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PubMed1978

The role of microorganisms in diaper dermatitis.

A quantitative microbiological survey of multiple sites in the diaper area in 40 normal infants and 100 infants with various forms of diaper dermatitis showed (1) no significant differences between normal infants and those with common chafing form of diaper dermatitis except for a low number of Staphylococcus aureus organisms in 50% of those with chafing dermatitis compared to no S aureus in normals; (2) S aureus occurred in high numbers in every case of atopic dermatitis and was frequently found at much lower levels in psoriasis, seborrheic dermatitis, and chafing dermatitis; (3) Candida albicans occurred in 80% of cases clinically diagnosed as moniliasis localized to the diaper area and in 33% of those suspected of Candida infection with dissemination beyond the diaper area, while C albicans was found in only five of 145 culture sites in 40 normal infants.

Candida albicans↗

PubMed1981

[In vitro blastogenic response of lymphocytes in pityriasis capitis and dermatitis seborrheica (using PHA-mitogen, Pityrosporum ovale and bacteria)].

63 patients with Pityriasis capitis (PC) "dandruff" and Seborrheic dermatitis (SD) as well as normal controls were studied. Antigenicity was checked "in vitro" by the lymphocytic transformation test. A significant transformation in the PC to P. ovale was observed while in SD it was to Stanphyloccocus and P. ovale. In view of results the authors suggest that there is a similar immunoalergic response in the host to those antigens. The clinic will differ according to the antigens. This is significant for a new local treatment and general.

Antigens, Bacterial↗

PubMed2002

Allergic contact dermatitis to topical minoxidil solution: etiology and treatment.

After more than a decade of use, topical minoxidil solution has proven to be a safe and effective treatment for androgenetic alopecia. However, some patients present with complaints of pruritus and scaling of the scalp. The most common causes of these symptoms include irritant contact dermatitis, allergic contact dermatitis, or an exacerbation of seborrheic dermatitis. Patients suffering from allergic contact dermatitis may benefit from patch testing to determine the causative allergen. Among the patients we patch tested, propylene glycol was found to be the contactant in a majority of cases, not the minoxidil itself. Many of these patients may be candidates for treatment with alternative formulations using other solvents, such as butylene glycol, polysorbate, or glycerol. Although predictive, patch testing results do not ensure that the compounded preparations will be tolerated. Unfortunately, patients found to be allergic to minoxidil are no longer candidates for topical treatment of their alopecia with any preparations of minoxidil.

Administration, Topical↗

PubMed1991

C-fos and c-jun proto-oncogene expression is decreased in psoriasis: an in situ quantitative analysis.

Psoriasis is a common, sometimes severe, non-malignant skin disease characterized by hyperproliferation and abnormal differentiation of keratinocytes. Because proto-oncogenes are implicated in both cell proliferation and differentiation, their expression could be modified in skin diseases such as psoriasis. The c-fos and c-jun proto-oncogenes, whose products associate to form a heterodimeric transcription factor, are among the first genes to be expressed when certain cells are stimulated to either proliferate or differentiate. Recent studies in our laboratory have shown that the c-fos proto-oncogene is highly expressed in normal human adult skin. In the present study, we used in situ hybridization with RNA to compare the expression and localization of c-fos and c-jun transcripts in 15 lesional and non-lesional psoriatic skin samples. Two clinical variants of psoriasis were studied: the most severe and chronic form or plaque-type psoriasis (N = 10) and rapidly resolutive guttate-type psoriasis (N = 5). Quantitative analysis was performed using a semi-automatic image analyzer and the "Starwise grain" software program. Our control samples included 10 normal skins and eight specimens from other benign hyperproliferative non-psoriatic skin diseases, consisting of three with inflammation (seborrheic dermatitis and atopic dermatitis), and 5 without inflammation (seborrheic keratoses). Control genes we used for in situ hybridization and RNA integrity were keratin 14, which is expressed in the epidermis and was normally expressed in all tissue analyzed, and ribosomal RNA. Our data showed that c-fos and c-jun were expressed to an equivalent extent, both spatially and quantitatively, in all specimens tested. Expression was significantly decreased in plaque-type but not in guttate-type psoriasis. It was also decreased in the three other benign inflammatory cutaneous hyperproliferative disorders, but not in the five non-inflammatory cases. These results were surprising because hyperproliferation was here associated with a decrease in proto-oncogene expression, thus suggesting that c-fos and c-jun do not play a crucial role in the control of keratinocyte proliferation in vivo. However, their reduced expression in some abnormally differentiated skins indicates that both c-fos and c-jun proto-oncogenes may play a key role in keratinocyte differentiation. Their altered expression correlated with severity of the disease and the presence of an inflammatory infiltrate. These data offer a new insight into the role and regulation of these proto-oncogenes in vivo in humans.

Chronic Disease↗

PubMedDate not supplied

Prevalence of mental health problems in acne patients.

BACKGROUND: Acne is the most common of all skin diseases. The condition affects young people at the time when they are undergoing maximum social and physical change and can produce significant psychological scarring. This study was done to determine the Mental Health problem in Patients suffering from acne and to determine significant difference of mental health problems in acne patients in comparison to seborrhic dermatitis patients as a control group. METHODS: 50 subjects with acne and 50 with seborrhic skin problems (13-25 yrs age) were included in this study through Psychiatry OPD of Lady Reading Hospital, Peshawar. The period of study was from March 1998 to August 1998. The patients were assessed for psychiatric problems by using WHO Guide to mental health in primary care ICD 10 chapter V primary care. The statistical significance was determined by chi square. RESULTS: The data shows that out of 50 acne patients 19 (38%) were suffering from Depression, with a female predominance. The control group (seborrhic) presented lower prevalence of Depression i.e. 57% in females. Similarly Anxiety problem in particular social anxiety were overall more in acne group (34%) as compared to seborrhea group (10%). A statistically significant difference was observed between the two groups indicating that depression and social anxiety was more in the acne group. A consistent finding in the study over six months depicted the difference between gender i.e. more females presenting with depression. Total Depressed Patients were 19, while total with suicidal Thoughts were 4 (21%). CONCLUSION: The importance of this study is to highlight depression among such patients.

Acne Vulgaris↗

PubMed1989

[Seborrhea-like dermatitis in the acquired immunodeficiency syndrome. Clinical, histological, and microbiological aspects and biochemical findings].

Seventy-six patients diagnosed as having seborrheic dermatitis (SD) were divided into two groups: group A (n = 22) otherwise healthy subjects (HIV negative) and group B (n = 54) HIV positive (ARC and AIDS cases). Thirty normal healthy subjects without SD were considered as control (group C). The three groups were subjected to the following analyses: A) skin surface lipids (SSL) and fatty acid pattern of cholesterol esters, wax esters, triglycerides and free fatty acids fractions in the affected areas; B) plasma levels of Vitamin E and fatty acids of phospholipids; C) erythrocyte glutathione peroxidase (3 cases for each group); D) frequency of Pityrosporum species in the affected areas; E) skin biopsy in the affected areas (2 cases for each group). Histological findings paralleled those reported in the Literature. SSL composition, fatty acid pattern and frequency of Pityrosporum species did not show significant variation among the 3 groups. On the contrary the blood levels of Vitamin E, polyunsaturated fatty acids of phospholipids and glutathione peroxidase were found significantly lower in A and B groups than in the controls.

AIDS-Related Complex↗

PubMed1983

Diaper dermatitis. Factors to consider in diagnosis and treatment.

Diaper dermatitis is a common problem in infants and young children. Although the pathogenesis of diaper dermatitis is not well defined, many associated factors have been identified, including individual predisposition to atopic or seborrheic dermatitis, occlusion and friction caused by the diaper, and overgrowth of bacteria and yeast. General treatment goals involve keeping the diaper area as dry as possible, washing the area as infrequently as possible, and avoiding tight-fitting diapers. Petrolatum, talc, baking soda, and fluorinated topical steroidal medications should be avoided. If all else fails, toilet training provides the final answer.

Candidiasis, Cutaneous↗

PubMed1999

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↗

PubMed2004

Eyelid dermatitis: a report of 215 patients.

Between April 2001 and October 2003, 215 persons presented with eyelid dermatitis for the first time. They ranged in age from 4 months to 95 years, with an average age of 49.6 years and a median age of 51 years. There were 173 females and 42 males. 165 of 215 had allergic contact dermatitis (ACD) and another 9 had protein contact dermatitis without relevant positive patch tests. Atopic eczema comprised 37 of 215 (17%), but 33 of 37 also had contact allergies. Seborrheic dermatitis, psoriasis or both were found in 35 (16%). Sources of ACD included personal care products in 54 (25%), including 12 with at least 1 positive patch test to cosmetic applicators and 12 sensitive to at least 1 botanical ingredient. Allergy to artificial nails and/or nail lacquer occurred in 18 of 215 (8%). 5 persons had rosacea or periorbital dermatitis, and 2 had dermatomyositis. Other causes included bacterial, fungal and viral infections, some of which were quite unusual. The evaluation of persons presenting with eyelid dermatitis remains a relatively complex but rewarding discipline.

Administration, Topical↗

PubMedDate not supplied

The differential diagnosis of atopic dermatitis in childhood.

Atopic is the most common of the dermatitides seen in infancy and childhood, but there are numerous other diseases that can mimic the skin findings. These include seborrheic dermatitis, immunodeficiency, and psoriasis in infancy; scabies, tinea corporis infection, perioral, nummular, contact, and molluscum dermatitis in childhood. It is sometimes extremely difficult to differentiate between ichthyosis and AD, and it is also important to differentiate AD from erythrodermic conditions including acrodermatitis enteropathica, biotin deficiency, and Netherton syndrome. A rare condition in children that may mimic AD is mycosis fungoides.

Child↗

PubMed2002

Scalpdex: a quality-of-life instrument for scalp dermatitis.

OBJECTIVE: To develop a scalp dermatitis-specific quality-of-life instrument. METHODS: Based on the results of directed focus sessions with 8 patients with scalp psoriasis or seborrheic dermatitis, we conceptualized 3 major constructs that explain the way scalp dermatoses affect patient quality of life: symptoms, functioning, and emotions. We constructed a 23-item instrument, Scalpdex, and tested its reliability, responsiveness, and validity. RESULTS: Fifty-two dermatology patients completed the study. We demonstrated construct validity by confirming that the factors derived by principal axes factor analyses with orthogonal rotation correlated to our hypothesized scales (r = 0.76-0.84) and that differences in symptom, functioning, and emotion scores differed among the varying levels of self-reported scalp severity more than would be expected by chance (P<.05 by analysis of variance). The instrument demonstrated reliability with internal consistency (Cronbach alpha, 0.62-0.80) and reproducibility (intraclass correlation coefficient, 0.90-0.97). The quality-of-life scores changed in the expected direction in our test for responsiveness (P<or=.05, by paired t test for functioning and emotion for those who improved). We ascertained the discriminant capability of Scalpdex compared with a dermatological generic quality-of-life tool, Skindex, by demonstrating superior responsiveness (P<or=.005 by paired t test in functioning and emotion) and improved overall sensitivity in individual items. CONCLUSIONS: Scalpdex is, to our knowledge, the first quality-of-life instrument specifically for patients with scalp dermatitis that is reliable, valid, and responsive. Clinicians can use the instrument to determine which aspect of the disease most bothers the patient and to evaluate quality of life as one variable of responsiveness to the therapeutic intervention.

Adult↗

PubMed1987

Classification of diaper dermatitis: an overview.

Several types of diaper dermatitis are discussed: generic diaper dermatitis is most common and involves a simple erythema and mild scaling of the gluteal crease, buttocks, thighs, and lower abdomen. Candidal diaper dermatitis involves clinically significant infection with Candida albicans and presents as a sharply marginated area of erythema with significant involvement of the anterior thighs, genital creases, abdomen, and genitalia. Noduloulcerative diaper dermatitis may develop in a small percentage of patients who have chronic diaper dermatitis, as large, raised erosions with rolled margins. The lesions are most noticeable on the prominent body parts-genitalia, abdomen, thighs, and buttocks. Infantile seborrheic dermatitis involves a distinctive pattern of inflammation that usually begins beneath the diaper as a sharply marginated area of erythema with satellite lesions. Within 1-2 weeks, lesions develop on the scalp, cheeks, arms, legs, and intertriginous parts of the body. Impetigo is common in the diaper area, particularly in the first 6 months of life and during the warmer summer season. The lesions are usually bullous and represent infection by Staphylococcus aureus. Folliculitis appears as small, perifollicular erythematous papules and pustules, usually on the buttocks, thigh and lower abdomen. It is common in the warm summer months and is usually caused by bacteria such as S. aureus. Intertrigo categorizes disease that does not fit into the above categories. Often the patient presents with simple erythema of the folds without pustules or induration. This probably represents irritation and low-grade infection. It is important for the clinician to be aware that many other diseases can have manifestations in the diaper area.(ABSTRACT TRUNCATED AT 250 WORDS)

Candidiasis, Cutaneous↗

PubMed2005

[Genotype analysis of the rRNA gene of Malassezia colonizing the skin surface of patients with atopic dermatitis].

Malassezia species are associated with pityriasis (tinea) versicolor, seborrheic dermatitis, and atopic dermatitis. Presently, eleven species are accepted in the genus Malassezia. Of these, M. globosa and M. restricta colonize the skin surface in atopic dermatitis patients, suggesting that they play a significant role in exacerbating the condition. The two species have different genotypes in the intergenic spacer (IGS) region of the rRNA gene, which correspond to patients and healthy individuals. In addition, the antifungal susceptibilities of the genotypic strains to itraconazole and ketoconazole differ. We found a new analytically significant role of the rRNA gene in Malassezia species, in addition to its use for fungal taxonomy and identification.

Dermatitis, Atopic↗

PubMed2001

Heteroduplex analysis of T-cell receptor gamma gene rearrangement as an adjuvant diagnostic tool in skin biopsies for erythroderma.

BACKGROUND: Erythroderma, defined as red skin covering most of the body surface often accompanied or followed by exfoliation, is the clinical manifestation of at least six different underlying etiologies with allergic or irritant contact dermatitis, atopic/asteotic dermatitis, pityriasis rubra pilaris (PRP), psoriasis, and seborrheic dermatitis accounting for the majority of cases. Approximately 10% of cases are due to adverse drug reactions with roughly another 10% due to cutaneous T-cell lymphoma (CTCL), predominantly mycosis fungoides, or leukemia. It is clear from multiple studies that the clinical diagnosis of the underlying entity is often difficult, as these diseases can present in a very similar fashion. A skin biopsy is usually employed in this setting as a diagnostic tool. However, the histopathologic diagnosis of the underlying cause is complicated by the subtlety of the distinguishing histologic features. In this situation, an ancillary technique demonstrating the presence of a monoclonal T-cell proliferation could help to rule in or out CTCL in cases that clinically and histopathologically do not allow a definitive diagnosis. METHODS: We retrospectively studied 25 biopsies from sixteen patients who presented to the Stanford Dermatology Clinic with erythroderma. We examined the specimens morphologically and analyzed the gamma chain of the T-cell receptor (TCR- gamma) by polymerase chain reaction (PCR) followed by heteroduplex analysis for clonality. We then correlated the results of our PCR and heteroduplex analyses with the patients' clinical outcomes. RESULTS: Four biopsies, from three patients, contained clonal TCR-gamma rearrangements; the four biopsies, all of which were equivocal histologically, correlated to diagnoses of mycosis fungoides (MF) or Sézary syndrome (SS). Twenty-one biopsies contained polyclonal T-cell populations. Eighteen of these biopsies represent patients with inflammatory dermatoses. Three of these biopsies, all of which were taken from a single patient, correlate to a diagnosis of MF. CONCLUSION: TCR-gamma PCR heteroduplex analysis seems to represent an important adjuvant diagnostic tool that, used in conjunction with histopathology and clinical history, could help to clarify the underlying etiology of erythroderma.

Aged↗

PubMed1984

Blepharoconjunctivitis.

Most patients with chronic blepharoconjunctivitis will fall into one of the four seborrheic groups or the primary meibomianitis group. With all of these, there appears to be a predisposition to develop an abnormality in sebaceous glands, as manifested by the fact that such patients have clinically diagnosable seborrheic dermatitis or acne rosacea. These patients tend to develop an abnormality of either the anterior portion of the eyelid with involvement of the gland of Zeis or the posterior portion of the eyelid with involvement of the meibomian glands. Patients in the staphylococcal group are typically younger, a higher percentage are female, and they have a history of symptoms for a relatively shorter period of time. It is only in this latter group that one can hope for a cure with therapy, whereas in the other groups one must aim for control of the disease process. The diagnosis of the various types of blepharoconjunctivitis is important not only because it directs therapy, but also because it gives both the physician and patient an idea about the prognosis. Laboratory evaluation in these patients appears to be of limited value; only in the staphylococcal and mixed seborrheic-staphylococcal group is a pathogen found in the form of S. aureus. The other organism that may contribute directly to disease is S. epidermidis. The antibiotic susceptibility patterns of these two organisms are fairly consistent, and so it is not necessary to culture them to determine antibiotic sensitivities: The majority are sensitive to both bacitracin and erythromycin ointments, as well as the aminoglycosides. Attempts to identify Demodex or to obtain conjunctival scrapings for cytology have not proved helpful. Therefore, the diagnosis is a clinical one and, from a practical standpoint, laboratory evaluation is not required for either diagnosis or management. Therapy for each case of chronic blepharoconjunctivitis must be tailored to the individual and based on the type and severity of blepharoconjunctivitis present. The mainstays in therapy are mechanical and hygienic (i.e., warm compresses and eyelid scrubs ). The use of topical antibiotics must be based on the sensitivities of the likely pathogens (i.e., S. aureus and S. epidermidis). Therefore, while sulfonamides would not appear to be appropriate therapy, bacitracin, erythromycin, or the aminoglycosides are effective antibiotics. The therapy is topical, with the exception of the rare and more severe case of seborrheic blepharoconjunctivitis with secondary meibomianitis and all cases of primary meibomianitis (meibomian keratoconjunctivitis).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1989

Atopic dermatitis in the first six months of life.

1,476/2,320 of our cases of atopic dermatitis (AD) start in the first six months of life. The diagnosis is usually easy, but at this age it is sometimes more difficult, mainly because of lack of or rare evidence of scratching, but also because of the brief clinical history that does not allow observation of the characteristic chronic and relapsing course. Moreover, the major atopic disorders-asthma, rhinitis-usually appears later in the natural history of atopic subjects. From a differential diagnosis point of view, AD is the most definite dermatological disorder at this age. Other not well defined conditions occurring in the first six months of life are usually referred to as infantile seborrheic dermatitis, a name that has been used for at least four different disorders: cradle cap, cradle cap with involvement of inguinal, axillary and retroauricular folds, napkin psoriasis and Leiner's erythroderma. From a clinical point of view, AD in the first months of life is characterized by the prevalence of exudating lesions; moreover, the lack of or the rare evidence of scratching allows us to observe isolated vesicular lesions that are found with difficulty in the further course of the disease.

Dermatitis, Atopic↗

PubMed1999

Facial dermatitis: patch test results and final diagnoses.

BACKGROUND: Facial dermatitis may result from allergic or irritant contact dermatitis, from endogenous conditions such as atopic or seborrheic dermatitis, or a combination of contributing factors. OBJECTIVE: To determine the final diagnoses in patients referred for evaluation of facial dermatitis, and the relevant allergens in those ultimately diagnosed with allergic contact dermatitis (ACD). METHODS: A retrospective chart analysis of all patients patch tested for evaluation of facial dermatitis in an Occupational and Contact Dermatitis referral clinic over a 2-year period from October 1995 to October 1997. RESULTS: Of the 383 patients patch tested, 85 (22%) had facial dermatitis. Of these 85 patients, 55 (65%) had spotty or diffuse facial involvement, 21 (25%) had only eyelid involvement, and in 9 (10%) only the lips were involved. Final diagnoses were relatively equally distributed among three categories: one third had ACD, one third had ACD with other contributing factors, and one third had diagnoses other than ACD. Among patients with ACD, the most common relevant allergens were personal care products, preservatives, and fragrances. CONCLUSION: Allergic contact dermatitis is a frequent cause of facial dermatitis in a referral dermatology clinic. However, in up to two thirds of patients, other diagnoses represent either the primary process or a major component contributing to the eruption. Personal care products, preservatives, and fragrances represent the most common relevant allergens in those diagnosed with ACD. A significant number of relevant reactions would be missed if only the TRUE test standard series were used.

Adolescent↗

PubMedDate not supplied

Pattern of skin disease at the Ethio-Swedish pediatric hospital, Addis Ababa, Ethiopia.

Although skin diseases are common in children, only a very few prospective studies are available, in the literature, mainly from developed countries. This work reports the pattern of skin diseases in a tertiary referral hospital in Addis Ababa, Ethiopia, from June 1995 to July 1997. A total of 1000 consecutive new pediatric patients, ages 0-12 years, were studied. The male:female ratio was 1:1. Allergic skin diseases were most frequently found (55%), followed by infections (33%) and photodermatosis (8%). Of the allergic skin diseases, atopic dermatitis was the most prevalent (47%), followed by seborrheic dermatitis (17.4%).

Child↗