Werner Sinclair

House-dust mite species in Bloemfontein, South Africa.

UNLABELLED House-dust mites (HDMs) are an important source of allergens that are reputed to act as a trigger for atopic disease. Climatic conditions in parts of South Africa are not suitable for their proliferation, and there is doubt whether they occur on the Highveld. We studied whether HDMs occur in homes in Bloemfontein, Free State. METHODS Ten houses were sampled over a 1-year period. Dust was collected monthly or quarterly from a mattress, a bedroom floor and the living room floor of each house and examined for the presence of HDMs. Climate data were collected during the same period and a questionnaire was completed by home-owners to gather data on indoor factors that could influence mite proliferation. RESULTS HDMs were regularly found in 3 houses (30%). Dermatophagoides farinae was the dominant species (97.5%). The highest numbers were found in winter, when climatic conditions were the least favourable. Climatic conditions never met the requirements for active proliferation of the mites. Indoor factors that may have promoted mite proliferation in some houses were artificial heating (especially under-floor heating), en-suite bathrooms and lack of adequate ventilation during the winter months. CONCLUSION HDMs do occur in central South Africa, owing to a microclimate created indoors. Adequate ventilation, to reduce indoor humidity, should suffice to reduce mite numbers and prevent atopic symptoms induced by them.

Guidelines on the Management of Atopic Dermatitis in Adolescents and Adults in South Africa

OBJECTIVE The guidelines for the management of atopic dermatitis in patients older than 18 years have been developed in an attempt to improve the outcomes of treatment of this condition in South Africa. This condition has a major impact on the quality of life of sufferers and it is expected that these guidelines, if implemented, will play a role in achieving this. RECOMMENDATIONS All health care workers involved in the management of atopic dermatitis should take note of these guidelines and try to implement them in clinical practice as far as possible. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of dermatitis treatment. VALIDATION These guidelines were developed through general consensus by a group of five South African dermatologists, from evidence based on extensive literature review. Draft documents were made available for comment to the dermatology community as a whole, via the official website of the Dermatological Society of South Africa. They were also presented and discussed at the annual congress of the Dermatological Society of South Africa. All input from these sources, where appropriate, were then incorporated into these guidelines.

Aetiopathogenesis of atopic dermatitis

The aetiopathogenesis of atopic dermatitis (AD) is complex and during recent years much has been learnt regarding the genetic predisposition to the development of this condition and how its interaction with the environment influences clinical manifestations. AD is not a simple condition. An inherited stratum corneum barrier defect, transepidermal water loss, early antigen exposure through the skin and over-hygienic care of the young child seem to be the major drivers in the manifestation of the disease. Many other, more specific, environmental factors may influence the clinical picture in individual patients; some of these have an allergic basis, while others do not. In this article, the terminology used in this issue of CME is explained, the evidence for the different aetiopathological factors is presented and the factors that worsen or improve AD are listed.

General approach to and summary of the guideline for the management of atopic dermatitis

General approach to and summary of the guideline for the management of atopic dermatitis - summary

Vitamin D levels in patients with albinism compared with those in normally pigmented Black patients attending dermatology clinics in the Free State province, South Africa.

Associations between vitamin D deficiency and a broad variety of independent diseases, including several bone diseases, various types of cancer, autoimmune diseases, hypertension, and cardiovascular disease, have been suggested. It is therefore important to detect and treat vitamin D deficiency in high‐risk groups. Because patients with albinism (PWA) practice a policy of strict sun avoidance, they may be at risk for low levels of vitamin D.

A histopathological study of melanocytic and pigmented skin lesions in patients with albinism

Oculocutaneous albinism (OCA) is a group of genetic disorders characterized by diminished pigmentation of the skin, hair and eyes. Individuals with OCA are at increased risk to develop sun‐induced skin malignancies. The incidence of malignant melanoma in OCA individuals is, however, very low. The aim of this study was to document pigmented and melanocytic skin lesions occurring in patients with OCA.

Topical and systemic pharmacological treatment of atopic dermatitis

Topical corticosteroids (TCSs) continue to be the mainstay of atopic dermatitis (AD) treatment. For more than four decades TCSs have provided effective flare control by means of their anti-inflammatory, antiproliferative, immunosuppressive and vasoconstrictive actions. They suppress the release of inflammatory cytokines and act on a variety of immune cells, including T lymphocytes, monocytes, macrophages, dendritic cells and their precursors. Various strengths and formulations of TCSs are available. The extent to which they induce cutaneous vasoconstriction and inhibit inflammation corresponds to their potency. Topical calcineurin inhibitors (TCIs) (pimecrolimus and tacrolimus) are complex macrocyclic compounds that result in selective inhibition of cytokine transcription in activated T cells. TCIs are registered for short-term and non-continuous chronic treatment of moderate to severe AD in immunocompetent patients aged ≥2 years. Systemic corticosteroids are frequently used for short-term therapy of severe AD, but their use is controversial. Complementary/alternative therapies have no proven benefit in AD.

Diagnosis of atopic dermatitis: From bedside to laboratory

Atopic dermatitis (AD) is essentially diagnosed clinically. In babies and young children, the diagnosis is usually straightforward. Dry, very pruritic dermatitis starts on the cheeks, with the neck and trunk often involved, but the nappy area spared. Limb involvement follows later – first extensoral, later classically flexural. This is mostly the picture of AD. In adults, the presentation may vary widely. Classic flexural dermatitis may persist, but erythroderma (whole-body involvement), head and neck dermatitis, isolated hand dermatitis and nummular dermatitis may be more difficult to identify as AD.

The rational use of systemic isotretinoin: A call for moderation

Systemic isotretinoin effectively treats all forms of acne vulgaris. However, it has many side-effects, some potentially serious, that warrant limiting its use to serious cases of acne. Inappropriate use in large numbers of patients puts prescribers at risk of malpractice litigation should serious side-effects occur where safer alternative treatments were available. Doctors also risk losing access to the drug should authorities limit its use to reduce the occurrence of side-effects.