E.J. van Zuuren

Psychosocial impact of acne vulgaris: Evaluation of the relation between a change in clinical acne severity and psychosocial state

Background: Although knowledge concerning the impact of acne vulgaris on quality of life has increased in recent years, relatively few studies have assessed the effect of a change in clinical severity on psychosocial state. Objective: Assessment of the effect of a change in clinical acne severity on psychosocial state. Methods: This was investigated by means of questionnaires and clinical assessements by acne patients and dermatologists. Fifty females with mild to moderate facial acne were seen before and after a 9-month treatment with oral contraceptives. Results: The results showed a great variability in psychosocial impairment between individuals. After 9 months, a significant reduction in clinical severity was seen overall which did not relate to the significant improvements in self-esteem, stability of self-esteem and acceptance of appearance. Conclusion: Perceived psychosocial impairment is individually based, is greater in women who subjectively overrate their acne and does not relate to clinical improvement.

Resurfacing the back of the hand as treatment and prevention of multiple skin cancers in kidney transplant recipients

BACKGROUNDnSkin cancer is a serious problem in renal transplant recipients. In some patients numerous skin cancers develop on the back of the hand. Instead of repeated excisions, a more radical procedure may be necessary. For these patients a new surgical therapy is available: resurfacing the back of the hand.nnnOBJECTIVEnOur purpose was to clinically evaluate this new procedure.nnnMETHODSnEleven kidney transplant recipients who underwent resurfacing of the back of the hand were analyzed in a retrospective follow-up study. With this surgical procedure the skin of the entire dorsum of the hand is excised and split-skin grafts harvested from thigh and buttock skin are then placed. Information was gathered from the medical records and questionnaires, and by physical examination.nnnRESULTSnThe mean follow-up time was 4.7 years. No recurrences of skin cancer were observed in the transplanted skin. The cosmetic appearance was acceptable, and there were few side effects.nnnCONCLUSIONnResurfacing the back of the hand can be a successful treatment for carefully selected patients with multiple skin cancers on the back of the hand and can be used prophylactically in patients with severely actinically damaged skin.

Anaphylaxis after consuming soy products in patients with birch pollinosis

bicycle ergometer lead to generalized urticaria and dizziness proving WDEIA in our patient. A contribution of gender or female sex hormones in allergic reactions has been discussed for a long time; however, mechanisms underlying hormone-triggered allergic reactions are still poorly understood (3). Based on medical history, menses was already assumed to be a potential triggering factor of WDEIA, but systematic provocation tests to prove an impact of menses in WDEIA were still missing (1, 4). Recently, Bito et al. demonstrated a patient in which anaphylaxis to cow milk exclusively developed following combined exposure to acetylsalicylic acid, cow milk, and physical exercise at the time of her premenstrual phase (5). Our report is the first that applied systematic provocation tests to outline the triggering potential of menstruation in a patient with WDEIA. As WDEIA in our patient exclusively occurred during her menses, medical history and diagnostic measures of anaphylactic reactions such as provocation tests need to record and include menstruation to diagnose WDEIA and other types of cofactor-induced anaphylaxis. The authors have declared that they have no conflict of interest.

Alpine climate treatment of atopic dermatitis: a systematic review

Climate therapy has been used for decades in the treatment of atopic dermatitis (AD), but evidence of its effectiveness has not yet been assessed systematically. A systematic literature search in Medline, Embase, and the Cochrane library was performed to identify all original studies concerning alpine climate treatment. The risk of bias of individual studies was assessed following the Cochrane Handbook, and level of evidence was rated using GRADE guidelines. Fifteen observational studies were included concerning 40 148 patients. Four studies concerning 2670 patients presented follow‐up data over a period of 1 year. Disease activity decreased in the majority of patients during treatment (96% of n = 39 006) and 12‐month follow‐up (64% of n = 2670). Topical corticosteroid use could often be reduced or stopped during treatment (82% of n = 1178) and during 12‐month follow‐up (72% of n = 3008). Quality assessment showed serious study limitations, therefore resulting in a very low level of evidence for the described outcomes. Randomized controlled trials designed with a follow‐up period including well‐defined patient populations, detailed description and measurement of applied interventions during climate therapy and using validated outcomes including cost‐effectiveness parameters, are required to improve the evidence for alpine climate therapy as an effective treatment for patients with AD.

A systematic review and meta-analysis on Staphylococcus aureus carriage in psoriasis, acne and rosacea

Staphylococcus aureus might amplify symptoms in chronic inflammatory skin diseases. This study evaluates skin and mucosal colonization with S. aureus in patients with psoriasis, acne and rosacea. A systematic literature search was conducted. Both odds ratios (OR) for colonization in patients versus controls and the prevalence of colonization in patients are reported. Fifteen articles about psoriasis and 13 about acne (12 having a control group) were included. No study in rosacea met our inclusion criteria. For psoriasis, one study out of three controlled studies showed increased skin colonization (OR 18.86; 95xa0% confidence interval [CI] 2.20–161.99). Three out of the five studies that reported on nasal colonization showed significant ORs varying from 1.73 (95xa0% CI 1.16–2.58) to 14.64 (95xa0% CI 2.82–75.95). For acne one of the three studies that evaluated skin colonization reported a significant OR of 4.16 (95xa0% CI 1.74–9.94). A relation between nasal colonization and acne was not found. Limitations in study design and low sample sizes should be taken into consideration when interpreting the results. Colonisation with S. aureus seems to be increased in patients with psoriasis. This bacterial species, known for its potential to induce long-lasting inflammation, might be involved in psoriasis pathogenesis. Information on acne is limited. Prospective controlled studies should further investigate the role of S. aureus in chronic inflammatory skin diseases.

Diphenylcyclopropenone in patients with alopecia areata. A critically appraised topic.

To assess the efficacy and safety of topical diphenylcyclopropenone (DPCP) in patients with alopecia areata.

A breathtaking DRESS due to amoxicillin–clavulanate presenting as polymorphic eruption of the pregnancy

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a delayed-type drug hypersensitivity reaction with potential life-threatening complications. To our knowledge, DRESS has never been described in pregnancy. Here, we report on a pregnant woman presenting with erythematous plaques on the abdomen, developing cardiac tamponade due to eosinophilic perimyocarditis and an interstitial pneumonitis five weeks after exposure to amoxicillin-clavulanate. This article is protected by copyright. All rights reserved.

Epidermal growth factor receptor inhibitor‐associated rash prevented by oral tetracyclines

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