Sensitisation to fungi in atopic dermatitis patients over 14 years of age and the relation to the occurrence of food hypersensitivity reactions.

The aim of this study was to evaluate if there is some relation between the sensitisation to fungi and the occurrence of food hypersensitivity reactions in atopic dermatitis patients aged 14 years and older. Complete dermatological and allergological examination was performed in all included patients; the occurrence of food hypersensitivity reactions was recorded and the sensitisation to mixture of fungi was examined (skin prick test, specific IgE). The statistical evaluation of the relation between the sensitisation to fungi and the occurrence of food hypersensitivity reactions was performed; 331 patients were included in the study, 110 men and 221 women, the average age was 26.8 years. The sensitisation to fungi was recorded in 100 patients (30%), the occurrence of food hypersensitivity reactions was recorded in 261 patients (79%). We confirmed that patients suffering from sensitisation to fungi suffer significantly more often from food hypersensitivity reactions to nuts (walnuts, peanuts) and sea fish; no significant relation was confirmed between the sensitisation to fungi and the occurrence of food hypersensitivity reactions to tomatoes, kiwi, apples, spices, oranges, capsicum, celery and carrot.

Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

The European Status Quo in legal recognition and patient-care services of occupational skin cancer.

BACKGROUND: Skin cancer is the most common malignancy in Caucasian populations worldwide and ultraviolet radiation (UVR) is known for being the number one carcinogen. As, especially in outdoor workers, UVR is an inevitable carcinogen, the prevention and management of UVR-related skin cancers in these at-risk populations represent a collective challenge for dermatologists and healthcare policymakers likewise. OBJECTIVE: To provide an overview on the current regulations on the acknowledgement and management of work-related skin cancer in 11 European countries. METHODS: Dermatologists from 11 countries networking within the EU Horizon 2020 COST Action TD1206 'StanDerm' contributed to a standardized survey regarding current national regulations, implemented for the recognition, prevention and management as well as possible compensation regulations in their individual country of residence. RESULTS: Ten of 11 participating countries in this survey reported the existence of an established programme available on certain occupational diseases; work-related skin diseases were only specifically recognized in eight countries. Seven of 11 countries recognize cutaneous squamous cell carcinoma in outdoor workers as 'occupational skin cancer'. Basal cell carcinoma (6 of 11), actinic keratosis (5 of 11), Bowen's disease (5 of 11) and malignant melanoma (5 of 11) are not as regularly approved as potentially 'work-induced'. Only a few of the countries included into this survey established a general documentation system (national registry) on occupational skin diseases. So far, representatives of only three countries of this survey referred to a specific established national programme for the prevention, management or compensation of occupational skin cancers acquired during work-related UVR exposure. CONCLUSION: This survey highlights the need for mandatory regulations on the prevention, management and potential compensation of work-related UV-induced skin cancer across Europe. Against the background of a joint European domestic market, equal standards of occupational safety across Europe should include binding regulations for the protection and management of work-related skin cancer. The design of a common regulation to meet the increasing incidence of skin cancers in outdoor workers should become part of the European agenda, ensuring equal working and living conditions in the member states.

Sensitization to aeroallergens in atopic dermatitis patients: association with concomitant allergic diseases.

BACKGROUND: A few reports demonstrate the relationship between IgE sensitization to aeroallergens in atopic dermatitis (AD) patients and other allergic diseases and parameters. OBJECTIVES: The objective of this study was to evaluate, if there is a significant relationship between the sensitization to common aeroallergens in AD patients and the occurrence of asthma bronchiale, rhinitis and other atopic parameters. METHODS: Sensitization to dust, mites, animal dander and bird feather was examined (skin prick test, specific IgE) and the relationship with the occurrence of asthma bronchiale, rhinitis, duration of AD, family history and onset of AD was evaluated. RESULTS: Two hundred and eighty-eight patients were examined - 90 men and 198 women. According to our results, IgE sensitization to animal dander, dust and mites may increase the risk of developing asthma or rhinitis. Persistent lesions of AD occur more often in patients with sensitization to animal dander, mites and dust. Patients with the sensitization to bird feather have the onset of AD more often above 5 years of age and in these patients, there is no relationship with the positive data about atopy in the family history. CONCLUSION: There is a greater likelihood of developing other allergic diseases in atopic dermatitis patients who suffer from sensitisation to animal dander, mites, and dust. Thus, prompt management of atopic dermatitis and allergy to inhallant allergens that develop in early infancy may be a successful method for preventing of atopic march.

Food hypersensitivity in patients over 14 years of age suffering from atopic dermatitis.

BACKGROUND: Patients suffering from atopic dermatitis often describe food hypersensitivity. Rising prevalence of food hypersensitivity and severe allergic reactions to foods have been reported, but the data are scarce. AIMS AND OBJECTIVES: Evaluation of food hypersensitivity reactions in patients suffering from atopic dermatitis. MATERIALS AND METHODS: The dermatological examination was performed in patients of age 14 years and above and the detailed history was taken concerning the food hypersensitivity. RESULTS: A total of 228 patients were examined-72 men, 156 women, average age 26.2 (SD 9.5) years. The food hypersensitivity reactions were recorded in 196 patients from 228 (86%), no reactions were recorded in 32 patients (24%). Foods with the most often recorded reactions are: Nuts (in 35% of patients), tomatoes (in 20%), and kiwi (in 17, 5%), apples and spices (in 16%), tangerines and oranges (in 15%), capsicum (in 13%), fishes (in 12%), celery (in 9%), and chocolate (in 7%). CONCLUSION: Food hypersensitivity reactions are recorded in 86% of patients suffering from atopic dermatitis. Nuts, tomatoes, and pollen-associated foods play a role in the majority of patients suffering from atopic dermatitis.

The effect of hypoallergenic diagnostic diet in adolescents and adult patients suffering from atopic dermatitis.

AIM: To evaluate the effect of a diagnostic hypoallergenic diet on the severity of atopic dermatitis in patients over 14 years of age. MATERIALS AND METHODS: The diagnostic hypoallergenic diet was recommended to patients suffering from atopic dermatitis for a period of 3 weeks. The severity of atopic dermatitis was evaluated at the beginning and at the end of this diet (SCORAD I, SCORAD II) and the difference in the SCORAD over this period was statistically evaluated. RESULTS: One hundred and forty-nine patients suffering from atopic dermatitis were included in the study: 108 women and 41 men. The average age of the subjects was 26.03 (SD: 9.6 years), with the ages ranging from a minimum of 14 years to a maximum of 63 years. The mean SCORAD at the beginning of the study (SCORAD I) was 32.9 points (SD: 14.1) and the mean SCORAD at the end of the diet (SCORAD II) was 25.2 points (SD: 9.99). The difference between SCORAD I and SCORAD II was evaluated with the Wilcoxon signed-rank test. The average decrease of SCORAD was 7.7 points, which was statistically significant (P=.00000). CONCLUSION: Introduction of the diagnostic hypoallergenic diet may serve as a temporary medical solution" in patients suffering from moderate or severe forms of atopic dermatitis. It is recommended that this diet be used in the diagnostic workup of food allergy.

[Biological treatment in dermatology--psoriasis]. / Biologická lécba v dermatologii--psoriáza.

Psoriasis is a chronic, relapsing skin disease affecting 1-2% of the population. Genetically-determined autoimmune inflammation is initiated by an infection (e.g. streptococcal). T-lymphocytes, producing a number ofcytokines, mainly of the Th1 profile, including TNF alpha, play a key role. The role of Th17 and its interleukin IL-23 has recently been confirmed. It contains p40 protein, also a component of IL-12. TNF alpha and p40 blockade appear to be an effective biological treatment of severe lesional psoriasis. Further research and new drug development is to assure modern individualized treatment of psoriasis as well as other skin diseases.

[Diabetic skin changes from the dermatological point of view]. / Kozní zmeny pri diabetu z pohledu dermatologa.

Even a half of diabetic patients are suffering from skin troubles. Hyperglykemia causes skin changes leading to higher incidence of bacterial and mycotic infections, provokes skin degenerative processes, macro- and microangiopathy and neuropathy. Diabetic dermopathy, rubeosis, bullousis and scleredema are based on these changes. Other skin diseases including necrobiosis lipoidica, granuloma anulare, vitiligo, perforating folliculitis accompany diabetes frequently but their etiopathogenesis is not clear.

[Photodynamic therapy used in dermatology--futher method development]. / Fotodynamická terapie v dermatologickém pouzití-- dalsí rozvoj metody.

Dermatological use of photodynamic therapy and photodynamic diagnostics is reviewed in this paper. Principle, practice, photosensitisers, indications and side effects are described.

Selected immunological changes in patients with Goeckerman's therapy TNF-alpha, sE-selectin, sP-selectin, sICAM-1 and IL-8.

Psoriasis is one of the most frequent inflammatory skin diseases in which abnormal individual immune reactivity plays an important role. The aim of the present study was to describe selected immunological changes, concerning pro-inflammatory cytokines (TNF-alpha, IL-8) and adhesion molecules (sE-selectin, sP-selectin, sICAM-1), in 56 patients cured by Goeckerman's therapy (GT). GT includes dermal application of crude coal tar (containing polycyclic aromatic hydrocarbons) and exposure to UV radiation. When compared with the control group (healthy blood donors), the patients before GT had significantly increased serum levels of sE-selectin (p<0.001), sP-selectin (p<0.001), sICAM-1 (p<0.001) and IL-8 (p<0.001). Significantly decreased serum levels of sE-selectin (p<0.05) and significantly increased serum levels of IL-8 (p<0.05) were found after GT therapy. Serum levels of sICAM significantly correlated with the disease activity and with serum levels of sE-selectin. The level of PASI score (Psoriasis Area and Severity Index) significantly decreased after GT (p<0.001) and confirms the high efficiency GT. These findings confirmed that pro-inflammatory chemokine (IL-8) and adhesion molecules (sE-selectin, sP-selectin, sICAM-1) play an important role in the development and regulation of inflammation in psoriasis. Determination of sE-selectin and sICAM seems to be a promising marker of psoriasis's activity. Chemokine pathway (IL-8) and TNF-alpha activity seem to be modulated by Goeckerman's therapy (polycyclic aromatic hydrocarbons).

[Sun photoaging]. / Slunecní stárnutí.

Only in the last years the recognition of the solar radiation danger has been glowing. The rising curve of the skin cancer makes it obvious mainly for the medical experts and it is the high time to warn the endangered laymen. There is a great quantity of the contemporary "photopathological" knowledge but there is still a long way to go. This short synopsis of the very last publications intends to renew the ultraviolet comprehension of the medical professionals in order to share it with their patients.

[Determination of the minimal erythema dosage and natural photoprotection of the skin in the population]. / Stanovení minimálních erytémových dávek a prirozené fotoprotekce kuze u nasí populace.

Effects of ultraviolet radiation (UV) on the human skin are summarized in the introductory part from physical and biological point of view, especially photoaging and photocarcinogenesis. Special attention has been paid to skin phototype which characterizes the individual susceptibility to UV. The minimal erythema dose (MED) serves for establishment of this susceptibility. The mean MEDs for white population in other countries are also shown here. Mechanisms of natural photoprotection in connection with instructions how to increase artificial photoprotection are described here. The investigation of skin type incidence in our population and determining their mean MEDs for UV-B and polychromatic light was the aim of practical work. The UV-B MED is in average 23.4 mJ/cm2. The further work has been concentrated on the assessment of pigmentation response after irradiation and especially on the comparison of the minimal erythema doses before season and after it. We found mean double increase of the MED after sunlight exposition during summer season. We suggested, that double increasing of seasonal natural photoprotection does not represent definitive protection for most people and does not impair summer warning system in media which is based on winter MEDs. Some recommendations for improvement of protection of Czech population against UV radiation are proposed in conclusion.

Skin side-effects of amiodarone therapy.

Amiodarone is a antiarrhythmic drug with many side-effects which include also the induction of photosensitivity and the development of greyish-blue pigmentations on the skin exposed to light. The authors examined 64 patients treated with amiodarone and 32 controls by means of a phototest using a xenon lamp. In 9.4% photosensitivity was recorded, in 9.4% there were greyish-blue hyperpigmentations in the face and on the back of the hands. Histological identification of these hyperpigmentations including electron microscopy was also performed.

[Malignant melanoma of the head and neck]. / Maligní melanom hlavy a krku.

The authors evaluate the group of 25 patients suffering from malignant melanoma in head and neck region. Patients were treated on ENT clinic in Hradec Králové during 1961-1991. The authors describe the localization of malignant melanoma, the process of therapy and the surviving of patients. The contemporary opinions are discussed for possibilities of therapy.

[The adverse effects of computer video monitors on their operators]. / Nezádoucí vliv pocítacových monitoru na obsluhu.

Probable undesirable influence of visual display terminals to attendance are characterized: electric and electrostatic fields, magnetic field, x-ray and UV-radiation. There are described protective arrangements here: terminals of a new construction, prospectively protective filters in front of old terminals.

[The role of ultraviolet rays in the etiopathogenesis of malignant melanoma]. / Prispevek k hodnocení úlohy ultrafialového zárení v etiopatogenezi maligního melanomu.

The aim of the study was to elucidate the role of UV radiation in the etiology of malignant melanoma within the conditions of East Bohemia region. In selected patients with malignant melanoma, anamnestic data pertinent to the frequency of sun-bathing as well as a bulk of the occupational indoor exposures brought about the action of UV-light artificial sources have been withdrawn from past history. Constitutional features for suspected photosensitivity such as the fair skin complexion and skin phototype, were investigated. The object of assumption was also the site of anatomical localization (i. e. body site distribution) of primary malignant melanoma. In a selected group of patients, routine phototesting followed by the above-threshold skin phototests were carried out with the aim to assess the capacity of reparative processes essentially occurring in the irradiated skin. In the epidemiologically oriented part of study, presumable relationships between the year's maxima of sunlight radiation and the increases in the incidence of malignant melanoma were treated statistically. It followed from the results obtained that sunlight itself is not a decisive factor and cannot explain an increased incidence of malignant melanoma in East Bohemia region.