Occupational hand dermatitis in a tertiary referral dermatology clinic in Taipei

Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the, European standard series and suspected allergens. Occupational hand dermatitis (OHD) WHS diagnosed according to medical history, work exposure, physical examination, and patch lest findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing. medical, chemical, and construction were the most important industries causing OHD. In the 16–1 patients with OHD. 58.5%. had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD: dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICQ Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD. ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate. nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents lo reduce OHD will be warranted.     

Community-acquired methicillin-resistant Staphylococcus aureus in a dermatology outpatient clinic

BACKGROUND: Community-acquired cutaneous infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a growing concern. These bacteria may produce Panton-Valentine leucocidin potentially leading to necrotizing pneumonia. We studied the prevalence of MRSA and Panton-Valentine leucocidin in dermatology clinic outpatients in order to adapt therapy where possible. PATIENTS AND METHODS: This was a prospective study including all patients seen at a dermatology outpatient clinic between 1st March 2005 and 31st December 2006 and presenting mucocutaneous bacteriological samples. The main MRSA risk factors studied were frequent hospital consultations, hospitalization, antibiotic therapy within the last three months and community life. The following risk factors were also analysed, although less routinely: substance abuse, immunosuppression, diabetes mellitus, recent travel abroad and a history of similar lesions. RESULTS: One hundred and twenty-two patients were included in the study and 235 samples (143 lesion samples and 92 nasal swabs) were carried out and S. aureus was isolated in 68 patients (56%). Twelve patients had MRSA (17.6%); seven of these were normal outpatients but five attended frequent hospital consultations (7.3%). MRSA resistance rates were as follows: 64% to ofloxacin, 36% to amikacin and erythromycin, 27% to fusidic acid, 9.1% to sulfamethoxazole-trimethoprim and 0% to pristinamycin. Community life was the only significant risk factor for MRSA in this study (p=0.045). Four of the 11 MRSA strains tested produced Panton-Valentine leucocidin. CONCLUSION: Dermatologists are increasingly faced with cutaneous infections caused by community-acquired MRSA. Bacterial samples should be taken routinely and probabilistic antibiotic therapy for MRSA instituted in severe infections.     

A survey of traditional Chinese medicine use in children with atopic dermatitis attending a paediatric dermatology clinic

Use of traditional Chinese medicine (TCM) for various paediatric diseases has been popular. Often, parents or caregivers believe that herbs possess therapeutic effects without any harmful consequence. This fallacy is especially prevalent in the caregivers of children with chronic diseases such as atopic dermatitis (AD). We interviewed 227 consecutive children with AD to assess the attitudes of the caregivers to TCM use, based on a 14-item questionnaire. Of these respondents, 67 (30%) admitted that the child had been given TCM in the past 12 months, one-third of these were currently taking TCM and one-quarter had used TCM for 6 months or more. TCM was prescribed by a Chinese medicine practitioner in 63 patients (94%), and herbal tea/soup was the commonest TCM taken. The majority (94%) had not been told of any possible side effects of TCM. Nearly 60% thought that TCM helped to improve their child's AD. Respondents for children with severe eczema were less likely to think that TCM helped to improve their child's eczema than those with mild or moderate eczema. TCM use was not associated with parental ages or 'grandparent as caregiver' but 'severe AD' was an independent factor for TCM use (OR 3.24, 95% CI 1.67-6.31; p = 0.0003).     

The role of the dermatology nurse in atopic dermatitis management

The dermatology nurse plays a unique role in managing atopic dermatitis (AD). Education and prevention are the primary focus of the dermatology nurse, and he or she can also play a vital role as a patient advocate.     

A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic

Background This is a retrospective study of the epidemiology and morbidity of herpes zoster and the risk factors for herpes zoster morbidity in Singapore. Results The mean age of 164 patients with herpes zoster seen at our dermatology clinic between January 1994 and December 1995 was 48.8 years, with a sex ratio of 1: 1. The common presenting symptoms were pain (90%), feelings of helplessness and depression (20%), and flu-like symptoms (12%). The commonest prodromes were pain (41%), itching (27%), and paresthesia (12%). Prodromal pain was more frequently experienced by patients aged more than 50 years (42%) than by patients aged less than 30 years (25%). The thoracic (45%) and cervical (23%) dermatomes were the most commonly affected in all age groups. There was no statistically significant difference in the frequency of dermatomal distribution among the different age groups and between the sexes. Pain was experienced by almost all (95%) patients during the course of their disease. It tended to be more severe in older patients. Burning (26%), stabbing (15%), and shooting (15%) pain were the most common types experienced. Post-herpetic neuralgia was significantly more common in older patients. The prevalence of post-herpetic neuralgia decreased over time in all age groups. A higher proportion of older patients (more than 50 years of age) (20%) suffered from post-herpetic neuralgia compared with younger patients (less than 30 years of age) (7%) (not significant). Patients in all age groups considered acute pain (46%) and persistent pain (25%) to be their most unbearable symptoms during the course of herpes zoster. The most significant problems caused by herpes zoster pain were insomnia (25%), misery (feeling helpless and depressed) (20%), limitation of movement (9%), and inability to continue work (8%). Insomnia was significantly more commonly experienced by patients more than 50 years of age (36%) than those less than 30 years of age (P= 0.026). Few patients (9%) consulted their general practitioner (GP) during the prodrome or on the day of appearance of skin eruptions. Most patients (45%) consulted their GP within the first 3 days of the onset of skin eruptions; 33% sought treatment more than 3 days after the appearance of zoster symptoms. Only 30% of patients were willing to pay more than $200 for antiviral therapy. Most (43%) were only prepared to pay for antiviral treatment if it cost less than $200. The most Important features the patients wished to derive from antiviral therapy were a shortening of the duration of skin lesions (55%) and a reduction in the severity of pain (acute and chronic) (30%). Conclusions Our study indicated that older patients (aged more than 50 years) were at a higher risk of developing post-herpetic neuralgia. They were also more likely to suffer morbidity, e.g. insomnia. There is a need to educate patients at risk to identify the prodrome and skin eruptions of herpes zoster so that early antiviral therapy can be considered.     

Pediatric skin disorders encountered in a dermatology outpatient clinic in Turkey

Abstract:  This study documents the spectrum and frequency of skin disorders in a total of 2370 children encountered in a dermatology outpatient clinic in Turkey. Infectious skin diseases were most frequently observed (27.6%) followed by, eczemas (17.9%), acne (14,5%), papulosquamous diseases (6.9%), hair diseases (4.1%), pigmentation disorders (3.8%), generalized pruritus (2.8%), urticaria (2.7%), and insect bite (2.3%). Epidemiologic data are useful in planning of the health care and taking preventive measures to decrease the prevalence of skin disorders in children.     

A survey of elderly new patients at a dermatology outpatient clinic

A study of all new dermatitic out patients greater than 70 years of age, referred in the period January-June 1987 (257 patients), was undertaken to obtain information on the types of skin diseases and the dermatological outpatient services required in the case of the elderly. The group accounted for 14% of all new patients. The leading diagnoses were seborrheic keratosis (15.6%), basal cell carcinoma (13.6%), solar keratosis (13.2%), psoriasis (9.7%) and leg ulcer (9.3%). A skin biopsy was required in 27%, and surgical treatment in 31% of the group, compared with 12% and 16%, respectively, of all new patients during the same period. Consequently, the elderly group were more likely to require a follow-up appointment and tended to be more time-consuming outpatients.     

Psychological distress and coping strategies in patients attending a dermatology outpatient clinic

Background Psychological distress is frequent among dermatological patients. The development of a positive attitude toward diagnosis and treatment is thought to be critical for successful coping and mental health outcomes. Objective The aim of this study was to assess the coping strategies and the psychological distress, due to anxiety and depression, in an unselected sample of dermatological patients. Methods Self‐administered questionnaires (HADS, COPE) were given to 603 dermatological patients. Results Out of 567 participants, 149 (26.2%) scored positive for Anxiety, and 52 (9.2%) scored positive for Depression. Multivariate analysis, adjusting for gender, age, socio‐economic status, and disease, showed that both Anxiety and Depression are associated with a less frequent use of Positive attitude coping. Conclusion Our results reinforce the notion that while planning the treatment of dermatological patients, evaluating their mental health might help to provide optimal treatment. Since coping ability was found to be important for mental health status, policy implications could include emphasis on social programs to assist individuals to manage stress, as well as psychological support.     

Filaggrin null mutations and association with contact allergy and allergic contact dermatitis: results from a tertiary dermatology clinic

Background: Filaggrin null (FLG) mutations lead to skin barrier disruption with a reduced resistance towards exogenous agents and also influence the course of disease in atopic dermatitis.
Objectives: To examine the association between FLG mutations and contact allergy, polysensitization, hand eczema at first appearance of disease, occurrence, and course of dermatitis.
Methods: A venous blood sample from 430 individuals was genotyped for FLG mutations R501X and 2282del4 with polymerase chain reaction followed by typing through hybridization to paramagnetic polystyrene beads and analysis on a BioPlex 200. All individuals had a minimum of one positive patch test reaction.
Results: In all, 3.5% were 2282del4 heterozygote and 5.1% were R501X heterozygote. An odds ratio (OR) of 1.49 [95% confidence interval (CI) 0.74–3.00] was found for nickel allergy, OR 0.84 (95% CI 0.41–1.74) for polysensitization, OR 0.78 (95% CI 0.25–2.43) for dermatitis, OR 0.96 (95% CI 0.48–1.92) for hand eczema at debut, OR 1.25 (95% CI 0.99–1.57) for duration of disease, and OR 0.76 (95% CI 0.59–0.97) for age at onset.
Conclusions: No association between nickel allergy, polysensitization, hand eczema at first appearance or occurrence of dermatitis, and FLG mutations was found. However, patients with FLG mutations had an earlier age of onset compared with the wild‐type genotype and a trend towards longer duration of disease.     

Psychological profile of patients with atopic dermatitis

Tests designed to measure psychopathological characteristics common to the neurotic population were administered to patients with atopic dermatitis, patients with other dermatological disorders and to control group of normal individuals. The parameters tested were manifest anxiety, neurosis, extro-version, depression, hypochondriasis and hysteria. The scores were statistically analyzed. The results showed that patients with atopic dermatitis responded significantly differently from patients with other dermatological diseases and from the control group in specific psychometric scales. Moreover, patients with skin conditions other than atopic dermatitis also responded significantly differently from the control group. The study clearly shows that patients with atopic dermatitis have a characteristic psychological profile not shared by the other two groups. The atopic dermatitis patients tend to be in state of high manifest anxiety, depressed, neurotic and hypochondriac.