New articles from Acta Dermato-Venereologica Acta Dermato-Venereologica is an international peer-review journal for clinical and experimental research in the field of dermatology and venereology. 96:5 2016 - Erratum
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2016-05-30 Erratum
96:5 2016 - Clinical and Pathological Aspects of Melanoma among Children in Finland
Abstract is missing (Short communication)]]>
2016-02-23 Shortcom
96:5 2016 - Long-term Follow-up of Longitudinal Melanonychia in Children and Adolescents Using an Objective Discrimination Index
Abstract is missing (Short communication)]]>
2016-02-10 Shortcom
96:5 2016 - Efficacy of Trimodality Therapy for Pretibial Myxoedema: A Case Series of 20 Patients
Abstract is missing (Short communication)]]>
2016-03-01 Shortcom
96:5 2016 - Long-term Outcome of Daylight Photodynamic Therapy with Amino-5-laevulinate Nanoemulsion vs. Methyl-5-aminolaevulinate for Actinic Keratoses
Abstract is missing (Short communication)]]>
2016-02-10 Shortcom
96:5 2016 - Photoallergic Drug Eruption Caused by Certolizumab Pegol
Abstract is missing (Short communication)]]>
2016-02-03 Shortcom
96:5 2016 - Fibulin Protein Expression in Mid-dermal Elastolysis and Anetoderma: A Study of 23 Cases
Abstract is missing (Short communication)]]>
2016-02-10 Shortcom
96:5 2016 - Malignant Peripheral Nerve Sheath Tumour Arising From Solitary Sclerotic Neurofibroma
Abstract is missing (Short communication)]]>
2016-01-27 Shortcom
96:5 2016 - Erythema Induratum in a Patient with Pulmonary Mycobacterium avium Infection
Abstract is missing (Short communication)]]>
2016-02-18 Shortcom
96:5 2016 - Dangerous Leg Cramps: Severe Pustular Exanthema Caused by an Over-the-Counter Drug
Abstract is missing (Short communication)]]>
2016-02-02 Shortcom
96:5 2016 - Subcutaneous Phaeohyphomycosis due to Alternaria dennisii in an Immunocompromised Patient
Abstract is missing (Short communication)]]>
2016-02-05 Shortcom
96:5 2016 - Alexithymia in Uraemic Pruritus
Abstract is missing (Short communication)]]>
2015-12-21 Shortcom
96:5 2016 - Itch and Pain Characteristics in Skin Carcinomas
Abstract is missing (Short communication)]]>
2016-01-11 Shortcom
96:5 2016 - Pemphigoid Gestationis Complicating an Egg Donation Pregnancy
Abstract is missing (Short communication)]]>
2016-02-03 Shortcom
96:5 2016 - Urethritis-associated Pathogens in Urine from Men with Non-gonococcal Urethritis: A Case-control Study
The aetiology of non-gonococcal urethritis (NGU) remains unexplained in 30–40% of patients. Urine samples from men attending Swedish sexually transmitted disease clinics were examined by species-specific quantitative PCRs for Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, Ureaplasma urealyticum, U. parvum, adenovirus, herpes simplex virus, Neisseria meningitidis, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae. A total of 187 men with acute NGU (symptoms ≤ 30 days) and 24 with chronic NGU (symptoms > 30 days) were cases, and 73 men without NGU were controls. Number of lifetime sexual partners was negatively associated with U. urealyticum bacterial load. C. trachomatis and M. genitalium were associated with NGU, as was U. urealyticum, with bacterial loads ≥ 1.3 × 103 genome equivalents/ml urine. Virus and H. influenzae might explain a few NGU cases, but the aetiology in at least 24% of patients with acute NGU was unexplained. In multivariate analysis, detection of U. urealyticum was significantly more common in acute NGU (20%) compared with controls (11%).]]>
2016-02-18 Investigative
96:5 2016 - Comparison of 5-Aminolevulinic Acid Photodynamic Therapy and Clobetasol Propionate in Treatment of Vulvar Lichen Sclerosus
The aim of this study was to evaluate the effectiveness of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for the treatment of vulvar lichen sclerosus (VLS) and compare its effectiveness with that of clobetasol propionate. Four sessions of topical photodynamic therapy (PDT) were administered at 2-week intervals (n?=?20). Clobetasol propionate (0.05%) was used daily for 8 weeks (n?=?20). The rate of complete response in the PDT group (14/20) was double that of the clobetasol propionate group (7/20) (p?
2016-02-10 Clinical
96:5 2016 - Patch Testing with Main Sensitizers Does Not Detect All Cases of Contact Allergy to Oxidized Lavender Oil
Lavender oil is an essential oil obtained from lavender (Lavendula angustifolia). The main components linalool and linalyl acetate have been shown to autoxidize in contact with oxygen in the air, forming sensitizing hydroperoxides. Patients with suspected allergic contact dermatitis were consecutively patch-tested with oxidized lavender oil 6% pet., oxidized linalyl acetate 6% pet., and oxidized linalool 6% pet. to investigate the frequency of contact allergy to oxidized lavender oil, and the pattern of concomitant reactions to oxidized linalool and oxidized linalyl acetate. Positive reactions to oxidized lavender oil were found in 2.8% of the patients. Among those, 56% reacted to oxidized linalool and/or oxidized linalyl acetate, while 52% reacted to the fragrance markers of the baseline series. Oxidized lavender oil showed among the highest frequencies of contact allergy to studied essential oils. A well-standardized preparation of oxidized lavender oil could be a useful tool for diagnosis of contact allergy to fragrances.]]>
2016-01-13 Clinical
96:5 2016 - Illness Perception and Psychological Distress in Persons with Porphyria Cutanea Tarda
Porphyria cutanea tarda (PCT) requires long-term treatment and follow-up, although many patients experience life-long remission. The aim of this cross-sectional postal survey was to describe and investigate the association between illness perception, health complaints, self-reported symptoms and distress in persons with PCT. The participants perceived PCT as a chronic condition with high levels of personal and treatment control. Persons who reported active symptoms scored higher on perceived illness threat, total health complaints and psychological distress compared with those in remission or latent phases. However, a higher perception of illness threat and the total burden of health complaints were more closely associated with psychological distress than were perceived PCT symptoms activity. This has implications for clinical consultation; dermatologists should be attentive to symptoms activity, but also recognize that patients in remission with a high perceived illness threat and multiple health complaints might be especially vulnerable to psychological distress with regards to PCT.]]>
2016-02-11 Clinical
96:5 2016 - Mycosis Fungoides: A Retrospective Study of 44 Swedish Cases
Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma with slow disease progression. There is a lack of descriptive data from Sweden concerning patients with this diagnosis. This study extracted data on patients admitted to the dermatology department at Lund University Hospital, Sweden from 1996 to 2010. Forty-four patients with clinically and histopathologically verified MF were identified during the period, with a mean follow-up time of 5.6 years. Median age at initial diagnosis was 64 years. In several cases other skin diseases preceded MF onset, such as non-specific dermatitis (32%) and parapsoriasis (30%). The majority of patients (86%, n = 38) had limited-stage (IA–IB) disease at the time of diagnosis. Overall response rate to psoralen plus ultraviolet A (PUVA) treatment was 81%. In adnexal MF, a trend to higher rate of progression to an advanced stage was observed when compared with non-adnexal disease (40% and 21%, respectively). Increased levels of soluble interleukin-2 (IL-2) receptor correlated with disease stage, being elevated in advanced stages or adnexal disease, but almost never elevated in early non-adnexal limited-stage disease. Overall mortality was 25%, but only 11% could be verified as caused by MF.]]>
2016-02-03 Clinical
96:5 2016 - Cost-utility Analysis of Supported Self-management with Motiva­tional Interviewing for Patients with Psoriasis
There are few studies evaluating the cost-effectiveness of self-management interventions for patients with psoriasis. Motivational interviewing (MI) as a telephone follow-up after climate-heliotherapy was effective on several clinical parameters, but its cost-effectiveness is unknown. A cost-utility analysis was conducted alongside a randomized controlled trial (RCT) comparing MI with usual care. A total of 169 Norwegian patients were included. A within-trial analysis compared the costs and quality-adjusted life years (QALYs). Utilities were measured with the 15D instrument, supplemented with Dermatological Life Quality Index (DLQI). A time-integrated summary score defined the clinical effects. QALYs were adjusted for baseline differences. MI provided equivalent quality of life and utility (15D: –0.0022 QALYs (95% Cl –0.02, 0.01), p = 0.77, and DLQI: –0.62 QALYs (95%CI –0.65, 0.41), p = 0.24, at lower costs €–1103 (–2293, 87), p = 0.058, compared with treatment-as-usual. The MI intervention was thus cost-effective. This result was more evident when using the DLQI as outcome measure compared with 15D. ]]>
2016-01-28 Clinical
96:5 2016 - Squamous Cell Carcinoma Following Photodynamic Therapy for Cutaneous Bowen’s Disease in a Series of 105 Patients
Photodynamic therapy (PDT) is an alternative to surgery for Bowen’s disease. This monocentric retrospective study included 105 patients with Bowen’s disease, treated with PDT between 2007 and 2013, who received a total of 151 different PDT fields. Comparison of immunocompromised and non-immunocompromised patients revealed that the former often had a previous history of squamous cell carcinoma (SCC; p = 0.004) and received more PDT fields (p = 0.007) than the latter. At least one SCC occurred post-PDT in 16 out of 105 patients in a PDT field. However, many of the patients were at risk of SCC and the possibility that the lesion did not have a mixed histology at baseline, but might simply be a transformation of non-PDT-responsive Bowen’s disease, cannot be excluded. Although it is rare, patients should be closely monitored for SCC post-PDT.]]>
2016-01-27 Clinical
96:5 2016 - Economic Burden of Psoriasis and Potential Cost Offsets with Biologic Treatment: A Swedish Register Analysis
Estimates of direct and indirect costs of psoriasis are limited. The aim of this study was to estimate: (i) costs in patients with psoriasis compared with controls; and (ii) impact on costs from initiating biologics. The study extracted data from Swedish administrative registers and compared 31,043 patients with 111,645 sex-, age- and residency-matched referents. Mean direct and indirect costs were estimated as US dollars (USD) 1,365 (62%) and USD 3,319 (50%) higher in patients compared with referents, respectively. The study included 352 patients treated with biologics who had at least 1-year follow-up before and after initiation of biologics. Among the 193 patients persistent with biologics for one year, 1-year costs of biologics were estimated at USD 23,293 (95% confidence interval (95% CI) 22,372−24,199). This cost was partially offset, with savings in direct cost estimated to range from USD –1135 (95% CI –2,050 to –328) to USD –4,422 (95% CI –6,552 to –2,771), depending on assumptions. The corresponding estimates for indirect costs savings were from USD –774 (95% CI –2,019−535) to USD –1,875 (95% CI –3,650 to –188). The study suggests that psoriasis is associated with substantial costs, which may be modifiable with treatment. ]]>
2016-02-02 Investigative
96:5 2016 - Immune-mediated Skin Inflammation is Similar in Severe Atopic Dermatitis Patients With or Without Filaggrin Mutation
Inflammatory cytokines can impair the skin barrier, but the question as to whether barrier alterations affect keratinocyte immune responses remains unanswered. The aim of this study was to investigate whether immune-mediated skin inflammation differs between severe atopic dermatitis patients with or without filaggrin mutation. The levels of filaggrin, inflammatory T helper 2 polarizing cytokines (thymic stromal lymphopoietin (TSLP) and interleukin 33 (IL-33)) and chemokine (C-C motif) ligand 27 (CCL27), histological severity markers, T and dendritic cell counts in biopsies from lesional skin of severe atopic dermatitis patients with and without filaggrin mutation and healthy skin were quantified by immunohistochemistry. The results were confirmed by quantitative PCR analyses. No significant differences were found between the 2 patient groups. Expression of atopic dermatitis-specific cytokines showed significant correlation with histological severity. These findings suggest that the immune-mediated skin inflammation (represented by keratinocyte-derived factors, T cell and dendritic cell counts) is similar in the 2 patient groups with severe atopic dermatitis, and that immune activation is connected to the severity of the disease rather than to the origin of barrier alterations.]]>
2016-02-03 Investigative
96:5 2016 - Non-invasive Imaging of Localised Scleroderma for Assessment of Skin Blood Flow and Structure
Extensive morphoea causes major morbidity, disability and disfigurement; pathophysiology is poorly understood. The aim of this study was to investigate, with non-invasive imaging, the relationship between localised abnormalities of skin structure and perfusion, which characterise morphoea. Thirty-two patients with morphoea underwent imaging at affected and unaffected sites. Skin thickness was imaged with optical coherence tomography (OCT) and high-frequency ultrasound (HFUS). Perfusion was imaged with dual-wavelength laser Doppler imaging (LDI) and thermography. Epidermal thickness showed a small increase from affected to unaffected site (OCT, active and inactive plaques [p = 0.005 and p = 0.004], HFUS active plaques only [p = 0.03]). Deeper perfusion was higher within affected than unaffected sites (LDI p < 0.001, thermography p < 0.0001, active and inactive plaques). Epidermal thickness was inversely related to superficial (but not deeper) perfusion. This novel study of OCT, HFUS, LDI and thermography confirms loss of epidermal thickness and increased deeper perfusion in morphea plaques.]]>
2016-02-10 Investigative
96:5 2016 - Cadherin 11 Involved in Basement Membrane Damage and Dermal Changes in Melasma
Basement membrane (BM) disruption and dermal changes (elastosis, collagenolysis, vascular ectasia) have been reported in melasma. Although ultraviolet (UV) irradiation can induce these changes, UV is not always necessary for melasma development. Cadherin 11 (CDH11), which is upregulated in some melasma patients, has previously been shown to stimulate melanogenesis. Because CDH11 action requires cell-cell adhesion between fibroblasts and melanocytes, BM disruption in vivo should facilitate this. The aim of this study was to examine whether CDH11 overexpression leads to BM disruption and dermal changes, independent of UV irradiation. Immunohistochemistry/immunofluorescence, real-time PCR, Western blotting, and zymography suggested that BM disruption/dermal changes and related factors were present in the hyperpigmented skin of CDH11-upregulated melasma patients and in CDH11-overexpressing fibroblasts/keratinocytes. The opposite was seen in CDH11-knockdown cells. UV irradiation of the cultured cells did not increase CDH11 expression. Collectively, these data demonstrate that CDH11 overexpression could induce BM disruption and dermal changes in melasma, regardless of UV exposure.]]>
2016-01-11 Investigative
96:5 2016 - Highly Concordant Results Between Immunohistochemistry and Molecular Testing of Mutated V600E BRAF in Primary and Metastatic Melanoma
This study tested the sensitivity and specificity of VE1 antibody raised against BRAFV600E protein, on 189 melanoma samples, compared with molecular testing. In addition, the therapeutic response to BRAF inhibitors was analysed in 27 patients, according to staining intensity (scored from weak to strong) and pattern (homogeneous or heterogeneous). BRAFV600E status during melanoma progression was evaluated in a cohort of 54 patients with at least paired-samples. High sensitivity (98.6%) and specificity (97.7%) of VE1 were confirmed. During melanoma progression different samples showed concordant phenotypes. Heterogeneous VE1 staining was observed in 28.5% of cases, and progression-free survival was higher in patients with tumour samples displaying such staining. These findings suggest that only VE1-negative tumours would be genotyped to detect other BRAFV600 mutations, and that either primary melanoma or metastasis can be tested using immunohistochemistry, according to the material available.]]>
2016-01-15 Investigative
96:5 2016 - Possible Antipruritic Mechanism of Cyclosporine A in Atopic Dermatitis
Cyclosporine A is an immunosuppressive agent that suppresses pruritus and is currently used in the treatment of patients with severe atopic dermatitis. The aim of this study was to elucidate the antipruritic mechanism of cyclosporine A using a mouse model of atopic dermatitis. Intraperitoneal injection of cyclosporine A (5 mg/kg) significantly reduced epidermal nerve density, number of scratching bouts, dermatitis scores, and transepidermal water loss, as well as decreasing the numbers of inflammatory cells in the dermis and decreasing epidermal thickness. Intraperitoneal injection of cyclosporine A dose-dependently inhibited increased itch-related receptor gene expression, such as interleukin-31 receptor A and neurokinin-1 receptor, in the dorsal root ganglion of atopic dermatitis model mice. Thus, the antipruritic efficacy of cyclosporine A may involve reduced epidermal nerve density and expression levels of itch-related receptor genes in the dorsal root ganglion, as well as improvement in acanthosis and reduction in cutaneous inflammatory cell number.]]>
2016-01-14 Investigative
96:5 2016 - Itch Perception and Skin Reactions as Modulated by Verbal Suggestions: Role of Participant’s and Investigator’s Sex
This study investigated sex-specific differences in itch perception and skin reactions, as modulated by verbal suggestions, and the role of the investigator’s sex. Healthy volunteers (50 males, 50 females), divided into 4 groups, were tested by male and female investigators. Itch was induced via prick testing with sodium chloride and histamine in 4 runs; 2 control conditions (with no exaggerated verbal comments about expected itch) and 2 experimental conditions (with exaggerated verbal comments). After 5 min, wheal and flare reactions were measured and itch intensity was rated by subjects on a numerical rating scale. Exaggerated verbal suggestions resulted in higher itch intensity ratings in the sodium chloride and histamine condition, and higher unpleasantness ratings and a wheal of greater extent in the sodium chloride condition, as well as a flare of greater extent in the histamine condition. The magnitude of the differences between the exaggerated verbal suggestion conditions and respective control conditions was only significantly different between male and female investigators concerning flare size in the histamine condition. There were no differences between male and female participants. Therefore, sex differences may play only a minor role in nocebo-induced itch perception.]]>
2016-02-02 Investigative
96:5 2016 - Psychophysiological Processing of Itch in Patients with Chronic Post-burn Itch: An Exploratory Study
A substantial proportion of patients with burn injury develop chronic itch, which can severely affect their quality of life. As found in research on chronic pain, different psychophysiological processes may also play a role in chronic itch, of which central sensitization, conditioned modulation, and attentional processes have been studied most frequently. This study aimed to explore psychophysiological processes of chronic post-burn itch by comparing 15 patients with long-term itch due to burn injury with 15 matched healthy controls. Exploratory results indicated tendencies for higher itch sensitivity in patients than in controls, for mechanical stimuli and histamine, but not for electrical stimulation. Results further suggest that the efficacy of itch modulation by an itch- or pain-conditioning stimulus or directing attention towards itch stimuli do not differ between these patients and controls. Further elucidation of the processes underlying post-burn itch may improve the early identification and treatment of burn patients developing chronic itch.]]>
2016-01-12 Investigative
96:5 2016 - Multidisciplinary Management of Mastocytosis: Nordic Expert Group Consensus
Mastocytosis is a heterogeneous group of diseases defined by an increased number and accumulation of mast cells, and often also by signs and symptoms of mast cell activation. Disease subtypes range from indolent to rare aggressive forms. Mastocytosis affects people of all ages and has been considered rare; however, it is probably underdiagnosed with potential severe implications. Diagnosis can be challenging and symptoms may be complex and involve multiple organ-systems. In general it is advised that patients should be referred to centres with experience in the disease offering an individualized, multidisciplinary approach. We present here consensus recommendations from a Nordic expert group for the diagnosis and general management of patients with mastocytosis.]]>
2016-02-17 Special
96:5 2016 - Eczema Trials: Quality of Life Instruments Used and Their Relation to Patient-reported Outcomes. A Systematic Review
It is unclear which quality of life instruments have thus far been used in eczema trials. Therefore, we aimed to identify these instruments. We searched the Global Resource of Eczema Trials (GREAT) database for reports of randomized controlled trials. Information on patient-reported outcomes, particularly quality of life, was extracted from eligible studies. 287 full texts reporting on 303 trials and 72 abstracts were included. 63/303 studies (20.8%) assessed quality of life and used 18 named and 4 unnamed instruments. The Dermatology Life Quality Index (DLQI), the Children’s Dermatology Life Quality Index (CDLQI), the Infant’s Dermatitis Quality of Life Index (IDQOL), and the Dermatitis Family Impact (DFI) were the most common measures in adults, children, infants, and caregivers, respectively. In conclusion, only about one fifth of eczema trials include a quality of life measure as outcome. Many different instruments are used, limiting the possibilities of comparing and synthesising individual trials’ findings.]]>
2016-02-09 Special
96:5 2016 - The Role of Neuromediators and Innervation in Cutaneous Wound Healing
The skin is densely innervated with an intricate network of cutaneous nerves, neuromediators and specific receptors which influence a variety of physiological and disease processes. There is emerging evidence that cutaneous innervation may play an important role in mediating wound healing. This review aims to comprehensively examine the evidence that signifies the role of innervation during the overlapping stages of cutaneous wound healing. Numerous neuropeptides that are secreted by the sensory and autonomic nerve fibres play an essential part during the distinct phases of wound healing. Delayed wound healing in diabetes and fetal cutaneous regeneration following wounding further highlights the pivotal role skin innervation and its associated neuromediators play in wound healing. Understanding the mechanisms via which cutaneous innervation modulates wound healing in both the adult and fetus will provide opportunities to develop therapeutic devices which could manipulate skin innervation to aid wound healing.]]>
2016-02-02 Review
96:5 2016 - Facial Erythema of Rosacea – Aetiology, Different Pathophysiologies and Treatment Options
Rosacea is a common chronic skin condition that displays a broad diversity of clinical manifestations. Although the pathophysiological mechanisms of the four subtypes are not completely elucidated, the key elements often present are augmented immune responses of the innate and adaptive immune system, and neurovascular dysregulation. The most common primary feature of all cutaneous subtypes of rosacea is transient or persistent facial erythema. Perilesional erythema of papules or pustules is based on the sustained vasodilation and plasma extravasation induced by the inflammatory infiltrates. In contrast, transient erythema has rapid kinetics induced by trigger factors independent of papules or pustules. Amongst the current treatments for facial erythema of rosacea, only the selective α2-adrenergic receptor agonist brimonidine 0.33% topical gel (Mirvaso®) is approved. This review aims to discuss the potential causes, different pathophysiologies and current treatment options to address the unmet medical needs of patients with facial erythema of rosacea. ]]>
2016-02-05 Review
96:4 2016 - Symmetrical, Hypopigmented Papules and Plaques on the Palms Induced by Contact with Water: A Quiz
Abstract is missing (Quiz)]]>
2015-11-24 Quiz
96:4 2016 - Urticaria as a Presenting Prodromal Manifestation of Attacks of Hereditary Angioedema
Abstract is missing (Correspondence)]]>
2016-02-09 Correspondence
96:4 2016 - Comment: Clinical Pathology Correlation: Clinical First, then Pathology, and Lastly Immunochemistry
Abstract is missing (Correspondence)]]>
2016-01-18 Correspondence
96:4 2016 - CD30-positive Cutaneous Pseudolymphoma Caused by Tocilizumab in a Patient with Rheumatoid Arthritis: Case Report and Literature Review
Abstract is missing (Short communication)]]>
2015-12-10 Shortcom
96:4 2016 - Cryoglobulinaemia (IgG-κ-type and IgM-γ-type) with Occluding Leukocytoclastic Vasculitis in a Patient with Vitiligo and Demyelinating Polyneuropathy
Abstract is missing (short communcation)]]>
2016-01-20 Shortcom
96:4 2016 - Non-infectious Panniculitis during Hydroxyurea Therapy in a Patient with Myeloproliferative Disease
Abstract is missing (Short communication)]]>
2016-01-11 Shortcom
96:4 2016 - Dual CD4/CD8-positive Ichthyosiform Mycosis Fungoides with Lymph Node, Peripheral Blood and Cardiac Involvement: A Case Report
Abstract is missing (Short communication)]]>
2015-12-14 Shortcom