ABSTRACT
Constitutional eczema in children is common. It itches and has a negative impact on quality of life. Although there are good treatments, in practice many children appear to be undertreated. Possible causes of this are: insufficient knowledge about background and treatment and insufficient cooperation between care providers. In addition, many parents are unjustly afraid of the adverse effects of hormone ointments. Some caregivers are just as afraid of hormone ointments as parents. A comment from one of them can damage the confidence of parents in the effectiveness and safety of these ointments.In our opinion, children with eczema deserve better. That is why we propose to organize regional care, education and cooperation for children with eczema. Not only general practitioners and dermatologists should participate; pharmacists and pharmacy assistants, youth health care physicians and nurses and paediatricians should also join. Information material must be uniform.
Subject(s)
Dermatitis, Atopic , Eczema , General Practitioners , Adolescent , Child , Dermatitis, Atopic/therapy , Eczema/therapy , Humans , Ointments , Quality of LifeABSTRACT
BACKGROUND: Microscopy of a potassium hydroxide preparation of skin scrapings or nail clippings, although widely advocated as a test for dermatomycosis, is used in only a small proportion of cases. AIM: This study set out to investigate the effect of potassium hydroxide testing on the subjectively assessed probability that a dermatomycosis was present. METHOD: The study was undertaken in 1992 in Limburg, a province in the south of the Netherlands. Ten general practitioners and eight trainees completed a questionnaire and performed a potassium hydroxide preparation for each patient presenting with a skin condition that they thought might be caused by dermatomycosis. Skin or nail material was also sent to a microbiology laboratory where another potassium hydroxide preparation as well as a culture were performed, these two tests serving as a gold standard against which to judge the potassium hydroxide preparation by the general practitioners. Data from a total of 164 cases were analysed. RESULTS: The results of the potassium hydroxide test carried out in the practice had a considerable influence on the subjectively assessed probability that a dermatomycosis was present, especially if the outcome was positive. The indication for antifungal treatment was altered as a result of the test in a quarter of all cases, mostly from negative to positive. Use of the practice potassium hydroxide test could increase the proportion of correct therapeutic decisions from 54% to 69%, with 20% of cases being undertreated. Of cases that gave a positive test result in the practice 83% also had a positive laboratory test result, while of cases that gave a negative practice result 43% were positive in the laboratory. CONCLUSION: The potassium hydroxide test improves the diagnostic process in cases of possible dermatomycosis and may result in a change in management. The test can provide a confirmation of the diagnosis of dermatomycosis but is not useful in the exclusion of this diagnosis.
Subject(s)
Dermatomycoses/diagnosis , Hydroxides , Potassium Compounds , Clinical Laboratory Techniques , Diagnosis, Differential , Evaluation Studies as Topic , Family Practice , Humans , NetherlandsABSTRACT
The purpose of this paper was to establish the diagnostic value of the C-reactive protein measurement (CRP) in patients attending their general practitioner (GP) with a new complaint for which the GP considers determination of the erythrocyte sedimentation rate (ESR) to be indicated. During 4 successive months in 1992, 11 GPs in four general practice centres in the Netherlands identified patients indicated for the erythrocyte sedimentation rate. ESR and CRP were determined at the local hospital laboratory. One year later, an independent GP established the follow-up diagnoses. By comparing the test results with the follow-up diagnoses, using logistic regression analysis and Receiver Operating Characteristic curves, sensitivities, specificities, predictive values and odds ratios were established. In 396 patients the prevalence of inflammatory diseases and malignancies ('pathology') was found to be 26% in males and 15% in females. Both ESR and CRP were valuable in discriminating pathology from harmless, often self-limiting diseases. The optimal upper limits of reference values ('cut-off points') for ESR were found to be 31 mm in both males and females. At these cut-off points, the diagnostic gains from positive and negative test results (positive predictive value minus prevalence, and negative predictive value minus 100% minus prevalence) were 45% and 4% for males and 30% and 2% for females. The optimal cut-off point for CRP was found at 15 mg L-1 in males and 34 mg L-1 in females. The diagnostic gain from positive and negative test results were 18% and 9% in males and 25% and 4% in females.(ABSTRACT TRUNCATED AT 250 WORDS)
