Clinical and histopathological findings of ''psoriatic neurodermatitis'' and of typical lichen simplex chronicus

BACKGROUND: We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or knees and have named this condition 'psoriatic neurodermatitis' (PN). OBJECTIVE: The purpose of this study was to compare clinical and histopathological characteristics of these patients to those of patients with typical lichen simplex chronicus (LSC). METHODS: Nineteen patients with PN and 34 patients with typical LSC were included. Besides clinical dermatological evaluation, the prick test was carried out on 49 patients; the Phadiatop test on 40 patients; the patch test with European standard series on 47 patients; histopathological evaluation on 39 patients; and clinical psychiatric examination on 38 patients. RESULTS: Almost exclusively, PN was seen in females and was located on the extremities. It caused more plaques than typical LSC did. In PN, the plaques were smaller, sharper, more keratotic and less excoriated, and had fewer lichenoid papules around them. Itching was usually more severe in the evening, while resting and in a hot environment in typical LSC, but not in PN. In plaques of PN, microabscesses in the horny layer, hypogranulosis, regular acanthosis and thinning of the suprapapillary plates were more frequent, and hyperpigmentation in the basal layer was less. In patients with PN, depressive disorder was found more frequently; and generalized anxiety disorder or psychosomatic characteristics, less. There were no significant differences in the results of prick, Phadiatop and patch tests between patients with PN and those with typical LSC. CONCLUSION: In our opinion, it is most likely that the so-called PN is itchy psoriasis superimposed by LSC.     

Narrow‐band ultraviolet B as a potential alternative treatment for resistant psychogenic excoriation: an open‐label study

Narrow‐band ultraviolet therapy has been used successfully for the treatment of inflammatory skin disorders and generalized pruritus. We have prospectively evaluated seven consecutive patients with resistant psychogenic excoriation (PE) treated with narrow‐band ultraviolet B (NB‐UVB). Approximately 70% of all patients showed improvement in their condition. NB‐UVB therapy was well tolerated, with no serious side effects. We may conclude that, when treating a patient with PE, NB‐UVB in combination with other approaches may provide extra benefit in resistant cases.     

Myeloperoxidase activity in skin lesions

The measurement of the myeloperoxidase activity was used to quantify the acute granulocyte reaction. A 35% loss of blood resulted in a clear decrease of the myeloperoxidase activity at the edges of experimental incision wounds in rat skin in the first day after inflicting the wounds. After 12 h only about one-third and after 24 h about half of the activity observed in the wounds without the loss of blood remained. After 3 days however the activity had returned to the same level as in the wounds without any loss of blood. In very deep excoriations of the rat skin where only a narrow zone of the dermis was left about double the activity increase was observed after 12 and 24 h when compared to values observed in very superficial or moderate excoriations. When the same type of excoriations were made in both thin inguinal skin and thick dorsal skin then a much higher peroxidase activity increase was observed over 4, 12 and 24 h in the thin inguinal skin than in the excoriations made in the thick dorsal skin. Received: 16 December 1996 / Received in revised form: 28 May 1997     

Emotion regulation in pathological skin picking: Findings from a non-treatment seeking sample

Pathological skin picking (PSP) is characterized by excessive picking of the skin, resulting in significant distress or functional impairment. The aim of the present study was to investigate the emotion regulation hypothesis of PSP. University students with PSP (n = 55) and without history of PSP (n = 55) were asked to retrospectively rate the intensity of affective states before, during, and after skin picking episodes. The results showed that for a majority of the PSP sufferers, intensity of certain negative affective states (i.e. anxiety, tension or boredom) was pronounced just before picking, and diminished significantly in the period from before to after picking. Relief and gratification increased during picking whereas guilt increased afterwards. A similar pattern emerged in the control group, although a much lower level of intensity was reported. Participants were also asked to fill out questionnaires concerning emotion regulation difficulties, emotion reactivity, depression, anxiety and worry. Hierarchical logistic regressions demonstrated that emotion regulation difficulties as well as emotion reactivity predicted PSP diagnosis after depression, anxiety and worry were controlled for. Furthermore, emotion regulation difficulties statistically mediated the relationship between emotion reactivity and PSP. Overall, the findings support an emotion regulation model of PSP.     

Psychodermatology of skin picking (excoriation disorder): A comprehensive review

Excoriation disorder (ED) is a primary psychiatric disorder characterized by recurrent skin picking, which may lead to self‐induced cutaneous lesions and significant distress or functional impairment. The affected patient is aware of his/her self‐destructive behavior but feels unable to give up this habit, despite having made repeated attempts to decrease or stop it. ED is a relatively frequent disorder, of notable heterogeneity and phenomenological complexity, accompanied by significant emotional and physical consequences. Therefore, further research is necessary to enhance the knowledge on its clinical manifestations, epidemiology, and comorbidities. This article presents an update regarding the etiopathogenesis, clinical aspects, and treatment options of ED to provide an up‐to‐date review for psychiatrists, dermatologists, and general practitioners.     

Morbidity and mortality of colostomy and its closure in children

Background

This study evaluated the complications of colostomy and its closure in infants and children.

Methods

One hundred forty-six colostomies were performed in 86 neonates, 23 infants, and 37 children older than 1 year. These children underwent colostomies for anorectal malformation (84), Hirschsprung’s disease (47), and other miscellaneous (15) conditions like colonic atresia, volvulus, rectal tuberculosis, traumatic rectal perforation, and intestinal obstruction caused by ascariasis.

Results

Of these, 17 (11.6%) had early complications, and 80 (69.8%) had stomal complications. Three patients died, but only 1 death was directly related to colostomy. Colostomy prolapse, peristomal excoriation, and malnutrition were the major complications. The complications were not dependant on the children’s age or primary indication. Sigmoid colostomy had a lower malnutrition rate than transverse colostomy (34.9% v 16.9% P = .009). Among the 56 children who underwent colostomy closure, major complications include death (1.8%), anastomotic leak (7.1%), and wound infection (12.6%).

Conclusions

A divided sigmoid colostomy should be performed whenever possible. Proper stomal care, regular nutritional assessment, and early closure of the colostomy would minimize morbidity and mortality of colostomy and its closure.