Current patch test results with the European baseline series and extensions to it from the 'European Surveillance System on Contact Allergy' network, 2007-2008.

BACKGROUND: The pattern of contact sensitization to the supposedly most important allergens assembled in the baseline series differs between countries, presumably at least partly because of exposure differences. Objectives. To describe the prevalence of contact sensitization to allergens tested in consecutive patients in the years 2007 and 2008, and to discuss possible differences. METHODS: Data from the 39 departments in 11 European countries comprising the European Surveillance System on Contact Allergy network (www.essca-dc.org) in this period have been pooled and analysed according to common standards. RESULTS: Patch test results with the European baseline series, and country-specific or department-specific additions to it, obtained in 25 181 patients, showed marked international variation. Metals and fragrances are still the most frequent allergens across Europe. Some allergens tested nationally may be useful future additions to the European baseline series, for example methylisothiazolinone, whereas a few long-term components of the European baseline series, namely primin and clioquinol, no longer warrant routine testing. CONCLUSIONS: The present analysis points to 'excess' prevalences of specific contact sensitization in some countries, although interpretation must be cautious if only few, and possibly specialized, centres are representing one country. A comparison as presented may help to target in-depth research into possible causes of 'excess' exposure, and/or consideration of methodological issues, including modifications to the baseline series.

Principles of dermatologic ultrasound diagnostics.

Ultrasound is a valuable diagnostic tool widely used in medicine. Recently, high-frequency ultrasonography has been introduced to dermatology owing to technical advances. Currently, the most often used frequency for skin imaging is between 20 and 25 MHz. Ultrasound images can be generated in different modes, i.e. one-dimensional A mode, two-dimensional B mode and C mode. This type of skin imaging is known as a noninvasive, reproducible and quantitative method, which can be used to evaluate skin characteristics in a variety of dermatologic diseases. It can found application in the assessment of skin tumors, morphea, psoriasis, lipodermatosclerosis, skin aging and photodamage, hypertrophic scars, wound healing processes and allergic reactions. Although skin ultrasonography and its clinical applications are still being explored, most probably it will be implemented in the routine dermatologic diagnosis in the forthcoming future.

Contact allergy to glucocorticosteroids in patients with chronic venous leg ulcers, atopic dermatitis and contact allergy.

The aim of the study was to assess the prevalence of contact allergy to glucocorticosteroids in patients with chronic venous leg ulcers (CVLU), atopic dermatitis (AD) and contact dermatitis (CD), and in a group of healthy individuals; and to estimate differences among these patient groups. Patch tests with the European standard series, antibiotics, glucocorticosteroid contact allergy screening markers and ointment vehicles were performed in a population of 140 patients. Positive patch tests results were recorded in 80% and contact allergy to glucocorticosteroids in 40% of CVLU patients. In the group of AD patients, the respective figures were 30% and 3%. In the group of CD patients, allergic type of disease was detected in 80% and positive patch tests for glucocorticosteroids in 20% of patients. In healthy individuals, allergic contact reaction was observed in 17% of cases. Statistically significant differences among patient groups were found according to the prevalence of contact allergy, polyvalent allergy and contact allergy to glucocorticosteroids. We suggest that glucocorticosteroid contact allergy should be considered as a crucial clinical problem in patients with inflammatory dermatoses like CVLU, AD and CD.

Bacterial flora of leg ulcers in patients admitted to Department of Dermatology, Poznan University of Medical Sciences, during the 1998-2002 period.

Venous leg ulcers are an important cause of morbidity in a significant percentage of the world population. The percentage of leg ulceration, either active or healed, in the European population is about 1%-2%. The aim of this study was to analyze the rate of colonization and qualitative composition of the bacterial flora isolated from leg ulcers in patients admitted to Dermatology Department, Poznan University of Medical Sciences, during the 1998-2002 period, with special reference to the infection risk factors. Bacteriological diagnosis of 175 wound swabs was performed in compliance with compulsory laboratory methods. In 173 positive results, the predominant culture composition included Staphylococcus aureus (56.57%), Pseudomonas aeruginosa (37.14%), Enterococcus faecalis (22.29%), Proteus mirabilis (13.71%) and Escherichia coli (12.57%). There was a significant increase in the incidence of Pseudomonas aeruginosa, Enterococcus faecalis and Escherichia coli, along with a decrease in the incidence of Staphylococcus aureus isolation during the study period. The rate of yeast-like fungi strains, mainly Candida albicans, recorded in culture composition showed a systematic increase. Changes in the qualitative and quantitative composition of bacterial flora, presence of multiple isolates, and concomitant diseases that may influence the characteristics of leg ulcer disease were closely monitored.

Analysis of antibiotic susceptibility and resistance of leg ulcer bacterial flora in patients hospitalized at Dermatology Department, Poznan University Hospital.

Effective treatment of frequently infected, poorly healing wounds such as leg ulcers due to chronic venous insufficiency poses a major clinical problem. Antibiotic resistance in dermatology patients, especially those with non-healing leg ulcers, is a widespread phenomenon. Various antibiotics, mainly broad-spectrum agents, are frequently and sometimes inappropriately prescribed, which often leads to the selection of antibiotic-resistant bacteria strains. The aim of this study was to analyze antibiotic susceptibility and resistance of bacterial isolates cultured from leg ulcers. Wound swabs were obtained from patients admitted to Dermatology Department, Poznan University of Medical Sciences, during the 1998-2002 period. Bacteriologic diagnosis of 175 wound swabs was performed in compliance with compulsory laboratory methods. The analysis yielded 173 positive results, predominated by Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, Proteus mirabilis and Escherichia coli. Bacterial isolates were evaluated for resistance to commonly used antibiotics, taking into consideration the presence of methicillin resistant Staphylococcus aureus strains. Antibiotic resistance profiles were compared between the years 1998 and 2002, with detailed account of clinical characteristics and history of leg ulcers disease. The study pointed to an increasing tendency of antibiotic resistance in the study group of patients.

Contact allergy in patients with chronic venous leg ulcers-- possible role of chronic venous insufficiency.

The purpose of this study was to evaluate frequency of contact allergy in patients with chronic venous leg ulcers (CVLU) and to estimate possible relationships between allergic contact reactions and characteristics of both chronic venous insufficiency (CVI) and CVLU. We performed patch tests with the European standard series, antibiotics, glucocorticosteroids and ointment vehicles in 50 patients with CVLU. Patients underwent detailed CVI diagnostics using colour flow duplex ultrasound examination, ankle brachial pressure index determination and leg ulcers area measurement. Positive patch tests results were found in 80% and polyvalent allergy in 56% of patients. Statistically significant correlations were recorded between CVI and CVLU duration, CVLU duration and CVLU area and between CVI duration and polyvalent allergy frequency. Statistically significant differences were observed between coexistence of superficial and deep system insufficiency and CVLU duration, characteristics of contact allergic reactions and CVI duration, frequency of allergic contact reaction and presence or absence of long saphenous vein insufficiency, incidences of vein thrombosis and characteristics of contact allergic reactions as well as between characteristics of contact allergic reactions and both CVLU duration and area. Complex pathophysiological processes, including inflammatory reactions, in course of CVI may influence development of allergic contact reaction in CVLU patients.