P.G.M. van der Valk

The natural history of chronic urticaria and angioedema in patients visiting a tertiary referral centre

Background Data on the natural history and prognostic variables of chronic urticaria and its subtypes are scarce.

The Impact of Chronic Skin Disease on Daily Life (ISDL): a generic and dermatology-specific health instrument

Background  In dermatological research and clinical practice, there is a need for comprehensive self‐report instruments that assess a broad spectrum of health implications of chronic skin diseases, including generic and skin‐specific aspects of disease‐related quality of life. The advantages of dermatology‐specific, multidimensional instruments over generic instruments or single‐dimensional quality‐of‐life measures are in the detailed and specific information they provide about health areas that are affected by the skin condition and that may change through therapeutic intervention.

Methyldibromoglutaronitrile is an important contact allergen in The Netherlands

From 15 May to 15 December 1994, 2943 patients sunspected of having contact dermatitis(1955 women, 988 men) were patch tested with methyldibromoglutarorutrile 0.3%, 0.1% and 0.05% pet. 119 patients (4.0%: women 4.1%, men 3.8%) proved to be allergic, 71% of the reactions were considered to be relevant. In 2/3 of the patients, causative products were cosmetics, in 1/3 moistened toilet tissues. Testing with methyldibromoghitaronitrile at lower concentrations (0.05% and 0.1%) commercial allergens (Euxyl® K 400 and methyldibromoglutaronitrile, both containing methyldibromoglutaronitrile 0.1%). resulted in a number of falsc‐negative reactions. All preservatives in the European standard series had lower scores than the 4% positive reactions to methyldibromoglutaronitrile (formaldehyde 2.0% MCI/MI (Kathon® CG) 3.2% parabens 1.0% quaternium‐15 1.3%). It is concluded that methyldibromoglutaronitrile (present in the commercial preservative Euxyl® K 400) is an important contact allergen in the Netherlands in cosmetics and moistened toilet tissues. It should be added to cosmetics series and to proctological series. The optimal test concentration is unknown, but may be 0.3% pet. The concentration of 0.1% methyldibromoglutaronitrile in the currenttly available commercial allergens appears to be too low. resulting in a number of false‐negative reactions.

Molecular diagnostics of psoriasis, atopic dermatitis, allergic contact dermatitis and irritant contact dermatitis.

Background  Microarray studies on the epidermal transcriptome in psoriasis and atopic dermatitis (AD) have revealed genes with disease‐specific expression in keratinocytes of lesional epidermis. These genes are possible candidates for disease‐specific pathogenetic changes, but could also provide a tool for molecular diagnostics of inflammatory skin conditions in general.

Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice

Background  Physical symptoms of skin diseases have been shown to negatively affect patients’ wellbeing. Although insight into physical symptoms accompanying skin diseases is relevant for the management and treatment of skin diseases, the prevalence of physical symptoms among patients with skin diseases is a rather unexplored territory.

Effectiveness of a multidisciplinary itch-coping training programme in adults with atopic dermatitis.

The short- and longer-term effectiveness of a brief, multidisciplinary itch-coping group training scheme in adults with atopic dermatitis was evaluated. Clinical severity scores (Eczema Area and Severity Index) and validated self-report measures were obtained in a waiting-list control condition (n=30) and a treatment condition (n=61) at pre- and post-treatment and in the treatment condition at 3- and 12-month follow-ups. Relative to the control condition, all post-treatment measures showed improvements in terms of enhanced skin status, reduced itching and scratching and improved itch-coping patterns. In the treatment condition, the changes were sustained or further improved at both follow-ups. Also, the dermatological healthcare use was significantly reduced during the follow-up periods, in terms of fewer visits to the dermatologist and decreased use of topical corticosteroids and itch-relieving medication (histamine antagonists). The brief multidisciplinary itch-coping programme in adults with atopic dermatitis considerably reduced itch-scratching patterns, improved their skin status and reduced the use of dermatological care, both in the short and longer term.

Cost-effectiveness analysis of a psoriasis care instruction programme with dithranol compared with UVB phototherapy and inpatient dithranol treatment

Background This study was part of a large national cost‐effectiveness analysis, and was funded by the National Fund for Investigational Medicine of the Health Care Insurance Board.

The effectiveness of integrated care for patients with hand eczema: results of a randomized, controlled trial.

Objectives. To evaluate the effectiveness of integrated, multidisciplinary care as compared with usual care for patients with moderate to severe, chronic hand eczema after 26 weeks of follow‐up.

Effect of a topical corticosteroid, a retinoid and a vitamin D3 derivative on sodium dodecyl sulphate induced skin irritation

Exposure of the skin to sodium dodecyl sulfate (SDS) leads to disruption of barrier and skin irritation. We used repetitive short exposure to a low molarity SDS solution as an in vivo model to mimic the development of irritant contact dermatitis. In this model, we studied clinical (erythema), functional (transepidermal water loss(TEWL)) and cell biological changes, 24 healthy volunteers were patch tested with SDS (0.2%) for 4 h a the day for 5 consecutive days. After removal of the patches, the exposed sites were treated 1 × daily either with a topical corticosteroid (triamcinolon acetoide cream 0.05%). a retinoid (tretinoin cream 0.025%). or a vitamin D3 derivative (calcipotriol ointment 50 microgram/g). Irritant reactions were assessed by erythema scoring and measurement of barrier function with TEWL up to 14 days after the first challenge. Skin biopsies were taken for cell biological changes at day 4. Vehicle‐treated sites served as controls. Repetitive exposure of human skin to SDS resulted in a gradual increase in erythema scoring and TEWL associated with the upregulation of proliferative cells as measured by the expression of Ki‐67‐antigen and of differentiation markers, visualized by increased expression of involucrin and epidermal‐fatty‐acid binding protein (E‐FABP). Skin irritation as assessed by erythema scoring and TEWL was not significantly suppressed by triamcinolone cream. However, a significant reduction of the number of cycling keratinocytes and a decrease in involucrin positive cell layers was observed in this group. Neither treatment with calcipotriol ointment nor with tretinoin cream induced improvement of skin irritation as judged by visual scoring and TEWL. In contrast to steroid treatment no significant elf eel of calcipotriol ointment or tretinoin cream treatment was observed with regard to the number of cycling cells and differentiation markers. Further studies are needed to assess whether treatment with topical corticosteroids is an effective modality in skin irritation and irritant contact dermatitis.

A comparison of twice-daily calcipotriol ointment with once-daily short-contact dithranol cream therapy: a randomized controlled trial of supervised treatment of psoriasis vulgaris in a day-care setting.

Background  Calcipotriol has become a first‐line treatment for psoriasis. Its efficacy and safety have been shown in many comparative clinical trials carried out in outpatients. In a comparative study in patients visiting the outpatient department once every 14 days, it was shown that calcipotriol was more effective and better tolerated compared with dithranol.