Diagnosing atopic dermatitis in infancy using established diagnostic criteria: a cohort study.

BACKGROUND: Diagnosing atopic dermatitis (AD) in infants is challenging. OBJECTIVES: To determine the incidence and persistence of eczema and AD in infants using the UK Working Party (UKWP) and Hanifin and Rajka (H&R) criteria. METHODS: A cohort of 1834 infants was examined clinically at 3, 6 and 12 months of age. AD was diagnosed by UKWP (3, 6 and 12 months) and H&R (12 months) criteria. Logistic regression models were used to assess the relationship between AD and eczema. RESULTS: Eczema was observed in 628 (34·2%) infants (n = 240, n = 359 and n = 329 at 3, 6 and 12 months, respectively), with AD diagnosed in 212 (33·7%) infants with any eczema and in 64/78 (82%) infants with eczema at all three visits. The odds of AD were lower with first presentation of eczema at 6 [odds ratio (OR) 0·33, 95% confidence interval (CI) 0·22-0·48] or 12 months (OR 0·49, 95% CI 0·32-0·74) than at 3 months, and higher in infants with eczema at three (OR 23·1, 95% CI 12·3-43·6) or two (OR 6·5, 95% CI 4·3-9·9) visits vs. one visit only. At 12 months, 156/329 (47·4%) fulfilled the UKWP and/or H&R criteria; 27 (8%) fulfilled the UKWP criteria only and 65 (20%) only the H&R criteria. Of the 129 infants who fulfilled the H&R criteria, 44 (34·1%) did not meet the itch criterion. CONCLUSIONS: Used in combination and at multiple timepoints, the UKWP and H&R criteria for AD may be useful in clinical research but may have limited value in most other clinical settings.

Vitamin D levels and atopic eczema in infancy and early childhood in Norway: a cohort study.

BACKGROUND: Epidemiological data and the effect of sun exposure on atopic eczema (AE) suggest that vitamin D (vitD) may be involved in the pathogenesis. OBJECTIVES: To investigate if vitD levels were associated with the presence or severity of AE in the first 2 years of life in children living in south-east Norway. METHODS: Infants, recruited to a clinical trial on acute bronchiolitis (n = 404) and from the general population (n = 240), were examined at 1-13 months (first visit) and at 2 years of age (second visit). Caregivers were interviewed using a structured questionnaire. AE was diagnosed clinically, based on well-established criteria. Disease severity was assessed using the SCORing Atopic Dermatitis index. Blood samples were taken for vitD measurements, using liquid chromatography-tandem mass spectrometry and for common filaggrin mutation analyses. Complete data on AE and vitD were available in 596 and 449 children at the first and second visit, respectively. RESULTS: Atopic eczema was diagnosed in 67 children (11%) at the first visit and in 103 children (23%) at the second. Mean vitD levels were 58·2 nmol L(-1) at the first visit and 66·9 nmol L(-1) at the second. Using vitD level tertiles in multivariate regression analysis, there was no association between vitD levels and AE at either visit, regardless of filaggrin mutation. In children without AE at the first visit, vitD levels did not predict AE at the second. CONCLUSIONS: In this cohort of young children in Norway, we found no association between vitD levels and the presence or severity of AE.

Vulvovaginal photodynamic therapy vs. topical corticosteroids in genital erosive lichen planus: a randomized controlled trial.

BACKGROUND: Genital erosive lichen planus (GELP) in women is a chronic inflammatory disease characterized by painful vulval and vaginal erosions. Topical photodynamic therapy (PDT) is increasingly used in premalignant and malignant diseases and may have an effect in inflammatory diseases. OBJECTIVES: To assess the feasibility, efficacy and safety of hexyl 5-aminolevulinate-hydrocloride (HAL)-PDT in GELP. METHODS: Forty women, diagnosed with GELP at a specialized vulva clinic, were randomized to one session HAL-PDT in vulva and/or vagina (n = 20) or daily applications of clobetasol propionate 0·05% ointment in vulva and optional hydrocortisone acetate 1·0% foam in vagina for 6 weeks (n = 20). After 6 weeks, all patients were allowed to use topical corticosteroids as needed. Clinical examinations were performed at weeks 0, 6 and 24, using a clinical score developed for the study. All patients wrote a weekly log on pain, topical corticosteroid use and adverse events. RESULTS: Three patients, all in the corticosteroid group, withdrew from the study after 1-3 weeks. The mean reduction in clinical scores was similar in the PDT group and the corticosteroid group; 25% vs. 22% after 6 weeks (P = 0·787) and 35% vs. 38% after 24 weeks (P = 0·801). The mean reduction in pain visual analogue scale scores was 38% vs. 55% after 6 weeks (P = 0·286) and 39% vs. 12% after 24 weeks (P = 0·452). Patients in the PDT group reported significantly less topical corticosteroid use during weeks 7-24 than those in the corticosteroid group. No major adverse events were reported. CONCLUSIONS: Vulvovaginal HAL-PDT seems to be an effective and safe treatment for GELP.

Conflicts of interest in medical publishing: it's all about trustworthiness.

Openness and transparency are vital for the trustworthiness of scientific journals and researchers. The term 'conflict of interest' should be defined broadly. Both financial and nonfinancial conflicts of interest may influence the reporting and evaluation of medical research. This should not hinder scientific cooperation between academic and industry-affiliated researchers. In the name of transparency, scientific journals should disclose the identity of a paper's peer reviewers and publish more information on the authors.

[How do Norwegian dermatologists keep themselves professionally updated?]. / Hvordan holder norske hudleger seg faglig oppdatert?

BACKGROUND: We have explored continuing medical education among Norwegian dermatologists, especially their use of medical journals and the Internet. MATERIAL AND METHODS: In April 2001, a questionnaire was sent to 170 dermatologists, including junior doctors in specialist training. 129 questionnaires (76%) were returned, of which 16 were excluded from the analysis. RESULTS: Mean time used per week reading articles in medical journals was 149 minutes (95% confidence interval (CI) 129-168 minutes). 90% of the respondents had Internet access at work and/or at home. Hospital consultants used the Internet for medical purposes for significantly more time per week than doctors in private practice (146 minutes (CI 98-195 minutes) versus 72 minutes (CI 52-93 minutes)). More hospital doctors had difficulties in getting or taking time off to attend courses and congresses (p < 0.01) and with financial costs (p < 0.001) than those in private practice. Most dermatologists found the paper version of journals (88%) and courses and congresses (79%) to be important for their continuing medical education, while fewer found medical databases on the Internet (57%) and the Internet version of journals (35%) to be so. In a logistic regression model, fewer private practitioners than hospital doctors (p = 0.011) and more female than male doctors (p = 0.014) had a feeling of insufficiency in regard to the increasing amount of medical information. INTERPRETATION: The Internet has become part of the professional life of most Norwegian dermatologists, but has so far not replaced traditional forms of continuing medical education.

[Etiology of non-melanoma skin cancer]. / Arsaker til hudkreft av ikke-melanomtype.

BACKGROUND: Most countries are experiencing an increased incidence of non-melanoma skin cancer (basal cell carcinoma and squamous cell carcinoma). MATERIAL AND METHODS: Based on relevant literature found by search in the PubMed database, an overview of the present knowledge of the etiology and pathogenesis of non-melanoma skin cancer is given. RESULTS: DNA damage caused by ultraviolet (UV) radiation from the sun is the main cause of non-melanoma skin cancer. Failure to repair these genetic alterations leads to unrestrained growth and ultimately tumour formation. In addition, ultraviolet radiation induces a relative immunosuppression in the skin that prevents cutaneous tumour rejection. UV-specific mutations in the p53 tumour suppressor gene probably play an important role through both tumour initiation and cell selection. INTERPRETATION: Physicians should advise their patients to avoid unnecessary sun exposure and to use sun protection, including sun screen creams.

Are heart transplant recipients more likely to develop skin cancer than kidney transplant recipients?

Non-melanoma skin cancer is frequent in organ transplant recipients. The risk of posttransplant cutaneous squamous cell carcinoma in Norwegian heart transplant recipients (n = 148) and kidney transplant recipients (n = 1020) on triple immunosuppressive therapy with cyclosporine, azathioprine, and prednisolone, transplanted between 1983 and 1992, were studied. After adjustment for age at transplantation in multivariable Cox models, heart transplant recipients had a significantly 2.8-times higher risk of developing squamous cell carcinoma relative to kidney transplant recipients. The risk relative to the general population (standardized incidence ratio) was higher in heart transplant recipients than in kidney transplant recipients. The results indicate that heart transplant recipients are more likely to be diagnosed with skin cancer than kidney transplant recipients, probably due to the higher doses of cyclosporine and azathioprine after heart transplantation used at our center in the study period.