Kinderen met constitutioneel eczeem: de gevolgen voor ouders.

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Quality of life in vitiligo patients after treatment with long-term narrowband ultraviolet B phototherapy.

Long-term treatments for chronic diseases such as vitiligo need to be evaluated for their clinical efficacy. Assessment of the quality of life (QOL), however, may provide the most relevant information on the actual benefit for these patients. In this study we evaluated QOL after long-term narrowband ultraviolet (UV) B for the treatment of vitiligo. All patients, with long-term stable vitiligo vulgaris, who were treated at our clinic during the last 4 years received specifically for this study a designed QOL questionnaire, which included questions about general well-being, camouflage and psychosocial aspects; 71.4% of the patients responded. Most patients indicated an improvement on a psychological level, but an increase in camouflaging. The present study shows that, after long-term narrowband UVB phototherapy, skin appearance does not play a major role in the life of vitiligo patients, while well being only improved in a minority of patients

VML 295 (LY-293111), a novel LTB4 antagonist, is not effective in the prevention of relapse in psoriasis.

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Ulcer-related problems and health care needs in patients with venous leg ulceration: a descriptive, cross-sectional study.

Contains fulltext : 52120.pdf (publisher's version ) (Closed access)BACKGROUND: Patients with leg ulceration often have long lasting and recurrent wounds. The treatment exists mainly of wound-care and compression therapy. International literature shows several indications of problems in relation to leg ulceration, but no studies were performed to give a comprehensive overview of all problems identified and care received related to these problems. OBJECTIVES: The aim of the study was to describe leg ulcer-related problems in patients with leg ulcers based on venous insufficiency or a mixed aetiology. Furthermore, an inventory of current care and care deficits in the care for leg ulcer patients was made. METHODS: The study had a descriptive, cross-sectional design. A sample of 141 patients was taken from the population of outpatient clinics of seven hospitals in the Netherlands. Data were collected through patient interviews, questionnaires and wound-observations. Medical information was provided by the dermatologist or derived from the patients' medical file. RESULTS: The study identified a number of serious problems. Main problems were pain (85%), outdoor mobility (47%) and problems in finding appropriate footwear (60%). Statistical analysis showed no differences between patients with ulcers based on a venous aetiology and ulcers based on mixed aetiology. Fifty to seventy percent of the patients did not receive any care in relation to these problems. Only a rather small proportion of the patients, however, regarded the help as insufficient. CONCLUSION: Care at outpatient clinics is mainly focused on wound care and compression therapy. Pain treatment and care related to problems encountered by patients appears to be insufficient. This is not only affecting the patient's quality of life, but is likely to affect also the healing process and prevention of leg ulcers. Nurses and dermatologist should take their responsibilities in this matter

Development and design of a multidisciplinary training program for outpatient children and adolescents with psoriasis and their parents

Contains fulltext : 118265.pdf (publisher's version ) (Closed access)INTRODUCTION: To describe and illustrate in a case-study design the development and design of a multidisciplinary training program for outpatient children and adolescents with psoriasis and their parents. METHODS: For the development of the program, a steering group was assembled, systematic semi-structured interviews were held and the literature was reviewed. RESULTS: Aim of the training program was to strengthen patients and their parents in coping with and diminishing psoriasis-related problems in an outpatient setting. The program included treatment modules of medical information and skin care, itch and scratch problems, psychological issues in coping with the psoriasis, sleep hygiene and relapse prevention. Descriptive results in the case patient showed improvement of all outcome variables in the expected direction. CONCLUSION: This is the first multidisciplinary training program for outpatient children and adolescents with psoriasis and their parents. It aims at improving coping skills and self-management and could be a promising addition to regular treatment

Effectiveness of a multidisciplinary itch-coping training programme in adults with atopic dermatitis.

Contains fulltext : 80858.pdf (publisher's version ) (Open Access)The short- and longer-term effectiveness of a brief, multidisciplinary itch-coping group training scheme in adults with atopic dermatitis was evaluated. Clinical severity scores (Eczema Area and Severity Index) and validated self-report measures were obtained in a waiting-list control condition (n=30) and a treatment condition (n=61) at pre- and post-treatment and in the treatment condition at 3- and 12-month follow-ups. Relative to the control condition, all post-treatment measures showed improvements in terms of enhanced skin status, reduced itching and scratching and improved itch-coping patterns. In the treatment condition, the changes were sustained or further improved at both follow-ups. Also, the dermatological healthcare use was significantly reduced during the follow-up periods, in terms of fewer visits to the dermatologist and decreased use of topical corticosteroids and itch-relieving medication (histamine antagonists). The brief multidisciplinary itch-coping programme in adults with atopic dermatitis considerably reduced itch-scratching patterns, improved their skin status and reduced the use of dermatological care, both in the short and longer term

Systemic treatment of psoriatic patients with bexarotene decreases epidermal proliferation and parameters for inflammation, and improves differentiation in lesional skin.

Contains fulltext : 57436.pdf (publisher's version ) (Closed access)BACKGROUND: Bexarotene, a novel synthetic retinoid X receptor (RXR)-selective retinoid, has been reported to have antiproliferative and apoptotic stimulating effects in cutaneous T-cell lymphoma. In benign, hyperproliferative, and retinoid sensitive disorders, such as psoriasis, bexarotene has not been evaluated so far and no information on these parameters is available. OBJECTIVE: In the present study, immunohistochemical parameters for proliferation, differentiation, inflammation, and apoptosis were investigated in a group of bexarotene-treated psoriatic patients. METHODS: Twenty-nine patients with plaque-type psoriasis were treated for 12 weeks with oral bexarotene in four dose-defined treatment panels. Treatment was initiated in the following consecutive order: 1.0 mg/kg/day, 2.0 mg/kg/day, 0.5 mg/kg/day, and 3.0 mg/kg/day. Biopsies for immunohistochemical analysis were taken at the baseline and after 12 weeks of treatment. RESULTS: Significant reductions in Ki-67, keratin 16, transglutaminase, dermal CD4, epidermal CD8, and inflammation scores were seen after bexarotene treatment in combination with a significant increase in keratin 10. No induction of keratin 13 and 19 and no alterations in apoptosis associated p53 expression were observed. Apart from a weak significant dose-response effect for Ki-67, no other significant dose-response effects were seen. CONCLUSION: We have demonstrated efficacy of oral bexarotene in psoriasis in doses up to 3.0 mg/kg/day during 12 weeks of treatment for proliferation, differentiation, and inflammation parameters. Studies investigating higher doses of bexarotene in a larger number of patients are necessary to reveal potentially dose-related immunohistochemical effects of this new rexinoid and to elucidate the role of RXR-signaling in retinoid-associated keratin expression

Haploinsufficiency of TNXB is associated with hypermobility type of Ehlers-Danlos syndrome.

Contains fulltext : 143688.pdf (publisher's version ) (Closed access

Professionals' shared competences in multidisciplinary dementia care: validation of a self-appraisal instrument.

Contains fulltext : 81847.pdf (publisher's version ) (Closed access