Lars Erik Bryld

Risk factors influencing the development of hand eczema in a population‐based twin sample

Background  A population‐based twin study has recently shown that genetic factors are of significance for hand eczema.

Hand eczema in twins: a questionnaire investigation

Hand eczema in a population‐based twin cohort of 6666 persons aged 20–44 years was investigated by means of a questionnaire regarding skin symptoms on the hands and self‐ or physician‐diagnosed hand eczema. Genetic influence was observed by significant differences between identical and fraternal twins regarding casewise concordance rate and correlations in liability under the threshold model. The casewise concordance rates were almost twice as high in identical compared with fraternal twins in both sexes. By extension of the threshold model a joint analysis could be performed, resulting in a heritability estimate of 0.65. Tendencies towards stronger genetic influence for men and for younger individuals were present, but neither was statistically significant. No particular symptom pattern expressed especially strong or weak genetic influence. Hereditary factors for hand eczema were observed despite a presumably substantial individual‐specific environmental variation. The hypothesis that hereditary risk factors may play a significant part in the development of hand eczema in the general population, when no extreme environmental exposure exists, seems justifiable. The relevance of known individual risk factors such as atopic dermatitis or contact allergy in relation to heredity remains to be analysed. The possible importance of age and temporal change also needs further consideration.

Relation between vesicular eruptions on the hands and tinea pedis, atopic dermatitis and nickel allergy

The aetiology of vesicular eruptions on the palms and on the sides of the fingers (pompholyx) is unclear. The present study was undertaken to establish whether tinea pedis, atopic dermatitis or nickel allergy is a risk factor for development of vesicular eruptions. Three-hundred-and-ninety-eight individuals (included from an ongoing population study on hand eczema in twins) were included. A history of previous hand eczema and atopic dermatitis was taken, and a clinical examination including a patch test with nickel was performed. A test sample for tinea pedis was taken from the fourth interdigital space on the right foot. The relative risk for vesicular eruptions present in individuals with tinea pedis was 3.58 (confidence limits 1.19-10.82, p < 0.05). For individuals with atopic dermatitis, relative risk was 1.44 (confidence limits 0.34-6.07, n.s.) and for those with nickel allergy it was 0.45 (confidence limits 0.06-3.36, n.s.). A relationship between tinea pedis and vesicular eruptions on the hands was statistically confirmed in the present study. In this part of the population study material, no association with atopic dermatitis or nickel allergy was observed.

Iodopropynyl butylcarbamate: a new contact allergen

Iodopropynyl butylcarbamate (IPBC) has been used for years as a fungicide and bactericide for wood and paint preservation without any reports of cutaneous side‐effects. During the last few years, it has entered cosmetic products and is temporarily permitted in the EU Cosmetics Directive in a use concentration of 0.1%. In the present study, we report our preliminary experience with patch testing consecutive contact dermatitis patients with IPBC. A patch lest concentration of 0.1% seems appropriate for initial screening but deserves further evaluation. Among 311 consecutive patch lest patients. 3 patients with a positive patch lest to IPBC have been identified. Contact allergy is Likely in at least 1 case, based on clinical history, exposure history, patch testing with dilution series. ROAT and chemical analysis.

Photodynamic therapy in a series of rosacea patients.

Background  Rosacea is a common disease that often has a chronic intermittent course despite current treatment; therefore, additional treatment options are desirable. The pathogenesis of the disease is unknown.

Allergic contact dermatitis from 3-iodo-2-propynyl-butylcarbamate (IPBC) - an update.

Results from 3 1/2 years of routine patch testing with 3‐iodo‐2‐propynyl‐butylcarbamate (IPBC) are presented. From 1996 to 1999, a total of 3168 persons (2093 women and 1075 men) were patch tested with IPBC, and 7 cases were found to be positive. In 2 cases, sensitization could be attributed to cosmetics, and in a further 2 cases cosmetics were the most likely cause of sensitisation. It is concluded that the use of IPBC in cosmetic products can lead to contact sensitization and allergic contact dermatitis. 2 of the 7 reported cases with IPBC allergy were also found positive to thiuram, and possible cross‐reactivity between IPBC and thiuram is discussed.

Hidradenitis Suppurativa Complicating Naevus Comedonicus: The Possible Influence of Mechanical Stress on the Development of Hidradenitis Suppurativa

Naevus comedonicus is a rare, benign hamartoma consisting of grouped abnormal hair follicles and, occasionally, associated with other diseases. We describe an infant who developed hidradenitis-like lesions in an inguinal naevus comedonicus following increased mechanical stress on the region. It is speculated that the degree of strain on a hair follicle is increased when its diameter is increased, leading to wall ruptures. We hypothesise that this serendipitous observation provides a model for the way mechanical stress can account for the development of hidradenitis suppurativa in some patients.

High Body Mass Index in Adolescent Girls Precedes Psoriasis Hospitalization

Psoriasis is associated with being overweight, but the temporal relationship is not known. This historical cohort study tested whether severe psoriasis resulting in hospitalization in adulthood was preceded by excess increase in age-adjusted body mass index, a known risk factor in childhood for being overweight in adulthood. The study cohort was based on the Copenhagen School Health Records Register, birth years 1930 to 1984 (309,152 schoolchildren). Cases were found through the Danish National Patient Register for the period 1977 to 2001. A total of 1074 (0.36%) of the schoolchildren were identified as having psoriasis, with at least one hospital admission. Multivariate analysis demonstrated an association between excess increase in body mass index and psoriasis in females only. Being overweight in adolescence was the main factor behind this observation. The female group showed a significant association between psoriasis and body mass index at ages 12 (p = 0.028) and 13 years (p = 0.010). This was not the case for males or for body mass index measured at ages 11 years and below.

Airborne contact dermatitis from Coleus plant

A 65-year-old woman with a 25-year history of facial dermatitis and no obvious external cause was patch tested with her houseplants and a wide range of common allergens. The only positive reaction found was to the plant Coleus blumei.

Teledermatology: The Atlantic Experience

It is beneficial if teledermatology is integrated in an existing structure for optimum utilisation of resources. Teledermatology has been used to redistribute the workload of specialists. Teledermatology provides continuous access to specialist assessment of patients in collaboration with local physicians. Simple store-and-forward teledermatology is well suited for follow-up of patients initially seen by a specialist. Milder cases of some clinically characteristic diseases such as acne are well suited to management through teledermatology. Teledermatology offers the possibility of case-based continued medical education of non-specialists. Teledermatology generally follows the life curve of other successful new organisational models and does not affect demand for health services.