Update on the activities of the European Dermato-Epidemiology Network (EDEN).
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Dermatology↗
Biomedical subjects
T Diepgen
Publications and source records attributed to T Diepgen.
The objective severity assessment of atopic dermatitis (OSAAD) score: validity, reliability and sensitivity in adult patients with atopic dermatitis.
BACKGROUND: The Objective Severity Assessment of Atopic Dermatitis (OSAAD) score is a recently developed scale for evaluation of severity of atopic dermatitis, constructed from the assessment of epidermal barrier function, and properties using noninvasive bioengineering methods and computer-assisted estimates of disease extent. The method has been validated for use in infants and children with atopic dermatitis and compared with a referent scoring system. OBJECTIVES: The aim of the present study was to test the validity, reliability and sensitivity of the OSAAD score as an objective tool for the assessment of the severity of atopic dermatitis in adult patients. METHODS: Thirty-two adult patients with atopic dermatitis were included in the study. To assess the validity of the OSAAD score we tested it against the Severity Scoring of Atopic Dermatitis (SCORAD) index of the European Task Force on Atopic Dermatitis as a referent clinical severity scale, and the serum levels of interleukin (IL)-16 as a laboratory variable for monitoring the activity of atopic dermatitis. Responsiveness to change was assessed in a longitudinal study comparing OSAAD, SCORAD and serum levels of IL-16 before and after treatment. To test the reliability of the OSAAD score we studied the interobserver variability of the score recorded by three independent board-certified dermatologists in 16 patients and compared it with SCORAD. RESULTS: We report a significant correlation between the OSAAD and the SCORAD index as an acknowledged referent severity scale. The OSAAD score correlated significantly with the serum levels of IL-16 in the acute stage of atopic dermatitis. In a longitudinal study, the OSAAD score decreased significantly, parallel with improvement of the skin findings and a significant decrease in the SCORAD score and IL-16 serum levels. We report improved interobserver variability for the OSAAD score compared with SCORAD. CONCLUSIONS: This is the first study validating the OSAAD score as a sensitive and reliable tool for the assessment of the severity of atopic dermatitis in adult patients.
Acute Disease↗
Testing for irritation with a multifactorial approach: comparison of eight non-invasive measuring techniques on five different irritation types.
BACKGROUND: Non-invasive bioengineering methods are widely used in the assessment of irritant skin reactions. OBJECTIVES: To assess the ability of eight non-invasive measurement techniques to distinguish changes in skin conditions over time, these changes being induced by five different irritants. METHODS: The following techniques were compared in a multivariate analysis: laser-Doppler perfusion imaging (LDI), laser-Doppler flowmetry (LDF), transepidermal water loss (TEWL), visual scoring (VS), colorimetric measurements (Chromameter CR 200 a* and L* scales), Mexameter Hb scale (Mexa Hb) and capacitance (Corneometer CM 820). Irritants tested were sodium lauryl sulphate 2% (SLS), tape stripping (TS), tretinoin 0.05% (TRET), ultraviolet (UV) exposure to 30 W m(-2) UVB/95 W m(-2) UVA, and dithranol 0.5% (DIT). Measurements were performed at baseline and after 24, 48 and 72 h. The study was conducted on the upper back of 11 healthy volunteers of both sexes aged 27-51 years. RESULTS: For DIT it was possible to discriminate over time with CR 200 a* and L*, VS, LDI, LDF and Mexa Hb. In SLS discrimination over time was seen with TEWL and LDF. Discrimination in TS was demonstrated for TEWL, VS, CR 200 a*, CM 820, LDF, LDI and Mexa Hb. In TRET discrimination ability was seen for LDI, LDF, Mexa Hb and VS. For UV it was possible to discriminate using VS, TEWL, LDF, LDI and Mexa Hb. CONCLUSIONS: Different irritation patterns need different measurement modalities in order to give optimal discrimination over time.
Adult↗
[Current status of the interdisciplinary model project "Neurodermatitis Education for Children and Adolescents"].
With the help of the German Ministry of Health and the health insurance companies a national interdisciplinary project for children and adolescents with atopic eczema will be developed. The aim of the project is to generate standardized teaching concepts for parents and children covering medical, psychological and social aspect of the disease. 800 children and adolescents of different age groups will be enrolled in this project. Furthermore, during the three years of the study the efficacy of the teaching concept will be evaluated.
Adaptation, Psychological↗
Patch testing with corticosteroid mixes in Europe. A multicentre study of the EECDRG.
This study investigated whether a corticosteroid mix containing tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate could detect contact allergy to corticosteroids. 2 corticosteroid mixes, 1 with a high (mix I) and 1 with a low (mix II) concentration and the 3 individual constituents, each at 2 concentrations, were inserted into the standard series of 16 participating clinics. Tests were read on day (D) 3 or 4. 5432 patients were tested, and 110 (2.0%) had positive reactions to at least 1 of the 8 test preparations. Of the 8 preparations, mix I identified most allergic patients, followed by mix II, budesonide 0.10%, budesonide 0.002%, and tixocortol pivalate, both concentrations (1.0 and 0.10%) tracing the same number. With the mixes, 53.2-59.6% of tixocortol pivalate allergy was missed. 47 patients were allergic to either concentration of tixocortol pivalate, 25% of these only to 1.0% and another 25% only to 0.10%. Testing with mix I and tixocortol pivalate 0.10% picked up 98/110, testing with tixocortol pivalate 1.0% and 0.10% and budesonide 0.10% picked up 105/110. 3379 patients were read on both D3 or D4 as well as on D7. Without a late reading (D7), up to 30% of contact allergy to corticosteroid markers was missed.
Administration, Topical↗
Significance of saliva for the denture-wearing population.
UNLABELLED: This paper summarises a series of studies already published in German and presents new data related to the aetiology of the 'dry mouth' and its associated problems. AIMS: To study factors affecting mucous and serous salivary gland secretion, the aetiology of the 'dry mouth' and its associated problems, causative factors for hyposalivation and it's treatment. SETTING: Two university dental hospitals. SUBJECTS: 587 denture wearers and 521 control subjects, and autopsy material. INTERVENTIONS: Exercise, chewing, water, oestrogen, pilocarpine, and anetholtrithion therapy, biopsy of the minor glands. MAIN OUTCOME MEASURES: Palatal secretion (PAL, microL/cm2/min) and parotid salivary flow (PAR), subjective complaints and clinical findings. RESULTS: Resting flow rates for PAL between 0 and 65 microliters/cm2/min were seen in every age group. The flow rates of PAR (0 to 3.7 ml/10 min) were not correlated with PAL. Most patients with a resting flow rate of PAL < or = 6.0 microliters/cm2 suffer from a 'dry mouth' and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with or without chronic lesions of the oral mucosa. Etiological factors for the incidence of reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency, radiotherapy, thyroid dysfunction, smoking or continuous wearing of complete upper dentures. PAL also correlated with the retention of upper complete dentures. PAL was correlated with the water content of epithelial tissues. PAL and PAR were both increased by drinking ample fluid, improving their circulation by physical exercises, chewing intensively, or taking oestrogens, pilocarpine, anetholtrithion. CONCLUSIONS: Variation in palatal salivary secretion occurs and is clinically important.
Adult↗
Patch testing with budesonide in serial dilutions. A multicentre study of the EECDRG.
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Administration, Topical↗
EU-project medCERTAIN: Certification and Rating of Trustworthy and Assessed Health Information on the Net.
Med-CERTAIN (MedPICS Certification and Rating of Trustworthy Health Information on the Net, http://www.medpics.org/medcertain/) is a recently launched project funded under the EU Action Plan for safer use of the Internet. It will provide the technical infrastructure for an international system of "quality seals" for Internet health information. Digital "quality seals" may be evaluative metainformation (using standards such as PICS = Platform for Internet Content Selection, now being replaced by RDF/XML) assigned by trusted third-party raters. The project will also enable and encourage self-labelling with descriptive metainformation by web authors. Together these measures will help consumers to identify high-quality information on the Internet. Med-CERTAIN will establish a fully functional demonstrator for a self- and third-party rating system enabling patients and consumers to filter harmful health information and to positively identify and select high quality information. We aim to provide a system allow European citizens to place greater trust in networked information, exemplified in the domain of health information, whilst also making a significant contribution for similar projects with different target domains. The project will demonstrate how PICS-based content rating and filtering technologies can automate and exploit value-adding resource description services. The proposed technology strategy combines a pragmatic use of simple existing technologies for data acquisition with a future-oriented standards policy intended to lead rather than follow the evolution of definitions for information-mediation services.
Europe↗
The Cochrane Skin Group. Preparing, maintaining, and disseminating systematic reviews of clinical interventions in dermatology.
In 1979, Prof Archie Cochrane challenged the medical profession to produce a critical summary of randomized controlled clinical trials according to specialty, which should be updated periodically. The Cochrane Collaboration, an international voluntary group of reviewers and researchers from a range of professional backgrounds dedicated to producing systematic reviews, was established in 1992 in response to Cochrane's challenge. Systematic reviews produced by the Cochrane Collaboration start with individuals who formulate questions that are important to the care of patients. Every effort is then made to locate published and unpublished evidence to answer the question, and explicit criteria are used to select studies for inclusion in the review and to assess their quality. If appropriate, meta-analysis is used to combine results from several smaller studies to produce an overall result. Reviews are published in the Cochrane Library, an electronic publication (CD-ROM or diskette form), and the reviews are updated quarterly. In December 1997, a Cochrane Skin Group was registered with the Cochrane Collaboration to prepare, maintain, and disseminate reviews on the effects of health care for people with dermatological conditions. Currently, 25 titles and 9 review protocols have been registered with the Cochrane Skin Group, and the first set of dermatological reviews will be available before the end of 1999. The Cochrane Skin Group aims to become the best source of unbiased external evidence for summarizing the effects of dermatological care.
Dermatology↗
A systematic review of five systemic treatments for severe psoriasis.
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Humans↗
An international dermatological image atlas on the WWW: practical use for undergraduate and continuing medical education, patient education and epidemiological research.
We describe the development of an image database DOIA (Dermatological OnlIne Atlas) and present several spin-off projects using images of the atlas, e.g. student education using the atlas including results of an questionnaire evaluating computer-literacy, prerequisites and interests of students for using computers and the World-Wide-Web (WWW), a patient information system and an experiment to collect epidemiological data from patients with dermatological diseases via WWW. The database, available on the WWW at http:@www.derma.med.uni-erlangen.de, contains about 3,000 clinical images covering more than 540 dermatological diagnoses. It is designed for worldwide use; international submissions are encouraged. One aim of the project is to compile an international reference for dermatological images, containing images of high educational quality and also covering conditions on different skin types and rare diagnoses which are not commonly illustrated in ordinary textbooks. All images were originally mapped to the Erlanger Diagnosis Code, which is a proprietary modified ICD-9 key, later also to the UMLS (Unified Medical Language System). In addition, images are described with keys for the location, physical attributes of the location and clinical and histopathological features of the lesion. In order to facilitate the integration of the atlas into other web-based medical resources and to allow easy access to additional information, the Erlanger Diagnosis Code was mapped to the CUIs (unique concept identifiers) of the UMLS Metathesaurus. One purpose of the UMLS is to allow conversion of terms from one controlled medical vocabulary to another, thus, mapping of our diagnosis code to the UMLS CUIs allows simultaneous search for a given diagnosis in a number of other databases and also access to our image database from other databases. Mapping was successful for 619 out of 1383 dermatological diagnosis terms. For images with these diagnoses we are able to provide a hyperlink to other databases available on the Internet, such as MEDLINE, PDQ and OMIM, with automatic retrieval using the preferred vocabulary of the respective database. By grouping all diagnoses into sets with similar morphologies we further integrated a differential diagnosis mode. In order to educate patients via the Internet, a separate patient information system has been developed, using images of the electronic atlas. As an experiment to explore the feasibility of the Internet to gather epidemiological data from patients, users are asked to complete an electronic questionnaire covering signs for atopy. We conclude that an online image atlas has multiple educational, clinical and research applications.
Computer-Assisted Instruction↗
High-dose UVA1 radiation therapy for localized scleroderma.
BACKGROUND: Fibrotic skin lesions in patients with localized scleroderma can cause muscle atrophy, disfigurement, and flexion contractures. There is no effective therapy for this disease. Skin fibrosis is thought to be caused by decreased collagenase activity. Collagenase activity can be induced in dermal fibroblasts by UVA1 irradiation. OBJECTIVE: Our purpose was to assess whether UVA1 radiation therapy is effective for patients with localized scleroderma. METHODS: Patients with localized scleroderma (n = 17) were exposed 30 times to 130 J/cm2 UVA1 (high-dose UVA1 therapy; n = 10) or 20 J/cm2 UVA1 (low-dose UVA1 therapy; n = 7). Therapeutic effectiveness was assessed by evaluation of (1) clinical features, (2) thickness of sclerotic plaques, and (3) cutaneous elastometry. Sequential biopsy specimens from treated lesions were analyzed for collagenase I messenger RNA (mRNA) expression by semiquantitative reverse transcriptase-polymerase chain reaction. RESULTS: In all patients, high-dose UVA1 therapy softened sclerotic plaques, and complete clearance was observed in four of 10 patients. High-dose UVA1 therapy significantly reduced thickness and increased elasticity of plaques. These changes could not be detected in unirradiated control plaques and were still present in 9 of 10 patients 3 months after cessation of therapy. For all factors assessed, high-dose UVA1 was superior to low-dose UVA1 therapy (p = 0.001). High-dose UVA1 therapy increased collagenase I mRNA expression about 20-fold in treated plaques. CONCLUSION: High-dose UVA1 therapy is effective in the treatment of localized scleroderma. Effectiveness is UVA1 dose dependent and is associated with induction of collagenase I expression.
Adult↗
Dermatology on the Internet. A source of clinical and scientific information.
Rivaling textbooks and journals, the Internet is about to become the most important source of information in virtually any academic profession. Dermatology has a growing presence in many areas of the Internet. A number of sites offer dermatologic data in the form of text and images. Discussion groups and continuing education programs invite regular participation. A dermatologic image data base has been created, which is aiming to provide clinical and histopathological images for most dermatological diseases. However, there is a deplorable lack of dermatologic basic research data and discussion on the Internet. In this mini-review we shall give an overview of the available information sites.
Computer Communication Networks↗
The occurrence of atopic dermatitis in north Europe: an international questionnaire study.
BACKGROUND: Atopic dermatitis is a common multifactorial disease that seems to be increasing in frequency. OBJECTIVE: Our purpose was to determine the increased prevalence of atopic dermatitis in North Europe. METHODS: Approximately 3000 7-year-old children in Denmark, Germany, and Sweden were enrolled in a cross-sectional questionnaire study that was conducted in the autumn of 1992 with common protocols and standardized procedures. RESULTS: The response rate was 90%. The frequency of atopic dermatitis was calculated to be 15.6% (95% confidence interval 14.2% to 17%) with some regional differences. Girls more often had flexural eczema and outnumbered boys in a ratio of 1.3:1.0. Boys more often had a personal history of asthma, whereas girls more often had a family history of asthma. CONCLUSION: The increasing prevalence of atopic dermatitis has been confirmed. This simple questionnaire model works well, is cost effective, and is sufficiently sensitive and specific to conduct large-scale epidemiologic investigations in school children.
Asthma↗
High-dose UVA1 therapy in the treatment of patients with atopic dermatitis.
BACKGROUND: Besides glucocorticosteroids, there is currently no known effective therapy for patients with acute atopic dermatitis. OBJECTIVE: The therapeutic effectiveness of high-dose UVA1 irradiation in the management of patients with acute exacerbation of atopic dermatitis was examined. METHODS: Patients in the high-dose UVA1 group (n = 15) were irradiated with 130 joules/cm2 UVA1; the control group (n = 10) was treated with UVA-UVB therapy in a minimal erythema dose-dependent manner (total number of treatments 15). RESULTS: High-dose UVA1 irradiation was found to induce a significant clinical improvement of atopic dermatitis (p less than 0.001). In comparison with UVA-UVB therapy, significant differences in favor of high-dose UVA1 were observed (p less than 0.01). High-dose UVA1, but not UVA-UVB treatment, significantly reduced the elevated serum level of eosinophil cationic protein in patients with atopic dermatitis (p less than 0.003). CONCLUSION: These studies indicate that high-dose UVA1 irradiation may represent a novel phototherapeutic modality for the treatment of patients with an acute exacerbation of atopic dermatitis.
Adult↗
Pre- and postdexamethasone cortisol and prolactin levels in sexual dysfunction and normal controls.
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Adult↗
Gonadal steroid and gonadotropin response to dexamethasone: a study in sexual dysfunction and normal controls.
Numerous investigations have reported an alteration of hormonal response to dexamethasone in depressive disorder. No such data are available in psychogenic sexual dysfunction. Pre- and postdexamethasone levels of testosterone, estradiol, LH and FSH were studied in 20 male patients with sexual dysfunction and 20 male healthy controls. Dexamethasone had no influence on testosterone, estradiol, LH and FSH in normal controls. The patients showed an increase in testosterone and LH but not in FSH levels in the morning after dexamethasone administration. When compared with basal levels, the increase in postdexamethasone levels in sexual dysfunction was significant for testosterone (delta T) but not for LH (delta LH). The altered gonadal steroid and gonadotropin response to dexamethasone in sexual dysfunction might be due to disturbances of dexamethasone metabolism and glucocorticoid receptor density comparable to similar findings in depressive disorder.
Adult↗
Effects of UVA on human stratum corneum histidine and urocanic acid isomers.
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Adult↗