G.B.E. Jemec

Skin problems in stoma patients

Ostomy patients are dependent on the integrity of their peristomal skin to maintain a normal lifestyle. Peristomal skin problems are thought to be common and may interfere with the use of ostomy pouching systems. This is a specialist area not commonly seen by dermatologists. This article seeks to provide an overview of the topic for the general dermatologist. A systematic literature search was conducted. The articles found were reviewed and relevant articles were selected by two investigators. Loss of skin integrity may be related to chemical injury, mechanical destruction, infectious conditions, immunological reactions, disease‐related conditions. Peristomal irritant dermatitis caused by skin contact with ostomy effluent is by far the most ordinary condition seen. Mechanical trauma, infection and aggravation of pre‐existing skin diseases are also seen. Allergic contact dermatitis, which is often cited as the cause of peristomal skin problems, appears to be a rare condition with an estimated prevalence of only 0.6%. In spite of the importance of the integrity of peristomal skin, the topic is poorly described in the literature. The existing publications suggest that although peristomal skin disease can be diagnosed and treated, additional information on both patients and physicians is necessary to optimize patient care.

Ethnicity and stratum corneum ceramides

Backgroundu2002 The barrier function of the skin is dependent on an optimal composition of the stratum corneum lipids, exemplified by the altered lipid profile in patients with atopic eczema (AE). Differences in the global prevalence of AE point to the environment as an important factor in AE. Studies on filaggrin point to a genetic aspect in AE. The influence of environment and genes needs to be explored.

Efalizumab for severe refractory atopic eczema: retrospective study on 11 cases.

Backgroundu2002 Efalizumab is a recombinant humanized murine monoclonal antibody against CD11a, approved for the treatment of plaque psoriasis. However, recent reports suggest that it also may be effective in the treatment of severe atopic dermatitis (AD).

Validation of Cyanoacrylate Method for Collection of Stratum Corneum in Human Skin for Lipid Analysis

Background and Objective: Lipids in the stratum corneum (SC) are of major importance for the skin barrier function. Many different methods have been used for the collection of SC for the analysis of SC lipids. The objective of the present study was to validate the cyanoacrylate method for the collection of SC in relation to lipid analysis. Methods: The results of the lipid analysis (ceramide/cholesterol and ceramide profile) of SC samples obtained by the cyanoacrylate method were compared to the results of the lipid analysis of mechanically removed SC samples. The intra- and interindividual variations in lipid composition were assessed when using the cyanoacrylate method, and lipid compositions in cyanoacrylate samples and samples taken from different depths of SC were compared. Results: No statistically significant differences were found between mean values of lipids from the mechanically removed total thickness of the SC and cyanoacrylate samples. With respect to the cyanoacrylate samples, the intraindividual variation was significantly smaller than the interindividual variation, and the results did not indicate a change in lipid profile related to the depth of SC. The results clearly indicate that the cyanoacrylate method used for obtaining SC for lipid analysis is a useful and valid method for the purpose.

Why quality of life measurement is important in dermatology clinical practice: An expert-based opinion statement by the EADV Task Force on Quality of Life.

The aim of this study was to describe the many ways in which quality of life (QoL) measurement may potentially be advantageous in routine clinical dermatology practice. Thirteen members of the EADV Task Force on Quality of Life, eight dermatologists, three health psychologists, one epidemiologist and one pharmacoepidemiologist, independently listed all of the ways they thought this may be advantageous. A total of 108 different ways of using QoL information in clinical practice were suggested (median per participant = 8, range = 4–15), and were classified into 20 descriptive groups. These were sorted into the following five categories: inform clinical decisions, clinician–patient communication, awareness of skin disease burden, informing the consultation and clinical service administration. The wide range of potential benefits identified may not only encourage clinicians to use these measures but also highlights many areas requiring evidence to establish the true value of routine use of QoL measures.

What's new in hidradenitis suppurativa?

On average only four to six new papers (as indexed by Medline/Index Medicus) appear every year on the topic of hidradenitis suppurativa. It is, therefore, obviously either a dauntingly complex problem or one that has just not caught the attention of the academic community. In contrast, hidradenitis suppurativa is a disease that rightfully attracts much attention from the patients, whose lives are often greatly affected by the recurrent, recalcitrant, painful lesions. They are further distressed by often inefficient treatments, and when they realize that cure is unlikely, a natural depression can be added to their burden. Similar frustration can easily affect the dermatologists who treat hidradenitis patients. Perhaps the most important new thing in hidradenitis is, therefore, that it is beginning to attract more attention, which is in no small part due to the energy and efforts of the international patient association HIDE (Hidradenitis Information Development and Exchange) (http://webhome.globalserve.net/hidecan). Systematic, well-defined data form the basis of any evidencebased medical practice. 1 Evidence-based diagnoses require either a pathognomonic test, which is often not available, or epidemiological data of the highest quality. The database of approximately 2000 possible dermatological diagnoses is highly variable, and whereas some diseases such as allergic contact dermatitis are described extensively, others such as hidradenitis suppurativa are not. In their description of the natural history of hidradenitis suppurativa von der Werth and Williams (this issue, pp. 389–392) have therefore provided important data for future studies of this disease. Progress is, however, being made even if initially this is by the exclusion of established but incorrect preconceptions. In recent years the definition of the disease has been improved. It is not only an important psychological achievement to name the evil that is intruding into your life, it is also an important and necessary step in the investigation of any disease, and an absolute prerequisite for the practice of evidence-based dermatology. Hidradenitis suppurativa can be defined as a recurrent disease, restricted to inverse areas and characterized by a progression from non-inflamed nodules to painful, rounded deep-seated inflamed lesions and subsequently scarring and chronic suppuration. Nodules are restricted to the skin and may persist for years with occasional episodes of inflammation. Progression occurs from inflamed nodules when spontaneously draining dermal sinus tracts appear. Sinus tracts persist and cause periodic flares of inflammation. Various chronic infections and metastatic Crohn’s disease can be excluded by additional specific investigation. 2

Significant one week efficacy of a calcipotriol plus betamethasone dipropionate scalp formulation

Backgroundu2002 A two‐compound scalp formulation containing calcipotriol (50u2003μg/g) and betamethasone (0.5u2003mg/g; as dipropionate) (Xamiol®, Taclonex Scalp®) has been shown to be an effective and safe treatment for scalp psoriasis.

Severe hidradenitis suppurativa responding to treatment with secukinumab: A case report

An inappropriate immunological response to an unknown antigen has been suggested to play a role in the pathogenesis of hidradenitis suppurativa (HS). Studies have identified elevated levels of several proinflammatory cytokines, including interleukin (IL)‐17A and tumour necrosis factor‐α, nominating these as possible therapeutic targets.1 Secukinumab is an IL‐17A monoclonal antibody, which binds to IL‐17A and inhibits the cytokine interaction with the IL‐17 receptors, inhibiting the inflammatory cascade. Here we report a case of a 47‐year‐old man, with Hurley stage III lesions on the neck, axillae, breasts, genital skin and buttocks, who had experienced only temporary benefit from different medical treatments over several years. After 12 weeks of treatment with secukinumab, the number of lesions reported by the patient within the period of the last 4 weeks was reduced from 23 to seven, his pain visual analogue scale (VAS) score was reduced from 5 to 3 and pain/utility/handicap VAS score was reduced from 7 to 4. These results may be taken to imply that IL‐17 blockade could provide a possible therapeutic approach in the treatment of HS.

In vivo microvascular imaging of cutaneous actinic keratosis, Bowen's disease and squamous cell carcinoma using dynamic optical coherence tomography.

A clear distinction between actinic keratosis (AK), Bowens disease (BD) and squamous cell carcinoma (SCC) cannot reliably be made by clinical and dermoscopic evaluation alone. Dynamic optical coherence tomography (D‐OCT) is a novel angiographic variant of OCT that allows for non‐invasive, in vivo evaluation of the cutaneous microvascular morphology.

A pilot study of unemployment in Hidradenitis Suppurativa Patients in Denmark

Hidradenitis Suppurativa (HS) is a chronic, inflammatory and relapsing skin disease, characterized by repeated outbreaks of painful inflamed nodules in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and perianal region). These nodules can progress to abscesses, sinus tracts (tunnels) and scarring. (1) The estimated prevalence is 1-4% worldwide and HS is approximately three times more common in women than in men. (1) n nHS is associated with significant disability and handicap. The lesions are often painful and lead to loss of mobility. n nThis article is protected by copyright. All rights reserved.