Atopic dermatitis burden scale: creation of a specific burden questionnaire for families.

BACKGROUND: The notion of individual burden, associated with a disease, has been introduced to determine the 'disability' in the broadest sense (psychological, social, economic and physical). Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases with an estimated prevalence of 5%-30% in children. OBJECTIVE: To develop and validate a specific questionnaire which assess the burden of families of children with AD: the Atopic dermatitis Burden Scale (ABS). METHODS: Items for inclusion in ABS were initially generated from a literature review and a verbatim report from parents whose child had AD. ABS was refined via item reduction according to interquestion correlations, consensus among experts and exploratory factor analysis. Internal consistency was determined by calculating the Cronbach's α, concurrent validity by calculating the correlation between ABS and the Short-Form 12 items. Discriminant validity was analysed according to the severity degrees of AD assessed by Patient-Oriented SCORing index of Atopic Dermatitis (PO-SCORAD). RESULTS: From an initial list of 29 items, ABS was reduced to a 14-item questionnaire, grouped into four dimensions based on the exploratory factor analysis. Construct validity was demonstrated and ABS showed good internal coherence (Cronbach's α: 0.78). ABS was significantly correlated to the mental dimension of Short-Form 12 (r = -0.49), but it was not correlated to the physical dimension (r = 0.04). ABS scores were significantly different according to the severity degrees of AD, with higher ABS score in parents whose child had severe AD. CONCLUSION: The ABS questionnaire is a validated tool for assessing the burden of families of children with AD. An implementation of a prospective study is planned to estimate sensitivity to change and to confirm its domain structure in larger samples.

A parsimonious score with a free web tool for predicting disability after an ischemic stroke: the Parsifal Score.

BACKGROUND: Most of the models to predict prognosis after an ischemic stroke include complex mathematical equations or too many variables, making them difficult to use in the daily clinic. We want to predict disability 3 months after an ischemic stroke in an independent patient not receiving recanalization treatment within the first 24 h, using a minimum set of variables and an easy tool to facilitate its implementation. As a secondary aim, we calculated the capacity of the score to predict an excellent/devastating outcome and mortality. METHODS: Eight hundred and forty-four patients were evaluated. A multivariable ordinal logistic regression was used to obtain the score. The Modified Rankin Scale (mRS) was used to estimate disability at the third month. The results were replicated in another independent cohort (378 patients). The "polr" function of R was used to perform the regression, stratifying the sample into seven groups with different cutoffs (from mRS 0 to 6). RESULTS: The Parsifal score was generated with: age, previous mRS, initial NIHSS, glycemia on admission, and dyslipidemia. This score predicts disability with an accuracy of 80-76% (discovery-replication cohorts). It has an AUC of 0.86 in the discovery and replication cohort. The specificity was 90-80% (discovery-replication cohorts); while, the sensitivity was 64-74% (discovery-replication cohorts). The prediction of an excellent or devastating outcome, as well as mortality, obtained good discrimination with AUC > 0.80. CONCLUSIONS: The Parsifal Score is a model that predicts disability at the third month, with only five variables, with good discrimination and calibration, and being replicated in an independent cohort.

Sensitive skin in Europe.

INTRODUCTION: Sensitive skin appears as a very frequent condition, but there is no comparative data between countries. OBJECTIVES: To perform an epidemiological approach to skin sensitivity in different European countries. METHODS: An opinion poll was conducted in eight European countries: Belgium, France, Germany, Greece, Italy, Portugal, Spain and Switzerland. This sample (4506 persons) was drawn from a representative sample of each population aged 15 years or older. RESULTS: Sensitive or very sensitive skin was declared by 38.4% and slightly or not sensitive skin by 61.6%. Women declared more sensitive skin than men. A dermatological disease was declared by 31.2% of people with very sensitive skin, 17.6% of those with sensitive skin, 8.7% of those with slightly sensitive skin and 3.7% of those who do not have sensitive skin. A history of childhood atopic dermatitis was more frequent in patients with sensitive or very sensitive skin. The interviewees who declared that they had dry or oily skin also reported significantly more frequently sensitive or very sensitive skin than those with normal skin. Sensitive and very sensitive skins were clearly more frequent in Italy and France. DISCUSSION: This study is the first study that compares skin sensitivity in European countries. Prevalence is high, but significant differences are noted between these countries. Dermatological antecedents (or treatments?) could be involved in the occurrence of skin sensitivity.

Influence of the fluidity of liposome compositions on percutaneous absorption.

The penetration into the stratum corneum of fluorescein, as the acid form or as a sodium salt, encapsulated in liposomes formed by liquid- or gel-state phospholipids, with or without cholesterol, was investigated in humans by the stripping method. Liposomes prepared by extrusion were applied to the forearms of healthy human volunteers and 30 min later, strippings were performed. Fluorescein was extracted and determined by spectrofluorimetry. The skin penetration of sodium fluorescein was higher from fluid liposomes (phosphatidylcholine) than from rigid liposomes (hydrogenated phosphatidylcholine), but it was independent of the content of cholesterol. It seems that the liquid-crystalline state of the lipids is the main aspect involved in the fluidity of the liposome bilayer itself as well as in the interaction with the lipids of the stratum corneum. The similar enhanced penetration behavior obtained for unsaturated liposomes containing sodium or acid fluorescein seems to support the hypothesis of a previous destruction of the vesicles during its passage through the lipid intercellular pathway in the stratum corneum.

The effect of liposomes on skin barrier structure.

The present work deals with the 'in vivo' stripping technique to evaluate the percutaneous absorption of sodium fluorescein (NaFl) vehiculized in two different liposome preparations formed by phosphatidylcholine (PC) and lipids mimicking the stratum corneum (SC; ceramides, cholesterol, palmitic acid and cholesteryl sulphate), respectively. Furthermore, the possible effect of these vesicles on the SC lipid alkyl chain conformational order were evaluated at different depths of SC by non-invasive biophysical techniques: Corneometer, Tewameter and especially ATR-FTIR. The results of NaFl percutaneous absorption indicate the highest penetration in the case of incorporation in PC liposomes, which could be related to the increase in SC lipid disorder detected by ATR-FTIR, i.e. a decrease in skin barrier function. On the other hand, SC lipid liposomes have been shown to have a higher affinity for SC owing to the high amount of NaFl found in this layer, suggesting a greater reservoir capacity of SC when similar lipid composition formulation is applied. A lipid order increase is observed by infrared spectroscopy, when these types of liposomes are topically applied, resulting in a strong barrier effect. These results could be useful in designing specific liposomal topical applications.