Bacteriological aspects of Darier’s disease

Background There are no established data on the prevalence of bacterial colonization of lesional skin, nares and perineum in Darier’s disease (DD), or its contribution to the clinical manifestations of the disease. Objective To determine the prevalence of bacterial colonization of lesional skin and Staphylococcus aureus (S. aureus) in nares and perineum in 75 patients with DD, the association of these parameters with disease and patient characteristics, and the features of the bacterial skin infection in this group. Methods Medical interviews and physical examinations were performed. Bacteria were isolated from swabs taken from lesional skin, nares and perineum. Results S. aureus was isolated in 68%, 47% and 22% of lesional skin, nares and perineum cultures respectively. Subjects with positive S. aureus culture from lesional skin and/or nares had a statistically significant higher percentage of skin area affected and a more severe disease than patients with negative culture. Thirty of the 75 patients (40%) recalled bacterial skin infection, most often on the chest. Conclusions Patients with DD have high prevalence of S. aureus colonization in lesional skin and nares, with a correlation between disease severity and extent of the colonization. Further studies examining the consequences of S. aureus eradication in those sites may establish the need for S. aureus lesional skin and nares colonization screening and eradication as part of the treatment of DD exacerbations.     

Health‐related quality of life and marital quality of vitiligo patients in China

Background  Vitiligo can adversely affect the quality of life and sexual relationships of patients. Combination of the DLQI with the generic SF‐36 and ENRICH may give further insight in the evaluation of the burden in vitiligo patients. Objective  We sought to assess the health‐related quality of life (HRQoL) and marital quality of Chinese vitiligo patients and to identify the relevant clinical and socio‐demographic determinants. Methods  A total of 101 vitiligo patients and 126 healthy controls completed the questionnaires. HRQoL was measured using DLQI and SF‐36, and marital quality was measured using the ENRICH marital inventory. Results  Patients with vitiligo experienced significantly impaired health‐related quality of life and unstable marital relationships. Gender, distribution pattern of vitiligo and disease severity were independent predictors of DLQI, SF‐36 and ENRICH in this cohort. Conclusions  Vitiligo is associated with impairment of HRQoL and marital quality among Chinese patients. Alongside the medical interventions, the psychological and sociocultural assessment and intervention should be an essential part of the management of these cases.     

Health‐related quality of life in children with cutaneous adverse drug reactions

Adverse drug reactions (ADRs) are a common problem in children. Health‐related quality of life in patients with such conditions has not been well studied. In this study we found that health‐related quality of life is adversely affected in children who developed ADRs with cutaneous manifestations.     

Health‐related quality of life in adolescents with psoriasis: an interview‐based study

Psoriasis is a common skin disease affecting the physical, psychological and social well‐being of patients and their families. Most research so far has been limited to adults, and little is known about the experiences of young people with psoriasis. The aim of this study, from Denmark, was to provide an in‐depth understanding of the impact of psoriasis on adolescents’ health‐related quality of life (HRQoL). Thirty‐sixs interviews were conducted with 18 adolescents with psoriasis (aged 12–17 years), 14 of their parents and four health professionals working with psoriasis. The interview guide included broad, open‐ended questions asking about different life domains (e.g. physical, emotional and social) rather than specific issues previously addressed in existing (e.g. questionnaire‐based) research. However, when participants raised issues previously addressed in existing questionnaires, the authors prompted them to provide more information on these issues. The participants reported that psoriasis affected their quality of life within six main themes: physical symptoms (e.g. itching and flaking, fluctuation of symptoms), feeling different (e.g. feeling alone, body image issues), psoriasis‐related worry about the future (e.g. disease worsening, education and work, starting a family), increased attention (e.g. comments, staring, bullying), attempts to conceal skin (e.g. choosing specific clothing, avoiding swimming) and treatment‐related frustrations and worry (e.g. side‐effects and inconvenience). Taken together, a broad range of the reported difficulties appeared to arise from appearance‐related concerns. The impact of psoriasis and its treatment on the adolescents’ daily lives varied considerably. The authors believe that dermatologists during consultations could help by including patients’ HRQoL concerns in planning treatment, and also simply asking about these factors. In more complicated cases, referral to psychologists or counselling might be necessary.     

Successful Treatment of Darier’s Disease with Adapalene Gel

Abstract: We report a 12‐year‐old Japanese boy with a 3‐year history of skin lesions that had been unsuccessfully treated with topical steroids. We initiated two different topical treatments with adapalene gel 0.1% (Differin^® Gel 0.1%) and high‐concentration vitamin D3 (tacalcitol) ointment; the lesions treated with adapalene gel improved dramatically in the first 2 months, whereas the high‐concentration vitamin D3 ointment resulted in little improvement. Topical adapalene gel 0.1% may be a promising choice as a topical treatment of Darier’s disease because of its high efficiency and lack of adverse effects.     

Health‐related quality of life and healthcare resource use in European patients with plaque psoriasis: an association independent of observed disease severity

Background. Healthcare resource utilization (HCRU) by patients with plaque psoriasis increases with skin lesion severity; however, the relationship between patient quality of life (QoL), which correlates only weakly with clinical severity, and HCRU is less understood. Aim. To evaluate the relationship between QoL, HCRU and employment in European patients with plaque psoriasis. Methods. Patients (n = 897) were recruited in five European countries. Data were analysed by group according to the Dermatology Life Quality Index (DLQI): ≤ 10 (better QoL) and > 10 (worse QoL). Results. Mean numbers of primary dermatologist visits and hospitalizations were significantly higher for patients with DLQI > 10. Likewise, significantly more patients with worse QoL reported employment disadvantages. Significant differences were maintained even after adjusting for age, gender and body surface area affected. Conclusions. In patients with plaque psoriasis, poorer QoL is associated with increased HCRU, independent of clinical severity. This suggests that QoL, in addition to skin lesion severity, should be considered in predicting the economic burden of disease.     

Successful treatment of combination therapy with tacalcitol lotion associated with sunscreen for localized Darier’s disease

We herein report a sporadic case of Darier’s disease localized to the bilateral side of the neck in a 39‐year‐old Japanese woman. Several clinical variants of Darier’s disease have so far been recognized including unilateral Darier’s disease, localized Darier’s disease, segmental Darier’s disease and acral Darier’s disease. Few cases of Darier’s disease, restricted to sun‐exposed areas such as the bilateral side of the neck, have been described in the published work. It remains controversial, however, whether ultraviolet exposure can induce the onset of Darier’s disease. Our patient’s skin lesions, which were resistant to previous treatment with corticosteroid, improved substantially with high‐concentration tacalcitol lotion and sunscreen. This is the first report on the efficacy of topical tacalcitol lotion associated with sunscreen for the treatment of localized Darier’s disease.     

Clinical follow‐up study of adult‐onset Still’s disease

Eighteen patients with adult‐onset Still’s disease have been followed up for 3–22 years in our department. Initial manifestations were fever with skin rash in 14 patients, fever, skin rash and sore throat in two, skin rash in one and arthralgia in one. During the follow‐up period, typical skin rash was seen in all patients, of them five patients (29%) revealed atypical skin rash simultaneously. Atypical rash included persistent erythema with pigmentation in two, persistent plaques and papules with linear erythema in two and edema of the eyelids mimicking dermatomyositis in one. Persistent papules and plaques revealed histologically characteristic features, such as dyskeratotic keratinocyte and liquefaction degeneration as well as a sparse superficial dermal infiltrate containing scattered neutrophils. In patients of chronic articular type and polycyclic systemic type, atypical skin rash, lymphadenopathy and hyperferritinemia were noted to be significantly higher than those of monocyclic type. These factors might be prognostic factors of adult‐onset Still’s disease in our study.