Distribution of atopic dermatitis lesions in United States adults.

BACKGROUND: The distribution of atopic dermatitis (AD) lesions and its impact on quality of life (QOL) is not well established in the US adult population. OBJECTIVE: To elucidate the distribution of AD lesions and its impact on QOL in US adults with AD. METHODS: A cross-sectional, population-based study of 602 adults was performed. AD was determined using modified UK Diagnostic Criteria, and its lesional distribution was assessed. QOL was assessed using Dermatology Life Quality Index (DLQI). Latent class analysis (LCA) was used to determine distinct phenotypes of AD lesional distribution. Multivariable logistic regression was used to determine the relationship between DLQI and distinct phenotypes. RESULTS: The most common sites of skin lesions were reported to be the popliteal fossae, lower legs, dorsal feet and antecubital fossae. Most persons reported partial (19.0%) or complete (63.0%) symmetry of lesions on the extremities. Lesions on the trunk were significantly more common in blacks and Hispanics. Age ≥ 60 years was associated with significantly lower proportions of active lesions on the face and scalp, and significantly higher proportion of lesions on the buttocks or genitals. LCA identified 5 classes of lesional distribution: 1. lower probabilities of lesions affecting any sites; 2. Higher probability of lesions involving the anterior and posterior neck and trunk; 3. lesions involving the antecubital fossae and upper extremities; 4. lesions involving the arms, posterior hands, genitals and buttocks, and to a lesser extent face, palms and legs; 5. lesions affecting all sites. Class-2 (multivariable logistic regression; adjusted odds ratio [95% confidence interval]: 7.19 [3.21-16.07], class-3 (7.11 [3.20-15.80]), class-4 (6.90 [3.07-15.50]) and class-5 (7.92 [3.54-17.71]) were all significantly associated with higher DLQI scores compared to class 1. CONCLUSION: AD is associated with heterogeneous distribution of AD lesions, and distinct phenotypes that are associated with QOL impact.

Head lice infestations in rural Honduras: the need for an integrated approach to control neglected tropical diseases.

BACKGROUND: Pediculosis capitis is a neglected tropical disease (NTD) that receives little attention in countries where it continues to be endemic. This study aimed to understand the impact of Pediculus humanus capitis infestations in the lives of Honduran children living in extreme poverty. METHODS: A qualitative study on head lice infestation was conducted in June 2016 in a rural community in Honduras. Parents were invited to bring their children for head lice inspection using a dry-combing technique with a stainless steel-toothed comb with suction power. A semistructured questionnaire was administered to participants. Questions were broadly grouped into knowledge about transmission, control practices, barriers to treatment, and the overall impact of these infestations in children's wellbeing. Responses were coded, categorized, and organized through a theme-based approach. RESULTS: In total, 52 children aged 2-14 years (42 girls) and their mothers were enrolled in the study. The overall proportion of children with an infestation was 83%. Response analysis revealed a lack of understanding regarding lice transmission and stigmatization of infested children and the widespread belief that head lice were acquired during bathing in the slow-flowing river running through the village. An agricultural plaguicide was commonly used to rid children of head lice. CONCLUSIONS: The study underscores the dire situation of the rural poor, their physical and mental health affected by pediculosis capitis as well as other NTDs. These results highlight the need to reassess approaches and action towards combating NTDS under an integrated framework.

A multicentre, open, investigator-initiated phase IV clinical trial to evaluate the efficacy and safety of ingenol mebutate gel, 0·015% on the face and scalp, and 0·05% on the trunk and extremities, in Korean patients with actinic keratosis (PERFECT).

BACKGROUND: Ingenol mebutate gel is a novel, field-directed topical treatment for actinic keratosis (AK). Most pivotal studies have targeted Western populations. No clinical study has been conducted to investigate its efficacy and safety in Asian populations. OBJECTIVES: To evaluate the efficacy and safety of ingenol mebutate gel for treating AK of face/scalp and trunk/extremities in a large Asian (Korean) population. PATIENTS AND METHODS: In this multicentre, open-label, interventional, parallel-group, prospective phase IV study (PERFECT, trial registration no.: NCT02716714), the eligible patients were allocated into either the face/scalp or the trunk/extremities group, according to their selected treatment area location. After application of ingenol mebutate gel, the participants were followed up for 6 months. The primary efficacy endpoint was complete clearance (CC) of AK lesions in the selected treatment area at day 57. Quality of life was evaluated using Skindex-29. Safety endpoints included local skin responses, scar, pigmentation, pain and adverse events. RESULTS: In total, 78·1% [95% confidence interval (CI) 66·86-86·92%] of subjects had CC at day 57, with 76·6% (95% CI 64·31-86·25%) in the face/scalp group and 88·9% (95% CI 51·75-99·72%) in the trunk/extremities group. Among them, CC was sustained in 88·9% (48 of 54, 95% CI 77·37-95·81%) at month 6. The local skin responses significantly increased 1 day after the treatment compared with baseline, and decreased afterwards. Among the total subjects, 7·8% (6 of 77) had hyperpigmentation on the application area. Scars were not reported. CONCLUSIONS: Ingenol mebutate is effective for the treatment of AK in Asians, with tolerable safety profiles.

[Psychosomatic disorders of the scalp]. / Psychosomatik der Kopfhaut.

Psychosomatic disorders of the scalp have some special characteristics due to the visibility, possible stigmatization, and amount/patterns of hair. Of practical relevance is trichotillomania, which is now classified as an obsessive-compulsive disorder (OCD). Patients who are obsessed with normal physiological hair loss represent a further psychodermatological challenge. Psychosomatic therapy includes basic psychosomatic care, behavior therapy, or treatment with psychopharmaceuticals.

Clinical characteristics and HLA alleles of a family with simultaneously occurring alopecia areata.

Alopecia areata (AA) is a T-cell-mediated autoimmune disease resulting in partial or total noncicatricial hair loss. HLA class II antigens are the most important markers that constitute genetic predisposition to AA. Various life events and intense psychological stress may play an important role in triggering AA attacks. We report an unusual case series of 4 family members who had simultaneously occurring active AA lesions. Our aim was to evaluate the clinical and psychiatric features of 4 cases of active AA lesions occurring simultaneously in a family and determine HLA alleles. The clinical and psychological features of all patients were examined. HLA antigen DNA typing was performed by polymerase chain reaction with sequence-specific primers. All patients had typical AA lesions over the scalp and/or beard area. Psychological examinations revealed obsessive-compulsive personality disorder in the proband's parents as well as anxiety and lack of self-confidence in both the proband and his sister. HLA antigen types were not commonly shared with family members. These findings suggest that AA presenting concurrently in members of the same family was not associated with genetic predisposition. Shared psychological disorders and stressful life events might be the major key points in the concurrent presentation of these familial AA cases and development of resistance against treatments.

Topical treatment for scalp psoriasis: Comparison of patient preference, quality of life and efficacy for non-alcoholic mometasone emulsion versus calcipotriol/betamethasone gel in daily clinical practice.

OBJECTIVE: To evaluate patients' assessment of therapy, efficacy, quality of life and treatment adherence in patients with scalp psoriasis treated with non-alcoholic mometasone emulsion or calcipotriol/betamethasone gel. METHODS: Prospective, open-label, multicentre, non-interventional study. Patients with non-severe scalp psoriasis were treated with mometasone emulsion or calcipotriol/betamethasone gel. Evaluations included patient's global assessment of treatment, physician's global assessment of disease severity, quality of life (Dermatology Life Quality Index), physician's subjective evaluation of therapy, treatment adherence and adverse events. RESULTS: Ninety-five patients treated with mometasone emulsion and 88 treated with calcipotriol/betamethasone gel were included in the intention-to-treat analysis. Patients' global assessment of treatment favoured mometasone emulsion over calcipotriol/betamethasone gel (p = 0.008), with treatment rated as good/very good by 91% versus 82.5%. Patients were less likely to report irritation of fingers' skin with mometasone than with calcipotriol/betamethasone (p = 0.0015). Severity of scalp psoriasis and quality of life improved in both groups. Adherence to treatment was similar in both groups. Physicians' perception of efficacy, tolerability and compliance was better for mometasone emulsion. CONCLUSION: Non-alcoholic mometasone emulsion achieved greater acceptability to patients and physicians than calcipotriol/betamethasone gel for the treatment of scalp psoriasis. Both topical treatments were similarly effective in terms of disease severity and quality of life.

The relationship between quality of life and the severity of psoriasis in Turkey.

BACKGROUND: Patients with psoriasis experience a low quality of life and high treatment burden: OBJECTIVES: To assess psoriatic patient quality of life using the Dermatology Life Quality Index (DLQI) in the Northeastern Anatolia region of Turkey. Additionally, we evaluated the correlation between the DLQI and the clinical severity of psoriasis and examined demographic data and their relationship with the DLQI and psoriasis severity: MATERIALS AND METHODS: This study was a single-center, prospective, cross-sectional study at the University of Kafkas, Kars, Turkey. 127 adult patients were included in the study. The Turkish version of the DLQI was used. To measure psoriasis severity, the Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) were simultaneously evaluated. The patient demographics were compared with quality of life and the severity of psoriasis: RESULTS: DLQI scores ranged from "very large" to "extremely large" in 61% of the patients. The psoriasis severity (BSA and PASI) was "mild" in 63% of patients. The quality of life was significantly affected in cigarette smokers and in patients whose disease included nail involvement. The PASI and BSA scores of patients with scalp and nail involvement were significantly higher. A significant, positive correlation was found between disease duration and the severity of psoriasis. BSA correlated with PASI: CONCLUSION: The quality of life of psoriasis patients is strongly reduced. A significant relationship was found for DLQI with nail psoriasis and smoking. A linear, positive correlation was detected between the DLQI and BSA but not between the DLQI and PASI.

Quality of life in patients with scalp psoriasis.

AIM: The aims of this study were to describe the quality of life (QoL) in patients suffering of scalp psoriasis and to assess the impact of the socio-demographic and clinical features of this condition on patients' health-related QoL, using general and specific QoL scales. METHODS: This research is a cross-sectional study. The study involved 55 patients attending their first examination at the Dermatology Clinic of Padua University over the course of one year (April 2010-March 2011). The outcome was quality of life analyzed by means Scalpdex and SF-36 questionnaire. RESULTS: The sample's mean Scalpdex score was 43.60±17.52, while the mean SF-36 score was 68.28±20.32. The SF-36 identified statistically significant differences between the psoriasis patients and the Italian general population in two domains, i.e. general health (P=0.0075) and emotional role (P=0.0048). The severity of patients' scalp lesions emerged as a factor associated with a reduced QoL in these patients, irrespective of the severity of their disease as a whole. Sex, age, schooling and other socio-demographic factors also characterized patients' perceived QoL. CONCLUSION: Patients with scalp psoriasis suffered from a lower QoL relating to the highly visible site of their psoriatic lesions. Specific supportive measures should be dedicated to these patients by health care workers.

Reliability, responsiveness and validity of Scalpdex in children with scalp psoriasis: the Dutch study.

This aim of this study was to validate the Scalpdex, a quality of life questionnaire for adults with scalp dermatitis, in children with scalp psoriasis. The reliability, responsiveness and validity of the 3 scales (symptoms, functioning and emotions) of this 22-item questionnaire were analysed in a cohort of children with scalp psoriasis (age range 6-18 years). A total of 94 children completed the questionnaire once, and 53 children a second time, after treatment of their scalp psoriasis. The Children's Scalpdex in Psoriasis (CSP) demonstrated reliability with internal consistency (Cronbach's α, 0.69-0.91). The CSP scales proved sensitive to change in the expected direction for children whose scalp psoriasis improved. Moderate effect sizes were observed between both visits for all 3 scales of the CSP (Cohen's d, 0.44-0.58). In conclusion, the CSP is a reliable, responsive and valid questionnaire, which is the first to illustrate the specific influence of scalp psoriasis on quality of life in children.

Quality of life assessment of patients with scalp dermatitis using the Italian version of the Scalpdex.

The aim of this study was to assess quality of life in patients with scalp dermatitis using the Italian version of the Scalpdex, and to validate the instrument in Italian. The survey was conducted in outpatients with psoriasis, seborrhoeic dermatitis, alopecia, or follicular lichen. Data were completed on 194 patients, 78% of whom had psoriasis. Scalpdex scores were always higher in women than in men, and in younger people compared to elderly people. The most frequent items were: being ashamed, embarrassed, bleeding scalp, feeling self-conscious, bothered that the condition is incurable, having the choice of colour of clothes affected, having a negative effect on daily life. The Italian Scalpdex showed good internal consistency, test-retest reliability, convergent validity, and responsiveness. In conclusion, the Italian version of the Scalpdex is a useful instrument to measure quality of life in patients with a scalp condition.

Head lice: the feelings people have.

BACKGROUND: Head lice are a source of amusement for outsiders and an embarrassing nuisance to those who have to deal with them. Our study collected the emotions experienced by people dealing with head lice. An area with extremely sparse literature, our purpose is to inform the development of more effective programs to control head lice. METHODS: We asked "what were your feelings upon discovery of head lice?" as part of a study exploring the experience of those treating head lice. A short questionnaire was available via the authors' head lice information internet site. A total of 294 eligible responses were collected over several months and analyzed, supported by QSR N6. RESULTS: The predominantly female (90 · 9%) respondents were residents of Australia (56 · 1%), USA (20 · 4%), Canada (7 · 2%), or UK (4 · 4%), and working full-time (43·0%) or part-time (34 · 2%). Reactions and feelings fell into three categories: strong (n = 320; 79% of all stated emotions), mediocre (n = 56; 20%), and neutral (n = 29; 9 · 8%). There were no positive emotions. COMMENT: The significant negative reaction was expected. The range of feeling expressed demonstrates the stigma held for these ectoparasites within western market economies. This contrasts with conceptions of head lice in traditional societies. The negative social effects of this perception create more problematic issues than the infection itself; these include quarantine, overtreatment, and a potentially negative psychological impact. Head lice control strategies and programs that address these negative emotional reactions may prove more effective than current biomedical focus.

Difficulties experienced by families following unsuccessful treatment of Pediculosis capitis: the mothers' perspective.

OBJECTIVE: The study aimed to determine the psychological and social difficulties faced by primary school children and their families, particularly from the mothers' perspective, when treatment for Pediculosis capitis fails. METHODS: This descriptive study comprised 14 mothers of 19 children in the primary school in Kocaeli. The children and families were infested with lice and nits and were unsuccessfully treated with pediculicides. Data were collected by a semi-structured questionnaire with in-depth individual interviews with a qualitative approach from mothers. RESULTS: Seven social difficulties were experienced by children and families during treatment from the mothers' perspective, lack of support from other family members; children's exposure to verbal and physical violence; exclusion from the school and society due to stigma; children's refusal to be treated; difficulties in the physical removal of the nits; inability to pay for the pediculicide; and inappropriate physical conditions of the house. Eight psychological difficulties were experienced by children and their families: worry, upheaval, embarrassment/shame, guilt, being overwhelmed, disgust, scorn and despair. CONCLUSION: Parents and children, whose treatment for Pediculosis capitis failed, experienced many psychological and social difficulties. Further studies should be conducted to determine the relation to pediculosis management and their difficulties of chidren and families from different socio-economic levels.

Delusional infestation with unusual pathogens: a report of three cases.

Delusional infestation (DI) is a psychiatric disorder characterized by a fixed, false belief that the patient is infested with extracorporeal agents. It is known by several names, including the more commonly used term 'delusional parasitosis'. The psychiatric disease is responsible for the cutaneous pathology. About 90% of patients with DI seek help from dermatologists, and most reject psychiatric referral. Thus, effective management requires incorporation of psychiatric principles. We report three cases of DI with inanimate materials, and examine 'Morgellons' disease. We believe that patients with unusual presentations of DI are likely to be seen more commonly in the future. These patients appear to be a subgroup of DI, and may be even more difficult to treat than other patients with DI.

Parental attitudes towards head lice infestation in Greece.

BACKGROUND: Pediculosis capitis constitutes a growing problem worldwide and is usually considered as an inconvenience. Parents often handle this infestation on their own initiative. OBJECTIVE: We conducted a survey in order to depict the parental attitudes towards head lice infestation in Greece. METHODS: Parents of children aged 3-14 years, attending a dermatology outpatient clinic at a children's hospital, were given a questionnaire regarding head lice. Demographic data, management, and prevention strategies were included in the questionnaire. RESULTS: Three-hundred and seventy-two complete questionnaires were analyzed (response rate: 89%). Pediculosis capitis was more prevalent in the age groups 3-5 years and 6-8 years. The percentage of parents of infested children who sought advice on treatment from the pharmacist was 73%, and only 15% consulted their doctor. Chemical agents to treat head lice were used by 59% of them, products containing natural oils by 38%, and wet combing in parallel was employed by 79% of them. Preventive measures were employed by 66% of the respondents, and 54% applied botanical and synthetic products commercially available for this purpose. CONCLUSION: There is a trend towards the use of natural oils for either prevention or treatment. More needs to be done to promote public education and rational use of either pediculicides or non-pharmacological agents for pediculosis capitis infestation.

Effective treatment and improvement of quality of life in patients with scalp psoriasis by topical use of calcipotriol/betamethasone (Xamiol®-gel): results.

BACKGROUND: Quality of life of patients with scalp psoriasis is greatly impaired due to itch and scaling. To control the disease long-term therapy is necessary and treatment success is greatly dependent on compliance. PATIENTS AND METHODS: In a prospective, non-interventional trial in German dermatological practices 721 patients with scalp psoriasis received Xamiol(®) gel (calcipotriol 50 µg/g, betamethasone 0,5 mg/g) topically for 4 weeks. Severity was assessed by physician's global assessment (PGA) and quality of life by using a scalp-specific questionnaire at the beginning of the study and after 4 weeks of treatment. RESULTS: The mean disease severity of scalp psoriasis (PGA) improved from 4.26 to 2.49 (-41.8 %, p < 0.0001) during 4 weeks of treatment and quality of life improved from 10.57 to 3.22 (-69.5 %, p < 0.0001). Among patients with pre-treatment 89.5 % of patients and 87.9 % of dermatologists judged treatment response to Xamiol(®) gel as better/much better compared to previous therapy. Tolerability of Xamiol(®) gel was rated good/very good by 98 % of dermatologists and patients, respectively. The use of Xamiol(®) gel was found easy/very easy by 90.4 % of the patients. CONCLUSIONS: Due to the major improvement of quality of life and quick onset of improvement together with the high acceptance by the patients Xamiol(®) gel may be regarded as the topical treatment of choice for scalp psoriasis.

Sebaceoma o sebomatricoma. A propósito de un caso / Sebaceoma o sebomatricoma. A case report

El Sebaceoma o Sebomatricoma es una neoplasia benigna rara con diferenciación sebácea. Se presentó paciente masculino, de 25 años de edad,que hace 20 días atrás mientras se peinaba le sangró una lesión en cuero cabelludo, hasta ese momento inadvertida. Acude a nuestro centro donde se constata pequeña lesión tumoral de color amarillento, en región parietal derecha. Desde el punto de vista clínico se hicieron los siguientes planteamientos diagnósticos: nevus intradérmico, nevus sebáceo de Jadassohn. Se realizó exéresis quirúrgica del tumor con estudio histopatológico. El diagnóstico histológico fue sebaceoma. Se revisó la entidad y se coincidió con el diagnóstico histopatológico, sin embargo los numerosos términos usados en la literatura médica internacional para describir esta afección engendran gran confusión en la práctica médica diaria por lo que consideramos necesario un consenso mundial entre dematopatólogos (AU)

The sebomatricoma or sebaceoma is a rare benign cutaneous neoplasm with sebaceous differentiation. A 25 years old, male patient who notice acutaneous mass in the scalp after bleeding on combing is reported. At the physical examination the patient showed a yello wish tumoral lesion.The first clinical diagnosis was intradermic nevus and sebaceous nevus of Jadassohn. A surgical exceresis was performed and the histological study defined a sebaceoma. The reason of this publication is to take into account this entity for the confusion that this term offer to the dermatologist and pathologist world (AU)

Quality of life in patients with scalp psoriasis treated with calcipotriol/betamethasone dipropionate scalp formulation: a randomized controlled trial.

BACKGROUND: Psoriasis vulgaris of the scalp has a significant psychosocial impact on individuals affecting their quality of life (QoL). A combination of calcipotriol and betamethasone dipropionate in a formulation suitable for treatment of scalp psoriasis has been developed. OBJECTIVE: To assess the impact of treatment with either calcipotriol plus betamethasone dipropionate scalp formulation or calcipotriol scalp solution on QoL in patients with scalp psoriasis (both within and between treatment groups). METHODS: This 8-week, randomized, investigator-blind study, compared the once-daily, two-compound scalp formulation (calcipotriol 50 microg/g plus betamethasone 0.5 mg/g as dipropionate; Xamiol, LEO Pharma A/S, Ballerup, Denmark) with twice-daily calcipotriol scalp solution (50 microg/mL; Daivonex, LEO Pharma A/S) in patients with scalp psoriasis of at least moderate severity covering > or = 10% of the scalp. QoL was assessed (weeks 0, 2, 4, 8) using the 36-item Short Form Health Survey (version 2; SF-36v2) and Skindex-16. RESULTS: Treatment with the two-compound scalp formulation (n = 207) resulted in significant improvements from baseline on the SF-36v2 (Physical Component Summary, P = 0.005, week 8; Mental Component Summary, P < 0.05, weeks 2, 4, 8). A significant change from baseline in the calcipotriol scalp solution group (n = 105) was seen only on the Mental Component Summary (P = 0.04, week 8). Change from baseline in Skindex-16 was significantly in favour of the two-compound scalp formulation. Change was significant on both total score and individual scales. CONCLUSION: The two-compound scalp formulation was superior to calcipotriol scalp solution in improving QoL in patients with scalp psoriasis.

A survey on knowledge and perceptions regarding head lice on a sample of teachers and students in primary schools of north and south of Italy.

High rates of pediculosis are found in every part of the world. The age-range most affected is between 3 and 12 years. No-nit policies are ineffective in preventing infestations. On the other hand, misdiagnosis and overuse of pediculicides, increase resistance to treatment. Lack of information leads people to consider this kind of infestation to be associated to low social classes and immigrants. This research has been implemented to find out about the information level on pediculosis on a sample of students (722) and teachers (408) of some primary schools in northern and southern Italy, and to highlight the role of personal aspects such as age, gender, cultural level, geographical position which may influence this topic and, eventually, allow the use of the correct knowledge in developing appropriate procedures within the school district. Data was obtained through a questionnaire containing 21 multiple choice questions for the teachers and 14 for the students. Standard descriptive statistics were computed. chi2 tests were applied to highlight statistical association among observed variables; test for the difference of two proportions were applied to confirm significant differences among the observed proportions. The level of information for students seems to be, approximately, the same both for northern and southern Italy. There was a slight prevalence of correct answers from southern teachers, probably because the phenomenon of pediculosis has a positive trend of growth in the south. The number of correct answers was, for all, on average about 60.0%; a negative result in itself considering the simplicity of the questions. Knowledge about the biology of the louse was virtually absent. The area of prevention showed lack of information and need for improvement. Most of the teachers believe that there are specific products that can prevent infestation by louse. Most of the teachers have information which does not come from scientific sources. Students receive some short and incomplete information from their parents. Deficiencies in teachers' knowledge indicate that they are inadequately equipped to manage lice infestation. Educational interventions with teachers and families and, as a consequence, with students should be taught at school to allow a correct understanding of the pediculosis, increasing the teachers' competence and, consequently, as soon as the infestation should manifest, a rapid alert of the Health Service so that proper treatment could be provided.

Podophyllin reaction mimicking Bowen's disease in a patient with delusions of verrucosis.

A 40-year-old woman presented with a delusion of warts on the forehead, for which she was applying podophyllin toxin. A skin biopsy was taken, which showed prominent mitotic figures in the basal and suprabasal layers of the epidermis and apoptotic keratinocytes. Histopathologically Bowen's disease was suspected, but was discounted after clinicopathological correlation was obtained and showed absence of epidermal atypia or disorganization. This case demonstrates the histological resemblance of podophyllin reaction to Bowen's disease. Differentiation of self-inflicted from organic skin disease may be difficult, especially where histopathological findings are confounded by cutaneous application of toxins.