Ing-Marie Bergbrant

A double-blind study comparing the effect of glycerin and urea on dry, eczematous skin in atopic patients.

Moisturizing creams have beneficial effects in the treatment of dry, scaly skin, but they may induce adverse skin reactions. In a randomized double-blind study, 197 patients with atopic dermatitis were treated with one of the following: a new moisturizing cream with 20% glycerin, its cream base without glycerin as placebo, or a cream with 4% urea and 4% sodium chloride. The patients were asked to apply the cream at least once daily for 30 days. Adverse skin reactions and changes in skin dryness were assessed by the patient and a dermatologist. Adverse skin reactions such as smarting (a sharp local superficial sensation) were felt significantly less among patients using the 20% glycerin cream compared with the urea-saline cream, because 10% of the patients judged the smarting as severe or moderate when using glycerin cream, whereas 24% did so using urea-saline cream (p < 0.0006). No differences were found regarding skin reactions such as stinging, itching and dryness/irritation. The study showed equal effects on skin dryness as judged by the patients and the dermatologist. In conclusion, a glycerin containing cream appears to be a suitable alternative to urea/sodium chloride in the treatment of atopic dry skin.

Fusidic Acid-resistant Staphylococcus aureus in Impetigo Contagiosa and Secondarily Infected Atopic Dermatitis

Fusidic acid-resistant Staphylococcus aureus (FRSA) has been identified as a causative agent in outbreaks of impetigo and its emergence has been associated with increased use of topical fusidic acid. The frequency of FRSA in atopic dermatitis (AD) has been less extensively investigated. The aim of this study was to investigate the bacterial spectrum and frequency of FRSA in patients with impetigo or secondarily infected AD. A prospective study in our clinic in 2004 to 2008 included 38 patients with impetigo and 37 with secondarily infected AD. S. aureus was the predominant finding in all groups (bullous impetigo 92% (12/13), impetigo 76% (19/25) and secondarily infected AD 89% (33/37)). Seventy-five percent of S. aureus were fusidic acid resistant in bullous impetigo, 32% in impetigo and 6.1% in secondarily infected AD (bullous impetigo vs. AD p < 0.0001, impetigo vs. AD p < 0.05). We then performed a retrospective patient record review including all patients with impetigo or secondarily infected AD seen at the clinic during the first and last year of the prospective study. In the first year 33% (19/58) of the S. aureus isolates were fusidic acid-resistant in impetigo and 12% (5/43) in secondarily infected AD (p < 0.05). In the last year corresponding values were 24% (6/25) for impetigo and 2.2% (1/45) for AD (p < 0.01). In summary, the prospective study and the patient record review both showed higher FRSA levels in impetigo than in AD. FRSA levels were persistently low in AD. Continued restrictive use of topical fusidic acid is advised to limit an increase in FRSA levels in dermatology patients.

Microorganisms in intertriginous psoriasis: no evidence of Candida

Infection can be a trigger and an aggravating factor in psoriasis. Antibacterial and/or antifungal agents are commonly used in the treatment of intertriginous psoriasis, because it is believed that flexures in psoriasis are often colonized by Candida species and Staphylococcus aureus. Bacterial and fungal cultures were studied from 32 psoriatic patients with no topical treatment in the intertriginous areas, from 13 psoriatic patients treated with topical steroids and from 19 patients with no psoriasis or other affections of the skinfolds. Untreated psoriatic patients were colonized by S. aureus significantly more often than the control group but infection seemed to be unlikely. Candida was not found in any of the groups. It is proposed that intertriginous psoriasis be treated with topical steroids alone and that the routine use of antimycotic and antibacterial combinations should be avoided.

Profiles of Dental Caries and Periodontal Disease in Individuals With or Without Psoriasis

BACKGROUND Psoriasis is a chronic inflammatory disease that is manifested on the skin. Studies of oral health in psoriasis patients are limited. The aim of this study is to assess the experience and risk of caries and periodontal disease in individuals with and without psoriasis. METHODS The material consisted of 89 individuals with mild-to-moderate chronic plaque psoriasis and 54 without psoriasis, recruited at the University Hospital in Gothenburg, Gothenburg, Sweden. Psoriatic arthritis (PsoA) was diagnosed in 25 of the individuals with psoriasis. All participants answered questionnaires and were subjected to saliva sampling and oral radiologic and clinical examinations. Two computer applications were used for illustration of oral disease risk profiles. RESULTS Individuals with psoriasis had lower salivary pH, fewer remaining teeth, fewer sites with probing depth ≤4 mm, and a lower radiographic alveolar bone level than individuals without psoriasis (P <0.05). Most of the differences remained significant after controlling for confounders. Differences in alveolar bone levels were no longer significant, particularly after introducing the confounder sex into the regression model. Similar numbers of decayed and filled teeth, sites with deep pockets, sites that bled on probing, and risk profiles were observed. Individuals with PsoA exhibited a lower stimulated salivary secretion rate than those without psoriasis (P <0.05). CONCLUSIONS There were no differences in profiles of caries and periodontal disease experience and risk between individuals with and without psoriasis. Fewer remaining teeth were observed in individuals with psoriasis. However, the exact reason for tooth loss could not be identified. Meanwhile, the reduced salivary pH in individuals with psoriasis and salivary secretion in individuals with PsoA may pose some risk for future caries.

Frequency of bacteria, Candida and malassezia species in balanoposthitis.

Balanoposthitis is an inflammatory disorder of the prepuce and glans penis. Microbes involved in balanoposthitis have been investigated, but no single study has covered the growth of both bacteria, Candida and Malassezia. We report here the prevalence of these microbes in 100 patients with balanoposthitis and in 26 control patients. Among patients with balanoposthitis there was a significantly higher frequency of positive cultures than in the control group (59% and 35%, respectively, p<0.05). In the balanoposthitis group Staphylococcus aureus was found in 19%, group B streptococci in 9%, Candida albicans in 18% and Malassezia in 23% of patients. In the control group S. aureus was not found at all, whereas C. albicans was found in 7.7% and Malassezia in 23% of patients. Different microbes did not correspond with distinct clinical manifestations. In summary, we report increased frequency of microbes, specifically S. aureus, in the area of the prepuce and glans penis in balanoposthitis.

Patients' visual analogue scale: a useful method for assessing psoriasis severity.

The quality of life of patients with psoriasis can be severely diminished. The disease often affects life at a physical, social and emotional level (1). In clinical studies, a wide variety of assessment tools is used to evaluate the severity of psoriasis, but there is a lack of standardization (2). The introduction of quality of life (QoL) instruments has improved psoriasis evaluation, but there is a need for consensus in order to make valid comparisons between studies (3). The Psoriasis Area and Severity Index (PASI) is the most commonly used method to describe severity of psoriasis, and the Dermatology Life Quality Index (DLQI) is the most common method for measuring QoL in randomized controlled trials (4). The visual analogue scale (VAS) is an often-used tool to measure subjective phenomena, which has shown good reliability and validity in terms of assessment of pain (5).The aim of this study was to compare the simple VAS instrument with the most-used instruments for measuring psoriasis severity and QoL. PATIENTS AND METHODS

Reducing queues: demand and capacity variations

PURPOSE The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting-times. DESIGN/METHODOLOGY/APPROACH Cases were selected according to successful and sustained queue reduction. The approach in this study is action research. FINDINGS Accessibility improved as out-patient waiting lists for two clinics were reduced. The main success was working towards matching demand and capacity. It has been possible to sustain the improvements. RESEARCH LIMITATIONS/IMPLICATIONS Results should be viewed cautiously. Transferring and generalizing outcomes from this study is for readers to consider. However, accessible healthcare may be possible by paying more attention to existing solutions. PRACTICAL IMPLICATIONS The study indicates that queue reduction activities should include acquiring knowledge about theories and methods to improve accessibility, finding ways to monitor varying demand and capacity, and to improve patient processing by reducing variations. ORIGINALITY/VALUE Accessibility is considered an important dimension when measuring service quality. However, there are few articles on how clinic staff sustain reduces waiting lists. This paper contributes accessible knowledge to the field.

Adherence of Malassezia furfur to human stratum corneum cells in vitro: a study of healthy individuals and patients with seborrhoeic dermatitis

The role of Malassezia furfur adherence to human stratum corneum cells in vitro was studied. The adherence assay was performed with one strain of M. furfur and stratum corneum cells from 30 healthy individuals and from 28 patients with seborrhoeic dermatitis. Stratum corneum cells from patients with seborrhoeic dermatitis contained significantly lower numbers of adherent M. furfur cells than cells from healthy individuals. No correlation was found with sex or age. The adherence assay was also performed with stratum corneum cells from one healthy individual and M. furfur strains from 15 patients with seborrhoeic dermatitis and 13 healthy controls. Malassezia furfur strains from patients with seborrhoeic dermatitis showed the same in vitro capacity for adherence to stratum corneum cells as strains from healthy individuals. This in vitro study does not indicate that M. furfur adherence to human stratum corneum cells is of importance in the pathogenesis of seborrhoeic dermatitis.

Pityrosporum ovale and seborrhoeic dermatitis in HIV-seropositive and HIV-seronegative men. Quantitative cultures and serological studies

Abstract Background Previous studies of quantitative determinations of Pityrosporum ovale in HIV-seropositive patients with and without seborrhoeic dermatitis are contradictory. Objective To investigate the number of P. ovale among HIV-seronegative and HIV-seropositive men using contact plates containing cows milk as the main lipid source and to analyse sera with ELISA for IgG antibodies to a P. ovale protein extract. Results There was no difference in the number of P. ovale between healthy controls and HIV-positive patients with and without seborrhoeic dermatitis. HIV-seropositive patients had significantly lower IgG antibody titres to a P. ovale protein extract compared with healthy individuals.

Evaluation of anamnestic criteria for the identification of patients with acute community onset viral gastroenteritis in the emergency department—A prospective observational study

Abstract Background: To our knowledge no clinical criteria for the identification of community onset viral gastroenteritis in individual patients have been evaluated systematically with modern PCR-based diagnostic assays as gold standard. Objective: The aim of this study was to identify factors independently associated with the detection of virus by PCR in rectal swab samples from patients with acute community onset gastroenteritis. Methods: A prospective observational study was conducted from December 2010 through March 2011 at the emergency department (ED) of a large teaching hospital. All patients who reported vomiting and/or diarrhoea up to 48 h prior to their visit to the ED were asked to participate. A rectal swab sample was obtained from each patient. Symptoms, date of onset, and epidemiological data were recorded. Samples were analysed with a multiple real-time PCR targeting 6 viral agents (astrovirus, adenovirus, rotavirus, sapovirus, and norovirus GI and GII). Results: Two hundred and five patients fulfilled the inclusion criteria, of whom 66 agreed to participate; their median (IQR) age was 65 (38–84) y and 43 (65%) were females. Thirty-one (47%) were positive by PCR for at least 1 of the agents examined (26 norovirus, 2 sapovirus, 2 rotavirus, and 1 adenovirus). Diarrhoea and a short duration of symptoms (≤ 2 days) were independently associated with a positive rectal swab sample, with odds ratios of 7.5 (95% confidence interval (CI) 2.0–28) and 10.4 (95% CI 1.9–56), respectively (p < 0.01 for both). A multivariate model including these 2 variables had a sensitivity of 81% (25/31) and a specificity of 69% (24/35). Conclusions: Diarrhoea and a short duration of symptoms were the only anamnestic criteria independently associated with acute community onset viral gastroenteritis confirmed by PCR.