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Erythema Score (erythema + score)

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A randomized, single-blind, placebo-controlled, split-face study with pimecrolimus cream 1% for papulopustular rosacea

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2008
AA Karabulut
Abstract Background, Rosacea is a common inflammatory skin disorder for which the pathogenesis is unclear. Currently, there is no cure for rosacea, and it seems that standard therapies have focused mainly on minimizing inflammation. Objectives, The aim of this study is to investigate the potential efficacy, tolerability and safety profile of 1% pimecrolimus cream for the treatment of rosacea. Methods, Twenty-five patients with papulopustular rosacea were enrolled to a randomized, single-blinded, placebo-controlled, split-face trial of pimecrolimus cream 1% consisting 4 week treatment and 2 week follow-up period. The patients were instructed to apply first the ,left side cream' labelled placebo cream (Ultrabase cream, Intendis GmbH, Berlin, Germany) to the left hemi-face then the ,right side cream' labelled 1% pimecrolimus cream (Elidel; Novartis Pharma, Nuremberg, Germany) to the right hemi-face, twice daily. They were informed to apply a standard amount of each cream with the fingertip-unit and not allowed to use any other agent concomittantly other than sunblock. Clinical evaluation and subjective severity assessment were obtained along with photographic documentation at baseline, first, second, and fourth weeks of the therapy and at the follow-up visit. Rosacea severity score for each sign of erythema, papules, pustules, oedema, and telengiectesia were graded from 0 to 3. Patients were questioned for the subjective symptoms, overall improvement on appearance and side-effects. Results, Twenty-four patients completed the study with an exceptional compliance and tolerable safety profile. One patient withdrew from the study due to severe flare-up reaction affecting both hemi-faces. The mean baseline total rosacea severity scores were 5.06 + 1.29 for both sides and reduced to 2.5 ± 1.06 vs. 3.25 ± 1.24 on pimecrolimus vs. placebo applied sides without the significance (P = 0.06). There was not any significant difference concerning each rosacea sign scores and total rosacea severity scores except for the significant improvement in erythema score and total rosacea severity score obtained on the pimecrolimus-applied hemi-face at 2nd week of therapy (P =0.01 and P = 0.03, respectively). The reduction rates of the mean subjective severity scores at 4th week were 49.77% vs. 38.89% for pimecrolimus vs. placebo, respectively, without a statistical significance (P = 0.15). Subjective symptoms responded well in 54.16% of patients concerning pimecrolimus application compared with 12.50% for the placebo application. The side-effects were mostly transient local irritations. Conclusion, Our data implicated that pimecrolimus cream is not superior to placebo except for its efficacy on erythema. We believe that pimecrolimus cream can be a treatment option for rosacea patients with high erythema score for whom an initial accelerated improvement is needed. We believe further studies with topical pimecrolimus cream on larger study groups with different subtypes and severity of rosacea will clarify the potential effect of pimecrolimus cream for the treatment of rosacea. [source]

Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts

BRITISH JOURNAL OF DERMATOLOGY, Issue 5 2002
M.A. Ben-Gashir
SummaryBackground The prevalence of atopic dermatitis (AD) has been shown to be higher in London-born black Caribbean children than in their white counterparts, but little is known about the severity of the disease. Objectives To carry out a longitudinal survey to investigate potential risk factors for AD severity in children. We report our findings in relation to differences in disease severity between white and black children and the effect of inclusion and exclusion of erythema scores on this comparison. Methods The recruited children were identified by their general practitioners (GPs) as having presented with AD, and the U.K. diagnostic criteria for AD were used to verify the diagnosis. Interview and clinical examination of children took place up to four times, 6 months apart. Each time, the same observer assessed AD severity using the SCORAD (SCORe Atopic Dermatitis) index. Potential risk factors and confounders were evaluated with a five-page questionnaire. Non-parametric tests were used for statistical analysis and the study participant remained the unit of the analysis. Results In total, 137 children (82 urban and 55 rural) were recruited, and each seen up to four times. This gave 380 observations (69% of an expected 548). The urban population contained 42 (51%) white children, 26 (32%) black children and 14 (17%) from other races. The rural population was entirely white. The 14 children from other races were completely excluded from the statistical analysis. The black children were all born in the U.K. On crude analysis, children with black skin showed a non-significantly lower risk of severe disease when compared with white children (odds ratio, OR 0·84; 95% confidence interval, CI 0·4,1·76; P = 0·65), while a highly significantly increased risk was found after adjusting for erythema score (OR 5·93; 95% CI 1·94,18·12; P = 0·002). The difference remained significant even after controlling for other potential confounders. Conclusions Black children with AD are about six times more at risk of having severe AD than their white counterparts. GPs and dermatologists should note that erythema can be a misleading indicator of severity in black children. Difficulties of assessment due to skin pigmentation might mean that severe cases are not being detected and appropriately treated. [source]

Incidence of seropositivity to bordetella pertussis and mycoplasma pneumoniae infection in patients with chronic laryngotracheitis,

THE LARYNGOSCOPE, Issue 9 2009
FACS, Mary Es Beaver MD
Abstract Objectives/Hypothesis: Determine the incidence of bordetella pertussis and mycoplasma pneumonia infection in patients with chronic laryngotracheitis. Study Design: A prospective case study. Methods: Fifty-four consecutive adult patients presenting with symptoms (throat clearing, hoarseness, cough, globus) and signs (laryngeal and subglottic erythema and edema) of chronic laryngotracheitis (CLTR) for >6 weeks were included in the study. A single blood draw for anti-pertussis toxin IgG, IgA, IgM, and mycoplasma IgM was performed at presentation. Duration of symptoms, symptom score (Reflux Symptom Index [RSI]), and physical exam score were recorded. Results: Thirteen patients (24%) had elevated IgA and IgG to pertussis toxin. Nine patients (17%) had elevated IgM to pertussis toxin. Eight patients (15%) had elevated IgM to mycoplasma pneumoniae. There were no significant differences in symptom duration, RSI score, or Voice Handicap Index-10 score among patients with current infection, recent past infection, or no infection. Subglottic erythema scores were significantly higher for patients with current or recent past infection compared to the no infection group. Patients with current infection or recent past infection had significantly more tracheal erythema than supraglottic or vocal fold erythema. Conclusions: Bordetella pertussis and mycoplasma pneumoniae infection play a significant role in the etiology of CLTR. Pertussis can be a mild but chronic presentation and may not produce typical symptoms of severe cough. Symptom duration and severity cannot differentiate between CLTR of infectious or other etiology. Infection should be considered in patients with CLTR that have significant tracheal erythema. Laryngoscope, 2009 [source]