Biomedical subjects
Isaak Effendy
Publications and source records attributed to Isaak Effendy.
Primary prevention in health care employees: a prospective intervention study with a 3-year training period.
Irritant contact dermatitis is a mayor problem in health care employees. Because educational programs have shown convincing success in certain occupations (e.g. in hairdressers), this study investigates the effect of a special training program in health care trainees. 521 trainees from 14 nursing schools in Central Germany were randomly divided in 2 groups, (i) an intervention group with a regular teaching protocol regarding all aspects of primary prevention and (ii) a control group without any further teaching. Morphological changes of the hands, use of hand care creams and knowledge regarding skin care were evaluated regularly during their 3 years lasting training period (1999-2002). In the intervention group, we found at the end of the 3-year training period a significant better skin condition of the hands than in the control group: a 3-year prevalence of morphological skin changes of 66.7% versus 89.3%. The unteached trainees (control group) had an odds ratio (OR) of 4.8 [95% confidential interval (CI): 2.9-7.8] for developing any skin changes on the hands after 3 years. Besides the effect of the teaching, the history of hand dermatitis before the study start was an independent risk factor for development of further hand dermatitis [OR 1.9, 95% CI: 1.0-3.6). Age and sex showed no influence on the skin condition. Atopic constitution had an influence on the development of skin changes only at the evaluation after 18 month. The observed effect in the intervention group may best be explained by different behaviour of the trainees, e.g. the amount of hand washing was reduced, while procedure of hand disinfection remained unchanged compared with the control group. However, the amount of used skin care cream did not differ between the both groups. This study shows that primary prevention of skin disease by regularly teaching during the training period of medical employees can effectively reduce the risk of development of irritant skin changes of the hands. Therefore, teaching and continuous motivation regarding preventive individual and collective measures during the training of medical staff should be an obliged part of the curriculum.
[Candidiasis of the skin].
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[Staphylococcal infections of the skin and mucous membranes. Guideline of the German Dermatologic Society, Study Group of Dermatologic Infectiology].
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Glycosylphosphatidylinositols synthesized by Trichophyton rubrum in a cell-free system.
The opportunistic fungi Trichophyton rubrum and T. mentagrophytes, are responsible for relatively non-inflammatory chronic dermatophytes infections in immunocompromised patients but also in healthy individuals. This chronic infection is associated with immunosuppressive effects of the cell wall components particularly the polysaccharides secreted by these organisms. We have studied glycosylphosphatidylinositol (GPI) anchor biosynthesis in the pathogenic fungus T. rubrum and could demonstrate that T. rubrum is able to synthesize GPI structures. Glycolipids synthesized in a cell-free system prepared from the dermatophyte T. rubrum and labeled with [3H]mannose, and [3H]galactose using GDP-[3H]mannose and UDP-[3H]galactose, respectively, were identified and structurally characterized as GPIs. The evolutionary conserved backbone of T. rubrum GPIs incorporates galactose. Further, all glycolipids lack the acyl group on the inositol which was shown for Saccharomyces cerevisiae and mammalian GPIs. Our data suggest significant differences in the GPI biosynthetic pathway between mammalian and T. rubrum cells that could perhaps be exploited for the development of an antimycotic for Trichophyton infection.
Allergy and irritation: an adverse association in patients with atopic eczema.
The pathomechanism of atopic eczema is complex. Two of the most important exogenous factors for atopic eczema are allergenic and irritant substances. In this study we investigate the combined effect of topical aeroallergens and irritation on the skin of atopic individuals. We performed patch testing with several aeroallergens (atopy patch test) and with an irritant, sodium lauryl sulphate, on clinically unaffected skin of 30 sensitized patients with atopic eczema. Application was conducted alone and as a consecutive application. Healthy volunteers served as controls. Evaluation was made by measurement of transepidermal water loss 2 h after removal of the patches. In atopic patients, we found increased levels of transepidermal water loss induced by the aeroallergens as well as by sodium lauryl sulphate. The most impressive barrier disruption was seen after application of house dust mite, followed by cat dander and grass pollen. However, the consecutive application of aeroallergens and sodium lauryl sulphate led to a highly pronounced increase in transepidermal water loss. Hence, in sensitized atopic subjects the combined effect of aeroallergens and detergents may cause severe skin problems, and this may be relevant in daily practice.
The influence of body mass index on skin susceptibility to sodium lauryl sulphate.
BACKGROUND: The influence of nutrition on the physiological functions of man is well studied. Numerous diseases can be exacerbated by obesity. However, it has not yet been determined whether body weight and body mass index (BMI), as an indicator of a high body fat store, can influence skin sensitivity. OBJECTIVE: This study investigates the correlation between body mass index and the epidermal functions, evaluated by bioengineering methods, before and after an irritant patch test with sodium lauryl sulphate (SLS). METHODS: Epidermal functions were evaluated using an evaporimeter, chromameter and laser-Doppler-flowmeter. Patch testing was conducted for 48 h with two different concentrations of SLS (0.25% and 0.5%) on the forearms of healthy volunteers. Measurements were performed 24h after patch removal. RESULTS: Obese individuals showed significantly increased transepidermal water loss (TEWL), skin blood flow and skin colour (red) as compared to a control group. However, the degree of skin sensitivity to SLS was not correlated with BMI. CONCLUSION: Basal biophysical parameters of the skin are primarily correlated with the BMI. This may be caused by obesity-induced physiological changes, e.g. increased sweat gland activity, high blood pressure and physiological temperature-regulating system. The epidermal barrier function, as evaluated after SLS patch testing is, however, not correlated with a high BMI, indicating a normal skin barrier.
The spectrum of contact allergy in elderly patients with and without lower leg dermatitis.
BACKGROUND: There is a strong influence of lower leg dermatitis on the spectrum of allergic contact sensitivity in elderly patients. OBJECTIVE: To quantitatively assess the impact of this factor which confounds the age-related pattern of allergic contact sensitivity. METHODS: Stratified analysis of allergic contact sensitivity data collected between 1996 and 1999 in the 32 centres of the Information Network of Departments of Dermatology (three age groups: < or =60, 61-75, > or =76 years), both as crude and as directly standardised (for sex and leg dermatitis) proportions. RESULTS: Among the 36,070 patients tested with the German standard series, allergic contact sensitivity to neomycin, lanolin, cetostearylic alcohols, colophony, fragrance mix and balsam of Peru, among others, was (much) more common in the elderly, with proportions more or less affected by standardisation. CONCLUSION: The comparison of crude and standardised proportions provides evidence that allergic contact sensitivity to several allergens strongly depends not only on age itself, but on age-related and thus confounding co-morbidity.
Prevention of irritant contact dermatitis.
The prevention of skin diseases is accepted as an important part of occupational dermatology. Irritant dermatitis in particular, is a skin disease which can be avoided by preventional measures. Hence, an early introduction of trainees to preventional measures seems to be necessary to avoid bad habits which then become a matter of routine. The role of the dermatologist is not only the identification of individuals with a higher risk for developing irritant dermatitis, he should also inform his patients about the relevant irritants in their occupation (or of irritants in the household or leisure activities). Prevention by collective measures must be combined with individual measures (like gloves and protective clothing, correct skin cleaning and external creams). Periodical training and motivation of individuals at most risk is of utmost importance, because the best preventive measures are of no effect when they are not used regularly.
Skin changes in geriatric nurses prior to training heralding a particular risk of hand dermatitis.
Irritant skin changes are a well known problem in nursing services. Especially geriatric nurses often complain of hand dermatitis, most likely induced by frequent washing and hand disinfections. In this cohort study, demographic data and skin changes from 521 nurse trainees were recorded. The data of geriatric nurse trainees (n = 149) were compared to that of other nurse trainees (n = 372), mostly of surgery, internal medicine, pediatric and obstetrics. Geriatric nurse trainees were significantly older and had noticeably severer irritant skin changes at the start of the training. Geriatric nurse trainees were more often undergoing retraining, because they had other jobs before. Interestingly, some nurses performed the retraining because they had problems with hand dermatitis in their previous job. More education concerning the risk of irritant dermatitis in health care occupations is desirable, not only for the starting nurse but also for the employment offices.