Suffering in psoriasis patients: its relation with illness severity and subjective well-being.

OBJECTIVE: The aim of the present study was to explore the relationship among subjective illness impact, subjective well-being, and psoriasis severity as assessed by dermatologists. Furthermore, subjective well-being of psoriasis patients was compared to available norm data. METHODS: Fifty-nine psoriasis patients participated in this study. The following measures were administered: (a) the Pictorial Representation of Illness and Self Measure - Revised (PRISM-R), yielding Self-Illness Separation (SIS), and Illness Perception Measure (IPM); (b) subjective health status; (c) life satisfaction, and (d) psychological well-being. In addition, the Psoriasis Area and Severity Index (PASI) was determined by dermatologists. RESULTS: Psoriasis patients scored significantly below the norm data on subjective health status and psychological well-being. No differences were found concerning life satisfaction. PASI failed to correlate significantly with any of the disease impact and subjective health measures. Neither did SIS correlate significantly with any of the subjective health measures, whereas IPM was negatively associated with subjective health status, life satisfaction, and psychologic well-being. In a regression analysis with PASI as the dependent measures, none of the subjective health measures showed up as a relevant predictor. CONCLUSION: In comparison with the norm data, psoriasis patients report less subjective health status and well-being whereas their life satisfaction is not affected. There is no clear association among illness impact, subjective well-being, and illness severity as assessed by dermatologists.

Porokeratotic palmoplantar keratoderma discreta--a new entity or a variant of porokeratosis plantaris discreta?

We report a family with hyperkeratotic lesions on palms and soles. The lesions became evident in the second to third decade, and there is an autosomal dominant mode of transmission. Skin biopsy specimens show a central epidermal depression filled by a compact hyperkeratotic plug of columnar parakeratosis, like a broad cornoid lamella. The lesions resemble porokeratosis plantaris discreta clinically and histologically. The cornoid lamella is a broad, solid keratin plug rather than a centrifugally enlarging annular or serpentine ridge as can been seen in other types of porokeratosis. Perhaps the lesions of porokeratosis plantaris discreta should not be classified as a true porokeratosis but as porokeratotic plantar keratoderma discreta. We have therefore called the lesions in our patients porokeratotic palmoplantar keratoderma discreta, and suggest that porokeratotic palmoplantar keratoderma discreta is a variant of porokeratosis plantaris discreta.

Venous stasis ulcers. Diagnostic and surgical considerations.

BACKGROUND: Less than 10% of venous ulcers are refractory to a conservative treatment with compression bandages. Patients with such chronic or frequently recurring ulcers are candidates for surgical intervention. OBJECTIVE: This review article discusses the various therapeutic modalities for venous ulcers resistant to compression therapy. METHODS: Each therapeutic modality is discussed separately. RESULTS: There are several therapeutic options. It is not easy to determine the proper place of each therapeutic modality in the management of venous leg ulcers. No type of surgical or medical management is truly curative of venous insufficiency, only palliative. An algorithm is proposed, which may serve as a guideline for chosing the best suitable therapeutic option. CONCLUSION: With a better understanding of therapeutic options other than compression therapy the care for each individual patient may be optimized.

Fungal infections in the Netherlands. Prevailing fungi and pattern of infection.

BACKGROUND: Species of fungi have specific characteristics in geographic distribution, and they have a predilection for certain body areas. OBJECTIVE: To obtain information about the prevailing fungi and their pattern of infection in the Netherlands. METHODS: An analysis was made of the results of mycological examinations carried out in subjects referred to the mycological laboratory of the Department of Dermatology, University Hospital Leiden, the Netherlands, in the period of 1972-1992. RESULTS: The feet, extremities and groin were most commonly infected. The feet and extremities were mainly infected with dermatophytes (Trichophyton rubrum), but in the groin Candida albicans accounted for 49.9% of the fungal infections. Onychomycosis ranked third in prevalence (17.3% of all fungal infections). The main etiologic agent in the toenails was T. rubrum, but in fingernails C. albicans seems to be at least as important as T. rubrum. On the trunk (mainly the chest, especially in women) and buttocks C. albicans was again the main etiologic agent for fungal infections. Dermatophytes accounted for only 32.4% and 14.2% of the fungal infections on the buttock and trunk, respectively. On the buttock and trunk T. rubrum was the main etiologic agent as far as dermatophytes are concerned. On the trunk, Microsporum canis and M. ferrugineum were of some importance as well. The prevalence of tinea capitis was very low and accounted for only 0.7% of all fungal infections. CONCLUSION: Cutaneous candidosis accounted for 30.3% of all fungal infections and is therefore important. On the chest, buttocks, groin and finger-nails, the prevalence of C. albicans is higher than that of dermatophytes.

Treatment of contact hypersensitivity with urocanic acid.

In order to investigate the effect of cis-urocanic acid (UCA) on a delayed-type hypersensitivity response in humans, a contact hypersensitivity reaction was induced on four test sites on the back of 33 volunteer subjects. The first test site was pretreated with cis-UCA immediately before application of the allergen. The second and third test sites were posttreated on the second and third days of the hypersensitivity response with cis-UCA and a class III corticosteroid, respectively. The fourth test site was used as a positive control. The cutaneous blood flow of the test sites was measured using laser Doppler flowmetry. Pretreatment with cis-UCA reduced the hypersensitivity response significantly. It is possible that cis-UCA could be used in the preventive treatment of contact hypersensitivity responses.

[Fungi causing onychomycoses in The Netherlands]. / Fungi die onychomycosis veroorzaken in Nederland.

OBJECTIVE: To obtain information about prevalences of fungi responsible for onychomycosis in the Netherlands. DESIGN: Retrospective. SETTING: Mycological laboratory of the Dermatological department, University Hospital, Leiden, the Netherlands. METHODS: The results of mycological tests of nail samples collected in the period of 1987-1992 were analysed. If the culture was positive, the nature of the yeast or dermatophyte was determined. RESULTS: Nail samples were obtained from 861 patients (22% fingernails, 78% toenails). No mycological confirmation of clinical diagnosis could be obtained in 60% of fingernail samples and 45% of toenail samples. Of the mycologically confirmed finger onychomycoses 77.5% were caused by yeasts, the remaining part by Trichophyton rubrum. Toenail onychomycosis in 9.9% of the cases was caused by yeasts, in 11.8% by T. mentagrophytes, in 1.2% by Epidermophyton floccosum, and in under 1% by non-dermatophytes. Just as in fingernail onychomycosis, the major cause of toenail onychomycosis is T. rubrum. CONCLUSION: Onychomycosis cannot be diagnosed on clinical grounds, without mycological testing. Since antimycotic treatment is not always effective in onychomycosis caused by yeasts and non-dermatophytes, mycological diagnosis is necessary.

[Swimmer's eczema: intertrigo, erythrasma or a yeast or fungus infection?]. / Zwemmerseczeem: intertrigo, erythrasma of een infectie met een gist of schimmel?

OBJECTIVE: To determine the proportional contributions of tinea pedis, intertrigo, erythrasma and Candida to 'swimmer's eczema.' DESIGN: Descriptive. SETTING: Department of Dermatology, University Hospital Leiden, the Netherlands. METHOD: General practitioners were encouraged to refer every patient with clinical signs of foot mycosis. Mycological tests (culture and microscopy) were performed. RESULTS: A total of 296 patients with interdigital mycosis and 30 with tinea pedis of the moccasin type were included. In 56% of the patients with swimmer's eczema dermatophytes were recognised, 10% showed erythrasma and in 30% no cause could be found. Candida only played a minor role. Trichophyton mentagrophytes was found more often in swimmer's eczema than in tinea pedis of the moccasin type. CONCLUSION: Swimmer's eczema has several causes, which can be determined with mycological tests. Microscopy is the most sensitive method in regard to demonstrating dermatophytes and erythrasma.

Site variations in patch test responses on the back.

To establish the existence of intra-regional variations in response to allergens on the back, we performed patch tests in 21 patients at 2 different sites on the back. Visual readings using the numerical scale established by the International Contact Dermatitis Research Group were carried out 2 days after application of the allergen. After each visual reading, the skin blood flow at the test sites was quantified by laser Doppler flowmetry. The results of laser Doppler flowmetry showed a highly significant difference between the upper and lower back. It is therefore necessary that in quantitative and comparative investigations, symmetrical sites, i.e., left versus right sides of the body, should be studied.

Tinea capitis in Northwestern Europe 1963-1993: etiologic agents and their changing prevalence.

BACKGROUND: Although tinea capitis is endemic in many countries, its prevalence in Northwestern Europe (Belgium and the Netherlands) has not been established. MATERIALS AND METHODS: Scales, pus, and hair were examined from 435 cases of tinea capitis for etiologic agents and their relative percentages calculated for 5-year period between 1963 and 1992. RESULTS: There was a change in organisms associated with tinea capitis in the Netherlands from Trichophyton schoenleinii to Trichophyton violaceum. Increased immigration from the Mediterranean is held partly responsible for the increased prevalence of T. violaceum infections. Infection with zoophilic dermatophytes, such as T. canis, has also become more frequent in the Netherlands. CONCLUSIONS: The zoophilic dermatophytes have supplanted the anthropophilic dermatophytes as the cause of tinea capitis in the Netherlands.

Ulcerating necrobiosis lipoidica effectively treated with pentoxifylline.

A 30-year-old man had suffered from persistent ulceration within an area of necrobiosis lipoidica diabeticorum for 13 months. The ulcerating necrobiosis lipoidica was resistant to topical therapy and oral therapy with acetylsalicylic acid. However, the ulcers healed completely within 8 weeks of administration of 400 mg pentoxifylline twice daily.

Sustained renal function loss in psoriasis patients after withdrawal of low-dose cyclosporin therapy.

Eight patients with psoriasis received low-dose cyclosporin (CyA) treatment for an average period of 12 months (range 4-16 months). There was great variability in minimal effective CyA dose. In 50% of the patients long-term treatment was limited by dose reductions necessitated by side-effects. A considerable impairment of renal function during CyA therapy was found. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured with 125I-iothalamate and 131I-hippuran, respectively. Both at the end of the active treatment period (GFR-CyA and ERPF-CyA), and 4 months after withdrawal of CyA (GFR-4mo and ERPF-4mo), there was sustained renal impairment: GFR-BL = 97 (64-117), GFR-CyA reduction 17.8% (2.2-31.9%) [P < 0.02], GFR-4mo reduction = 9.8% (5.5-21.5%) ml/min/1.73 m2 (P < 0.05 vs. BL); ERPF-BL = 401 (232-607), ERPF-CyA reduction = 10.1% (7.4-27.3%) [P < 0.05], ERPF-4mo reduction = 13.5% (3.0-32.9%) ml/min/1.73 m2 (P < 0.02). Further studies of the effects on renal function during, and after, long-term therapy of psoriasis with low-dose CyA are warranted.