De kinderhuid spreekt!

Dat ‘de kinderhuid spreekt!’ zal ik U in het vervolg duidelijk maken. De dermato- venereologie is een deelgebied van de geneeskunde, dat zich bezighoudt met de diagnostiek en de behandeling van ziekten van de huid en de slijmvliezen. Dit vakgebied omvat ook de fl ebologie, hoewel dat in de naam niet tot uiting komt. Flebologie is een belangrijk onderdeel geworden. Door veroudering van de bevolking is dermato-oncologie eveneens een belangrijk sub - aandachtsgebied. Net zoals de gehele geneeskunde heeft de dermato-venereologie een enorme ontwikkeling doorgemaakt. De specialisatie tot dermatoloog kent vele subspecialisaties, waarbij voor ieder onderdeel specifieke kennis en vaardigheden noodzakelijk zijn. Algemene dermatologie, allergologie, oncologische dermatochirurgie, flebologie, proctologie en venereologie wisselen elkaar in de dagelijkse praktijk van de dermatoloog van patiënt tot patiënt af of van dagdeel tot dagdeel af en vragen ieder om een eigen benadering. De subspecialisatie kinderdermatologie neemt daarbij om meerdere redenen een bijzondere plaats in.Rede, in verkorte vorm uitgesproken ter gelegenheid van het aanvaarden van het ambt van bijzonder hoogleraar in de Kinderdermatologie aan het Erasmus MC, faculteit van de Erasmus Universiteit Rotterdam op 16 juni 200

Serological diagnosis of gonorrhoea using gonococcal pili as antigen

The studies described in the following chapters were performed in an attempt to contribute to a solution of the problems mentioned in chapter two. For the purpose of these studies, material had to be collected from patients and several techniques had to be developed. Material and techniques were then used to study a number of specific problems concerning the serological diagnosis of gonorrhoea.' 1. Almost the entire material was collected from patients attending the STD clinic of the Rotterdam University Hospital Dijkzigt. Gonococci were isolated from all patients with gonorrhoea, and stored. Sera were collected from patients with and without gonorrhoea. The patients were divided into well-defined groups on the basis of history, sex and diagnosis. Blood samples were obtained on the day of the first examination (D 1) and on at least one other day (D2), generally 11-22 days after Dl. More than two sera were collected from some patients. 2. For serodiagnostic purposes an ELISA was developed, using a purified gonococcal pilus preparation from a single strain as antigen. The sera were also submitted to two tests routinely used elsewhere: an IHA using a pilus antigen from another gonococcal strain (used at the Statens Seruminstitut, Denmark), and a GCFT using a crude extract from a single gonococcal strain as antigen, (used at the National Health Institute, Bilthoven, The Netherlands). 3. The first objective of this study was to evaluate the sensitivity and specificity of the abovementioned ELISA as applied to sera from various groups of patients. After application of the IHA and the GCFT to the same sera, the results were compared with those of the ELISA. 4. Next, the influence of the choice of gonococcal pilus antigen on the sensitivity and specificity of the serological test was studied. 5. Finally, a study was made of the contribution of the ELISA to the diagnosis of gonorrhoea when this test was applied to females without complaints who attended the STD clinic for examinatio

A statistical model to predict the reduction of lichenification in atopic dermatitis

Acute symptoms of atopic dermatitis (AD), such as erythema, oedema/papulations and excoriations, respond quickly to topical corticosteroid treatment. Conversely, lichenification is regarded as a troublesome non-acute symptom of chronic AD which can take months of treatment before any improvement is seen. However, very little data actually support this opinion. Here, we analyse lichenification scores in 3 multicentre, short-term studies of nearly similar design. Two of these studies were active comparator dosage trials administered with either fluticasone propionate cream or ointment once or twice daily, the third study was a placebo control. In each of these 4-weeks studies lichenification was measured weekly. For the evaluation of the lichenification score over time a random-coefficients regression model was used. In all active treatments lichenification significantly improved (p 80% of patients scoring no, very mild or mild lichenification after 4 weeks. We developed a model in which the lichenification score drops off linearly with the square root of time. The resulting convexly-shaped downward time trend of lichenification was significant during all treatments. This effect was significantly stronger during active treatment than with placebo. Fluticasone propionate can improve moderate to severe lichenification in a relative short period of time

Phakomatosis Pigmentovascularis

We report a patient with phakomatosis pigmentovascularis IIb and numerous iris hamartomas. Phakomatosis pigmentovascularis IIb is characterized by the simultaneous occurrence of a nevus flammeus, a mongolian spot, and sometimes a nevus anemicus in the same individual, with systemic involvement. To our knowledge, the association with multiple iris hamartomas has been reported only once. This second patient suggests that the association might be more common. Additional reports will indicate if such an association is more frequent than is now assumed

Use of skin substitute dressings in the treatment of staphylococcal scalded skin syndrome in neonates and young infants

Background: Staphylococcal scalded skin syndrome (SSSS) is a rare toxin-mediated skin disease caused by Staphylococcus aureus and seen in infants and children younger than 5 years. Objectives: The supportive role of skin substitutes in SSSS is stressed as a new and relatively unknown method. Methods: Retrospective observational case-series study, in neonates and young infants diagnosed with SSSS. Results: Seven infants with SSSS, treatment with antibiotics, skin substitutes, strict pain relief strategy and prognosis were described. One of them was severely affected and deceased. Conclusion: This study describes 7 infants with SSSS and stresses the important role of skin substitutes as Omiderm® and Suprathel® as valuable adjuvant treatment modality. Copyrigh

Ichthyosis, exocrine pancreatic insufficiency, impaired neutrophil chemotaxis, growth retardation, and metaphyseal dysplasia (Shwachman syndrome).

The Shwachman syndrome comprises exocrine pancreatic insufficiency, growth retardation, and bone marrow hypoplasia resulting in neutropenia. Clinical, morphological, and ultrastructural studies, as well as hair analysis, were performed in a patient with Shwachman's syndrome and severe ichthyosis. Clinical findings were lamellar ichthyosiform desquamation on the extremities. The hair was scanty and short on the scalp, in the eyelashes, and in the eyebrows. The nails were hyperkeratotic. Morphologic findings were slight, regular acanthosis and severe diffuse hyperkeratosis with variable parakeratosis. The granular layer was thickened. The papillary dermis showed very slight perivascular lymphocyte infiltration. The most prominent ultrastructural finding was the presence of solitary or multiple droplets of varying size in the cytoplasm of the keratinocytes. Hair analysis revealed no abnormalities; the cystine concentration in hair specimens was normal

Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial

OBJECTIVE: To test the hypothesis that fusidic acid would not increase the treatment effect of disinfecting with povidone-iodine alone in children with impetigo. DESIGN: Randomised placebo controlled trial. SETTING: General practices in Greater Rotterdam. PARTICIPANTS: 184 children aged 0-12 years with impetigo. MAIN OUTCOME MEASURES: Clinical cure and bacterial cure after one week. RESULTS: After one week of treatment 55% of the patients in the fusidic acid group were clinically cured compared with 13% in the placebo group (odds ratio 12.6, 95% confidence interval 5.0 to 31.5, number needed to treat 2.3). After two weeks and four weeks the differences in cure rates between the two groups had become smaller. More children in the placebo group were non-compliant (12 v 5) and received extra antibiotic treatment (11 v 3), and more children in the placebo group reported adverse effects (19 v 7). Staphylococcus aureus was found in 96% of the positive cultures; no strains were resistant to fusidic acid. CONCLUSIONS: Fusidic acid is much more effective than placebo (when both are given in combination with povidone-iodine shampoo) in the treatment of impetigo. Because of the low rate of cure and high rate of adverse events in the placebo group, the value of povidone-iodine in impetigo can be questioned