Background: Staphylococcus aureus has a peculiar ability to colonize the skin of patients with eczema and atopic dermatitis (AD), and is consistently found in eczematous skin lesions in these patients. A correlation b...Background: Staphylococcus aureus has a peculiar ability to colonize the skin of patients with eczema and atopic dermatitis (AD), and is consistently found in eczematous skin lesions in these patients. A correlation between the severity of the eczema and colonization with S. aureus has been demonstrated, and it has been determined that bacterial colonization is an important factor aggravating skin lesions. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. Objectives: To investigate the colonizing features of S. aureus in the lesional and nonlesional skin of patients with eczema and AD in China and to compare the therapeutic effect of mupirocin plus hydrocortisone butyrate with vehicle ointment plus hydrocortisone butyrate. Methods: A multicentre,double-blind randomized trial was conducted. Eczema Area and Severity Index (EASI) scores were evaluated before the start of the trial and on the 7th, 14th and 28th day of treatment. Swabs for bacterial isolation were taken from lesional skin before the start of the trial and on the 7th, 14th and 28th day of treatment, and from nonlesional skin only before the start of the trial. A combination topical therapy with mupirocin plus hydrocortisone butyrate ointment was used in the experimental group, with vehicle ointment plus hydrocortisone butyrate ointment as a control. Results: Of 327 patients enrolled in the study, 208 had eczema and 119 had AD. Bacteria were isolated from 70.2%of lesional and 32.7%of nonlesional skin samples from patients with eczema, of which S. aureus accounted for 47.3%and 27.9%, respectively. Bacteria were isolated from 74.8%of lesional and 34.5%of nonlesional skin samples from patients with AD, of which S. aureus accounted for 79.8%and 80.5%, respectively. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin, both in patients with eczema and with AD (P < 0.01, P < 0.05), and was positively correlated with lesion severity. Considering the EASI scores before and after treatment and the final effective rate, good therapeutic effects were obtained in both the combination experimental groups and the control groups (P < 0.01), and there were no differences in the global therapeutic effect between the two groups in patients with eczema and with AD (P > 0.05). However, in patients with eczema with a clinical score of > 8 or in patients with AD with a clinical score of > 7, the therapeutic effect in the experimental groups was superior to that in the control groups (P < 0.05) on the 7th day of treatment. There were no differences between the two groups on the 14th and 28th days of treatment (P > 0.05). Following the improvement of symptoms and signs of eczema and AD, the positive rates of bacteria and S. aureus were reduced on the 7th day of treatment.Conclusions: This study confirmed that lesional skin of patients with eczema and AD was more frequently colonized with S. aureus than was nonlesional skin. The more severe the eczema, the higher the colonization rate of S. aureus, and S. aureus was also more often present in lesional and nonlesional skin in patients with AD than in those with eczema. Staphylococcus aureus infection is related to the pathogenesis of eczema and AD. An antibiotic-corticosteroid combination and corticosteroid alone both gave good therapeutic effect in eczema and in AD, and both reduced colonization by S. aureus. Early combined topical therapy is beneficial to patients with moderate to severe eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild eczema or AD.展开更多
Background: Eosinophilic fasciitis (EF) is a rare fibrosing disorder associated with peripheral eosinophilia and scleroderma-like induration of the distal extremities which affects substantially quality of life. Altho...Background: Eosinophilic fasciitis (EF) is a rare fibrosing disorder associated with peripheral eosinophilia and scleroderma-like induration of the distal extremities which affects substantially quality of life. Although the disease has been described 30 years ago, the etiology and pathomechanisms are still obscure, and consensus for therapy is lacking. Numerous case reports of patients with EF exist but series are scarce. Patients and Methods: Eleven patients with EF from the Department of Dermatology, Kantonsspital Aarau, the University Hospital Basel and the OutpatientClinic of Dermatology, Triemli Hospital Zurich, Switzerland, were retrospectively studied. Results:In 4 patients the initial diagnosis was not recognized by the referring non dermatologists. The median age was 55 years, excluding the youngest patient ever diagnosed with EF (age =1 year). All patients showed an induration of the skin, which led to painful contractures in the joints in 3 cases. All but 2 patients demonstrated edema. A slight predominance of the upper extremities was observed. Sclerodactyly was noticed in 1 patient. Three patients reported an initial trauma at the affected site. Two patients were tested positive for borreliosis. One patient subsequently developed aplastic anemia and Hashimoto thyroiditis. Visceral or extracutaneous involvement was absent. Eight patients had a full or partial recovery under corticosteroids whereas in 2, improvement could be achieved only with cyclosporine, azathioprine or cyclophosphamide. Conclusions: The diagnosis of EF can be established by clinical, laboratory and histological findings. In general, corticosteroids are highly efficacious in EF and only a minority of patients need other immunosuppressive or cytostatic drugs.展开更多
The aim of this study is to find out the causes of skin diseases in one-third of the staff of a perfume factory,in which 10 different perfume sprays were being manufactured.Site inspection,dermatological examination a...The aim of this study is to find out the causes of skin diseases in one-third of the staff of a perfume factory,in which 10 different perfume sprays were being manufactured.Site inspection,dermatological examination and patch testing of all 26 persons at risk with 4 perfume oils and 30 ingredients of them.The results showed 6 bottlers were found suffering from allergic contact dermatitis,2 from irritant contact dermatitis,12 workers showed different strong reactions to various fragrances.The main causes of allergic contact dermatitis were 2 perfume oils(12 cases)and their ingredients geraniol(12 cases),benzaldehyde(9),cinnamic aldehyde(6),linalool,neroli oil,terpenes of lemon oil and orange oil(4 each).Nobody was tested positive to balsam of Peru.Job changes for office workers,packers or printers to other rooms,where they had no longer contact with fragrances,led to a settling.To conclude,automation and replacement of glass bottles by cartridges from non-fragile materials and using gloves may minimize the risk.展开更多
Actinic reticuloid(AR)is the severest clinical variant of chronic actinic dermatitis(CAD)and describes a persistent photoinduced skin disorder often associated with delayed-type hypersensitivity reactions.Histopatholo...Actinic reticuloid(AR)is the severest clinical variant of chronic actinic dermatitis(CAD)and describes a persistent photoinduced skin disorder often associated with delayed-type hypersensitivity reactions.Histopathologically,AR resembles pseudolymphoma and may also show features of cutaneous lymphoma.In contrast to other UV-induced skin diseases,AR patients show persistent photosensitivity to UV radiation and visible light parallel to permanent changes of skin texture with infiltrated papules and thickened plaques.Therapeutically,CAD is a problematic condition.Daily application of sun protection has to be combined with local or systemic immunosuppression.However,various therapeutic approaches including systemic corticosteroids and other systemic immunosuppressive agents are limited by severe side effects.Tacrolimus,a Streptomyces-derived immunosuppressive macrolide antibiotic and inhibitor of calcineurin,has been proven successful in various inflammatory skin diseases including atopic eczema,allergic contact dermatitis and photodermatoses without undesired side effects.We present a case of severe recalcitrant and nodular chronic actinic dermatitis responding to topically applied tacrolimus(Protopic).To avoid further relapses we continued this therapy twice a day over a period of 2 years.展开更多
Four patients presenting a peculiar clinical variant of erythema annulare centrifugum are reported. The lesions were clinically and histopathologically indistinguishable from classic superficial erythema annulare cent...Four patients presenting a peculiar clinical variant of erythema annulare centrifugum are reported. The lesions were clinically and histopathologically indistinguishable from classic superficial erythema annulare centrifugum but constant annual and seasonal recurrences for many years or decades were observed. No clear precipitating factor could be identified. No associated symptoms were present and the eruption regressed spontaneously after a variable period of days to months. Annually recurring erythema annulare centrifugum seems to represent a rare distinct clinical entity that has received little attention in literature. Clinicopathologic features of this peculiar clinical disorder and the differential diagnosis with other recurrent seasonal eruptions are reviewed.展开更多
An easy-to-use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index ...An easy-to-use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index (OHSI) was developed for this purpose and the interobserver reliability investigated. The clinical severity was evaluated on the basis of the extension or clinical characteristics of six morphological characteristics. For the validation of the OHSI, hand eczema in 28 patients was investigated independently by one dermatologist and 2 occupational physicians. The agreement between the observers was determined by using kappa values, Kendall’ s coefficient of concordance, the intraclass correlation coefficient (ICC) and the 95% limits of agreement. The ICC for the total OHSI was 0.80 and the estimated limits of agreement (- 3.6 and 3.0) were sufficiently small to expect that ratings according to OHSI performed by independent observers of different medical specialities should produce similar results. It could be demonstrated that the use of the OHSI is simple and practicable. The interobserver reliability for the summary score is good. OHSI seems a reliable tool for assessing the severity of occupational hand eczema.展开更多
文摘Background: Staphylococcus aureus has a peculiar ability to colonize the skin of patients with eczema and atopic dermatitis (AD), and is consistently found in eczematous skin lesions in these patients. A correlation between the severity of the eczema and colonization with S. aureus has been demonstrated, and it has been determined that bacterial colonization is an important factor aggravating skin lesions. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. Objectives: To investigate the colonizing features of S. aureus in the lesional and nonlesional skin of patients with eczema and AD in China and to compare the therapeutic effect of mupirocin plus hydrocortisone butyrate with vehicle ointment plus hydrocortisone butyrate. Methods: A multicentre,double-blind randomized trial was conducted. Eczema Area and Severity Index (EASI) scores were evaluated before the start of the trial and on the 7th, 14th and 28th day of treatment. Swabs for bacterial isolation were taken from lesional skin before the start of the trial and on the 7th, 14th and 28th day of treatment, and from nonlesional skin only before the start of the trial. A combination topical therapy with mupirocin plus hydrocortisone butyrate ointment was used in the experimental group, with vehicle ointment plus hydrocortisone butyrate ointment as a control. Results: Of 327 patients enrolled in the study, 208 had eczema and 119 had AD. Bacteria were isolated from 70.2%of lesional and 32.7%of nonlesional skin samples from patients with eczema, of which S. aureus accounted for 47.3%and 27.9%, respectively. Bacteria were isolated from 74.8%of lesional and 34.5%of nonlesional skin samples from patients with AD, of which S. aureus accounted for 79.8%and 80.5%, respectively. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin, both in patients with eczema and with AD (P < 0.01, P < 0.05), and was positively correlated with lesion severity. Considering the EASI scores before and after treatment and the final effective rate, good therapeutic effects were obtained in both the combination experimental groups and the control groups (P < 0.01), and there were no differences in the global therapeutic effect between the two groups in patients with eczema and with AD (P > 0.05). However, in patients with eczema with a clinical score of > 8 or in patients with AD with a clinical score of > 7, the therapeutic effect in the experimental groups was superior to that in the control groups (P < 0.05) on the 7th day of treatment. There were no differences between the two groups on the 14th and 28th days of treatment (P > 0.05). Following the improvement of symptoms and signs of eczema and AD, the positive rates of bacteria and S. aureus were reduced on the 7th day of treatment.Conclusions: This study confirmed that lesional skin of patients with eczema and AD was more frequently colonized with S. aureus than was nonlesional skin. The more severe the eczema, the higher the colonization rate of S. aureus, and S. aureus was also more often present in lesional and nonlesional skin in patients with AD than in those with eczema. Staphylococcus aureus infection is related to the pathogenesis of eczema and AD. An antibiotic-corticosteroid combination and corticosteroid alone both gave good therapeutic effect in eczema and in AD, and both reduced colonization by S. aureus. Early combined topical therapy is beneficial to patients with moderate to severe eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild eczema or AD.
文摘Background: Eosinophilic fasciitis (EF) is a rare fibrosing disorder associated with peripheral eosinophilia and scleroderma-like induration of the distal extremities which affects substantially quality of life. Although the disease has been described 30 years ago, the etiology and pathomechanisms are still obscure, and consensus for therapy is lacking. Numerous case reports of patients with EF exist but series are scarce. Patients and Methods: Eleven patients with EF from the Department of Dermatology, Kantonsspital Aarau, the University Hospital Basel and the OutpatientClinic of Dermatology, Triemli Hospital Zurich, Switzerland, were retrospectively studied. Results:In 4 patients the initial diagnosis was not recognized by the referring non dermatologists. The median age was 55 years, excluding the youngest patient ever diagnosed with EF (age =1 year). All patients showed an induration of the skin, which led to painful contractures in the joints in 3 cases. All but 2 patients demonstrated edema. A slight predominance of the upper extremities was observed. Sclerodactyly was noticed in 1 patient. Three patients reported an initial trauma at the affected site. Two patients were tested positive for borreliosis. One patient subsequently developed aplastic anemia and Hashimoto thyroiditis. Visceral or extracutaneous involvement was absent. Eight patients had a full or partial recovery under corticosteroids whereas in 2, improvement could be achieved only with cyclosporine, azathioprine or cyclophosphamide. Conclusions: The diagnosis of EF can be established by clinical, laboratory and histological findings. In general, corticosteroids are highly efficacious in EF and only a minority of patients need other immunosuppressive or cytostatic drugs.
文摘The aim of this study is to find out the causes of skin diseases in one-third of the staff of a perfume factory,in which 10 different perfume sprays were being manufactured.Site inspection,dermatological examination and patch testing of all 26 persons at risk with 4 perfume oils and 30 ingredients of them.The results showed 6 bottlers were found suffering from allergic contact dermatitis,2 from irritant contact dermatitis,12 workers showed different strong reactions to various fragrances.The main causes of allergic contact dermatitis were 2 perfume oils(12 cases)and their ingredients geraniol(12 cases),benzaldehyde(9),cinnamic aldehyde(6),linalool,neroli oil,terpenes of lemon oil and orange oil(4 each).Nobody was tested positive to balsam of Peru.Job changes for office workers,packers or printers to other rooms,where they had no longer contact with fragrances,led to a settling.To conclude,automation and replacement of glass bottles by cartridges from non-fragile materials and using gloves may minimize the risk.
文摘Actinic reticuloid(AR)is the severest clinical variant of chronic actinic dermatitis(CAD)and describes a persistent photoinduced skin disorder often associated with delayed-type hypersensitivity reactions.Histopathologically,AR resembles pseudolymphoma and may also show features of cutaneous lymphoma.In contrast to other UV-induced skin diseases,AR patients show persistent photosensitivity to UV radiation and visible light parallel to permanent changes of skin texture with infiltrated papules and thickened plaques.Therapeutically,CAD is a problematic condition.Daily application of sun protection has to be combined with local or systemic immunosuppression.However,various therapeutic approaches including systemic corticosteroids and other systemic immunosuppressive agents are limited by severe side effects.Tacrolimus,a Streptomyces-derived immunosuppressive macrolide antibiotic and inhibitor of calcineurin,has been proven successful in various inflammatory skin diseases including atopic eczema,allergic contact dermatitis and photodermatoses without undesired side effects.We present a case of severe recalcitrant and nodular chronic actinic dermatitis responding to topically applied tacrolimus(Protopic).To avoid further relapses we continued this therapy twice a day over a period of 2 years.
文摘Four patients presenting a peculiar clinical variant of erythema annulare centrifugum are reported. The lesions were clinically and histopathologically indistinguishable from classic superficial erythema annulare centrifugum but constant annual and seasonal recurrences for many years or decades were observed. No clear precipitating factor could be identified. No associated symptoms were present and the eruption regressed spontaneously after a variable period of days to months. Annually recurring erythema annulare centrifugum seems to represent a rare distinct clinical entity that has received little attention in literature. Clinicopathologic features of this peculiar clinical disorder and the differential diagnosis with other recurrent seasonal eruptions are reviewed.
文摘An easy-to-use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index (OHSI) was developed for this purpose and the interobserver reliability investigated. The clinical severity was evaluated on the basis of the extension or clinical characteristics of six morphological characteristics. For the validation of the OHSI, hand eczema in 28 patients was investigated independently by one dermatologist and 2 occupational physicians. The agreement between the observers was determined by using kappa values, Kendall’ s coefficient of concordance, the intraclass correlation coefficient (ICC) and the 95% limits of agreement. The ICC for the total OHSI was 0.80 and the estimated limits of agreement (- 3.6 and 3.0) were sufficiently small to expect that ratings according to OHSI performed by independent observers of different medical specialities should produce similar results. It could be demonstrated that the use of the OHSI is simple and practicable. The interobserver reliability for the summary score is good. OHSI seems a reliable tool for assessing the severity of occupational hand eczema.
