摘要:

Over the past 30 years we have witnessed a change in our approach to soaps. The turning point was, in fact, the publication of an article by Frosch and Kligman in 1979, in which they described a new method for assessing the irritancy of soaps. They maintained that the chief weakness of the usage tests in the past was that the reactions under normal usage conditions were weak and did not discriminate adequately between different soaps. They proposed a test, called the soap chamber test, which was conducted under extreme conditions, on people known to have a sensitive skin, thereby resulting in strong reactions that emphasized the slight differences between the various soaps. Frosch and Kligman’s work opened up a whole new era in the field of assessment of soap quality. Following their initial studies, many other studies were conducted, including the exaggerated use tests, often in conjunction with instrumental methods of evaluation, such as measurement of transepidermal water loss, electrical conductance, skin color and blood flow, and other tests designed to evaluate the irritation potential of various soaps. All those tests had a common purpose: to achieve extreme conditions which would provide greater sensitivity and discriminating power and would accentuate and emphasize the differences between soaps as much as possible: the greater the discrimination and the differences between the products, the more efficient and useful the test. The introduction and publication of tests such as those completely changed our approach to soaps. The sought-after qualities in a soap became safety, mildness, gentleness, less irritation, less drying – in particular, gentleness and mildness were emphasized. Rather surprisingly, the soap’s main purpose – cleaning the skin – was set aside; people no longer talked of the soap’s most important quality – skin cleansing. Is the above change in approach justified? What really constitutes a good soap? Which soap should we recommend to our patients? Is a soap that scored well on irritancy tests under extreme conditions really the best soap? It seems to me that it would be a mistake to ignore all the accumulated clinical experience in favor of new, modern testing methods. A balance must be found between new information resulting from modern testing methods, and clinical experience that has proven itse

ISSN:1018-8665    

DOI:10.1159/000246841

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background: Previous investigators noted an association of multiple basal cell carcinomas (BCC) with certain HLA antigens; however, these findings were contradictory, and the associations were only weak. Objective: The aim of the study was to objectify the previously found associations. Methods: Serologic HLA typing for class I and class II antigens was performed in 49 unrelated patients with 5 or more BCCs. Results: HLA-DR4 showed decreased frequencies in the patient group as compared with healthy controls (n = 716). Cw7 was found to be increased in the total group of patients as well as in a subgroup with multiple BCCs of the face (n = 24), while a subgroup with BCCs mainly on the trunk (n = 25) revealed increased frequencies of HLA-A11, -B17, -B22 and -Cw3. However, none of these deviations appeared significant after correction of p values. Conclusion: We conclude that, if at all, the HLA system plays only a minor role in the development of multiple BCCs.

ISSN:1018-8665    

DOI:10.1159/000246842

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background: In Spring 1992, an epidemic outbreak of papular and follicular rashes caused by a new line of cosmetics occurred throughout Switzerland. Objective: Epidemiological and clinical data were collected in order to identify the offending agent and to specify the pathophysiological mechanisms. Methods: The data concerning 263 patients seen by dermatologists plus 642 additional cases directly reported by consumers to the manufacturer were analyzed. Seventy-seven patients were patch-tested, 26 extensively, and 15 performed a repeated open application test for a duration of 4 weeks. Control patch and use tests were performed in 73 and 25 patients, respectively. The results were analyzed statistically. In addition, 12 skin biopsies were performed for histological examination. Biochemical studies on the cosmetics (final products and offending ingredient) supplemented the clinical studies. Results: The lesions were mainly papular and follicular, widely distributed, with pronounced pruritus, which was aggravated by sweating or heat exposure, and were long lasting. In a few cases, the papules were located on intensely erythematous, well-defined plaques, suggesting irritation rather than allergy. Both immediate and delayed onsets of the lesions were observed. Skin biopsies showed signs of folliculitis and perifolliculitis with little alteration of the interfollicular epidermis. Patch and use testing disclosed vitamin E linoleate® (a mixture of tocopheryl esters, mainly tocopheryl linoleate) as the offending agent. An in vitro time-dependent formation of oxidative products under storage or oxidation-stimulating conditions was observed. Conclusion: Though vitamin E esters have been widely and safely used for decades in dermatological preparations and in cosmetics, vitamin E linoleate was the cause of about 1,000 cases of unusual papular mainly follicular contact dermatitis. Oxidized vitamin E derivatives could act in vivo as haptens and/or irritants, possibly with synergistic effects

ISSN:1018-8665    

DOI:10.1159/000246843

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background: Patients suffering from severe psoriasis report high levels of personal distress and disability as a result of their disease. Objective: The purpose of this study was to examine the relationship between disease severity, personal distress and disability. Methods: Twenty-two patients provided a self-rating of disease severity and completed the Psoriasis Disability Index (PDI) and the General Health Questionnaire (GHQ). A dermatologist provided a clinical assessment from the case notes. Results: Although the clinical assessment was not related to patient ratings, patientrated severity scores, GHQ and PDI were correlated with each other. GHQ could only be predicted by disease severity when it was mediated by PDI scores. Conclusions: These results indicated that psoriasis affects psychological distress through its effects on the patients’ everyday live

ISSN:1018-8665    

DOI:10.1159/000246844

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background: Some reports have suggested that psoriasis and eczema are seldom found together. Knowledge of disease co-occurrence could lead to improved understanding of shared or opposing pathological mechanisms. Objective: We sought to determine whether psoriasis and eczema could exist simultaneously and consecutively in the same individuals. Methods: Skin examination data relating to 9,263 British children born during March 3rd to 9th, 1958 (the National Child Development Survey), were analysed for the co-occurrence of eczema and psoriasis. Results: Of 354 children with visible eczema at the ages of 11 or 16 years, 5 (1.4%) were also noted to have visible psoriasis, compared to 89 (1.0%) of 8,909 children who did not have visible eczema at 11 or 16 years. The relative risk of psoriasis in a case of eczema was 1.41, 95% confidence intervals from 0.58 to 3.46. Conclusion: Contrary to some hospital-based studies which have suggested that the two diseases are seldom found together, this study of a large and representative population suggests that eczema and psoriasis may co-occur concurrently and consecutively in the same individual.

ISSN:1018-8665    

DOI:10.1159/000246845

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Chronic actinic dermatitis (CAD) has distinct clinical features different from polymoφhous light eruption (PLE). In order to clarify the difference between CAD and PLE, not only in clinical histories and findings but also in photobiological and histopathological reactions to phototests, we investigated 6 Japanese patients with CAD and performed provocative phototests which are our standardized methods in diagnosing PLE. On provocative phototests in CAD, pruritic papules were reproduced with smaller doses of UVB, at longer hours after irradiation (48-72 h) and they lasted for more days than in patients with PLE. Our study demonstrated that although milder cases of CAD and severe cases of PLE could not be distinguished clearly based on photobiological reactions alone, typical cases of CAD showed completely different provocative phototest results from those of PLE

ISSN:1018-8665    

DOI:10.1159/000246846

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background: Palpebral syringomas have been reported to be more frequent in patients with Down’s syndrome than in the normal population. Objective: The aim of the present study was to evaluate, in a population of institutionalized patients with Down’s syndrome, the prevalence of syringomas and their possible cytogenetic relationships. Methods: Sixty-one institutionalized patients with Down’s syndrome were examined in order to assess the presence of palpebral syringomas. Sixty mentally retarded non-Down’s syndrome individuals were used as a control group. Results: Fourteen patients, 13 females and 1 male, were found to be affected. The prevalence of syringomas in both sexes was 23%; 42% of all females, and 55% when only adult females were considered, had syringomas. Thirteen of the 14 affected patients had a karyotype of Down’s syndrome with free trisomy 21, 1 had a mosaicism 47, XX,+21/46, XX. Histologic examination confirmed the diagnosis in all 4 biopsied cases. A clear-cell pattern was observed only in 1 patient while, sporadically, few tubules showed a central syringial-type cuticula. Conclusion: The higher prevalence found in females, as compared to males, can be partially explained by their older age (mean 23.8 vs. 13.9 years). Palpebral syringomas are a common cutaneous pathology in adult females with Down

ISSN:1018-8665    

DOI:10.1159/000246847

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background: Cutaneous plasmacytosis is a rare disease characterized by peculiar multiple eruptions and hypergammaglobulinemia. More than 40 cases have been reported, mainly in Japan, although information concerning the disorder was limited to individual case reports. Objective and Methods: To clarify the clinicopathological and laboratory features, we reviewed 41 cases. Results: All patients were Japanese and the male-to-female ratio was 1:0.6. The onset ages ranged from 20 to 62 years, with a mean and median of 37 and 37 years. A superficial lymphadenopathy was detected in 58% (22/38), and polyclonal hypergammaglobulinemia was found in 93% (38/41). No cases were associated with any apparent underlying diseases. The course was chronic without spontaneous remission. Four patients died, 3 of whom succumbed to leukemia, respiratory failure or renal failure, respectively. Conclusion: The results suggest that the condition appears to be a variant of reactive plasmacytic disorders of unknown origin.

ISSN:1018-8665    

DOI:10.1159/000246848

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background: The optimal therapeutic regimen of bath-PUVA therapy of psoriasis is still under debate. Objective: We investigated the safety and efficacy of an aggressive and individualized bath-PUVA regimen. Methods: Two closely matched groups of 22 psoriatic patients were treated either with 30-min baths in 0.0003% 8-methoxypsoralen (8-MOP) aqueous solution or oral administration of the drug. According to the standard European regimen, treatments were delivered 4 times a week starting with the minimal phototoxic dose. Results: Complete clearing or marked improvement was observed in all the patients. However, with bath-PUVA, the same therapeutic effect required smaller cumulative UVA doses (39.3 ± 15.8 vs. 123.8 ± 39.9 J/cm2) and lower numbers of exposures (15.2 ± 4.4 vs. 20.6 ± 4.2). Both differences were significant at the 0.01 level (Student’s t test). Gastrointestinal side effects were of course restricted to oral 8-MOP. The incidences of burns and pruritus were similar. Conclusion: Using an aggressive and individualized schedule, bath-PUVA therapy showed a greater efficacy than oral PUVA therapy while being just as

ISSN:1018-8665    

DOI:10.1159/000246849

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Background and Design: A multi-centre, open, prospective study of 12 months duration was performed to assess safety, efficacy and tolerability of topical calcipotriol in the long-term treatment of psoriasis. One hundred and sixty-seven adults with chronic plaque psoriasis who had previously responded to calcipotriol entered the study. Disease activity was monitored using the psoriasis area and severity index (PASI). Calcipotriol ointment 50 μg/g was applied twice daily until remission was attained. Treatment was then stopped but reinstituted in the event of relapses. Results: Of the 167 recruited patients, 6 patients did not receive any treatment during the trial. A total of 39 patients were withdrawn: 15 due to inadequate control of their psoriasis, 9 due to irritant reactions, 7 due to defaulting and 8 for miscellaneous voluntary reasons. A further 24 patients either reached the study medication limit of 2,500 g or were considered to have completed the study a few weeks prior to the 12-month period. Accordingly, 98 patients were assessable after 12 months of therapy. Complete clearing was obtained in 26% of subjects, who then used the treatment intermittently. The remaining patients required continuous treatment for 12 months. The mean PASI fell from 8.1 (SD ± 6.67, n= 167) at baseline to 3.90 ( ± 3.50, 136) at 2 months and 2.71 ( ± 2.12, 98) at 12 months. There was no rise in the mean serum total calcium. Conclusion: Calcipotriol ointment was safe, effective and well tolera

ISSN:1018-8665    

DOI:10.1159/000246851

出版商:S. Karger AG    

年代:1994

数据来源: Karger