Clinical severity and prognosis of hand eczema.

BACKGROUND: Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. OBJECTIVES: In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. METHODS: Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased from 19.9 points at baseline to 11.2 points at follow-up (P < 0.001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age (P < 0.001), atopic dermatitis (P = 0.01) and > or = 1 positive patch test (P < 0.001). Being an unskilled worker was a predictor for a poor prognosis at follow-up (P = 0.04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P = 0.02) and a poor prognosis (P = 0.04). CONCLUSIONS: Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.

Identification of novel and known mutations in the genes for keratin 5 and 14 in Danish patients with epidermolysis bullosa simplex: correlation between genotype and phenotype.

Epidermolysis bullosa simplex (EBS) is a group of autosomal dominant inherited skin diseases caused by mutations in either the keratin 5 (K5) or the keratin 14 (K14) genes and characterized by development of intraepidermal skin blisters. The three major subtypes of EBS are Weber-Cockayne, Koebner, and Dowling-Meara, of which the Dowling-Meara form is the most severe. We have investigated five large Danish families with EBS and two sporadic patients with the Dowling-Meara form of EBS. In the sporadic Dowling-Meara EBS patients, a novel K14 mutation (N123S) and a previously published K5 mutation (N176S) were identified, respectively. A novel K14 mutation (K116N) was found in three seemingly unrelated families, whereas another family harbored a different novel K14 mutation (L143P). The last family harbored a novel K5 mutation (L325P). The identified mutations were not present in more than 100 normal chromosomes. Six polymorphisms were identified in the K14 gene and their frequencies were determined in normal controls. These polymorphisms were used to show that the K14 K116N mutation was located in chromosomes with the same haplotype in all three families, suggesting a common ancestor. We observed a strict genotype-phenotype correlation in the investigated patients as the same mutation always resulted in a similar phenotype in all individuals with the mutation, but our results also show that it is not possible to predict the EBS phenotype merely by the location (i.e., head, rod, or linker domains) of a mutation. The nature of the amino acid substitution must also be taken into account.

Immunological studies in sarcoidosis: a comparison of disease activity and various immunological parameters.

We found it valuable to separate the heterogeneous types of sarcoidosis into more homogeneous groups on the basis of activity and duration of the disease. This view is supported in the present study by the finding of a marked depression of T-cell function in patients with chronic-active sarcoidosis. Patients with acute or chronic-inactive disease had only moderately depressed T-cell function as measured by tuberculin skin test and DNCB index. These results are in agreement with those of some previous investigations. The remainder of the abnormal findings, particularly low total number of circulation T lymphocytes, elevated serum IgG levels, and presence of autoantibodies, could not be correlated to disease activity, extent of the disease, or T-cell function. We have found no explanation for the presence of autoantibodies but suspect that they may be nonspecifically related to the disease process.

Chromosome analysis in patients with sarcoidosis.

Chromosome analysis of lymphocytes from the peripheral blood of 20 patients with sarcoidosis and 10 healthy controls showed a significantly greater number of hypomodal cells among the patients. Two patients receiving systemic treatment with glucocorticoids had many chromosomal aberrations.

Circulating antibodies in rabbits against a Kveim Material.

For 1 year five rabbits were sensitized with a solubilized Kveim material. After 50 days, precipitating antibodies were demonstrated by passive immunodiffusion. Crossed immunoelectrophoresis using Kveim material against concentrated rabbit serum showed ill-defined precipitates, while two well-defined precipitates were seen when rocket immunoelectrophoresis was used. One of the precipitates probably represented an antibody against human serum protein in the K veim material, while the other may have been a specific antibody against the K veim material. No precipitates were seen when rocket immunoelectrophoresis was applied to sera from two patients with active sarcoidosis.

Stomatitis and systemic dermatitis from mercury in amalgam dental restorations.

Patients who are hypersensitive to mercury may develop stomatitis on mucosa adjacent to amalgam dental restorations. This reaction, an allergic contact dermatitis, often resembles lichen planus but is distinguished by its location adjacent to restorations. Widespread dermatitis and urticaria are also possible.

Microscopy of tonsillar smears and sections in tonsillar gonorrhoea.

Microscopy of methylene-blue and Gram-stained smears from the tonsillar surface and an immunofluorescence (IF) test were carried out for 130 patients, 129 with genital and/or anal gonorrhoea, 27 of whom also had tonsillar gonorrhoea. One patient had only tonsillar gonorrhoea. 5 of the 28 patients with tonsillar gonorrhoea had acute tonsillitis and for these, agreement was found between culture, light microscopy and IF test, while only 5 of the remaining 23 patients had positive microscopy. Among the 102 patients who did not have tonsillar gonorrhoea a few false-positive light microscopies and IF tests were found. Microscopy of haematoxylin-eosin stained sections of 8 tonsils from 4 patients with recurrent tonsillitis and tonsillar gonorrhoea showed subacute tonsillitis. Methylene-blue and Gram-stained sections revealed gram-negative diplococci morphologically similar to gonococci. The bacteria were located in the superficial layers of the mucous membrane (frequently intracellularly in leukocytes) and occasionally in cellular debris in the crypts.

Cytologic examination and viral and bacterial culture in herpes simplex, herpes zoster, and varicella.

Cytologic examination of epithelial cells from the base of vesicles, virus isolation, and bacterial culture were carried out in thirty-one patients with herpes simplex, in eleven patients with herpes zoster, and in three patients with varicella. Determination of herpes simplex complement fixation reaction was made in the patients with herpes simplex. Cytologic manifestations consistent with herpes were found 65 percent of patients with herpes simplex, while herpesvirus hominis was isolated in 77 percent of these patients. Diagnostic cytologic manifestations were found in 82 percent of the patients with herpes zoster or varicella. Varicella-zoster virus was isolated in 27 percent of these patients. The presence of pathogenic bacteria did not seem to influence the frequency of virus isolation or finding of characteristic cytologic features.

Cutaneous Metastases simulating other dermatoses.

Two patients with unusual cutaneous metastases from internal cancer are presented herein. In a patient with breast cancer, cutaneous metastases developed which appeared as erythema annulare centrifugum. A patient with prostatic cancer had cutaneous metastases which mimicked pyodermas. The importance of skin biopsy as a diagnostic tool is emphasized.

Topical metronidazole in the treatment of rosacea.

One percent metronidazole in an emollient cream base was compared with 250 mg oral tetracycline taken twice daily for the treatment of seventy-five patients with rosacea. After eight weeks of treatment there was no statistically significant difference between the results of the two treatments. Tetracycline did have a more rapid onset of effect on papules and pustules. Both treatments were well tolerated.

Hydrocortisone 17-butyrate (Locoid) 0.1% cream versus hydrocortisone (Uniderm) 1% cream in the treatment of children suffering from atopic dermatitis.

A randomized, double-blind, left-right study to compare the therapeutic efficacy of hydrocortisone 17-butyrate (Locoid) 0.1% cream with hydrocortisone (Uniderm) 1% cream was performed in forty children suffering from atopic dermatitis. The medications were applied to symmetrical bilateral skin lesions twice daily for a maximum of 4 weeks or until complete clinical clearance of such lesions had occurred. Complete clearance of skin symptoms was found in 36% of the Locoid-treated sides and in 23% of the Uniderm-treated sides following 2 weeks of therapy and in 60% and 30%, respectively, after 4 weeks of treatment. This difference in clearance rate after 4 weeks between both preparations was significantly in favour of Locoid cream. The expressed preferences of patients/parents and investigator were also significantly in favour of Locoid cream, both after 2 and 4 weeks. No serious side-effects were reported during this study. It is concluded that Locoid cream is significantly superior to Uniderm cream in the treatment of atopic dermatitis in children.

Treatment of hand eczema.

Hand eczema is a common skin disease that tends to become chronic and may interfere with many types of work. Emollients have been shown to be useful in reducing eczema activity and in the primary prevention of hand eczema. Protection of the hands is very important for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Although topical corticosteroids are the mainstay of treatment, few studies of their rational use, efficacy and side-effects have been conducted. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. Botulinum toxin has been used with success in the treatment of dyshidrotic hand eczema. PUVA is effective as a systemic treatment. Bath-PUVA treatment, UVB and Grenz rays can also suppress hand eczema.

[Aluminum allergy caused by DTP vaccine]. / Aluminiumallergi forårsaget af Di-Te-Pol-vaccine.

All children referred to two private dermatological practices from 1 Jan. 1985 to 31 Dec. 1990 who had pruritus and subcutaneous infiltrates in the areas of immunization with Di-Te-Pol vaccine were patch tested with a Finn Chamber or with 2% aqueous aluminium chloride. Di-Te-Pol vaccine contains aluminium hydroxide. Contact allergy to aluminium was demonstrated in 32 children (20 girls and 12 boys). Of the three patch test methods used, testing with 2% AlCl3 occluded with a Finn Chamber proved to be the most sensitive. Immunization of children who have been shown to be allergic to aluminium should be carried out with vaccines which do not contain aluminium.

[Milker's nodules]. / Malkerknuder.

Milker's nodule is a parapox virus infection seen mostly on the hands of dairy farmers. We saw 15 cases over a period of two years in the County of North Jutland. Clinically, milker's nodule goes through a papular, a nodular and a crusted stage. Most patients were seen when the infection was in the nodular stage, an often painful condition requiring treatment. Three patients developed an erythema multiformelike secondary eruption. Lesions from nine patients were removed for histological examination. The histology of all lesions was consistent with milker's nodule. In three of seven patients parapox virus was demonstrated by electron microscopy. Treatment was commonly curettage followed by cauterization.

[Results of treatment of non-melanoma skin cancer in a dermatologic practice. A prospective study]. / Behandlingsresultater af non-melanom hudkraeft i en dermatologisk speciallaegepraksis. En prospektiv undersøgelse.

The study was carried out to determine the results of treatment of a cohort of patients with histologically verified non-melanoma skin cancer diagnosed and followed prospectively for two years in a private practice of dermatology. Throughout the follow-up period, any new non-melanoma skin cancers among this cohort were recorded. Six hundred and forty-six consecutive patients seen in the Dermatology Clinic, Vesterbro 99, Aalborg, Denmark, from July 1, 1990, to June 30, 1993, had a total of 768 tumours that were histologically verified as basal cell carcinoma, squamous cell carcinoma or Bowen's disease. Six hundred and twenty-eight tumours in 526 patients were treated in our clinic, 91% of these with curettage followed by electrocautery. Hundred and twenty patients with a total of 140 tumours were referred to a local hospital for treatment. Thirty-six of the 508 basal cell carcinomas treated in the clinic recurred during the follow-up period, and one mixed tumour (basal cell and squamous cell carcinoma) recurred. During the follow-up period, 151 new non-melanoma skin cancers were detected. In addition, 10 patients each developed 10 or more new tumours.

[HIV testing and HIV surveillance of a venereological clientele in Denmark]. / HIV-testning og HIV-overvågning blandt et venerologisk kleintel i Danmark.

The object of this investigation was to evaluate the suitability of unlinked anonymous HIV screening of persons visiting one of eight out of the nine Danish clinics for venereal diseases in the national HIV surveillance. Data were collected during the period July 1, 1990-March 31, 1991 and included: gender, sexual orientation, history of intravenous drug use (IVDU), syphilis testing and HIV testing. A total of 7,455 persons participated of whom 75% were tested for HIV antibodies. The HIV test activity was significantly higher among male IVDUs than homo/bisexuals, and higher among female IVDUs than heterosexuals. The overall HIV prevalence among tested individuals was 0.6%, ranging from 0.1% among heterosexual women to 5.3% among female IVDUs. A total of 81% were tested for syphilis with an overall HIV prevalence of at least 1.1%, ranging from 0.2% among heterosexuals to 9.3% among homo/bisexual men. Since the non-participation is great and the venereological clientele is very heterogeneous, using blood taken for syphilis serology from this group for unlinked anonymous HIV screening, would not be particularly important as a supplement to the Danish HIV surveillance.

[Keratin diseases]. / Keratinsygdomme.

The rapid development in human genome research has resulted in a tremendous increase in our understanding of the molecular basis of many genetic skin diseases. One outstanding example of this is diseases caused by mutations in keratin genes, which comprise several disorders of the epidermis, as for example the different types of epidermolysis bullosa simplex. In this respect, the most important questions have been to 1. Define the molecular defect. 2. Unravel the pathophysiological mechanisms that lead to the characteristic phenotype and 3. Design of new therapeutic strategies. Molecular research has contributed significantly to the first two issues whereas a therapeutic break-through has yet to appear.

[Epidermolysis bullosa simplex: genotype-phenotype correlation in Danish patients]. / Epidermolysis bullosa simplex: korrelation mellem genotype og faenotype hos danske patienter.

Epidermolysis bullosa simplex (EBS) is a group of autosomal dominant inherited skin disorders caused by mutations in the keratin genes K5 or K14. We examined five Danish families with EBS-Weber-Cockayne (WC) or EBS-Koebner (K) and two sporadic cases of EBS-Dowling-Meara (DM) in order to investigate the mutational spectrum and evaluate the genotype-phenotype correlation in Danish patients. Three new K14 mutations, one new and one previously described K5 mutation were identified by DNA sequence analysis. The positions of the EBS-DM mutations were consistent with previous studies, whereas the EBS-WC and EBS-K mutations were found in regions of the keratin genes not typically associated with this type of EBS mutations. In conclusion, we found a strict genotype-phenotype correlation. Furthermore, we found that the position of the mutation in the keratin gene is not the only determinant for severity of the disease; the nature of the amino acid substitution should also be considered when predicting the severity of the EBS disorder.