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[A traveling exhibit: "Protecting the hands at work"].

Information is an important and even essential step in the prevention process. An exhibition, which traditionally favours a visual approach, is a way of providing information for the public at large. The exhibition, the first to be produced under the auspices of the Claude Verdan foundation, tackles the issue in a general way. The aim is to: make people aware and encourage prevention in the work environment; situate the hand in a preventive context; show the importance of the hand as a work-tool; present the quantitative and qualitative extent of diseases and accidents of the hand; make the interest and difficulties in collecting information known (especially about professional diseases and workers not affiliated to the CNA); stimulate continuing search of information about prevention in the work environment. The exhibition presents certain aspects of the history of prevention in the working world, Swiss institutions involved, notions of epidemiology of professional diseases and accidents of the hand (obtained from the CNA files), as well as different types of available prevention. The material used is light (posters, slides, video) and thus transportable, and so can be widely used for the people concerned at their place of work....

Accidents, Occupational↗

The frequency of Candida species in onychomycosis.

Mycological investigation of 108 nail specimens taken from a total of 41 patients examined over three years included direct microscopy and repeated cultures. A higher incidence of onychomycosis of the fingernails (75%) was observed in women while afflictions of the toenails (71%) prevailed in men. The highest prevalence of onychomycosis was found in patients between 50 and 70 years of age. Candida albicans was the dominant organism causing onychomycosis (prevalence rate 60.9%), followed by C. parapsilosis (19.6%), C. tropicalis (9.8), C. krusei (4.9), C. guilliermondii and C. zeylanoides (2.4% each).

Adult↗

[Bullous pemphigoid manifesting as dyshidrotic eczema and prurigo nodularis].

A 63-year-old woman presented simultaneously with two rare forms of bullous pemphigoid. Initially she had a dyshidrotic palmoplantar eczema. Repeated epicutaneous patch tests ruled out a type IV allergic reaction to common allergens. Six months later the patient developed disseminated pruritic nodules. After 4.5 years she then demonstrated scattered bullae within erythematous plaques indicative of bullous pemphigoid. A skin biopsy showed linear IgG and IgM as well as C3 deposits at the dermo-epidermal junction and circulating autoantibodies against the basement membrane could be found in serum. Accordingly, the diagnosis of bullous pemphigoid was made. In retrospect, the vesicular palmoplantar eczema and pruritic nodules could be interpreted in this case as early manifestations of bullous pemphigoid. We recommend that in patients with persistent pruritic skin lesions, which are resistant to standard therapy, bullous pemphigoid should be excluded by adequate immunological examinations.

Biopsy↗

[Treatment of lichen planus pemphigoides with acitretin and pulsed corticosteroids].

A patient with lichen planus pemphigoides first developed multiple pruritic papules and subsequently, tense blisters on trunk and extremities. Histopathologic examination of a skin biopsy demonstrated both the typical changes of lichen planus and subepidermal blisters as in bullous pemphigoid. Direct immunofluorescence microscopy revealed both cytoid bodies and linear C3 deposits at the dermal-epidermal junction. By indirect immunofluorescence microscopy on 1 M NaCl-split-skin, circulating autoantibodies labeled the epidermal side of the split. Immunoblot analysis showed binding of the antibodies to the cell-derived soluble 120 kD domain of the 180 kD bullous pemphigoid antigen and to a recombinant form of the immunodominant NC16A region of this protein. When treated with pulsed intravenous corticosteroids, the patient continued to develop new papules and blisters, but when oral acitretin was added, the skin lesions cleared. The immunoblot reactivity of the patient's autoantibodies well reflected disease activity, while the indirect immunofluorescence microscopy titers did not.

Acitretin↗

[Palmoplantar vesicular lesions in childhood].

BACKGROUND AND OBJECTIVE: Palmoplantar vesicles in children have various underlying causes, requiring different therapies. We evaluated the most common underlying diseases and determined simple criteria for differentiation. PATIENTS/METHODS: Within a two years period all children up to 14 years of age who presented with acral vesicles were included in this study. RESULTS: The most common causes of acral vesicles in a group of 32 patients, were dyshidrotic eczema with (n=11) or without atopic diathesis (n=11) and scabies (n=7). Rarely, the cause of vesicular lesion was tinea (n=2) or infantile acropustulosis (n=1). While dyshidrotic eczema was a disease of late childhood, palmoplantar lesions caused by scabies developed in younger children up to the age of 4 years. Scabies in contrast to infantile acropustulosis tend to present with more generalized lesions, not being restricted to acral location. Dyshidrotic eczema revealed lesions bilaterally and in case of atopy, additional body areas were involved. Unilateral presentation was a clue for tinea. CONCLUSIONS: Acral vesicles in childhood can be diagnostically discriminated by the age of the patient and the distribution of the lesions.

Adolescent↗

[Bleomycin prick in therapy-resistant verruca vulgaris].

Common warts can be highly resistant to conventional treatments such as cryotherapy, laser surgery, salicylic acid and mechanical removal. Intralesional bleomycin has been described as an effective treatment for common warts since 1970. We treated a 27-year-old woman with Sharp's syndrome who was on immunosuppressive drugs and had suffered for nine years from therapy-resistant warts on palms and soles. A bleomycin-prick technique using a bifurcated needle to introduce bleomycin sulfate (1 mg/ml sterile saline solution) into the warts resulted in almost complete remission after 16 treatment sessions.

Adult↗

Nail matrix arrest in the course of hand, foot and mouth disease.

UNLABELLED: Onychomadesis describes complete nail shedding from the proximal portion; it is consecutive to a nail matrix arrest and can affect both fingernails and toenails. It is a rare disorder in children. Except for serious generalised diseases or inherited forms, most cases are considered to be idiopathic. Few reports in literature concern common triggering phenomena. We present four patients in whom the same benign viral condition in childhood appeared as a stressful event preceding onychomadesis. In each case, spontaneous complete healing of the nails was achieved within a few weeks. CONCLUSION: Onychomadesis and/or onycholysis is a newly recognised complication in the course of viral infections presenting clinically as hand, foot and mouth disease, and because of mild forms, is probably underestimated.

Adolescent↗

Idiopathic palmoplantar eccrine hidradenitis in children.

Idiopathic palmoplantar eccrine hidradenitis (IPPH) is a recently described disorder characterized by painful erythematous plantar nodules and in three cases, showed a typical neutrophilic infiltrate around and within the eccrine sweat apparatus. Five cases of IPPH on the soles of the feet in healthy children are reported. The disorder presented after intense physical activity in four cases. The course was benign and self-limiting. Complete bed rest for several days without any medical therapy led to alleviation of the pain and disappearance of all the lesions. Conclusion. Idiopathic palmoplantar eccrine hidradenitis may be more common than reported. Paediatricians should be aware of it in order to avoid unnecessary diagnostic tests and treatments.

Chilblains↗