Epidemiology and clinical features of atopic dermatitis in India

Literature on atopic dermatitis (AD) has experienced a spurt in the recent years with interest on genetics, immunology, pathogenesis, psychological impact, development of newer more effective and safer treatment agents. Indian literature on AD is limited, probably due to lower prevalence, and milder disease. In this review, we have discussed the Indian literature on epidemiology and clinical features of AD.     

Skin manifestations with Rotavirus infections

Rotavirus infection is one the most frequent cause of diarrhea among infants and children. Although it is not associated to specific dermatologic clinical pictures, recently, different clinical manifestations have been reported in association with this infection. They include exanthema, Gianotti-Crosti syndrome, and Acute Infantile Hemorrhagic Edema. The condition can be diagnosed microbiologically with stool cultures. The prognosis is excellent in healthy, immunocompetent individuals.     

Epidemiology of human papillomavirus infections.

Human papillomavirus infection represents the most common mucocutaneous viral infection, and 3% to 5% of all patients have clinically evident warts. Human papillomavirus infections of the genital tract are one of the most common sexually transmitted viral infections in the United States. Data from STD clinics and private physicians' offices reveal that genital warts, one manifestation of genital HPV infection, have been diagnosed more frequently in recent years. With the use of a variety of diagnostic techniques, asymptomatic HPV infection has been identified in men and women and is probably much more common than is clinically apparent infection.     

Skin and soft tissue infections due to rapidly growing mycobacteria: comparison of clinical features, treatment, and susceptibility

OBJECTIVE: To compare the demographics, clinical features, susceptibility patterns, and treatment for skin and soft tissue infections due to Mycobacterium fortuitum and Mycobacterium chelonae or Mycobacterium abscessus. DESIGN: Retrospective medical record review. SETTING: Mayo Clinic, Rochester, Minn. PATIENTS: All patients seen at our institution with a positive culture for M chelonae, M abscessus, or M fortuitum from skin or soft tissue sources between January 1, 1987, and October 31, 2004. MAIN OUTCOME MEASURES: Patient demographics, clinical characteristics, therapeutic data, microbiological data, and outcomes. RESULTS: The medical records of 63 patients with skin or soft tissue infections due to rapidly growing mycobacteria were reviewed. Patients with M chelonae or M abscessus were older (61.5 vs 45.9 years, P<.001) and more likely to be taking immunosuppressive medications (60% vs 17%, P = .002) than patients with M fortuitum. Mycobacterium fortuitum tended to manifest as a single lesion (89% vs 38%, P<.001), while most M chelonae or M abscessus manifested as multiple lesions (62% vs 11%, P<.001). More patients with M fortuitum had a prior invasive surgical procedure at the infected site (56% vs 27%, P = .04). Patients with multiple lesions were more likely to be taking immunosuppressive medications than those with single lesions (67% vs 30%, P = .006). Seven patients failed treatment, several of whom were immunocompromised and had multiple comorbidities. CONCLUSIONS: Skin and soft tissue infections due to rapidly growing mycobacteria are associated with systemic comorbidities, including the use of immunosuppressive medications. There are significant differences in the demographic and clinical features of patients who acquire specific organisms, including association with immunosuppression and surgical procedures.     

Condyloma acuminatum in Rochester, Minn., 1950-1978. I. Epidemiology and clinical features

From 1950 through 1978, condyloma acuminatum was diagnosed in 746 residents of Rochester, Minn (246 male and 500 female subjects). With the number of cases increasing almost every year until 1975, the mean annual incidence rate reached 106.5 per 100,000 population in the period 1975 through 1978, apparently the highest reported to date. Among age groups, the rate was highest in the 20- through 24-year-old group. Female patients contracted the infection at a higher rate and at a younger age than male patients. Anal condyloma occurred in one third of the male subjects studied and recurrent condyloma in 30% of the male subjects. More female than male patients had lesions at multiple locations.     

Epidemiology and clinical features of pediatric psoriasis in tertiary referral psoriasis clinic

Few epidemiological studies of pediatric patients with moderate to severe psoriasis have been available despite there being no approved systemic therapy for these patients. The aim of the present study was to elucidate clinical features of pediatric psoriasis in a tertiary referral psoriasis clinic. We analyzed the clinical data of 358 patients under 18 years of age referred to our clinic from other private clinics and medical centers. Our data showed a male :female ratio of 1.06:1 and a peak age of onset of 10-11 years. Of the patients, 32.4% had a positive family history. The most prevalent phenotype was plaque type (67.3%) and the mean Psoriasis Area and Severity Index score was 17.2 ± 12.7. The most frequently affected body part was the trunk (69.5%), followed by the legs (65.3%). Exposure to sunlight and summer season improved psoriatic lesions, while stress and winter season aggravated the clinical course. Only 26.0% of patients received systemic therapy or phototherapy during the therapeutic course. Oral acitretin (11.2%) was most frequently used followed by ultraviolet B phototherapy (7.3%). The childhood group (<13 years) showed higher prevalence of guttate and generalized pustular phenotypes and more severe clinical course compared with the adolescent group (13-18 years). In conclusion, our patients showed distinctive features in clinical phenotypes, disease severity and affected body parts compared with previous reports. We also found that clinical application of systemic therapies were limited considering the severe disease state of our patients, demanding a need for more research on treatment of pediatric psoriasis.     

Epidemiology of HPV infections

Since the infectivity of various HPVs cannot be studied otherwise, the only available information about this important question is provided by clinical and epidemiologic observations of warts.     

Skin infections in athletes

Athletes represent a unique group of dermatologic patients. Intense and close contact with others' skin primarily places the athlete at risk for infection. Failure to acknowledge the role of sports participation in the genesis of skin infections leads to delayed diagnoses, inappropriate therapy, and subsequent epidemics. Simple prevention measures curb epidemics and allow teams to practice and compete without disruption.     

Epidemiology of gonococcal and chlamydial infections in Harrow and Brent.

OBJECTIVE: To describe the epidemiology and associated clinical features of gonorrhoea and chlamydial infection and to develop a profile of sexually transmitted diseases (STDs) in an outer London health district. DESIGN: Hospital-based retrospective study. SETTING: Genitourinary medicine clinic, Northwick Park Hospital, Harrow and Brent Health Authority. SUBJECTS: 70 male and female individuals with gonorrhoea and 129 with chlamydial infection, diagnosed consecutively over 28 months in 1992-94. RESULTS: More men than women had gonorrhoea (43 versus 27) but more women than men had chlamydial infection (84 versus 45), p < 0.001. There was a clear tendency for cases with either infection to locate along major road and rail transport routes. Foci of gonococcal infection were concentrated mainly in the densely populated areas, whereas chlamydial cases were more evenly spread. There was no significant effect of gender or type of STD on the odds ratio for residence in Harrow, single marital status or attendance for test of cure. However, the odds ratios for women having sexual intercourse with a regular partner only or previous STD were 5 (95% CI 2.4 to 10.2), p < 0.001 and 0.3 (95% CI 0.18 to 0.69), p = 0.002 times the odds for men, respectively. The odds ratios for patients with gonococcal infection being employed or having sex with a regular partner only were 0.5 (95% CI 0.27 to 0.98), p = 0.04 and 0.30 (95% CI 0.15 to 0.60), p < 0.001 times the odds for patients with chlamydial infection, respectively. Of the women with gonorrhoea and previous pregnancy, 68% gave a history of abortion compared with 44% of those with chlamydial infection (p = 0.03). CONCLUSION: The identification of foci gonococcal and chlamydial infection and apparent location of these infections along the major transport routes in our health district require further study. That chlamydial infection, unlike gonorrhoea, is evenly distributed irrespective of population concentration and deprivation, suggests urgent need for a comprehensive local effort to control both STDs.     

泌尿生殖道支原体感染的流行病学现状

泌尿生殖道支原体感染是引起非淋菌性尿道炎、宫颈炎、盆腔炎、不孕不育等疾病的重要病因之一.研究表明,性工作者、有泌尿生殖道症状者、合并免疫相关性疾病者等人群中支原体检出率较高.泌尿生殖道支原体感染之后致病是否与病原体的类别及亚型、患者的性别及年龄、性行为方式以及是否合并其他性传播疾病等因素有关.     

Epidemiology of superficial fungal infections

Fungal infections of the skin, hair, and nails are common worldwide, and their incidence continues to increase. The principal causative agents are dermatophytes, and their geographic distribution is variable. This is reflected in the differing patterns of dermatophytoses seen in different parts of the world. The epidemiology of dermatophyte infection has changed as a result of migration, lifestyle, drug therapy, and socioeconomic conditions. This contribution discusses global patterns of dermatophyte infection and the changing epidemiology of the causative agents.     

Chronic dermatophyte infections. I. Clinical and mycological features

One hundred and six patients with chronic dermatophytosis unresponsive to griseofulvin were studied. Trichophyton rubrum was the causative organism in 93% of cases. Chronic dermatophyte infections caused by organisms other than T. rubrum occurred predominantly, but not exclusively, in patients with underlying diseases. Forty-nine percent of the patients had a personal or family history of atopy but other abnormalities included disorders of keratinization, collagen vascular disease and systemic steroid therapy. The commonest sites of infection were the palms and soles, as opposed to toe webs or groins in control patients with griseofulvin-responsive dermatophyte infections. A significant proportion of chronically infected patients had raised IgE levels. Only 11% of the chronically infected group showed delayed hypersensitivity responses to intradermal trichophytin but 58% showed immediate hypersensitivity responses to trichophytin as well as other fungal and non-fungal allergens.     

Epidemiology of sexually transmitted diseases and infections

Sexually transmitted diseases and infections (STDIs) are known to have a major socioeconomic and biologic impact, par notticularly on women (e.g., sterility, ectopic pregnancies, neo notplasms, etc.) and fetus (intrauterine and perinatal mortality, infection, malformations). Sex work noters do not use health services appropriately and are a high-risk category. Despite this evidence, data on prostitution and STDIs in some countries are limited. Sexual health medicine is involved in the community by identifying and minimizing the STDI problems through laboratory screening, diagnostic testing, education, and research.     

Skin infections in the elderly

The diagnosis and management of viral diseases of the skin are significant issues in the elderly population. With advances in these areas, there are new tools to combat these diseases and limit morbidity. It is important for clinicians to monitor and treat these diseases aggressively in the elderly because of the potential for immunosuppression in this population. Further advances in antiviral therapy and the potential for the development of antiviral vaccines will aid in the therapy of these diseases. Onychomycosis is found more frequently in the elderly. In this population, the most common clinical presentations are distal and lateral subungual onychomycosis (which usually affects the great or first toe) and white superficial onychomycosis (which generally involves the third or fourth toes). Over the past several years, new treatments for this disorder have emerged that offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria, such as MRSA and drug-resistant pneumococci. Although vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw a rise in vancomycin-resistant bacteria, including VRE. With treatment options limited, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin-dalfopristin.