RESUMO
BACKGROUND: Comprehensive data on the epidemiology and comorbidities of chronic urticaria (CU) in Germany are either limited, or not contemporary. OBJECTIVES: To investigate the epidemiology of CU, overall comorbidities and healthcare resource utilized by patients with CU in Germany, using an anonymized statutory health insurance (SHI) database. METHODS: Anonymized SHI claims research database of the Institute for Applied Health Research, Berlin [InGef] (01 January 2015-30 September 2018) was used to analyse insured individuals with a confirmed diagnosis of CU (ICD-10-GM codes). Twelve-month diagnosed prevalence and incidence, comorbidities (vs. atopic dermatitis and psoriasis), and healthcare utilization by patients with CU were investigated. RESULTS: Of 4 693 772 individuals of all ages listed in the database, 3 538 540 were observable during 2017. Overall, 17 524 patients (Ë0.5%) were diagnosed with CU; chronic spontaneous urticaria (CSU: 71.2%), chronic inducible urticaria (CIndU: 19.7%), CSU+CIndU (9.1%). Females, vs. males, had higher diagnosed prevalence (0.62% vs. 0.37%) and diagnosed incidence (0.18% vs. 0.11%) of CU among all patients. Patients most frequently visited general practitioners (41.3% of total visits). Hypertensive diseases (43.5%), lipoprotein metabolism disorders (32.1%) and affective disorders (26.0%) were the most frequently reported comorbidities of special interest. Rates of most comorbidities of special interests were similar to atopic dermatitis and psoriasis patients, and all higher vs. overall population. More than half (54.1%) of all CU patients were not prescribed any treatment. Second-generation H1 -antihistamines were the most commonly prescribed medication for adult (17.9%) and paediatric (27.9%) patients. Patients with CIndU (paediatric, 15.5%; adult, 7.8%) were more often hospitalized versus patients with CSU (paediatric, 9.9%; adult, 4.6%). CONCLUSIONS: In Germany, prevalence of CU along with multiple comorbidities may pose increased burden on the healthcare system. Awareness of adhering to treatment guidelines, and aiming for complete control of urticaria, needs to be driven and may improve outcomes.
Assuntos
Urticária Crônica , Urticária , Adulto , Criança , Doença Crônica , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Urticária/epidemiologiaRESUMO
Ultraviolet (UV) filters may cause allergic and more frequently photoallergic contact dermatitis. Therefore, a photopach test should always be performed in case of a suspected contact sensitivity to UV filters. We report a case of a 65-year-old woman with a recurrent erythema of the face and décolleté after sun exposure despite application of a sunscreen. The (photo)patch test revealed a contact sensitivity to the UV filter butyl-methoxybenzoylmethane. Treatment with a topical glucocorticoid and avoidance of the particular UV filter led to a rapid improvement.
Assuntos
Dermatite Alérgica de Contato/etiologia , Dermatite Fotoalérgica/etiologia , Propiofenonas/efeitos adversos , Protetores Solares/efeitos adversos , Raios Ultravioleta/efeitos adversos , Idoso , Dermatite Alérgica de Contato/diagnóstico , Dermatite Fotoalérgica/diagnóstico , Dermatite Fotoalérgica/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Testes do Emplastro/métodos , Propiofenonas/administração & dosagem , Protetores Solares/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: Subcutaneous allergen immunotherapy with grass pollen allergoids has been proven to be effective and safe in the treatment of patients with allergic rhinoconjunctivitis. Based on the extensive cross-reactivity among Pooideae species, it has been suggested that grass pollen extracts could be prepared from a single species, rather than from a multiple species mixture. OBJECTIVE: To find the optimal dose of a Phleum pratense (P. pratense) allergoid preparation and compare its efficacy and safety to a 6-grass pollen allergoid preparation. METHODS: In this double-blind, placebo-controlled study (EudraCT: 2011-000674-58), three doses of P. pratense allergoid (1800 therapeutic units (TU), standard-dose 6000 TU and 18 000 TU) were compared with placebo and the marketed 6-grass pollen allergoid (6000 TU). In a pre-seasonal dosing regimen, 102 patients were randomized to five treatment groups and received nine subcutaneous injections. The primary efficacy endpoint was the change in weal size (late-phase reaction [LPR]) in response to the intracutaneous testing (ICT) before and after treatment, comparing the active allergoids to placebo. Secondary outcomes were the change in Total Nasal Symptom Score (TNSS) assessed in the allergen exposure chamber (AEC), the changes in P. pratense-serum-specific IgG4 and the incidence of adverse events (AEs). RESULTS: All three doses of the P. pratense and the 6-grass pollen allergoid preparations were significantly superior to placebo for the primary outcome, whereas there were no significant differences in the change in TNSS. Compared to the standard-dose, the high-dose of P. pratense did not produce any additional significant benefit, but showed a slight increase in AEs. Yet this increase in AEs was lower than for the 6-grass pollen preparation. CONCLUSIONS & CLINICAL RELEVANCE: The standard-dose of the new P. pratense allergoid was comparable to the marketed 6-grass pollen preparation at equal dose for the parameters measured.
Assuntos
Alérgenos/imunologia , Relação Dose-Resposta Imunológica , Phleum/efeitos adversos , Extratos Vegetais/imunologia , Pólen/imunologia , Rinite Alérgica Sazonal/imunologia , Rinite Alérgica Sazonal/terapia , Adolescente , Adulto , Idoso , Alergoides , Dessensibilização Imunológica/efeitos adversos , Dessensibilização Imunológica/métodos , Feminino , Alemanha , Humanos , Imunoglobulina E/imunologia , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagem , Rinite Alérgica Sazonal/diagnóstico , Imunoterapia Sublingual , Resultado do Tratamento , Adulto JovemRESUMO
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.
Assuntos
Dermatite Alérgica de Contato/epidemiologia , Vigilância da População , Adulto , Alérgenos/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Metais Pesados/toxicidade , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
BACKGROUND: Cosmetic products are subject to the European Cosmetics Regulation: They shall not harm human health when used under "normal or reasonably foreseeable conditions". Hazardous cosmetic products are reported by the EU Member States to the EU Commission and are listed in the database of the European Rapid Alert System RAPEX. MATERIAL AND METHODS: The reports from Germany on dangerous cosmetic products from the years 2005-3/2017 in the European RAPEX database were systematically analyzed. RESULTS: During the study period, 157 dangerous cosmetic products were reported from Germany. The most common product categories were bleaching creams (24.2%) because of the content of hydroquinone, mercury or corticosteroids, creams/lotions/gels (10.8%) mainly due to microbiological contamination, henna products (10.2%) because of sensitizing concentrations of paraphenylene diamine, and nail adhesives (8.9%) because of high levels of methyl methacrylate. CONCLUSIONS: Hazardous cosmetic products appear to be rare in view of the high market volume of cosmetics, even though the total number of official investigations the RAPEX reports based on is not known. Dermatologists should inform the competent monitoring authorities in case of a suspected harm to health caused by dangerous cosmetic products so that the products can be examined and, if necessary, withdrawn from the market.
Assuntos
Cosméticos/toxicidade , Bases de Dados Factuais , Adesivos/toxicidade , Clareadores/toxicidade , Alemanha , Glucocorticoides/toxicidade , Humanos , Hidroquinonas/toxicidade , Mercúrio/toxicidade , Metilmetacrilato/toxicidade , Naftoquinonas/toxicidade , Fenilenodiaminas/toxicidade , Creme para a Pele/efeitos adversosRESUMO
Pigmentary nail changes may have a variety of causes, e. g., chronic inflammation, and occur more often in patients of African descent compared to Caucasians. Subungual malignant melanoma is the most important differential diagnosis and must be ruled out in any case. Dermatoscopy might be helpful. If no biopsy is taken, clinical follow-ups are necessary at short intervals. In case of chronic paronychia, optimization of occupational skin protection measures may contribute to the healing process.
Assuntos
Doenças da Unha/diagnóstico , Doenças da Unha/terapia , Transtornos da Pigmentação/diagnóstico , Transtornos da Pigmentação/terapia , Adulto , Dermoscopia/métodos , Diagnóstico Diferencial , Feminino , Humanos , Doenças da Unha/etnologia , Transtornos da Pigmentação/etnologiaRESUMO
Vulvar cysts are rare und benign entities. They are epidermoid cysts which may develop following trauma or surgery. They can also spontaneously develop. They vary in number and size. They grow slowly and tend to show calcification. The treatment consists of surgical removal. Other methods are pinch-punch excision, heat application, and incision.
Assuntos
Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Dermatopatias/patologia , Dermatopatias/cirurgia , Doenças da Vulva/patologia , Doenças da Vulva/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Resultado do TratamentoRESUMO
Cutaneous infections with Trichophyton species of Arthroderma (A.) benhamiae are increasingly being detected in Germany. This dermatophyte typically causes tinea corporis, tinea faciei or tinea capitis with in part heavy clinical manifestation like kerion celsi. In special cases diagnosis and therapy can be difficult. In this article, four clinical cases are presented, whereby attention is given to special clinical situations and therapeutic aspects with regard to Trichophyton species of A. benhamiae: Case 1: Kerion celsi by in a 6-year-old boy; Case 2: Deep trichophytia at the mons pubis in a 32-year-old man working in a pet shop and his 27-year-old female partner; Case 3: Tinea manuum in a 7-year-old girl; Case 4: Tinea corporis in an 8year-old girl.
Assuntos
Antifúngicos/uso terapêutico , Tinha/diagnóstico , Tinha/tratamento farmacológico , Trichophyton/isolamento & purificação , Adulto , Arthrodermataceae/classificação , Arthrodermataceae/isolamento & purificação , Criança , Feminino , Humanos , Masculino , Especificidade da Espécie , Tinha/microbiologia , Resultado do TratamentoRESUMO
Tobacco smoking is known to influence various inflammatory skin diseases. A systematic review with a meta-analysis was conducted to analyse a possible association between the lifestyle factor tobacco smoking and hand dermatitis. We performed a systematic review using the MEDLINE, Embase and Cochrane Central Register databases. Our search was limited to English and German language, human-subject studies published between January 1, 1980 and December 31, 2013. A total of 43 articles were identified from the initial search, and after taking into account exclusion criteria, only three studies remained investigating the risk factors for hand eczema in the general and in high-risk populations (e.g. bakers, hairdressers, dental technicians). The extracted data were pooled and analysed by standard statistical methods. The studies meeting inclusion criteria consisted of one cohort study and two cross-sectional studies based on a total of 4.113 subjects with hand dermatitis and 34.875 subjects without hand dermatitis. While one of the studies had reported a significant association between hand dermatitis and smoking, the meta-analysis did not confirm this finding (OR 0.99; 95% CI 0.88-1.11). However, heterogeneity across studies was high (I(2) = 72%). Our meta-analysis did not show tobacco smoking to be a risk factor for hand dermatitis. However, these results depend mainly on two large studies from one country. From present data, it cannot be excluded that smoking may influence the course of hand dermatitis. Even though smoking does not seem to be associated with hand dermatitis, it may still negatively influence the course of the disease.
Assuntos
Acrodermatite/etiologia , Fumar/efeitos adversos , Mãos , HumanosRESUMO
Granuloma annulare (GA) is a benign inflammatory skin disease. Localized GA is likely to resolve spontaneously, while generalized GA (GGA) is rare and may persist for decades. GGA usually is resistant to a variety of therapeutic modalities and takes a chronic course. The objective of this study was to summarize all reported treatments of generalized granuloma annulare. This is a systematic review based on MEDLINE, Embase and Cochrane Central Register search of articles in English and German and a manual search, between 1980 and 2013, to summarize the treatment of generalized granuloma annulare. Most medical literature on treatment of GGA is limited to individual case reports and small series of patients treated without a control group. Randomized controlled clinical studies are missing. Multiple treatment modalities for GGA were reported including topical and systemic steroids, PUVA, isotretinoin, dapsone, pentoxifylline, hydroxychloroquine, cyclosporine, IFN-γ, potassium iodide, nicotinamide, niacinamide, salicylic acid, dipyridamole, PDT, fumaric acid ester, etanercept, infliximab, adalimumab. While there are numerous case reports of successful treatments in the literature including surgical, medical and phototherapy options, well-designed, randomized, controlled clinical trials are required for an evidence-based treatment of GGA.
Assuntos
Granuloma Anular/terapia , HumanosRESUMO
The different definitions of skin disease in medicine and in law are frequently confusing for dermatologists. While a skin disease may be defined medically referring to the definition of health by the WHO as a pathological condition of the skin leading to a disruption of the physical, mental and social well-being of the individual, legal definitions vary depending on the field of insurance law that is referred to. In the law of private health insurance, a skin disease is defined as an anomalous condition of the skin requiring medical treatment that exists independently of the subjective judgement of the insured person and needs to be objectively confirmed by a medical evaluation. In contrast, in the law of the social health insurance, the Federal Court of Social Justice defines disease as irregular physical or mental condition, deviating from the perception of a healthy human being that requires medical treatment or leads to inability to work. Substantial bodily disfigurement may be regarded as an irregular physical condition. In the law of the statutory accident insurance, occupational skin diseases are defined under clause 5101 of the occupational disease regulation as serious or repeatedly relapsing skin diseases that have forced a person to refrain from any work activities causal for the development, the aggravation or the recurrence of the disease. The Federal Court of Social Justice interprets the term "skin disease" from the protective purpose of the law, i.e. the protection against the economic and health consequences of the exposure to harmful agents and a thereby forced change of profession. This broad interpretation of the term "skin disease" leads to the recognition of diseases of the conjunctiva of the eye or diseases of the blood vessels of the skin due to cold damage as skin diseases according to clause 5101. For the correct treatment and possibly notification of occupational skin diseases in collaboration with various insurance carriers, dermatologists should be familiar not only with the medical definition, but also with these different legal definitions of skin disease.
Assuntos
Dermatologia/legislação & jurisprudência , Doenças Profissionais/classificação , Medicina do Trabalho/legislação & jurisprudência , Dermatopatias/classificação , Terminologia como Assunto , Dermatologia/normas , Alemanha , Doenças Profissionais/diagnóstico , Medicina do Trabalho/normas , Dermatopatias/diagnósticoRESUMO
Scabies is an infectious skin disease caused by the human itch mite (Sarcoptes scabiei var. hominis). It is mainly transmitted by direct skin-to-skin contact. The spread of scabies can cause major difficulties in healthcare institutions, particularly in residential homes for the elderly. The disease is characterized by intense nocturnal itching, erythematous papules arranged in a linear order, and scratching resulting in excoriations. The diagnosis is confirmed by identification of the mite or by finding one or more mite tunnels in the skin. An individually occurring case does not need to be reported. If two or more cases occur in the same institution, the company physician and the appropriate public health department are to be informed in Germany. In case of a suspected scabies infection in medical personnel due to exposure in their work setting, medical notification to the statutory occupational accidents' insurance (Nr. 3101) is to be issued in accordance with § 202, Volume VII of the German Social Code. First line treatment is topical therapy with 5 % permethrin. If scabies control is required in an institution, systemic treatment with ivermectin may be considered. In the case of a scabies outbreak, all patients, contact persons, and staff must be treated simultaneously.
Assuntos
Notificação de Abuso , Doenças Profissionais/diagnóstico , Doenças Profissionais/terapia , Medicina do Trabalho/legislação & jurisprudência , Escabiose/diagnóstico , Escabiose/terapia , HumanosRESUMO
BACKGROUND: To date, there are no legally binding requirements concerning product testing in cosmetics. This leads to various manufacturer-specific test methods and absent transparent information on skin cleansing products. A standardized in vivo test procedure for assessment of cleansing efficacy and corresponding barrier impairment by the cleaning process is needed, especially in the occupational context where repeated hand washing procedures may be performed at short intervals. METHODS: For the standardization of the cleansing procedure, an Automated Cleansing Device (ACiD) was designed and evaluated. Different smooth washing surfaces of the equipment for ACiD (incl. goat hair, felt, felt covered with nitrile caps) were evaluated regarding their skin compatibility. RESULTS: ACiD allows an automated, fully standardized skin washing procedure. Felt covered with nitrile as washing surface of the rotating washing units leads to a homogenous cleansing result and does not cause detectable skin irritation, neither clinically nor as assessed by skin bioengineering methods (transepidermal water loss, chromametry). CONCLUSIONS: Automated Cleansing Device may be useful for standardized evaluation of the cleansing effectiveness and parallel assessment of the corresponding irritancy potential of industrial skin cleansers. This will allow objectifying efficacy and safety of industrial skin cleansers, thus enabling market transparency and facilitating rational choice of products.
Assuntos
Cosméticos/química , Detergentes/química , Cabelo/efeitos dos fármacos , Testes Cutâneos/instrumentação , Testes Cutâneos/normas , Tecnologia Farmacêutica/instrumentação , Tecnologia Farmacêutica/normas , Animais , Cosméticos/administração & dosagem , Cosméticos/análise , Detergentes/análise , Detergentes/farmacologia , Desenho de Equipamento , Análise de Falha de Equipamento , Alemanha , Cabras , Guias como Assunto , Cabelo/química , Robótica/instrumentação , Robótica/normasRESUMO
BACKGROUND: Skin cleansers for occupational use are manufactured for different types and degrees of soiling without common, legally binding requirements for product testing. This leads to different, manufacturer-specific test methods and a lack of comparable information on skin cleansing products. OBJECTIVES: The aim of this investigation was to validate a newly developed standardized automated cleansing device (ACiD) for in vivo evaluation of industrial skin cleansers. METHODS: Two ACiD were tested regarding the intra- and inter-device specific reproducibility of test results. RESULTS: Skin cleansing process carried out by the three independent washing modules which constitute an ACiD-unit and two separate ACiD-units led to highly comparable results. There was no significant difference between the washing modules or between the two separate ACiD-units detected. Only different parameter settings resulted in significantly different detergency. CONCLUSIONS: Intra- and inter-device specific test results of an in vivo model of skin cleansing using the automated cleansing device (ACiD) were reproducible. The long-term aim is a standardized classification of occupational skin cleansing products comparing their skin cleansing effectiveness in relation to their skin irritancy. This might then provide the basis for a rational specific product selection by consumers and may be used as a tool for future product development by manufacturers.
Assuntos
Cosméticos/efeitos adversos , Dermatite de Contato/diagnóstico , Dermatite de Contato/etiologia , Detergentes/efeitos adversos , Cabelo/efeitos dos fármacos , Testes Cutâneos/instrumentação , Testes Cutâneos/normas , Tecnologia Farmacêutica/instrumentação , Adulto , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Alemanha , Guias como Assunto , Cabelo/química , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Robótica/instrumentação , Robótica/normas , Sensibilidade e Especificidade , Tecnologia Farmacêutica/normasRESUMO
Infectious diseases of the skin have become rarer in industrialized nations, but they still affect a considerable part of the population in tropical regions. Skin diseases induced by protozoa, worms and ectoparasites are among the 17 "neglected tropical diseases" defined by the WHO (leishmaniasis, dracunculiasis, lymphatic filariasis, onchocerciasis). Skin symptoms in travellers returning from the tropics may challenge dermatologists in Germany regarding differential diagnostic assessment and therapy. Among the 12 most frequent skin diseases in travellers are cutaneous larva migrans, leishmaniasis and myiasis. In this review, diagnosis, treatment and prevention of some the most relevant tropical dermatoses due to protozoa, worms and ectoparasites are discussed.
Assuntos
Helmintíase/diagnóstico , Helmintíase/terapia , Infecções por Protozoários/diagnóstico , Infecções por Protozoários/terapia , Dermatopatias Parasitárias/diagnóstico , Dermatopatias Parasitárias/terapia , Clima Tropical , Ectoparasitoses/diagnóstico , Ectoparasitoses/terapia , Humanos , ViagemRESUMO
Dengue fever with its subtle rash is today more common than malaria in travellers returning to Europe from the tropics (meta-analysis Geo Sentinel network). Up to 5 % of all safari tourists experience African tick bite fever during or soon after their journey; it is caused by rickettsiae and clinically presents with exanthems, focal necrotizing vasculitis (eschar, tache noir), lymphadenopathy and moderate fever. Typhoid fever is a severe infectious disease is which is difficult to diagnosis at first assessment. The presence of rose spots, which may be found in up to 33 % of patients with typhoid fever, can lead the way to diagnosis. Exanthems can be subtle and may occur weeks after infection without any other distinctive clinical sign. Particular importance in travel medicine has to be paid to acute HIV infection and secondary syphilis after exposition and infection in the tropics. Also the highly contagious infectious diseases of childhood as measles and rubeola have to be taken into account in adults with no or insufficient vaccination after a stay in tropical countries.
Assuntos
Dengue/diagnóstico , Dengue/terapia , Exantema/diagnóstico , Exantema/terapia , Infecções por Rickettsia/diagnóstico , Infecções por Rickettsia/terapia , Clima Tropical , Diagnóstico Diferencial , Humanos , ViagemRESUMO
BACKGROUND: Skin diseases are frequent in tropical countries and cause a significant burden for their health systems. Tropical dermatoses are frequently of infectious nature. DIAGNOSTICS: Dermatopathology plays an important role in the diagnosis of many tropical skin diseases. This refers specially to leishmaniasis, tropical helminthic diseases, tuberculosis, leprosy, and deep fungal infections. In addition, dermatopathology is important for the differential diagnosis of non-infectious inflammatory diseases in pigmented skin; their identification may be more challenging than when seen in Caucasian skin. CONCLUSION: While it is usually not problematic to perform a dermatopathologic workup in travelers and expatriates returning from the tropics into Western industrialized countries, dermatopathologic services are frequently non-existent or severely limited in many tropical countries. Therefore, in improving health systems, not only should a dermatologic workforce be developed, but also training of dermatopathologists and the establishment of dermatopathology laboratories should be considered.
Assuntos
Biópsia/métodos , Dermatologia/métodos , Dermoscopia/métodos , Dermatopatias Infecciosas/patologia , Viagem , Clima Tropical , HumanosRESUMO
Under the conditions of economic pressure in the medical system and the DRG system for hospitals in Germany, so-called "uneconomic" services and fields of specialized dermatologic competence such as pediatric dermatology, trichology, occupational dermatology and tropical dermatology are increasingly being neglected. While hospitals tend to train fewer residents in these subspecialties, there is a demand for additional high-quality training opportunities that are certified by the German Dermatologic Academy (DDA). Tropical and travel-related skin diseases are more frequently observed in Germany which can be explained by the increased world-wide travel activities, but also by the international migration from developing countries into Europe. Furthermore, dermatologists trained in Germany are working more and more also internationally. Thus, they require knowledge and experience in tropical and travel-related dermatology. The certificate "Tropical and Travel Dermatology (DDA)" was developed and published in 2013 in a cooperation between the International Society for Dermatology in the Tropics in cooperation with the German Academy of Dermatology (DDA). It consists of 3 full day teaching modules (basic, additional and special seminar). The first seminar cycle in 2013/2014 showed a high demand from dermatologists in hospitals and private practices. While the basic and the special seminars were held in Germany, the additional seminar took place in cooperation with the Regional Dermatology Training Center (RDTC) in Moshi, Tanzania. Many attending dermatologists fulfilling the requirements for the new certificate have practiced in developing countries or plan to do so. In order to gain practical experience on the basis of the knowledge acquired in the qualifying seminars, the International Society for Dermatology in the Tropics supports dermatologists to find internships and work placements in dermatological units in developing countries.
Assuntos
Certificação/normas , Dermatologia/educação , Dermatologia/normas , Educação Médica Continuada/normas , Emigração e Imigração , Garantia da Qualidade dos Cuidados de Saúde/normas , Dermatopatias Infecciosas , Currículo/normas , Alemanha , HumanosRESUMO
BACKGROUND: Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. METHODS: SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n = 3-5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. RESULTS: Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. CONCLUSIONS: There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential.