The effect of Aloe vera gel and sweet almond oil on striae gravidarum in nulliparous women.

BACKGROUND AND OBJECTIVE: Striae are linear depressions of the skin and causes psychological and sexual problems in person. Different methods are used to prevent and treat them but there is no definitive method. We compared the effect of Aloe vera gel and sweet almond oil on striae gravidarum. MATERIALS AND METHODS: In this double-blind clinical trial, 160 nulliparous women were enrolled and randomly divided into three case groups and one control group. The four groups were given 700 g Aloe vera, sweet almond oil, and base cream to use topically on the abdominal skin and forth group don't receive any medication as control group in five steps, they were examined study's variables (itching, erythema, and spread of striae) using statistical tests in SPSS. RESULT: The findings showed that Aloe vera and sweet almond oil creams are more effective than the base cream and the control group to decrease itching and erythema and to prevent the spread of striae on the surface of abdomen (p < .05); however, all three creams had a similar effect on the diameter and the number of striae (p > .05). CONCLUSIONS: Aloe vera and sweet almond oil creams reduce the itching of striae and prevent their progression.

Determination of minimal erythema dose and anomalous reactions to UVA radiation by skin phototype.

BACKGROUND: Phototesting is a technique that assesses the skin's sensitivity to UV radiation by determining the smallest dose of radiation capable of inducing erythema (minimal erythema dose [MED]) and anomalous responses to UV-A radiation. No phototesting protocol guidelines have been published to date. METHODOLOGY: This was a multicenter prospective cohort study in which 232 healthy volunteers were recruited at 9 hospitals. Phototests were carried out with solar simulators or fluorescent broadband UV-B lamps. Each individual received a total of 5 or 6 incremental doses of erythemal radiation and 4 doses of UV-A radiation. The results were read at 24hours. RESULTS: At hospitals where solar simulators were used, the mean (SD) MED values were 23 (8), 28 (4), 35 (4), and 51 (6) mJ/cm(2) for skin phototypes i to iv, respectively. At hospitals where broadband UV-B lamps were used, these values were 28 (5), 32 (3), and 34 (5) mJ/cm(2) for phototypes ii to iv, respectively. MED values lower than 7, 19, 27, and 38 mJ/cm(2) obtained with solar simulators were considered to indicate a pathologic response for phototypes I to IV, respectively. MED values lower than 18, 24, and 24mJ/cm(2) obtained with broadband UV-B lamps were considered to indicate a pathologic response for phototypes ii to iv, respectively. No anomalous responses were observed at UV-A radiation doses of up to 20J/cm(2). CONCLUSIONS: Results were homogeneous across centers, making it possible to standardize diagnostic phototesting for the various skin phototypes and establish threshold doses that define anomalous responses to UV radiation.

Derivation of the Genital Injury Severity Scale (GISS): a concise instrument for description and measurement of external female genital injury after sexual intercourse.

INTRODUCTION: Inconsistencies abound in the current forensic literature regarding the definition, and as a result, the significance of female genital injury after sexual intercourse. These definitions are based on variables related to the anatomic locations that are examined, the actual physical findings types, and the methods used to detect the findings. PURPOSE: To derive and perform initial clinimetric analyses on a simple instrument that defines, and based on severity, quantifies external genital injury after sexual intercourse. The scale utilizes standard injury definitions and a standardized examination method. METHODS: After empirical investigation, it was determined that the application of the tool would require the use of magnification and toluidine blue in order to have the sensitivity to detect the majority of injuries that occur after sexual intercourse. Separate matrices were constructed based on anatomic locations and injury types from data collected from sexual assault genital injury examination forms. Principal Components Analyses were applied. A clinical model was constructed from the resultant variables, utilizing operational definitions and forming a template for the instrument. RESULTS: A twelve-factor instrument measuring five variables along five "types" of severity and two "classes" of severity ensued. The resultant instrument was tested for internal consistency and differential validity. Very good internal consistency was attained (Cronbach's Coefficient α = 0.8). In a pilot study, the scale was able to distinguish a cohort of sexual assault patients from one of consensual intercourse subjects based on type and class of injury (p < 0.0001). CONCLUSION: The findings presented demonstrate that while employing a standardized examination method, the Genital Injury Severity Scale has utility in defining and measuring external genital injury after sexual intercourse.

Localized reactive erythemas of different types in a family.

"Reactive erythemas" is an umbrella term grouping several different conditions, all of which have in common the fact of being stereotypical inflammatory clinical patterns of the skin in response to disparate infectious, immune, or toxic factors. Typically, such eruptions are symmetrical or disseminated. The here reported cases are different. An elderly man underwent recurrent infections of an epidermoid cyst, accompanied by a typical erythema annulare centrifugum near the infectious focus. His grandson, aged ten months, presented with an infectious conjunctivitis, during the resolution of which two small annular lesions, compatible with annular erythema of infancy, appeared on the face. A man aged 42, respectively son and father of the two former patients, presented with an erythema multiforme target lesion proximally to an infected wound. There were no detectable predisposing factors in all cases. Familial cases of reactive erythemas have been reported. However, such limited distributions have not yet been described.

Effective treatment of facial redness caused by atopic dermatitis using intense pulsed light systems.

BACKGROUND: Patients with facial atopic dermatitis (AD) experience psychological and social distress. OBJECTIVE: To evaluate the safety and the efficacy of intense pulsed light (IPL) treatment in patients with facial AD. MATERIALS AND METHODS: Eleven patients (9 men, 2 women; aged 14-39) with mild to moderate refractory facial AD were included in this study. In three separate sessions at 2-week intervals, the whole face was exposed to an IPL device using a 590-nm cut-off filter. Objective clinical response was examined using the Eczema Severity Score (ESS), a polarization color imaging system, and two dermatologists' evaluations. Data on quality of life were evaluated using the Dermatology Life Quality Index (DLQI). RESULTS: The ESS in 11 patients with facial AD was significantly lower 4 weeks after the third treatment (p=.005). Scaling (p=.003); edema, induration, and papules (p=.011); erythema (p=.009), and lichenification (p=.008) improved significantly. The erythema scale, examined using the polarization color imaging system, also decreased significantly (p=.04). No patients showed any noticeable side effects. Mean DLQI score improved significantly after the completion of therapy (from baseline to 4 weeks after the last IPL treatment; p=.005). CONCLUSION: IPL treatment could be used as an adjunct modality for the treatment of refractory facial AD with minimal side effects.

Analysis of erythema after Er:YAG laser skin resurfacing.

BACKGROUND: Postoperative erythema can be expected to occur in every patient after laser resurfacing, and pigmentary disturbances may be related to the intensity and the duration of erythema. OBJECTIVE: This study was undertaken to assess the clinical features of erythema, the factors that influence its duration, and the relation between the duration of erythema and the incidence of hyperpigmentation and hypopigmentation in skin of Asian persons after Er:YAG laser resurfacing. METHODS: A total of 218 patients (skin phototypes III to V) were recruited and treated with a short-pulsed Er:YAG laser, a variable-pulsed Er:YAG laser, or a dual-mode Er:YAG laser for skin resurfacing. Clinical assessments were performed retrospectively using medical charts and serial photographs. RESULTS: Postoperative erythema was observed in all patients after Er:YAG laser resurfacing with a mean duration of 4.72 months. In 98.2% of patients, erythema faded completely within 12 months. Postinflammatory hyperpigmentation was observed in 38.1% of patients after Er:YAG laser resurfacing. CONCLUSIONS: Skin phototype, level of ablation, and depth of thermal damage caused by a long-pulsed laser appear to be important factors that affect the duration of erythema. Moreover, prolonged erythema was related to the risk of postinflammatory hyperpigmentation.

Polarization color imaging system for on-line quantitative evaluation of facial skin lesions.

BACKGROUND: A number of studies have been performed for accurate evaluation of chromophores in skin lesions. Qualitative methods are subjective and cause user-dependent error in evaluation. Quantitative methods have limitations for widely distributed skin lesions due to poor spatial resolution, potential skin blanching, and difficulty in relocating identical sites for subsequent measurements and analysis. OBJECTIVE: The objective was to develop a new imaging modality that provides both qualitative and quantitative methods to evaluate widely distributed skin lesions. METHODS: We have developed a prototype polarization color imaging system named "DermaVision," which provides quantitative on-line image analysis of polarization color images. Herein, we describe the hardware and software of DermaVision in terms of its performance and usefulness for dermatologic applications. RESULTS: Polarization color images were successfully acquired from patients with vascular or pigmented skin lesions. The erythema and melanin index images were successfully computed and quantitatively confirmed the degree of erythema and pigmentation in the skin lesions. CONCLUSION: We believe that DermaVision can be a useful auxiliary tool in dermatology because it simultaneously provides both qualitative and quantitative images of skin lesions.

The reliability of two observation methods of nonblanchable erythema, Grade 1 pressure ulcer.

Accurate identification of nonblanchable erythema (NBE) is essential in pressure ulcer prevention. This descriptive study assessed interrater reliability between a researcher and trained nurses in observing blanchable erythema and NBE and examined the predictive validity and level of agreement between two observation methods for NBE. Findings suggest that the transparent disk method should be preferred to the finger method. The interrater reliability between the researcher and the nurses was substantial and was higher for the observations at the sacrum than for those at the heels. Educational level and years of nursing experience did not seem to influence interrater reliability.

Solar ultraviolet radiation: definitions and terminology.

In the rapidly developing field of photobiology as it relates to solar ultraviolet radiation (UVR), there is a need as never before to ensure that definitions and terminology are current, correct, and standard. This article provides a basic definition of UVR; a review of correct UVR radiometric symbols, units, and nomenclature; defines extraterrestrial and terrestrial solar UVR; and reviews the measurement of biologically effective dose of solar UVR in humans.

Erythrokeratodermas: a classification in a state of flux?

The term 'erythrokeratodermas' or 'erythrokeratodermias' has been applied to a group of inherited disorders characterized by well-demarcated erythematous lesions and hyperkeratotic plaques. Connexin mutations have been demonstrated to be responsible for most cases of erythrokeratoderma variabilis but there remain some cases without demonstrated connexin mutations, suggesting genetic heterogeneity. The position of progressive symmetric erythrokeratoderma has become rather unclear. Loricin mutations have been found in some cases that clinically resemble variant Vohwinkel syndrome and other cases have features that overlap with those of erythrokeratoderma variablis. Whether progressive symmetric erythrokeratoderma exists as a distinct entity is under question.

Objective measurements of radiotherapy-induced erythema.

BACKGROUND/AIMS: The development of acute radiation erythema is a common phenomenon among patients under-going radiotherapy treatment. Because of the absence of reliable objective classification methods, the degree of skin reaction can at present mainly be judged subjectively in the clinic. This has motivated the present preliminary study,concerning the first steps in the development of an objective method for skin reaction classification. METHODS: Three non-invasive techniques were used:near-infrared (NIR) spectroscopy, laser Doppler perfusion imaging and digital photography. The NIR spectra were analysed with principal component analysis (PCA), and the results from the other two with traditional univariate methods. Measurements were made on breast cancer patients who had been exposed to different irradiation doses. A total of 28 breast cancer patients participated one to three times each; 12 were treated with photons at 4 or 6MeV and 16 were treated with high-energy electrons between 10 and 20 MeV to a maximum dose of 50 Gy. RESULTS: PCA of NIR spectra shows that information on radiation dose lies mainly in the first principal component. It is observed that the higher the dose the higher the score value. The results from the laser Doppler measurements show that in 79% of the cases the perfusion increases significantly with radiation dose. Analysis of the digital photography shows that a proposed skin redness index(SRI), increases with a higher radiation dose. However,the increase in most cases is not significant. By combining all data, correlation to radiation doses was seen for 74% of the patients who participated more than once. CONCLUSION: All three non-invasive methods correlate with the radiation dose but to various degrees. NIR spectroscopy, laser Doppler and a combination of the three techniques are the most promising methods for characterising erythema.

Erythema annulare centrifugum: results of a clinicopathologic study of 73 patients.

Erythema annulare centrifugum is classified generally into a superficial and a deep type. Whether those types are variants of the same process or unrelated to one another, and whether they represent non-specific patterns or specific clinico-pathologic entities, is controversial. To answer those questions, we analyzed 82 biopsy specimens from 73 patients with a clinical and histopathologic diagnosis of erythema annulare centrifugum, gyrate erythema, or figurate erythema regarding a variety of clinical and histopathologic findings. We found substantial differences between cases with a wholly superficial type and cases with a superficial and deep infiltrate. Clinically, a collarette of scales was seen only in the superficial type. Histopathologically, some findings were much more common in the superficial type (eg, spongiosis, parakeratosis, crusts, edema of the papillary dermis, epidermal hyperplasia) and others in the deep type (eg, sleeve-like arrangement of the infiltrate, melanophages, subtle vacuolar changes at the dermo-epidermal junction, individual necrotic keratinocytes). Whereas cases of the superficial type could be distinguished from differential diagnoses by a variety of clinical and histopathologic findings, most cases of the deep type showed subtle signs of lupus erythematosus. Neither type was associated consistently with any other systemic disease. Because the superficial and the deep type of erythema annulare centrifugum seem to be unrelated to one another, they should not be referred to by the same name. We believe that the term should be reserved for the superficial type because the latter seems to be a specific clinico-pathologic entity. By contrast, most cases of the deep type seem to be annular examples of tumid lupus erythematosus and should be diagnosed that way. If findings militate against the diagnosis of lupus erythematosus, we suggest using a descriptive term that signals non-specificity-namely, deep figurate erythema.

Erythema annulare centrifugum: report of a case with neonatal onset.

Darier's erythema annulare centrifugum (EAC) is often associated with infectious, autoimmune or neoplastic disease, nevertheless, most cases of EAC remain unexplained. We report a case of EAC with neonatal onset and a clinical course of over 20 years. The patient presented from the 6th day of life with erythematous papules that enlarged centrifugally to form figurate, annular or policyclic plaques involving the entire cutaneous surface. The clinical picture had a chronic course, disappearing only during unrelated febrile episodes. Histologic examination revealed a normal epidermis and a dense perivascular lymphohistiocytic infiltrate and numerous eosinophils in the superficial and reticular dermis. Today the patient is 24 years old and his lesions are still unchanged. Recently, clinical evaluation revealed a diffuse sderodermic induration. A second biopsy showed a diffuse thickening of collagen fibers in the dermis. To our knowledge, this is the second report of EAC with neonatal onset and such a long and peculiar clinical course.

Liquen plano y eritema discrómico perstans: correlación clínica, histológica e inmunofluorescencia directa / Lichen planus and erythema dyschromicum perstans: histological and clinical correlation and direct fluorescence

El liquen plano y el eritema discrómico perstans son entidades cuyo diagnóstico clínico e histopatológico tienden a ser específicos. El presente trabajo tuvo como finalidad correlacionar la clínica, histopatología y la imunofluorescencia directa de piel de estas enfermedades, obteniéndose una correlación estadísticamente significativa entre la clínica y la histopatología, por lo que la realización de la inmunofluorescencia directa como método diagnóstico específico, se reserva únicamente para aquellos casos dudosos

Eritema anular centrífugo: estudo retrospectivo / Erythema annulare centrifugum: a retrospective study

FUNDAMENTO - Eritema anular centrífugo (EAC) é dermatose pouco comum, com etiologias variadas e necessidade de investigaçäo. OBJETIVOS - Estabelecer a correlaçäo clínica, epidemiológica e comparar os achados com a literatura. PACIENTES - Estudo retrospectivo de dez pacientes, realizado no ambulatório de Dermatologia da Universidade Federal do Paraná e consultório privado, no periódo de agosto de 1968 a outubro de 1993. RESULTADOS - Apesar de o diagnóstico clínico ser fácil, há dificuldade de se estabelecer a etiologia, sendo necessária investigaçäo clínica e laboratorial básica.