The significance of spectrophotometric image analysis for diagnosis of the melanocytic skin tumours in association with their thickness.

BACKGROUND: Cutaneous melanoma is a melanocytic skin tumour, which has very poor prognosis while it is highly resistant to treatment and tends to metastasize. Thickness of melanoma is one of the most important biomarker for stage of disease, prognosis and surgery planning. In this study, we hypothesized that the analysis of spectrophotometric (SIAscope) images can provide the information about skin tumour thickness. METHODS: The intensity of blood displacement, "erythematous blush", collagen holes, intensity of collagen, dermal and epidermal melanin were estimated in SIAgraphs. Tumour thicknesses were evaluated non-invasively in ultrasound images before excision. The diagnosis and Breslow index of each tumour were evaluated during routine histological examination. RESULTS: The logistic regression analysis of two thicknesses groups of melanocytic tumours (≤1 mm, n = 72 and >1 mm, n = 30), using six SIAscopic features lead to achieve the areas under the ROC curves of 0.9 and 0.96 respectively. Overall the sensitivity and specificity of SIAscopy observed in this study is 81.4% and 86.4% respectively. CONCLUSION: The features of SIAgraphs individually are not enough specific for melanoma diagnosis with different thickness. Promising results were observed for differentiation of melanocytic skin tumour, using all 6 SIAscopic features, which correspond to the distribution, location and concentration of skin chromophores.

Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14.

BACKGROUND: Contact allergy is a common condition and can severely interfere with daily life or professional activities. Due to changes in exposures, such as introduction of new substances, new products or formulations and regulatory intervention, the spectrum of contact sensitization changes. OBJECTIVE: To evaluate the current spectrum of contact allergy to allergens present in the European baseline series (EBS) across Europe. METHODS: Retrospective analysis of data collected by the European Surveillance System on Contact Allergies (ESSCA, www.essca-dc.org) in consecutively patch-tested patients, 2013/14, in 46 departments in 12 European countries. RESULTS: Altogether, 31 689 patients were included in the analysis. Compared to a similar analysis in 2004, the prevalence of contact allergy to methylisothiazolinone went up to around 20% in several departments. In comparison, contact allergy to the metals nickel, cobalt and chromium remained largely stable, at 18.1%, 5.9% and 3.2%, respectively, similar to mostly unchanged prevalence with fragrance mix I, II and Myroxylon pereirae (balsam of Peru) at 7.3%, 3.8% and 5.3%, respectively. In the subgroup of departments diagnosing (mainly) patients with occupational contact dermatitis, the prevalence of work-related contact allergies such as epoxy resin or rubber additives was found to be increased, compared to general dermatology departments. CONCLUSION: Continuous surveillance of contact allergy based on network data offers the identification of time trends or persisting problems, and thus enables focussing in-depth research (subgroup analyses, exposure analysis) on areas where it is needed.

COMPETENCE IN TOPIC OF PSORIASIS AMONG NURSES IN HEALTHCARE INSTITUTIONS.

UNLABELLED: Nurses in their everyday work meet patients with various diseases (including chronic skin diseases), and play an important role in improving patients' quality of life. Nurses working in dermatology clinics frequently play leading roles in the care of patients with skin disorders. The aim of the study was to investigate the knowledge about the psoriasis among nurses working in non-dermatological healthcare institutions. A cross-sectional study in randomly selected 16 healthcare institutions of Kaunas city was conducted. The study included 505 nurses. A questionnaire to assess the knowledge was developed, containing 15 questions about signs of psoriasis. Based on the responses, the nurses' level of knowledge was evaluated in points. The respondents' age was 45.34±10.52 years, and the mean duration of their work experience was 23.2±11.42 years. CONCLUSION: the nurses' level of knowledge depended on their education level and the frequency of contacts with psoriasis patients. Nurses working in non-dermatological healthcare institutions had insufficient knowledge about psoriasis, and expressed willingness to learn more.

The role of phenotype, body mass index, parental and sun exposure factors in the prevalence of melanocytic nevi among schoolchildren in Lithuania.

BACKGROUND: The occurrence and number of melanocytic nevi (MN) are among the most important known risk factors for the development of cutaneous melanoma (CM). OBJECTIVES: To estimate the prevalence of MN among schoolchildren and its relationship with phenotype, body mass index (BMI), parental and sun exposure factors. METHODS: A cross-sectional study was conducted on N = 1277 schoolchildren aged 7-19 years old in Kaunas city, Lithuania. Subjects were interviewed using a self-administered questionnaire and were assessed by a dermatologist. MN of all sizes and ≥2 mm in diameter were counted; phenotypic features and skin phototype were defined. BMI and body surface area (BSA) were calculated. Whole-body MN counts were expressed both as totals and as counts per unit of BSA - MN density (MND). Biological parents completed questionnaires regarding nevus counts, family history of skin cancer and CM. RESULTS: The numbers of all sizes and ≥2 mm MN increased according to age, respectively, from median values of 44 (IQR 28, 60) and 5 (IQR 2, 8) at the age of 7-9 years to 85 (IQR 55, 128) and 16 (IQR 8, 30) at the age of 16-19 years. A higher MND was found in children with light skin colour (P < 0.001), I-II skin phototype (P < 0.001), extensive facial freckling (P < 0.005) and multiple nevi on the father's and mother's arms (P < 0.05). 20.2% of pupils were overweight or obese, 130 males and 118 females. Overweight and obese children had a higher all sizes MND (P = 0.033, P = 0.044). Acquired suntan at the end of summer was associated with a higher all sizes MND (P < 0.05), outdoor activities at midday - with a higher ≥2 mm MND (P = 0.047) respectively. CONCLUSIONS: The prevalence of MN among schoolchildren is age-dependent and strongly determined by skin colour, skin phototype, facial freckling and BMI. Parental nevus numbers, acquired suntan and outdoor activities at midday must be considered.

Topical photodynamic therapy of actinic keratoses with 5-aminolevulinic acid: randomized controlled trial with six months follow-up.

BACKGROUND: Topical 5-aminolevulinic acid (ALA) photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AK) with some transient adverse events. OBJECTIVE: The purpose of the study was to evaluate the efficacy and side effects of two different light doses when treating AKs with ALA-PDT on the face/scalp. METHODS: Thirty-eight patients with two histologically confirmed AKs were enrolled in the within-patient comparison study. ALA-PDT was performed twice with two weeks interval for each AK. Patients were randomized to receive a light dose of 70 or 100 J/cm2 as their first split face/scalp treatment. Follow-up examinations were carried out at months 3 and 6. Efficacy end point included clinical/histological AK clearance rate. RESULTS: No significant difference in therapeutic efficacy and adverse events of ALA-PDT was found between the two light doses at both follow-up visits. At months 3 and 6 after PDT the RATE of complete remission were respectively 100% and 92.1% for 70 J/cm2, 92.1% and 84.2% for 100 J/cm2. The adverse events of the treatment were rosacea 5/76 (6.58%), hyperpigmentation 4/76 (5.26%), hypopigmentation 4/76 (5.26%), transient milia 3/76 (3.95%). CONCLUSIONS: The topical ALA-PDT with the red light dose of 70 J/cm2 is an effective treatment for mild and moderate AKs on the face/scalp with expected adverse events of pigmentation changes, rosacea and transient milia.

The prevalence and risk factors of adolescent acne among schoolchildren in Lithuania: a cross-sectional study.

BACKGROUND: Acne is one of the most common chronic inflammatory dermatological diseases among adolescents. OBJECTIVES: We sought to estimate the prevalence of acne among schoolchildren and its association with puberty, body mass index (BMI), acne history of parents, nutritional habits, smoking and alcohol consumption. METHODS: A cross-sectional study was conducted on 1277 pupils aged 7-19 years. Children were interviewed with self-administered questionnaires, and were subsequently examined by one specially trained dermatologist. To evaluate the onset of puberty, girls provided details about their menarche and boys--about their facial hair growth. RESULTS: The overall response rate of the study was 51.4%. The prevalence of acne among respondents was 82.9%, and was strongly age-dependent with highest rates in the age groups of 13-15 and 16-19 years. The prevalence of pre-pubertal acne among participating girls and boys was 69.9% and 73.6% respectively. The main risk factors of acne were facial hair growth in boys (OR = 4.9), menarche in girls (OR = 3.1), overweight/obesity (BMI ≥ 25 kg/m(2) at 18 years of age) (OR = 2.6), acne history from both parents (OR = 2.6) and from mother alone (OR = 2.1). We did not find any associations between acne and nutritional habits, smoking or alcohol consumption. The self-reported prevalence of acne among children who refused to take part in the study was lower than that among participants of the study. CONCLUSIONS: The overall prevalence of acne among schoolchildren is high and age-dependent. The onset of puberty, overweight/obesity and history of acne from both parents are the top risk factors for acne.

Principles of high-frequency ultrasonography for investigation of skin pathology.

Ultrasonography is a valuable diagnostic tool widely used in medicine. During the last three decades, this non-invasive skin imaging method has been extended to dermatology. High-frequency ultrasonography with higher than 20MHz scanners is well-established for measuring tumour thickness and skin thickness when treating inflammatory skin diseases such as scleroderma or psoriasis. High-frequency ultrasonography has become extremely helpful for the preoperative assessment of skin melanoma. The correlation between ultrasonic and histological measurements of melanomas thickness is significantly similarly good using transducers of 20, 75 or 100MHz frequency (r range from 0.895 to 0.99) and better compared with transducers of 7.5MHz frequency (r=0.76). The preoperative sonographically estimated thickness of skin melanoma is sometimes overestimated, because of an underlying inflammatory infiltrate and other reasons. Assessment of skin melanoma thickness using transducers of 100MHz frequency has better agreement with histology, compared with ultrasonography with 20MHz transducers. However, the ultrasonic penetration depth is limited to 1.5mm in case of 100MHz. The newer ultrasonic techniques such as high-frequency ultrasonography and colour Doppler sonography could be used for assessment of the tumour vascularization and its metastatic potential. The wide variety of diagnostic information provided by high-frequency ultrasonography undoubtedly improves the management of oncological and inflammatory skin conditions and underlines its essential position in dermatological practice.

The European baseline series in Lithuania: results of patch testing in consecutive adult patients.

BACKGROUND: In Lithuania, data on patch testing are lacking and the applicability of the European baseline series needs to be evaluated. OBJECTIVE: The aim of the study was to examine the prevalence of contact allergy to the European baseline series in the population of patients with suspected allergic contact dermatitis in Lithuania. METHODS: Between April 2006 and October 2008, 816 consecutive adult patients referred to the Department of Skin and Venereal Diseases, Kaunas University of Medicine, with suspected allergic contact dermatitis were patch tested with the European baseline series. Demographic data were collected in accordance with the European Surveillance System on Contact Allergies 'minimal data set'. RESULTS: The positive patch test was observed in 384 (47.4%) patients. The most prevalent contact allergens were nickel sulphate (17.1%), Myroxylon pereirae resin (8.0%), p-phenylenediamine (6.0%), methyldibromo glutaronitrile (5.5%) and colophonium (5.0%). The sex and age factors strongly influenced the prevalence of nickel sensitization. The lowest sensitization prevalences were found to N-isopropyl-N'-phenyl-p-phenylene diamine (0.1%) and 2-mercaptobenzothiazole (0.1%). Differences in the sensitization prevalences to some allergens of the European baseline series compared with other European countries were recognized. CONCLUSION: The current European baseline series is a suitable diagnostic tool for contact allergy in Lithuania.