Area of skin disease can be used to indicate amount of treatment needed.
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Administration, Topical↗
Biomedical subjects
A Y Finlay
Publications and source records attributed to A Y Finlay.
Questionnaire techniques in assessing acne handicap: reliability and validity study.
The purpose of this study was to examine and compare the reliability and validity of two acne-specific measures, the Cardiff Acne Disability Index (CADI), the Acne Disability Index (ADI) and a general health status instrument, the United Kingdom Sickness Impact Profile (UKSIP). The test-retest reliability was carried out for the UKSIP, ADI and CADI with an interval of 10 days in 70 patients with acne. The correlation coefficient for the overall UKSIP score was high (r = 0.99, p < 0.001) for the CADI was 0.96 (p < 0.001) and for the ADI was 0.98 (p < 0.001). Individual category score correlations in the UKSIP and ADI were greater than 0.83. Tests of internal consistency of the instruments scored highly. A further 100 patients with acne and 50 controls completed all three instruments. The overall UKSIP mean score of patients was 5.6 (sd = 4.7) and of controls was 0.45. The ADI mean patient score was 40.3%, controls 17.6%. The CADI mean patient score was 42.1%, controls 13.2%. The CADI was the only instrument that correlated with the clinical acne severity score (p < 0.05); the UKSIP score correlated with the CADI score (p < 0.05) but not with the ADI score. This study has established aspects of the reliability and validity of the UKSIP, the ADI and the CADI.
Acne Vulgaris↗
Cyclosporine in severe childhood atopic dermatitis: a multicenter study.
BACKGROUND: Severe atopic dermatitis (AD) remains difficult to treat. Cyclosporine is effective in adults but has not previously been investigated in children with AD. OBJECTIVE: The aims were to investigate the efficacy, safety, and tolerability of cyclosporine in severe refractory childhood AD. METHODS: Subjects 2 to 16 years of age were treated for 6 weeks with cyclosporine, 5 mg/kg per day, in an open study. Disease activity was monitored every 2 weeks by means of sign scores, visual analogue scales for symptoms, and quality-of-life questionnaires. Adverse events were monitored. Efficacy and tolerability were assessed with five-point scales. RESULTS: Twenty-seven children were treated. Significant improvements were seen in all measures of disease activity. Twenty-two showed marked improvement or total clearing. Quality of life improved for both the children and their families. Tolerability was considered good or very good in 25 subjects. CONCLUSION: Cyclosporine may offer an effective, safe, and well-tolerated short-term treatment option for children with severe AD.
Administration, Oral↗
Handicap in Darier's disease and Hailey-Hailey disease.
One hundred and thirty-seven patients with Darier's disease and 66 patients with Hailey-Hailey disease completed the Dermatology Life Quality Index (DLQI). The average DLQI score for Darier's disease was 5.89 (19.6% of the maximum score), median = 4, quartiles: 1.9. The average DLQI score for Hailey-Hailey disease was 6.06 (20.2% of the maximum score), median = 5, quartiles: 2.9. The DLQI score did not correlate with the physician's assessment of clinical severity in both diseases, thus emphasizing the importance of remembering the potential for handicap even in patients with disease that seems to be mild. The domains of the questionnaire with the highest mean scores in both diseases were for questions relating to symptoms and feelings. Domains relating to personal relationships and work obtained low mean scores even in severe disease. It is encouraging that most patients with Darier's disease and Hailey-Hailey disease maintain good relationships at work and home and seem to be able to adapt to their skin disease.
Adolescent↗
Disability and handicap in dermatology.
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Attitude to Health↗
Multiple linear lichen planus in the lines of Blaschko.
The lines of Blaschko describe a distribution pattern which may represent embryological development pathways. The distribution may occasionally be followed by some skin disorders. We report a patient who had multiple lesions of linear lichen planus which followed Blaschko's lines. There were multiple streaks affecting several different areas of the body.
Humans↗
Measurement of disease activity and outcome in atopic dermatitis.
Many different systems have been proposed for the recording and measurement of disease activity in atopic dermatitis (AD). This review describes the techniques that have been used and published in recent years for clinical evaluation and for objective measurement of AD, as well as for recording its effects on quality of life. Recommendations are made concerning which methods should be used.
Dermatitis, Atopic↗
Coping with psoriasis.
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Adaptation, Psychological↗
Dermatology in-patient management greatly improves life quality.
The aim of this study was to measure the effect of in-patient management on the quality of life of adult dermatology patients, and to identify the diagnostic categories which show the greatest improvement. Over a 6-month period, all 230 patients admitted to the dermatology ward of the University Hospital of Wales were invited to complete a Dermatology Life Quality Index (DLQI) questionnaire on admission, and again 4 weeks after discharge. Two hundred and seventeen (93%) of these patients entered the study, and 181 (83.4%) returned both questionnaires. The mean DLQI on admission was 13.2 (standard deviation [SD] 7.6; n = 181), and 4 weeks after discharge it was 7.7 (SD 6.8; P < 0.001). Seventy-three per cent of the 181 patients showed improvement, 5.5% remained unchanged, and 21.5% worsened. Patients with psoriasis improved from 13.7 (SD 6.5) to 6.7 (SD 5.6; n = 63; P < 0.001), and those with eczema improved from 16.2 (SD 6.3) to 9.6 (SD 7.6; n = 56; P < 0.001). Patients with pruritus showed little improvement, as did those admitted for liver biopsy. Patients with psoriasis and severe eczema showed, overall, a significant decrease in impairment of life quality following in-patient treatment. Severe eczema has a greater adverse impact on the quality of life than severe psoriasis. The parameters for which most improvement was seen were those which were of most concern to the patients, i.e. their symptoms (score after discharge = 1.2; DS 0.9; P < 0.001) and their embarrassment (0.9; SD 1.0; P < 0.001).
Adolescent↗
The effect of severe psoriasis on the quality of life of 369 patients.
The aim of this survey was to quantify the level of handicap experienced by patients with severe psoriasis, and to assess the value that patients place on their disease using various questionnaire techniques. Dermatologists throughout the U.K. each gave a questionnaire to up to five psoriasis patients, who were either being admitted for in-patient care or were starting systemic therapy. Three hundred and sixty-nine questionnaires were completed. Of the 150 patients currently working, 59.3% had lost a mean of 26 days (SD 21.9) from work during the preceding year because of their psoriasis, and of the 180 not working 33.9% attributed not working to their psoriasis. The mean Psoriasis Disability Index (PDI) score was 38.2% (SD 23.3, n = 248), with the mean sub-scores of the 'daily activities' and 'treatment' sections being greater than those of the other three sections. Despite having severe psoriasis, the majority of patients felt that it would be worse to have diabetes, asthma or bronchitis than to have psoriasis. Forty-six, 42 and 32% considered it would be either 'better' or 'the same' to have diabetes, asthma or bronchitis, respectively. However, in those patients who also had the comparative disease, 87, 80 and 77% considered it would be 'better', or 'the same' to have the comparative disease. Forty-nine per cent of patients (n = 362) stated they would be prepared to spend 2 or 3 h each day on treatment if this might result in normal skin for the rest of the day.(ABSTRACT TRUNCATED AT 250 WORDS)
Absenteeism↗
The Children's Dermatology Life Quality Index (CDLQI): initial validation and practical use.
Skin disease can cause severe disability and handicap in children. Measurement of the impact of skin disease on the quality of life is required to aid clinical decision-making, for clinical research, for audit of paediatric dermatology services, and for political reasons, to aid arguments for more resources for the care of children with skin disease. Adult measures are inappropriate, as the lives of children differ markedly from those of adults. The purpose of this study was to create and initially validate a simple practical questionnaire for use in children. One hundred and sixty-nine children, aged 3-16 years, attending a paediatric dermatology clinic, wrote down, with the help of their parents, all the ways in which their skin disease affected their lives. One hundred and eleven different aspects were identified; 10 questions were composed to cover these aspects, using a structure similar to the Adult Dermatology Life Quality Index. This draft questionnaire was piloted on two series, totalling 40 children, and minor alterations were made to improve clarity. The Children's Dermatology Life Quality Index (CDLQI) questionnaire (maximum score 30) was then given to a further 233 dermatology paediatric out-patients (CDLQI mean = 5.1, SD = 4.9), 47 normal controls (mean 0.4, 0.7) and 55 control patients attending a general paediatric clinic (mean 0.7, 2.5). The CDLQI scores for eczema (mean = 7.7, 5.6, n = 47), psoriasis (5.4, 5.0, n = 25) and acne (5.7, 4.4, n = 40), were all highly significantly greater than for moles and naevi (2.3, 2.9, n = 29). The highest mean score was that for scabies (mean = 9.5, 10.5, n = 6).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Effect of terbinafine on the pharmacokinetics of cyclosporin in humans.
Cyclosporin is largely metabolized by hepatic cytochrome P450 enzymes, and azole drugs that inhibit cytochrome P450 may precipitate cyclosporin toxicity. The allylamine terbinafine binds to a small subfraction of hepatic cytochrome P450 in type I fashion, and has no effect upon hepatic metabolism of cyclosporin in vitro. The purpose of this study was to determine whether oral terbinafine alters the pharmacokinetics of oral cyclosporin in vivo. Twenty male volunteers (age 19-44 years), were randomly allocated to two groups. The first group received three single oral doses of cyclosporin 300 mg at intervals of 21 d. The second and third doses of cyclosporin were preceded by a 6-d course of oral terbinafine 250 mg each morning. A further 250 mg of terbinafine was taken with the second and third doses of cyclosporin. Blood levels of cyclosporin and terbinafine were monitored for 36 h after each dose. The second group received a 7-d course of terbinafine 250 mg each morning. On the seventh day a single dose of cyclosporin 300 mg was taken together with the terbinafine. Blood levels of both cyclosporin and terbinafine were monitored for 36 h. Two further single doses of cyclosporin 300 mg were given at intervals of 2 weeks and the cyclosporin levels again monitored. In both groups each cyclosporin dose was preceded by an 8-h fast. The mean peak blood concentration of cyclosporin when taken alone was 958 micrograms/l, and 822 when taken with terbinafine. The mean area under the curve for cyclosporin was 4207 micrograms/l/h when taken alone and 3665 when taken with terbinafine. The mean absorption half-life for cyclosporin when taken alone was 0.29 h, and 0.33 when taken with terbinafine. The mean time of maximum concentration and elimination half-life of cyclosporin were unaltered by terbinafine. The results suggest that terbinafine is likely to prove a safe systemic anti-fungal treatment for patients who are taking cyclosporin.
Absorption↗
Congenital dysmorphism of finger and toenails associated with acro-osteolysis.
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Child↗
Global overview of Lamisil.
Terbinafine (Lamisil) is a new antifungal drug which is now available in many countries worldwide. This review seeks to summarize why terbinafine is of interest and how well it reaches its target sites--the stratum corneum and nail plate. The diseases in which it is potentially effective are described and evidence that terbinafine is of value in these diseases is cited. There are very few effective drugs which do not have some potential for producing side-effects and these are discussed.
Antifungal Agents↗
The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis.
A working party of 13 dermatologists, two family practitioners and a paediatrician was assembled, with the aim of developing a minimum list of reliable discriminators for atopic dermatitis. Each physician was asked to select 10 consecutive new cases of unequivocal mild to moderate atopic dermatitis and 10 controls with other inflammatory dermatoses. Each subject was examined by two independent observers, who were blind to the clinical diagnosis and study aim, with regard to 31 clinically useful diagnostic features for atopic dermatitis. Two hundred and twenty-four patients were studied (120 cases and 102 controls). Using the key physician's clinical diagnosis as a gold standard, the sensitivity and specificity of each of the 31 diagnostic criteria were tested. Using multiple logistic regression techniques, a minimum set of diagnostic criteria for atopic dermatitis was derived. These were: history of flexural involvement, history of a dry skin, onset under the age of 2, personal history of asthma, history of a pruritic skin condition, and visible flexural dermatitis. Adjustment for age, sex, region, social class and ethnic group did not alter the choice of final criteria. The discriminatory value of these criteria was also satisfactory when tested against a further sample of 150 patients drawn from the community, who did not have skin disease.
Adolescent↗
Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use.
A simple practical questionnaire technique for routine clinical use, the Dermatology Life Quality Index (DLQI) is described. One hundred and twenty patients with different skin diseases were asked about the impact of their disease and its treatment on their lives; a questionnaire, the DLQI, was developed based on their answers. The DLQI was then completed by 200 consecutive new patients attending a dermatology clinic. This study confirmed that atopic eczema, psoriasis and generalized pruritus have a greater impact on quality of life than acne, basal cell carcinomas and viral warts. The DLQI was also completed by 100 healthy volunteers; their mean score was very low (1.6%, s.d. 3.5) compared with the mean score for the dermatology patients (24.2%, s.d. 20.9). The reliability of the DLQI was examined in 53 patients using a 1 week test-retest method and reliability was found to be high (gamma s = 0.99).
Adolescent↗
Dermatology examination performance: wide variation between different teaching centres.
Three hundred and one clinical medical students in four universities took the same 50 question MCQ dermatology examination after their dermatology teaching. In one centre, half the students had had additional teaching; these students performed better (mean score 47.5%, n = 29) than those who had no extra teaching (mean score 40.9%, n = 29). In another centre, the students' mean score improved from 24.1 (SD = 6.7) before to 41.6 (SD = 7) (n = 46, P < 0.001) after their dermatology teaching. The different subject areas covered by the examination were analysed separately. In the lowest scoring centre (mean score 34.0, SD = 9.4) the students scored lowest in 9 of the 14 subject areas. In the highest scoring centre (mean score 47.5, SD = 9.9) students scored highest in 7 of these 14 subject areas. This study enabled questions of high discriminatory value to be identified for future use. The use of the same examination in different centres provides feedback for the centres concerning strengths and weaknesses of their teaching.
Dermatology↗
Cyclosporin greatly improves the quality of life of adults with severe atopic dermatitis. A randomized, double-blind, placebo-controlled trial.
A multicentre, randomized, double-blind, controlled crossover clinical trial was conducted on 33 patients with severe refractory atopic dermatitis, to determine the effects of cyclosporin (5 mg/kg/day) on their health-related quality of life. Treatments were administered for 8-week periods. One group (n = 16) received placebo followed by cyclosporin, and the other (n = 17) received cyclosporin and then placebo. Health-related quality of life was assessed at 0, 8 and 16 weeks using a general measure, the United Kingdom Sickness Impact Profile (UKSIP), an eczema-specific measure, the Eczema Disability Index (EDI), and a global 5-point rating scale of overall health (very good to very poor). In addition, clinical assessments (i.e. extent and activity of disease) were made by the investigators. UKSIP and EDI scores indicated significant improvement in quality of life (P < 0.05-P < 0.01) of patients with atopic dermatitis after treatment with cyclosporin. Although no patient required withdrawal from the study, 20 patients receiving cyclosporin reported adverse events, compared with eight taking placebo. There was a close correlation (P < 0.05-P < 0.01) between the UKSIP and EDI scores. In contrast, there was either no correlation, or only a very poor correlation, between the quality of life parameters and clinical measures of extent and activity of eczema. When cyclosporin was stopped, relapse was rapid, but the mean scores for disease activity and extent of disease were less than their baseline values (i.e. an improvement of greater than 25% was maintained in 11 patients at week 4).(ABSTRACT TRUNCATED AT 250 WORDS)
Activities of Daily Living↗