Michael Heidenheim

The prevalence of hidradenitis suppurativa and its potential precursor lesions

BACKGROUND The morbidity of hidradenitis suppurativa can be considerable, but little is known about its epidemiology. OBJECTIVE Our purpose was to describe the 1-year and point prevalences of hidradenitis suppurativa and its potential precursor lesions. METHODS We obtained the histories and examined an unselected sample (599 persons) of the general population (1-year prevalence), and we performed physical examinations for a consecutive sample of 507 persons undergoing screening for sexually transmitted diseases (point prevalence). RESULTS The point prevalence was 4.1% (95% confidence interval [CI] = 3.0-6.0) on the basis of objective findings. The 1-year prevalence of hidradenitis was 1.0% (CI = 0.4-2.2) on the basis of subject recollection only. The patients in the sample on which point prevalence is based were younger than those in the unselected sample of the general population (p < 0.001). Hidradenitis was significantly more common in women (p = 0.037), which may result from a female preponderance of genitofemoral lesions (odds ratio [OR] = 5.4; CI = 1.5 - 19.3). No sex difference was found in the prevalence of axillary lesions. CONCLUSION Hidradenitis suppurativa is significantly more common than hitherto estimated. The female preponderance of patients is confirmed, except for patients with axillary lesions. Additional longitudinal studies are necessary to assess the importance of potential precursor lesions such as noninflamed nodules or comedones.

Hidradenitis suppurativa ‐ characteristics and consequences

The general characteristics of patients with hidradenitis suppurativa have not been previously described in detail. Although rare complications of the disease have been described, little is known of the average impact of hidra‐denitis suppurativa. We have now aimed to describe the general characteristics of the disease and its impact on patients with an established diagnosis of hidradenitis (a= 68) and compare these with those of an unselected general population sample (n= 523).

SIDE EFFECTS OF CRYOTHERAPY

tion in patients who are receiving streptoldnase therapy is unclear. Vasculitis, as well as hypotension, may occur despite concomitant use of intravenous corticosteroids and streptokinase. 7 The Second International Study of Infarct Survival (ISIS-2) l J trials reported a 4.4% incidence of allergic reactions to streptokinase. However, ISIS 1~ trials did not report patients who had only mild fever, shivering, and myalgia, as opposed to those who had these symptoms along with vasculitis.

Teledermatology with an integrated nurse-led clinic on the Faroe Islands--7 years' experience.

Background  Telemedicine is an increasingly suggested answer to the problem of providing high‐class medical service to rural and remote areas in a modern society. Dermatology is a promising candidate for telemedical service, because it is well suited for clinical questions forwarded together with photographs.

The influence of sex hormones on UVB induced erythema in man

Clinical and experimental evidence suggests that sex hormones can modify the inflammatory response in a number of diseases. In a pilot study the influence of sex hormones on UV-induced inflammation, testing was done with oestradiol-17beta, testosterone and progesterone, as a double-blind vehicle-controlled study in 47 healthy volunteers. Inflammation was graded using laser-doppler velocimetry. Oestradiol (5 mg/100 g) was found to increase the inflammatory response significantly when compared with placebo or testosterone treated areas (P < 0.03). These findings support previous experimental and epidemiological observations of an increased inflammation following oestrogenic stimulation, and suggest that non-lymphocyte-mediated mechanisms may be involved as well.

Teledermatology on the Faroe Islands

The use of teledermatology as an adjunct to conventional clinical dermatology on the Faroe Islands is described. The service is based on a nurse‐led dermatological clinic, and teledermatology is combined with specialist visits for more complex diagnosis or procedures.

Do generalists and specialists agree on descriptive acne morphology

Background  Acne is a common skin disease, which is treated by many different specialities. Clinical guidelines for treatment are based on the recognition of acne morphology. The assessment of acne morphology is therefore an important element of the proper diagnosis and treatment of acne.

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.

Validation of a Screening Questionnaire for Chronic Leg Ulcers

The use of a validated screening questionnaire to identify individuals with chronic leg ulcers allows large-scale population-based studies to be conducted that measure and monitor the prevalence of the disease. The aim of this study was to design and validate such a screening questionnaire to identify patients with chronic leg ulcers. A simple 3-item questionnaire was developed at the Department of Dermatology, University Hospital of Zealand, Denmark. In total, 90 patients attending the department’s outpatient clinic for dermatological diseases and chronic wounds were included in this study. All included participants completed the questionnaire and were subsequently examined by dermatologists. We found that the constructed 3-item questionnaire in this study had a sensitivity and specificity of 95% and 93% and a positive predictive value and negative predictive value of 78% and 95%, respectively. Moreover, we found that the use of the 3-item questionnaire, as compared with a single question, in which the participants were asked whether they currently have a leg ulcer, resulted in significantly higher positive predictive value (+11.6%, P = .035) and specificity (+5.6%, P = .046) of the diagnostic test. Future studies are merited to investigate the diagnostic accuracy of the questionnaire in other populations and settings.

Acquired Localized Cutis Laxa due to Increased Elastin Turnover

Cutis laxa is a rare disease characterized by abnormal skin wrinkling and laxity, due to decreased elastin synthesis or structural extracellular matrix defects. We have explored elastin metabolism in a case of adult onset cutis laxa localized to the upper body of a woman. For this purpose, we obtained skin biopsies from affected and unaffected skin areas of the patient and analyzed these with microscopy, polymerase chain reaction, western blotting and cell culture experiments. Skin from the affected area lacked elastin fibers in electron microscopy but had higher mRNA expression of elastin and total RNA. Levels of an apparent tropoelastin degradation product were higher in the affected area. Fibroblast cultures from the affected area were able to produce elastin and showed higher proliferation and survival after oxidative and UVB stress compared to fibroblasts from the unaffected area. In conclusion, we report a case of acquired localized cutis laxa with a lack of elastic fibers in the skin of the patients upper body. The lack of elastic fibers in the affected skin was combined with increased mRNA expression and protein levels of elastin. These findings indicate that elastin synthesis was increased but did not lead to deposited elastic fibers in the tissue.