Birth weight and atopic dermatitis: systematic review and meta-analysis

Several studies examined the relationship between birth weight and atopic diseases, but no consensus has yet been reached regarding the results.The purpose of this paper was to perform a meta-analysis of the existing studies regarding the role of birth weight in the occurrence of atopic dermatitis. We carried out an extensive search in the international databases (Pubmed, Cochrane Library, and Web of Knowledge). We selected the cross-sectional, case-control, and cohort studies which analyzed the role of birth weight in the occurrence of atopic dermatitis. We performed a meta-analysis of the selected studies, and calculated the odds ratio (OR) and corresponding 95% confidence intervals (95% CI). We included 10 studies in the final meta-analysis, which comprised 110974 patients. Weight classification was in compliance with Pediatric Nutrition Surveillance System (PedNSS) Health Indicators. In the first meta-analysis, we selected patients with low weight (below 2500 g) and atopic dermatitis and compared them with those with normal weight (2500 – 4000 g) and atopic dermatitis. The analysis showed that low birth weight represents a protective factor in the occurrence of atopic dermatitis (OR = 0.68, CI: 0.63 – 0.75, P&lt;0.0001). In the second meta-analysis, we compared patients with high weight (over 4000 g) and atopic dermatitis with those with normal weight and atopic dermatitis. The results indicated that increased birth weight represents a risk factor for atopic dermatitis (OR = 1.1; CI: 1.02 – 1.17; P = 0.01)Thus, low birth weight represents a protective factor for the occurrence of atopic dermatitis and high birth weight represents a risk factor for the occurrence of this disease.</p

Tophaceous Gout – When the Skin Comes First

Gout represents a metabolic disorder with systemic echo, in which needle-like crystals of monosodium urate are deposited in various tissular structures. Crystals accumulation in the connective tissue (tophi) represents the late, chronic stage of this disease, usually emerging after an average of 10 years after disease onset. Herein we report three cases of patients aged 70, 33, and 53 who presented with painful subcutaneous nodules located on various body areas. All of them had hyperuricemia. Several conditions had to be investigated in order to establish the etiology of uric acid metabolism alterations. Laboratory and pathology findings established the diagnosis of gout, with tophi as the first symptom of the disease. Following patient education, diet and lifestyle changes, and medication, the outcome in all patients was favorable, with alleviation of the symptoms. Tophaceous gout as a first presentation of this disease is currently uncommon, but dermatologist should be aware of this rare finding for proper management of such cases and to prevent the resultant significant functional and quality of life impairment if not recognized early

Extreme Dermatology – the Intensive Care Skills of Dermatologists in Three Case Presentations of Acute Skin Failure

Dermatological emergencies include a number of clinicalconditions usually accompanied by systemic symptoms that can leadto life-threatening complications.From the broad spectrum of life-threatening dermatoses, three casesare presented: a case of febrile ulceronecrotic Mucha-Habermann disease(FUMHD), a case of pemphigus vulgaris mimicking Stevens-Johnsonsyndrome (SJS), and a case of toxic epidermal necrolysis (TEN).Those cases were considered extreme, and presented to illustrate thepositive outcome of timely intensive dermatological care.An interdisciplinary approach is essential in the diagnosis, treatment,management, and follow up of patients with life-threatening dermatoses

Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis

BACKGROUND Two phase 3 trials (UNCOVER-2 and UNCOVER-3) showed that at 12 weeks of treatment, ixekizumab, a monoclonal antibody against interleukin-17A, was superior to placebo and etanercept in the treatment of moderate-to-severe psoriasis. We report the 60-week data from the UNCOVER-2 and UNCOVER-3 trials, as well as 12-week and 60-week data from a third phase 3 trial, UNCOVER-1. METHODS We randomly assigned 1296 patients in the UNCOVER-1 trial, 1224 patients in the UNCOVER-2 trial, and 1346 patients in the UNCOVER-3 trial to receive subcutaneous injections of placebo (placebo group), 80 mg of ixekizumab every 2 weeks after a starting dose of 160 mg (2-wk dosing group), or 80 mg of ixekizumab every 4 weeks after a starting dose of 160 mg (4-wk dosing group). Additional cohorts in the UNCOVER-2 and UNCOVER-3 trials were randomly assigned to receive 50 mg of etanercept twice weekly. At week 12 in the UNCOVER-3 trial, the patients entered a long-term extension period during which they received 80 mg of ixekizumab every 4 weeks through week 60; at week 12 in the UNCOVER-1 and UNCOVER-2 trials, the patients who had a response to ixekizumab (defined as a static Physicians Global Assessment [sPGA] score of 0 [clear] or 1 [minimal psoriasis]) were randomly reassigned to receive placebo, 80 mg of ixekizumab every 4 weeks, or 80 mg of ixekizumab every 12 weeks through week 60. Coprimary end points were the percentage of patients who had a score on the sPGA of 0 or 1 and a 75% or greater reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at week 12. RESULTS In the UNCOVER-1 trial, at week 12, the patients had better responses to ixekizumab than to placebo; in the 2-wk dosing group, 81.8% had an sPGA score of 0 or 1 and 89.1% had a PASI 75 response; in the 4-wk dosing group, the respective rates were 76.4% and 82.6%; and in the placebo group, the rates were 3.2% and 3.9% (P<0.001 for all comparisons of ixekizumab with placebo). In the UNCOVER-1 and UNCOVER-2 trials, among the patients who were randomly reassigned at week 12 to receive 80 mg of ixekizumab every 4 weeks, 80 mg of ixekizumab every 12 weeks, or placebo, an sPGA score of 0 or 1 was maintained by 73.8%, 39.0%, and 7.0% of the patients, respectively. Patients in the UNCOVER-3 trial received continuous treatment of ixekizumab from weeks 0 through 60, and at week 60, at least 73% had an sPGA score of 0 or 1 and at least 80% had a PASI 75 response. Adverse events reported during ixekizumab use included neutropenia, candidal infections, and inflammatory bowel disease. CONCLUSIONS In three phase 3 trials involving patients with psoriasis, ixekizumab was effective through 60 weeks of treatment. As with any treatment, the benefits need to be weighed against the risks of adverse events. The efficacy and safety of ixekizumab beyond 60 weeks of treatment are not yet known

A burst in the incidence of viral exanthems

Background: Vaccines have a major role in eradication programs of viral diseases. Vaccines against measles, rubella, and varicella are included in the vaccination schedules for children in most countries. Objective: A comparative analysis between 2011 and 2012 was performed to investigate if the number of patients with viral exanthemas reported to our clinic in 2012 was increased. Materials and Methods: Patients were grouped in four categories: rubella, measles, varicella and other viral exanthemas. Results: Between January and April 2011, there were registered 37 cases with viral exanthemas: 69.5% presented with varicella and 30.5% with other viral exanthemas. Between January and April 2012, there were 178 cases registered with viral eruption, of which 37% were of other viral exanthemas, 35.4% rubella, 19.7% measles and 7.9% varicella. The highest incidence was seen in patients aged between 20 and 29 years (52.2%), with 21% having measles, 32.2% rubella, 9% varicella and 37.6% having other exanthemas. In 2012, the number of cases of viral exanthemas increased 5 times, with important outbreaks of new cases of measles and rubella. Conclusions: Although vaccines against measles and rubella were being used since 1979 and 1998 respectively, it was only in 2004, that these vaccines became part of the mandatory vaccination schedule. Although persons under 32 years should be protected against measles infection if they are previously vaccinated, more than 90% of the registered cases of measles occurred in such patients. The patients registered between January and April 2011 were mostly pediatric. Adults also were much more affected with measles, rubella, or varicella viruses in 2012 than in 2011

CHESTIONARUL ”NOSQ-2002” AR PUTEA FI O METODĂ DIAGNOSTICĂ UTILĂ ÎN SUPRAVEGHEREA STĂRII DE SĂNĂTATE A PERSONALULUI MEDICAL DIN SECTORUL MEDICINEI DENTARE – UN STUDIU ROMÂNESC

Occupational skin diseases are under-reported in many countries, especially in the Eastern Europe, including Romania. Improper healthcare legislation and regulations in the field of health and safety at work might be a few causes of developing occupational skin diseases, but also the lack of standardised diagnostic criteria and evaluation tools are common in these countries. Dental staff is exposed to a wide range of occupational hazards, many of them being haptens, which could cause occupational skin diseases. The most common occupational skin diseases in contact dermatitis. Without a reliable diagnostic tool in place, usually the dental staff (as many other professions) overlook and underestimate the presence of occupational skin diseases, which can lead to unproper prevention, chronic skin lesions, disability and loose of efficiency and productivity. Periodic medical examination is mandatory in many countries all over the globe, comprising in a minimum set of investigations, including clinical examination, questionnaires, blood tests and additional procedures, tailored on the occupation, workplace, industrial sector and potential exposure. It is important to standardise the employees’ periodical medical evaluation using reliable tools oriented to the skin pathology. The Nordic Occupational Skin Questionnaire (NOSQ) might represent one of these tools which might be useful for a comprehensive evaluation of the potential occupational skin diseases. NOSQ  was created by a group of experts from the Nordic countries and it is meant to assess the presence and clinical features of occupational skin diseases in the workplace.   Key words: dental healthcare, occupational diseases, skin, questionnaireBolile profesionale ale tegumentului au o raportare relativ scăzută &icirc;n multe țări, &icirc;n special &icirc;n Europa de Est, implicit &icirc;n Rom&acirc;nia. Legislația și reglementările necorespunzătoare &icirc;n domeniul sănătății și al securității la locul de muncă pot fi c&acirc;teva din cauzele aparției bolilor profesionale ale pielii, dar deasemenea lipsa criteriilor standard de diagnostic și ale metodelor de evaluare sunt frecvente &icirc;n aceste țări [1]. Personalul medical care lucrează &icirc;n cabinetele stomatologice este expus la o gamă largă de riscuri profesionale, multe dintre ele fiind antigene ce pot produce dermatoze profesionale. Cea mai frecventă dermatoză profesională este dermatita de contact. Fără metode de diagnostic, personalul din stomatologie (ca și alte multe profesii), subestimează prezența bolilor dermatozelor profesionale, ceea ce duce la o prevenție ineficientă, dizabilități și pierderea eficienței și productivității muncii. Examinarea medicală periodică este obligatorie &icirc;n multe țări de pe glob, cuprinz&acirc;nd un set minim de investigații, inclusiv examen clinic obiectiv, chestionare, analize de s&acirc;nge și investigații suplimentare &icirc;n funcție de locul de muncă, sectorul industrial și potențiala expunere. Este important ca evaluarea medicală periodică să fie standardizată, utilizandu-se metode de evaluare și diagnostic orientate către patologiile tegumentului. Chestionarul &rdquo;Nordic Occupational Skin Questionnaire&rdquo; (NOSQ) poate reprezenta una dintre aceste metode care poate fi utilă &icirc;ntr-o evaluare completă a potențialelor boli profesionale ale pielii. NOSQ a fost creat de către un grup de experți din țările nordice și este menit să evalueze prezența și caracteristicile clinice ale bolilor profesionale ale pielii la locul de muncă. &nbsp; Cuvinte cheie: servicii stomatologice, boli profesionale, piele, chestiona

RECOMMENDED STRATEGIES FOR ATOPIC DERMATITIS MANAGEMENT IN ROMANIA

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a relapsing course that has a significant impact on the quality of life of both patients and their families. The pathogenesis of AD is due to a multitude of factors and can be associated with other allergy-related diseases, including asthma, food allergies or rhinitis. Treatment of AD aims to reduce duration, severity, and frequency of disease exacerbations. Understanding the maintenance of skin barrier integrity by continuing the use of basic therapy can prevent breaks. Patient and family education is important