Adaptation of the Evidence-Based Nursing Practice Guideline: Prevention and Management of Moisture Associated Skin Damage / 임상간호연구

PURPOSE: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. METHODS: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. RESULTS: The adapted MASD clinical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. CONCLUSION: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.

El problema médico legal de las dermatosis ocupacionales / The legal medical problem of occupational dermatoses

Resumen:La dermatosis profesional es aquella alteración dermatológica que se ve originada o empeorada por las condiciones de trabajo. Los estudios comparativos entre países se ven limitados por las diferencias existentes en la notificación de enfermedades profesionales, siendo muchas veces su incidencia subestimada a pesar de ser de gran impacto socioeconómico, pues éstas son una causa frecuente de incapacidad y/o discapacidad relacionada con el trabajo, pudiendo constituir un porcentaje importante de las indemnizaciones económicas en muchas naciones. Es difícil establecer la relación de causalidad entre las dermatosis y una profesión o actividad laboral específica sin disponer de parámetros objetivos, por lo que este artículo busca dar un amplio panorama de cómo abordar el problema médico legal de las dermatosis ocupacionales en las pericias diarias de un médico legista.

Abstract:The professional dermatosis is a dermatological alteration that is originated or worsened by conditions of work. The comparative studies among different countries are limited by the differences in the notification system of occupational diseases, in such a manner that is often underestimated even though they have a socioeconomic impact. In the case of the occupational dermatosis, in many countries they constitute an important percentage of the economic indemnifications, and also a frequent reason of disability related to the job itself. Being able to establish a relation of causality between the dermatosis and a profession or specific labor activity without having objective parameters is most of the time difficult, so that this article seeks to give a wide panorama of how to approach the medical legal problem of the occupational dermatosis in the daily expertise of a forensic doctor.

Dermatite de contato em crianças / Contact dermatitis in children

A dermatite de contato é uma doença comum que ocorre em qualquer faixa etária, inclusive em crianças. Alguns fatores devem ser considerados no desenvolvimento da dermatite de contato, como idade, cor, sexo, a localização da dermatose, contato com substâncias alergênicas e a associação com outras dermatoses.

A Case of Irritant Dermatitis due to Ranunculus japonicus / 대한피부과학회지

Irritant dermatitis is the most frequent type of plant-related dermatitis. Plant families most commonly associated with irritation are Ranunculaceae, Euphorbiaceae, Cruciferae, Brassicaceae, Urticaceae, and Solanaceae. We report a case of irritant contact dermatitis caused by Ranunculus japonicus for the treatment of arthralgia in a 78 year old female.

Primary Irritant Dermatitis to Povidone-Iodine after Caudal Anesthesia: A Case Report / 대한마취과학회지

Povidone-iodine (PVP-1) is a widely used antiseptic because of its low toxicity and germicidal effect. A 16 year old patient who had undergone incision and debridement of an anal abscess developed contact dermatitis on his buttocks postoperatively. The lesion had been exposed to a gauze immersed in a 10% povidone-iodine solution for 8 hours, but the skin around the surgical field directly painted with 10% povidone-iodine solution didn't show any effect. A patch test with povidone-iodine produced a negative response in this patient. These observations indicate that prolonged exposure to wet povidone-iodine is harmful. It is important that povidone-iodine be used carefully to prevent contact dermatitis.

Two Cases of Irritant Dermatitis due to Clematis apiifolia A.P.DC / 대한피부과학회지

The clematis apiifolia A.P. DC. is a plant which belongs to Clematis Linne, Ranunculaceae. It contains anemonol, clematiscampher, clematin, labenzyme, saponin, of which anemonol is a probable irritant reacting component. We report two cases of irritant dermatitis due to Clematis apiifolia A.P.DC. plant. These patients developed painful, inflamed erythematous patches with flaccid bullae and erosions on the application sites of the crushed plant for self-treatment of arthralgia.

A Case of Primary Irritant Dermatitis due to Ranunculus Tachiorei / 대한피부과학회지

Ranunculus tachiorei is a member of the buttercup family (Ranunculaceae) which contains unsaturated lactone and protoanemonine. Protoanemonine is formed by the breakdown of the glycoside Ranunculin after injury to the plant and causes severe vesiculation and linear streaks after contact with field buttercups(Ranunculus spp.) The amount of protoanemonine in buttercups varies widely with the species of plant and its stage of growth, the highest content being at the time of flowering. We report a case of primary irritant dermatitis due to contact with Ranunculus Tachiorei which was applied for the folk treatment of Bell palsy.

A Case of Irritant Dermatitis due to Pulsatilla Koreana / 대한피부과학회지

Pulsatilla koreana is a member of the buttercup familly(Ranuculaceae) which contains the unsaturated lactone, protoanemonin(C3H4O2), formed after injury to the plant by the breakdown of the glycoside ranunculin. It has been prescribed as a herbal medicine or a folk medicine for antipyretic, analgesic, anti-inflammatory, astringent and hemostatic effects in Korea. A 20 year-old famale patient presented with confluent vesicobullae on the erythematous base with a burning sensation on her upper back. This was caused by contact with crushed Pulsatilla koreana, a folk medicine for the treatment of left facial nerve palsy, that had occurred 10 days before her visit. A provocation patch test with Pulsatilla koreana upon a heathy male volunteers upper back showed strong positive reactions with the stalk and leaf in fresh and frozen stat.e and after thaw ing resptively. However no reaction was seen when the folk medicine was used in a dried form or with the root in any state. This case indicates that misadvice and ignorant folk remedies could cause misfortunate results to innocent people.

The Effects of Multiple UVB Exposures on Proliferation and Melanization in Cultured Human Melanocytes / 대한피부과학회지

BACKGROUND: In the skin, the major stimulus for cutaneous pigmentation is ultraviolet radiation. The most important physiologic role of melanin is protection against harmful UV radiation to skin. It is known there are some differences in melanization between a single and multiple exposures of UVB, in vivo. Little if known about the functions of the melanocyte alone in cutaneous pigmentation after ultraviolet exposure, because of the complexity of interactions in the whole epidermis. OBJECTIVE: To investigate the effects of multiple exposures at various dosages of UVB, and to compare the effect of UVB in multiple divided exposures with a single exposure at the same total dosage of UVB on proliferation and melanization in cultured human melanocyte. METHODS: Melanocytes were cultured by modified TIC medium. The melanoctes were exposed daily for three consecutive days to UVB at 2, 4, 8 and 16 mJ/cm2and a single exposure at 24 mJ/cm2. The morphologic changes were examined by phase contrast microscopy. The melanocytes were counted by hemocytometer and melanin contents were assayed by spectrophotometer. RESULTS: 1. The effects of multiple UVB exposures: 1) The morphologic changes were as follows: With three time exposures at a dosage of 8 mJ/cm2, themelanocytes enlarged in size, and elongated their dendrites slightly; with three time exposures at a dosage of 16 mJ/cm2, enlargement in sized and elongation of dendrited were more significant. 2) With three time exposures at dosages of 2 nd 4 mJ/cm2, the proliferation of melanocytes was stiumlated significantly(p<0.05). However, with three time exposures at dosages of 8 and 16 mJ/cm2the proliferation was inhibited(p<0.05). 3) With three time exposures at dosages of 2 and 4 mJ/cm2, the melanin contents were decreased. However, with three tiem exposures at a dosage of 16 mJ/cm2, the melanin contents were highly increased(p<0.01). 2. The comparison between multiple divided exposures and a single exposure at the same toal dosage of UVB: 1) There were no morphologic differences of dendrities between with three time exposures at a dosage of 8 mJ/cm2 and with a single exposure at a dosage of 24 mJ/cm2. However enlarged melanocytes were more numerous with a single exposure. 2) The proliferation of melanocytes was more inhibited with a single exposure than with multiple divided exposures(p<0.05). 3) The melanin contents were more increased with a single exposure than with multiple divided exposures(p<0.05). CONCLUSION: With multiple exposures at lower dosages of UVB, the proliferation of melanocytes was stimulated, and melanization was decreased. However, with multiple exposures at higher dosages of UVB, the proliferation was inhibited, and melanization was increased. At the same total dosage of UVB, the proliferation was more inhibited, and the melanization was more increased with a single exposure than with multiple divided exposures.

Three cases of primary irritant dermatitis due to paraquat(gramoxone) / 대한피부과학회지

Paraquat(Gramoxone) is the most commonly used herbicide in Korea. But serious paraquat poisoning in human beings has occurred following ingestion or exposure to the skin. Exposure to paraquat through the skin has resulted in local irritation or inflammation of varyiig degree, sometimes severe. We report three cases of primary irritant dermatitis due to paraquat. Two patients developed generalized vesicobullae and necrotirulcer in the scrotum, respectively. The other patient developed painful whitish patch and erosion in ttie tongue after accidental exposure.

Three cases of primary irritant dermatitis due to buttercup / 대한피부과학회지

The buttercup is an inportant irritant plant which contairs an unsaturated lactone, protoanemonin, formed by the breakdown of a glucoside in injured plants. We report the three cases of irritant contact dermatitis due to buttercup(Ranunculus sceleratus). These patient developed erythematous and edematous patches with tense vesicles or bullae on t,he application site of pounded buttercup for the treatment of diabetes mellitus, arthralgia, and neuralgia, respectively.

In Vitro Effects of Several Irritants Using Human Keratinocyte Culture Model / 대한피부과학회지

Primary irritant dermatitis is one of the most common skin disease caused by various hazardous chemicals produced from the environment. For the detection of skin irritant potency, in vivo models such as human and animal patch test have been used, Keratinocyte culture method which has been set up very recently is another alternative in vivo method of detecting skin irritarlcy. LVe have investigated the effects of three skin irritants, phenol, benzoyl peroxide (BP), and sodium lauryl sulfate(SLS) on the keratinocyte culture system. Prostaglandin E(PGE) measurement, cell count and electron microscopic observation were performed after adding three irritants of different concentrations to the cultured keranocyte cells. The main results of this study were as follows : 1. There were statistically significant decreased cell number in concentration of 10 M phenol, 10 4M BP and SLS. The order of cytotoxic potency was SLS>BP >phenol. 2. In case of PGE production, decreased PGE production was observed 6 hours after addition of the irritants, except 10 M phenol and 10M BP groups. Decrea sing tendency sustained until 24 hours, however all were statistically nonsignificant comparing with control group. 3. Electron microscopic finding showed that dilatation of endoplasmic reticulums in 10 M phenol group, condensation and dilatation of mitochondrias in 10 4M BP group, and most of the cells were swollen in 10 4M SLS group. These results suggest that cell count is a useful model for performing cytotoxi city test in keratinocyte culture decreased PGE production represents cytotoxic effect in high concentration of primary irritants and ultrastructural changes may reflect the different pathomechanisms in cytotoxicity.