Solar urticaria in Singapore: an uncommon photodermatosis seen in a tertiary dermatology center over a 10-year period

BACKGROUND: Solar urticaria is an uncommon photodermatosis, characterized by the appearance of pruritic wheals after sun exposure. In this study, we examine the photobiological characteristics of solar urticaria in the heterogeneous group of Singaporean patients. METHODS: The photobiological features of all patients treated for solar urticaria at a tertiary dermatology center in Singapore over a 10-year period were retrospectively examined. RESULTS: A total of 19 patients were diagnosed to have solar urticaria from 1993 to 2002. The mean age at diagnosis was 26 years, with a racial distribution of 17 (90%) Chinese, one (5%) Malay, and one (5%) Indian. Fifteen (79%) patients were males and four (21%) were females. The face/neck (47%) and arms/forearms (58%) were most often affected. Six (32%) patients had a history of atopy and two (11%) had dermographism. Fifteen (79%) patients had Fitzpatrick's skin type IV, three (16%) had skin type III and one (5%) patient had skin type V. The mean exposure time to wheal formation was 23 min. The action spectra of solar urticaria were visible light for 12 (63%) patients, ultraviolet (UV) A for one (5%), visible light and UVA for five (27%), and natural sunlight for one (5%) patient. All patients reported partial improvement with a combination of antihistamines and sunscreens as the main modality of treatment. CONCLUSIONS: Our data suggest that solar urticaria is an uncommon photodermatosis and a rare form of urticaria. Wheals were mostly elicited by visible light and/or UVA. A combination of antihistamines and sunscreens provided a useful form of therapy for patients with solar urticaria.     

Scientific output of Spanish dermatology departments in international journals, 1997-2006

BackgroundThe aim of this study was to determine the scientific output in international journals by Spanish dermatologists between 1997 and 2006 using PubMed.Material and methodsPublications were identified with the following search query: (dermat*) and (spain or espagne or espanha or espana or spanien), with the limit “affiliation”. Articles described in PubMed as “journal articles” or “reviews” were included and those published in Spanish journals excluded.ResultsWe identified 1018 articles: 492 published between 1997 and 2001, and 526 published between 2002 and 2006. The majority were case reports (705, 69.3 %), but there were also 120 reviews (11.8 %). Most of the articles were published in dermatology journals with Science Citation Index impact factors (877, 86.1 %), with the following representing the main ones: Contact Dermatitis (129, 12.7 %), Journal of the European Academy of Dermatology and Venereology (115, 11.3 %), and the British Journal of Dermatology (86, 8.4 %). Nine institutions accounted for more than 50 % of the articles published. Notable among them were the following: Hospital Universitario La Princesa in Madrid (78, 7.7 %), Hospital Santa Creu i Sant Pau in Barcelona (71, 7.1 %), and Hospital Clínic in Barcelona (63, 6.2 %). Seven provinces produced 80 % of the publications, with Madrid (257, 25.2 %), Barcelona (244, 24.0 %), and A Coruña (98, 9.6 %) accounting for the highest proportion. Five autonomous communities accounted for 82 % of the publications: Madrid (257, 25.2 %), Catalonia (251, 24.7 %), Galicia (116, 11.4 %), the Autonomous Community of Valencia (112, 11.0 %), and Andalusia (96,9.4 %).ConclusionsThe scientific output in international journals has remained stable over the last decade. Authors and institutions from Barcelona and Madrid continued to be the most productive.     

Microbiologic evaluation of skin wounds: alarming trend toward antibiotic resistance in an inpatient dermatology service during a 10-year period

BACKGROUND: Increasing resistance to commonly used antibiotics has been seen for patients with superficial skin wounds and leg ulcers. OBJECTIVES: We sought to evaluate bacterial isolates from leg ulcers and superficial wounds for resistance to commonly used antibiotics and to compare current data with previous data. METHODS: We performed a chart review for patients admitted to a tertiary care dermatology inpatient unit from January to December 2001. Comparison was made with 2 previous surveys of the same inpatient service from 1992 and 1996. RESULTS: Bacterial isolates were cultured from 148 patients, 84% (72 of 86) with leg ulcers and 38% (76 of 202) with superficial wounds. Staphylococcus aureus and Pseudomonas aeruginosa were the most common bacterial isolates in both groups. For patients with leg ulcers, S aureus grew in 67% of isolates (48/72) of which 75% (36/48) were methicillin-resistant (MRSA). Of leg ulcers, 35% (25/72) grew P aeruginosa, which was resistant to quinolones in 56% of cultures (14/25). For patients with superficial wounds, S aureus was isolated in 75% (57/76) and 44% were MRSA (25/57). P aeruginosa grew in 17% of isolates (13/76) and was resistant to quinolones in 18%. We found a marked increase in antibiotic resistance for both leg ulcers and superficial wounds. Over time, MRSA increased in leg ulcers from 26% in 1992 to 75% in 2001. For superficial wounds, MRSA increased from 7% in 1992 to 44% in 2001. P aeruginosa resistance to quinolones in leg ulcers increased from 19% in 1992 to 56% in 2001, whereas for superficial wounds there was no resistance in 1992 and 18% resistance in 2001. CONCLUSION: Rapid emergence of antibiotic-resistant bacteria continues and is a problem of increasing significance in dermatology. Common pathogenic bacteria, S aureus and P aeruginosa, showed increased resistance to commonly used antibiotics. Selection of antibiotics should be on the basis of local surveillance programs.     

Results of photopatch testing in Rotterdam during a 10-year period

BACKGROUND: Photoallergic contact dermatitis is of importance in a proportion of photodermatoses and can be evaluated through photopatch testing. OBJECTIVES: To conduct a retrospective evaluation of photopatch tests performed in patients with suspected photodermatoses at the clinic at the University Hospital Rotterdam during a 10-year period. METHODS: During the first 5(1/2) years 44 patients were tested with a standard set of 14 allergens, and during the next 4(1/2) years 55 patients were tested with a standard set of 23 allergens. RESULTS: Photocontact reactions were found in 9% and 27% of patients in the two periods, respectively. In the second period, positive reactions were mostly produced by sunscreens. The difference in the percentage of positive photopatch tests was probably caused by the difference in composition of the standard set of allergens (more sunscreens in the second period), this being the only alteration in the test procedure. CONCLUSIONS: The standard set of photoallergens has to be updated periodically. Standardization of the test procedure is needed to compare the test results of different institutions.     

Quality of abstracts in 3 clinical dermatology journals

BACKGROUND: Structured abstracts have been widely adopted in medical journals, with little demonstration of their superiority over unstructured abstracts. OBJECTIVES: To compare abstract quality among 3 clinical dermatology journals and to compare the quality of structured and unstructured abstracts within those journals. DESIGN AND DATA SOURCES: Abstracts of a random sample of clinical studies (case reports, case series, and reviews excluded) published in 2000 in the Archives of Dermatology, The British Journal of Dermatology, and the Journal of the American Academy of Dermatology were evaluated. Each abstract was rated by 2 independent investigators, using a 30-item quality scale divided into 8 categories (objective, design, setting, subjects, intervention, measurement of variables, results, and conclusions). Items applicable to the study and present in the main text of the article were rated as being present or absent from the abstract. A global quality score (range, 0-1) for each abstract was established by calculating the proportion of criteria among the eligible criteria that was rated as being present. A score was also calculated for each category. Interrater agreement was assessed with a kappa statistic. Mean +/- SD scores were compared among journals and between formats (structured vs unstructured) using analysis of variance. MAIN OUTCOME MEASURES: Mean quality scores of abstracts by journal and by format. RESULTS: Interrater agreement was good (kappa = 0.71). Mean +/- SD quality scores of abstracts were significantly different among journals (Archives of Dermatology, 0.78 +/- 0.07; The British Journal of Dermatology, 0.67 +/- 0.17; and Journal of the American Academy of Dermatology, 0.64 +/- 0.15; P =.045) and between formats (structured, 0.71 +/- 0.11; and unstructured, 0.56 +/- 0.18; P =.002). The setting category had the lowest scores. CONCLUSIONS: The quality of abstracts differed across the 3 tested journals. Unstructured abstracts were demonstrated to be of lower quality compared with structured abstracts and may account for the differences in quality scores among the journals. The structured format should be more widely adopted in dermatology journals.     

Analysis of original contributions in three dermatology journals

In a cross-sectional analysis, the three top ranking dermatology journals ( Archives of Dermatology , British Journal of Dermatology , and the Journal of the American Academy of Dermatology ) were evaluated for their scientific content, the characteristics of their authors, and funding aspects in 2002. A flood of scientific papers are published each year covering a broad variety of dermatologic topics. Aside from the actual content, a scientific article provides information about the number of authors, their nationality and affiliations, and, with some limitation, about previous presentations and funding. The present study analyzes this situation in dermatology by evaluating the content in the three top dermatologic journals.     

对3种皮肤科杂志10年刊载的浅部真菌病临床治疗文献评价

目的：评价国内3种皮肤科杂志所载有关浅部真菌病治疗试验的质量，为改变和提高临床治疗试验水平提供依据。方法：对1992—2001年发表在中华皮肤科杂志、临床皮肤科杂志和中国皮肤性病学杂志上的浅部真菌病临床治疗试验文献共369篇进行调查和分析、结果：随机对照试验62篇(16．80％)，对照试验中以药物对照为主；疗效标准缺乏统一性。结论：浅部真菌病治疗试验设计总体质量有待提高。     

Quality of reporting in systematic reviews published in dermatology journals

Systematic reviews (SRs) are considered the gold-standard for putting together evidence in healthcare. They serve clinicians and other stakeholders of the healthcare field, such as patients and policy makers, by summarizing the available data that we have on a medical subject, while highlighting the quality of the studies existing in the literature. In literature from other medical specialties, the use of reporting guidelines, such as the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), has been shown to increase transparency and reproducibility (the extent to which consistent results are obtained when an experiment is repeated). To date, however, no studies have looked at how well dermatology SRs adhere to items from the PRISMA guideline, which is what the authors of this study, based in Canada, aimed to address. It is important that the methodology of systematic reviews is transparent and appropriately reported, so that readers have a clear understanding of what was done and why. To do this, we reviewed all SRs published in the five dermatology journals with the highest impact factors from 2013 to 2017. We evaluated how well selected PRISMA items were reported and whether the adherence of reporting was associated with factors such as year of publication, protocol registration, and funding source. We found that among SRs published in five dermatology journals from 2013-17, all (136 of 136) had at least one inadequately reported PRISMA item, while 93% (127 of 136) had at least one fully non-reported item. Reporting improved over time and SRs that stated they used a pre-registered protocol were associated with better reporting of the PRISMA items we assessed. Several items remain commonly under-reported in dermatology systematic reviews and we identified these in the hopes that it improves reporting going forward. With the results from this study, we feel that authors, reviewers, journal editors and editorial committees should strive to encourage pre-registration of SR protocols and better SR reporting. This is a summary of the study: Quality of reporting in systematic reviews published in dermatology journals     

Pediatric psychotherapy within the scope of dermatology]

The possibilities of psychotherapy of children with psychosomatic skin diseases on an outpatient basis are reported. Twenty children in their pre-school and school years were treated over a period of one to two years using conversational therapy and the Sceno test (from G. v. Staabs). The results underline the necessity of identification and working up of conflicts in order to prevent recurrences or shifting of the disease.