Psychometric properties of the Chinese version of the attitude towards the prevention of incontinence-associated dermatitis (C-APrIAD) among Chinese nurses.

AIM: Nurses' attitude is a significant determinant of incontinence-associated dermatitis (IAD) prevention, and a positive attitude may benefit quality improvement projects. This research aimed to translate the attitude towards the prevention of incontinence-associated dermatitis instrument (C-APrIAD) into Chinese and test the reliability and validity among Chinese nurses. METHODS: The C-APrIAD was translated into Chinese using a standard procedure of backward-forward translation and cross-cultural adaption. Totally 170 nurses were recruited through the convenience sampling method from three tertiary hospitals in Tianjin, Shandong, and Heilongjiang province of China. Reliability (internal consistency, stability) and validity (content validity, structure validity, and convergent validity), were assessed. Convergent Validity was evaluated by correlation with the General Self-Efficacy Scale (GSES). RESULTS: Of the 170 completed questionnaires, 158 (93%) were suitable for analysis. The item-total correlation coefficients ranged from 0.39 to 0.80. The content validity of C-APrIAD was 0.96. A factor analysis indicated the construct of a 14-item instrument in a four factors solution: (1) beliefs about the impact of IAD on patients, (2) beliefs about team responsibility to prevent IAD, (3) beliefs about personal responsibility to prevent IAD, and (4) beliefs about the effectiveness of IAD prevention products and procedures. The correlation coefficient between the GSES and C-APrIAD was 0.49 (P < 0.01). For the total instrument, the Cronbach's α coefficient was 0.87 and the test-retest reliability was 0.99. CONCLUSION: The C-APrIAD is reliable and valid. The C-APrIAD may benefit nursing research as well as clinical practice to optimize interventions to improve IAD prevention.

A Single-arm, Practical Application Assessment of User Experience and Peristomal Skin Condition Among Persons With an Ileostomy Using a New Barrier Seal With Assisted Flow.

Peristomal skin complications are a common problem for persons with an ileostomy. PURPOSE: The purpose of this pilot study was to solicit user feedback and perform an initial assessment of the performance of a new barrier seal designed to decrease the risk of chemical-induced dermatitis. METHODS: Seven (7) potential participants who were at least 18 years of age, >6 months post surgery, with an end or loop ileostomy and unbroken peristomal skin, and who were capable of changing their appliance themselves or had the availability of care assistance were identified and recruited by the stoma care nurse at the University Hospital, Limerick, Ireland. At the initial visit and after 1 and 2 weeks, participants were asked to rate device comfort, security, and handling; skin condition was assessed by the research nurse using the Ostomy Skin Tool. Descriptive statistics were used to tabulate the results. RESULTS: Five (5) participants completed the study. Discoloration, erosion, and tissue overgrowth scores improved in 3 of 5 patients, and the mean Ostomy Skin Tool score decreased from 5.4 ± 2.19 at the initial assessment to 4 ± 1.87 at the week 2 visit. Comfort, handling, and security ratings increased from a median of 8 at the beginning of the study to 10 at week 2. CONCLUSION: Initial patient feedback regarding the new product was positive, and skin assessment results suggest the new seal may help improve peristomal skin condition. Larger studies with longer patient follow-up are needed to confirm the results of this pilot evaluation.

Disease Severity and Quality of Life Measurements in Contact Dermatitis: A Systematic Review 2005-2015.

BACKGROUND: Contact dermatitis (CD) has been assessed by numerous disease severity indices resulting in heterogeneity across published research. OBJECTIVE: This study aims to evaluate published CD severity scales and identify a criterion standard for assessment. METHODS: Scopus and Ovid MEDLINE were searched for human randomized controlled trials (RCTs) on CD severity measures published during a 10-year period. Eligible studies were English-language RCTs reporting disease severity outcome measures for CD in humans. Studies were excluded if they were duplicates, not available in English, not related to CD, not RCTs, not conducted on human subjects, or did not report relevant outcome measures. RESULTS: A total of 22 disease outcome measures were used in 81 included RCTs. Instrument-based measures were used in 40 (49.4%) studies, and visual assessments were used in 66 (81.5%) RCTs. Only 5 (6.2%) studies reported quality of life (QoL) outcomes. Two (2.5%) studies used a clinical severity scale, which combined both QoL and visual assessments. LIMITATIONS: This study was limited by the exclusion of non-RCTs and gray literature. CONCLUSIONS: Wide variation in CD outcome measures exists including instrument-based measures, visual assessments, and QoL outcomes. A standardized outcome measure must be generated to reduce heterogeneity.

Current Quality-of-Life Tools Available for Use in Contact Dermatitis.

Contact dermatitis is a common dermatologic condition that can cause significant impairment in patients' overall quality of life (QoL). This impact is separate and potentially more clinically relevant than one's disease "severity" in contact dermatitis and should be consistently addressed by dermatologists. Despite this, QoL tools specific to contact dermatitis are lacking, and there is little consistency in the literature regarding the tool used to evaluate clinical response to therapies. Measurements currently available to evaluate disease-related QoL in contact dermatitis fit into 1 of the following 3 general types: generic health-related QoL measures, dermatology-related QoL measures, or specific dermatologic disease-related QoL measures. This article reviews the strengths and weaknesses of existing QoL tools used in contact dermatitis including: Short Form Survey 36, Dermatology Life Quality Index, Skindex-29, Skindex-16, Dermatology-Specific Quality of Life, and Fragrance Quality of Life Index.

Therapies and nursing care of women with vulvar dermatologic disorders.

Vulvar dermatologic disorders are common among women, and prevalence increases with age. Treatment can provide women with symptomatic relief and can halt further progression of disease. Numerous therapies are available, and nurses who work with women across the life span should have an understanding of vulvar dermatologic disorders and therapeutic modalities. We provide an overview of general vulvar care, four vulvar dermatologic disorders, and common treatment modalities including topical and systemic pharmacologic management.

Illness perception and quality of life in patients with contact dermatitis.

BACKGROUND: People's subjective perceptions of illness are important determinants of their ways of coping with health threats and the ensuing physical and mental outcomes, including quality of life (QoL), which has been consistently reported to be impaired by contact dermatitis. OBJECTIVES: To investigate the relationships of subjective illness perceptions and dermatological QoL in atopic, contact and occupational dermatitis patients and a comparison group of patients with other dermatological diseases. PATIENTS AND METHODS: Three hundred and three patients of four diagnostic groups filled in the Brief Illness Perception Questionnaire and the Skindex-16 (+ occupational impact items) Dermatological QoL questionnaire before clinical examination and patch testing. RESULTS: Perceptions of serious consequences, greater symptom burden and more uncertainty and worry were associated with lower QoL (r(s) > 0.50). Overall, patients reported low personal control over their condition and low understanding of the disease (3.5 and 4.8, respectively, on a 0-10 scale). QoL was most impaired among occupational dermatitis patients (mean = 46) and least impaired among patients who were later diagnosed as suffering from conditions other than contact dermatitis (mean = 62). CONCLUSIONS: Identifying critical components of illness perceptions in patients with atopic, contact and occupational dermatitis may enable the design of consultations and interventions to fit patients' perceptions, which could affect their QoL.

Disease severity and quality of life in a follow-up study of patients with occupational contact dermatitis.

BACKGROUND: Few studies have investigated how occupational contact dermatitis and its severity affect patients' quality of life (QoL). OBJECTIVES: To investigate the impact of occupational contact dermatitis and its severity on patients' QoL, and to examine the association between different QoL measures. METHOD: Patients previously diagnosed with occupational contact dermatitis completed the Short Form Health Survey (SF-36) and Dermatology Life Quality Index (DLQI). Disease severity was rated both by the patient and by the physician. RESULTS: Of a possible 725, a total of 119 patients (16.4%) were included in the study, and, at follow-up, just over 21% had normal skin and 18.3% had progressed to persistent dermatitis. The SF-36 median physical component summary score was 52 [interquartile range (IQR): 43-56] and the mental component summary median score was 51 (IQR: 44-57). The correlation between patient-rated and physician-rated disease severity was moderate (r = 0.708, p < 0.00001). The correlation between the disease severity measures and DLQI was moderate, whereas the SF-36 correlated poorly with both the DLQI and disease severity measures. CONCLUSIONS: QoL was generally reduced in this group of patients with occupational contact dermatitis, with some correlation between severity and DLQI. The DLQI was a more sensitive measurement of QoL than the SF-36 in this patient population. Incorporating disease severity rating with a QoL questionnaire is valuable in occupational contact dermatitis and is recommended.

Quality of life and contact dermatitis: a disease-specific questionnaire.

BACKGROUND: Contact dermatitis (CD) is a chronic disease with a significant impact on quality of life (QoL). There have been relatively few reports in the literature on specific QoL outcomes for patients suffering from CD. OBJECTIVES: To develop a new instrument specifically designed to measure QoL in CD and to investigate which disease features could strongly influence QoL. METHODS: Three hundred seventy-two patients affected by CD were administered a 20-item questionnaire, which comprised some questions taken and modified from the Dermatology Life Quality Index and the Skindex 16. Six more items were added. Univariate analysis and a chi-square test were performed. RESULTS: Females reported lower QoL scores than males. Three aspects (itching, discomfort, and difficulty in daily activities) were strongly associated with a poor QoL; even if patients who experienced difficulty in using their hands at work had a poor QoL, the statistical significance was very low. CONCLUSION: A CD-specific questionnaire can be used to understand a priori the impact on psychological behaviour of the patient and can lead to specific choices, such as the appropriate therapy to be used, the evaluation of treatment efficacy, the choice of preventive devices, and the comparison with QoL of other dermatoses.

Contact sensitisation in hand eczema patients-relation to subdiagnosis, severity and quality of life: a multi-centre study.

BACKGROUND: Contact sensitisation has been identified as a factor associated with poor prognosis for patients with hand eczema. OBJECTIVES: To study implications of contact sensitisation with respect to severity, quality of life (QoL) and subdiagnosis of hand eczema. METHODS: The study was performed as a multi-centre, cross-sectional study from 10 European clinics. All patients were patch tested, and severity of hand eczema assessed by Hand Eczema Severity Index. A multi-variate analysis was performed to explore which factors influenced severity, QoL and sick leave. RESULTS: A total 416 patients were included, and 63% had contact sensitisation to one or more of the tested allergens. More women (66%) than men (51%) were sensitized. No significant association was found between sensitisation to specific allergens, disease severity, QoL or diagnostic subgroups. High age, male sex, atopic eczema and presence of contact sensitisation were independent risk factors for increased severity as measured by Hand Eczema Severity Index. Furthermore, the severity of hand eczema increased by the number of contact sensitisations detected (P = 0.023). High age and personal history of atopic eczema were independent risk factors for low QoL, as measured by Dermatology Life Quality Index, and atopic eczema as well as allergic contact dermatitis as subdiagnosis was associated with increased sick leave. CONCLUSION: Diagnostic subgroups were not found to be related to specific allergens. Contact sensitisation was found to be a risk factor for increased severity of hand eczema, as did high age, male sex and atopic eczema.

Health-related quality of life in health care workers with work-related skin diseases.

BACKGROUND: Occupational skin diseases (OSDs) are common among health care workers (HCWs). Little is known about how OSD impacts on health-related quality of life (HRQoL) in HCWs with suspected OSD and associated factors. OBJECTIVES: To describe HRQoL in 278 HCWs with suspected OSD, compare data with the general and populations with skin diseases and analyse HRQoL's associations with clinical and demographic variables. METHODS: HCWs with suspected OSD completed a generic (SF-36) and specific (Skindex-29) instrument. RESULTS: Seven of 8 SF-36 dimensions were significantly lower in HCWs than the general population. Compared with norms for patients with skin disease and cleaning and kitchen employees (CKEs) with suspected OSD, physical functioning (PF) and general health perception were less impaired in HCWs. Skindex-29 scores were similar to CKEs' while they appeared better than patients' norms. Multivariate analysis found severity unrelated to SF-36, apart from pain but associated with all Skindex-29 scales. CONCLUSIONS: Although HCWs with suspected OSD display considerable HRQoL impairments, (general) PF and general health perception appear less affected than expected. Severity appears to affect specific and to a lesser extent general HRQoL. Clinical and demographic variables contributed moderately to the prediction of specific and little to the prediction of general HRQoL.

Perceptions of sensitive skin: women with urinary incontinence.

BACKGROUND: Urinary incontinence is common among women, and these individuals may have different perceptions about sensitive skin than the general population. OBJECTIVES: We used an epidemiological approach to determine patterns of perceived sensitive skin among incontinent women. In addition, perceptions about sensitivity to certain products and environmental factors were evaluated. METHODS: A total of 29 women over the age of 50 suffering from light urinary incontinence filled out questionnaires designed to evaluate perceptions of sensitive skin in general, and at specific body sites (face, body and genital area). Results were compared to age- and gender-matched control subjects. RESULTS: A significant difference was found between incontinence and controls for perceived sensitivity in general, however, no significant differences were found for perceived sensitivity at the three specific body sites, i.e., face, body and genital area. The majority of participants in both the control and incontinent groups were fairly consistent with the perception of sensitive skin in general and sensitive skin of the face and body. Both groups were less consistent in describing the skin of the genital area. Responses of the two groups were similar regarding the perception of the certain environmental factors and products cause irritation. CONCLUSIONS: A significantly higher percentage of subjects with urinary incontinence describe their skin overall as "sensitive". Incontinents tended to describe the skin of the genital area as less sensitive than skin overall, whereas the controls tended to the genital area as more sensitive.

Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients.

BACKGROUND AND OBJECTIVES: Hand eczema is a chronic disease with negative impact on quality of life (QoL). In this study, QoL in hand eczema patients is assessed and related to age, sex, severity, and diagnostic subgroups. METHODS: A total of 416 patients with hand eczema from 10 European patch test clinics participated in the study. Data on QoL were obtained from a self-administered questionnaire using the Dermatology Life Quality Index (DLQI). Severity was assessed by a scoring system (Hand Eczema Severity Index, HECSI) as well as frequency of eruptions and sick leave due to hand eczema. RESULTS: No significant difference was found between males and females with respect to QoL [DLQI median values and 25/75 percentiles for males and females being 7.0 (3-14) and 8.0 (3-13), respectively], although males were more severely affected than females (P < 0.025). A significant positive correlation was found for hand eczema severity and age (P < 0.001), while no significant correlation was found for QoL and age. QoL was found increasingly reduced when sick leave was getting higher (P < 0.001). A statistically significant correlation between QoL (as measured by DLQI) and hand eczema severity as measured by HECSI was found (P < 0.001). No significant difference in QoL was found between diagnostic subgroups. CONCLUSIONS: QoL was found markedly negatively affected in hand eczema patients and was significantly correlated to disease severity. No significant difference in QoL was found between males and females, in spite of significantly more severe eczema in males, indicating that QoL in female patients is more easily affected.

Alteration of sensorineural circuits in spinal cord by chronic contact dermatitis.

In the present study, eczema-induced alteration of sensorineural circuits of the spinal dorsal horn was investigated. Eczematous lesions resembling atopic dermatitis were induced by repeated application of diphenylcyclopropenone (DCP) onto murine right hind paws. Immunohistochemical labeling of calcitonin gene-related peptide and substance P was increased in the dorsal horn on the DCP-treated side. Expression of calcium binding proteins, calretinin and calbindin-D28K, normally widely seen in dorsal horn interneurons, was up-regulated on the DCP-treated side. E-Cadherin and alpha-N-catenin, synapse-related molecules, were intensely expressed in the spinal dorsal horn of the DCP-treated side. Interestingly, c-Fos positive cells were also significantly increased in laminae I and III of the DCP-treated side. These results suggest an enhanced release of neuropeptides from peripheral afferents and alterations in the sensorineural circuitry of the dorsal horn. These changes may account for the enhanced sensory sensitivity recognized in patients with chronic eczema and atopic dermatitis.

Hand dermatitis: a problem commonly affecting nurses.

Hand dermatitis is regarded as one of the most often observed dermatological disorders among nurses. The factors that increase the risk of developing hand dermatitis are as follows: frequent washing hands, using disinfectants, wet-work conditions, exposure to medical substances, detergents and wearing rubber gloves. Most cases of occupational hand dermatitis is due to chronic exposure to irritants that cause the inflammation on the nonallergic pathway. Recurring contact to irritants disturbes the natural skin barrier and causes inflammation. There are reports showing the presence of skin barrier alterations among nurses working in operating room units. The most common contact allergens in the hospital environment include rubber, latex, medicaments and antiseptic products. In our study the incidence of self-reported hand dermatitis in hospital staff was very high. About 70% of respondents declared the presence of symptoms of hand eczema within the last 12 months and about 46% of the studied group had skin lesions at the moment of self-examination. Almost 75% of employees with hand dermatitis had observed the worsening of skin problems in relation to work and 79% reported improvement of skin changes during the leisure time. We also noted that a personal or family history of atopy increases the risk of developing hand dermatitis in nurses. We would also like to emphasize the psychological consequencies that affect nurses with hand dermatitis. According to our data 48% of hospital employees with hand eczema declare psychological distress caused by their skin lesions.

Inhibition of scratching behaviour caused by contact dermatitis in histidine decarboxylase gene knockout mice.

A neuronal system dedicated to itch consists of primary afferent and spinothalamic projection neurons. Histamine is thought to be one of the main mediators for the transmission of itch sensation. However, there are little available information on the role of histamine in scratching behaviour and sensory transmission of atopic dermatitis and chronic eczema. In the present study, the role of histamine in scratching behaviour and neural conduction of sensation in the chronic eczema model was investigated by using l-histidine decarboxylase (HDC) gene knockout mice lacking histamine. The chronic contact dermatitis was induced with daily application of diphenylcyclopropenone (DCP) on a hind paw of HDC (+/+) and HDC (-/-) mice for 2 months. The observation of scratching behaviour and the hot-plate test were performed in both mice. Histological studies were performed in the skin and spinal cord tissues. Histological examination revealed that both HDC (+/+) and HDC (-/-) mice displayed the similar extent of inflammatory cell infiltration, hyperplastic epidermis and newly spreading of neuronal processes in the skin tissue. Scratching behaviour was exclusively induced in HDC (+/+) mice, whereas it was barely observed in HDC (-/-) mice. The expression of c-Fos was specifically upregulated in HDC (+/+) mice in lamina I of the spinal dorsal horn following repeated DCP application. Scratching behaviour in chronic contact dermatitis in mice was thought mainly mediated with histamine. The afferent pathway of sensation in chronic contact dermatitis model may connect with the central nervous system through lamina I of the spinal dorsal horn.

[Quality of life of patients with occupationally-induced hand eczema]. / Lebensqualität bei Patienten mit berufsbedingten Handekzemen.

In recent years quality of life has been studied in a growing number of different dermatological diseases. Internationally validated questionnaires such the RAND-36 (identical to the SF-36) do not contain enough questions which are relevant for skin diseases. There is no publication on quality of life issues in occupational skin diseases, and only one short report gives data on quality of life in hand eczema. The widely used skin specific instrument DLQI has only 2 questions that indirectly refer to employment issues. A quality of life questionnaire on occupational skin diseases (mostly hand eczema) should ideally include questions on work-related impairment of both physical functioning and interaction with colleagues.

Psychological stress exerts an adjuvant effect on skin dendritic cell functions in vivo.

Psychological stress affects the pathophysiology of infectious, inflammatory, and autoimmune diseases. However, the mechanisms by which stress could modulate immune responses in vivo are poorly understood. In this study, we report that application of a psychological stress before immunization exerts an adjuvant effect on dendritic cell (DC), resulting in increased primary and memory Ag-specific T cell immune responses. Acute stress dramatically enhanced the skin delayed-type hypersensitivity reaction to haptens, which is mediated by CD8(+) CTLs. This effect was due to increased migration of skin DCs, resulting in augmented CD8(+) T cell priming in draining lymph nodes and enhanced recruitment of CD8(+) T cell effectors in the skin upon challenge. This adjuvant effect of stress was mediated by norepinephrine (NE), but not corticosteroids, as demonstrated by normalization of the skin delayed-type hypersensitivity reaction and DC migratory properties following selective depletion of NE. These results suggest that release of NE by sympathetic nerve termini during a psychological stress exerts an adjuvant effect on DC by promoting enhanced migration to lymph nodes, resulting in increased Ag-specific T cell responses. Our findings may open new ways in the treatment of inflammatory diseases, e.g., psoriasis, allergic contact dermatitis, and atopic dermatitis.

Contact dermatitis and quality of life: a structured review of the literature.

Quality of life (QoL) assessment has rapidly become an important outcome variable in dermatology research. Even though the importance of the patient's personal morbidity is generally accepted as being important by dermatologists, scepticism and confusion remain about the usefulness of QoL in dermatological research and how it should be measured. QoL assessments in individuals with contact dermatitis are few. A structured review of the literature is presented. All studies reviewed found that contact dermatitis is associated with impaired health-related QoL. Hand eczema appears to be as equally impairing as generalized eczema and an early, confirmed diagnosis is associated with improved QoL. Disease duration, atopic dermatitis, age and gender do not seem to have a major impact on QoL, although contradictory findings exist. Assessment of QoL in contact dermatitis is required for future clinical research and may be a valuable tool to the clinician to evaluate new treatments. A combination of dermatology-specific (e.g. Dermatology Life Quality Index) and generic questionnaires (e.g. the Short Form-36) is supported.