[Dermatological laser- and light treatments of scars].

Many patients struggle with tender, rigid and erythematous scars. Various modalities are used to treat cutaneous scars and in recent years, laser treatments are emerging as promising procedures. This article describes laser systems used for scar treatment according to scar type, evaluates the highest available level of evidence from randomized controlled trials (RCTs) and introduces a guideline for laser treatment of scars. Twelve RCTs documented effect on acne, burn and surgical scars. It is recommended that laser- and light-based treatments are considered according to the scar type.

Full-course drug challenge test in the diagnosis of delayed allergic reactions to penicillin.

BACKGROUND: Drug challenge test (DCT) has long been the most sensitive test in the allergological work-up when investigating for penicillin allergy. OBJECTIVE: To improve sensitivity of the diagnostic work-up in diagnosing penicillin allergics with histories of allergic reactions on day 2 or later in the course of penicillin treatment. METHODS: A full-course DCT was added to the current protocol if specific IgE, skin tests and DCT were all negative in patients who had a nonimmediate reaction to penicillin treatment. Sixteen patients with a history of an immediate reaction to penicillin treatment underwent testing with negative outcomes. RESULTS: Fifty percent of patients undergoing full-course DCT experienced a cutaneous adverse drug reaction. None of the controls reacted (p = 0.001). The mean time of reaction was 6 days. Penicillin V accounted for most reactions. Urticaria was the most frequent clinical reaction observed. CONCLUSIONS: Full-course DCT offers an improvement of sensitivity and predictive values of the diagnostic work-up of allergic reactions to penicillin occurring on day 2 of penicillin treatment or later.

Cutaneous adverse drug reactions seen at a university hospital department of dermatology.

Patients with suspected cutaneous adverse drug reactions are often referred to allergy clinics or departments of dermatology for evaluation. These patients are selected compared with patients identified in prospective and cross-sectional studies of hospital populations. This explains the observed variation in prevalence of specific reactions and of eliciting drugs. This study investigated the prevalence of cutaneous adverse drug reactions in a university hospital department of dermatology that is specially focused on allergy. An 8-month survey was carried out during the period April-December 2003. Consecutive patients suspected of having cutaneous adverse drug reactions during this period were examined by dermatologists and investigated. Drug imputability was assessed in the 194 patients included; 33.5% had an exanthema with certain or likely drug imputability. Urticaria and local reactions at injection sites were the most frequent reactions (25% and 18.8%, respectively). Beta-lactam antibiotics, extracts for desensitization and insulins were the main drug groups involved, and accounted for 22.8%, 17.1% and 14.2%, respectively, of the reactions. Extracts for desensitization and insulins elicited more reactions than expected. This probably reflects the referral pattern to an allergy clinic.

The prevalence of acute cutaneous drug reactions in a Scandinavian university hospital.

To investigate the epidemiology of acute cutaneous adverse drug reactions, a cross-sectional study was designed with four visits, equally distributed over one year, to all clinical departments of a large university hospital in order to find patients with possible drug-induced exanthema of less than 2 weeks' duration. Patients were examined clinically and offered investigation for possible drug allergy, including blood tests, and skin tests when appropriate. Subsequent drug challenge tests were performed in selected cases. Finally, the history and test results were evaluated to determine the imputability of each drug as the possible culprit. In a cohort of 11,371 in- and out-patients, 131 were referred for evaluation. Twenty-nine cases of acute cutaneous drug reactions were identified, giving a prevalence of 0.33% in in-patients, 0.14% in out-patients, and 0.25% overall. Twenty-five percent of the case patients died within 6 months after the study period. The most common type of skin reactions were symmetrically distributed maculo-papular exanthema and eczematous eruptions. Several more rare types of skin reactions were each represented by a single case. Beta-lactam antibiotics and chemotherapeutics were the most common eliciting drugs. The prevalence was lower than reported previously, but similar to a recent study. However, prospective studies are few and rarely performed in large hospital settings. Furthermore, variations in the pharmacotherapeutic traditions between countries may affect the outcome of such studies.

The prevalence of suspected and challenge-verified penicillin allergy in a university hospital population.

Suspected penicillin allergy is common among hospitalised patients, but the quality of the information given by the patient is often doubtful. Alleged penicillin allergic are likely to be treated with more toxic, broad-spectrum, and more expensive antibiotics, with effects on microbial resistance patterns and public economy as a consequence. We performed a cross-sectional case-control study with two visits to all clinical departments of a large university hospital in order to find in-patients with medical files labelled "penicillin allergy" or who reported penicillin allergy upon admission. Patient histories were obtained via a questionnaire, and they were offered investigation for penicillin allergy with specific IgE, basophil histamine release, skin prick tests, intradermal tests and drug challenge tests. Finally, the pharmaco-economical consequences of the penicillin allergy were estimated. In a cohort of 3642 patients, 96 fulfilled the inclusion criteria giving a point-prevalence of alleged penicillin allergy of 5% in a hospital in-patient population. Mean time elapsed since the alleged first reaction to penicillin was 20 years. The skin was the most frequently affected organ (82.2%), maculo-papular exanthema (35.4%) and urticaria (10.4%) being the most frequently reported reactions. 25% did not recall the time of their reaction. 82.2% did not remember the name of the penicillin they reacted to. 34.8% had been treated with penicillins after suspicion of penicillin allergy had been raised. None of these reacted to penicillins. 33.3% of the patients receiving antibiotics during their current hospitalisation were prescribed penicillins. 2% developed non-severe exanthema. The average acquisition costs for antibiotics to penicillin allergic patients were euro 278, compared to euro 119 had they been non-allergic. The prevalence of suspected penicillin allergy was lower than reported elsewhere. A substantial number of patients failed to recall basic information about their alleged allergy. Patients reporting penicillin allergy upon admission and labels stating penicillin allergy on medical files are ignored in almost a third of patients receiving antibiotics. The acquisition costs for antibiotics to penicillin allergic patients were higher, compared to the cost had the patients been non-allergic.

[Investigation of penicillin allergy. Procedures and retrospective statement of results for the period 1997 to 2001]. / Udredning af penicillinallergi. Procedurer og retrospektiv opgørelse af resultater for perioden 1997-2001.

INTRODUCTION: We describe procedures in and findings of investigation for allergy to penicillin as it was performed at the Dermatological Department and the Allergy Centre of Odense University Hospital in the 5-year period 1997-2001 and compare history with findings on skin tests and systemic challenge. MATERIAL AND METHODS: Retrospective evaluation of findings in the investigation of penicillin allergy. A total of 109 patients with a history of reaction to treatment with penicillins and a negative specific IgE for penicillins G and V were successively skin prick tested, intracutaneously skin tested, challenged orally and by intramuscular injection. Further testing was cancelled when a positive result occurred. RESULTS: Fifteen of 109 (13.7%) had positive reactions on investigation. There was no correlation between the type and severity of cutaneous or systemic reactions to penicillin or presence of other allergies and test positivity or negativity. 20% of the test-positive developed severe systemic reactions (respiratory, cardiovascular) upon systemic challenge. DISCUSSION: 13.7% in a selected patient material with a history of penicillin allergy and negative specific IgE were found to have reaction to penicillin upon investigation. A high percentage of patients (20%) experienced systemic reactions to provocation. This finding has resulted in new procedures for the investigation of allergy to penicillin in our clinic.