skin-care-3.matches: skin care
'Eczema school' to improve compliance in an occupational dermatology clinic.

Kalimo K, Kautiainen H, Niskanen T, Niemi L.

Department of Dermatology, Turku University Central Hospital, Finland.

From the beginning of 1990 a trained nurse has been employed at our Department of Dermatology to give information about skin care, allergen avoidance and skin protection to the patients. To find out the possible benefit obtained by this patient education, a questionnaire was sent out to 540 patients who had been diagnosed with an occupational skin disease established at the Department of Dermatology between 1985 and 1992. It is evident that direct comparison in this kind of longitudinal follow-up must be carried out with great criticism, since changes in patients' work exposure and socioeconomical situation during the follow-up time will also affect the prognosis. In this study, 424 patients returned the questionnaire, 252 who had been examined before 1990 and 172 later. According to the answers, it appeared that during the last 12 months, the majority (65%) had suffered from dermatitis, 13% from constant and 52% from periodic symptoms. However, when the diagnosis had been irritant contact dermatitis without allergens found, the prognosis was significantly better (p<0.008) among those who had received "extra education" and none had persistent dermatitis. Patients with contact allergy to metals or synthetic resins had also managed better, as compared to those who had received traditional treatment (p<0.002, p<0.003). Other factors such as personal motivation and possibilities for work reorganization were also important for the prognosis. 60% of patients were not initially aware of the decision given by the insurance companies, although 94% of their skin diseases had been accepted as occupational dermatoses. Generally, the patients were satisfied with the extra information given by the nurse.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10617211&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Polymorphous light eruption: A clinical, photobiologic, and follow-up study of 110 patients.

Boonstra HE, van Weelden H, Toonstra J, van Vloten WA.

Department of Dermatology, University Hospital Utrecht, The Netherlands.

BACKGROUND: Polymorphous light eruption is a common chronic idiopathic photodermatosis. The action spectrum and therapy are under debate. OBJECTIVE: The aim of the study was to analyze the clinical aspects of this dermatosis, the photodiagnostic tests, and the results of therapy in an academic center. METHODS: To obtain a reasonable follow-up period, we examined all available data of the patients who underwent diagnostic phototests in the period 1985 through 1991. Our procedure of phototesting included determination of minimal erythema doses, photoprovocation tests, and photopatch tests. The evaluation of the effect of the therapy was based on the patients' experiences, time spent outdoors, and amount of sun exposure. RESULTS: Our collection included data on 35 men and 75 women. The age at onset differed significantly between men and women (averages 46 and 28 years, respectively; P <.01). The minimal erythema doses for UVB were lowered in 43% of the men and in 4% of the women (P <.01); the minimal erythema doses for UVA were lowered in 37% of the men and in 11% of the women (P <.01). The photoprovocation tests showed a pathologic reaction to both UVB and UVA in 88% of the men and in 52% of the women (P <.01). In the remaining patients we found pathologic reactions to UVB alone (for men 9%, for women 24%; P >.05) or UVA alone (for men 3%, for women 24%; P <.01). The abnormal reactions to visible light were almost exclusively observed in those patients who reacted pathologically to both UVB and UVA (43% of the male patients, 11% of the female patients; P <.01). The photopatch tests showed a large number of positive test results, mainly to skin care products or sunscreens (75% of all patients). The 70 most sensitive patients (64%) were treated with prophylactic UVB therapy 2 or 3 times a week at home or initially in the outpatient department. This treatment was normally done from February to June, but in severe cases throughout the whole year. CONCLUSION: Phototests revealed abnormal reactions to UVB as well as UVA and to some extent also to visible light. Prophylactic UVB therapy is a successful treatment for polymorphous light eruption.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10642673&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Skin care management practices for premature infants.

Baker SF, Smith BJ, Donohue PK, Gleason CA.

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

OBJECTIVE: To describe current skin care practices for preterm infants in neonatal intensive care units in the United States. We hypothesized that there would be little consensus among facilities. STUDY DESIGN: Neonatal intensive care units (n = 823) listed in the 1996 United States Neonatologists Directory (American Academy of Pediatrics, Section on Perinatal Pediatrics) were sent a 28-question survey dealing with many aspects of neonatal skin care along with descriptive data about their neonatal intensive care unit. Descriptive data analysis was performed. RESULTS: A total of 305 surveys were returned (37% return rate); of these, 241 of the respondents reported admitting infants weighing < or = 1000 gm. Some neonatal skin care practices showed wide consensus (> 70%) (e.g., scrub procedure for staff; use of a skin barrier under tapes/adhesives), whereas other practices showed little consensus (< 30%) (e.g., routine surveillance cultures; use of Aquaphor). CONCLUSION: Consensus on skin care practices was not found among neonatal intensive care units. Data from this survey can be used to develop studies to examine whether certain skin care management practices can improve neonatal outcomes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10685272&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Complications of prone ventilation in patients with multisystem trauma with fulminant acute respiratory distress syndrome.

Offner PJ, Haenel JB, Moore EE, Biffl WL, Franciose RJ, Burch JM.

Department of Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 80204, USA. poffner dhha.org

INTRODUCTION: Prone ventilation improves oxygenation in selected patients with acute respiratory distress syndrome (ARDS). However, prone positioning of critically ill patients with multiple invasive lines and tubes is potentially dangerous. Trauma patients, in particular, may require special consideration because of skeletal fixation devices or prior operative procedures. Our objective was to critically evaluate our experience with prone positioning in patients with severe postinjury ARDS. METHODS: Injured patients admitted to our Level I trauma center who developed ARDS were prospectively identified. Serial lung injury severity and pulmonary mechanical data, as well as complications of prone ventilation were recorded. RESULTS: During the 12-month period ending August of 1998, nine patients with postinjury ARDS were treated with prone ventilation because of hypoxemia refractory to other ventilatory strategies. All patients suffered blunt trauma. Their mean age was 29 +/- 4.5 years; seven patients were men. The average Injury Severity Score was 26 +/- 5; and, at the time of prone positioning, the mean Lung Injury Score was 3.5. The mean PaO2/FIO2 ratio increased from 75 +/- 7 to 147 +/- 27 with prone ventilation (p < 0.05, paired t test); and in six patients, the FIO2 could be decreased. Four major complications occurred (44%). One patient experienced a midline abdominal wound dehiscence. Severe facial or upper chest wall pressure necrosis developed in two patients, despite extensive padding and careful attention to skin care. The fourth patient sustained a cardiac arrest immediately after prone positioning. CONCLUSION: Prone ventilation in postinjury patients with ARDS may improve oxygenation but has the potential for significant complications. Careful consideration is required before prone positioning in this subset of patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10697078&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Development of diaper rash in the newborn.

Visscher MO, Chatterjee R, Munson KA, Bare DE, Hoath SB.

Skin Sciences Institute, Children's Hospital Research Foundation, University of Cincinnati, Ohio, USA.

Diaper rash is a common infant malady. This study documents the earliest stages of rash in a cohort of 31 healthy term newborns over the first 28 days of life. The diaper area was evaluated using a standardized diaper rash grading scale. The anal, buttock, genital, intertriginous, waistband, and leg areas were assessed separately. At birth the average grade was 0.1 and none of the infants had specific features of advanced rash. Nineteen percent had dryness and/or slight redness. By day 7, 71% of infants had some features of skin compromise, giving rise to an overall grade of 0.6. Both the frequency and overall grade increased during postnatal weeks 2 and 3. Overall scores for days 21 and 28 were the same (1.1). The perianal area had the highest overall regional rash grade. Gender differences were present for the genital area only. These findings indicate that epidermal barrier breakdown is an uncommon finding at birth. Clinical signs of irritated skin in the diaper area develop progressively over the first postnatal month. A better understanding of the mechanisms conferring epidermal barrier protection at birth may be important for developing skin care products and practices to extend this protection later into life.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10720989&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Skin reactions during radiotherapy for breast cancer: the use and impact of topical agents and dressings.

Porock D, Kristjanson L.

School of Nursing, University of Hull, Willerby, UK. D.C.Porock nursing.hull.ac.uk

Radiation skin reactions occur in the majority of cases of patients undergoing radiotherapy for breast cancer with varying degrees of severity. Guidelines for skin care and for the use of topical agents and dressings have developed over the years of practice but there is little empirical evidence on which to base a decision for best practice. This paper describes the incidence of radiation skin reactions in a sample of 126 women treated for breast cancer post-lumpectomy. The results show that by the end of whole breast irradiation between 4-8% of patients will have no reaction and less than 10% will have moist desquamation as measured by the RTOG acute scoring system. The majority of patients did not require application of a topical agent during the treatment period. Statistical analysis of relationships between the severity of radiation skin reaction and the use of topical agents found no support for additional healing or preventative benefit. However, these topical agents were found to promote comfort. The use of Fixomull as a protector and potential preventive measure for moist desquamation is described.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10763645&dopt=Abstract skin, skin care, skin care medicine skin-care-3.matches: skin care
Effect of complex decongestive physiotherapy on gene expression for the inflammatory response in peripheral lymphedema.

Foldi E, Sauerwald A, Hennig B.

Foldiklinik for Lymphology, Beiersdorf AG, Hamburg, Germany.

Complex decongestive physiotherapy (CDP), consisting of manual lymph drainage, compression bandaging, remedial exercises and skin care, mobilizes accumulated edema fluid and increases lymph flow. On the other hand, it also has a beneficial therapeutic effect on fibrosclerosis. Because little is known of its possible mode of action on a molecular level, this preliminary study evaluated CDP in patients with peripheral leg lymphedema as to the potential role of gene expression in the inflammatory response. The quantitative expression of genes for CD14, interferon-gamma receptor (IFN gamma R), tumor necrosis factor-alpha (TNF alpha), integrin alpha 4 beta 1 (VLA-4), tumor necrosis factor receptor p55 (TNFR1) and CD44 (standard form) was examined in 9 patients with primary or secondary leg lymphedema before and after phase 1 of CDP. Overall, there was a decrease of expression of these pro-inflammatory genes after CDP, suggesting that biologic mechanisms implicated in the inflammatory cascades in other disorders are also involved in the fibrosclerotic reactivity in lymphedema. However, whereas each patient acted as his or her own control before and after CDP, gene expression in normal patients and normal limbs before and after CDP needs to be examined before the full meaning of these observations can be understood.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10769812&dopt=Abstract skin, skin care, skin care medicine