-test including acoustic, mental and physical stressors. Five patients withdrew or did not meet for any follow-up examination, giving 17 subjects in total for data analysis. Significant reduction in sweating after surgery lasting at least 12 months was found based on skin conductance, gravimetry and visual analogue scale scoring. Comparison between types of treatment revealed a significantly better effect of tumescent suction curettage than curettage only.]]> 2013-08-26 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1643
A variety of animals host parapoxviruses. Orf virus is prevalent in sheep and goats in the Tyrol region of Austria and Northern Italy. Zoonotic infections in humans mostly occur after occupational exposure. We report here a case of a hunter with a typical Orf lesion (contagious ecthyma) on the finger, with no history of direct contact with domestic animals. Three weeks previously he had been hunting chamois (Rupicapra rupicapra) and cut his finger while handling a carcass. Parapoxvirus infection was confirmed by electron microscopy and PCR, and the species was identified by DNA sequencing. The sequence was highly homologous with prevalent sheep Orf virus and rather distant from parapoxviruses found in red deer in Northern Italy. As this case indicated that the infection was acquired via game, we performed spot testing in the suspected area and detected several seropositive animals. This is a strong indication that Orf virus has been introduced into chamois in Western Austria. This probably occurred via roaming domestic sheep sharing the high alpine areas during the summer months.]]> 2013-08-05 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1718
Genital warts are caused by human papillomavirus (HPV). HPV is a leading cause of anogenital malignancies and a role of HPV in the aetiology of oro-pharyngeal cancers has been demonstrated. The frequency of oral HPV infection in patients with genital warts and the association between concomitant genital, anal and oral infection is unclear. A total of 201 men and women with genital wart-like lesions were recruited. Swab samples were obtained from the genital warts and the anal canal and an oral rinse was collected. Anal HPV was found in 46.2% and oral HPV in 10.4% of the participants. Concordance between anal and genital wart HPV types was 78.1%, while concordance between oral and genital wart types was 60.9%. A lower concordance of 21.7% was observed between anal and oral HPV types. Significantly more women than men had multiple HPV types and anal HPV. In conclusion, extra genital HPV is common in patients with genital warts. A gender inequality seems to exist. ]]> 2013-09-25 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1666
Detection of anti-desmoglein-1 (anti-DSG-1) and anti-DSG-3 autoantibodies is widely used in the diagnosis of pemphigus. Two validated scoring systems, Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), are used for the evaluation of clinical severity. The aim of this cross-sectional study was to interpret the titres of pemphigus autoantibodies in correlation with either total or location-dependent PDAI scores and ABSIS. A total of 35 pemphigus patients were selected and evaluated at 3 time points. Total PDAI and ABSIS seemed useful in pemphigus with cutaneous lesions or in the mucocutaneous form, while location-dependent PDAI and ABSIS scores were useful in the mucosal form. Anti-DSG-1 autoantibodies titres better showed the disease extent in pemphigus with cutaneous only or with mucocutaneous lesions. Anti-DSG-3 autoantibodies titres did not correlate to disease activity.]]> 2013-08-06 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1622
This aim of this study was to validate the Scalpdex, a quality of life questionnaire for adults with scalp dermatitis, in children with scalp psoriasis. The reliability, responsiveness and validity of the 3 scales (symptoms, functioning and emotions) of this 22-item questionnaire were analysed in a cohort of children with scalp psoriasis (age range 6–18 years). A total of 94 children completed the questionnaire once, and 53 children a second time, after treatment of their scalp psoriasis. The Children’s Scalpdex in Psoriasis (CSP) demonstrated reliability with internal consistency (Cronbach’s α, 0.69–0.91). The CSP scales proved sensitive to change in the expected direction for children whose scalp psoriasis improved. Moderate effect sizes were observed between both visits for all 3 scales of the CSP (Cohen’s d, 0.44–0.58). In conclusion, the CSP is a reliable, responsive and valid questionnaire, which is the first to illustrate the specific influence of scalp psoriasis on quality of life in children. ]]> 2013-07-03 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1697
Psychiatric morbidity is frequent in patients with psoriasis. We compared the effectiveness of dermatological vs. interdisciplinary dermatological and psychiatric care for psoriasis. Adults with moderate-to-severe psoriasis were randomly allocated to dermatological (n = 24) or interdisciplinary care (n = 23) and treated accordingly. Primary endpoint was the mean change in Dermatology Life Quality Index (DLQI) at 6 months. Data was analysed by intention-to-treat. Mean ± SD change in DLQI was 7.5 ± 7.3 and 10.5 ± 9.9 after 6 months of dermatological and interdisciplinary care, respectively (p = 0.27). At baseline, 10 patients in the interdisciplinary treatment group (43%) had at least one psychiatric disorder. These patients showed significantly better DLQI response (DLQI change 14.8 ± 9.7) than patients receiving dermatological care only (p = 0.03). Ninety percent of psoriasis patients with DLQI scores exceeding psoriasis area and severity index (PASI) scores had comorbid psychiatric disease. Although psychiatric co-treatment is not generally required for patients with moderate-to-severe psoriasis, those patients with higher DLQI scores than PASI scores might benefit from interdisciplinary care. ]]> 2013-08-21 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1672
The aim of this study was to determine self-reported consumption of dermatological pharmaceuticals and quality of life (QoL), measured with Short Form 36, in relation to eczema, acne, psoriasis and other inflammatory skin conditions in the Swedish population. A questionnaire containing questions on the occurrence of skin diseases, health-related QoL and the use of pharmaceuticals was sent to a cross-sectional sample of the Swedish population, age range 18–84 years (n = 8,000). The response rate was 61%. The 1-year prevalence of skin diseases was 30–35%, with females reporting a higher prevalence. The prevalence was 11.5% for eczema other than hand eczema, 10.2% for acne, 7.5% for hand eczema, 3.9% for psoriasis and 3.1% for urticaria. QoL was significantly affected and 25% of females and 19% of males had used a dermatological drug. Compared with hand eczema, persons with psoriasis and other eczema reported significantly more use of topical steroids on prescription and more use of dermatological pharmaceuticals in total. Skin conditions are common; they affect QoL and lead to a high consumption of dermatological drugs; which deserves increased awareness in the society.
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Physical activity promotes health and prevents disease. When patients with atopic dermatitis (AD) undertake exercise, the itch often gets worse due to sweating, and this may reduce their engagement in physical exercise. The aim of this study was to determine the level of physical exercise in patients with AD compared with a control group from a normal population. Our hypothesis was that patients with AD have a lower level of physical exercise due to their skin disease. A total of 110 patients with AD and 196 subjects from a normal population, age range 20–34 years, answered a questionnaire. Eleven patients with AD underwent an in-depth interview. The patients with AD had the same level of physical exercise and attitude to physical exercise as the normal population. Therefore, our hypothesis could not be confirmed. In conclusion, the skin symptoms of AD do not appear to be an obstacle to moderate physical exercise. ]]> 2013-03-27 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1681
The aim of this study was to analyse factors associated with remission of atopic dermatitis (AD) in childhood. A population-based AD cohort of 894 children aged 1–3 years from a cross-sectional baseline study in 2000 was followed up in 2005. The association between remission, background, health, lifestyle, and environmental variables was estimated with crude and multivariable logistic regression. At follow-up, 52% of the children had remission. Independent factors at baseline predicting remission were: milder eczema (adjusted odds ratio (aOR), 1.43; 95% confidence interval (95% CI) 1.16–1.77); later onset of eczema (aOR 1.40; 95% CI 1.08–1.80); non-flexural eczema (aOR 2.57; 95% CI 1.62–4.09); no food allergy (aOR 1.51; 95% CI 1.11–2.04), and rural living (aOR 1.48; 95% CI 1.07–2.05). Certain aspects of AD and rural living were important for remission, but despite the initial hypotheses to the contrary, the environmental factors examined in this paper were not substantial predictors of remission.]]> 2013-08-28 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1679
The increased risk of squamous cell carcinomas (SCC) in renal transplant recipients (RTR) is related to impaired immunosurveillance as a consequence of immunosuppressive therapy. Since dendritic cells (DC) play an important role in immunosurveillance, we investigated the quantity of DC subsets and macrophages in normal skin of RTR and immunocompetent controls by immunohistochemistry. In this comparative study Langerhans’ cells (LC) were present in similar numbers in RTR and controls. The number of CD11c+ DC was significantly reduced in RTR, particularly in patients on triple treatment therapy, compared with controls. Macrophages were significantly increased. Plasmacytoid DC were not detected in normal skin. The reduced quantity of CD11c+ DC and increased number of macrophages in normal skin of immunosuppressed RTR may contribute to the increased incidence of SCC in RTR. This finding underlines the role of DC subsets in immunosurveillance, and may have implications for our understanding of the effect of immunosuppression on DC subsets. ]]> 2013-08-06 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1664
Herpes zoster neural injury was assessed by determining cutaneous nerve density in skin biopsies from the affected dermatomes of 35 adult patients with herpes zoster in the acute phase and 3 months post-treatment, using protein gene product 9.5 immunohistochemistry. In contrast to the significant increase in subepidermal nerve fibre density (11.77 ± 4.88/mm vs. 13.29 ± 5.74/mm, p = 0.045) after 3 months, no differences were found in epidermal free nerve endings (2.43 ± 2.35/mm and 2.8 ± 2.86/mm, p = 0.168). Patients with post-herpetic neuralgia had significantly lower subepidermal nerve fibre densities (9.7 ± 2.05/mm vs. 14.72 ± 6.13/mm, p = 0.011) compared with non-post-herpetic neuralgia patients. No differences in cutaneous nerve density were found in relation to antiviral therapy. In conclu-sion, 3 months after acute infection, no sign of epidermal innervation recovery is observed, while the increased subepidermal nerve fibre density in the affected dermatomes probably reflects nerve regeneration that is not affected by antiviral agent type. Subepidermal nerve fibre density is decreased in patients with post-herpetic neuralgia 3-months post-acute herpes zoster infection. ]]> 2013-08-05 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1632
The aim of the CARPE registry is to investigate characteristics and medical care in patients affected by chronic hand eczema. Patients are assessed by dermatological examination and patient questionnaire. Socio-economic and clinical data are collected, and quality of life is measured using the Dermatology Life Quality Index (DLQI). A total of 1,163 patients with chronic hand eczema were eligible for analysis (mean age 47.0 years; 54.6% female; mean disease duration 7.6 years). At inclusion, chronic hand eczema was very severe in 23.4%, severe in 47.0%, moderate in 20.1%, and clear or almost clear in 9.6% of patients. Median DLQI was 8.0. In all, 93.8% of patients reported use of topical corticosteroids, 25.6% systemic antihistamines, 28.3% topical calcineurin-inhibitors, 38.0% ultraviolet phototherapy, and 35.3% systemic treatment (19.7% alitretinoin) prior to inclusion in the registry. A significant proportion of patients may not receive adequate treatment according to the guideline on management of hand eczema. ]]> 2013-07-04 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1680
Angiopoietin-like protein 3 (ANGPTL3), which is part of a family of secreted glycoproteins that are structurally similar to angiopoietins, is principally expressed in the liver and is involved in lipid metabolism and angiogenesis. The aim of this study was to determine the clinical significance of serum ANGPTL3 levels, measured with a specific enzyme-linked immunosorbent assay, in patients with systemic sclerosis. Serum ANGPTL3 levels correlated positively with skin score in diffuse cutaneous systemic sclerosis with a disease duration ≤ 6 years. Furthermore, the prevalence of digital ulcers was significantly higher in patients with elevated serum ANGPTL3 levels than in other patients. Moreover, among patients excluding diffuse cutaneous systemic sclerosis with disease duration ≤ 6 years, serum ANGPTL3 levels correlated positively with estimated right ventricular systolic pressure. In conclusion, ANGPTL3 may contribute to the development of progressive skin sclerosis and proliferative obliterative vasculopathy, such as digital ulcers and pulmonary vascular involvement leading to pulmonary arterial hypertension, in systemic sclerosis. ]]> 2013-08-06 Clinical http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1667
Adequate sun protection is often neglected during occupational outdoor work. To investigate the acceptance and usability of sunscreens during outdoor work a single-blind, randomized-controlled, cross-over trial was performed in 40 subjects. Two sunscreen formulations were used daily on working days for 4 weeks at a time, with a wash-out phase before crossover. The primary outcome was overall acceptance of the products with daily application. More than 80% of the outdoor workers were fully satisfied with the cosmetic properties, sweat resistance, performance and usability of both products under outdoor working conditions. With respect to overall performance, the milk was rated slightly better than the gel. In terms of ease of application, the milk was preferred (p<0.05). Sunscreens for those working outdoors must contain very high, broad-spectrum, photostable filters for both UVB and UVA, they must be easy to apply and sweat resistant, and should not irritate the eyes.]]> 2013-08-06 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1685
A course of treatment with narrow-band ultraviolet B (NB-UVB) improves psoriasis and increases serum 25-hydroxyvitamin D (25(OH)D). In this study 12 patients with psoriasis who were supplemented with oral cholecalciferol, 20 µg daily, were given a course of NB-UVB and their response measured. At baseline, serum 25(OH)D was 74.14 ± 22.9 nmol/l. At the 9th exposure to NB-UVB 25(OH)D had increased by 13.2 nmol/l (95% confidence interval (95% CI) 7.2–18.4) and at the 18th exposure by 49.4 nmol/l (95% CI 35.9–64.6) above baseline. Psoriasis Area Severity Index score improved from 8.7 ± 3.5 to 4.5 ± 2.0 (p < 0.001). At baseline, psoriasis lesions showed low vitamin D metabolizing enzyme (CYP27A1, CYP27B1) and high human β-defensin-2 mRNA expression levels compared with those of the healthy subjects. In conclusion, NB-UVB treatment significantly increases serum 25(OH)D in patients with psoriasis who are taking oral vitamin D supplementation, and the concentrations remain far from the toxicity level. Healing psoriasis lesions show similar mRNA expression of vitamin D metabolizing enzymes, but higher antimicrobial peptide levels than NB-UVB-treated skin in healthy subjects.]]> 2013-08-06 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1642
Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program–Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.]]> 2013-08-22 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1752
Skin cancer is common among white populations and rapid increases in incidence are being observed in many countries, leading to a large burden on healthcare systems. Unnecessary referrals from general practitioners (GPs) may contribute to this burden. The aim of this study was to analyse the quality of referrals from GPs of patients with skin tumours. Referral letters for 734 patients were collected. The proposed diagnoses were compared with definitive diagnosis made by dermatologists. In 44.5%, lesions appeared to be benign. Malignant skin tumours were poorly recognised by GPs and seborrheic keratoses were often mistaken for naevi (33.6%). Furthermore, with total body examination, dermatologists found 111 additional malignant lesions. We discussed several recommendations to minimise unnecessary referrals as well as the future role of GPs in skin cancer care.]]> 2013-12-05 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1683
The aim of this study was to evaluate the practical importance of the presence of shiny white streaks (SWS) (chrysalis or crystalline structures in polarized dermoscopy) for suspicion of malignancy, diagnosis of melanoma, and pre-operative estimation of Breslow thickness and its correlation with total dermoscopy score (TDS). SWS were present in 13.6% of 800 consecutive excised lesions. The presence of SWS was associated with malignancy (odds ratio (OR) 10.534, 95% confidence interval (95% CI) 6.357–17.455, p < 0.0005) in the context of melanocytic lesions with invasive melanoma (OR 10.333, 95% CI 3.812–28.014) and melanomas with high TDS (OR 6.286, 95% CI 1.673–23.619), but was also a factor in the diagnosis of featureless and some thin melanomas. These results corroborate the clinical applicability of SWS in aiding the diagnosis of malignancy and helping to raise the general dermatologist’s awareness in cases of doubt and featureless lesions. ]]> 2013-08-07 Investigative http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1767
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Abstract is missing (Quiz)]]> 2013-03-07 Quiz