Multidisciplinary educational programme for caregivers of children with atopic dermatitis- in South East Norway - an observational study.

BACKGROUND: Educational programmes for caregivers of children with atopic dermatitis (AD) are reported to reduce the severity of AD and improve quality of life (QOL). Oslo University Hospital (OUH) in Norway offers a multidisciplinary educational programme for caregivers of children with AD. We aimed to evaluate the AD educational programme by assessing QOL of the family, the severity of the disease and caregiver's fear of topical corticosteroid (TCS) before and after attending the programme. METHODS: This was a small observational prospective cohort study including 41 caregiver-child pairs. The children (mean age 3.4 years) had doctors' diagnosed AD with a difficult to treat eczema. The children's caregivers were referred from physicians to attend the AD educational programme at our hospital. At inclusion and at a 3 months follow-up QOL was assessed by Dermatitis Family Impact (DFI), the eczema severity by Patient-Orientated - SCORing Atopic Dermatitis (PO-SCORAD) and caregivers fear of TCS was recorded by asking a dichotomous "yes" or "no" question: "Are you worried about using TCS on your child?" RESULTS: Three months after caregivers attending the educational programme there was an improvement in QOL by reduced mean DFI from 9.6 (SD 6.3) to 6.8 (SD 5.4), the mean PO-SCORAD was reduced from 38.5 (SD 15.1) to 24.6 (SD13.6), the number of caregivers reporting fear of TCS use was reduced from 33/46 (72%) to 12/41 (29%). All results p < 0.001. CONCLUSION: Our study suggests beneficial effects by improving QOL of the family, the severity of the eczema and in reducing the fear of TCS when caregivers of children with difficult to treat AD attend an AD multidisciplinary educational programme. Lack of control group makes it difficult to draw definite conclusions.

Skin bioengineering in the diagnosis of occupational protein contact dermatitis.

Protein contact dermatitis (PCD) often presents as chronic hand eczema (CHE) with an immediate hypersensitivity to protein proved by a positive skin prick test or by the presence of specific immunoglobulin E. This is frequently induced by occupational exposure to proteins in food workers, farmers, animal breeders, veterinarians and healthcare professionals. While skin barrier impairment is crucial in the pathogenesis of PCD, methods to assess skin barrier function such as trans-epidermal water loss and stratum corneum hydration are not widely used in clinical settings. We describe the diagnostic workup of occupational PCD due to Argentinean shrimps and discuss how the use of skin bioengineering methods including assessment of corneocytes morphology by Scanning Electron Microscopy provides with insightful information on skin barrier function. Diagnosis of PCD is time-consuming and a multidisciplinary team contributes to early diagnosis and proper occupational rehabilitation.

Self-reported skin morbidity in Oslo. Associations with sociodemographic factors among adults in a cross-sectional study.

BACKGROUND: Previous studies on prevalence of skin diseases in the population have been based on clinical examination of a sample of the population. A questionnaire on self-reported skin complaints has recently been developed and validated for use in population surveys, but has not been used until now. OBJECTIVES: To quantify the skin morbidity in an adult urban population assessed by a newly developed self-measurement instrument, and to explore the associations between skin morbidity and sociodemographic factors in the community. METHODS: The study was a population-based cross-sectional study carried out in the city of Oslo. Adult participants (n = 18 770) aged 30-76 years answered a questionnaire giving information on self-reported skin complaints, and which included demographic, psychosocial and general health variables. RESULTS: Itch was the dominating skin complaint in all age groups. Adjusted odds ratios for itch, self-reported hand eczema and self-reported acne showed significant associations with female gender and reporting households of middle income. There was no association with employment categories. CONCLUSIONS: This study shows that skin complaints referring to the most common chronic skin diseases varied with age, gender and marital status, and worsened with middle-income household. It provides evidence that household income is associated with skin morbidity, bringing dermatological aspects to studies on health inequalities.

Self-reported skin complaints: validation of a questionnaire for population surveys.

BACKGROUND: Estimation of skin diseases in the community is challenging because we do not easily have access to the nonhealthcare-seeking population. A potential tool is a questionnaire asking for self-reported skin complaints. Such an instrument has not yet been developed. OBJECTIVES: To validate a simple instrument assessing skin morbidity in the general adult population, to predict clinical skin morbidity from self-reported skin complaints. METHODS: A questionnaire was drawn up in Norwegian and validated against clinical signs in two samples of an urban population, 100 healthcare-seeking adults in a dermatological clinic, and 100 nonhealthcare-seeking adults. A total self-reported score was calculated and validated against severity of clinical signs (no sign, trivial, moderate or severe). The inter-rater agreement was assessed in a small study including 16 patients from a dermatological clinic. RESULTS: The participation rate was 98%. The sensitivity was 61%, the specificity 69% and the positive predictive value 82% when the caseness criterion was any clinical sign of skin disease. The agreement was good between the two observers for clinical skin morbidity, with kappa = 0.67. CONCLUSIONS: This questionnaire is a simple tool to evaluate skin morbidity in an adult population. The use of self-reported complaints to predict clinical morbidity may be of value in quantifying and exploring skin diseases at the population level. Further studies are needed to improve the instrument. It is our intention to demonstrate the potential usefulness of this questionnaire in a forthcoming population survey in Norway.

[Contact allergy to essential oils]. / Kontaktallergi overfor eteriske oljer.

Ethereal oils are widely used, in food, toothpaste, as flavouring agents in perfumes and cosmetics, and in dermatological treatment, as antiseptics, adstringenta, antipruritic tinctures, lotions and pomades. The use of ethereal oils seems to have increased in recent years, probably due to a growing interest in alternative medicine, and especially aromatherapy. By describing the cases of three patients with allergic contact dermatitis, we wish to point out possible unwanted side effects of using ethereal oils.

[Atopic eczema]. / Atopisk eksem.

Atopic eczema is one of the most common skin diseases of our time, and has commonly been regarded, without further proof, as caused by allergic factors. Although allergy may be involved in some cases, it is probably no more than an exacerbating factor and not the underlying cause. This has important implications for diagnosis and therapy. In recent years the interest has centred on the functional aspects of the skin barrier, with emphasis on lipid constituents in stratum corneum. The authors present some new data on the barrier function which are relevant to diagnosis and therapy.

[ADP-registration of patients with contact dermatitis at the Ullevål hospital. A 1-year material]. / EDB-registrering av pasienter med kontaktdermatitt ved Ullevål sykehus.

Databases for monitoring patients with contact dermatitis have become indispensable for managing a constantly increasing variety of products which cause allergic and toxic dermatitis. As a result of collaboration between the Department of Dermatology and Department of Information Technology, Ullevål Hospital, we now have developed a database for registering patients with occupational dermatitis. The programming tool is DataEase, which contains files for the patients' personal data, site of the dermatitis, results of tests and diagnosis.

An epidemiological study of hand eczema. I. Prevalence and cumulative prevalence among hairdressers compared with a control group of teachers.

The aim of this cross-sectional study was to estimate the prevalence of dermatitis of the hands and/or forearms among hairdressers compared with a control group of elementary school teachers. Questionnaires were sent to 818 hairdressers and 816 teachers. The response rates were 83% and 65%, respectively. The mean age for those completing the questionnaire, was 28 years (range: 17-71) for the hairdressers and 45 years (range: 20-70) for the teachers. The mean number of months employed in these occupations was 105 (range: 1-672) and 186 (range: 0-516), respectively. Forty-two per cent of the hairdressers and 23% of the teachers suffered or had been suffering from exanthema of the hands and/or forearms. Sixty-one and 15%, respectively, related the skin disease to work.

An epidemiological study of hand eczema. II. Prevalence of atopic diathesis in hairdressers, compared with a control group of teachers.

The aim of this cross-sectional study was to estimate the prevalence of atopic dermatitis in hairdressers compared with a control group of elementary school teachers. Both groups consisted of employees who reported exanthema on the hands and/or forearms at the time of completing a questionnaire. The mean age for the affected hairdressers was 26 years (range: 17-63) and for the teachers 44 years (range: 28-65). The mean duration of employment was 85 months for the hairdressers (range: 2-552) and 177 months for the teachers (range: 24-360). The frequency of atopic dermatitis was 12.7% (C.I.: 6.3-19.2) in the group of hairdressers and 25% (C.I.: 7.7-42.3) in the group of teachers. No difference was observed between the groups regarding atopic mucosal symptoms or familial atopy.

An epidemiological study of hand eczema. III. Characterization of hairdressers with and without hand eczema, regarding demographic factors and medical histories.

The aim of this study was to compare, by stratification, subgroups of hairdressers. Three groups were considered: Group I (102 persons) consisted of hairdressers reporting skin affection at the time of completing an earlier mailed questionnaire (point prevalence). Group II reported exanthema prior to completing, while group III reported not having had exanthema at all (51 and 50 persons, respectively). No significant difference was found between these groups with regard to age and duration in work. The mean number of months since start of disease was significantly higher for group I (64 (range: 0.5-552)) than group II (7 (range: 0.6-38)). The frequency of atopic dermatitis was 12.7% (C.I: 6.3-19.2) in group I, compared with 3.9% (C.I: 0.0-9.2) in group II and none in group III. This difference between groups was significant. A significantly higher extent of sick leave was found in group I, compared to group II.

An epidemiological study of hand eczema. IV. Degree and pattern of eczema in affected hairdressers, with and without atopic symptoms, compared with a control group of affected teachers.

The aim of this study was to show degree and pattern of hand eczema in affected hairdressers (n = 69), compared with a control group of teachers (n = 19). Both groups consisted of employees having eczema, confirmed by the visit of a doctor at the working place. The mean age for the affected hairdressers was 27 years (range: 17-63) and for the teachers 43 years (range: 27-57). The mean duration of employment was 96 months for the hairdressers (range: 2-552) and 182 months for the teachers (range: 25-336). The localization of eczematous lesions, presence of efflorescenses and extent of skin affection were recorded by constructing scores for these variables. The mean number of localizations was significantly higher in hairdressers than in teachers; this was caused by greater affection of fingers in hairdressers compared to teachers. Seventy-five percent of the hairdressers and 79% of the teachers had only modest or very moderate erythema. Fourteen percent and 5%, respectively, had vesicular dermatitis. The right upper limb was most affected in both hairdressers and teachers. Three subgroups of hairdressers were considered: hairdressers with atopic dermatitis, those with only atopic mucosal symptoms and those without atopic symptoms. No significant differences were found between these groups, except a significant higher finger involvement in atopics compared to non-atopics.

An epidemiological study of hand eczema. V. Prevalence among hairdresser trainees, compared with a general population of hairdressers.

The aim of this study was to show degree and pattern of hand eczema in affected hairdresser trainees (n = 52), compared with a general population of affected hairdressers (n = 69). The mean ages were 18 years (range: 16-25) for the trainees and 27 years (range: 17-63) for the hairdressers. For the latter group, the mean number of months spent in profession was 96 (range: 2-552) and the number of working hours per week was 36 (range: 4-50). Twenty-seven per cent of all trainees (67/246) were reported to have had initial of eczematous lesions on the hands and/or forearms during their apprenticeship. The extent of skin affection, as assessed by scores for localization and distribution of eczema, was significantly lower in trainees, compared with the general population of hairdressers. Patch test revealed sensitization to nickel to be prominent in both groups; 34% among affected hairdressers and 26% among affected and non-affected trainees. Of the hairdressers, 3% had allergy to hair dye (2.5-toluenediamine), while 8% were sensitized to glyceryl monothioglycolate. None of the trainees were sensitized to those two chemicals.

An epidemiological study of hand eczema. VI. A follow-up of hairdresser trainees, with the focus on various health complaints.

The aim of this follow up study was to show how career dropouts among young hairdressers are related to various health complaints. Questionnaires were sent to 286 hairdressers, who had been registered as trainees three to five years earlier. The forms were returned from 124 hairdressers, of whom 26 (21%) reported that they stopped working as hairdressers because of various health complaints. Eight (6.5%) left their job because of skin conditions.

[Epicutaneous testing (patch testing)]. / Epikutantesting (lappetesting).

At present, patch testing is the only practical way of diagnosing allergic contact dermatitis, manifested as delayed hypersensitivity (type IV reaction). It can serve to confirm relevant allergens, but may also help to exclude suspected contact sensitivity. The test procedure varies somewhat from one clinic to another but has been standardized by the International Contact Dermatitis Research Group. Choice of test materials and their application may appear simple, but test readings and interpretation of results are most important. Positive reactions can be positive (allergic) or false positive (irritant), and relevant or not relevant to an existing or previous dermatitis. The dermatologist is the person best qualified to diagnose contact dermatitis by this test procedure.

[Rubber allergy. An increasing health problem?]. / Gummiallergi. Et økende helseproblem?

Allergic reactions to rubber (latex) are now being reported more frequently. Symptoms include urticaria, contact dermatitis, rhinitis, local angioedema, asthma and anaphylactic shock. Medical workers and some groups of patients seem to be at risk of developing rubber allergy. The increased use of rubber gloves and condoms to prevent the spread of infections seems to lead to increased incidence of latex hypersensitivity. We report the case of a patient who experienced an immediate allergic reaction after using a condom. We then discuss latex antigens, the incidence and diagnosis of latex allergy, and associated risk factors.

[Delayed allergy against rubber gloves. An occupational dermatitis among health personnel]. / Senallergi mot gummihansker. En yrkesdermatose hos helsepersonell.

Allergic reactions to rubber gloves, an increasing problem in medical health services, have become an prominent topic in occupational dermatology. A broad spectrum of immunological mechanisms are involved, from antibody-induced immediate reactions to delayed cell-mediated reactions. We review the causes of the reactions and discuss diagnostic procedures. The main allergens are rubber additives, such as accelerators and antioxidants. In this connection it is important to develop and produce gloves using other basic materials and ingredients, and thereby avoid the most frequent allergens.