Background: No cure for psoriasis exists for the 1-3%of the American population who suffer from it; however, anecdotal reports from patients with psoriasis visiting Hawaii who purchased kukui nut oil, claim it helped ...Background: No cure for psoriasis exists for the 1-3%of the American population who suffer from it; however, anecdotal reports from patients with psoriasis visiting Hawaii who purchased kukui nut oil, claim it helped reduce the severity of their lesions. Objective: This pilot study was a double-blind, placebo-controlled clinical trial to determine the effectiveness of kukui nut oil as a topical treatment for psoriasis. Methods: Thirty adult subjects (18-78 year) were recruited from the community for a 12-week randomized, double-blind, placebocontrolled pilot study. Subjectswere previously diagnosedwith mild, stable plaque psoriasis (less than 15%of total body surface area [TBSA]) and agreed to abstain from other treatments during the course of the study. Following a 4-week washout period the subjects were randomized into a treatment group (15 subjects applying kukui nut oil) or a control group (15 applying the mineral oil placebo). Patients were seen every 2 weeks (seven visits at 0, 2, 4, 6, 8, 10, and 12 weeks) by a dermatological nurse practitioner under the general supervision of a board certified dermatologist. Measurable outcomes included evaluation of one targeted lesion and of the overall severity of their, psoriasis using clinical evaluation, Psoriasis Area and Sensitivity Index (PASI), Global Severity of Psoriasis Scale, and photographs. Each patient also evaluated their own lesions daily using the Global Severity of Psoriasis Scale, and noted any side-effects or other treatments used. Results: Although both groups improved, we found no significant difference between the treatment (kukui nut oil) and the placebo (mineral oil) among the 24 out of 30 subjects (80%) who completed the study. No side-effects or adverse events were reported. Conclusion: Kukui nut oil did not significantly reduce symptoms of psoriasis; however, this was a small pilot study, and the use of this oil cannot be dismissed without using a larger study population of patients with psoriasis.展开更多
Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospec...Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30%or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM)-inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN)-were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73%of patients (n=11) with sparse inflammation survived, only 47%(n=7) with moderate and 29%(n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65%using grade of inflammation, 68%with mean cell count, and 71%with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.展开更多
患儿男,顺产出生12 d。患儿于生后第9天出现全身多处皮肤剥脱、坏死,持续3 d症状未见改善,由外地前往广州市妇儿医疗中心就诊后,转诊广州市第一人民医院新生儿科。入院体查:T:36.5℃,P:143次/分,R:41次/分,BP:62/32 mm Hg(1 mm Hg=0.33 ...患儿男,顺产出生12 d。患儿于生后第9天出现全身多处皮肤剥脱、坏死,持续3 d症状未见改善,由外地前往广州市妇儿医疗中心就诊后,转诊广州市第一人民医院新生儿科。入院体查:T:36.5℃,P:143次/分,R:41次/分,BP:62/32 mm Hg(1 mm Hg=0.33 k Pa)。患儿头面部、躯干、四肢大片皮肤剥脱、坏死,创面呈烫伤样改变。血常规:展开更多
文摘Background: No cure for psoriasis exists for the 1-3%of the American population who suffer from it; however, anecdotal reports from patients with psoriasis visiting Hawaii who purchased kukui nut oil, claim it helped reduce the severity of their lesions. Objective: This pilot study was a double-blind, placebo-controlled clinical trial to determine the effectiveness of kukui nut oil as a topical treatment for psoriasis. Methods: Thirty adult subjects (18-78 year) were recruited from the community for a 12-week randomized, double-blind, placebocontrolled pilot study. Subjectswere previously diagnosedwith mild, stable plaque psoriasis (less than 15%of total body surface area [TBSA]) and agreed to abstain from other treatments during the course of the study. Following a 4-week washout period the subjects were randomized into a treatment group (15 subjects applying kukui nut oil) or a control group (15 applying the mineral oil placebo). Patients were seen every 2 weeks (seven visits at 0, 2, 4, 6, 8, 10, and 12 weeks) by a dermatological nurse practitioner under the general supervision of a board certified dermatologist. Measurable outcomes included evaluation of one targeted lesion and of the overall severity of their, psoriasis using clinical evaluation, Psoriasis Area and Sensitivity Index (PASI), Global Severity of Psoriasis Scale, and photographs. Each patient also evaluated their own lesions daily using the Global Severity of Psoriasis Scale, and noted any side-effects or other treatments used. Results: Although both groups improved, we found no significant difference between the treatment (kukui nut oil) and the placebo (mineral oil) among the 24 out of 30 subjects (80%) who completed the study. No side-effects or adverse events were reported. Conclusion: Kukui nut oil did not significantly reduce symptoms of psoriasis; however, this was a small pilot study, and the use of this oil cannot be dismissed without using a larger study population of patients with psoriasis.
文摘Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30%or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM)-inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN)-were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73%of patients (n=11) with sparse inflammation survived, only 47%(n=7) with moderate and 29%(n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65%using grade of inflammation, 68%with mean cell count, and 71%with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trials should consider the possibility that various patient subsets exist within the TEN population, and a role for immunocytes needs to be critically reevaluated in this devastating disease.
文摘患儿男,顺产出生12 d。患儿于生后第9天出现全身多处皮肤剥脱、坏死,持续3 d症状未见改善,由外地前往广州市妇儿医疗中心就诊后,转诊广州市第一人民医院新生儿科。入院体查:T:36.5℃,P:143次/分,R:41次/分,BP:62/32 mm Hg(1 mm Hg=0.33 k Pa)。患儿头面部、躯干、四肢大片皮肤剥脱、坏死,创面呈烫伤样改变。血常规:
