[An adult woman with a linear skin eruption]. / Een vrouw met een streepvormige huidafwijking.

A 43-year-old woman presented with a linear skin eruption following the Blaschko lines on the left flank. Histopathological examination revealed lichenoid inflammation and a perieccrine lymphocytic infiltrate. Based on these clinical and histopathological findings the diagnosis lichen striatus was made.

Sugar tax and product reformulation proposals reduce the perceived legitimacy of health-promotion institutions: a randomized population-based survey experiment.

BACKGROUND: Structural nutrition interventions like a sugar tax or a product reformulation are strongly supported among the public health community but may cause a considerable backlash (e.g. inspiring aversion to institutions initiating the interventions among citizens). Such a backlash potentially undermines future health-promotion strategies. This study aims to uncover whether such backlash exists. METHODS: We fielded a pre-registered randomized, population-based survey experiment among adults from the Longitudinal Internet Studies for the Social Sciences panel (n = 1765; based on a random sampling of the Dutch population register). Participants were randomly allocated to the control condition (brief facts about health-information provision/nudging), or one of two experimental groups (the same facts, expanded with either a proposed sugar tax on or reformulation of sugar-sweetened beverages). Ordinary least squares regression was used to estimate the proposed interventions' effects on four outcome variables: trust in health-promotion institutions involved; perceptions that these institutions have citizens' well-being in mind (i.e. benevolence); perceptions that these institutions' perspectives are similar to those of citizens (i.e. alignment of perspectives); and attitudes toward nutrition information. RESULTS: Trust, perceived benevolence and perceived alignment of perspectives were affected negatively by a proposed sugar tax (-0.24, 95% CI -0.38 to -0.10; -0.15, -0.29 to -0.01; -0.15, -0.30 to 0.00) or product reformulation (-0.32, -0.46 to -0.18; -0.24, -0.37 to -0.11; -0.18, 0.33 to -0.03), particularly among the non-tertiary educated respondents. CONCLUSIONS: Sugar taxes or product reformulations may delegitimize health-promotion institutions, potentially causing public distancing from or opposition to these bodies. This may be exploited by political and commercial parties to undermine official institutions. TRIAL REGISTRATION: https://osf.io/qr9jy/?view_only=5e2e875a1fc348f3b28115b7a3fdfd90. Registered 3 February 2022.

Receptive to an authoritative voice? Experimental evidence on how patronizing language and stressing institutional sources affect public receptivity to nutrition information.

Common strategies to make official nutrition information more persuasive include highlighting its institutional sources and using simple and direct language. However, such strategies may be counterproductive, as institutions are no longer self-evidently deemed to be legitimate in contemporary societies and such language can be viewed as patronizing. Our preregistered, population-based survey experiment fielded among a high-quality Dutch probability sample in February 2022 (n = 1947) 1) examines whether these dominant strategies hold up when tested against suggestions of psychological reactance and source derogation, and 2) scrutinizes if such responses are stronger among less-educated citizens. Our experiment mirrored real-life examples of health-information campaigns concerning healthy and unhealthy beverages, with data collected on seven outcome measures to discern receptivity toward the information and its sources. We found that just highlighting institutional sources in the information did not lead to it being perceived more negatively. This was also the case when the language used could be perceived as patronizing, with reactance only present for one outcome measure. Moreover, while less-educated citizens were generally less receptive to nutrition information (six of seven outcome measures), versions that could possibly be perceived as patronizing or/and highlighted institutional sources did not make them less receptive systematically. Importantly, therefore, while our results show that the dominant health-communication strategies do not increase receptivity either, their use will probably not have a negative effect on the general public and so do not need to be discarded.

Suggested explanations for the (in)effectiveness of nutrition information interventions among adults with a low socioeconomic status: a scoping review.

Unhealthy diets are a major threat to population health and are especially prevalent among those with a low socioeconomic status (SES). Health promotion initiatives often rely on nutrition information interventions (NIIs), but are usually less effective among adults with a low SES than in their high-SES counterparts. Explanations for this lower effectiveness are set out in extant studies. These have been conducted across a wide range of disciplines and subject fields and using a variety of methodological approaches. We have therefore conducted a scoping review to identify and synthesise the following: (1) explanations suggested in studies carried out in high-income countries for why NIIs are (in)effective among adults with a low SES and (2) whether these suggested explanations were studied empirically. Eight databases were searched for relevant studies published since 2009 across various disciplines. This identified 4951 papers, 27 of which were included in our review after screening. Only fifteen of these proposed an explanation for the (in)effectiveness of NIIs among adults with a low SES. The following four main themes were uncovered: health literacy, economic resources, social resources and convenience. Ten studies tested their explanations empirically, but the results were inconsistent. The reasons why NIIs are (in)effective among low-SES adults are therefore still largely unclear. Also, current literature predominantly relies on individualistic explanations, most notably focusing on psychological and economic attributes. Consequently, if the effectiveness of NIIs among low-SES populations is to be improved, future studies should examine a wider range of explanations and test them systematically and empirically.

Why are anti-smoking health-information interventions less effective among low-socioeconomic status groups? A systematic scoping review.

ISSUES: This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti-smoking health-information interventions (HII) among low-socioeconomic status (SES) adults in high-income countries. APPROACH: We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low-SES adults of anti-smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low-SES effects, equity effects, proposed explanations and whether these were studied empirically. KEY FINDINGS: Thirty-eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low-SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self-efficacy. IMPLICATIONS: Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti-smoking HIIs for low-SES adults. CONCLUSIONS: To our knowledge, this is the first review to explore the explanations proposed for why anti-smoking HIIs are (in)effective among low-SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti-smoking interventions.

An incongruous intervention: Exploring the role of anti-institutionalism in less-educated individual's limited uptake of nutrition information.

Despite many efforts, nutritional health interventions have been largely unable to reduce health inequalities between less- and more-educated individuals, since their effectiveness among the former is often limited. Conventionally, adverse financial circumstances and poorer health literacy are argued to explain this. Drawing on recent sociological insights, we propose a complementing and novel sociocultural explanation based on how contemporary power relations in society breed anti-institutionalism among less-educated individuals. Using a survey of a representative sample of the Dutch population (n = 2398), we focus on the strategic case of the lower uptake of nutrition information among less-educated individuals. We find that two aspects of anti-institutionalism, i.e. institutional distrust and antipaternalism, substantially account for the educational gap in the uptake of nutrition information. This indicates that current nutrition information inspires opposition among less-educated individuals. More generally, it suggests that the development of nutritional health interventions should avoid invoking institutional connotations, to increase their acceptance by those who commonly need these most.

Twelve-week treatment of lentigo maligna with imiquimod results in a high and sustained clearance rate.

Topical imiquimod cream is increasingly applied in the treatment of lentigo maligna (LM), in particular for large lesions where surgery may lead to disfiguring scars. Published studies suggest that more frequent and prolonged treatment with topical imiquimod is associated with higher efficacy. In this study we prospectively treated 27 patients suffering from LM on the face with imiquimod 5% cream using an intensive treatment regimen consisting of daily applications for 12 weeks inducing skin inflammation for at least 10 weeks. Twenty-four patients completed the treatment as recommended, 23 were available for follow-up (mean 39 months). Clinical and histo-pathological clearance was observed in 20 patients after a mean of 14 weeks of treatment. Notably, histopathological examination of a skin biopsy showed clearance of the LM in all 24 patients, including those who still showed some hyperpigmentation at 4 weeks off treatment. A clinical recurrence occurred in only 1 of the 23 patients available at follow-up. These findings suggest that the efficacy of imiquimod can be improved by implementing a more intensive treatment regimen. Randomized controlled trials are needed to confirm our results and establish the role of topical imiquimod in the treatment of LM.

[A boy with nail abnormalities]. / Een jongen met nagelafwijkingen.

A 12-year-old boy consulted the dermatologist for nail abnormalities. Three weeks earlier, he was treated with doxycycline 100 mg BID for 10 days because of erythema chronicum migrans. Following sun exposure, the patient had developed distal onycholysis surrounded by a hyperpigmented zone. He was diagnosed with doxycycline-induced photo-onycholysis.

Treatment of lentigo maligna with imiquimod cream: a long-term follow-up study of 10 patients.

BACKGROUND: The first choice of treatment for lentigo maligna (LM) is excision. Initial studies of treatment with imiquimod 5% cream have shown promising results with excellent cosmetic outcome, but the follow-up duration in these studies was short. OBJECTIVES: To evaluate the results of treatment of patients with LM with imiquimod in routine clinical practice with long-term follow-up. METHODS: We prospectively followed 10 patients with LM who were treated with imiquimod 5% cream between 2004 and 2007 with a median follow-up of 31 months (range 11-56 months). Histological clearance was assessed in all patients using post-treatment biopsies. RESULTS: Complete clinical clearance was achieved in nine of 10 patients after treatment with imiquimod. During follow-up, three clinical and histological recurrences were observed at 9, 10, and 27 months after treatment cessation. In a fourth patient, histological recurrence without clinical signs was demonstrated 17 months after treatment. Five of 10 patients are in sustained clinical remission. CONCLUSIONS: Imiquimod appears to be an effective treatment for a subset of patients with LM. We recommend long-term follow-up and taking multiple post-treatment biopsies, even in the absence of a clinical recurrence. This case series emphasizes the need for finding an optimal treatment regimen.

Soluble E-selectin and soluble ICAM-1 levels as markers of the activity of atopic dermatitis in children.

The expression of adhesion molecules is up-regulated in the skin of atopic dermatitis (AD) patients, and the levels of the soluble adhesion molecules sE-selectin and sICAM-1 have been reported to reflect the endothelial activation in the skin of AD patients. The objective of the study was to investigate the relationship between symptom score and levels of sE-selectin, sICAM-1 and sVCAM-1 before and after 2 weeks of treatment. Eighteen children with an exacerbation of AD were admitted and treated with corticosteroid dilutions under occlusive wet dressings (wet-wrap treatment). Symptom score (objective SCORAD) and levels of sE-selectin, sICAM-1, and sVCAM-1 were assessed before and after 2 weeks of treatment. A significant correlation between the objective SCORAD before treatment and the level of sE-selectin (p < 0.05), but not the level of sICAM-1 (p = 0.7) or sVCAM-1 (p = 0.5) was observed. The treatment resulted in a high degree of remission, which was reflected by a significant decrease in the level of sICAM-1 (p < 0.01), whereas there was only a trend in the level of sE-selectin to decrease (p = 0.08). The level of sE-selectin after 2 weeks of treatment still correlated significantly with the objective SCORAD before treatment (p < 0.005). Soluble E-selectin is a relative objective marker for the severity of AD. SCORAD is a treatment-sensitive symptom of AD, whereas E-selectin may be a more stable underlying systemic representation of AD.