Severe retention hyperkeratosis occurring with Susac syndrome.

A 50-year-old woman presented for asymptomatic yellow hyperkeratotic plaques limited to her face. The plaques reportedly arose over the six months prior to her clinic visit. She was healthy prior to the diagnosis of Susac syndrome (retinocochleocerebral vasculopathy) two years before. A punch biopsy was performed and revealed retention hyperkeratosis. Retention hyperkeratosis is a benign and commonly seen skin condition in primary care and dermatology. Retention hyperkeratosis occurs when there is abnormality of routine desquamation that can be associated with poor hygeine. It can be associated with acne or ichthyosis. Our case of retention hyperkeratosis is unique because of the profound presentation in a setting of an untreated psychiatric condition. Treatment consisted of daily topical exfoliative care. We also encouraged her family members to help her to seek medical attention for Susac syndrome.

Quality of life and site of the lesion in dermatological patients.

BACKGROUND: The visible aspect of skin lesions and its psychological impact interfere in the quality of life of patients. OBJECTIVES: To assess the quality of life and site of dermatological lesion; to check associations between variables and compare levels of quality of life in patients with lesions on the face and/or hands and patients with lesions in parts of the body other than face and/or hands. METHODS: descriptive, association-based cross-sectional study. Two hundred and five subjects were assessed using SF-36 Generic Life Quality Questionnaire "The Medical Outcomes Study 36-item Short-Form Health Survey" (SF-36); the Dermatology Life Quality Index DLQI-BRA, and socio-demographical and lesion site data files. RESULTS: No significant differences were observed in the results for quality of life between the two groups but the number of associations between SF-36 and DLQI-BRA was higher in the group with lesions on the face and/or hands. Significant differences were verified in a further detailed division into five groups. The significant difference (p=0.05) appeared between the group with lesions on the face and/or hands and the group with generalized lesions, being that the latter presented an average ranking of 114.06 compared with 69.1935 in the former group. CONCLUSION: Regardless of the site of lesion, the feeling of exposure and the damages to which the dermatological patients are exposed are similar. It seems that skin diseases bring about the feeling of exposure and embarrassment no matter which site of the body is affected because in any intimate approach there is some sort of exposure involved.

Qualidade de vida e localização da lesão em pacientes dermatológicos / Quality of life and site of the lesion in dermatological patients

FUNDAMENTOS - O aspecto visível das lesões de pele e seu impacto psicológico interferem na qualidade de vida dos pacientes. OBJETIVOS - Avaliar qualidade de vida e localização da lesão dermatológica, verificar associação entre variáveis e comparar níveis de qualidade de vida em pacientes com lesões na face/ou mãos e pacientes somente com lesões em outras regiões do corpo que não face e/ou mãos. MÉTODO - Estudo transversal, descritivo, de ssociação. Foram avaliados 205 sujeitos através do Questionário Genérico de Qualidade de Vida- SF-36 "The Medical Outcomes Study 36-item Short-Form Health Survey" (SF-36) e do Dermatology Life quality Index, fichas de dados sócio-demográficos e de localização da lesão. RESULTADOS - Não foram observadas diferenças significativas na qualidade de vida entre os dois grupos, mas o número de associações entre SF-36 e DLQI-BRA foi superior no grupo com lesões em face e/ou mãos. Diferenças significativas foram verificadas quando da divisão em cinco grupos. A diferença significativa (p=0,05) foi entre o grupo com lesões somente em face e/ou mãos e o grupo com lesões generalizadas, sendo que este último teve posto médio de 114,06 contra 69,1935 do outro grupo. CONCLUSÕES - Independente da localização da lesão, o sentimento de exposição e os prejuízos a que fica sujeito o paciente dermatológico são semelhantes. As doenças da pele, ao que parece, provocam sentimento de exposição e constrangimento, independente do local do corpo acometido, pois na aproximação mais íntima de outra pessoa está implicada certa exposição.

BACKGROUND - The visible aspect of skin lesions and its psychological impact interfere in the quality of life of patients. OBJECTIVES- To assess the quality of life and site of dermatological lesion; to check associations between variables and compare levels of quality of life in patients with lesions on the face and/or hands and patients with lesions in parts of the body other than face and/or hands. METHODS - descriptive, association-based cross-sectional study. Two hundred and five subjects were assessed using SF-36 Generic Life Quality Questionnaire "The Medical Outcomes Study 36-item Short-Form Health Survey" (SF-36); the Dermatology Life Quality Index DLQI-BRA, and socio-demographical and lesion site data files. RESULTS - No significant differences were observed in the results for quality of life between the two groups but the number of associations between SF-36 and DLQI-BRA was higher in the group with lesions on the face and/or hands. Significant differences were verified in a further detailed division into five groups. The significant difference (p=0.05) appeared between the group with lesions on the face and/or hands and the group with generalized lesions, being that the latter presented an average ranking of 114.06 compared with 69.1935 in the former group. CONCLUSION - Regardless of the site of lesion, the feeling of exposure and the damages to which the dermatological patients are exposed are similar. It seems that skin diseases bring about the feeling of exposure and embarrassment no matter which site of the body is affected because in any intimate approach there is some sort of exposure involved.

Management of actinic keratosis patients: a qualitative study.

OBJECTIVES: In order to reinforce the appropriate UV-related behaviour of patients with actinic keratosis (AK), it is of importance to understand the underlying psychological aspects of having AK. MATERIALS AND METHODS: Open and systematic explorative interviews were conducted with 15 AK patients. Open, single interviews (n = 6) were made and summarized. Partly based on topics found by the single interviews, two qualitative group interviews (n = 7) with AK patients were performed. The topics of general importance were identified through analysis of the statements given at the group interviews. A third group interview (n = 2) was made to confirm the analytical results from the former interviews. RESULTS: Important topics for patients with AK were found to relate to the way to act in the sun (leisure time and outdoor work), a changed appearance, the seriousness of the AK diagnosis, control of the disease, and the sense of illness due to AK. Emotional reactions included worry, fear, irritation, doubt, guilt, and a relaxed attitude. CONCLUSION: It is suggested that the topics touched upon form psychological and pedagogical reference points for patient behaviour. Awareness of these topics is therefore recommended in the management of patient information related to AK.

[Ichthyoses and related keratinization disorders. Management, clinical features and genetics]. / Ichthyosen und verwandte Verhornungsstörungen. Versorgung, Klinik und Genetik.

This review concerns ichthyoses and related keratinization disorders. These are rare genetic skin diseases which are associated with marked scaling, often considerable cutaneous inflammation and a severe disease burden both physically as well as psychosomatically. The review briefly discusses how to establish a clinical diagnosis, how to provide genetic counseling for the patient and their family and how to best manage such diseases. Particular emphasis is given to the new possibilities in diagnosis and treatment opened by the recently established network for ichthyoses and related keratinization disorders (NIRK). This network is funded by the German Ministry for Education and Research and aims to integrate research efforts into disease mechanisms and to spread and transfer knowledge about these diseases to achieve better clinical care for the patients.

Basal cell carcinoma and actinic keratoses: patients' perceptions of their disease and current treatments.

BACKGROUND: The increasing incidence of nonmelanoma skin cancer constitutes a significant worldwide epidemic. Chronic exposure to ultraviolet light is the predominant risk factor for basal cell carcinoma (BCC), which will make up approximately 80% of new cases of skin cancer per year, and for actinic keratoses (AK), an early manifestation of squamous cell carcinoma. BCC and AK are associated with considerable morbidity, which can be decreased if detected and treated early. METHODS: Patients in the United States (US), Australia, Spain and Germany took part in discussion groups in which they were asked about their knowledge of BCC or AK and current diagnosis and treatment processes. RESULTS: In this study, patients were found to have only a basic understanding of BCC or AK, and furthermore, they were not satisfied with the amount of information provided by their physician about their treatment options, and possible side-effects such as pain and scarring. CONCLUSIONS: Increased public awareness about BCC and AK may potentially aid in their early detection and treatment.

Queratosis artefacta / Keratosis artefacta

Los trastornos compulsivos en dermatología son variados e incluyen diversas afecciones, tales como tricotilomanía, onicofagia y escoriaciones neuróticas, entre otras.Se describen nueve pacientes con un trastorno autoinfligido de tipo compulsivo. Las lesiones artefactas estaban producidas por el hábito incontrolable y repetitivo de morderse y/o frotarse la piel de sectores localizados de las manos o de los dedos. Las lesiones consistían en nódulos hiperqueratósicos localizados especialmente en el dorso de las manos o de los dedos. El diagnóstico diferencial debe establecerse con otros tipos de callosidades (AU)

Behavioural dynamics of a clinical trial of sunscreens for reducing solar keratoses in Victoria, Australia.

OBJECTIVE: To determine whether the behaviour of participants based on perception of treatment group in a randomised trial contributed to clinical outcome. DESIGN: A double blind randomised controlled trial of the effect of daily application of SPF 17 broad spectrum sunscreen cream (or placebo) on solar keratoses. SETTING: A rural city in Victoria, Australia. Residents aged 40 years or over were invited by letter to attend for a skin cancer screening check. Of these, 588 people with between one and 30 solar keratoses enrolled in the trial and 431 completed the trial, which extended over a six month period that included summer. Participants' perceptions of their treatment allocation, adherence with the treatment regimen, adoption of other sun protection behaviours, side effects, and perceptions of change in condition were measured at two monthly intervals. RESULTS: There were no significant differences between those who completed the study and those that did not for sex, age, treatment group, skin type, number of solar keratoses or correct perception of treatment group. Thirty per cent of those completing the study correctly guessed their treatment allocation, and people were just as likely to be right as to be wrong when they stated their opinion about their treatment allocation (z = 1.04; p = 0.15). Study group, skin type, amount of time spent outdoors, presence of side effects, perceptions of change in skin condition did not significantly predict correct perception of treatment allocation. Multivariate analysis of variance indicated that adoption of other sun protection and adherence with cream use were not significantly affected by actual treatment allocation, correct perception of treatment allocation nor by their interaction. Poisson regression analysis showed a significantly lower difference ratio of solar keratoses in the sunscreen group compared with the placebo base cream group (OR 0.55; CI = 0.46, 0.64), and for women compared with men (OR = 0.76; CI = 0.63, 0.93) but no independent effect of any of the indices of other sun protection or adherence. CONCLUSIONS: A sufficient level of commitment to study procedures was achieved, so that trial participants did not adopt other behaviours that affected treatment outcomes. It is recommended that the potential threat to validity posed by the behaviour of participants be recognised at an early stage in planning of clinical trials, so that strategies to deal with this can be integrated into study protocols.

Fifth metatarsal head resection for correction of tailor's bunions and sub-fifth metatarsal head keratoma: a retrospective analysis.

A variety of surgical procedures traditionally have been employed in the treatment of tailor's bunions and sub-fifth metatarsal head keratomas. The overwhelming majority of literature on this subject evaluates the advantages and disadvantages of various fifth metatarsal osteotomies. The authors have initiated a preliminary investigative study to evaluate the effectiveness of fifth metatarsal head resection and to compare these results with those of other studies that have focused on osteotomy techniques. Subjective and objective analyses of 50 procedures (34 patients) were performed retrospectively. Patients were either satisfied or very satisfied in 84% of the cases reviewed. Symptomatic transfer lesions occurred in only 3% of all feet examined. The most frequent postoperative complication was that of fifth digital malalignment, which presented in nearly 60% of the cases. The procedure possesses advantages and disadvantages, which prior to this study, have been discussed in anecdotal fashion only.

Tobacco smoking habits and attitudes of Australians with oral mucous membrane keratoses.

The purpose of this study was to ascertain whether or not a relationship existed between the presence of oral mucous membrane keratoses and tobacco smoking habits. Two groups of tobacco smokers, one group exhibiting oral mucous membrane keratoses, and the other no such changes, were chosen for their similar smoking habits. Detailed tobacco smoking histories of each group were ascertained. Similar results for both groups, in terms of the number of years of smoking, quantity of tobacco consumed dialy, type of tobacco smoked and the method of inhalation and exhalation were found. Eighty per cent of patients wanted to stop smoking with the fear of cancer being the major reason in the subjects with oral keratoses and the continued cost of smoking the major reason in the control subjects. In the affected patients the prevalence of white patches was not related to the quantity of tobacco consumed but rather to the number of years the subject had smoked.