[Ulcers on a hairy scalp]. / Ulcera op het behaarde hoofd.

A 74-year-old woman presented herself at the outpatient clinic for dermatology with three temporoparietal ulcers on her scalp which are diagnosed as complications of temporal arteritis. The core symptoms of temporal arteritis are often non-specific, causing diagnostic delay. This dermatological complication can be an important clinical clue urging the physician to start treatment.

[Hand-foot-mouth disease in an adult: a clinical presentation caused by an atypical viral agent]. / Een vrouw met een kinderziekte.

This case concerns a woman with blisters and vesicles on both palms and soles and crusts around the nose caused by Coxsackie virus type A6. This is an atypical viral agent which increasingly causes hand-foot-mouth disease in adults. However, in the Netherlands it is unrecognized as a relevant possible agent.

[A new form of Kaposi sarcoma]. / Een nieuwe vorm van het kaposisarcoom.

BACKGROUND: Kaposi sarcoma is an vascular neoplasm caused by infection with human herpesvirus-8. Known risk groups are Mediterranean, eastern European Jewish and African ancestry men or men with AIDS. Nowadays we distinguish more subgroups. CASE DESCRIPTION: We present a healthy 39 year old man with a lesion on the right foot, having homosexual contacts, without HIV infection. Previous histology revealed signs of hemangioma. Recent clinical signs and histology confirmed multifocal Kaposi sarcoma. He was treated with radiotherapy. We also present a 65 year old MSM with and a lesion on the sole of the foot. Histology revealed for a solitary nodular Kaposi sarcoma. A short term relapse after surgical excision occurred. CONCLUSION: Kaposi sarcoma is subdivided into different categories. Kaposi Sarcoma in HIV-negative MSM is seen more frequently today, yet usually shows an indolent course. An adjusted less aggressive treatment and follow-up is therefore justified.

[Chondrodermatitis nodularis helicis: a practical overview with treatment recommendations for the primary and secondary care]. / Chondrodermatitis nodularis helicis.

Chondrodermatitisnodularishelicis is characterized by a sore nodule of the helix or antihelix of the ear. Pressure plays an important role in the pathogenesis of the benign inflammatory condition. Pressure relieving is a rational first-line treatment modality and could be applied in combination with or followed by intralesional steroid injections. If the condition remains, a surgical procedure is warranted. Cartilage removal without skin excision is the procedure of choice. Particular attention should be paid to the complete removal of all defective cartilage. This procedure is elegant and simple compared to the conventional wedge excision and has a lower risk of recurrence. Because of high recurrence rates of non-surgical treatments, early surgical treatment is recommended.

[An 84-year-old man with an ulcer on his ankle]. / Een 84-jarige man met een ulcus op zijn enkel.

Hydroxycarbamide is a cytotoxic drug that is used in haematological cancers. On long-term use (2-15 years) of 1500-2000 mg a day, there is a 9% risk of developing ulcers. This patient's ulcer was painful, of punched out aspect, with a necrotic base and swollen wound edges. Upon discontinuation of hydroxycarbamide, the wound healed within 2 months.

[Adhesion problems of stoma accessories due to peristomal dermatitis]. / Slecht hechtende stomaplak door dermatitis.

Peristomal dermatitis is a frequent problem in stoma patients. This causes problems with the adhesion of stoma material. Not being able to rely on a leak-free stoma plaque has major social consequences for stoma patients. In this article we discuss the differential diagnosis, pathophysiology and therapy based on a patients case. If the dermatitis is based on an irritating contact dermatitis due to the stoma adhesive, the dermatitis should be treated with a local corticosteroid, preferably in the form of a nasal spray.

[Decubitus or incontinence-associated dermatitis?]. / Dermatitis of decubitus bij incontinentie.

A lack of understanding about the distinction between incontinence-associated dermatitis and pressure sores leads to inadequate treatment and therefore a higher incidence of pressure sores. Pressure relief may not be adequately carried out due to concentration exclusively on treatment of incontinence. In this article we will discuss the multifactorial approach, based on 2 patient cases. In order to prevent pressure sores, the cause of incontinence has to be investigated and treated if possible. Appropriate pressure relief must be carried out, in addition to adequate skin care.

[A newborn with an acute itchy skin rash]. / Een meisje met een acute jeukende huiduitslag.

A 36-week-old girl presented with an itching papulous skin eruption symmetrically on her cheeks, buttocks and limbs. Based on the specific clinical presentation she was diagnosed with Gianotti-Crosti-syndrome. This is a self-limiting cutaneous response to a viral infection.

Erlotinib-induced rash spares previously irradiated skin.

BACKGROUND: Erlotinib is an epidermal growth factor receptor inhibitor prescribed to patients with locally advanced or metastasized non-small cell lung carcinoma after failure of at least one earlier chemotherapy treatment. Approximately 75% of the patients treated with erlotinib develop acneiform skin rashes. CASE REPORT: A patient treated with erlotinib 3 months after finishing concomitant treatment with chemotherapy and radiotherapy for non-small cell lung cancer is presented. Unexpectedly, the part of the skin that had been included in his previously radiotherapy field was completely spared from the erlotinib-induced acneiform skin rash. CONCLUSION: The exact mechanism of erlotinib-induced rash sparing in previously irradiated skin is unclear. The underlying mechanism of this phenomenon needs to be explored further, because the number of patients being treated with a combination of both therapeutic modalities is increasing. The therapeutic effect of erlotinib in the area of the previously irradiated lesion should be assessed.

The DESIRE study--psoriasis patients' satisfaction with topical treatment using a fixed combination of calcipotriol and betamethasone dipropionate in daily clinical practice.

Daivobet (Dovobet) is a fixed combination ointment of calcipotriol and betamethasone dipropionate. The real-life clinical use of calcipotriol/betamethasone dipropionate treatment was assessed in this multi-centre, single-group, non-interventional study. Patients with psoriasis vulgaris who had a recent calcipotriol/betamethasone dipropionate prescription prior to the study start evaluated their satisfaction with the treatment after a 4-week course and after repeated courses for up to 6 months. Of the 1224 patients enrolled, 81.5% completed the 6-month study period. Approximately 75% of the patients were satisfied/very satisfied after one calcipotriol/betamethasone dipropionate treatment course and the satisfaction was high regardless of initial disease severity. Repeated calcipotriol/betamethasone dipropionate courses were prescribed for 22.9% of the patients and treatment satisfaction remained high (about 80%). The majority (60%) of the patients were willing to provide co-payments for calcipotriol/betamethasone dipropionate within their national health insurance system.

An Unexpected Detrimental Effect on the Incidence of Heel Pressure Ulcers After Local 5% DMSO Cream Application: A Randomized, Double-blind Study in Patients at Risk for Pressure Ulcers.

UNLABELLED: Background. Ischemia-reperfusion injury and reactive oxygen species (ROS) are considered to play an important role in the pathogenesis of pressure ulcers (PU). Antioxidants may diminish the inflammation and damage of these ROS in pressure ulcer formation. Dimethyl sulfoxide (DMSO) is a hydroxyl antioxidant that inhibits leukocyte adherence. When used topically, DMSO is a safe and well-tolerated drug with excellent penetrating properties. In this prospective randomized study, the effect of topically applied DMSO on the prevention of PU formation is analyzed. METHODS: In a randomized double-blinded study, the effects of massage with or without DMSO creams were assessed against controls for 2 locations (ie, heel and buttocks) in 79 patients prone for development of PU. RESULTS: There was no difference in PU incidence between the 3 interventions on the buttocks. Surprisingly, the topical 5% DMSO cream group showed an increase in superficial pressure ulcers for the heel location. CONCLUSION: This is the first study on the possible role of DMSO in the prevention of PU. The results suggest an adverse effect on PU incidence in heel, whereas on the buttocks the DMSO cream seems to have no effect. Possible explanations for this unexpected detrimental effect are discussed.

Epidermodysplasia verruciformis: unsuccessful therapeutic approach with imiquimod.

Epidermodysplasia verruciformis (EV) is a rare heritable disease characterized by an unusual susceptibility to infection with specific types of human papillomavirus and a propensity for developing skin malignant tumors. Partial defects in cell-mediated immunity have been demonstrated in this disease. Here, we describe a patient with EV who was treated unsuccessfully with imiquimod.

The effectiveness of massage with and without dimethyl sulfoxide in preventing pressure ulcers: a randomized, double-blind cross-over trial in patients prone to pressure ulcers.

BACKGROUND: Although guidelines advise against massage, it is one of the methods widely regarded and used by nurses to prevent pressure ulcers (PU). OBJECTIVES: The purpose of this study was to examine the effectiveness of different variations of massage in preventing pressure ulcers. METHODS: A randomized, double-blind cross-over design, in which patients of nursing homes who are prone to PU underwent two of the three possible interventions; 'position changes only', 'massaging with an indifferent cream' and 'massaging with a dimethyl sulfoxide (DMSO) cream'. RESULTS: The results of three interventions did not differ significantly. DMSO did not fulfil the expectations raised by literature and a previous pilot-study.

Is the distinction between superficial pressure ulcers and moisture lesions justifiable? A clinical-pathologic study.

OBJECTIVE: Pressure ulcers are classified into 4 distinct stages, which allows comparisons between institutions and even countries. Recently, attempts have been made to single out so-called moisture lesions from the early stages of pressure ulcer lesions as a distinct entity. METHODS: To investigate the justification for this development, 14 histopathologic samples from patients with both incontinence and pressure ulcer lesions were studied in an attempt to delineate differences in the pathophysiology and histopathology. RESULTS: Two distinct histopathologic pictures emerged: an ischemic pattern and a pattern of irritation. The latter appeared to be associated with lesions that clinically fit the description of moisture lesions, but this association was not absolute. CONCLUSIONS: There is no justification for singling out moisture lesions from pressure ulcer lesions. The distinction may even be dangerous when proper preventive measures for the development of pressure ulcers are not taken because of the existence of a possible moisture lesion.

Safety, efficacy, and dosage of 1% pimecrolimus cream for the treatment of atopic dermatitis in daily practice.

INTRODUCTION: Although several controlled clinical trials have demonstrated the efficacy and good tolerability of 1% pimecrolimus cream for the treatment of atopic dermatitis, the results of these trials may not apply to real-life usage. The objective of this study was to evaluate the safety and efficacy of a pimecrolimus-based regimen in daily practice. METHODS: This was a 6-month, open-label, multicenter study in 947 patients aged >or=3 months with atopic dermatitis of all severities. The investigators incorporated 1% pimecrolimus cream into patients' standard treatment protocols on the basis of their clinical diagnosis. Use of topical corticosteroids was allowed at the discretion of the physician. Safety and tolerability were evaluated by monitoring adverse events. Efficacy was evaluated by recording changes in the Investigators' Global Assessment scores and pruritus scores at each visit. RESULTS: No clinically unexpected adverse events were reported. The discontinuation rate for adverse events was 2.3%. The disease improvement rate was 53.7% at week 1 and 66.9% at week 24. The pimecrolimus-based regimen was particularly effective for the treatment of lesions involving the face (improvement rate: 61.9% at week 1 and 76.7% at week 24). The greatest therapeutic response was experienced by pediatric patients with mild or moderate disease. Nonetheless, 64% and 65% of infants and children, respectively, with severe/very severe facial disease at baseline were clear/almost clear of signs of atopic dermatitis on their face at week 24. In patients aged <18 years, most of the improvement occurred within the first week of treatment, while in adults a progressive improvement was observed over the entire study period. Worsening of disease by the end of the study occurred in 9.5% of patients and was most frequent in adults (12.6%). The discontinuation rate for unsatisfactory therapeutic effect was 4.8%. The mean number of treatment days was 135.6 (SD 53.2). The mean drug consumption (non-US centers only) was 4.2 g per treatment day. Drug consumption decreased over time as disease improved. In total, 47% of patients who completed the study never used topical corticosteroids over 6 months. CONCLUSION: In daily practice, incorporation of 1% pimecrolimus cream into patients' standard treatment regimen is well tolerated and improves atopic dermatitis in approximately two-thirds of patients. Disease improvement is particularly evident on the face. The greatest therapeutic response is experienced by pediatric patients with mild or moderate disease. In these patients, most of the improvement is observed within 1 week from the start of treatment.

Pressure ulcer risk in hip fracture patients.

Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU were high age and the length of time on the operating table. The risk assessment tool had a low predictive value, however. It is thus hard to predict which patients will develop PU and which will not. Accordingly, we propose maximum preventive measures against PU for all patients presenting with hip fractures.