Background review for the 2016 European guideline on Mycoplasma genitalium infections

Mycoplasma genitalium is a cause of 10–35% of non‐chlamydial non‐gonococcal urethritis in men and in women, and is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. In women, symptoms include vaginal discharge, dysuria or symptoms of PID – abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Asymptomatic infections are frequent. In this review, we present the evidence base for the recommendations in the 2016 European guideline on M. genitalium infections and describe indications for testing, recommended diagnostic methods, treatment and patient management. The guideline was prepared on behalf of the European branch of The International Union against Sexually Transmitted Infections; the European Academy of Dermatology and Venereology; the European Dermatology Forum; the European Society of Clinical Microbiology and Infectious Diseases; the Union of European Medical Specialists. The European Centre for Disease Prevention and Control and the European Office of the World Health Organisation also contributed to their development.     

On the development of the European S3 guidelines on the systemic treatment of psoriasis vulgaris: structure and challenges

Background The development of evidence based guidelines is a demanding and time consuming process. Therefore it is important to share the knowledge and discuss the structure of these guidelines in detail. Objectives To present a method report on the development process of the European evidence based guidelines on the systemic treatment of psoriasis vulgaris with the aim to offer guidance to other guidelines groups with lesser experience and to critically appraise the methodology of the guidelines development process. Methods The guidelines are based on the previously evaluated literature from three European national evidence based guidelines and an additional systematic search and evaluation of new literature. Further steps included a structured consensus conference and a DELPHI procedure to develop the recommendations, as well as several internal and external reviews. All steps were coordinated by the Division of evidence based medicine in cooperation with a group of methodologists. Results A total of 114 studies were included, serving as base for the efficacy chapters of the intervention. The recommendations, based on the efficacy and the level of evidence of the included studies were discussed and finally consented by the guidelines group. After subsequent reviews the guidelines were presented to the European Dermatology Forum, European Academy of Dermatology and Venereology and Union Européenne des Médicins Spécialistes for approval and published in October 2009. Conclusion The development of European evidence based guidelines requires a coordinated structure which can be achieved by the integration of an experienced group of methodologists. Nevertheless further improvements are imaginable and might be considered for an update or other European evidence based guidelines.     

The European baseline series in Lithuania: results of patch testing in consecutive adult patients

Background In Lithuania, data on patch testing are lacking and the applicability of the European baseline series needs to be evaluated. Objective The aim of the study was to examine the prevalence of contact allergy to the European baseline series in the population of patients with suspected allergic contact dermatitis in Lithuania. Methods Between April 2006 and October 2008, 816 consecutive adult patients referred to the Department of Skin and Venereal Diseases, Kaunas University of Medicine, with suspected allergic contact dermatitis were patch tested with the European baseline series. Demographic data were collected in accordance with the European Surveillance System on Contact Allergies ‘minimal data set’. Results The positive patch test was observed in 384 (47.4%) patients. The most prevalent contact allergens were nickel sulphate (17.1%), Myroxylon pereirae resin (8.0%), p‐phenylenediamine (6.0%), methyldibromo glutaronitrile (5.5%) and colophonium (5.0%). The sex and age factors strongly influenced the prevalence of nickel sensitization. The lowest sensitization prevalences were found to N‐isopropyl‐N′‐phenyl‐p‐phenylene diamine (0.1%) and 2‐mercaptobenzothiazole (0.1%). Differences in the sensitization prevalences to some allergens of the European baseline series compared with other European countries were recognized. Conclusion The current European baseline series is a suitable diagnostic tool for contact allergy in Lithuania.     

Revisión de las últimas novedades en el manejo del paciente con urticaria crónica: Consenso multidisciplinar de la comunidad autónoma de Andalucía

Chronic urticaria is a difficult-to-treat skin disorder that has a major impact on patient quality of life. The latest update of the European guideline on the management of urticaria was published in 2018. In this consensus statement, produced in the autonomous community of Andalusia, Spain, we describe a multidisciplinary approach for applying the new treatment algorithm proposed by the European guideline in our region.     

Photopatch testing: recommendations for a European photopatch test baseline series

In order to establish a consensus recommendation for performing photopatch testing, a photopatch test taskforce group was established under the joint umbrella of the European Society for Contact Dermatitis and the European Society for Photodermatology in 2000. After proposing the most adequate methodology in 2004 and completing a European multicentre photopatch test study in 2011, this taskforce is recommending a list of photoallergens that should form part of a baseline series for photopatch testing in Europe. It contains mainly ultraviolet filters and drugs, mostly non‐steroidal anti‐inflammatory drugs. The choice of chemicals was based on the results of a recent multicentre study, previous published cases of photoallergy, and use of the substances in the European market. It is suggested that an extended list of photoallergens should be photopatch tested in selected cases, along with patients' own products. Two contact allergens, cinnamyl alcohol and decyl glucoside, should be simultaneously patch tested in order to clarify photopatch and patch test reactions, respectively, to ketoprofen and methylene bis‐benzotriazolyl tetramethylbutylphenol (Tinosorb M?).     

Management of bullous pemphigoid: the European Dermatology Forum consensus in collaboration with the European Academy of Dermatology and Venereology

Bullous pemphigoid is the most common autoimmune subepidermal blistering disease of the skin and mucous membranes. This disease typically affects the elderly and presents with itch and localized or generalized bullous lesions. In up to 20% of affected patients, bullae may be completely absent, and only excoriations, prurigo‐like lesions, eczematous lesions, urticated lesions and/or infiltrated plaques are observed. The disease is significantly associated with neurological disorders. The morbidity of bullous pemphigoid and its impact on quality of life are significant. So far, a limited number of national treatment guidelines have been proposed, but no common European consensus has emerged. Our consensus for the treatment of bullous pemphigoid has been developed under the guidance of the European Dermatology Forum in collaboration with the European Academy of Dermatology and Venereology. It summarizes evidence‐based and expert‐based recommendations.     

The European standard series in 9 European countries, 2002/2003 -- first results of the European Surveillance System on Contact Allergies

Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.     

Role of the practitioner, public health officer, dermatologist, and other specialists in the teaching, investigation and treatment of STD. The situation in the Common Market countries.

The training of undergraduates and postgraduates in the original member countries of the European Community (Belgium, Federal Republic of Germany, France, Italy, Luxemburg, and the Netherlands) is outlined and compared with training in the U.K. and Ireland. It is noted that, in the European Community, training is inadequate and should be improved. Harmonizing with the U.K. will require concessions to be made on both sides.     

Role of the practitioner, public health officer, dermatologist, and other specialists in the teaching, investigation and treatment of STD. The situation in the Common Market countries.

The training of undergraduates and postgraduates in the original member countries of the European Community (Belgium, Federal Republic of Germany, France, Italy, Luxemburg, and the Netherlands) is outlined and compared with training in the U.K. and Ireland. It is noted that, in the European Community, training is inadequate and should be improved. Harmonizing with the U.K. will require concessions to be made on both sides.     

Monitoring the European standard series in 10 centres 1996-2000

A 5-year retrospective study of the frequency of sensitization to the 25 allergens of the European standard series (ESS) was conducted in 10 centres in 8 European countries. Included were the results of 26 210 patients. The range in sensitivities differed moderately between the centres. Combining results of different centres and drawing conclusions on incidences can be done only with great care. The information on the ranking of the allergens and their sensitization incidence in the clinics are useful for decisions on the future composition of the standard series. The ESS is still a valid screening tool, and no substances should be deleted.     

The European Surveillance System of Contact Allergies (ESSCA): results of patch testing the standard series, 2004

Background The European Surveillance System on Contact Allergies (ESSCA) began in 2001 as project funded by a European Union grant to monitor and evaluate contact sensitization (CS) based on clinical data collected by participating European dermatology departments. Objectives ESSCA aims to detect trends in CS in an international patch test population, monitoring the frequency of CS to (standard series) allergens, evaluating the effectiveness of intervention (e.g. governmental regulations) and improving standardization of the patch test procedure on an international level. Methods In 2004, 31 ESSCA dermatology departments in 11 European countries collected patch test results and medical histories of patients tested with the European Standard Series (ESS) or a local standard allergen series using the multilingual Winalldat/ESSCA database, the German Winalldat/Information Network of Departments of Dermatology (IVDK) database or a locally created database including the items of the ESSCA ‘minimal data set’. Data were sent to the ESSCA data centre where they were imported, pooled, examined for quality and subsequently analysed. Results The departments patch tested 11 643 patients with a standard series, and 44% of the patients tested positive to one or more substances of the ESS. Nickel sulphate, the fragrance mix, Myroxylon pereirae resin, cobalt chloride, potassium dichromate, methyldibromoglutaronitrile and paraphenylenediamine are (still) the most important allergens detected. Several additional substances tested on consecutive patients in some clinics were also examined. Among these allergens, propolis and Compositae mix had a relatively high CS prevalence. Conclusions The expanding ESSCA network continues to provide up‐to‐date information regarding the pattern of CS diagnosed in participating departments across Europe.     

Guidelines for the laboratory diagnosis of trichomoniasis in East European countries

The laboratory diagnosis of sexually transmitted infections in many Eastern European countries remains suboptimal. The main objective of the present evidence‐based guidelines is to provide comprehensive information regarding the laboratory diagnosis of infections caused by Trichomonas vaginalis in East European countries. In particular, the present guidelines recommend: (i) to encourage examination of the wet mounts of vaginal exudates, instead of stained smears, at all clinical settings; (ii) nucleic acid amplification tests (NAATs) or culture could be employed if no trichomonads are detected on microscopic examination of the wet preparation and there is a strong indication of infection and (iii) the use of NAATs is encouraged in screening, using non‐invasive specimens, or high volume testing situations. In the absence of internationally recognized commercial NAAT systems, tests developed in‐house should be validated using obtainable international standards and quality assured strictly. Individual East European countries may be required to make minor national adjustments to these guidelines as a result of lack of accessibility to some reagents or equipment, or laws in a specific country.     

Ultraviolet tanning equipment: six questions

Recreational tanning, particularly as promoted by commercial salons with 'sunbeds' or booths, has generated increasing attention from the regulatory and the biomedical communities. Several agencies have weighed in with opinions on recommended modifications in guidelines, training procedures, regulatory controls, and consumer awareness. Currently there is little uniformity in the guidance provided by trade groups, in recommendations supplied by health agencies and medical associations, or in regulatory approaches taken or proposed by the many countries involved. In an effort to provide a clearer focus for its concerns in this area, the EU Directorate General Health and Consumer Affairs formulated six questions on ultraviolet (UV) tanning, all of a technical or biomedical nature. The questions were stimulated in part by the fact that the European Commission no longer regards the European standard EN 60335-2-27:1997 ('Particular requirements for appliances for skin exposure to ultraviolet and infrared radiation') as giving presumption of conformity to the Low Voltage Directive 73/23/EEC. (The latter Directive governs marketing of electrical devices in EC countries.) Initially, the questions were posed to an EU Scientific Committee. Subsequently, industry representatives and the European Commission jointly requested that the scientific community provide answers to the questions. We received the questions with a request for our technical responses and opinions. Our response was in the form of the following essay, submitted earlier this year to the European Commission. We offer it here in the hope of stimulating constructive discussion and comment.     

Paederus dermatitis: apropos of an outbreak in Conakry (Guinea) in November 1989]

Paederus sabaeus is a coleopter of the Staphylinidae family. With its toxins present in the hemolymph (pederin, pseudopederin, pederone), it causes a delayed vesicular inflammatory dermatosis. The contact between skin and toxin is only possible when the insect is injured or killed, which occurs most frequently when it is crushed on the skin. In November 1989, in Conakry, a huge proliferation of this insect was responsible for an epidemic of Paederus dermatitis. The European sailors working in the port of this town were affected preferentially, as well as the entire European population for sociocultural reasons. The clinical picture is very characteristic when the lesions are linear or "kissing lesions" on both sides of the folded part of an articular joint. This dermatosis is more frequent on the uncovered parts of the body. Healing is spontaneous, requiring 7 to 10 days, if there are no further infections.     

Bilateral nevus of Ota--a case report

We report on a case of the bilateral type of nevus fuscocaeruleus ophthalmomaxillaris Ota, which is rarely seen in European countries. We refer to other possible disturbances associated with this disorder.     

Contact allergy to metals in metalworkers: A systematic review and meta-analysis

Occupational hand eczema is frequent in metalworkers. The contribution of metal allergies is poorly elucidated even though such exposures are common at the workplace. To estimate the prevalence of metal allergy to cobalt (Co), chromium (Cr) and nickel (Ni) in metalworkers and compare these to estimates from the European Surveillance System on Contact Allergies (ESSCA). Two authors independently searched PubMed for studies reporting on the prevalence of metal allergy in metalworkers. Proportion meta-analyses were performed to calculate the pooled proportions of metal allergy in metalworkers. In total, 29 studies (22 from Europe) were included yielding 5691 subjects for quantitative analysis. The pooled proportion (95% confidence interval) of Co, Cr and Ni in European metalworkers with dermatitis referred to patch test clinics was 8.2% (5.3%–11.7%), 8.0% (5.1%–11.4%), and 11.0% (7.3%–15.4%), respectively. The corresponding estimates for unselected metalworkers from workplace studies were 4.9% (2.4%–8.1%), 5.2% (1.0%–12.6%), and 7.6% (3.8%–12.6%), respectively. In comparison, the prevalence of metal allergy in 13 382 consecutive European males with dermatitis was 3.9% (3.6%–4.2%), 4.4% (4.1%–4.8%) and 6.7% (6.3%–7.0%) for Co, Cr and Ni, respectively. Data on sex, age, body piercings and atopic dermatitis in metalworkers with metal allergy was mostly lacking. Metal allergy to all three metals was significantly more common in European metalworkers with dermatitis attending patch test clinics as compared to ESSCA data, indicating a relationship to occupational exposures, however, confounders could not be accounted for.     

Esthetic considerations for treating the patient of European descent: Thriving in diversity international roundtable series

Background

The European esthetic experience is informative for understanding both innovation as well as how to care for patients of various backgrounds and ages.

Aims

To discuss best practices for treating the European population and how these approaches may be applied to patient populations across the globe.

Patients/Methods

In support of clinicians who wish to serve a diverse patient population, a 6-part, international roundtable series focused on diversity in esthetics was conducted from August 24, 2021 to May 16, 2022. In each roundtable, expert clinicians were invited to contribute and share best practices.

Results

The results of the fifth roundtable in the series, the European Patient, are described here. Key ideas include the growing number of people over the age of 65 years in Europe and the management of this more mature patient population; the role of functional anatomy in treating patients with both fillers and botulinum toxin; and the role of ultrasound in clinical practice for mapping vasculature.

Conclusions

While there is no typical European face, there is much to be learned from thoughtful consideration of how to best manage more mature patients as well as how to use minimally invasive modalities, such as injectables, efficiently to achieve natural-looking results.     

S2k guideline for treatment of cutaneous lupus erythematosus – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV)

Cutaneous lupus erythematosus (CLE) is a rare inflammatory autoimmune disease with heterogeneous clinical manifestations. To date, no therapeutic agents have been licensed specifically for patients with this disease entity, and topical and systemic drugs are mostly used ‘off‐label’. The aim of the present guideline was to achieve a broad consensus on treatment strategies for patients with CLE by a European subcommittee, guided by the European Dermatology Forum (EDF) and supported by the European Academy of Dermatology and Venereology (EADV). In total, 16 European participants were included in this project and agreed on all recommendations. Topical corticosteroids remain the mainstay of treatment for localized CLE, and further topical agents, such as calcineurin inhibitors, are listed as alternative first‐line or second‐line topical therapeutic option. Antimalarials are recommended as first‐line and long‐term systemic treatment in all CLE patients with severe and/or widespread skin lesions, particularly in patients with a high risk of scarring and/or the development of systemic disease. In addition to antimalarials, systemic corticosteroids are recommended as first‐line treatment in highly active and/or severe CLE. Second‐ and third‐line systemic treatments include methotrexate, retinoids, dapsone and mycophenolate mofetil or mycophenolate acid, respectively. Thalidomide should only be used in selected therapy‐refractory CLE patients, preferably in addition to antimalarials. Several new therapeutic options, such as B‐cell‐ or interferon α‐targeted agents, need to be further evaluated in clinical trials to assess their efficacy and safety in the treatment of patients with CLE.     

Legislative and preventive measures related to contact dermatitis

Legislation can be a useful tool in the prevention of contact dermatitis. This is particularly true for dermatitis due to exposure to the many contact allergens that are chemical substances in products. A brief review is given of the most important European legislation--the EU Nickel Directive, the Cosmetics Directive, the Hazardous Substances Directive and the Hazardous Preparations Directive--and of some national regulations and standardization projects. It is concluded that it is essential that experts on contact dermatitis support, with their expert knowledge, national and European authorities.