Occupational contact dermatitis: Return to work using a multidisciplinary clinic model.

BACKGROUND: Occupational contact dermatitis often results in work disruption. Return-to-work (RTW) is an important outcome. OBJECTIVE: The objective of this study was to determine RTW outcomes and factors associated with such outcomes using a multidisciplinary clinic model. METHODS: Chart abstraction was performed for 194 workers who received RTW assistance over a 6-year period. Elements abstracted included demographic and diagnostic information and information about the RTW program including principles, program components, barriers, and facilitators. RESULTS: Of the 902 workers seen for dermatologic assessment, 194 received RTW assistance. At initial assessment, 37% were not working because of their skin disease, and at follow-up, 7% were not working because of their skin disease. The RTW plan components included a graduated or trial of RTW, specific recommendations for avoiding exposure, personal protective equipment, skin management, and ongoing skin monitoring. Principles associated with successful RTW included good communication and the availability of modified work and a worker adherence to the plan. Barriers included lack of modified work, unresponsive employers, and ongoing skin problems. CONCLUSIONS: Specific approaches are important to identify if RTW is to be successful for workers with occupational contact dermatitis.

Hand eczema treatment: Change behaviour with text messaging, a randomized trial.

BACKGROUND: Irritant contact dermatitis is the most common type of hand eczema. Effective treatment usually involves avoidance of irritants and use of appropriate topical medication. In this study, the effectiveness of using text messaging addressing preventive behaviours and appropriate medication adherence was evaluated. METHODS: Patients who were admitted to Istanbul Training and Research Hospital Dermatology Department March 1, 2015 to July 31, 2015, and diagnosed with hand eczema were enrolled. Patients were randomly divided into the SMS group and the non-SMS group. Text messages were sent to the mobile phones of the patients in the SMS group. Severity of hand eczema, compliance to treatment, patients' information level, adherence to preventive behaviours, and the protective behaviour score were evaluated at baseline, and at the 4th and 8th week. RESULTS: Eighty-one patients with hand eczema were included in the study. After 8 weeks, the decrease in the Hand Eczema Severity Index score was 70.2% (SD 35.2) in the SMS group and 38.9% (SD 67.7) in the non-SMS group (P = .017). Sending SMS to patients increased the use of moisturizer. There was no statistically significant difference in other behaviours. CONCLUSION: This study demonstrated that text messaging improves the treatment success and specifically the frequency of moisturizer use in patients with hand eczema.

Management of incontinence-associated dermatitis patients using a skin protectant in acute care: a case series.

OBJECTIVE: Incontinence-associated dermatitis (IAD) is a common type of irritant contact dermatitis. It is categorised by persistent erythema and can be associated with denudation and/or colonisation and infection. IAD is challenging to treat and affects 3.4-50% of patients. This case series evaluates a novel, elastomeric, advanced skin protectant (3M Cavilon Advanced Skin Protectant) in a UK acute health-care setting, for the management of IAD in patients suffering from moisture-associated skin damage (MASD) in the sacral/genital area. METHOD: The patient's skin was assessed by clinicians using the GLOBIAD classification tool at the point of recruitment and to monitor progress throughout the study period. The product was applied as a single layer in accordance with the instructions for use. Patients, when able, were asked to assess their own pain level using the Wong-Baker FACES pain scale. Photographs were taken as part of the ongoing assessment. RESULTS: The skin protectant was used on average every 2.28 days. Of the 18 IAD patients recruited, 79% (n=11) were classified as IAD-free, based on the GLOBIAD categorisation tool, by the end of the evaluation period. Skin deterioration during the evaluation period was seen in one patient (6%), and of the patients able to complete pain assessments, 55% (n=6) reported a reduction in pain. CONCLUSION: These results suggest that the elastomeric skin protectant, applied every three days, plays a role in the improvement of IAD. The skin protectant adheres to wet and weeping partial-thickness wounds and may aid IAD management. Reducing application to every third day supports a change in practice which may offer benefits to patients and caregivers.

Contact dermatitis and patch testing for the allergist.

OBJECTIVE: To review of contact dermatitis (CD) and its key allergens and provide updates and recommendations for the practicing allergist. DATA SOURCES: Through the use of various scientific search engines (eg, PubMed and MEDLINE), we reviewed literature on CD, patch tests (PTs), key allergens, occupational dermatitis, and treatment. STUDY SELECTIONS: Studies on CD, important allergens, and PTs were considered. RESULTS: Contact-induced dermatitis may be due to allergic CD, irritant CD, systemic CD, contact urticaria, and protein CD. Key allergens include metals (nickel, gold), topical medicaments (topical corticosteroids), and cosmetics and personal care products (fragrances and preservatives such as methyl- and methylchloro-isothiazolinone). Present relevance of a positive PT result is the combination of definite, probable, and possible relevance and should be correlated with the patient's history and physical examination. Treatment of allergic CD includes identification of relevant allergens, patient education, avoidance, and provision of alternative products the patient can use. CONCLUSION: CD is a common inflammatory skin disease and should be suspected in patients presenting with acute, subacute, or chronic dermatitis. The gold standard for diagnosing allergic CD is a PT. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist in their practice.

A Single-Center, Randomized, Double-Blind, Placebo-Controlled Clinical Trial of the Effectiveness of ANT1 Soybean Extract Cream on Skin Recovery After Nd: YAG Laser Treatment.

Nd:YAG laser has been used extensively for its versatility in treating many common aesthetic problems, but numerous adverse effects are often complained by recipients of Nd:YAG laser. This study introduces the ANT1 soybean extract cream, which was formulated to alleviate adverse effects after laser therapy. This study explores whether ANT1 enhances the repair mechanism of the postlaser skin, decreases laser-induced complication, and shortens recovery time. The study also aims to pinpoint the ANT1 concentration that is most effective in improving the skin condition after Nd-YAG laser therapy. MATERIALS AND METHODS: This study was a single-center, randomized, double-blind, placebo-controlled trial. Patients eligible for the study were Asian women, aged 25 to 40 years, who were free of dermatological diseases and allergic reaction. There were a total of 45 subjects. Each subject received a session of Nd-YAG laser therapy every 2 weeks, totaling 3 sessions. Facial skin assessment was achieved via VISIA complexion analysis. VISIA complexion analysis quantitatively assessed the skin condition and tracked the recovery progress of each subject at baseline, immediately after all 3 laser sessions, and a week after the final laser treatment. RESULTS: Skin condition was evaluated by VISIA complexion analysis. Skin condition was recorded in aspects of pigmented spots, wrinkles, texture, pores, and red area. After Nd-YAG laser therapy, postlaser inflammation was observed in all subjects. Throughout the laser sessions and the outpatient follow-up clinic, the adverse effects of laser therapy, such as redness, spots, wrinkles, pores, and textures, decreased with the use of ANT1 cream. There has been a marked effect in wrinkle reduction in the patients who received a higher concentration of ANT1 cream (P ≤ 0.05). Statistically significant improvement in spots and pores is also seen (P ≤ 0.05). CONCLUSIONS: Through this study, the results suggest that the application of ANT1 soybean extract cream ameliorates the complications and enhances the cosmetic effects of Nd-YAG laser therapy. A higher concentration of the ANT1 cream significantly reduces wrinkles and redness after laser. All in all, this study proves that the ANT1 soy extract cream may be a useful addition to postlaser care for an overall enhancement in skin condition and recovery.

Management of Moisture-Associated Skin Damage: A Scoping Review.

BACKGROUND: Protecting the skin against moisture-associated damage is an important component of comprehensive skin and wound care. Based on a review of literature, the authors propose key interventions to protect and prevent damage in the skin folds, perineum, and areas surrounding a wound or stoma. OBJECTIVE: The aim of this scoping review is to identify and provide a narrative integration of the existing evidence related to the management and prevention of moisture-associated skin damage (MASD). METHODS: Study authors searched several databases for a broad spectrum of published and unpublished studies in English, published between 2000 and July 2015. Selected study information was collated in several different formats; ultimately, key findings were aggregated into a thematic description of the evidence to help generate a set of summative statements or recommendations. RESULTS: Based on inclusion criteria, 37 articles were considered appropriate for this review. Findings included functional definitions and prevalence rates of the 4 types of MASD, assessment scales for each, and 7 evidence-based strategies for the management of MASD. CONCLUSIONS: Based on this scoping review of literature, the authors propose key interventions to protect and prevent MASD including the use of barrier ointments, liquid polymers, and cyanoacrylates to create a protective layer that simultaneously maintains hydration levels while blocking external moisture and irritants.

A decade of research on Incontinence-Associated Dermatitis (IAD): Evidence, knowledge gaps and next steps.

BACKGROUND: Incontinence-Associated Dermatitis (IAD) is one of the clinical manifestations of Moisture- Associated Skin Damage (MASD). IAD is a common problem in aged patients with fecal and/or urinary incontinence. AIM: Update about IAD terminology, etiology, epidemiology, observation, prevention, and treatment. METHODS: Integrative review. RESULTS: The lack of an ICD-10 code and an internationally validated and standardized method for IAD data collection contribute to a variation in epidemiological data. Frequent episodes of incontinence (especially fecal), occlusive containment products, poor skin condition, reduced mobility, diminished cognitive awareness, inability to perform personal hygiene, pain, pyrexia, certain medications (antibiotics, immunosuppressants), poor nutritional status, and critical illness are associated with IAD. Correctly diagnosing IAD and distinguish it from pressure ulcers is difficult. Even though the clinical presentation of partial thickness pressure ulcers and IAD is similar, the underlying etiologic factors differ. However, incontinence and IAD were found to be risk factors for pressure ulcer development. IAD management should essentially focus on skin cleansing to remove dirt, debris and microorganisms; skin moisturization to repair or augment the skin's barrier; and the application of a skin barrier product to prevent skin breakdown by providing an impermeable or semi-permeable barrier on the skin. The body of evidence is still limited, but growing since the last decade. CONCLUSION: Incontinence causes disruptions of the skin barrier function and leads to superficial skin damage. Macerated skin and superficial skin changes due to incontinence are associated with pressure ulcer development. Skin maceration, chemical irritation, and physical irritation should be targeted to effectively prevent and treat IAD.

Systematic mapping review about costs and economic evaluations of skin conditions and diseases in the aged.

BACKGROUND: Skin conditions and dermatological diseases associated with advanced age (e.g. fungal infection, dry skin and itch) receive increasingly attention in clinical practice and research. Cost and economic evaluations are important sources to inform priority setting and ressource allocation decisions in healthcare. The economics of skin conditions in aged populations has not been systematically reviewed so far. OBJECTIVES: The aim of this mapping review was to summarize the economic evidence of selected skin conditions in the aged (65 + years). METHODS: A mapping literature review and evidence summary was conducted. Searches were conducted in data bases Medline and Embase via OVID. Cinahl was searched using EBSCO. References lists of potential eligible studies, reviews, guidelines or other sources were screened for additional literature. For evaluation of methodological quality of full economic analyses the Consensus on Health Economic Criteria (CHEC) checklist was used. RESULTS: Database searches resulted in 1388 records. A total of 270 articles were read in full-text. Thirty-five publications were finally included in the data analysis reporting 38 economic analyses. Ten cost of illness analyses and 26 cost-effectiveness analyses reporting about pressure ulcers, skin tears, pressure ulcers, incontinence associated dermatitis and intertrigo/contact dermatitis/candidiasis treatment and prevention and onychomycosis testing were identified. Limited evidence indicated that low air loss beds were more cost effective than standard beds for prevention of pressure ulcers. Standardized skin care regimens seem to lower the incidence of pressure ulcers, skin tears and IAD but a cost saving effect was not always observed. CONCLUSIONS: Findings of this mapping review indicate that there is a paucity of high quality evidence regarding the economic impact of age-associated skin conditions and diseases. Substantial heterogeneity in terms of study design, evaluation perspective, time period, and way of cost estimation was identified. Because of the overall low methodological quality clear cut conclusions cannot be drawn. Robust and large scales economic evaluations about skin conditions and disease in aged populations are needed in the future.

Managing Occupational Irritant Contact Dermatitis Using a Two-Step Skincare Regimen Designed to Prevent Skin Damage and Support Skin Recovery.

Occupational irritant contact dermatitis (ICD) affecting the hands is a common and difficult-to-manage condition. Occupations that necessitate contact with harsh chemicals, use of alcohol-based disinfectants, and frequent hand washing elevate the risk of ICD. Management strategies that do not adequately prevent accumulated damage and repair skin, can develop into chronic dermatoses which negatively impact work productivity and quality of life. A 2-step skin-care regimen (Excipial Daily Protection Hand Cream (EP) and Excipial Rapid Repair Hand Cream (ER), Galderma Laboratories, L.P.) has been developed as a daily-use management strategy to protect and repair vulnerable hands. The protective barrier cream is formulated with aluminum chlorohydrate and designed for pre-exposure application to enhance the skin's natural protective barrier and minimize excessive moisture while wearing protective gloves. The repair cream, a lipid-rich formulation, is intended for post-exposure application to rehydrate and facilitate the skin's natural healing process. The results of 3 clinical studies highlighted in this review demonstrate how the use of a 2-step skin-care regimen offers a greater protective effect against ICD than the use of barrier cream alone, and also how the formulation of the barrier cream used in these studies helps minimize the occlusion effect caused by gloves and does not interfere with the antibacterial efficacy of an alcohol-based hand sanitizer. This 2-step skin-care regimen is effectively designed to manage and minimize the risk of ICD development in a variety of patients and provides clinicians an additional tool for helping patients manage ICD. J Drugs Dermatol. 2016;15(12):1504-1510.

Wound-Related Allergic/Irritant Contact Dermatitis.

PURPOSE: To provide information from a literature review about the prevention, recognition, and treatment for contact dermatitis. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Identify signs and symptoms of and diagnostic measures for contact dermatitis.2. Identify causes and risks for contact dermatitis.3. Select appropriate treatment for contact dermatitis and its prevention. ABSTRACT: Contact dermatitis to wound care products is a common, often neglected problem. A review was conducted to identify articles relevant to contact dermatitis.A PubMed English-language literature review was conducted for appropriate articles published between January 2000 and December 2015.Contact dermatitis is both irritant (80% of cases) or allergic (20% of cases). Frequent use of potential contact allergens and impaired barrier function of the skin can lead to rising sensitization in patients with chronic wounds. Common known allergens to avoid in wound care patients include fragrances, colophony, lanolin, and topical antibiotics.Clinicians should be cognizant of the allergens in wound care products and the potential for sensitization. All medical devices, including wound dressings, adhesives, and bandages, should be labeled with their complete ingredients, and manufacturers should be encouraged to remove common allergens from wound care products, including topical creams, ointments, and dressings.

Prospective multicenter survey on the clinical management of pediatric contact dermatitis.

BACKGROUND: Contact dermatitis can be defined as an inflammatory process affecting the skin surface and induced by contact with chemical, physical and/or biotic agents in the environment. It causes lesions to skin, mucosae and semi-mucosae by means of allergic and irritant pathogenic mechanisms. Among the main triggers of contact dermatitis in the pediatric age are chemical or physical agents, which cause irritant contact dermatitis (ICD), and sensitizers, which cause a tissue damage through an allergic mechanism (allergic contact dermatitis [ACD]). METHODS: A prospective, multicenter, observational study was carried out in 204 children affected by contact dermatitis, aged up to 14 years, and enrolled by pediatricians from 7 different Italian provinces. The diagnosis of contact dermatitis was based on the pediatrician's clinical evaluation. The data were collected through a series of simple and multiple choice questions, anonymously filled out by pediatricians. RESULTS: In 90% of cases (184 of 204 patients), there was complete remission of contact dermatitis, with no cases of worsening. No adverse events were observed, either. The effectiveness of the therapy was rated as "very effective" by 84.4% of the parents and 86.8% of the pediatricians. In only 10 patients a new therapy had to be prescribed. CONCLUSIONS: Contact dermatitis is a heterogeneous inflammatory skin disease induced by contact with different kinds of environmental agents. Cutaneous manifestations are highly variable and depend on the modality of contact, on the causative agent and on the pathogenesis. This Italian experience of a clinical approach to contact dermatitis stresses the need of daily skin care through different therapeutic strategies, based on the diagnosis, the clinical severity and the parents and children compliance. The first therapeutic measure to be implemented is prevention, through the removal of the causative agent and the use of protective devices. Indeed, preserving the skin's barrier function is an important goal and a priority of treatment algorithms.

An Exploratory Study of Skin Problems Experienced by UK Nursing Home Residents Using Different Pad Designs.

PURPOSE: The primary aim of this study was to determine whether the severity of incontinence-associated dermatitis (IAD) among nursing home-based incontinence pad users varies between pad designs. A second aim was to examine the utility of a simple method for reporting skin health problems in which healthcare assistants were asked to record basic observational data at each pad change. STUDY DESIGN: Randomized, multiple crossover, observational, exploratory. SUBJECTS AND SETTING: Twenty-one men and 57 women using absorbent continence products to contain urinary and/or fecal incontinence were recruited from 10 nursing homes in London and the south of England. METHODS: A day-time variant and a night-time variant of each of the 4 main disposable pad designs on the market for moderate/heavy incontinence were tested: (1) insert pads with stretch pants; (2) 1-piece all-in-one diapers; (3) pull-up pants; and (4) belted/T-shape diapers. All pad variants for day-time use had an absorption capacity of 1900 mL ± 20% (measured using ISO 11948-1 International Standards Organization) while the capacity of night-time variants was 2400 mL ± 20%. Each resident used each of the 4 pad designs (day-time and night-time variants) for 2 weeks and the order of testing was randomized by nursing home. Skin health data were collected using 2 methods in parallel. Method 1 comprised visual observation by researchers (1 observation per pad design; 4 observations in total over 8 weeks). In method 2, healthcare assistants logged observational data on skin health at every pad change for the 8 weeks. The primary outcome variable was severity of the most severe skin problem noted by the researcher for each resident, and for each pad design (method 1). Descriptive data on skin care methods used in the nursing homes were also collected using short questionnaires and researcher observation. RESULTS: No significant differences in the severity or incidence of skin problems were found between observations using the 4 pad designs. However, a wide range of skin conditions was recorded that made classification difficult; the skin was often marked with creases from absorbent products, temporary marks, and pink/purple discoloration. We observed few cases of the severe erythema, rashes, and vesicles that are commonly used descriptors in previous skin tools. Nevertheless, the collected data reflect an abundance of skin problems that were difficult to categorize neatly. Researcher observations (method 1) showed that nearly all the residents (96%) had at least 1 IAD skin problem recorded over the 8-week period and 64% of residents had at least 1 problem that was rated as maximum severity. Healthcare assistants logged skin problems on 6.1% of pad changes. The discrepancy between researcher and healthcare assistant data appears to be largely due to healthcare assistants sometimes discounting low-grade IAD as normal for that population. CONCLUSION: Incontinence-associated dermatitis is common among nursing home residents who use incontinence pads, and it is often severe. No evidence was found that any design of pad was more likely than any others to be associated with skin problems. The method devised to enable healthcare assistants to record basic observational data on skin health in the diaper area at each pad change (Method 2) proved simple to use but still resulted in substantial underreporting of IAD, suggesting that further work is needed to develop a tool that more successfully encourages them to log and treat IAD problems.

Contact Dermatitis, Patch Testing, and Allergen Avoidance.

In patients presenting with a complaint of rash, contact dermatitis is often the underlying diagnosis making it an entity with which health care providers should be familiar. Contact dermatitis can be divided into irritant contact dermatitis and allergic contact dermatitis. In a patient suspected of having allergic contact dermatitis, patch testing can be done to identify specific allergens. Education focused on allergen avoidance and safe products is an integral part of treatment for the contact dermatitis patient. Knowledge of the most common allergens is helpful for clinicians to be able to provide this education.

Occupational contact dermatitis in tertiary university hospital: a 5-year retrospective study.

BACKGROUND: Thailand, an agricultural country developing into an industrial country, has diferences in work environment, substance exposure, and climate. These factors may lead to a distinct epidemiology of occupational contact dermatitis (OCD). OBJECTIVE: To study the prevalence of allergic and irritant occupational contact dermatitis in Thailand. MATERIAL AND METHOD: The records of patients diagnosed of OCD and patch tested between 2006 and 2010 at Siriraj University Hospital were retrospectively reviewed. RESULTS: From 885patch tested patients, 194 (21.9%) had OCD. Of those 194 patients, 76.8% were female and23.2% were male. Allergic contact dermatitis (ACD; 76.3%) wasfoundto be more common than irritant contact dermatitis (ICD; 24.2%). The common affectedpart was hands (51.5%). The mostfrequent occupation was wet work (35.1%), followed by office work (24.7%), industrial work (16%), and medical personnel (13.4%). The most common occupational allergens were nickel sulfate (33.1%), potassium dichromate (19.6%), and carba mix (15.5%). Water (56.1%), foods (4.9%), and oil/grease (2.4%) were the most common occupational irritants. CONCLUSION: In our setting, allergic OCD was more common than irritant OCD. Nickel sulfate was the most common occupational allergen. Occupational A CD and lCD are most commonly found in industrial work and wet works, respectively.

Complications of stomas: their aetiology and management.

The formation of a stoma is an essential part of many colorectal operations. Despite the frequency with which these surgeries are performed and the number of specialists involved in stoma care, complications are still common. This article investigates the most common complications, explains the reasons for their occurrence and suggests potential management options. Common stoma complications were identified by the colorectal/ stoma clinical nurse specialist (CSCNS) and a literature search was performed using a variety of online databases, including Medline and CINAHL using the keywords stoma, complications, prolapse, ischaemia, retraction, hernia and stenosis. Articles used were selected on the basis of relevance to the topic. The commonest complications of stomas included skin irritation, prolapse, retraction, ischaemia, hernia and stenosis.

Diagnosing and treating moisture-associated skin damage.

Certain types of moisture can cause debilitating damage to the skin. Terms such as perineal dermatitis, diaper rash, incontinence-associated dermatitis, or moisture-associated skin damage describe some of the conditions caused by moisture from wound drainage, fecal and/or urinary incontinence, and perspiration. It is important for clinicians to correctly diagnose and to locally treat the cause of skin damage, as well as promote appropriate cleaning techniques, to keep patients' skin healthy.

Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges.

In 2010, an international consensus conference was held to review current evidence regarding the pathology, prevention, and management of incontinence-associated dermatitis (IAD). The results of this literature review were published in a previous issue of this Journal. This article summarizes key consensus statements agreed upon by the panelists, evidence-based guidelines for prevention and management of IAD, and a discussion of the major challenges currently faced by clinicians caring for these patients. The panelists concur that IAD is clinically and pathologically distinct from pressure ulcers and intertriginous dermatitis, and that a consistently applied, structured, or defined skin care program is effective for prevention and management of IAD. They also agreed that differential assessment of IAD versus pressure ulceration versus intertriginous dermatitis remains a major challenge. Panel members also concur that evidence is lacking concerning which products and protocols provide the best outcomes for IAD prevention and treatment in individual patients. Issues related to differential assessment, product labeling and utilization, staff education, and cost of care are the primary focus of this article.

Incontinence-associated dermatitis in a long-term acute care facility.

PURPOSE: The objectives of this study were to (1) measure the prevalence of incontinence-associated dermatitis (IAD) and pressure ulcers (PUs) on admission to a long-term acute care (LTAC) facility; (2) identify factors associated with IAD and PU on admission to an LTAC facility; and (3) measure the incidence of incontinence and PUs in LTAC patients. DESIGN: This was a longitudinal, repeated-measures study; data were collected over a 12-week period. SUBJECTS AND SETTING: One hundred seventy-one patients, with a median age of 55 years. Fifty-four women and 117 men were evaluated. The sample comprises all patients admitted to the 4 LTAC units at the Drake Center in Cincinnati, Ohio. METHODS: Patients were examined using the "Hospital Survey on Incontinence and Perineal Skin Injury" instrument within 24 hours of admission and they were reevaluated weekly using the same tool until discharge. All data were collected by the Drake Center Advanced Wound Team. Prevalence was defined as the frequency of PUs or IAD identified at admission. Incidence was calculated using the formula: the number of new IAD cases/the number of patients without IAD on admission. Pressure ulcer incidence was measured using 2 formulas: (1) the number of patients with new PUs/the number of all patients who did not have PU on admission and (2) the number of patients with new PUs or a PU in a new location/the number of all patients. RESULTS: Thirty-nine out of 171 patients had IAD on admission, yielding a prevalence of 22.8%. Sixty of 171 patients had a PU on admission, yielding a prevalence of 35.1%. Ten of 132 patients who did not have IAD at admission developed IAD during follow-ups, yielding a 7.6% incidence. Two PU incidence rates were measured; those patients without PUs on admission 3.6% (4/111) and all patients 8.2% (14/171). CONCLUSION: The LTAC admission PU prevalence rate in this study was greater than that reported previously in acute or long-term care settings. The LTAC PU incidence rate was less than those reported for both acute and long-term care settings. The LTAC IAD admission prevalence rate closely reflected the acute care rate but was substantially higher than the long-term care rate.

[Contact dermatitis: an approach used by a medical officer].

The article deals with contact dermatitis issues, that are of interest not only for dermatologists and specialists in professional pathology, but as well as for general practitioners. Issues of contact dermatitis classification, pathogenic peculiarities of the disease main forms and their basic causes are discussed. Clinical manifestations of irritative and allergic contact dermatitis are described in detail, aspects of differential diagnostics analysed. A detailed consideration is given to allergic diagnostics of contact dermatitis using application test-systems with the most common contact allergens. Main principles of contact dermatitis treatment are outlined in the article. The necessity of a complex approach to this disease therapy that requires not only external therapy, but the compliance with an appropriate treatment regimen, diet as well as application of a particular system therapy is shown. Recommendations for contact dermatitis prophylaxis are given.