The art, the science, and the practice of dermatology in the next millennium.
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Dermatology↗
Biomedical subjects
R Marks
Publications and source records attributed to R Marks.
The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia.
BACKGROUND: Nonmalignant skin conditions are believed to be common in adults, although there are very few community-based studies to determine their exact frequency. OBJECTIVE: To record the prevalence of common, nonmalignant skin conditions in adults in central Victoria, Australia. METHODS: A total of 1457 respondents from a random selection of adults aged 20 years and over from Maryborough, central Victoria, were given a total body examination by a dermatologist or dermatology trainee. People with any nail or skin signs suggestive of tinea had scrapings taken for fungal culture. RESULTS: The age- and sex-adjusted prevalence of warts was 7.1% (95% confidence interval (CI), 5.8-8.4%), acne 12.8% (95% CI, 11.0-14.5%), atopic dermatitis 6.9% (95% CI, 5.6-8.3%), seborrheic dermatitis 9. 7% (95% CI, 8.2-11.2%), asteatotic dermatitis 8.6% (95% CI, 7.1-10. 0%), psoriasis 6.6% (95% CI, 5.7-7.9%), culture-positive tinea 12% (95% CI, 10.3-13.6%), seborrheic keratoses 58.2% (95% CI, 55.6-60. 7%), and Campbell de Morgan spots (cherry angiomas) 54.4% (95% CI, 51.9-57.0%). There was variation in the prevalence of many of these conditions with age. CONCLUSIONS: This study demonstrates that nonmalignant skin conditions are common in adults in Australia. Their diagnosis and management represent a considerable burden not only to those suffering from the conditions, but also to the health system which provides for their care.
Acne Vulgaris↗
Two decades of the public health approach to skin cancer control in Australia: why, how and where are we now?
Incidence and mortality rates due to skin cancer are rising in most Western countries. Early detection of these tumours at a stage when they can be easily cured is the primary approach taken by many people wishing to deal with the problem. A primary prevention approach, that is, reduction in sunlight exposure, is being considered by an increasing number of organizations. The public health approach to primary prevention of skin cancer, including melanoma, requires an understanding of the role of sunlight in the production of these tumours. Despite a clear understanding of exactly how sunlight does this, there is enough epidemiological and laboratory evidence to suggest a broad approach to the problem. This includes reduction of sunlight exposure, particularly in childhood and adolescence. It also suggests the need to recommend avoidance of suntanning and particularly the excessive exposures that lead to sunburn. Widespread primary prevention public health programmes have been running in Australia for almost 20 years. The data measuring the effect of these programmes indicate a very large shift in knowledge attitudes and beliefs about sunlight exposure and suntans, and major shifts in behaviour. Suntans are no longer as popular as they were and people are reducing their sunlight exposure by a variety of methods encapsulated in Slip! Slop! Slap! Cohort analysis of the incidence rates for melanoma and non-melanoma skin cancer show that the incidence of these tumours is levelling out in young people and is dropping in some instances. These are the people who were able to be influenced by the public health programmes in recent decades. Finally, following initial dramatic changes in all the behavioural variables related to the programme, a period of consolidation with continuing effort and more specific targeting will be required in the coming decades to maintain the improvement.
Australia↗
A review of the epidemiology of tinea unguium in the community.
Tinea unguium is a common, chronic fungal infection of the nails. Many epidemiological studies have looked at the frequency with which this condition is seen in hospital outpatients clinics or mycological laboratories along with other dermatomycoses. Only recently have studies begun to emerge looking at the prevalence of this condition in populations. Hospital and mycological laboratory-based studies give valuable information about tinea unguium prevalence in a particular clinic, but cannot be compared with other studies due to confounding factors inherent in the different people attending individual clinics. From population-based studies the prevalence of tinea unguium lies between 2 and 8%. Tinea unguium increases steadily with age. It is infrequent but definitely found in children. With the increasing life expectancy in the Western world the prevalence of tinea unguium is likely to increase further without adequate prevention and treatment.
Adolescent↗
The descriptive epidemiology of atopic dermatitis in the community.
Atopic dermatitis (AD) is a common condition in the community, particularly amongst children. Although comparison of prevalence data between surveys is made difficult by differences in methodology, the available data suggest that there has been a substantial rise in the prevalence of AD, and that social, geographical and racial variation in disease frequency exists. There is a lack of quality data relating to the prognosis of AD. Recently a reliable set of diagnostic criteria has been developed and a number of severity scoring systems have been proposed for use in epidemiological studies.
Dermatitis, Atopic↗
The significance and measurement of scaling.
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Diagnosis, Differential↗
Optimising the use of tazarotene in clinical practice: consensus statement from the European advisory panel for tazarotene (Zorac TM).
BACKGROUND: This paper reports the proceedings of the European Advisory Panel Meeting for tazarotene (Zoractrade mark), which took place in Cologne on May 7, 1998. AIM: The aim of this meeting was to discuss recommendations for the use of tazarotene based on the clinical data available and on the clinical experience of the Advisory Panel members, and to identify future research needs. RECOMMENDATIONS: Based on currently available data, tazarotene can be used for the treatment of chronic, stable, plaque-type psoriasis, on the trunk or limbs covering up to 20% of the body surface area. In clinical trials, patients generally experienced a clinical response within 4 weeks of starting tazarotene treatment, and improvement was maintained for up to 12 weeks after stopping therapy. Results from published and not yet published clinical trials show that the efficacy and tolerability of tazarotene can be enhanced by the addition of topical corticosteroids to the treatment regimen and that, when used in combination with broad-band UVB phototherapy, tazarotene reduces the amount of UV light required to treat plaques. Tazarotene gel is available in two concentrations, 0.05 and 0.1%. The Advisory Panel recommends that the choice of concentration should be based on factors such as the irritability of the patient's skin and the thickness of plaques. Irritation can be managed by reducing the concentration or frequency of application, or by adding a topical corticosteroid to therapy. Tazarotene shows promise as a treatment for psoriasis in special localisations, such as the scalp, face and skin folds, although clinical studies are required.
Humans↗
Common red scaly rashes. Traps for the unwary--Part 1.
BACKGROUND: Red scaly rashes often provide difficulties for general practitioners leading to a 'try and see' approach which, although successful on many occasions, may delay adequate treatment when there is lack of a correct diagnosis. OBJECTIVE: A study of 61 general practitioners, providing them with photographs and clinical history, highlighted areas of uncertainty particularly in diagnosis, but also in treatment of common red scaly rashes including seborrhoeic dermatitis, pityriasis versicolor, psoriasis, superficial basal cell carcinoma, eczema, and tinea. On the basis of their responses, practical tips have been suggested to overcome them. DISCUSSION: Simple diagnostic procedures that can be done within the general practice setting include biopsy, skin scrapings and fungal microscopy. They have been highlighted as an important component of the approach to diagnosis of common red scaly rashes. While the study showed a substantial proportion of correct treatment being recommended, there was still an area of need, particularly in diagnosis, which could be enhanced by learning these simple techniques.
Adult↗
Common red scaly rashes. Traps for the unwary--Part 2.
BACKGROUND: Red scaly rashes often provide difficulties for GPs leading to a 'try and see' approach which, although successful on many occasions, may delay adequate treatment when there is lack of a correct diagnosis. OBJECTIVE: A study of 61 GPs' knowledge of the diagnosis and treatment of a number of red scaly rashes, was undertaken with the use of photographs and clinical history. The study highlighted areas of uncertainty particularly in diagnosis, but also in treatment of common red scaly rashes. On the basis of their responses, practical tips have been suggested to overcome them. DISCUSSION: Simple diagnostic procedures that can be done within the general practice setting include biopsy, skin scrapings and fungal microscopy. They have been highlighted as an important component of the approach to diagnosis of common red scaly rashes. While the study showed a substantial proportion of correct treatment being recommended, there was still an area of need, particularly in diagnosis, which could be enhanced by learning these simple techniques.
Diagnosis, Differential↗
Editorial: technical persistence.
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Acquired Immunodeficiency Syndrome↗
Editorial: intimate understanding.
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Female↗
Trends in the incidence of non-melanocytic skin cancer (NMSC) treated in Australia 1985-1995: are primary prevention programs starting to have an effect?
Non-melanocytic skin cancer (NMSC) is the most common cancer in Australia, but data on its incidence are not routinely collected by cancer registries. National surveys were conducted in 1985, 1990 and 1995 to estimate NMSC incidence. Trends in incidence between 1985 and 1995 have been examined to determine the impact of primary prevention campaigns aimed at controlling skin cancer in Australia. National random household surveys of Australians aged over 13 years were used to estimate NMSC incidence in 1985, 1990 and 1995. Age- and sex-specific rates by survey year were modelled using Poisson regression. Basal cell carcinoma (BCC) rates in 1995 were 788 per 100,000, an increase of 19% since 1985. Squamous cell carcinoma (SCC) rates rose by 93% over the same period, from 166 to 321 per 100,000. The ratio of BCC:SCC changed from 4:1 in 1985 to 2.5:1 in 1995. BCC rates in latitudes <29 degrees S remained at about 3 times those in latitudes >37 degrees S over the decade. The ratio of SCC incidence between these latitudes changed from around 7:1 to 3:1 over the same period. Although NMSC incidence rates continue to rise, there have been reductions in BCC observed in younger age groups. Incidence rates of NMSC continue to rise in Australia, but there is evidence of a reduction in BCC incidence in younger cohorts. This is evidence that public health campaigns to reduce sun exposure may be having a beneficial effect on skin cancer rates.
Adolescent↗
GMDP for psoriasis.
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Acetylmuramyl-Alanyl-Isoglutamine↗
Mechanisms of recovery from experimental autoimmune encephalomyelitis: T cell deletion and immune deviation in myelin basic protein T cell receptor transgenic mice.
Experimental autoimmune encephalomyelitis (EAE) is a Th1-type cell-mediated autoimmune disease directed against central nervous system (CNS) myelin antigens such as myelin basic protein (MBP). EaE is usually characterized by spontaneous remission of clinical disease and immune pathology despite the persistence of self myelin antigens in the central nervous system. Following induction of an acute episode of EAE, spontaneous remission also occurs in MBP T cell receptor (TCR) transgenic mice even through most T cells express a TCT specific for MBP. To investigate the mechanisms of recovery associated with EAE, we examined the behavior of MBP-specific T cells in the MBP TCR transgenic mouse model during disease progression and recovery. We found that recovery from EAE was associated with three major immunologic changes: (1) deletion of encephalitogenic T cells in the brain; (2) deviation of MBP-specific transgenic (Tg+) T cells both in the periphery and in the central nervous system from INF- gamma secretin Th1 type cells to cells that secrete IL-4, IL-10, and TGF- beta ; and (3) deletion of Tg+ T cells in the thymus through apoptosis. Thus spontaneous recovery from a classic Th1 type organ specific autoimmune disease is associated with two mechanisms of immune tolerance, deletion of autoreactive cells and immune deviation of autoreactive cells to a non-pathogenic phenotype.
Animals↗
Comparison of the use of standardized diagnostic criteria and intuitive clinical diagnosis in the diagnosis of common viral warts (verrucae vulgaris).
OBJECTIVE: To assess the diagnostic value of standardized diagnostic criteria compared with the clinical intuitive diagnosis for verrucae vulgaris. DESIGN: A blind comparison with cross-over of experienced dermatologists using either intuitive clinical diagnosis or else recording the presence of standardized diagnostic criteria in verrucae vulgaris. SETTING: Clinical outpatient department in a major teaching hospital. PATIENTS: Fifteen patients aged 6 to 60 years with 21 verrucae vulgaris and 24 control lesions. INTERVENTION: Dermatologists examined the lesions and recorded either the diagnosis by the usual clinical intuitive method or else whether standardized diagnostic criteria were present in the lesion of each patient. Each dermatologist did 1 only of the 2 methods for each lesion with the other doing the alternative method for the same lesion, neither of them having previously been aware of any of the diagnoses. MAIN OUTCOME MEASURE: The sensitivity, specificity, and positive predictive, negative predictive, and relative values for each diagnostic approach were compared. RESULTS: Use of intuitive clinical diagnosis resulted in 100% specificity, sensitivity, and positive predictive, negative predictive, and relative values for both the verrucae vulgaris and the control lesions. Recording the presence of the diagnostic criteria reduced to a varying extent all the parameters of diagnostic accuracy with site--fingers and hands, elbows, and knees--being the most efficacious of the criteria. CONCLUSIONS: These data indicate that care is required in relying too much on standardized criteria as the basis for clinical diagnosis, even for a lesion as simple as a wart. They also reinforce the value of clinical experience obtained from repeated exposure to multiple variants of a disease in the traditional bedside teaching model.
Adolescent↗
Pharmacokinetics and safety review of tazarotene.
The safety profile of tazarotene is superior to that of orally administered retinoids. The limited percutaneous penetration of tazarotene limits its systemic absorption and this, combined with its rapid metabolism in the skin and the plasma to the more water-soluble active metabolite, tazarotenic acid, helps prevent accumulation of the drug in fat containing tissues. Urinary and fecal elimination are virtually complete within 2 to 3 days and 7 days after dosing, respectively. Tazarotene also exhibits no indication of mutagenicity, carcinogenicity, phototoxic potential, photoallergic potential, or contact sensitization.
Administration, Cutaneous↗
A methodology report of a randomized prospective clinical trial to assess velopharyngeal function for speech following palatal surgery.
Cleft lip and palate occurs in approximately 1 in every 750 live human births, making it one of the most common congenital malformations. Surgical closure of the palatal cleft does not always result in a velopharyngeal port capable of supporting normal speech. The University of Florida (UF), in collaboration with the University of São Paulo (USP), is engaging in a 5-year prospective, randomized controlled study to compare velopharyngeal function for speech outcomes between patients undergoing palatoplasty for complete unilateral cleft lip and palate performed using the von Langenbeck procedure with intravelar velarplasty and those receiving the Furlow double-reversing Z-plasty palatoplasty. The von Langenbeck procedure was selected as the time-tested standard against which the Furlow procedure could be judged. The Furlow procedure, a relatively new operation, has been reported to yield substantially higher rates of velopharyngeal competency for speech than have most other reported series and theoretically should result in less disturbance to midfacial growth. A total of 608 patients will be entered into one of two age categories. Inclusion of two age groups will allow a comparison of results between patients having surgery before 1 year of age (9-12 months) and patients undergoing surgery at approximately 1.5 years of age (15-18 months). Speech data will be collected and will be available for definitive analysis throughout the last 3 years of the study. Collection of preliminary growth data will require more than 5 years; growth analysis is anticipated to continue until all patients have reached maturity. The Hospital for Research and Rehabilitation of Patients with Cleft Lip and Palate at the University of São Paulo (USP-HPRLLP) in Bauru, Brazil, is uniquely situated for conducting this study. The well-equipped and modern facilities are staffed by well-trained specialists representing all disciplines in cleft-palate management. In addition, an already existing social services network throughout Brazil will ensure excellent follow-up of study cases. The clinical caseload at this institution currently exceeds 22,000, and more than 1200 new cases are added annually. This project represents a unique opportunity to obtain prospective data from a large number of subjects while controlling the variables that have traditionally plagued cleft-palate studies. This study is designed to determine which of the two proposed surgical procedures is superior in constructing a velum capable of affecting velopharyngeal competency for the development of normal speech.
Cleft Palate↗
Celtic ancestry, HLA phenotype and increased risk of skin cancer.
Individuals of Celtic ancestry are claimed to be at greater risk of skin cancer than non-Celts, and various positive and negative associations between certain human leucocyte antigen (HLA) phenotypes and the development of skin cancer have been described. The aims of this study were to determine whether any HLA phenotypes are associated either with Celtic or non-Celtic ancestry, or skin type. One thousand and ten members of the Welsh Bone Marrow Donor Registry (WBMDR), whose HLA phenotypes are known, were asked to complete a questionnaire which enquired as to their family origins and their 'Index of Celtic Ancestry' scored out of 12. Three groups were identified: non-Celts (score < 3), Celts (score > 9), and a subset of the Celts--'high scoring' Celts (score > 10). Details of hair and eye colour and skin type were also requested. Skin type and HLA-A, -B, -DR and -DQ frequencies were compared between the three groups (Celts, non-Celts and 'high scoring' Celts), and a random indigenous population of 9196 members of the WBMDR. Seven hundred and thirty-six replies were received (279 male, 457 female, mean age 31 years). One hundred and forty-four Celts, 51 'high scoring' Celts and 170 non-Celts were identified. Forty-six (32%) Celts had skin type I or II compared with 36 (21%) non-Celts (P = 0.039), and 37 (73%) 'high scoring' Celts had skin type I or II (P < 0.0001). However, there were no significant differences between the groups with regard to hair colour, eye colour or number of episodes of painful sunburn. The frequency of HLA-DR4 was 32% in the non-Celtic group, 44% in the Celtic group (not significant), and 53% in the 'high scoring' Celts (P = 0.008). However, the difference was not significant after correction. There were no significant associations between skin type and HLA phenotype. HLA-DR4 is known to be associated with an increased risk of both basal cell carcinoma and malignant melanoma and its increased frequency in Celts may be an independent risk factor for skin cancer in addition to skin type.
Adult↗