RESUMO
BACKGROUND: Palmoplantar psoriasis is a clinical variant of psoriasis characterized by well-defined erythematous desquamating plaques on palms and soles, which may or may not include pustules. Hyperkeratotic lesions of palm and sole commonly include Psoriasis, Eczema and Tinea. These conditions often present with overlapping clinical and histopathological features requiring clinicohistopathological correlation for a conclusive diagnosis. The presence of munro's microabscess or spongiform pustule of kogoj differentiates psoriasis of palm and sole from other hyperkeratotic lesions of palm and sole. The objective of this study was to study the clinical and histopathological profile of palmoplantar psoriasis and correlate clinical diagnosis with histopathological diagnosis. METHOD: A hospital-based, descriptive study was conducted from January 1, 2020, to December 31, 2020. Fifty-two patients were clinically diagnosed as palmoplantar psoriasis with or without involving other parts of body and routine histopathological evaluation was carried out as per standard protocols. RESULT: Clinically diagnosed 52 cases of palmoplantar psoriasis showed varied histopathology with hyperkeratosis (100%), parakeratosis (100%), regular acanthosis (75%), Supra-papillary thinning (44.2%), spongiosis (65.4%), tortuous vessels in the papillary dermis (78.8%) and mixed inflammatory infiltrates (predominantly lymphocytic-100%), which were observed to be prominent findings in skin biopsies of our patients. Clinicopathological correlation was achieved in 88.5% of cases. CONCLUSION: This study shows clinically diagnosed palmoplantar psoriasis with histopathological features consistent with palmoplantar psoriasis in 88.5% cases. Thus, clinically inconclusive hyperkeratotic lesions with palmoplantar psoriasis can be diagnosed with histopathological correlation improving the therapeutic intervention.
Assuntos
Psoríase , Centros de Atenção Terciária , Humanos , Psoríase/patologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Idoso , Dermatoses da Mão/patologia , Pele/patologiaAssuntos
Dermatoses da Mão , Humanos , Animais , Masculino , Dermatoses da Mão/patologia , Dermatoses do Pé/patologia , Boidae , FemininoRESUMO
Onychomycosis, a fungal nail infection, is primarily caused by dermatophytes, yeasts, and non-dermatophyte moulds (NDMs). The incidence of this disease and the predominance of specific pathogens vary across different regions and evolve. This study aimed to elucidate the epidemiology of onychomycosis and the pattern of causative pathogens in Beijing, and to ascertain the in vitro antifungal susceptibility profiles of Trichophyton rubrum against itraconazole (ITR), terbinafine (TER), and fluconazole (FLU). Involving 245 patients of onychomycosis with positive fungal culture results, the study implemented internal transcribed spacer (ITS) sequencing of ribosomal DNA (rDNA) on all collected samples. The mean age of the participants was 37.93 ± 13.73 years, with a male-to-female ratio of 1.53:1. The prevalence of toenail infections was significantly higher than that of fingernails. Distal and lateral subungual onychomycosis (DLSO) were the most frequent clinical classifications. PCR results indicated that dermatophytes were the most prevalent pathogens, followed by yeasts and NDMs, among which T. rubrum was the most dominant dermatophyte. TER demonstrated high sensitivity to T. rubrum. However, in clinical settings, some patients with onychomycosis exhibit a poor response to TER treatment. The relationship between in vitro antifungal sensitivity and clinical effectiveness is complex, and understanding the link between in vitro MIC values and clinical efficacy requires further investigation.
Assuntos
Antifúngicos , Fluconazol , Dermatoses do Pé , Itraconazol , Testes de Sensibilidade Microbiana , Onicomicose , Terbinafina , Humanos , Onicomicose/microbiologia , Onicomicose/tratamento farmacológico , Onicomicose/epidemiologia , Masculino , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Feminino , Adulto , Pessoa de Meia-Idade , Terbinafina/farmacologia , Terbinafina/uso terapêutico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/tratamento farmacológico , Itraconazol/farmacologia , Itraconazol/uso terapêutico , Fluconazol/farmacologia , Arthrodermataceae/efeitos dos fármacos , Adulto Jovem , Dermatoses da Mão/microbiologia , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/epidemiologia , China/epidemiologia , Prevalência , Trichophyton/efeitos dos fármacos , Idoso , AdolescenteRESUMO
BACKGROUND: Chronic hand eczema is a fluctuating, inflammatory, pruritic, often painful disease of hands and wrists that strongly impacts quality of life and occupational capabilities of patients. The aim of phase 3 DELTA 1 and DELTA 2 was to assess the efficacy and safety of twice-daily applications of the topical pan-Janus kinase inhibitor delgocitinib cream 20 mg/g versus cream vehicle in adults with moderate to severe chronic hand eczema. METHODS: Both trials were randomised, double-blinded, and vehicle-controlled, with DELTA 1 being conducted at 53 trial centres in Canada, France, Germany, Italy, Poland, and the UK and DELTA 2 at 50 trial centres in Belgium, Canada, Denmark, Germany, the Netherlands, Poland, and Spain. Adults (aged ≥18 years) with moderate to severe chronic hand eczema were randomly assigned 2:1 to twice-daily delgocitinib cream 20 mg/g or cream vehicle for 16 weeks. The primary endpoint was Investigator's Global Assessment for Chronic Hand Eczema (IGA-CHE) treatment success at week 16, defined as IGA-CHE score of 0 (clear) or 1 (almost clear, defined as only barely perceptible erythema). Efficacy and safety were assessed in all patients who were exposed to trial treatment. These trials are registered with ClinicalTrials.gov, NCT04871711 and NCT04872101. FINDINGS: Between May 10, 2021, and Oct 31, 2022, 487 patients (181 male and 306 female) were enrolled in DELTA 1; between May 25, 2021, and Jan 6, 2023, 473 patients (161 male and 312 female) were enrolled in DELTA 2. 325 patients in DELTA 1 and 314 in DELTA 2 were assigned to delgocitinib cream; 162 patients in DELTA 1 and 159 in DELTA 2 were assigned to cream vehicle. At week 16, a greater proportion of delgocitinib-treated patients versus cream vehicle patients had IGA-CHE treatment success (64 [20%] of 325 vs 16 [10%] of 162 in DELTA 1 and 91 [29%] of 313 vs 11 [7%] of 159 in DELTA 2; both trials p≤0·0055). The proportion of patients who reported adverse events was similar with delgocitinib (147 [45%] of 325 in DELTA 1 and 143 [46%] of 313 in DELTA 2) and the cream vehicle (82 [51%] of 162 in DELTA 1 and 71 [45%] of 159 in DELTA 2). Most frequent adverse events occurring in at least 2% of patients were similar in both treatment groups and included COVID-19 and nasopharyngitis. INTERPRETATION: Overall, delgocitinib cream showed superior efficacy versus cream vehicle and was well tolerated over 16 weeks. These results support the clinical benefit of delgocitinib cream as a potential treatment option for patients with moderate to severe chronic hand eczema, who are unable to adequately control their disease with basic skin care practices and topical corticosteroids. FUNDING: LEO Pharma.
Assuntos
Eczema , Dermatoses da Mão , Pirróis , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Crônica , Método Duplo-Cego , Eczema/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Pirróis/uso terapêutico , Índice de Gravidade de Doença , Creme para a Pele , Resultado do TratamentoAssuntos
Mãos , Humanos , Masculino , Diagnóstico Diferencial , Dermatoses da Mão/diagnóstico , FemininoRESUMO
BACKGROUND: Mainly women work as foot care specialists (FCS). They are at risk to develop occupational dermatitis (OD). OBJECTIVES: The objective of this study is to describe the contact sensitisation pattern of female FCS with OD. METHODS: In a retrospective study, patch test and clinical data collected by the Network of Departments of Dermatology (IVDK) from 2008 to 2022 were analysed. Data of 116 female FCS with OD were compared with data of 13 930 female patients with OD working in other professions and 78 612 female patients without OD. RESULTS: Hand dermatitis (93.1%) was significantly more common and face dermatitis (0.9%) significantly less common in female FCS with OD compared to other female patients with or without OD. Frequent suspected allergen sources were disinfectants, gloves, leave-on and nail cosmetics. Occlusion and wetness were important co-factors. The most common diagnoses were irritant contact dermatitis (26.7%) and allergic contact dermatitis (21.6%). No sensitisation to any of the baseline series allergens was significantly more frequent in female FCS with OD than in the two control groups. However, sensitisations to allergens which FCS are abundantly exposed to, including fragrances, preservatives, rubber ingredients and disinfectants, were most common. CONCLUSIONS: FCS should be aware of the OD risk and prevention should be promoted.
Assuntos
Dermatite Alérgica de Contato , Dermatite Irritante , Dermatite Ocupacional , Dermatoses da Mão , Testes do Emplastro , Humanos , Feminino , Dermatite Ocupacional/epidemiologia , Dermatite Ocupacional/etiologia , Dermatite Ocupacional/diagnóstico , Dermatite Alérgica de Contato/etiologia , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/diagnóstico , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Estudos de Casos e Controles , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/etiologia , Dermatite Irritante/epidemiologia , Dermatite Irritante/etiologia , Alérgenos/efeitos adversos , Dermatoses Faciais/epidemiologia , Dermatoses Faciais/etiologia , Cosméticos/efeitos adversos , Desinfetantes/efeitos adversos , Luvas Protetoras/efeitos adversos , Dermatoses do Pé/epidemiologiaRESUMO
BACKGROUND: Most studies investigating the prevalence of hand eczema (HE) in professional cleaners use self-reported questionnaire-based data. However, no validation studies of self-reporting of HE among professional cleaners have previously been conducted. OBJECTIVES: To investigate (1) the point prevalence of self-reported HE, (2) the point prevalence of HE estimated by physical examination of the hands and (3) the sensitivity and specificity of self-reporting of HE compared with the diagnosis based on physical examination among professional cleaners. METHODS: Professional cleaners at three different hospitals in Region Zealand were invited to fill out a questionnaire. The point prevalence of self-reported HE was estimated based on questions from the Nordic Occupational Skin Questionnaire. After completing the questionnaire, each cleaner underwent a physical examination of the hands by a dermatologist on the same day. RESULTS: In total, 234 cleaners were invited to participate in the study, and 224 (response rate = 96.0%) agreed to take part. Based on the self-reported questionnaires, 5.3% (n = 12) of the cleaners had current HE. Based on an examination by a physician, 19.2% (n = 43) of the cleaners had current HE. The sensitivity of self-reported HE was found to be 28.0%, while the specificity was found to be 100.0%. The positive predictive value was found to be 100.0%, while the negative predictive value was 85.0%. CONCLUSION: The true point prevalence of HE among professional cleaners is underestimated when based on self-reporting.
Assuntos
Dermatite Ocupacional , Eczema , Dermatoses da Mão , Autorrelato , Sensibilidade e Especificidade , Humanos , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/diagnóstico , Dermatite Ocupacional/epidemiologia , Dermatite Ocupacional/diagnóstico , Masculino , Feminino , Adulto , Prevalência , Eczema/epidemiologia , Eczema/diagnóstico , Pessoa de Meia-Idade , Inquéritos e Questionários , Exame Físico , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/epidemiologiaAssuntos
Eczema , Dermatoses da Mão , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , China , Fármacos Dermatológicos/uso terapêutico , Fármacos Dermatológicos/efeitos adversos , População do Leste Asiático , Eczema/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Pirimidinas/uso terapêutico , Pirimidinas/efeitos adversos , Estudos Retrospectivos , Sulfonamidas/uso terapêutico , Sulfonamidas/efeitos adversos , Resultado do TratamentoAssuntos
Antituberculosos , Mycobacterium tuberculosis , Exposição Ocupacional , Tuberculose Cutânea , Médicos Veterinários , Humanos , Masculino , Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Pele/patologia , Pele/microbiologia , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/microbiologia , Tuberculose Cutânea/patologia , Pessoa de Meia-Idade , Biópsia , Isoniazida/uso terapêutico , Rifampina/uso terapêutico , Etambutol/uso terapêutico , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/microbiologia , Dermatoses da Mão/patologia , Exposição Ocupacional/efeitos adversosRESUMO
Contact dermatitis is a common cutaneous inflammatory condition, triggered by exposure to irritant substances or allergens. Nickel is the most prevalent allergen, a metal widely used in accessories, furniture, office materials, food and in industry, with multiple exposure pathways, making it difficult to assess which exposure is causing allergic dermatitis. Here, we report a case of an administrative worker with chronic hand eczema, limited to the radial metacarpophalangeal region of the left hand, caused by occupational exposure to nickel, confirmed by nickel deposition test on the hand and a positive test with a metallic stapler used at her workplace.
Assuntos
Dermatite Alérgica de Contato , Dermatite Ocupacional , Níquel , Humanos , Níquel/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Dermatite Alérgica de Contato/diagnóstico , Dermatite Ocupacional/etiologia , Dermatite Ocupacional/diagnóstico , Feminino , Dermatoses da Mão/induzido quimicamente , Dermatoses da Mão/etiologia , Adulto , Exposição Ocupacional/efeitos adversos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Twin studies revealed that genetic effects play a role in hand eczema (HE), but the responsible genetic factors are unknown. OBJECTIVES: To identify and characterise genetic loci associated with HE and to provide insight into the genetic overlap between HE and atopic dermatitis (AD). METHODS: We used questionnaire-derived and genotype data from the European population-based Lifelines cohort and biobank. We performed a discovery genome-wide association study (GWAS) of HE (2879 cases and 16 249 controls) and of AD (1706 cases and 17 190 controls). We replicated our findings in an independent Lifelines sample for HE (1188 cases and 6431 controls) and AD (757 cases and 6747 controls). We conducted several post-GWAS analyses and performed genetic correlation analyses between our HE results and independent AD data. RESULTS: The two-step GWAS of HE, regardless of adjusting for AD, identified one independent locus 20q13.33, likely driven by a number of causal single-nucleotide polymorphisms. For the AD GWAS, we replicated a known stop-gained rs61816761 at locus 1q21.3 (FLG, FLGAS1). We found a strong genetic correlation (p < 0.01) between HE and AD (rg = 0.65), regardless of adjusting for AD (rg = 0.63). CONCLUSIONS: Locus 20q13.33 is associated with HE, and there is a large genetic overlap between HE and AD.
Assuntos
Dermatite Atópica , Eczema , Estudo de Associação Genômica Ampla , Dermatoses da Mão , Polimorfismo de Nucleotídeo Único , Humanos , Dermatite Atópica/genética , Masculino , Eczema/genética , Feminino , Dermatoses da Mão/genética , Adulto , Estudos de Casos e Controles , Predisposição Genética para Doença , Pessoa de Meia-Idade , Genótipo , Loci Gênicos , Proteínas FilagrinasAssuntos
Eritema , Humanos , Masculino , Eritema/etiologia , Eritema/diagnóstico , Eritema/patologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/patologia , Dermatoses da Mão/etiologia , Mãos/patologia , Doença Aguda , Adulto , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/patologiaAssuntos
Melanócitos , Humanos , Melanócitos/patologia , Dermatoses da Mão/patologia , Feminino , Masculino , Biópsia , Mãos/patologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Healthcare workers are at high risk of developing occupational hand dermatitis (HD) due to their frequent exposure to wet-work and use of gloves. Complaints of HD may interfere with work and cause loss of work productivity, or sick leave, and may have impact on job pleasure and performing daily activities. The prevalence of HD among intensive care unit (ICU) nurses is unknown. OBJECTIVES: To investigate the point prevalence and the 1-year prevalence of HD among ICU nurses, and to determine the impact of HD on work and daily activities. METHOD: A questionnaire-based cross-sectional study was performed among ICU nurses. Participants were recruited in the Amsterdam University Medical Centre. A symptom-based questionnaire was used to determine HD and atopic predisposition, and an additional questionnaire was used concerning the influence of HD. ICU nurses with an atopic predisposition or symptoms suiting HD were invited for the hand dermatitis consultation hour (HDCH). Data were analysed with logistic regression. RESULTS: A total of 184 ICU nurses were included. The point prevalence of HD was 9.8% (95% CI: 5.9-15.0) and the 1-year prevalence was 26.6% (95% CI: 20.4-33.6). Sick leave was reported by 0.5%. HD seemed to have more impact on job pleasure than on work productivity. CONCLUSION: The high prevalence rate of HD resulting from our study highlights the need for the prevention of occupational HD among healthcare workers.