Estimating emollient usage in patients with eczema.

BACKGROUND: Atopic eczema (AE) is characterized by reduced skin hydration (SH) and impaired integrity of the skin. Proper emollient usage is an important facet of AE management and patients are encouraged to use emollients liberally. AIM: To evaluate whether the amount of emollient and skin cleanser used correlates with eczema severity, SH or transepidermal water loss (TEWL), and whether liberal usage alters disease severity, SH and TEWL. METHODS: We studied SH and TEWL at three common measurement sites on the forearm (antecubital flexure, 20 mm below the antecubital flexure, mid-forearm) and determined the SCORing Atopic Dermatitis (SCORAD) score, Nottingham Eczema Severity Score (NESS), Children's Dermatology Life Quality Index (CDLQI) and the amount of emollient and cleanser usage over a 2-week period in consecutive new patients seen at the paediatric skin clinic of a teaching hospital. RESULTS: In total, 48 subjects and 19 controls were recruited. Patients with AE had significantly higher TEWL and lower SH in the studied sites. Emollient and cleanser usage was significantly higher (P = 0.001 and P = 0.041, respectively) in patients with AE than in controls. The amount of emollient usage was correlated with NESS, SCORAD, CDLQI, TEWL and mid-forearm SH. No such correlation was found with cleanser usage. Regardless of SCORAD, prescribing 130 g/m(2)/week of emollient met the requirement of 95.8% of patients, and 73 g/m(2)/week met that of 85.4%; for the cleanser, prescribing 136 g/m(2)/week met the requirement of 91.7% of patients. Although skin dryness and SH were improved, there was no significant improvement in SCORAD or TEWL after 2 weeks. In terms of global acceptability of treatment, three-quarters of patients with AE and controls rated the combination of cream and cleanser as 'good' or 'very good'. CONCLUSIONS: Adequate amounts of emollient and bathing cleanser should be prescribed to patients with AE. These amounts can be conveniently estimated based on body surface area instead of the less readily available tools for disease severity, degree of SH or skin integrity. However, liberal usage of emollients and bathing cleanser alone does not seem to alter disease severity or TEWL within 2 weeks, implying that additional treatments are necessary to manage AE.

Filaggrin null mutations in childhood atopic dermatitis among the Chinese.

Atopic dermatitis (AD) is associated with loss or reduced expression of filaggrin (FLG). We evaluated five FLG null mutations, namely R501X, 2282del4, R2447X, S2554X, and S2889X, in 174 Chinese children with AD and 191 matched controls. 2282del4, R2447X, S2554X and S2889X mutations were not found in these patients. Heterozygous carriage of R501X was only found in four male patients, and associated with long-term disease severity. FLG mutations prevalent in Caucasian and other Asian populations are rarely found in our series.

Chronic otitis media and early speech development: a case study.

A case study of the speech development in a male infant with chronic otitis media is reported. The phonetic behavior characterizing the child's vocalizations was sampled monthly between the ages of 11 and 21 months, as he progressed from pre-speech to early speech periods of language development. Results of monthly phonetic inventory analyses indicated age-appropriate types of consonants in his pre-word and later-word vocalizations. However, the child's repertoire of consonants was considerably reduced as he first began to produce meaningful speech. Results of phonetic diversity analyses revealed an overall lack of phonetic complexity in his vocalizations throughout the course of study. In general, the child's early sound productions were characteristic of developmental delay, closely resembling the speech patterns found among severely hearing-imparied children. Findings are discussed with respect to the probable influence of chronic otitis media with effusion on a child's eventual speech development.

Relative timing characteristics of hearing-impaired speakers.

Speech duration characteristics of phrase-level utterances produced by 26 severely and profoundly hearing-impaired adults were examined acoustically using relative timing measures. The measures were then compared to the same utterances produced by 13 normal-hearing adults. Although absolute speech durations of the hearing-impaired subjects were significantly longer than their normal-hearing counterparts, relative timing did not differ between groups. Findings are discussed in relation to the biological constraint hypothesis associated with speech timing, as well as the role of auditory feedback in models of speech production.

Hearing levels of secondary school band directors.

Pure-tone AC HTLs were obtained from 52 secondary-school band directors aged 25-58 yrs with 1-28 yrs experience as directors. None reported any history of ear disease or excessive noise exposure other than their musical backgrounds. Groups I, II, and III had mean director experience of 5.3, 12,3, and 20.5 yrs, respectively. The hearing levels of Groups I, II, and III were, respectively, 5, 10, and 15 db less sensitive than those of comparably aged men with no noise exposure (Corso, 1963). SPLs in dbA of typical director locations were assessed. Though the 8-hr time-weighted exposures of the directors were below the "action level" for initiating a hearing conservation program, periodic audiometry was recommended.

Development of a distinctive feature discrimination test.

Construction and standardization is described of a distinctive feature discrimination test (DFDT) incorporating a modified Miller-Nicely system of distinctive features. The test is a rhyme-type where error responses in a closed set were chosen to be one, two, and three distinctive features removed from the stimulus word. Performance-intensity (P.I) functions were established with 6 normal-hearing young women (12 ears) at SPLs or 20, 25, 30, 35, and 40 db under each of three filter bandpass conditions: .2-6, .2-1.2, and .2-.6 kc/s. P-I functions were presented for unweighted scores and for scores where error responses were weighted in terms of distinctive feature differences from stimulus items. The 4 DFDT lists generated, and their 3 randomizations each, appear to have a reasonable degree of inter-list reliability and it is felt that the 12 resultant list may be used interchangeably, This preliminary study indicated that the DFDT test may provide more diagnostic information than currently-used discrimination test.

Influence of acoustic reflex on pure-tone thresholds in sensorineural patients.

Discrete-frequency Bekesy HTLs (.25, .5, 1, and 2 kc/s) of 12 sensorineural impaired Ss (8 bilateral, 4 unilateral) were compared under 3 conditions to determine the influence of the acoustic reflex (AR). The conditions were (1) tones in quiet, (2) tones with contralateral noise 20 db below the AR threshold for noise, and (3) tones with contralateral noise 10 db above AR threshold. The results revealed statistically and clinically significant threshold shifts due to the AR. Clinical implications were discussed.