Home About us Contact
|
Home About us Contact | ||
|
|
||
Hand Eczema (hand + eczema)
Kinds of Hand Eczema Terms modified by Hand Eczema Selected AbstractsORIGINAL RESEARCH,PAIN: Sexual Dysfunction in Patients with Chronic Hand Eczema in the Turkish PopulationTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2007Mahizer Ergün MD ABSTRACT Introduction., Hand eczema can cause considerable psychosocial disorders, such as anxiety, depression, and difficulties at work, and it may also cause sexual dysfunction. Aim., The aim of this study was to investigate sexual function in patients with hand eczema and to find out whether concomitant depression has an additional negative effect on sexual function in these patients. Main Outcome Measures., Sexual functions were evaluated in hand eczema patients. Methods., Ninety-one female (43 patients vs. 48 controls) and 79 male (45 patients vs. 34 controls) subjects were enrolled in the study. Hand eczema severity index was used to determine severity of hand eczema. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) were used to assess sexual function. Quality of life was assessed with the Dermatology Life Quality Index. Diagnosis of depression was made based on the Structured Clinical Interview for the DSM-IV, while the Hamilton Depression Rate Scale was used for grading depression. Results., Among 43 female subjects with hand eczema, 26 had depression (60.46%); of the 45 male patients, 11 had depression (24.44%). FSFI total score was found to be significantly decreased in female patients with both eczema and depression compared with controls (20.84 ± 9.19 vs. 24.04 ± 3.40, P < 0.05). FSFI total score was found to be significantly decreased in female patients with both eczema and depression compared with those without depression (20.84 ± 9.19 vs. 22.23 ± 5.82, P < 0.05). IIEF total score was also found to be significantly decreased in male patients with or without depression compared with controls (52.36 ± 14.83 vs. 59.88 ± 5.65 vs. 62.03 ± 11.04, P < 0.05). Conclusions., The results of the study demonstrated that patients with hand eczema had sexual dysfunction, and concomitant depression had an additional negative effect on sexual dysfunction. Patients with hand eczema should be evaluated with regard to sexual function and depression to provide a better quality of life. Ergün M, Türel Ermertcan A, Öztürkcan S, Temelta, G, Deveci A, and Dinç G. Sexual dysfunction in patients with chronic hand eczema in the Turkish population. J Sex Med 2007;4:1684,1690. [source] Classification of atopic hand eczema and the filaggrin mutationsCONTACT DERMATITIS, Issue 5 2008Charlotte Giwercman Hand eczema is a common disease with various risk factors of which atopic dermatitis is known to be one of the most important. Recently, two mutations in the gene coding for filaggrin, a protein important for the skin barrier, have repeatedly been shown to be associated with atopic dermatitis. Moreover, one study point towards an association between the filaggrin null alleles and the subgroup of patients having both hand eczema and atopic dermatitis. For the remainder of hand eczema patients, still unknown genetic risk factors exist. We propose that in future, classification of atopic hand eczema should distinguish between patients with and without the filaggrin null alleles and to further differentiate between associations with type I allergy, type IV allergy and exposure to irritants, respectively. Furthermore, we suggest future studies of atopic hand eczema to analyse for the filaggrin mutations. We believe this will increase the possibility of subgrouping this otherwise heterogenic disease and thereby enable a better phenotype,genotype characterization of hand eczema. This could improve the preventive initiatives, secure better information of patients about the prognosis for their disease, and possibly enable targeted treatment. [source] Hand eczema: causes, course, and prognosis ICONTACT DERMATITIS, Issue 6 2008Niels K. Veien Background:, Hand eczema is a common dermatosis. The course is often protracted. The prognosis is not well described. Objective:, To describe in detail a consecutive cohort of hand eczema patients with regard to aetiology and morphology as well as the dynamics of the hand eczema. Patients and Methods:, This prospective study included 522 consecutive patients (175 men and 347 women with hand eczema) seen in 1 year in a private practice of dermatology. 425 (81%) of the patients were patch tested in relation to the current study. Most of the remainder had been previously patch tested. Results:, 38% had mild dermatitis, 49% had dermatitis of moderate severity, and 11% had severe dermatitis. 23% had had dermatitis for more than 10 years. 33% had irritant contact dermatitis, 13% of the men and 20% of the women had allergic contact dermatitis, and 15% of the men and 16% of the women had atopic dermatitis. For 34% of the men and 29% of the women, the dermatitis was certainly or possibly occupational. There was no relationship to smoking. Conclusions:, The majority of this cohort of hand eczema patients had long-standing disease. Irritant contact dermatitis was the most common aetiological diagnosis. [source] Management of chronic hand eczemaCONTACT DERMATITIS, Issue 4 2007Thomas L. Diepgen Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the ,management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidence-based approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity. [source] FS05.1 Treatment of hand eczemaCONTACT DERMATITIS, Issue 3 2004Niels K Veien Hand eczema is a common skin disease that often becomes chronic, and treatment of the disease is often challenging. Skin protection is of great importance for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Emollients have been shown to be successful in the primary prevention of hand eczema as well as in reducing eczema activity. Topical corticosteroids are still the mainstay of treatment, but randomised controlled trials of their efficacy are needed. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects. UV-therapy and Grenz rays can also suppress hand eczema. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. Treatment possibilities for hand eczema, indications and side effects will be discussed. [source] Differences between the sexes with regard towork-related skin disease ,CONTACT DERMATITIS, Issue 2 2000Birgitta Meding Work-related skin disease is common and usually presents as hand eczema. From the Occupational Injury Information System in Sweden, as well as from registers of industrial injuries in other countries, it is evident that females report skin disease more often than males. Epidemiological studies of hand eczema also show that women are more often affected than men, in particular young women. The most common type of hand eczema is irritant contact dermatitis, which is often caused by wet work. Many female-dominated occupations involve extensive wet work, e.g., hairdressing, catering, cleaning and health-care work. These occupations are also high-risk occupations for hand eczema. Experimental studies of skin irritation have not confirmed differences between the sexes; thus, the higher prevalence of irritant contact dermatitis among females is most likely due to exposure, occupational and non-occupational. Nickel allergy is the most common contact allergy, which is most frequent in young females, and in 30,40% results over time in hand eczema. Hand eczema has an impact on quality of life and females seem to report a higher degree of discomfort than males. To achieve the optimal effect of preventive efforts regarding occupational skin disease, the focus for prevention should aim at reducing wet exposure. [source] Alitretinoin in the treatment of hand eczemaFUTURE PRESCRIBER, Issue 2 2008Dr John English Consultant Dermatologist Hand eczema is an umbrella term for dermatoses of different clinical sub-types involving the hands. It varies in severity from mild changes affecting a few fingers to a severe blistering, itchy eruption involving the entire hand.1 Hand eczema has a major impact on earnings and quality of life, often resulting in repeated con-sultations, unemployment, time off work and interference with leisure activities.2,3 Copyright © 2008 John Wiley & Sons, Ltd. [source] Hand eczema by rubberized grip of ballpoint pen in patients with atopic eczemaALLERGY, Issue 9 2006H. Kimata No abstract is available for this article. [source] ORIGINAL RESEARCH,PAIN: Sexual Dysfunction in Patients with Chronic Hand Eczema in the Turkish PopulationTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2007Mahizer Ergün MD ABSTRACT Introduction., Hand eczema can cause considerable psychosocial disorders, such as anxiety, depression, and difficulties at work, and it may also cause sexual dysfunction. Aim., The aim of this study was to investigate sexual function in patients with hand eczema and to find out whether concomitant depression has an additional negative effect on sexual function in these patients. Main Outcome Measures., Sexual functions were evaluated in hand eczema patients. Methods., Ninety-one female (43 patients vs. 48 controls) and 79 male (45 patients vs. 34 controls) subjects were enrolled in the study. Hand eczema severity index was used to determine severity of hand eczema. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) were used to assess sexual function. Quality of life was assessed with the Dermatology Life Quality Index. Diagnosis of depression was made based on the Structured Clinical Interview for the DSM-IV, while the Hamilton Depression Rate Scale was used for grading depression. Results., Among 43 female subjects with hand eczema, 26 had depression (60.46%); of the 45 male patients, 11 had depression (24.44%). FSFI total score was found to be significantly decreased in female patients with both eczema and depression compared with controls (20.84 ± 9.19 vs. 24.04 ± 3.40, P < 0.05). FSFI total score was found to be significantly decreased in female patients with both eczema and depression compared with those without depression (20.84 ± 9.19 vs. 22.23 ± 5.82, P < 0.05). IIEF total score was also found to be significantly decreased in male patients with or without depression compared with controls (52.36 ± 14.83 vs. 59.88 ± 5.65 vs. 62.03 ± 11.04, P < 0.05). Conclusions., The results of the study demonstrated that patients with hand eczema had sexual dysfunction, and concomitant depression had an additional negative effect on sexual dysfunction. Patients with hand eczema should be evaluated with regard to sexual function and depression to provide a better quality of life. Ergün M, Türel Ermertcan A, Öztürkcan S, Temelta, G, Deveci A, and Dinç G. Sexual dysfunction in patients with chronic hand eczema in the Turkish population. J Sex Med 2007;4:1684,1690. [source] Filaggrin null mutations increase the risk and persistence of hand eczema in subjects with atopic dermatitis: results from a general population studyBRITISH JOURNAL OF DERMATOLOGY, Issue 1 2010J.P. Thyssen Summary Background, Hand eczema is prevalent in the general population. It remains unclear whether or not filaggrin gene (FLG) null mutations increase the overall risk of hand eczema or only increase the risk of hand eczema in subjects with atopic dermatitis. Objectives, To investigate the association between FLG null mutations and hand eczema. Methods, A random sample of 3335 adults from the general population in Denmark was patch tested, FLG genotyped for R501X and 2282del4 null mutations and questioned about hand eczema. Results, Participants with combined presence of atopic dermatitis and FLG null mutation status had a significantly higher prevalence of hand eczema, an earlier onset of hand eczema and a higher persistence of hand eczema compared with subjects with normal FLG status and absence of atopic dermatitis. Logistic regression analyses revealed positive associations between hand eczema within the past 12 months and FLG null mutation status in participants with a history of atopic dermatitis [odds ratio (OR) 2·98; 95% confidence interval (CI) 1·27,7·01], but not in subjects without atopic dermatitis (OR 0·82; 95% CI 0·41,1·67). Conclusions,FLG null mutations were significantly associated with hand eczema (< 12 months) in subjects with atopic dermatitis. Combined atopic dermatitis and filaggrin null mutation status was strongly associated with early onset of hand eczema and hand eczema persistence. [source] Classification of atopic hand eczema and the filaggrin mutationsCONTACT DERMATITIS, Issue 5 2008Charlotte Giwercman Hand eczema is a common disease with various risk factors of which atopic dermatitis is known to be one of the most important. Recently, two mutations in the gene coding for filaggrin, a protein important for the skin barrier, have repeatedly been shown to be associated with atopic dermatitis. Moreover, one study point towards an association between the filaggrin null alleles and the subgroup of patients having both hand eczema and atopic dermatitis. For the remainder of hand eczema patients, still unknown genetic risk factors exist. We propose that in future, classification of atopic hand eczema should distinguish between patients with and without the filaggrin null alleles and to further differentiate between associations with type I allergy, type IV allergy and exposure to irritants, respectively. Furthermore, we suggest future studies of atopic hand eczema to analyse for the filaggrin mutations. We believe this will increase the possibility of subgrouping this otherwise heterogenic disease and thereby enable a better phenotype,genotype characterization of hand eczema. This could improve the preventive initiatives, secure better information of patients about the prognosis for their disease, and possibly enable targeted treatment. [source] Occurrence and prognosis of hand eczema in the car industry: results from the PACO follow-up study (PACO II)CONTACT DERMATITIS, Issue 6 2008Christian J. Apfelbacher Background:, Only a few epidemiological studies on hand eczema (HE) in the metalworking industry have been conducted, and no study has attempted a long-term follow-up. Objectives:, In the Prospective Audi Cohort (PACO) II follow-up study, we aimed to estimate burden and prognosis of HE in a car industry setting (follow-up > 10 years). Patients/Methods:, Eligible participants were individuals who had been examined in the original PACO study (1990,1998) and had been followed through until the end of their apprenticeship (n = 1909). Participants were interviewed and underwent dermatological examination. An exposure assessment was carried out according to a pre-defined algorithm. Results:, The follow-up rate was 78.3% (1494/1909). Mean follow-up time was 13.3 [standard deviation 1.3] years. The period prevalence of HE in the follow-up period was 21.0% [95% confidence interval (CI) 19.0,23.1%], yielding a cumulative incidence of 29.3% (95% CI 26.9,31.6%) in the entire study period. HE persisted after the end of apprenticeship in 40.0% (95% CI 33.3,46.7%) of subjects who had had HE during apprenticeship (n = 205). 18.0% (95% CI 15.9,20.1%) developed HE in the follow-up period (n = 1289). Conclusions:, Around 30% of subjects were affected by HE at least once during the study period. HE persisted in 40% of the participants affected during apprenticeship. [source] Hand eczema: causes, course, and prognosis ICONTACT DERMATITIS, Issue 6 2008Niels K. Veien Background:, Hand eczema is a common dermatosis. The course is often protracted. The prognosis is not well described. Objective:, To describe in detail a consecutive cohort of hand eczema patients with regard to aetiology and morphology as well as the dynamics of the hand eczema. Patients and Methods:, This prospective study included 522 consecutive patients (175 men and 347 women with hand eczema) seen in 1 year in a private practice of dermatology. 425 (81%) of the patients were patch tested in relation to the current study. Most of the remainder had been previously patch tested. Results:, 38% had mild dermatitis, 49% had dermatitis of moderate severity, and 11% had severe dermatitis. 23% had had dermatitis for more than 10 years. 33% had irritant contact dermatitis, 13% of the men and 20% of the women had allergic contact dermatitis, and 15% of the men and 16% of the women had atopic dermatitis. For 34% of the men and 29% of the women, the dermatitis was certainly or possibly occupational. There was no relationship to smoking. Conclusions:, The majority of this cohort of hand eczema patients had long-standing disease. Irritant contact dermatitis was the most common aetiological diagnosis. [source] The epidemiology of contact allergy in the general population , prevalence and main findingsCONTACT DERMATITIS, Issue 5 2007Jacob Pontoppidan Thyssen A substantial number of studies have investigated the prevalence of contact allergy in the general population and in unselected subgroups of the general population. The aim of this review was to determine a median prevalence and summarize the main findings from studies on contact allergy in the general population. Published research mainly originates from North America and Western Europe. The median prevalence of contact allergy to at least 1 allergen was 21.2% (range 12.5,40.6%), and the weighted average prevalence was 19.5%, based on data collected on all age groups and all countries between 1966 and 2007. The most prevalent contact allergens were nickel, thimerosal, and fragrance mix. The median nickel allergy prevalence was 8.6% (range 0.7,27.8%) and demonstrates that nickel was an important cause of contact allergy in the general population and that it was widespread in both men and women. Numerous studies demonstrated that pierced ears were a significant risk factor for nickel allergy. Nickel was a risk factor for hand eczema in women. Finally, heavy smoking was associated with contact allergy, mostly in women. Population-based epidemiological studies are considered a prerequisite in the surveillance of national and international contact allergy epidemics. [source] Management of chronic hand eczemaCONTACT DERMATITIS, Issue 4 2007Thomas L. Diepgen Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the ,management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidence-based approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity. [source] FS02.5 Nickel allergy and hand eczema , a twenty-year follow-upCONTACT DERMATITIS, Issue 3 2004Anna Josefson Aim:, To investigate the occurrence of hand eczema after 20 years in schoolgirls previously patch-tested to nickel. Methods:, In 1982,83, 960 schoolgirls, aged 8, 11 and 15 years, were investigated for the occurrence of nickel allergy (Larson-Stymne B and Widström L, Contact Dermatitis 1985:13:289,293). The girls were patch-tested and the prevalence of nickel allergy was 9%. Twenty years later, the same individuals have received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. After two reminders, the response rate was 81%. Results:, In total 17.5% of the girls reported hand eczema after the age of 15. The 1-year prevalence of hand eczema was 12.6%. Of the previously patch-tested schoolgirls who answered the questionnaire, 63 were sensitive to nickel. In this study, the prevalence of hand eczema among those 63 was 16%, compared to 17% in the non-sensitive group (NS). Excluding persons with atopic dermatitis, the prevalence of hand eczema was 12.5% in the nickel-sensitive group, and 10% among the others (NS). 32% of the persons who had had atopic dermatitis reported hand eczema after 15 years of age, compared to 10% of those with no history of atopic dermatitis (p < 0.001). Conclusion:, Contact allergy to nickel in early childhood (8,15 years) did not seem to increase the prevalence of hand eczema later in life. The prevalence of hand eczema was increased by a factor of three among those with a history of atopic dermatitis, which is in accordance with earlier reports. [source] FS05.1 Treatment of hand eczemaCONTACT DERMATITIS, Issue 3 2004Niels K Veien Hand eczema is a common skin disease that often becomes chronic, and treatment of the disease is often challenging. Skin protection is of great importance for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Emollients have been shown to be successful in the primary prevention of hand eczema as well as in reducing eczema activity. Topical corticosteroids are still the mainstay of treatment, but randomised controlled trials of their efficacy are needed. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects. UV-therapy and Grenz rays can also suppress hand eczema. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. Treatment possibilities for hand eczema, indications and side effects will be discussed. [source] FS07.1 A survey of occupational hand eczema in DenmarkCONTACT DERMATITIS, Issue 3 2004Rikke Skoet Background:, The need for prevention to reduce the number of occupational hand eczema is high. Occupational hand eczema is the most frequently recognised work-related disease in Denmark. Previous findings have shown that almost half of all cases develop a chronic condition with persistent dermatitis, and the annual cost to society is immense. Aims:, The aim of this study was to survey the trends and development of occupational hand eczema in Denmark and thereby help to ensure future successful prevention of chronic disabling occupational hand eczema. Methods:, 758 patients with recognised occupational hand eczema were included prospectively in the period October 2001- November 2002. Data on diagnoses, disease duration, severity, absence from work and occupation was obtained from The Danish National Board of Industrial Injuries and an additional questionnaire was administered by mail. Results:, 621 patients answered the questionnaire (response rate 82%). Irritant contact dermatitis was the most frequent diagnosis and the female/male ratio was 2:1. High prevalence was found in particularly wet occupations. 19 per cent had sick leave more than 5 weeks per year and the mean disease duration was 4.8 years (median 2.1 years). 68.2% had chronic changes. Conclusion:, The results showed a marked gender difference in the pattern of diagnosis and occupation. The impact of occupational hand eczema is still high with prolonged absence from work and a high percentage of chronic disease. The results of the study give important suggestions for future preventive strategies for health authorities. [source] FC03.1 Experience from joint occupational health/dermatology clinicsCONTACT DERMATITIS, Issue 3 2004Yat Wing Wong Background:, A monthly consultant led occupational health/dermatology clinic was started in 1999 providing rapid access to staff with suspected occupational skin disease including natural rubber latex (NRL) allergy and teaching for the occupational health staff. Objectives:, To evaluate the characteristics and outcome of staff attending this clinic and to assess patient satisfaction. Methods:, A retrospective case note survey was performed from staff attending the clinic from 1999 to 2002. A questionnaire was sent to them >3 months following consultation. Results:, A total of 116 patients were identified (12 male, 104 female), and 85 (73%) were nurses. 77 (66%) patients were referred with hand eczema (HE). Of the 45 patients referred with adverse reactions or exacerbation of hand dermatitis following the use of latex gloves, only 4 had positive prick tests and were considered to have NRL allergy. Patients with significant HE or occupational exacerbation of HE were referred for patch testing (n = 36). Of the remainder, most could be discharged after a single visit. 49/95 (52%) questionnaires were returned, 34/45 (76%) patients found the consultation useful. As a separate study, the data recorded within the patch test clinic looking at health care workers (HCW) referred both from this clinic and from other sources was analysed. This showed relevant positive patch tests in 16/49 (33%) patients. In 55/99 (56%), an occupational cause was likely. Conclusion:, Occupational skin disease in HCW is common, attendance at the clinic was beneficial and a single visit was sufficient in most cases. [source] Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposureCONTACT DERMATITIS, Issue 2 2003P Susitaival Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool , Nordic Occupational Skin Questionnaire (NOSQ-2002) , for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries. [source] Differences between the sexes with regard towork-related skin disease ,CONTACT DERMATITIS, Issue 2 2000Birgitta Meding Work-related skin disease is common and usually presents as hand eczema. From the Occupational Injury Information System in Sweden, as well as from registers of industrial injuries in other countries, it is evident that females report skin disease more often than males. Epidemiological studies of hand eczema also show that women are more often affected than men, in particular young women. The most common type of hand eczema is irritant contact dermatitis, which is often caused by wet work. Many female-dominated occupations involve extensive wet work, e.g., hairdressing, catering, cleaning and health-care work. These occupations are also high-risk occupations for hand eczema. Experimental studies of skin irritation have not confirmed differences between the sexes; thus, the higher prevalence of irritant contact dermatitis among females is most likely due to exposure, occupational and non-occupational. Nickel allergy is the most common contact allergy, which is most frequent in young females, and in 30,40% results over time in hand eczema. Hand eczema has an impact on quality of life and females seem to report a higher degree of discomfort than males. To achieve the optimal effect of preventive efforts regarding occupational skin disease, the focus for prevention should aim at reducing wet exposure. [source] The use of protective gloves and the prevalence of hand eczema, skin complaints and allergy to natural rubber latex among dental personnel in the county of Uppsala, SwedenCONTACT DERMATITIS, Issue 1 2000Magnus Lindberg During the past decade, there has been an increasing problem with acrylate allergy and natural rubber latex (NRL) allergy among dental personnel. The aim of the present study was to evaluate the prevalence of these problems among dentists, dental nurses and dental hygienists in Uppsala county, Sweden. The study was based on a self-administered questionnaire sent to 690 persons with 527 responders (76%). The most common skin problem was dry skin, fissures and/or itching on the hands. Of the 72 persons (13.6%) reporting to have suffered from hand eczema during the past 12 months, 41 were patch tested with the TRUE Test standard series and the Swedish dental screening series. In the patch tested group, 9.8% reacted to 1 or more of the acrylates. In addition, 389 persons were tested for NRL allergy with the Pharmacia Upjohn CAP-RAST test, and of these, we found 7.2% to be positive. The prevalence of self-reported hand eczema and the number of positive CAP-RAST tests differed between the 3 occupations, with higher figures for the dentists. There was also a correlation between atopic eczema and hand eczema. Of those reporting skin symptoms, 67.7% connected them to the place of work and 28.8% related them to the use of gloves. [source] Alitretinoin in the treatment of hand eczemaFUTURE PRESCRIBER, Issue 2 2008Dr John English Consultant Dermatologist Hand eczema is an umbrella term for dermatoses of different clinical sub-types involving the hands. It varies in severity from mild changes affecting a few fingers to a severe blistering, itchy eruption involving the entire hand.1 Hand eczema has a major impact on earnings and quality of life, often resulting in repeated con-sultations, unemployment, time off work and interference with leisure activities.2,3 Copyright © 2008 John Wiley & Sons, Ltd. [source] Nargile (Hubble-Bubble) smoking-induced hand eczemaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2002Meltem Onder MD A 65-year-old retired man with hand eczema presented to the Dermatology clinic in October of 2001. He complained of scaly, fissured plaque-type lesions over the radial margin of his right index finger and thumb (Fig. 1). He first noticed these changes 2 years ago. There was no history of irritation from his occupation. None of the other family members were affected. There was no history of atopy or psoriasis. Figure 1. Hyperkeratotic scaly plaques along the outer margin of the right index finger and thumb related with habit of nargile smoking The physical examination was remarkable for scaly, fissured, hyperkeratotic patches on the palms and palmar surfaces of the finger tips of the right hand. No nail changes were noted. The other fingers were free from lesions. There were no changes on the feet or soles. A diagnosis of eczema was suspected. Hobbies and repeated trauma to the hands were investigated. He had a habit of "nargile" smoking,starting at 35 years of age and he was using this apparatus more than 2 h a day. We performed patch tests with European standart test serial and they were negative. Yeast examination using KOH was negative. The diagnosis of Nargile (Hubble-bubble) eczema was made. It was advised that he stop smoking. Mild topical corticosteroids and emollient with urea were started. Clinical evaluation demonstrated resolution of the lesions after 2 weeks of therapy. [source] A 7-step consultation plan for health care workers and hairdressersJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 9 2007Stephanie Soost Summary Background: Skin diseases are among the most common occupational disor-ders in health care workers and hairdressers. Optimal prevention methods make it possible for more individuals to remain active in their profession. We devised a 7-step consultation plan which was employed in a standard fashion and then evaluated. Patients and Methods: 264 employes were evaluated in the Education and Support Center of the German Accident Prevention and Insurance Association in the Health and Welfare Services (BGW schu.ber.z Berlin) from 2003 to 2005 in a standardized manner. Included were detailed history, physical examination, skin physiology measurements (transepidermal water loss, corneometry, sebumetry) and then making a diagnosis and therapeutic recommendations. Results: Within the study group of 264 employes the most frequent diagnosis were toxic-irritant hand eczema (28.4%), allergic contact eczema (19.7%), atopic eczema (15.5%) and irritant contact eczema with atopic diathesis (13.6%). The frequency of contact sensitivity was high in the study group (80.7%). The skin physiological parameters were not remarkably altered and did not differ between individuals with an atopic diathesis versus without an atopic diathesis. Conclusion: This standardized protocol for a "7-step consultation plan"when applied in a standardized manner offers quality-controlled but also individually-adapted support considering dermatological, educational and occupational aspects. Skin physiology parameters did not provide any further information indicating the need of the development of novel techniques to measure skin barrier function. [source] Botulinum toxin in dermatology , beyond wrinkles and sweatJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2005Uwe Wollina Summary Botulinum toxin (BTX) types A and B have been used with success in cosmetic dermatology and hyperhidrosis treatment. The present review focuses on other uses of BTX in dermatology. Discussed in particular are the available data on BTX in inflammatory diseases, proctology, and some other indications. From studies in various types of eczema, it seems that BTX-A not only acts as a potent inhibitor of acetylcholine but also as an inhibitor of substance P and of glutamate as well. By those mechanisms, BTX-A may be antipruritic, which may help explain the benefits of BTX-A in lichen simplex and dyshidrotic hand eczema. In Hailey,Hailey disease, facial eccrine hidrocystomas, salivary fistulas, and intrinsic rhinitis, BTX-A blocks the secretion of sweat/saliva/mucus. BTX-A has important applications in proctology where it has become the most powerful nonsurgical therapy for anal fissures. In proctalgia fugax and after hemorrhoidectomy, BTX-A is analgesic. Current treatment applications of BTX-A and its limitations are reviewed in this paper. [source] The efficacy of ,0.05% Clobetasol + 2.5% zinc sulphate' cream vs. ,0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema: a double-blind studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2008G Faghihi Abstract Background, Many therapeutic modalities have been suggested for treatment of the chronic hand eczema. Despite good immediate efficacy of some of these treatments, there is high recurrence of the dermatitis following cessation of the treatment. Aim, Regarding the beneficial effects of the zinc sulfate on the skin, we designed a double blind study to evaluate the efficacy of the ,0.05% Clobetasol + 2.5% zinc sulphate' cream versus ,0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema. Subjects and Methods, This study was a double-blind, right to left, prospective, clinical trial. In total, 47 patients with chronic hand eczema admitted to dermatology center of Isfahan University of Medical Sciences were selected and their right hand or left hand were selected at random to be treated with either the ,0.05% Clobetasol + 2.5% zinc sulphate' cream or ,0.05% Clobetasol alone' cream twice daily for 2 weeks. All of the patients were treated for 2 weeks and were followed up at weeks 2, 4, 6 and 8 after starting the treatment. For determining the severity of chronic hand eczema, we assessed and scored 4 different characteristics of the lesions including redness; scaling; lichenification and pruritus. The data were analyzed using SPSS program (release 13) and statistical tests including Mann-Whitney test. Results, Overall, 47 patients (94 samples) were evaluated. All of these patients had similar and symmetrical lesions on their right and left hands. Out of them, 35 patients were females and 12 patients were male. In all of the evaluated characterisitics, the ,0.05% Clobetasol + 2.5% zinc sulphate' cream was more effective than ,0.05% Clobetasol alone' cream (P < 0.05). The recurrence rate of eczema was significantly lower in the group treated with this combination treatment (P < 0.05). Conclusion, With regard to the encouraging results of the combination treatment with Clobetasol + zinc sulphate, we suggest that in a more extensive clinical trial, the efficacy of this treatment against chronic hand dermatitis be evaluated. In addition, evaluation of this combination therapy against other inflammatory dermatosis seems to be logical. [source] Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema: incorrect assertion of treatment equivalencePHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 2-3 2007Saleem Mustafa Taibjee No abstract is available for this article. [source] Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema: incorrect assertion of treatment equivalence (response to Saleem Mustafa Taibjee)PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 2-3 2007Engin Sezer No abstract is available for this article. [source] Latest news and product developmentsPRESCRIBER, Issue 8 2008Article first published online: 12 MAY 200 Glargine preferred to lispro as type 2 add-on Basal insulin glargine (Lantus) and insulin lispro (Humalog) at mealtimes improved glycaemic control equally well in patients with type 2 diabetes poorly controlled by oral agents, but patient satisfaction was greater with basal insulin (Lancet 2008;371:1073-84). The 44-week APOLLO trial, funded by Sanofi Aventis, was a nonblinded randomised comparison of basal and prandial insulin regimens added to oral treatment in 418 patients. It found similar reductions in HbA1C (,1.7 vs ,1.9 per cent respectively). Fasting and nocturnal glucose levels were lower with insulin glargine and postprandial levels were lower with insulin lispro. The basal regimen was associated with fewer hypoglycaemic events (5.2 vs 24 per patient per year), less weight gain (3.01 vs 3.54kg) and greater improvement in patient satisfaction scores. Treating hypertension cuts mortality in over-80s Treating hypertension in the over-80s reduces all-cause mortality by 21 per cent, the HYVET study has shown (N Engl J Med online: 31 March 2008; doi: 10.1056/NEJMoa 0801369). Compared with placebo, treatment with indapamide alone or with perindopril for an average of 1.8 years also reduced the incidence of fatal stroke by 39 per cent, cardiovascular death by 23 per cent and heart failure by 64 per cent. The incidence of stroke was reduced by 30 per cent but this was of borderline statistical significance. Fewer serious adverse events were reported with treatment than with placebo. New work for NICE The DoH has announced the 18th work programme for NICE. Seven public health interventions include preventing skin cancer, smoking by children and excess weight gain during pregnancy. Public health guidance will include the provision of contraceptive services for socially disadvantaged young people. Two new clinical guidelines are sedation in young people and management of fractured neck of femur. New technology appraisals may include eight therapies for cancer, two new monoclonal antibodies for psoriasis and rheumatoid arthritis, an oral retinoid for severe chronic hand eczema and methylnaltrexone for opioid-induced bowel dysfunction. Combinations no better against CV disease Taking ezetimibe and simvastatin (Inegy) does not appear to slow the progression of atherosclerosis more than high-dose simvastatin alone, say researchers from The Netherlands (N Engl J Med 2008;358: 1431-43). In patients with hypercholesterolaemia, there was no difference in regression or progression of atherosclerosis after two years' treatment with simvastatin 80mg per day alone or combined with ezetimibe 10mg per day. Adverse event rates were similar. In patients with vascular disease or high-risk diabetes, there was no difference between the ACE inhibitor ramipril 10mg per day or the ARB telmisartan (Micardis) 80mg per day as monotherapy, or their combination, in the risk of a composite outcome of cardiovascular death, MI, stroke and admission for heart failure (N Engl J Med 2008;358:1547-59). Combined treatment was associated with higher risks of hypotensive symptoms, syncope and renal dysfunction. Twice-daily celecoxib increases CV risk Taking celecoxib (Celebrex) twice daily carries a higher risk of cardiovascular events than the same total dose taken once daily, a metaanalysis suggests (Circulation 2008; doi: 10.1161/ CIRCULATIONAHA.108. 764530). The analysis of six placebo-controlled trials involving a total of 7950 patients taking celecoxib for indications other than rheumatoid arthritis found that the combined risk of cardiovascular death, myocardial infarction, stroke, heart failure or thromboembolic event increased with dose over the range 400-800mg per day. The risk was significantly greater with 200mg twice daily (HR 1.8) than 400mg once daily (HR 1.1). Patients at greatest baseline risk were at disproportionately increased risk from celecoxib. Long-term etanercept effective in AS An open-label study suggests that etanercept (Enbrel) remains effective in the treatment of ankylosing spondylitis in the long term (Ann Rheum Dis 2008;67:346-52). Of 257 patients who completed six months' treatment with etanercept and who entered the nonblinded extension study, 126 completed a total of 168-192 weeks' treatment. The commonest adverse events were injection-site reactions (22 per cent), headache (20 per cent) and diarrhoea (17.5 per cent). The annual rate of serious infections was 0.02 per person. Response and partial remission rates after 192 weeks were similar to those reported after 96 weeks. Metformin reduces risk Metformin reduces the risk of developing diabetes in individuals at increased risk, a meta-analysis suggests (Am J Med 2008;121:149-57.e2). The study included 31 mostly small, randomised, controlled trials involving a total of 4570 participants and lasting at least eight weeks (8267 patient-years of treatment). Metformin was associated with reductions in body mass (,5.3 per cent), fasting glucose (,4.5 per cent) and insulin resistance (,22.6 per cent); lipid profiles also improved. The odds of developing diabetes were reduced by 40 per cent,an absolute risk reduction of 6 per cent over 1.8 years. MHRA clarifies cough and colds advice Press reports mistakenly suggested that the MHRA had banned some cough and cold remedies when it issued new guidance on treating young children, the MHRA says. The Agency's advice followed a review of over-thecounter cough and cold medicines for children by the Commission on Human Medicines. Children under two are at increased risk of adverse reactions and should no longer be treated with products containing antihistamine (chlorphenamine, brompheniramine, diphenhydramine), antitussives (dextromethorphan, pholcodine), expectorants (guaifenesin, ipecacuanha) and decongestants (phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and xylometazoline). The MHRA said these products, which are classified as general sale medicines, should be removed from open shelves until available in new packaging that complies with the advice. They may still be supplied by a pharmacist for the treatment of older children. Coughs and colds should be treated with paracetamol or ibuprofen for fever, a simple glycerol, honey or lemon syrup for cough, and vapour rubs and inhalant decongestants for stuffy nose. Saline drops can be used to thin and clear nasal secretions in young babies. Parents are being urged not to use more than one product at a time to avoid inadvertently administering the same constituent drug twice. Perindopril brand switch Servier Laboratories is replacing its current formulations of perindopril (Coversyl, Coversyl Plus) with a new product that is not bioequivalent. The current Coversyl brand contains perindopril erbumine (also known as tert -butylamine). The new formulation contains perindopril arginine; it will be distinguished by new brand names (Coversyl Arginine, Coversyl Arginine Plus) and new packaging. Coversyl 2, 4 and 8mg tablets are equivalent to Coversyl Arginine 2.5, 5 and 10mg. Servier says the change is part of the simplification and harmonisation of global manufacturing; the arginine salt is already used in other countries and offers greater stability and a longer shelf-life. Both Coversyl and Coversyl Arginine will be in the supply chain for the next few weeks. Generic perindopril will continue to be the erbumine salt and prescriptions for generic perindopril are not affected. New from NICE Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical Guidance No. 63, March 2008 This clinical guideline focuses on additional aspects of care for women with gestational diabetes (88 per cent of cases) or pre-existing diabetes (of which about 40 per cent is type 2 diabetes) and their babies. To date, insulin aspart (NovoRapid) is the only drug in the guideline specifically licensed for use in pregnancy and NICE advises obtaining informed consent to implement its recommendations for using other insulins and oral hypoglycaemic agents. As with other guidelines, NICE begins by stressing the importance of patient-centred care and involving women in decisions about their treatment. The guideline is divided into six sections, dealing with consecutive periods of pregnancy. Preconceptual planning should include empowering women to help them reduce risks, optimising glycaemic control (after retinal assessment) and increasing monitoring intensity, and providing information about the effects of pregnancy on diabetes. Metformin may be recommended as an adjunct or alternative to insulin, but other oral hypoglycaemic agents should be replaced with insulin, although glibenclamide is an option during pregnancy. Isophane insulin is the preferred long-acting insulin; lispro (Humalog) and aspart are considered safe to use. ACE inhibitors and angiotensin-II receptor blockers should be replaced with other antihypertensive agents and statins should be discontinued. Recommendations for screening and treatment of gestational diabetes build on previous guidance (CG62). Drug treatment will be needed by 10-20 per cent , this includes insulin (soluble, aspart or lispro) and/or metformin or glibenclamide, tailored to individual need. Antenatal care includes optimising glycaemic control. Insulin lispro or aspart should be considered in preference to soluble insulin. If glycaemic control cannot be achieved with insulin injections, an insulin pump may be indicated. The guideline includes a timetable for appointments and the care that should offered after each interval. Recommendations for intrapartum care, which supplement those in CG55, include frequent monitoring of blood glucose. Neonatal care includes recommendations for monitoring and screening the infant and the management of hypoglycaemia. Postnatal care (supplementing CG37) involves adjusting maternal treatment to avoid hypoglycaemia and recommendations for returning to community care. Metformin and glibenclamide are the only oral agents suitable for breastfeeding women. Women with gestational diabetes need advice about glycaemic control and planning for future pregnancies. Lifestyle advice and measurement of annual fasting plasma glucose should be offered. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal No. 138, March 2008 The latest technology appraisal of asthma treatments covers inhaled steroids for adults and children over 12 with chronic asthma. It makes only two recommendations. First, the cheapest appropriate option is recommended. Second, when a steroid and a long-acting beta2-agonist are indicated, the decision to prescribe a combined inhaler or separate devices should take into account therapeutic need and likely adherence. Combined inhalers are currently less expensive than separate devices, though they may not remain so. When a combined inhaler is chosen it should be the cheapest. NICE concludes that, at equivalent doses, there is little difference in the effectiveness or adverse event profile of the available steroids or the fixed-dose combinations. According to specialist advice, choosing the best device for an individual remains the overriding concern. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Technology Appraisal No. 139, March 2008 NICE recommends continuous positive airway pressure (CPAP) for adults with moderate or severe obstructive sleep apnoea, and for those with a milder disorder if quality of life and functioning are impaired and alternative strategies such as lifestyle change have failed. Diagnosis and treatment is the responsibility of a specialist team. A CPAP device costs £250-£550 and lasts for seven years. Copyright © 2008 Wiley Interface Ltd [source] | |||||||||||||||||||||||||