Wound,pressure ulcer and burn guidelines – 6: Guidelines for the management of burns,second edition

“Wound, pressure ulcer and burn guidelines – 6: Guidelines for the management of burns, second edition” is revised from the first edition which was published in the Japanese Journal of Dermatology in 2016. The guidelines were drafted by the Wound, Pressure Ulcer and Burn Guidelines Drafting Committee delegated by the Japanese Dermatological Association, and intend to facilitate physicians’ clinical decisions in preventing, diagnosing and treating burn injury. All sections are updated by collecting documents published since the publication of the first edition. Especially, the recommendation levels of dressing materials newly covered by the Japanese national health insurance are mentioned. In addition, the clinical questions (CQ) regarding the initial treatment of electrical (CQ15) and chemical burns (CQ16), and also the use of escharotomy (CQ22), are newly created.     

Wound,pressure ulcer and burn guidelines – 1: Guidelines for wounds in general,second edition

The Japanese Dermatological Association prepared the clinical guidelines for the “Wound, pressure ulcer and burn guidelines”, second edition, focusing on treatments. Among them, “Guidelines for wounds in general” is intended to provide the knowledge necessary to heal wounds, without focusing on particular disorders. It informs the basic principles of wound treatment, before explanations are provided in individual chapters of the guidelines. We updated all sections by collecting references published since the publication of the first edition. In particular, we included new wound dressings and topical medications. Additionally, we added “Question 6: How should wound-related pain be considered, and what should be done to control it?” as a new section addressing wound pain, which was not included in the first edition.     

Trends of reactive hyperaemia responses to repetitive loading on skin tissue of rats – Implications for pressure ulcer prevention

Tissue recovery is important in preventing tissue deterioration, which is induced by pressure and may lead to pressure ulcers (PU). Reactive hyperaemia (RH) is an indicator used to identify people at risk of PU. In this study, the effect of different recovery times on RH trend is investigated during repetitive loading. Twenty-one male Sprague-Dawley rats (seven per group), with body weight of 385–485 g, were categorised into three groups and subjected to different recovery times with three repetitive loading cycles. The first, second, and third groups were subjected to short (3 min), moderate (10 min), and prolonged (40 min) recovery, respectively, while fixed loading time and pressure (10 min and 50 mmHg, respectively). Peak hyperaemia was measured in the three cycles to determine trends associated with different recovery times. Three RH trends (increasing, decreasing, and inconsistent) were observed. As the recovery time is increased (3 min vs. 10 min vs. 40 min), the number of samples with increasing RH trend decreases (57% vs. 29% vs. 14%) and the number of samples with inconsistent RH trend increases (29% vs. 57% vs. 72%). All groups consists of one sample with decreasing RH trend (14%). Results confirm that different recovery times affect the RH trend during repetitive loading. The RH trend may be used to determine the sufficient recovery time of an individual to avoid PU development.     

Guidelines for the treatment of skin and mucosal lesions in Behçet's disease: A secondary publication

In the current study, we present guidelines for the diagnosis and treatment of the mucocutaneous lesions of Behçet's disease, which is a chronic inflammatory disease characterized by the involvement of various organs, including mucocutaneous, ocular, vascular, intestinal and central nervous system lesions. It is often identified in the Middle East Mediterranean to East Asia region. Skin manifestations include erythema nodosum, papulopustular lesions and thrombophlebitis, and mucosal manifestations include oral and genital ulcers. These mucocutaneous lesions are characteristically the first signs of Behçet's disease and are important to be recognized for the early diagnosis of the disease. Moreover, these manifestations also recur and persist over the long-term course of the disease. The management of mucocutaneous lesions is important to prevent recurrence. We developed consensus guidelines that provide recommendations for general practitioners and dermatologists and physicians on the management of the mucocutaneous lesions of Behçet's disease.     

British Association of Dermatologists' guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are urgent, serious immune reactions in which there is skin loss and severe ulcers in the mouth, eyes and genital areas. It affects about 5-6 people per million under 18 years of age in the U.K. each year. It has a mortality of (causes death in) 5-10% and re-occurs in up to 18% of survivors. The British Association of Dermatologists led a group of relevant experts to examine the evidence in developing guidelines to aid diagnosis and management of SJS/TEN in children and young people. As with many rare conditions, there are few high-quality trials comparing one treatment with another. Most of the evidence comes from patient examples reported in the medical literature (i.e. medical journals). The research reveals some important differences between children and adults in terms of the cause and outcomes of SJS/TEN. Infections are a more common cause in children and young people although medication can be the cause in all ages. Children are less likely to die from SJS/TEN than adults. Preventing long-term complications is of key importance. Management in the early stages should ensure the identification of the cause, stopping any possible medications that might be the cause, and consideration of infection as the trigger. The best evidence for improved outcomes is good supportive care in the right clinical environment. This requires admission to appropriate specialist units with experience in managing skin loss, and a team of hospital specialists who can address all potential clinical complications. Longer-term management involves supporting patients and their families with any resulting complications including those affecting the eyes, skin, lungs and psychological impact. The guidelines highlight that there is still much that is unknown about the best way to manage this potentially devastating reaction, and identifies the need for better routine data collection, diagnosis and standardised treatment, as well as a multi-disciplinary (involving different types of healthcare workers) approach to management.     

Understanding the association between pressure ulcers and sitting in adults what does it mean for me and my carers? Seating guidelines for people,carers and health & social care professionals

The aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time. This publication was developed at the request of the Tissue Viability Society in order to revise the original seating guidelines from 2008 as evidence and subsequent care has moved forward in relation to this area. Since 2008, the costs for the prevention and management of pressure ulcers have increased significantly and there is limited published advice from health and social care organisations on seating and preventing pressure ulcers. These guidelines have been written for:

• •People
• •Carers
• •Health and Social Care professionals
• •Education and training staff
• •Independent sector.

Who live or work in primary, secondary, and tertiary settings.     

Assessment of the ‘no eosinophils' rule: are eosinophils truly absent in pityriasis lichenoides,connective tissue disease,and graft‐vs.‐host disease?

Eosinophils are often present in the inflammatory infiltrate of an interface dermatitis, but the diagnostic specificity of eosinophils in interface dermatitis has not been formally evaluated. We retrospectively identified 97 examples of interface dermatitis with clinically confirmed diagnoses, including lupus erythematosus (LE), lichen planus, pityriasis lichenoides (PL), graft-vs.-host disease (GVHD), dermatomyositis (DM) and drug reaction. Diagnoses were clinically confirmed by at least two dermatologists. Slides were reviewed in a blinded fashion by at least two dermatopathologists. The average eosinophil count per 10 ×200 (×20 objective) fields was lowest for PL (0.2), DM (0.3), GVHD (0.4), and LE (0.5) [defined as Group 1] and was higher for lichen planus, drug reactions, erythema multiforme (major and minor) and viral exanthems [defined as Group 2]. Distinction between Group 1 and Group 2 was maximized using an eosinophil count cutoff of 1.1. In conclusion, eosinophils are usually rare to absent in PL, DM, most forms of LE and GVHD. While final interpretation requires a composite assessment of all features, our results suggest that the presence of even a single eosinophil within nine or ten ×20 fields argues against a diagnosis of PL, DM or LE.     

Impact of the COVID-19 pandemic on the course and management of chronic inflammatory immune-mediated skin diseases: What's the evidence?

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, medical professionals have been overwhelmed by questions beyond the infection itself. In dermatology practice, clinicians have been facing difficulties about the management of chronic immune-mediated skin diseases. Issues arose, such as the grade of immunosuppression or immunomodulation, discontinuation or modification of treatment, and initiation of new treatments. In this comprehensive review, we present the current evidence about the course and management of chronic inflammatory dermatoses during the COVID-19 pandemic, focusing on psoriasis, atopic dermatitis, and hidradenitis suppurativa.     

Temperature and humidity affect the incidence of hand,foot, and mouth disease: a systematic review of the literature – a report from the International Society of Dermatology Climate Change Committee

Hand, foot, and mouth disease (HFMD) is an enterovirus-mediated condition that predominantly affects children under 5 years of age. The tendency for outbreaks to peak in warmer summer months suggests a relationship between HFMD and weather patterns. We reviewed the English-language literature for articles describing a relationship between meteorological variables and HFMD. Seventy-two studies meeting criteria were identified. A positive, statistically significant relationship was identified between HFMD cases and both temperature (61 of 67 studies, or 91.0%, reported a positive relationship) [CI 81.8–95.8%, P = 0.0001] and relative humidity (41 of 54 studies, or 75.9%) [CI 63.1–85.4%, P = 0.0001]. No significant relationship was identified between HFMD and precipitation, wind speed, and/or sunshine. Most countries reported a single peak of disease each year (most commonly early Summer), but subtropical and tropical climate zones were significantly more likely to experience a bimodal distribution of cases throughout the year (two peaks a year; most commonly late spring/early summer, with a smaller peak in autumn). The rising global incidence of HFMD, particularly in Pacific Asia, may be related to climate change. Weather forecasting might be used effectively in the future to indicate the risk of HFMD outbreaks and the need for targeted public health interventions.     

The Podoprint® plantar pressure platform: Evaluation of reliability and repeatability,and determination of the normality parameters

IntroductionThe Podoprint® pressure platform system is widely used in routine podiatric clinical practice to measure plantar pressures. It allows non-invasive examination of the patient, and provides fast results with high levels of precision, reliability, and repeatability. Once these conditions have been demonstrated, the clinical and/or research use of baropodometry allows results to be obtained in the field of podology that are far from inconsiderable.The study was designed to evaluate the repeatability and reliability of the platform, and to identify the normal foot pressure parameters.MethodsRecords were collected from 52 random healthy individuals, 10 men and 42 women, in two sessions separated by one week. The study variables were: maximum pressure, mean pressure, support surface areas (heel, midfoot, and forefoot), and contact time. Repeatability and reliability were evaluated by calculating the interclass correlation coefficient (ICC) and the coefficient of variation (CV) in the three tests.ResultsThe ICCs showed moderate to good repeatability for the variables of interest, and the CVs were all less than 18%. The maximum pressure was under the forefoot (mean 2675.4 ± 513.8 g/cm²). The mean contact time of the steps was 0.72 ± 0.07 s.ConclusionsThe Podoprint® system is a reliable tool for evaluating the distribution of plantar pressures in the dynamic study of the barefoot gait of healthy individuals.     

Case of melorheostosis associated with ipsilateral verrucous epidermal nevus,linear connective tissue nevus,diffuse hyperpigmentation and hypertrichosis: A fortuitous coincidence?

Melorheostosis (MEL) is a rare benign bone disorder that can be associated with several anomalies, including vascular abnormalities, nevus sebaceus, unilateral nevoid telangiectasia, linear scleroderma and hypertrichosis. We report the case of a 6-year-old patient who showed an unusual co-occurrence of bone hyperostosis and different skin lesions affecting the same side of the body: MEL, verrucous epidermal nevus, connective tissue nevus, linear scleroderma-like disorder, hyperpigmentation and hypertrichosis. The spatial co-occurrence of these conditions made us speculate as to whether they originated from a common genetic mechanism or if their co-occurrence was completely accidental.     

Only 33% of visits for skin disease in the US in 1995 were to dermatologists: is decreasing the number of dermatologists the appropriate response?

The National Ambulatory Medical Care Survey conducted in 1995 provides an assessment of ambulatory medical practice including diagnoses, physician specialties, and insurance information. The National Center for Health Statistics collected data from non-federally employed physicians of all specialties using their standardized sampling technique. The database was reviewed for aspects of visits for skin diseases for all patients. The total number of visits for dermatologic disease in 1995 was estimated to be 22.0 million. 21.7% of these were first time visits and 24.3% were referrals. The leading dermatologic diagnoses in 1995 in order of frequency were acne, contact dermatitis, hypertrophic and atrophic conditions of skin, viral warts, malignant neoplasm of skin, benign neoplasm of skin, psoriasis, cellulitis and abscess, disorders of skin and subcutaneous tissue, and localized superficial swelling/mass/lump. Dermatology led all specialties in providing 32. 6% of the dermatologic outpatient care in 1995, followed by general/family medicine (22.7%), internal medicine (12.8%), pediatrics (11.2%), and all other specialties (20.7%). Of the visits to dermatologist in 1995, 3.78% were paid for by Medicaid. This paper presents dermatologic information pertaining to insurance, first time visits, referrals, diagnoses, and physician specialties.