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Sample records for irritated seborrheic keratosis

  1. Sebaceoma associated with seborrheic keratosis.

    PubMed

    Fernandez-Flores, Angel; Manjón, José Antonio

    2017-01-01

    Sebaceoma associated with seborrheic keratosis has only been described once in the literature. Herein, we present an additional case in a 69-year-old woman who complained of a multicolored plaque on the left breast. Dermatoscopy showed a central orange lesion with orange globules suggestive of dilated glands. The periphery of the lesion was brown and gray, with some more pigmented zones. The histopathological study demonstrated a seborrheic keratosis in the peripheral areas, whereas the central part of the lesion was a sebaceoma. We performed an immunohistochemical study with antibodies against MSH6, MSH2, MLH1, and PMS2, which demonstrated preserved nuclear expression of the mismatch repair proteins, therefore ruling out Muir-Torre syndrome.

  2. Clinical and Histopathological Investigation of Seborrheic Keratosis

    PubMed Central

    Roh, Nam Kyung; Hahn, Hyung Jin; Lee, Yang Won; Choe, Yong Beom

    2016-01-01

    Background Seborrheic keratosis (SK) is one of the most common epidermal tumors of the skin. However, only a few large-scale clinicohistopathological investigations have been conducted on SK or on the possible correlation between histopathological SK subtype and location. Objective The aim of this study was to analyze the clinical and histopathological features of a relatively large number of cases of diagnosed SK. Methods Two hundred and seventy-one pathology slides of skin tissue from patients with clinically diagnosed SK and 206 cases of biopsy-proven SK were analyzed. The biopsy-proven cases of SK were assessed for histopathological subclassification. The demographic, clinical, and histopathological data of the patients were collected for analysis of associated factors. Results The most frequent histopathological subtype was the acanthotic type, followed by mixed, hyperkeratotic, melanoacanthoma, clonal, irritated, and adenoid types; an unexpectedly high percentage (9.2%) of the melanoacanthoma variant was observed. The adenoid type was more common in sun-exposed sites than in sun-protected sites (p=0.028). Premalignant and malignant entities together represented almost one-quarter (24.2%) of the clinicopathological mismatch cases (i.e., mismatch between the clinical and histopathological diagnoses). Regarding the location of SK development, the frequency of mismatch for the sun-exposed areas was significantly higher than that for sun-protected areas (p=0.043). Conclusion The adenoid type was more common in sun-exposed sites. Biopsy sampling should be performed for lesions situated in sun-exposed areas to exclude other premalignant or malignant diseases. PMID:27081260

  3. Multiple Pigmented Seborrheic Keratosis with Sebaceous Differentiation - A Case Report.

    PubMed

    Chander, R Vimal; Jajaganesh, P; Sekhar, Ganthimathy; Chitra, S

    2017-02-04

    Seborrheic keratosis is a benign lesion that is common in the trunk and head and neck regions. It shows a considerable variety of histological appearances leading to different variants. The presence of sebaceous differentiation in seborrheic keratosis is very rare and can histologically mimic benign and malignant tumors with sebaceous differentiation. We present a case of a 65-year-old male presenting with multiple nodules over the right and left sides of neck and the right preauricular region, histopathological examination of which revealed multiple pigmented seborrheic keratoses with sebaceous differentiation. This case is reported for its rare sebaceous differentiation and multiplicity along with the importance of differentiating it from a variety of benign to malignant neoplasms showing sebaceous differentiation.

  4. A Clinicopathological and Dermoscopic Correlation of Seborrheic Keratosis

    PubMed Central

    Alapatt, Geethu Francis; Sukumar, D; Bhat, M Ramesh

    2016-01-01

    Background: Seborrheic keratosis (SK) is the most common benign epidermal tumor of the skin. Even though SK has been well characterized clinically, dermoscopically, and histopathologically, data regarding clinical dermoscopic and histopathological correlation of different types of SK are inadequate. Aim: We carried out this study to establish any correlation between the clinical, dermoscopic, and histopathological appearance of SK and its variants. Methods: This was a descriptive study. Patients with SK were evaluated with respect to age, sex, family history of similar lesions, site of lesions, and symptoms associated with the lesions. Dermoscopy was performed in all cases. Biopsies were taken from the lesions and assessed for histopathology. Results: The most common age group affected by SK was 31–50 years (42%). A female preponderance of 76% was seen. Majority of our patients had a positive family history (62%), though Sun exposure was not seen to be a major factor. The most common clinical variant was common SK (CSK) (46%). The most common dermoscopic findings seen in CSK were comedo-like (CL) openings, fissures and ridges (FR), and milia-like (ML) cysts. Dermatosis papulosa nigra and pedunculated SK had characteristic FR and CL openings on dermoscopy. Stucco keratoses showed network-like (NL) structures and sharp demarcation. CL opening on dermoscopy corresponded to papillomatosis and pigmentation, ML cysts corresponded to horn cysts, FR corresponded to papillomatosis, and NL structures corresponded to an increase in basal layer pigmentation. Conclusions: This study emphasizes the use of dermoscopy in improving the diagnostic accuracy of SK. The correlation between the various histological and dermoscopic features is described. PMID:27904179

  5. No Evidence of Human Papillomaviruses in Non-genital Seborrheic Keratosis.

    PubMed

    Meibodi, Naser Tayyebi; Nahidi, Yalda; Meshkat, Zahra; Esmaili, Habibollah; Gharib, Masoumeh; Gholoobi, Aida

    2013-07-01

    Seborrheic keratosis (SK) is a benign epidermal tumor of unknown etiology. Because of its wart-like morphology, Human papillomaviruses (HPVs) have been suggested as a possible causative agent. Viral involvement, however, has not been confirmed yet despite research and the association between HPVs and seborrheic keratosis has not been studied among Iranian population by PCR. The aim of this case-control study was to evaluate the presence of HPVs DNA in non-genital SK by PCR. Fifty biopsy specimens obtained from patients with non-genital SK and 50 controls were analyzed using polymerase chain reaction (PCR). No HPVs DNA was detected by PCR within the tissue extracts from paraffin-embedded SK samples, while one of the controls was HPVs DNA positive. The age range of the patients was 20 to 82 yrs (mean = 52). Twenty-eight patients (56%) were males and 22 patients (44%) were females. The most common anatomic site was the face. Histopathologic changes due to viral infection such as koilocytosis (10%), dyskeratosis (66%), mitosis (28%), and parakeratosis (88%) were evident within the lesions. The most common histologic type was acanthotic type. Our results showed that there is no association between HPVs and seborrheic keratosis in investigated subjects.

  6. A comparison of dermoscopic features among lentigo senilis/initial seborrheic keratosis, seborrheic keratosis, lentigo maligna and lentigo maligna melanoma on the face.

    PubMed

    Sahin, Mustafa Turhan; Oztürkcan, Serap; Ermertcan, Aylin Türel; Güneş, Ali Tahsin

    2004-11-01

    Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun-exposed face because of the flat rete ridges without network-derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate-gray streaks, dark globules, slate-gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia-like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.

  7. Autofluorescence of seborrheic keratosis (warts) and of tissue surrounding malignant tumors

    NASA Astrophysics Data System (ADS)

    Lohmann, Wolfgang; Schill, Wolf-Bernhard; Bohle, Rainer M.; Dreyer, Thomas

    1997-12-01

    Autofluorescence measurements on human tissue have revealed a decrease in intensity in malignant tumors and an increase in the healthy region adjacent to the tumor. This latter event might serve as a protective wall against the invasive tumor cells. The composition of this wall is still unknown. Antioxidants such as NADH might be involved. In the case of seborrheic keratosis (wart), the intensity is increased in the pigmented spots. Care must be taken, therefore, when warts are attached to malignant tumors. The resulting value is, then, not indicative for the condition of the system.

  8. Seborrheic keratosis

    MedlinePlus

    ... Tumor Review Date 11/14/2014 Updated by: Richard J. Moskowitz, MD, Dermatologist in private practice, Mineola, ... commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer ...

  9. Differentiation of hidroacanthoma simplex from clonal seborrheic keratosis--an immunohistochemical study.

    PubMed

    Liu, Han-Nan; Chang, Yun-Ting; Chen, Chih-Chiang

    2004-06-01

    Hidroacanthoma simplex (HS) is an uncommon poroid neoplasm confined within the epidermis. The clinical features of HS are not distinctive and histopathologically HS may be confused with clonal seborrheic keratosis (CSK) if cystic or ductal structure is not present. The purpose of our study was to differentiate HS from CSK by the immunohistochemical expressions of various cytokeratins, CEA, CD1a, and S-100 protein, as well as by the degrees of deposition of melanins and glycogen. Four cases of HS and seven cases of CSK were included in the research. In contrast with CSK, HS showed a very low density of Langerhans cells (19.9 +/- 7.7 versus 3.1 +/- 1.0 CD1a (+) cells/mm, P = 0.027) and sparse melanin deposition in the nests. However, HS could not be set apart from CSK by the expressions of cytokeratins. The nests of both HS and CSK showed very similar patterns of cytokeratin expression and seemed to be mainly composed of basaloid cells with focal differentiation toward epidermal suprabasal cells.

  10. Intraepidermal proliferation of Merkel cells within a seborrheic keratosis: Merkel cell carcinoma in situ or Merkel cell hyperplasia?

    PubMed

    McFalls, Jeanne; Okon, Lauren; Cannon, Sarah; Lee, Jason B

    2017-05-01

    Intradepidermal proliferation of Merkel cells without any dermal component has been interpreted as either a hyperplastic process secondary to chronic ultraviolet radiation or a neoplastic process, namely Merkel cell carcinoma (MCC) in situ. The recent criteria that have been proffered to diagnose MCC in situ, unfortunately, are identical to those that have been applied to Merkel cell hyperplasia in the past, posing a diagnostic quandary when faced with an intraepidermal proliferation of Merkel cells. Most previously reported cases of MCC in situ have occurred within associated epithelial lesion that includes solar (actinic) keratosis and squamous-cell carcinoma in situ. Similarly, Merkel cell hyperplasia has been reported to occur in association with a variety of epithelial lesions as well as on chronically sun-damaged skin. Herein, a case of an intraepidermal proliferation of Merkel cells within a seborrheic keratosis is presented accompanied by a discussion on whether the proliferation represents another case of Merkel cell carcinoma in situ or an incidental hyperplastic process on chronically sun-damaged skin. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Seborrheic Dermatitis Overview

    MedlinePlus

    ... World Dialogues in Dermatology JAAD Mohs AUC MyDermPath+ Psoriasis Patient education resources Practice Management Center Coding and ... joints Rashes Scaly skin Actinic keratosis Ichthyosis vulgaris Psoriasis Psoriasis video library Seborrheic dermatitis Skin cancer Why ...

  12. Seborrheic Dermatitis: Signs and Symptoms

    MedlinePlus

    ... World Dialogues in Dermatology JAAD Mohs AUC MyDermPath+ Psoriasis Patient education resources Practice Management Center Coding and ... joints Rashes Scaly skin Actinic keratosis Ichthyosis vulgaris Psoriasis Psoriasis video library Seborrheic dermatitis Skin cancer Why ...

  13. Seborrheic Keratosis-like Lesions of the Cervix and Vagina: Report of a New Entity Possibly Related to Low-risk Human Papillomavirus Infection.

    PubMed

    Talia, Karen L; McCluggage, W Glenn

    2017-04-01

    We report a series of 7 unusual and morphologically distinct cervical or upper vaginal lesions in women aged 41 to 70 years. The lesions involved the cervix in 3 cases, the upper vagina in 2, the cervix and vagina in 1, and in 1 case the site of origin could not be determined. The lesions had a consistent morphologic appearance with a surface "plaque-like" or "stuck-on" configuration apparent in those cases where surrounding normal tissues were present. Broad coalescing solid sheets and interconnecting trabeculae of cytologically bland cells with a rather "basaloid" appearance emanated from the surface and there were scattered squamous eddies. Other features included peripheral palisading and a stroma containing hyalinized basement membrane-like material. Immunohistochemically, the lesions were diffusely positive with p63, CK5/6, and 34βE12 and focally positive with CK7, but largely negative with CK20, EMA, CEA, and BerEP4. p16 was negative or exhibited nonblock-type immunoreactivity and GATA3 was negative or weakly positive. Molecular testing detected human papillomavirus type 42 in 3 of 7 cases, with no virus detected in the remaining 4 cases. Rarely, similar cases have been reported previously as inverted transitional papilloma of the cervix or vagina, but based on the morphology and immunophenotype we do not feel these represent transitional lesions. We suggest the term seborrheic keratosis-like lesions to designate this new and rare entity, which may be associated with low-risk human papillomavirus infection. Limited follow-up in a small number of cases suggests that these lesions follow a benign clinical course.

  14. Diagnostic value of CD10 and Bcl2 expression in distinguishing cutaneous basal cell carcinoma from squamous cell carcinoma and seborrheic keratosis.

    PubMed

    Gaballah, Mohammad A; Ahmed, Rehab-Allah

    2015-12-01

    The distinction between cutaneous basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and seborrheic keratosis (SK), which are common entities in clinical practice, can be difficult clinically and histologically. CD10 and Bcl2 antigens are important factors in tumor growth, survival and spread. The aim of the present study is to define the frequency of CD10 and Bcl2 expression in such cutaneous tumors and its relation to the clinicopathological characteristics as well as their possible diagnostic utility. CD10 and Bcl2 immunohistochemistry was performed on 30 BCC, 20 SCC and 15 SK. 93.3% of SK cases and 53.3% of BCC cases showed significant expression of CD10 in tumor cells when compared either with each other or with SCC cases (100% negative). Stromal CD10 expression was positive in 50% of BCC cases and 75% of SCC cases. Stromal CD10 expression was significantly higher in high risk BCC and BCC with infiltrating deep margins; furthermore, it showed a significant positive correlation with grade of SCC. A significant inverse correlation between CD10 expression in stromal and tumor cells of BCC was present. Bcl2 was significantly expressed in 93.3% of SK cases and 80% of BCC cases when compared with SCC cases (100% negative). It was found that for distinguishing BCC from SK, only CD10 expression in tumor cells provided a high diagnostic value with positive likelihood ratio (PLR) was 7.00. In addition, CD10 and Bcl2 expression in tumor cells could give convincing diagnostic value to distinguish SCC from SK (PLR=15.00 for each marker). Moreover, for differentiating BCC from SCC, only Bcl2 in the tumor cells could provide a high diagnostic value (PLR=5.5). In conclusion, CD10 and Bcl2 can help in differentiating cutaneous BCC from SK and SCC. The overexpression of CD10 in the stromal cells of SCC and some variants of BCC suggests the invasive properties of such tumors.

  15. Actinic keratosis

    MedlinePlus

    Solar keratosis; Sun-induced skin changes - keratosis; Keratosis - actinic (solar); Skin lesion - actinic keratosis ... likely to develop it if you: Have fair skin, blue or green eyes, or blond or red ...

  16. A-101, a Proprietary Topical Formulation of High-Concentration Hydrogen Peroxide Solution: A Randomized, Double-Blind, Vehicle-Controlled, Parallel Group Study of the Dose-Response Profile in Subjects With Seborrheic Keratosis of the Face.

    PubMed

    DuBois, Janet C; Jarratt, Michael; Beger, Brian B; Bradshaw, Mark; Powala, Christopher V; Shanler, Stuart D

    2017-09-04

    Seborrheic keratosis (SK) is a common benign skin tumor, yet no topical treatments are approved in the United States. To evaluate the proprietary, stabilized, high-concentration hydrogen peroxide-based topical solution A-101 (32.5% and 40% concentrations) for treatment of facial SK lesions. In this multicenter, double-blind, vehicle-controlled study, eligible subjects were randomly assigned to receive up to 2 treatments of A-101 40%, A-101 32.5%, or vehicle solution applied to a single facial SK lesion. The primary efficacy assessment was the Physician's Lesion Assessment (PLA), a validated 4-ordinal scale. The primary end point, the mean reduction in PLA grade from baseline to Day 106 was 1.7 for A-101 40%, 1.4 for A-101 32.5%, and 0.1 for vehicle (p < .001, both concentrations vs vehicle). Lesions for 68%, 62%, and 5% of subjects, respectively, were judged to be clear or near clear (p < .001, both concentrations vs vehicle). Local skin reactions were predominantly mild and transient. No subjects discontinued because of treatment-related adverse events. A-101 solution demonstrated efficacy in treating SKs on the face. Greater magnitude of effect was seen with the 40% concentration than the 32.5% concentration. A-101 solution had a favorable safety and tolerability profile at both concentrations.

  17. Discrimination of squamous cell carcinoma in situ from seborrheic keratosis by color analysis techniques requires information from scale, scale-crust and surrounding areas in dermoscopy images.

    PubMed

    Shakya, N M; LeAnder, R W; Hinton, K A; Stricklin, S M; Rader, R K; Hagerty, J; Stoecker, W V

    2012-12-01

    Scale-crust, also termed "keratin crust", appears as yellowish-to-tan scale on the skin's surface. It is caused by hyperkeratosis and parakeratosis in inflamed areas of squamous cell carcinoma in situ (SCCIS, Bowen's disease) and is a critical dermoscopy feature for detecting this skin cancer. In contrast, scale appears as a white-to-ivory detaching layer of the skin, without crust, and is most commonly seen in benign lesions such as seborrheic keratoses (SK). Distinguishing scale-crust from ordinary scale in digital dermoscopy images holds promise for early SCCIS detection and differentiation from SK. Reported here are image analysis techniques that best characterize scale-crust in SCCIS and scale in SK, thereby allowing accurate separation of these two dermoscopic features. Classification using a logistic regression operating on color features extracted from these digital dermoscopy structures can reliably separate SCCIS from SK. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Seborrheic dermatitis

    MedlinePlus

    ... skin condition that causes flaky, white to yellowish scales to form on oily areas such as the ... symptoms of seborrheic dermatitis include: Skin lesions with scales Plaques over large area Greasy, oily areas of ...

  19. [Seborrheic dermatitis].

    PubMed

    Aschoff, R; Kempter, W; Meurer, M

    2011-04-01

    Seborrheic dermatitis is a frequent skin disorder in infancy and adulthood. It also often occurs in patients with HIV or neurologic disorders like Parkinson disease or mood disorders. It is characterized by greasy, yellow flakes or scales in areas of high sebaceous gland activity like the scalp, face, chest and upper back. Additionally, erythema and itching can be present. The etiology and pathogenesis of seborrheic dermatitis is unknown; however, the focus lies on the involvement of Malassezia yeasts or fatty acid metabolites of Malassezia, on hormones and immunologic factors. The diagnosis is usually a clinical one, based on history and the appearance and site of lesions. The therapy consists mainly of antifungal agents, corticosteroids, immunomodulators, and keratolytics. Because of the chronicity of the illness with frequent relapses, a treatment strategy in which effectiveness and potential side effects are weighed should be used.

  20. Seborrheic keratoses, solar lentigines, and lichenoid keratoses. Dermatoscopic features and correlation to histology and clinical signs.

    PubMed

    Elgart, G W

    2001-04-01

    Evaluation of the three benign lesions discussed here form the basis for dermoscopic evaluation of other pigmented skin lesions. The features of seborrheic keratosis, including [figure: see text] the various forms of fissures, comedo-like openings, and milia-like cysts, often allow easy interpretation of seborrheic keratosis; however, similar structures are commonly associated with melanocytic neoplasms, notably congenital nevi. Understanding solar lentigo and its dermoscopy features allows for the appreciation of pigment networks common in lentiginous melanocytic nevi and melanoma. The lichenoid keratosis is the model for lichenoid inflammation elsewhere, notably in halo nevi, regressing melanoma, and other melanocytic neoplasms with significant host inflammatory reactions.

  1. Seborrheic Dermatitis

    PubMed Central

    Berk, Thomas; Scheinfeld, Noah

    2010-01-01

    Abstract Seborrheic dermatitis is a common chronic inflammatory skin condition, characterized by scaling and poorly defined erythematous patches. It may be associated with pruritus, and it primarily affects sebum-rich areas, such as the scalp, face, upper chest, and back. Although its pathogenesis is not completely understood, some postulate that the condition results from colonization of the skin of affected individuals with species of the genus Malassezia (formerly, Pityrosporum). A variety of treatment modalities are available, including eradication of the fungus, reducing or treating the inflammatory process, and decreasing sebum production. PMID:20592880

  2. The relation between seborrheic keratoses and malignant solid tumours. A case-control study.

    PubMed

    Grob, J J; Rava, M C; Gouvernet, J; Fuentes, P; Piana, L; Gamerre, M; Sarles, J C; Bonerandi, J J

    1991-01-01

    In order to establish whether or not here is an association between cancer and intense growth of seborrheic keratosis, the so-called Leser-Trelat sign, we conducted a case control study in which the number and features of seborrheic keratosis in 82 patients with recent solid tumours, were compared with 82 age- and sex-matched controls. Neither numbers nor features of seborrheic keratosis differed significantly in patients and controls. Eruptive seborrheic keratosis was noted in only one patient and one control. This study showed that solid malignancies are not generally associated with an increase in the number or size of seborrheic keratosis lesions, thus suggesting that they are not controlled by a hypothetical secretion of growth factors by tumours. Our results suggest that Leser-Trelat is either a coincidence, or at most a very rare sign of unusual types of cancer. We also showed that multiple cherry angiomas, previously reported to be a paraneoplastic sign, are not regularly associated with solid tumours.

  3. Seborrheic dermatitis: an update.

    PubMed

    Bukvić Mokos, Zrinka; Kralj, Martina; Basta-Juzbašić, Aleksandra; Lakoš Jukić, Ines

    2012-01-01

    Seborrheic dermatitis is a chronic relapsing inflammatory skin disorder clinically characterized by scaling and poorly defined erythematous patches. The prevalence of adult seborrheic dermatitis is estimated at 5%. Although the exact cause of seborrheic dermatitis has yet to be understood, Malassezia yeasts, hormones (androgens), sebum levels and immune response are known to play important roles in its development. Additional factors including drugs, winter temperatures and stress may exacerbate seborrheic dermatitis. A variety of treatment modalities are available, including antifungal agents, topical low-potency steroids and calcineurin inhibitors (immunomodulators). This review summarizes current knowledge on the etiopathogenesis and therapy of adult seborrheic dermatitis.

  4. An unusual presentation of seborrheic keratoses in a man with hereditary hemochromatosis.

    PubMed

    Loh, Tiffany Y; Cohen, Philip R

    2017-04-15

    Hereditary hemochromatosis is an autosomal recessive disorder that disturbs iron metabolism and results in iron deposition throughout the body. Iron accumulation in various organs may cause a wide range of systemic symptoms and cutaneous manifestations of the disease are particularly striking. Classically, hereditary hemochromatosis has been termed "bronze diabetes." Although diffuse hyperpigmentation is a well-described feature of this disease, other cutaneous symptoms may also occur, and a variety of anomalies may be observed. We present a case of long-standing hereditary hemochromatosis associated with hypopigmented plaques, which were found to be seborrheic keratoses on histologic examination. The cutaneous findings in hereditary hemochromatosis are summarized and an unusual case of seborrheic keratosis manifesting as hypopigmented plaques in a man with hereditary hemochromatosis is described. PubMed was used to search the following terms: hemochromatosis, hereditary, hyperpigmentation, hypopigmentation, keratosis, melanin, seborrheic, siderosis. Despite the generalized hyperpigmentation that is usually observed in hereditary hemochromatosis, seborrheic keratosis may present rarely as hypopigmented lesions in individuals affected by this disease. Therefore, seborrheic keratoses should be considered in the differential diagnosis in hemochromatosis patients who present with uncharacteristic pigmentation.

  5. Adult Seborrheic Dermatitis

    PubMed Central

    2011-01-01

    Seborrheic dermatitis is a common chronic-recurrent inflammatory disorder that most commonly affects adults; however, a more transient infantile form also occurs. The definitive cause of seborrheic dermatitis is unknown. However, proliferation of Malassezia species has been described as a contributing factor. The adult form of seborrheic dermatitis affects up to approximately five percent of the general population. The disorder commonly affects the scalp, face, and periauricular region, with the central chest, axillae, and genital region also involved in some cases. Pruritus is not always present and is relatively common, especially with scalp disease. A variety of treatments are available including topical corticosteroids, topical antifungal agents, topical calcineurin inhibitors, and more recently, a nonsteroidal “device ”cream. This article reviews the practical topical management of seborrheic dermatitis in the United States, focusing on the adult population. PMID:21607192

  6. Reduced degree of irritation during a second cycle of ingenol mebutate gel 0.015% for the treatment of actinic keratosis.

    PubMed

    Jim On, Shelbi C; Haddican, Madelaine; Yaroshinsky, Alex; Singer, Giselle; Lebwohl, Mark

    2015-01-01

    Ingenol mebutate gel is a topical field treatment of actinic keratosis (AK). One of several proposed mechanisms of action for ingenol mebutate is induction of cell death in proliferating keratinocytes, suggesting a preferential action on AKs rather than healthy skin. Local skin reactions (LSRs) during 2 sequential 4-week cycles of AK treatment with ingenol mebutate gel 0.015% on the face or scalp were evaluated to test the hypothesis that reapplication of the study product would produce lower LSR scores than during the first treatment cycle. In this unblinded study, 20 participants with AKs on the face or scalp were treated with ingenol mebutate gel 0.015% once daily for 3 days in 2 sequential 4-week cycles. Composite LSR scores were evaluated during both cycles. The composite LSR score during the second cycle was found to be significantly lower than the first cycle (P=.0002). The proportion of participants who experienced LSRs in the second treatment cycle was less than the first cycle. Ingenol mebutate gel 0.015% may cumulatively reduce the burden of sun-damaged skin over 2 treatment cycles by targeting and removing transformed keratinocytes.

  7. Diclofenac Topical (actinic keratosis)

    MedlinePlus

    Solaraze® Gel ... Diclofenac topical gel (Solaraze) is used to treat actinic keratosis (flat, scaly growths on the skin caused by too much sun ... nonsteroidal anti-inflammatory drugs (NSAIDs). The way diclofenac gel works to treat actinic keratosis is not known. ...

  8. [Stress and seborrheic dermatitis].

    PubMed

    Misery, L; Touboul, S; Vinçot, C; Dutray, S; Rolland-Jacob, G; Consoli, S-G; Farcet, Y; Feton-Danou, N; Cardinaud, F; Callot, V; De La Chapelle, C; Pomey-Rey, D; Consoli, S-M

    2007-11-01

    It is widely accepted that episodes of seborrheic dermatitis are frequently induced by stress, as stated in all general reviews of the subject. However, there have been no studies to confirm this view. This prospective study was performed in two phases. An initial questionnaire collected information on patients' identity, somatic and psychiatric history and seborrheic dermatitis characteristics. Information on triggering episodes was sought by means of an open question and patients were then asked if they had experienced stress during the week or month prior to the active episode. A second questionnaire containing the same questions (except for history) was completed four months later. The two questionnaires contained psychopathological evaluation scales designed to detect symptoms of anxiety and depression among patients (HAD: Hospital Anxiety and Depression scale; Beck; STAI: State-Trait Anxiety Inventory) and determine their perceived stress (PSS: Perceived Stress Scale by Cohen and Williamson). Eighty-two patients (36 women and 46 men) were included in the study. 82% of patients presented involvement of scalp, 33% of the face, 19% of the chest and 13% of other sites (ears, skinfolds). Patients themselves identified stress as the main triggering factor, whether for episodes in general, for the first episode or for the current episode. A stressful event was in fact found in the majority of cases. The fact that stress was recognised as a triggering factor for episodes was not associated with a higher depression score (HAD or Beck) but was associated with a higher anxiety score (STAI). The psychological effects of the disease were pronounced in 11% of patients, moderate in 20%, mild in 35%, and nil in 25%, with 9% of patients stating no opinion. Patients with facial involvement were more depressed in terms of Beck Depression Index score. Two characteristics noted at inclusion were predictive for the onset of at least one further episode or persistence of an ongoing

  9. Keratosis follicularis spinulosa decalvans.

    PubMed

    Reddy, B S; Thadeus, J; Garg, B R; Rathnakar, C

    1995-01-01

    The case findings in a 22-year-old male patient of keratosis follicularis spinulosa decalvans are described. In addition to the characteristic cutaneous, occular and histological features, he had striking angular stomatitis and fissuring of the tongue simulating vitamin B-complex deficiency. This is an unreported feature to our knowledge. The mode of inheritance suggested X-linked trait.

  10. [The significance of yeasts in seborrheic eczema].

    PubMed

    Buslau, M; Hänel, H; Holzmann, H

    1989-10-01

    The high prevalence of seborrheic dermatitis in HIV-infected subjects has led to intensified the discussion of the etiopathogenesis of this dermatological disease. There is increasing controversy about the significance of Pityrosporum in seborrheic dermatitis. On the other hand, recent clinical and experimental data favor the role of intestinal candidiasis in seborrheic dermatitis: a high quantity of Candida in the feces of the affected patients, elevated phospholipase activity of the Candida sp. with special pathogenic relevance for mucosal adhesion and fast and long-lasting regression of seborrheic dermatitis after vigorous therapy with oral nystatin. Similar findings have been recorded in the seborrheic forms of psoriasis.

  11. Clinical and histopathologic study of benign lichenoid keratosis on the face.

    PubMed

    Kim, Han Su; Park, Eun Joo; Kwon, In Ho; Kim, Kwang Ho; Kim, Kwang Joong

    2013-10-01

    Benign lichenoid keratosis is a cutaneous entity that consists of a nonpruritic papule or slightly indurated plaque that is histologically characterized by a band-like inflammatory infiltrate with interface involvement. The purpose of this study was to investigate the clinical and histopathologic features of benign lichenoid keratosis localized on the face. Fourteen benign lichenoid keratosis patients diagnosed clinically and histopathologically in our clinic during the 10-year period from 2002 to 2012 were studied. Thirteen female and 1 male patients were included. The mean age at diagnosis was 46.5 years. The color of most of the lesions was brown (10 cases, 71%). The cheek was the most commonly involved area (10 cases, 71%). All of the lesions were single. There were 9 (64%) flat lesion cases and 5 (36%) raised lesion cases. Most patients denied having any symptoms; 3 had mild pruritus. The histopathological findings indicated that all the cases exhibited lichenoid inflammatory infiltrate obscuring the dermal-epidermal junction and vacuolar alteration of basal cell layer. The lesions showed focal parakeratosis (79%), melanophages (79%), hyperkeratosis (71%), and necrotic keratinocytes (71%). Solar elastosis (50%) and acanthosis (43%) were also seen frequently. Diagnosis of benign lichenoid keratosis should be made by a combination of clinical manifestations and histopathological findings. In particular, benign lichenoid keratosis should be considered if a middle-aged patient presents a solitary asymptomatic brown lesion on the face. We think benign lichenoid keratosis may be a specific disorder rather than the inflammatory stage of regressing solar lentigines, large cell acanthoma or reticulated seborrheic keratosis.

  12. Seborrheic dermatitis in neuroleptic-induced parkinsonism.

    PubMed

    Binder, R L; Jonelis, F J

    1983-06-01

    An increased prevalence of seborrheic dermatitis has previously been noted in idiopathic Parkinson's disease and in postencephalitic parkinsonism. Our study of 42 hospitalized patients with drug-induced parkinsonism and 47 hospitalized psychiatric patients without that disorder showed a statistically significant higher prevalence of clinically diagnosed seborrheic dermatitis in the group with drug-induced parkinsonism (59.5% v 15%). To our knowledge, this is the first report of an increased prevalence of seborrheic dermatitis with drug-induced parkinsonism.

  13. [Keratosis follicularis spinulosa decalvans].

    PubMed

    Helbig, D; Grabbe, S; Jansen, T

    2008-01-01

    Keratosis follicularis spinulosa decalvans is a rare, X-linked disorder of keratinization of the hair follicle with inflammation and atrophy associated with corneal dystrophy and other symptoms. A family with several affected members is reported. The unaffected parents were related. A 12-year-old girl and her 5-year-old brother had follicular spiny hyperkeratoses on the trunk and extremities. The girl had thinning of the eyelashes and eyebrows as well as scarring alopecia of the scalp as additional features of the disease. Both the girl and her brother had corneal dystrophy and photophobia. Two sisters aged 8 and 10 years did not show similar skin or eye findings.

  14. Eruptive seborrheic keratoses associated with adalimumab use.

    PubMed

    Eastman, Kristin L; Knezevich, Stevan R; Raugi, Gregory J

    2013-06-30

    Seborrheic keratoses are common, benign cutaneous growths, however in rare situations they can acutely erupt in large numbers. Eruptive seborrheic keratoses can be associated with internal malignancy (sign of Leser-Trelat), but may also appear in conjunction with inflammatory dermatoses and adverse drug reactions. A 71-year-old Caucasian man presented with acute onset of a pruritic, burning papular erythematous rash on his chest, upper extremities and lower extremities after a routine adalimumab injection for rheumatoid arthritis. Two skin biopsies obtained showed findings diagnostic of seborrheic keratoses. Spontaneous resolution of the diffuse eruptive seborrheic keratoses was achieved within 3 months of discontinuing adalimumab therapy. We believe the development of eruptive seborrheic keratoses due to adalimumab therapy is rare, and because our patient responded promptly to discontinuation of the drug we suggest this should be the preferred course of action in future cases.

  15. Optimizing Treatment Approaches in Seborrheic Dermatitis

    PubMed Central

    2013-01-01

    Seborrheic dermatitis is a chronic, recurring, cutaneous condition that causes erythema and flaking, sometimes appearing as macules or plaques with dry white or moist oily scales. In adults, it commonly occurs in areas with high concentrations of sebaceous glands. The face and scalp are the most frequently affected areas, and involvement of multiple sites is common. Dandruff is regarded as a mild noninflammatory form of seborrheic dermatitis. There is a high incidence of seborrheic dermatitis among persons with human immunodeficiency virus infection or Parkinson’s disease. The cause of seborrheic dermatitis is not well understood, but appears to be related to the composition of the sebaceous gland secretions, the proliferation of Malessezia yeasts, and the host immune response. Treatment options for nonscalp and scalp seborrheic dermatitis include topical agents and shampoos containing antifungal agents, anti-inflammatory agents, keratolytic agents, and calcineurin inhibitors. Because multiple body sites are usually involved, the physician should examine all commonly affected areas. Patients should be made aware that seborrheic dermatitis is a chronic condition that will probably recur even after successful treatment. PMID:23441240

  16. Diagnosis and treatment of seborrheic dermatitis.

    PubMed

    Clark, Gary W; Pope, Sara M; Jaboori, Khalid A

    2015-02-01

    Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.

  17. Seborrheic inclusion cyst of the skin positive for cytoplasmic inclusion bodies and HPV antigen.

    PubMed

    Terada, Tadashi

    2012-01-01

    Seborrheic inclusion cyst (SIC) is a very rare variant of epidermal cyst of the skin. SIC shows seborrheic keratosis (SK)-like lesion in epidermal cyst. SIC is extremely rare; only 6 case reports have been published in the English literature. However, no immunohistochemical study of SIC has been reported. A 41-year-old Japanese man noticed a subcutaneous tumor in the neck. Physical examination showed slightly mobile tumor in the subcutaneous tissue, and total excision was performed. Grossly, the tumor (1 x 1 x 0.8 cm) was cyst containing atheromatous keratin. Microscopically, the lesion is a cyst containing keratins. About one half of the cyst showed features of epidermal cyst consisting of mature squamous epithelium with granular layers. The other one half showed SK-like epidermal proliferation. The SK-like area showed basaloid cell proliferation with pseudohorn cysts. No significant atypia was noted. Many eosinophilic cytoplasmic inclusion bodies were noted in the SK-like area. Immunohistochemically, the SK-like area was positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, p63, and Ki-67 (labeling=8%) and HPV, but negative for p53. The pathological diagnosis was SIC.

  18. Seborrheic Dermatitis and Dandruff: A Comprehensive Review

    PubMed Central

    Borda, Luis J.; Wikramanayake, Tongyu C.

    2016-01-01

    Seborrheic Dermatitis (SD) and dandruff are of a continuous spectrum of the same disease that affects the seborrheic areas of the body. Dandruff is restricted to the scalp, and involves itchy, flaking skin without visible inflammation. SD can affect the scalp as well as other seborrheic areas, and involves itchy and flaking or scaling skin, inflammation and pruritus. Various intrinsic and environmental factors, such as sebaceous secretions, skin surface fungal colonization, individual susceptibility, and interactions between these factors, all contribute to the pathogenesis of SD and dandruff. In this review, we summarize the current knowledge on SD and dandruff, including epidemiology, burden of disease, clinical presentations and diagnosis, treatment, genetic studies in humans and animal models, and predisposing factors. Genetic and biochemical studies and investigations in animal models provide further insight on the pathophysiology and strategies for better treatment. PMID:27148560

  19. Solar keratosis: epidemiology, pathogenesis, presentation and treatment.

    PubMed

    Holmes, Cara; Foley, Peter; Freeman, Michael; Chong, Alvin H

    2007-05-01

    Solar keratosis is a common problem encountered by dermatologists, particularly in Australia. Solar keratosis is most commonly found on sun-exposed areas such as the scalp, face and forearms. UV radiation is thought to be the major aetiological factor, with age, immunosuppression and human papillomavirus being important contributing factors. Solar keratosis usually presents as a discrete, variably erythematous and irregular lesion with a scaly surface. Although the exact rate of malignant transformation to squamous cell carcinoma is unknown, the majority of squamous cell carcinomas appear to arise from within solar keratosis. For this reason, solar keratosis is commonly treated and, consequently, an increasing number of therapeutic options is now available. Traditional therapies, such as liquid nitrogen cryotherapy, are still popular, but newer choices, such as photodynamic therapy and imiquimod cream, are now providing further options with similar efficacy and superior adverse effect profiles, albeit at a higher cost.

  20. Pimecrolimus cream 1% can be an effective treatment for seborrheic dermatitis of the face and trunk.

    PubMed

    Rallis, E; Nasiopoulou, A; Kouskoukis, C; Koumantaki, E

    2004-01-01

    The ascomycin macrolactam derivative pimecrolimus is a novel, nonsteroidal, cell-selective inhibitor of inflammatory cytokines specifically developed for the treatment of inflammatory skin diseases. Our objective was to assess the efficacy, tolerability and safety of pimecrolimus cream 1% in the treatment of seborrheic dermatitis. Adults with seborrheic dermatitis of the face and upper trunk who were seen from October 2003 to April 2004 at the Dermatologic Outpatient Clinic of the University of Thrace were enrolled in this 9-week open-label uncontrolled study. Pimecrolimus cream 1% was applied as monotherapy twice daily for 7 days and for an additional period of 7 days thereafter, if needed, until complete clearance was achieved. In cases of recurrence a 5-day course was additionally applied. After screening and an appropriate washout period, subjects were evaluated at baseline (day 0) and at follow-up visits at weeks 1, 3, 6 and 9. The clinical severity of seborrheic dermatitis was estimated as mild (total score 1-3), moderate (total score 4-6) and severe (total score 7-9) in terms of erythema, scaling and lesional extent using a scale from 0 to 3 for each. Patients also assessed their symptoms on a scale from 0 to 5 in terms of the efficacy, safety and tolerability of topical application. Nineteen patients (12 males, seven females) were enrolled in this study. At the end of weeks 1, 3, 6 and 9 the percentages of complete clearance were 63%, 100%, 47% and 52%, respectively. At the end of the study, subjects' average assessment score was 9.73. Apart from topical burning and irritation of the skin in four patients, no other adverse event was mentioned. This pilot study indicates that pimecrolimus applied twice daily can be a safe and efficacious alternative in the treatment of seborrheic dermatitis. Further studies are needed to determine the initial and maintenance therapy.

  1. Actinic keratosis. Current treatment options.

    PubMed

    Jeffes, E W; Tang, E H

    2000-01-01

    Actinic keratoses are hyperkeratotic skin lesions that represent focal abnormal proliferation of epidermal keratinocytes. Some actinic keratoses evolve into squamous cell carcinoma of the skin, while others resolve spontaneously. The conversion rate of actinic keratosis to squamous cell carcinoma is not accurately known, but appears to be in the range of 0.25 to 1% per year. Although there is a low rate of conversion of actinic keratoses to squamous cell carcinoma, 60% of squamous cell carcinomas of the skin probably arise from actinic keratoses. The main cause of actinic keratoses in otherwise healthy Caucasians appears to be the sun. Therapy for actinic keratoses begins with prevention which starts with sun avoidance and physical protection. Sunprotection with sunscreens actually slows the return of actinic keratoses in patients already getting actinic keratoses. Interestingly, a few studies are available that demonstrate that a high fat diet is associated with the production of more actinic keratoses than is a low fat diet. One of the mainstays of therapy has been local destruction of the actinic keratoses with cryotherapy, and curettage and electrodesiccation. A new addition to this group of therapies to treat individual actinic keratoses is photodynamic therapy with topical aminolevulinic acid and light. In patients who have numerous actinic keratoses in an area of severely sun damaged skin, therapies which are applied to the whole actinic keratosis area are used. The goal of treating such an area of skin is to treat all of the early as well as the numerous clinically evident actinic keratoses at the same time. The classical approaches for treating areas of photodamaged skin without treating actinic keratoses individually include: the use of topically applied fluorouracil cream, dermabrasion, and cutaneous peels with various agents like trichloroacetic acid. Both topically as well as orally administered retinoids have been used to treat actinic keratoses but

  2. Treatment of Malassezia species associated seborrheic blepharitis with fluconazole.

    PubMed

    Zisova, Lilia G

    2009-01-01

    The AIM of the present study was to evaluate the therapeutic effect of fluconazole (FungoIon) in patients with seborrheic blepharitis. Four seborrheic blepharitis patients with Malassezia spp. positive cultures on Dixon's agar were treated with fluconazole (Fungolon) (0.200) weekly for 4 weeks. The therapeutic effect of the treatment was positive in all patients--the clinical symptoms withdrew and cultures became mycologically negative. The results indicate that antifungal agents are efficient in the treatment of seborrheic dermatitis.

  3. Pigmented squamous cell carcinoma of the cheek skin probably arising from solar keratosis.

    PubMed

    Terada, Tadashi; Yamagami, Jun; Fugimoto, Atsushi; Tanaka, Kyoko; Sugiura, Makoto

    2003-07-01

    We report a rare case of pigmented squamous cell carcinoma (SCC) of the cheek skin probably arising from solar keratosis. An 80-year-old man was referred to our clinic because of a black skin nodule in the right cheek. The nodular lesion was 1 cm in diameter, dome-shaped, hard, sharply demarcated, partially erosive and telangiectatic at the border. The lesion was completely excised under the clinical diagnosis of probable seborrheic keratosis. Microscopically, cutaneous horn and mildly atypical squamous epithelia suggestive of previous solar keratosis were present in the surface of the lesion. The lesion consisted of atypical squamous cells with keratinization and intercellular bridges, and it was regarded as SCC. The SCC cells were seen to invade lightly into the upper dermis, where lymphocytic infiltrations and melanophages were noted. Characteristically, heavy deposition of melanin pigment was recognized in the SCC cells as well as in proliferated dendritic and pigment blockade melanocytes that were scattered or colonized within the SCC cell nests. Masson-Fontana stain revealed numerous melanin granules in the SCC cells, as well as in dendritic and pigment blockade melanocytes. Immunohistochemically, the SCC cells were positive for cytokeratins and epithelial membrane antigen, and negative for S-100 protein and HMB45 antigen. Dendritic and pigment blockade melanocytes were negative for cytokeratins, epithelial membrane antigen, and HMB45 antigen, but positive for S-100 protein. The present case suggests that SCC cells of the skin may induce proliferation of melanocytes. The differential diagnosis and the histogenesis of pigmented SCC of the skin are discussed.

  4. Nilontinib induced keratosis pilaris atrophicans.

    PubMed

    Khetarpal, Shilpi; Sood, Apra; Billings, Steven D

    2016-08-15

    Keratosis pilaris (KP) is a disorder of follicular keratinization that is characterized by keratin plugs in the hair follicles with surrounding erythema. A 46-year-old man with chronic myelogenous leukemia (CML) was started on nilotinib, a second generation tyrosine kinase inhibitor (TKI). Two months later the patient noticed red bumps on the skin and patchy hair loss on the arms, chest, shoulders, back, and legs. Cutaneous reactions to nilotinib are the most frequent non-hematologic adverse effects reported. However, it is important to distinguish KP-like eruptions from more severe drug hypersensitivity eruptions, which can necessitate discontinuing the medication. Also, it is important to classify the cutaneous eruptions in patients on TKI according to the morphology instead of labeling them all as "chemotherapy eruption" to be able to better manage these adverse effects.

  5. Two brothers with keratosis follicularis spinulosa decalvans.

    PubMed

    Alfadley, Abdullah; Al Hawsawi, Khalid; Hainau, Bo; Al Aboud, Khalid

    2002-11-01

    Keratosis follicularis spinulosa decalvans is a rare, X-linked disorder affecting both the skin and eyes. There are few reports about this entity. The aim of this report is to describe 2 brothers with progressive scarring alopecia of the scalp, hypotrichosis with follicular prominence of the eyelashes, and extensive keratosis pilaris. The second patient has Down syndrome with palmoplantar keratoderma and partial alopecia of the eyebrows. We also reviewed the literature about this uncommon entity.

  6. Keratosis follicularis spinulosa decalvans in a female.

    PubMed

    Sequeira, Fiona F; Jayaseelan, Elizabeth

    2011-01-01

    Keratosis follicularis spinulosa decalvans (KFSD), is a rare follicular syndrome associated with widespread keratosis pilaris and progressive scarring alopecia. This genodermatoses often starts at infancy or early childhood with an X-linked mode of inheritance. Males are predominantly affected and females frequently show no disease or only a mild form. We describe this not so common entity of KFSD in a nine year old female child.

  7. Seborrheic dermatitis: a newly reported side effect of neuroleptics.

    PubMed

    Binder, R L; Jonelis, F J

    1984-03-01

    Of 42 chronic patients with neuroleptic-induced parkinsonism, 25 were found to have seborrheic dermatitis; this side effect was seen in only 1 of 17 acute patients with neuroleptic-induced parkinsonism. Parkinsonian symptoms may precede the onset of seborrheic dermatitis in patients receiving chronic neuroleptic treatment.

  8. Facial seborrheic dermatitis: a report on current status and therapeutic horizons.

    PubMed

    Bikowski, Joseph

    2009-02-01

    Seborrheic dermatitis, characterized by erythema and/or flaking or scaling in areas of high sebaceous activity, affects up to 5% of the US population and often appears in conjunction with other common skin disorders, such as rosacea and acne. Despite ongoing research, its etiology is puzzling. Increased sebaceous and hormonal (androgenic) activity is thought to play a part. Recent evidence suggests an important role for individual susceptibility to irritant metabolites of the skin commensal Malassezia, most probably M globosa. Current approaches thus include agents with antifungal as well as antikeratinizing, and anti-inflammatory activity. Azelaic acid, which has all 3 properties, may be a useful addition to first-line management, which now comprises of topical steroids, the immunosuppressant agents tacrolimus and pimecrolimus, azoles and other antifungals, and keratolytic agents. A recent exploratory study supports the efficacy and safety of azelaic acid 15% gel in seborrheic dermatitis. Azelaic acid may be especially valuable in this application because of its efficacy in treating concomitant rosacea and acne.

  9. Three etiologic facets of dandruff and seborrheic dermatitis: Malassezia fungi, sebaceous lipids, and individual sensitivity.

    PubMed

    DeAngelis, Yvonne M; Gemmer, Christina M; Kaczvinsky, Joseph R; Kenneally, Dianna C; Schwartz, James R; Dawson, Thomas L

    2005-12-01

    Application of new molecular and biochemical tools has greatly increased our understanding of the organisms, mechanisms, and treatments of dandruff and seborrheic dermatitis. Dandruff results from at least three etiologic factors: Malassezia fungi, sebaceous secretions, and individual sensitivity. While Malassezia (formerly P. ovale) has long been a suspected cause, implicated by its presence on skin and lipophylic nature, lack of correlation between Malassezia number and the presence and severity of dandruff has remained perplexing. We have previously identified the Malassezia species correlating to dandruff and seborrheic dermatitis. In this report, we show that dandruff is mediated by Malassezia metabolites, specifically irritating free fatty acids released from sebaceous triglycerides. Investigation of the toxic Malassezia free fatty acid metabolites (represented by oleic acid) reveals the component of individual susceptibility. Malassezia metabolism results in increased levels of scalp free fatty acids. Of the three etiologic factors implicated in dandruff, Malassezia, sebaceous triglycerides, and individual susceptibility, Malassezia are the easiest to control. Pyrithione zinc kills Malassezia and all other fungi, and is highly effective against the Malassezia species actually found on scalp. Reduction in fungi reduces free fatty acids, thereby reducing scalp flaking and itch.

  10. Keratosis follicularis spinulosa decalvans in a family.

    PubMed

    Bellet, Jane S; Kaplan, Andrew L; Selim, M Angelica; Olsen, Elise A

    2008-03-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare condition characterized by diffuse keratosis pilaris with a scarring alopecia of the scalp and associated photophobia, facial erythema, and palmoplantar keratoderma. Although initially described as a sex-linked disorder, several different inheritance patterns have been observed. We describe a patient whose father and sister were also affected with this condition, consistent with an autosomal dominant genetic transmission. Multiple topical and systemic treatments have been unsuccessful in this patient, attesting to the treatment refractoriness typically seen in KFSD.

  11. Scalp Psoriasis vs. Seborrheic Dermatitis: What's the Difference?

    MedlinePlus

    ... does a doctor tell the difference between scalp psoriasis and seborrheic dermatitis of the scalp? Answers from ... such as pitting. Compare signs and symptoms Scalp psoriasis Red skin covered with flakes and silvery scales ...

  12. Keratosis pilaris atrophicans in mother and daughter.

    PubMed

    Khumalo, N P; Loo, W J; Hollowood, K; Salvary, I; Graham, R M; Dawber, R P R

    2002-07-01

    We report two cases of keratosis follicularis spinulosa decalvans in a Caucasian family involving a 28-year-old woman and her mother. This is an unusual family in that no male relatives are similarly affected. Secondly, both patients have no significant eye changes but quite extensive scarring alopecia. To the best of our knowledge this is the second reported family in the UK.

  13. [Environmental and occupational risk factors in keratosis of the larynx].

    PubMed

    de Vincentiis, M; Gallo, A; Boccia, M M; Diletti, G; Simonelli, M; Della Rocca, C

    1993-01-01

    Laryngeal keratosis may frequently precede the appearance of carcinoma of the larynx which might well indicate that these diseases have a common denominator. A retrospective study of 120 subjects with laryngeal keratosis was examined. The intention of the Authors was to verify whether the principle risk factors involved in the appearance of laryngeal carcinoma were the same as those implicated in laryngeal keratosis formation. Sex age, work activity, cigarette smoke, alcohol consumption and vocal chord abuse were considered. Laryngeal keratosis takes keratosis with dysplasia as well as keratosis without. A link between these two types of keratosis and cancer was sought. In particular, the possibility that a persistent action of the mentioned risk factors could cause laryngeal dysplasia-free keratosis to change into dysplastic lesions and subsequently into cancer was investigated. A case-control study was performed in order to analyze the importance of work activity. Results were statistically significant (P < 0.001). The Cramer V2 calculation demonstrated a clear correlation between the number of cigarettes smoked and the appearance of dysplasia (V2 = 0.117; P < 0.005). Results showed a clearly different behaviour between sexes. The number of males was much higher than females as was the age at which keratosis appeared greater in males. The fact that the average age in which keratosis appeared preceded the appearance of laryngeal cancer by ten years indicates that this interrum is sufficient for keratosis with dysplasia to be transformed into cancer (due to the continued action of the mentioned etiologic factors, mainly referred to cigarette smoke). In our data analysis, no correlation was demonstrated between keratosis without dysplasia and cancer.

  14. Safe and effective treatment of seborrheic dermatitis.

    PubMed

    Elewski, Boni E

    2009-06-01

    Seborrheic dermatitis is a common chronic inflammatory skin disorder that can vary in presentation from mild dandruff to dense, diffuse, adherent scale. The disorder occurs throughout the world without racial or geographic predominance; it is more common in males than females. Its precise etiology remains unknown, but the condition is strongly associated with lipophilic Malassezia yeasts found among the normal skin flora and represents a cofactor linked to several risk factors, including T-cell depression, increased sebum levels, and activation of the alternative complement pathway. The goal of treatment is symptom control, with an emphasis on the importance of maintaining patient adherence to therapy to achieve low rates of recurrence. Available therapies include corticosteroids, antifungal agents, immunomodulators, and medicated keratolytic shampoos. Although corticosteroids are associated with recurrence, they sometimes may be recommended in combination with antifungal agents. Antifungal therapy is considered primary, but some agents are more effective than others because of their favorable pharmacokinetic profiles, high rates of absorption, anti-inflammatory and antipruritic properties, and vehicle.

  15. Malassezia furfur in infantile seborrheic dermatitis.

    PubMed

    Wananukul, Siriwan; Chindamporn, Ariya; Yumyourn, Poomjit; Payungporn, Sunchai; Samathi, Chanchuree; Poovorawan, Yong

    2005-01-01

    Our objective was to study both incidence and various strains of Malassezia in infantile seborrheic dermatitis (ISD). Sixty infants between 2 weeks and 2 years old with clinical diagnosis of ISD at the Department of Pediatrics, King Chulalongkorn Memorial Hospital from May 2002 to April 2003 were recruited. Malassezia spp. were isolated from cultured skin samples of the patients, genomic DNA was extracted and the ITS1 rDNA region was amplified. The PCR product was examined by agarose gel electrophoresis and DNA sequences were determined. The ITS1 sequences were also subjected to phylogenetic analysis and species identification. ISD is most commonly found in infants below the age of 2 months (64%), followed by those between 2 and 4 months (28%) old. Cultures yielded yeast-like colonies in 15 specimens. PCR yielded 200-bp products (Candida) in 3 patients and 300-bp products (Malassezia furfur) in 12 patients (18%). Sugar fermentation using API 20C aux performed on the three 200-bp PCR products yielded Candida species. M. furfur was the only Malassezia recovered from skin scrapings of children with ISD.

  16. Topical Pimecrolimus 1% Cream in the Treatment of Seborrheic Dermatitis

    PubMed Central

    Kim, Grace K.

    2013-01-01

    Seborrheic dermatitis is a multifactorial skin disease characterized by a chronic course with periods of exacerbation and remission. Although topical corticosteroids have been the mainstay of treatment, alternative therapies are often needed to avoid protracted use of topical corticosteroid therapy in order to avert side effects and to sustain control of the disorder. Topical pimecrolimus, a calcinuerin inhibitor, is a safe alternative for seborrheic dermatitis and is more ideal for long-term use. More specifically, topical pimecrolimus not only has an attractive safety profile with no risk of many of the potential side effects seen with topical corticosteroids, but also has favorable efficacy data, including more data on long-term use. This is a review of literature evaluating the efficacy and safety profile of topical pimecrolimus 1% cream for the treatment of seborrheic dermatitis. PMID:23441238

  17. Keratosis follicularis spinulosa decalvans: report of a new pedigree.

    PubMed

    Herd, R M; Benton, E C

    1996-01-01

    Keratosis follicularis spinulosa decalvans is a rare, X-linked genodermatosis characterized by follicular hyperkeratosis, scarring alopecia of the scalp, eyebrows and eyelashes, corneal dystrophy and photophobia. We describe two cases from a large family, the first with keratosis follicularis spinulosa decalvans to be reported in the U.K.

  18. Psychomotor retardation - an unusual association of keratosis follicularis spinulosa decalvans.

    PubMed

    Masood, Q; Manzoor, S; Hassan, I; Majid, I

    2000-01-01

    Keratosis follicularis spinulosa decalvans is one of a group of related disorders that shows keratosis pilaris with inflammation followed by atrophy. Here we report a case of this relatively rare disorder in a 6-year old boy who had associated psychomotor retardation.

  19. [A case of keratosis follicularis spinulosa decalvans (author's transl)].

    PubMed

    Salamon, T; Gvozdenović, B

    1975-01-01

    The case of a 2-year-old boy with keratosis follicularis spinulosa decalvans is described. On of his sisters had keratosis follicularis of the upper arms, forearms, thighs and legs as well as blepharonconjunctivitis chronica catarrhalis bilateralis and was considered as forme fruste of the anomaly. His mother had sparse eyebrows. The mode of inheritance and the Lyon hypothesis are discussed.

  20. Treating seborrheic dermatitis: review of mechanisms and therapeutic options.

    PubMed

    Bhatia, Neal

    2013-07-01

    Seborrheic dermatitis is one of those conditions that dermatologists and patients alike tend to find a routine for, and in many cases those routines are hard to break. And, unlike the new treatment paradigms for eczema, acne, and even actinic keratoses, combination therapies for addressing the disease process typically have not been a part of the approach to treating seborrheic dermatitis. However, with the advent of new therapies and vehicles as well as a better understanding of how neutrophils and free oxygen radicals impact inflammation,1 there are new options to maintain and control the disease process of seborrheic dermatitis to minimize flares. Although the needs of the scalp, face and chest are different, as are the variations in skin types, the fundamental mechanisms of the inflammatory process are often the same. If it is understood that seborrheic dermatitis is histologically classified as a papulosquamous disorder with paucineutrophilic and lymphocytic infiltrates, and if the trigger and etiologic agent most likely is Malassezia furfur, then the ideal mechanisms of action of therapies should be directed as such

  1. Keratosis follicularis spinulosa decalvans: case report.

    PubMed

    Berbert, Alceu L C V; Mantese, Sônia A O; Rocha, Ademir; Cherin, Cláudia P; Couto, Carolina M

    2010-01-01

    Keratosis follicularis spinulosa decalvans is a rare disease, with genetic transmission either X-linked or sporadic, characterized by follicular hyperkeratosis and cicatricial alopecia. The disease usually begins in early childhood exacerbating throughout adolescence. The therapies are somewhat effective, with frustrating treatment when there are changes which are predominantly cicatricial. It is reported a case of child with intense cicatricial alopecia, with precocious changes (already present at birth) that rapidly evolved to diffuse cicatricial alopecia on the scalp, which has limited the treatment, with disappointing results.

  2. The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff.

    PubMed

    Ro, Byung In; Dawson, Thomas L

    2005-12-01

    Most common scalp flaking disorders show a strong correlation with sebaceous gland (SG) activity. Early SG activity in the neonate results in microfloral colonization and cradle cap. After maternal hormonal control subsides, there is little SG activity until puberty, when the SG turns on under sex hormone control. When the SG activity increases, the present but low Malassezia population has a new food source and proliferates, resulting in the scalp itching and flaking common to greater than 50% of adults. Dry scalp flaking, dandruff, and seborrheic dermatitis are chronic scalp manifestations of similar etiology differing only in severity. The common etiology is a convergence of three factors: (1) SG secretions, (2) microfloral metabolism, and (3) individual susceptibility. Dandruff and seborrheic dermatitis (D/SD) are more than superficial stratum corneum disorders, including alteration of the epidermis with hyperproliferation, excess lipids, interdigitation of the corneal envelope, and parakeratosis. The pathogenic role of Malassezia in D/SD has recently been elucidated, and is focused on their lipid metabolism. Malassezia restricta and M. globosa require lipids. They degrade sebum, free fatty acids from triglycerides, consume specific saturated fatty acids, and leave behind the unsaturates. Penetration of the modified sebaceous secretions results in inflammation, irritation, and scalp flaking.

  3. Clinical Evaluation of a New-Formula Shampoo for Scalp Seborrheic Dermatitis Containing Extract of Rosa centifolia Petals and Epigallocatechin Gallate: A Randomized, Double-Blind, Controlled Study

    PubMed Central

    Kim, Yu Ri; Kim, Jeong-Hwan; Shin, Hong-Ju; Choe, Yong Beom; Ahn, Kyu Joong

    2014-01-01

    Background Scalp seborrheic dermatitis is a chronic type of inflammatory dermatosis that is associated with sebum secretion and proliferation of Malassezia species. Ketoconazole or zinc-pyrithione shampoos are common treatments for scalp seborrheic dermatitis. However, shampoos comprising different compounds are required to provide patients with a wider range of treatment options. Objective This study was designed to evaluate a new-formula shampoo that contains natural ingredients-including extract of Rosa centifolia petals and epigallocatechin gallate (EGCG)-that exert antioxidative, anti-inflammatory, and sebum secretion inhibitory effects, and antifungal agents for the treatment of scalp seborrheic dermatitis. Methods Seventy-five patients were randomized into three treatment groups; new-formula shampoo, 2% ketoconazole shampoo, and 1% zinc- pyrithione shampoo. The clinical severity scores and sebum levels were assessed by the same dermatologists at baseline (week 0), and at 2 and 4 weeks after using the shampoo. User satisfaction and irritation were also assessed with the aid of a questionnaire. Results The efficacy of the new-formula shampoo was comparable to that of both the 1% zinc-pyrithione shampoo and the 2% ketoconazole shampoo. Furthermore, it was found to provide a more rapid response than the 1% zinc-pyrithione shampoo for mild erythema lesions and was associated with greater user satisfaction compared with the 2% ketoconazole shampoo. However, the new-formula shampoo did not exhibit the previously reported sebum inhibitory effect. Conclusion Extract of R. centifolia petals or EGCG could be useful ingredients in the treatment of scalp seborrheic dermatitis. PMID:25473226

  4. Irritable Bowel Syndrome

    MedlinePlus

    ... Want to Know About Puberty Train Your Temper Irritable Bowel Syndrome KidsHealth > For Kids > Irritable Bowel Syndrome Print A ... to minimize or prevent these symptoms. What Is Irritable Bowel Syndrome? Irritable bowel syndrome (IBS) is a fairly common ...

  5. A Closer Look at Seborrheic Keratoses: Patient Perspectives, Clinical Relevance, Medical Necessity, and Implications for Management.

    PubMed

    Del Rosso, James Q

    2017-03-01

    The author sought to discover why seborrheic keratoses that are not symptomatic or clinically suspicious are not considered therapeutically important to most clinicians. The author conducted an office-based, observational study examining how the diagnosis of asymptomatic seborrheic keratoses personally affects patients and what these patients think concerning treatment. Many patients reported being bothered by the diagnosis of seborrheic keratoses, even when told it's not cancerous, and indicated an interest in its treatment. Lack of insurance coverage for the treatment of non-symptomatic seborrheic keratoses may be the primary reason clinicians do not consider seborrheic keratoses therapeutically important, as clinicians often find the discussion of "self payment" with their patients to be awkward. Furthermore, patients may not understand the implications that "lack of medical necessity" may have on their treatment options. The author describes a clinical approach that may better serve patients and clinicians through the compartmentalization of asymptomatic seborrheic keratoses treatment as a cosmetic procedure within the clinical practice model.

  6. [Cutaneous myiasis due to Cochliomyia hominivorax associated with seborrheic dermatitis].

    PubMed

    Calderón H, Perla; Rojas E, Camilo; Apt B, Werner; Castillo O, Douglas

    2017-02-01

    Myiasis is an infestation of tissues and organs of humans and animals by Diptera larvae (flies, horseflies, mosquitoes). They are located at different body sites, and classified clinically as cutaneous, visceral and cavitary. We report a 26-year-old woman with a history of seborrheic dermatitis and recent trip to Brazil. She presented with a seven days history of suppurating wounds in the parieto-occipital area of the scalp. At physical examination we found three ulcers of approximately 1.5 cm each, with multiple mobile larvae inside. The obtained larvae were analyzed, identifying Cochliomyia hominivorax larvae at L2 and L3 stages. The patient was managed successfully with oral antimicrobials and local cleansing. The screwworm Cochliomyia hominivorax in our country is rare. Known risk factors are wounds, poor personal hygiene, extreme ages, psychiatric disorders, presence of specific dermatosis such as psoriasis and seborrheic dermatitis, among others.

  7. Considerations for Use of Fluorouracil Cream 0.5% for the Treatment of Actinic Keratosis in Elderly Patients

    PubMed Central

    2008-01-01

    Actinic keratosis (AK), the initial lesion in a disease continuum that may progress to squamous cell carcinoma, often begins with ultraviolet B light-induced photo damage and increases in prevalence with age. Topical 5-fluorouracil (5-FU) for the treatment of widespread multiple AK lesions has cure rates of more than 90 percent. The associated skin irritation, however, may lead patients to prematurely discontinue treatment. To improve treatment efficacy and tolerability, 5-FU cream 0.5%, a novel Microsponge®-based formulation, was developed. In the elderly population, 5-FU cream 0.5% may be preferable because of its convenient (once daily) administration and its lower potential for irritation and systemic absorption, which may impact adherence to therapy and, thus, possibly increase cure rates. PMID:21103319

  8. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies.

    PubMed

    Dessinioti, Clio; Katsambas, Andreas

    2013-01-01

    Seborrheic dermatitis (SD) is a common skin condition seen frequently in clinical practice. The use of varying terms such as sebopsoriasis, seborrheic dermatitis, seborrheic eczema, dandruff, and pityriasis capitis reflects the complex nature of this condition. Despite its frequency, much controversy remains regarding the pathogenesis of SD. This controversy extends to its classification in the spectrum of cutaneous diseases, having being classified as a form of dermatitis, a fungal disease, or an inflammatory disease, closely related with psoriasis. Some have postulated that SD is caused by Malassezia yeasts, based on the observation of their presence in affected skin and the therapeutic response to antifungal agents. Others have proposed that Malassezia is incidental to a primary inflammatory dermatosis that resulted in increased cell turnover, scaling, and inflammation in the epidermis, similar to psoriasis. The presence of host susceptibility factors, permitting the transition of M furfur to its pathogenic form, may be associated with immune response and inflammation. Metabolites produced by Malassezia species, including oleic acid, malssezin, and indole-3-carbaldehyde, have been implicated. SD also has been traditionally considered to be a form of dermatitis based on the presence of Malassezia in healthy skin, the absence the pathogenic mycelial form of Malassezia yeasts in SD, and its chronic course. As a result, proposed treatments vary, ranging from topical corticosteroids to topical antifungals and antimicrobial peptides.

  9. Bran: may irritate irritable bowel.

    PubMed

    Lewis, M J; Whorwell, P J

    1998-05-01

    The irritable gut is known to be hypersensitive, and it is reasonable to suspect that patients with the disorder might be hyperreactive to agents that stimulate or irritate it. This appears to be a possible explanation for the adverse effects of bran on hospital patients with this disorder, but we do not yet know how this product affects community IBS sufferers. We cannot ignore the fact that fiber and bran have major beneficial effects in other areas, not least in the reduction of colonic carcinoma. In conclusion, it is probably best to recommend that patients with IBS be left to judge for themselves whether bran helps or exacerbates their symptoms, but there is enough evidence to suggest that the current dogma of routinely treating all IBS sufferers with bran should be challenged. Proprietary sources of fiber, such as ispaghula, may be more appropriate for those IBS subjects (for example, constipated) for whom fiber supplementation is believed justified.

  10. 21 CFR 358.710 - Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., seborrheic dermatitis, or psoriasis. 358.710 Section 358.710 Food and Drugs FOOD AND DRUG ADMINISTRATION... Psoriasis § 358.710 Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis. The... psoriasis. (1) Coal tar, 0.5 to 5 percent. When a coal tar solution, derivative, or fraction is used as...

  11. 21 CFR 358.710 - Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., seborrheic dermatitis, or psoriasis. 358.710 Section 358.710 Food and Drugs FOOD AND DRUG ADMINISTRATION... Psoriasis § 358.710 Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis. The... psoriasis. (1) Coal tar, 0.5 to 5 percent. When a coal tar solution, derivative, or fraction is used as...

  12. 21 CFR 358.710 - Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., seborrheic dermatitis, or psoriasis. 358.710 Section 358.710 Food and Drugs FOOD AND DRUG ADMINISTRATION... Psoriasis § 358.710 Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis. The... psoriasis. (1) Coal tar, 0.5 to 5 percent. When a coal tar solution, derivative, or fraction is used as...

  13. 21 CFR 358.710 - Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., seborrheic dermatitis, or psoriasis. 358.710 Section 358.710 Food and Drugs FOOD AND DRUG ADMINISTRATION... Psoriasis § 358.710 Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis. The... psoriasis. (1) Coal tar, 0.5 to 5 percent. When a coal tar solution, derivative, or fraction is used as...

  14. 21 CFR 358.710 - Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., seborrheic dermatitis, or psoriasis. 358.710 Section 358.710 Food and Drugs FOOD AND DRUG ADMINISTRATION... Psoriasis § 358.710 Active ingredients for the control of dandruff, seborrheic dermatitis, or psoriasis. The... psoriasis. (1) Coal tar, 0.5 to 5 percent. When a coal tar solution, derivative, or fraction is used as...

  15. Histopathological Differential Diagnosis of Psoriasis and Seborrheic Dermatitis of the Scalp

    PubMed Central

    Park, Ji-Hye; Park, Young Joon; Kim, Sue Kyoung; Kwon, Ji Eun; Kang, Hee Young; Lee, Eun-So; Choi, Jee Ho

    2016-01-01

    Background The differential diagnosis of psoriasis and seborrheic dermatitis can be difficult when both conditions are localized to the scalp without the involvement of other skin sites. Objective We aimed to evaluate the histopathological differences between psoriasis and seborrheic dermatitis on the scalp and identify favorable criteria for their differential diagnosis. Methods We evaluated 15 cases of psoriasis and 20 cases of seborrheic dermatitis of the scalp that had been clinicopathologically diagnosed. Skin biopsy sections stained with H&E were examined. Additional immunohistochemistry was performed, including Ki-67, keratin 10, caspase-5, and GLUT-1. Results On histopathological examination, mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, and clubbed and evenly elongated rete ridges were significantly more frequently observed in psoriasis. Follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis were significantly more common in seborrheic dermatitis. Moreover, significantly higher mitotic figures were observed in psoriatic lesions than in seborrheic dermatitis. Immunohistochemistry did not show any difference between psoriasis and seborrheic dermatitis. Conclusion Histopathological features favoring psoriasis include mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, clubbed and evenly elongated rete ridges, and increased mitotic figures (≥6/high-powered field). Features indicating seborrheic dermatitis are follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis. Immunohistochemistry was not helpful in differentiating psoriasis from seborrheic dermatitis. PMID:27489423

  16. Keratosis follicularis spinulosa decalvans associated with acne keloidalis nuchae and tufted hair folliculitis.

    PubMed

    Janjua, Shahbaz A; Iftikhar, Nadia; Pastar, Zrinjka; Hosler, Gregory A

    2008-01-01

    Keratosis follicularis spinulosa decalvans is a rare, X-linked disorder characterized by scarring alopecia of the scalp and eyebrows in the setting of widespread keratosis pilaris. Less frequent associations are ocular abnormalities and palmoplantar keratoderma. Acne keloidalis nuchae has previously been described in one patient with keratosis follicularis spinulosa decalvans. We report another case of keratosis follicularis spinulosa decalvans with acne keloidalis nuchae and tufted hair folliculitis, thus further establishing this association.

  17. ALLERGIC IRRITABILITY

    PubMed Central

    Lewis, Paul A.; Loomis, Dorothy

    1928-01-01

    The allergic irritability of closely inbred guinea pigs as represented by their capacity to produce hemolytic antibodies for beef and sheep corpuscles, and agglutinins for Bacillus typhosus and Bacillus abortus (Bang) differs by families and therefore is at least partly dependent on inherited characteristics. These differences show an imperfect but suggestive correlation with the differences in resistance of the same families to inoculation tuberculosis as previously determined by Wright and Lewis. The differences in antibody production also show an imperfect correlation with the differences in response in the anaphylactic reaction complex as previously determined by Lewis and Loomis. These studies suggest very strongly that the allergic irritability is one of the several inheritable characters which form a partial basis for the natural resistance to tuberculosis. The antibody-producing capacity is only satisfactorily defined when minimal or moderate amounts of antigen are used and this in single treatments. The irregularities in experimental result when repeated treatments or very large single treatments are used suggest that antibody production in the second or "acquired capacity" phase may rest on a somewhat different fundamental basis than the latent or potential natural capacity. There is some very slight evidence that production in the second phase may also be influenced by inherited qualities. PMID:19869422

  18. Keratosis Pilaris Revisited: Is It More Than Just a Follicular Keratosis?

    PubMed Central

    Thomas, Mary; Khopkar, Uday Sharadchandra

    2012-01-01

    Background: Keratosis pilaris (KP) is characterized by keratinous plugs in the follicular orifices and varying degrees of perifollicular erythema. The most accepted theory of its pathogenesis proposes defective keratinization of the follicular epithelium resulting in a keratotic infundibular plug. We decided to test this hypothesis by doing dermoscopy of patients diagnosed clinically as keratosis pilaris. Materials and Methods: Patients with a clinical diagnosis of KP seen between September 2011 and December 2011 were included in the study. A clinical history was obtained and examination and dermoscopic evaluation were performed on the lesions of KP. Results: The age of the patients ranged from 6-38 years. Sixteen patients had history of atopy. Nine had concomitant ichthyosis vulgaris. All the 25 patients were found to have coiled hair shafts within the affected follicular infundibula. The hair shafts were extracted with the help of a sterile needle and were found to retain their coiled nature. Perifollicular erythema was seen in 11 patients; perifollicular scaling in 9. Conclusion: Based on our observations and previously documented histological data of KP, we infer that KP may not be a disorder of keratinization, but caused by the circular hair shaft which ruptures the follicular epithelium leading to inflammation and abnormal follicular keratinization. PMID:23766609

  19. Keratosis follicularis spinulosa decalvans and acne keloidalis nuchae.

    PubMed

    Goh, Michelle S Y; Magee, Jill; Chong, Alvin H

    2005-11-01

    A 27-year-old man presented with a 10-year history of scarring alopecia on the vertex of the scalp associated with follicular crusting and pustule formation, and a papular eruption on the posterior neck. Additionally, there was keratosis pilaris on the cheeks, eyebrows and thighs. Histology from the vertex showed scarring with a mixed perifollicular inflammatory infiltrate and foci of acute suppurative folliculitis. With clinical correlation, the diagnosis of keratosis follicularis spinulosa decalvans and concurrent acne keloidalis nuchae was made. The association of keratosis follicularis spinulosa decalvans with acne keloidalis nuchae has not previously been described. The patient responded to treatment with oral isotretinoin 20 mg (0.25 mg/kg) daily for 12 months.

  20. [Keratosis follicularis spinulosa decalvans (Siemens' syndrome) associated with other abnormalities].

    PubMed

    Domenech, P; Ferrando, J; Corretger, M; Torras, H; Valls, X; González, A

    1985-01-01

    Keratosis follicularis spinulosa decalvans (ichthyosis follicularis or Siemens's syndrome) is considered a general form of keratosis pilaris decalvans. Localized types are keratosis pilaris atrophicans and atrophoderma vermicularis. A case of this unusual process is presented. Clinical, histological and scanning electron microscopic studies of the hair were performed. Clinically, a generalized hypotrichosis with hyperkeratotic follicular plugs is observed; especially in the scalp and the eyebrows. Other interesting clinical findings were cutis hyperelastica, gingival hypertrophy, mongoloid palpebral fissures, big pinnae and clinodactyly of the 5th finger. From the histological point of view we observed follicular plugging, dystrophic pilosebaceous follicles, absence of sebaceous glands, perifollicular fibrosis and minimal lymphomonocytic infiltrate. Scanning electronmicroscopy shows a brittle hair with cuticular abnormalities. Siemens's syndrome can be considered a specific pilosebaceous dysplasia because the absence or hypoplasia of sebaceous glands; which produces follicular hyperkeratosis and pilar atrophy with perifollicular fibrosis and alopecia.

  1. Seborrheic dermatitis due to Malassezia species in Ahvaz, Iran

    PubMed Central

    Zarei-Mahmoudabadi, Ali; Zarrin, Majid; Mehdinezhad, Forough

    2013-01-01

    Background and Objective Seborrheic dermatitis (SD) is a frequent disorder of the skin that is distinguished by the development of erythematous patches and yellow-gray scales. It is a multifactor disease that requires predisposing factors for its progress. Presence of these factors leads to reproduction of opportunistic yeast Malassezia spp. The aim of the present study was to isolate and identify distribution of Malassezia species on the scalp of SD patients in Ahvaz using modified Dixons agar. Materials and Methods A total of 110 patients diagnosed with SD were sampled. The sampling was carried out by brushing the hair and collecting the dandruff in paper pockets. For identification of Malassezia species, the scalp scales were cultured in Dixons agar. A combination of different characteristics including yeast cell morphology, ability to grow on Sabouraud dextrose agar, catalase test and ability to utilize individual Tweens (20, 40, 60 & 80) were used for identification of species. Results Twenty-seven of 110 (24.5%) SD patients had positive cultures for Malassezia species of which 17 (63%) were male and 10 (37%) were female. The most commonly identified Malassezia species was M. globosa (40.7%) followed by M. pachydermatis (22.2%), M. furfur (11.1%) and M. restricta(7.4%) and Malassezia species (18.5%). Conclusion Malassezia globosa was considered to be the most important orgaism involved in cases with Seborrheic dermatitisin this study. PMID:24475335

  2. A kindred with alopecia, keratosis, pilaris, cataracts, and psoriasis.

    PubMed

    Appell, M L; Sherertz, E F

    1987-01-01

    Three members of a family with numerous ectodermal abnormalities are described. These anomalies primarily include patchy alopecia beginning in childhood, premature cataracts, widespread keratosis pilaris, and psoriasis. The alopecia and premature cataracts appear to follow an autosomal dominant inheritance pattern with incomplete penetrance and appear to be linked. Psoriasis also occurs in several members of this family and probably represents a separate but possibly related genodermatosis. This kindred has features of both keratosis follicularis spinulosa decalvans and ichthyosis follicularis, and the disorder seems to fit into the group of follicular hyperkeratosis disorders.

  3. Apoptosis in seborrheic keratoses: an open door to a new dermoscopic score.

    PubMed

    Simionescu, Olga; Popescu, Bogdan Ovidiu; Costache, Mariana; Manole, Emilia; Spulber, Stefan; Gherghiceanu, Mihaela; Blum, Andreas

    2012-06-01

    The aetiology of seborrheic keratoses (SK), the most common benign epithelial tumours, and any relationship with malignancy are not yet known. As a protective anti-cancer mechanism, apoptosis reflects cellular loss as a reaction to proliferative activity. The objective of this study was to quantify apoptosis in different SK types (acanthotic, hyperkeratotic, reticulated, irritated and clonal) and correlate the dermoscopic picture with apoptosis rate. After a qualitative and quantitative analysis of dermoscopic images, we defined a new quantitative dermoscopic score (C3V2F, crypts, millia cysts, colours, hairpin vessels, irregular vessels, fissures) from 0 to 22, which enabled us to establish cut-offs correlating with apoptosis rates. All five SK forms were associated with lower apoptosis rates compared with normal skin. A C3V2F score >10 and greater number of crypts and colours reflected a higher apoptosis rate, which implies a benign character of evolution. In contrast, the presence of irregular vessels on more than 50% of the lesion surface implied a lower rate of apoptosis and probably associated with a risk of malignant transformation. On the basis of dermoscopic information, we used multiple regression to establish a model for estimating the rate of apoptosis with a 0.7 prediction interval (approximately 1S.D.). The new C3V2F score could be valuable for the clinical evaluation of possible SK prognosis and decisions regarding excision. © 2012 The Authors Journal of Cellular and Molecular Medicine © 2012 Foundation for Cellular and Molecular Medicine/Blackwell Publishing Ltd.

  4. Keratosis Follicularis Spinulosa Decalvans: A Report of Three Cases.

    PubMed

    Malvankar, Dipali D; Sacchidanand, S

    2015-01-01

    Keratosis follicularis spinulosa decalvans is a disorder affecting the hair follicles characterized by scarring alopecia of the scalp, eyebrows, and axillae, sometimes associated with photophobia and keratoderma. Being X-linked, it is more commonly seen in males but can be rarely seen in females also. We report three cases of this rare disorder including one in a female.

  5. Keratosis Follicularis Spinulosa Decalvans: A Report of Three Cases

    PubMed Central

    Malvankar, Dipali D; Sacchidanand, S

    2015-01-01

    Keratosis follicularis spinulosa decalvans is a disorder affecting the hair follicles characterized by scarring alopecia of the scalp, eyebrows, and axillae, sometimes associated with photophobia and keratoderma. Being X-linked, it is more commonly seen in males but can be rarely seen in females also. We report three cases of this rare disorder including one in a female. PMID:26622157

  6. Topical nicotinamide for seborrheic dermatitis: an open randomized study.

    PubMed

    Fabbrocini, Gabriella; Cantelli, Mariateresa; Monfrecola, Giuseppe

    2014-06-01

    Treatment of seborrheic dermatitis (SD) includes various options with different success and safety limitations. To evaluate the efficacy of topical nicotinamide (NCT) in the treatment of SD. A total of 48 patients with mild to moderate SD of the face were enrolled in the study (36 males and 12 females; age 20-50 years). Patients were randomized into two groups A and B, who were treated once a day with topical administration of NCT 4% cream and with the vehicle without NCT (placebo), respectively. Clinical measures were assessed by erythema, scaling, and infiltration, which were evaluated using a four-point scale 0-3 before starting treatment and after 2, 6, and 12 weeks' therapy. In comparison with baseline, a reduction of 75% of the total score was observed in patients treated with NCT, whereas for placebo-treated patients the reduction was of 35% (p < 0.05). Topical NCT 4% can have a potential for the treatment of SD.

  7. A Closer Look at Seborrheic Keratoses: Patient Perspectives, Clinical Relevance, Medical Necessity, and Implications for Management

    PubMed Central

    2017-01-01

    The author sought to discover why seborrheic keratoses that are not symptomatic or clinically suspicious are not considered therapeutically important to most clinicians. The author conducted an office-based, observational study examining how the diagnosis of asymptomatic seborrheic keratoses personally affects patients and what these patients think concerning treatment. Many patients reported being bothered by the diagnosis of seborrheic keratoses, even when told it’s not cancerous, and indicated an interest in its treatment. Lack of insurance coverage for the treatment of non-symptomatic seborrheic keratoses may be the primary reason clinicians do not consider seborrheic keratoses therapeutically important, as clinicians often find the discussion of “self payment” with their patients to be awkward. Furthermore, patients may not understand the implications that “lack of medical necessity” may have on their treatment options. The author describes a clinical approach that may better serve patients and clinicians through the compartmentalization of asymptomatic seborrheic keratoses treatment as a cosmetic procedure within the clinical practice model. PMID:28360965

  8. Atrophoderma vermiculatum: a case report and review of the literature on keratosis pilaris atrophicans.

    PubMed

    Luria, Rebecca B; Conologue, Theresa

    2009-02-01

    Atrophoderma vermiculatum (AV) is a rare follicular disorder primarily affecting children with reticular or honeycomb atrophy of the cheeks and forehead. Along with keratosis pilaris atrophicans faciei (KPAF) and keratosis follicularis spinulosa decalvans (KFSD), AV falls within the broader spectrum of keratosis pilaris atrophicans (KPA). Although these 3 variants of KPA have unique presentations and associations, they can all be frustratingly difficult to treat. We describe a sporadic case of AV that presented in late adolescence, a relatively late age of onset.

  9. Nagashima-type palmoplantar keratosis: a common Asian type caused by SERPINB7 protease inhibitor deficiency.

    PubMed

    Kubo, Akiharu

    2014-08-01

    Nagashima-type palmoplantar keratosis (NPPK) is an autosomal recessive diffuse non-epidermolytic palmoplantar keratosis caused by mutations in SERPINB7, a member of the serine protease inhibitor superfamily. Genetic studies suggest that NPPK is the most common palmoplantar keratosis in Japan, and probably Asia, but one that is extremely rare in Western countries. In this issue, Yin et al. report a founder effect of a SERPINB7 mutation in Chinese populations.

  10. Therapeutic efficacy of long-pulsed 755-nm alexandrite laser for seborrheic keratoses.

    PubMed

    Kim, Y K; Kim, D-Y; Lee, S J; Chung, W S; Cho, S B

    2014-08-01

    Both ablative and non-ablative laser devices have been used for the cosmetic treatment of seborrheic keratoses. We analysed treatment outcomes and adverse events in the treatment of seborrheic keratoses using a long-pulsed 755-nm alexandrite laser without colour enhancement. A total of 216 seborrheic keratoses in 13 patients were treated with one or three sessions of long-pulsed 755-nm alexandrite laser at 1-month intervals. The lesions were treated with settings of 35 J/cm(2) using a 6-mm spot size, a 3-ms pulse width, and 1-2 passes or until the appearance of fine bubbles on the irradiated lesions. A total of 216 seborrheic keratoses were treated with a mean 1.1 ± 0.4 sessions of long-pulsed 755-nm alexandrite laser and achieved a mean objective improvement score of 3.4 ± 0.7. Morphologic factors significantly impacted the number of treatment sessions required; in particular, papular lesions seemed to require more repetitive long-pulsed 755-nm alexandrite laser treatments than macular lesions. However, objective improvement score was not affected by the type of the seborrheic keratoses. The colour of seborrheic keratoses did not significantly affect the objective improvement score or required treatment sessions. Most of the lesions became crusted within a few days after the laser treatment and spontaneously peeled off within 7 days. The delivery of long-pulsed, high fluence laser energy to seborrheic keratoses with protection of the epidermis by an integrated dynamic cooling device is an effective treatment with low risk of side-effects, even in light-coloured lesions with few target pigments. © 2013 European Academy of Dermatology and Venereology.

  11. [Keratosis follicularis spinulosa decalvans and amino-aciduria (author's transl)].

    PubMed

    Grosshans, E; Heid, E; Stoll, C

    1978-04-01

    A new case of keratosis follicularis spinulosa decalvans (Siemens, 1925) in a 12 1/2 year old boy is related. This X-dominant inherited disturbance of follicular keratinization is associated with an amino-aciduria in the propositus and his mother, especially an increase of aspartic acid in urin and blood. The scarring infundibular plugs are constituted by nucleated keratin, which brightened up in polarized light and seems to be of internal trichilemmal origin.

  12. Arsenic-related Bowen's disease, palmar keratosis, and skin cancer.

    PubMed Central

    Cöl, M; Cöl, C; Soran, A; Sayli, B S; Oztürk, S

    1999-01-01

    Chronic arsenical intoxication can still be found in environmental and industrial settings. Symptoms of chronic arsenic intoxication include general pigmentation or focal "raindrop" pigmentation of the skin and the appearance of hyperkeratosis of the palms of the hands and soles of the feet. In addition to arsenic-related skin diseases including keratosis, Bowen's disease, basal-cell-carcinoma, and squamous-cell carcinoma, there is also an increased risk of some internal malignancies. Arsenic-related diseases are common in areas of the world where the drinking water has a high arsenic content. In this paper, we describe a 35-year-old male patient who had arsenic-related keratosis, squamous-cell carcinoma in the palmar area of his left hand, and Bowen's disease on his left thigh. The patient worked in a borax mine for 15 years, so he was exposed to arsenic in drinking water, airborne arsenic in his workplace, and had direct contact. The patient was treated for 11 months for arsenic-related keratosis until an axillary lymph node metastasis occurred; the lesion was excised and diagnosed to be malignant. Bowen's disease was detected when the patient was being treated for cancer. No other malignancy was found. The patient is still receiving regular follow-up care. Images Figure 1 Figure 2 PMID:10417369

  13. Comparison the efficacy of fluconazole and terbinafine in patients with moderate to severe seborrheic dermatitis.

    PubMed

    Alizadeh, Narges; Monadi Nori, Hamed; Golchi, Javad; Eshkevari, Shahriar S; Kazemnejad, Ehsan; Darjani, Abbas

    2014-01-01

    Background. Topical agents can be unpleasant due to long-term therapies in patients with moderate to severe seborrheic dermatitis. Systemic antifungal therapy is another alternative in treatment. Aim. This study was conducted to compare the efficacy of oral fluconazole and terbinafine in the treatment of moderate to severe seborrheic dermatitis. Methods. 64 patients with moderate to severe seborrheic dermatitis (SD) were enrolled in a randomized, parallel-group study. One study group took terbinafine 250 mg daily (n = 32) and the other one fluconazole 300 mg (n = 32) weekly for four weeks. Seborrheic dermatitis area severity index (SDASI) and the intensity of itching were calculated before, at the end of treatment, and two weeks after treatment. Results. Both drugs significantly reduced the severity of seborrheic dermatitis (P < 0.001). Multivariate linear regression revealed that efficacy of terbinafine is more than fluconazole (P < 0.01, 95% CI (0.63-4.7)). Moreover, each index of SD severity reduced 0.9 times after treatment. (P < 0.002, 95% CI (0.8-1.02)). The itching rate significantly diminished (P < 0.001); however, there was no difference between these two drugs statistically. Conclusions. Both systemic antifungal therapies may reduce the severity index of SD. However, terbinafine showed more reduction in the intensity of the disease. In other words, the more the primary intensity of the disease is, the more its reduction will be. This trial is resgistered with 201102205871N1.

  14. Topical pimecrolimus 1% cream for resistant seborrheic dermatitis of the face: an open-label study.

    PubMed

    Ozden, Muge Guler; Tekin, Nilgun Solak; Ilter, Nilsel; Ankarali, Handan

    2010-01-01

    Treatment options for seborrheic dermatitis are numerous, including both topical and systemic agents (e.g. topical corticosteroids, oral antifungals, and psoralen plus UVA). However, long-term use of topical corticosteroids may lead to adverse effects. Pimecrolimus 1% cream is an effective and well tolerated treatment for seborrheic dermatitis. To explore the efficacy of pimecrolimus 1% cream for the treatment of seborrheic dermatitis lesions resistant to conventional treatments. Sixteen patients with resistant seborrheic dermatitis of the face applied pimecrolimus 1% cream twice daily for 2 weeks. The lesions were assessed clinically and the severity of the signs were assessed using a 4-point score. Additionally, the scores of all affected regions (paranasal, forehead, and eyebrows) were evaluated separately to assess whether different results would be obtained in different regions of the face. Also, patients completed self-assessments on a 100 mm Visual Analogue Scale (VAS) at each visit. Statistically significant reductions in the scores of all parameters were observed at day 7 and day 14 of the study. There were no significant differences between the responses on the three regions of the face. No adverse effects were reported except for temporary pruritus immediately after the application of pimecrolimus 1% cream in one patient. Although the interpretation of efficacy was limited by the open-label, non-controlled study design and the small number of patients, this trial suggests that pimecrolimus 1% cream may be a successful treatment choice for patients with resistant seborrheic dermatitis of the face.

  15. Infantile seborrheic dermatitis: a pediatric Siddha medicine treatise.

    PubMed

    Thambyayah, Malinee; Amuthan, Arul

    2015-01-01

    Siddha medicine is one of the oldest (5000 years old) well-documented Indian traditional medicines, compared with Ayurveda, Unani, and traditional Chinese medicine, by way of keen observation and experimentation. It mentions 108 diseases that occur in childhood, which are further classified and described into various subtypes based on the clinical features and different stages of a particular disease. The authors translate the elegant and detailed description of one neonatal disorder, infantile seborrheic dermatitis (cradle cap), called kabaala kuttam (KK), described in 17 stanzas of four lines for each stanza from Tamil language script into English. There are five different types of cradle cap, including white type, dark black type, red type, weeping type, and toxic type. Four polyherbal formulations are described for external and oral administration, in which there is mention of 39 herbals and pure sulfur as ingredients. The safety and efficacy of these herbal products varies and has not been fully explored in infants, but may represent options for clinical development.

  16. 21 CFR 358.750 - Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... dandruff, seborrheic dermatitis, or psoriasis. 358.750 Section 358.750 Food and Drugs FOOD AND DRUG... Dermatitis, and Psoriasis § 358.750 Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis. (a) Statement of identity. The labeling of the product contains the...

  17. 21 CFR 358.750 - Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... dandruff, seborrheic dermatitis, or psoriasis. 358.750 Section 358.750 Food and Drugs FOOD AND DRUG... Dermatitis, and Psoriasis § 358.750 Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis. (a) Statement of identity. The labeling of the product contains the...

  18. 21 CFR 358.750 - Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... dandruff, seborrheic dermatitis, or psoriasis. 358.750 Section 358.750 Food and Drugs FOOD AND DRUG... Dermatitis, and Psoriasis § 358.750 Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis. (a) Statement of identity. The labeling of the product contains the...

  19. 21 CFR 358.750 - Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... dandruff, seborrheic dermatitis, or psoriasis. 358.750 Section 358.750 Food and Drugs FOOD AND DRUG... Dermatitis, and Psoriasis § 358.750 Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis. (a) Statement of identity. The labeling of the product contains the...

  20. 21 CFR 358.750 - Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... dandruff, seborrheic dermatitis, or psoriasis. 358.750 Section 358.750 Food and Drugs FOOD AND DRUG... Dermatitis, and Psoriasis § 358.750 Labeling of drug products for the control of dandruff, seborrheic dermatitis, or psoriasis. (a) Statement of identity. The labeling of the product contains the...

  1. [Clinical effectiveness and tolerance of climbazole containing dandruff shampoo in patients with seborrheic scalp eczema].

    PubMed

    Wigger-Alberti, W; Kluge, K; Elsner, P

    2001-08-16

    Pityrosporum ovale appears to play an important role in the pathogenesis of dandruff as a symptom of seborrheic dermatitis. Climbazole is an antimycotic agent with a high in vitro and in vivo efficacy against P. ovale. In the presented work we investigated the efficacy and safety of a climbazole 0.65% shampoo on seborrheic dermatitis of 30 volunteers. Subjects were diagnosed as having moderate to severe seborrheic dermatitis of the scalp. After a 1-week washout and a 4-week treatment the clinical evaluation showed a successful reduction of dandruff, skin redness and itching in 80% of the volunteers and a mild improvement in 20% of the volunteers. The cosmetic acceptability was very good by the majority. It is concluded that the formulation tested is effective in the treatment of moderate to severe dandruff.

  2. Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair.

    PubMed

    Kibar, Melike; Aktan, Şebnem; Bilgin, Muzaffer

    2015-01-01

    Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE). The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis. Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3(®)). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4). Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis. This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.

  3. Dermoscopic Findings in Scalp Psoriasis and Seborrheic Dermatitis; Two New Signs; Signet Ring Vessel and Hidden Hair

    PubMed Central

    Kibar, Melike; Aktan, Şebnem; Bilgin, Muzaffer

    2015-01-01

    Background: Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE). Objectives: The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis. Materials and Methods: Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3®). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4). Results: Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis. Conclusion: This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as

  4. Fussy or irritable child

    MedlinePlus

    ... Ask questions and take a history Examine your child Order lab tests, if needed Alternative Names Inconsolability; irritability Images Central nervous system and peripheral nervous system References ...

  5. Oral nicotinamide and actinic keratosis: a supplement success story.

    PubMed

    Kim, Burcu; Halliday, Gary M; Damian, Diona L

    2015-01-01

    Nicotinamide has shown potential as a safe and effective intervention for the prevention of malignant and premalignant skin lesions. Recent studies have shown that nicotinamide, in both oral and topical forms, is able to prevent ultraviolet-induced immunosuppression in humans [1,2,3] and mice [4,5]. Immunosuppression is a known factor for the progression of premalignant lesions, such as actinic keratosis [6]. Murine studies have shown that nicotinamide is also able to protect against photocarcinogenesis [4,5]. Preliminary human studies suggest that nicotinamide may help prevent skin cancers and enhance the regression of actinic keratoses.

  6. Is keratosis punctata of the palmar creases rare?

    PubMed

    Jaiswal, A K; Nidhi, H; Bhushan, B; Badrinath, S

    1996-01-01

    We determined the prevalence of keratosis punctata of the palmar creases (KPPC) in 5000 individuals. The group screened included patients, visitors and children. Fifteen (0.3%) cases were discovered to have characteristic KPPC lesions. The patients were mainly young with a male predominance (14M : 1F). The lesions in almost all cases were asymptomatic. No predisposing factors could be ascertained by history. Histopathologically, the lesions consisted of focal hyperkeratosis, and an epidermal depression corresponding to the pits. Special stains did not reveal any dermal components in the keratin masses. On comparing our findings with those reported earlier it appears that KPPC is not so rare as believed.

  7. Professors' Irritating Behavior Study

    ERIC Educational Resources Information Center

    Malikow, Max

    2007-01-01

    The purpose of this study was to quantify the irritating behaviors of professors as experienced and reported by 232 Le Moyne College students. In this study, "irritating behavior" was understood as "actions that vex, annoy, bother, pester, frustrate, or provoke anger." The survey used in this study was developed by Larry M. Ludewig, Ph.D.,…

  8. Irritable Bowel Syndrome

    MedlinePlus

    ... your belly area), constipation (when you can't poop), and diarrhea (when you poop too much). If you have irritable bowel syndrome, ... food particles are also known as stool, a bowel movement, or poop. Here's why an intestine gets "irritable." ...

  9. Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country.

    PubMed

    Araya, Manapajon; Kulthanan, Kanokvalai; Jiamton, Sukhum

    2015-01-01

    Seborrheic dermatitis is a common chronic inflammatory skin condition that can have a negative impact on a patient's quality of life. Few studies have been conducted to assess the clinical characteristics of the disease and quality of life of the patients, especially in tropical countries. The aim of this study was to demonstrate the clinical characteristics and quality of life of patients with seborrheic dermatitis in Thailand. A cross-sectional study was performed at a university-based hospital and tertiary referral center in Bangkok, Thailand. The validated Thai version of the dermatology life quality index (DLQI) was used to evaluate patients' quality of life. A total of 166 participants were included. One hundred and forty-seven patients (88.6%) experienced multiple episodes of the eruption. The mean of outbreaks was 7.8 times per years, ranging from once every 4 years to weekly eruption. The most common factor reported to aggravate seborrheic dermatitis was seasonality (34.9%), especially hot climate. The mean (SD) of the total DLQI score was 8.1 (6.0) with a range of 0 to 27. There was no statistically significant difference between the two DLQI categories regarding duration of disease, extent of involvement, symptoms or course of the disease. Although mild and asymptomatic, seborrheic dermatitis can have a great impact on the quality of life. Youth, female gender, and scalp lesions were significantly associated with higher DLQI scores.

  10. Clinical study of sertaconazole 2% cream vs. hydrocortisone 1% cream in the treatment of seborrheic dermatitis.

    PubMed

    Goldust, Mohamad; Rezaee, Elham; Masoudnia, Sima; Raghifar, Ramin

    2013-01-01

    Seborrheic dermatitis (SD) is an inflammatory skin disorder affecting the scalp, face, and trunk, however, there are controversies surrounding its treatment. The aim of the study is to compare the efficacy of sertaconazole 2% cream with hydrocortisone 1% cream in the treatment of seborrheic dermatitis. In total, 138 patients suffering from seborrheic dermatitis were studied. Sixty-nine patients received local sertoconazole 2% cream and they were recommended to use the cream twice a day and for 4 weeks. To create a control group, 69 patients received hydrocortisone 1% cream twice a day for four weeks. At the time of referral, and at 2 and 4 weeks after their first visit, the patients were examined by a dermatologist to check the improvement of clinical symptoms. The mean age of patients was 36.45 +/- 13.23. The highest level of satisfaction (85.1%) was observed 28 days after sertaconazole consumption: 76.9% was recorded for the hydrocortisone group. No relapse of the disease one month after stopping treatment was observed in either the sertaconazole 2% group or the hydrocortisone 1% group. Sertaconazole 2% cream may be an excellent alternative therapeutic modality for treating seborrheic dermatitis.

  11. Comparison of different regimens of pimecrolimus 1% cream in the treatment of facial seborrheic dermatitis.

    PubMed

    Zhao, Juemin; Sun, Wenjia; Zhang, Chengfeng; Wu, Jiaqiang; Le, Yan; Huang, Chunyun; Liu, Ye; Xiang, Leihong

    2017-06-07

    Pimecrolimus 1% cream has already been proved to be an effective and safe alternative to treat seborrheic dermatitis. However, the treatment periods were inconstant in previous studies. To evaluate the comparative efficacy of pimecrolimus 1% cream with different regimens for the treatment of facial seborrheic dermatitis. Thirty patients with facial seborrheic dermatitis were enrolled and randomly distributed to three groups. Patients of Group 1 were treated with topical pimecrolimus cream 1% twice daily for 2 weeks and then a moisturizer cream twice daily for 2 weeks. Patients of Group 2 were treated with pimecrolimus cream 1% twice daily for 2 weeks and then once daily for another 2 weeks. Patients of Group 3 had a consecutive course of pimecrolimus cream 1% twice daily for 4 weeks. Objective symptoms, subjective symptoms, and dermatology life quality index (DLQI) were measured at weeks 0, 2, 4, and 6. At week 4, the clinical severity scores of all three regimens significantly decreased (P<.01). The improvement of total severity score in Group 3 was more remarkable than groups 1 and 2 (both P<.05). This effect was maintained until the end of the study in Group 3. Life quality of all three groups was significantly improved at week 4 (P<.001), while there was no statistical difference on the improvement of life quality among three groups. We recommend pimecrolimus 1% cream could be applied twice a day for 4 weeks to treat seborrheic dermatitis. © 2017 Wiley Periodicals, Inc.

  12. Clinical and genetic heterogeneity in keratosis follicularis spinulosa decalvans.

    PubMed

    Castori, Marco; Covaciu, Claudia; Paradisi, Mauro; Zambruno, Giovanna

    2009-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is an uncommon genodermatosis mainly characterized by follicular hyperkeratosis, progressive cicatricial alopecia and photophobia. Although an excess of affected males and linkage studies strongly suggest an X-linked pattern of inheritance, an apparently rarer autosomal dominant form with prominent follicular inflammation has also been postulated. We report on a three-generation family with five affected individuals and male-to-male transmission. In addition to widespread keratosis pilaris, cicatricial alopecia and eye involvement, our patients show diffuse facial erythema, recurrent folliculitis, enamel hypoplasia, and thickened nails. A literature review of the last 50 years identified 43 additional KFSD cases. X-linked inheritance is demonstrated in two pedigrees by linkage studies and suspected in five. An autosomal dominant pattern is confirmed in three families, including ours, by male-to-male transmission and considered likely in four. Marked facial erythema, extensive folliculitis, onychodystrophy and multiple caries are frequently reported in the autosomal dominant variant, while palmo-plantar keratoderma and early onset seem more typical of the X-linked form. Moreover, three sporadic male patients showing additional multisystemic abnormalities might be explained by an X-linked contiguous-gene syndrome.

  13. 5-ALA induced fluorescent image analysis of actinic keratosis

    NASA Astrophysics Data System (ADS)

    Cho, Yong-Jin; Bae, Youngwoo; Choi, Eung-Ho; Jung, Byungjo

    2010-02-01

    In this study, we quantitatively analyzed 5-ALA induced fluorescent images of actinic keratosis using digital fluorescent color and hyperspectral imaging modalities. UV-A was utilized to induce fluorescent images and actinic keratosis (AK) lesions were demarcated from surrounding the normal region with different methods. Eight subjects with AK lesion were participated in this study. In the hyperspectral imaging modality, spectral analysis method was utilized for hyperspectral cube image and AK lesions were demarcated from the normal region. Before image acquisition, we designated biopsy position for histopathology of AK lesion and surrounding normal region. Erythema index (E.I.) values on both regions were calculated from the spectral cube data. Image analysis of subjects resulted in two different groups: the first group with the higher fluorescence signal and E.I. on AK lesion than the normal region; the second group with lower fluorescence signal and without big difference in E.I. between two regions. In fluorescent color image analysis of facial AK, E.I. images were calculated on both normal and AK lesions and compared with the results of hyperspectral imaging modality. The results might indicate that the different intensity of fluorescence and E.I. among the subjects with AK might be interpreted as different phases of morphological and metabolic changes of AK lesions.

  14. The development of actinic keratosis into invasive squamous cell carcinoma: evidence and evolving classification schemes.

    PubMed

    Anwar, Jamshaid; Wrone, David A; Kimyai-Asadi, Arash; Alam, Murad

    2004-01-01

    Actinic keratosis is an incipient form of cutaneous squamous cell carcinoma. Consequently, actinic keratoses must be treated expeditiously to forestall their downward growth. Several classification schemes have been proposed to better categorize actinic keratoses, and to guide their diagnosis and treatment. Among these approaches is the "keratinocyte intraepithelial neoplasia" (KIN) system developed by Cockerell; Goldberg's concept of the "proliferative actinic keratosis" (PAK), and Berhane's emphasis on the "inflamed actinic keratosis" (IAK). In the future, disparate classification schemes may be unified into a single pragmatic approach which accurately reflects the biological process whereby actinic keratoses devolve into invasive squamous cell carcinoma.

  15. Irritable Bowel Syndrome

    MedlinePlus

    Irritable bowel syndrome (IBS) is a problem that affects the large intestine. It can cause abdominal cramping, bloating, and a change in bowel ... go back and forth between the two. Although IBS can cause a great deal of discomfort, it ...

  16. Light emitting fabric for photodynamic treatment of actinic keratosis

    NASA Astrophysics Data System (ADS)

    Thecua, E.; Vicentini, C.; Vignion, A.-S.; Lecomte, F.; Deleporte, P.; Mortier, L.; Szeimies, R.-M.; Mordon, S.

    2017-02-01

    The integration of optical fibers into flexible textile structures, by using knitting or weaving processes can allow the development of flexible light sources. The paper aims to present a new technology: Light Emitting Fabrics (LEF), which can be used for example for PDT of Actinic Keratosis in Dermatology. The predetermined macro-bending of optical fibers, led to a homogeneous side emission of light over the entire surface of the fabric. Tests showed that additional curvatures when applying the LEF on non-planar surfaces had no impact on light delivery and proved that LEF can adapt to the human morphology. The ability of the LEF, coupled with a 635nm LASER source, to deliver a homogeneous light to lesions is currently assessed in a clinical trial for the treatment of AK of the scalp by PDT. The low irradiance and progressive activation of the photosensitizer ensure a pain reduction, compared to discomfort levels experienced by patients during a conventional PDT session.

  17. Possible nagashima-type palmoplantar keratosis in two siblings.

    PubMed

    Park, Kio; Kabashima, Kenji; Miyachi, Yoshiki

    2013-01-01

    Nagashima-type palmoplantar keratosis (PPK) is an autosomal recessive, transgressive and non-progressive form of PPK. It was once described as a mild form of mal de Meleda, but it is now proposed as a novel entity of PPK. Since its pathogenesis remains unclear, it is important to clarify the mode of inheritance. Here, we present a case of possible Nagashima-type PPK in 2 siblings. The siblings had non-affected parents, suggesting that the mode of inheritance was autosomal recessive. At present, reports on PPK in the English literature are limited, and thus the clinical features of Nagashima-type PPK may not be well appreciated in Western countries. More reports and concise clinical observations with genetic studies are required to establish this new entity of PPK.

  18. Cloudy and starry milia-like cysts: how well do they distinguish seborrheic keratoses from malignant melanomas?

    PubMed Central

    Stricklin, S.M.; Stoecker, W.V.; Oliviero, M.C.; Rabinovitz, H.S.; Mahajan, S.K.

    2011-01-01

    Background Seborrheic keratoses are the most common skin lesions known to contain small white or yellow structures called milia-like cysts (MLCs). Varied appearances can sometimes make it difficult to differentiate benign lesions from malignant lesions such as melanoma, the deadliest form of skin cancer found in humans. Objective The purpose of this study was to determine the statistical occurrence of MLCs in benign vs. malignant lesions. Methods A medical student with 10 months experience in examining approximately 1000 dermoscopy images and a dermoscopy-naïve observer analysed contact non-polarized dermoscopy images of 221 malignant melanomas and 175 seborrheic keratoses for presence of MLCs. Results The observers found two different types of MLCs present: large ones described as cloudy and smaller ones described as starry. Starry MLCs were found to be prevalent in both seborrheic keratoses and melanomas. Cloudy MLCs, however, were found to have 99.1% specificity for seborrheic keratoses among this group of seborrheic keratoses and melanomas. Conclusion Cloudy MLCs can be a useful tool for differentiating between seborrheic keratoses and melanomas. Received: 18 June 2010; Accepted: 27 October 2010 PMID:21923811

  19. Cloudy and starry milia-like cysts: how well do they distinguish seborrheic keratoses from malignant melanomas?

    PubMed

    Stricklin, S M; Stoecker, W V; Oliviero, M C; Rabinovitz, H S; Mahajan, S K

    2011-10-01

    Seborrheic keratoses are the most common skin lesions known to contain small white or yellow structures called milia-like cysts (MLCs). Varied appearances can sometimes make it difficult to differentiate benign lesions from malignant lesions such as melanoma, the deadliest form of skin cancer found in humans. The purpose of this study was to determine the statistical occurrence of MLCs in benign vs. malignant lesions. A medical student with 10 months experience in examining approximately 1000 dermoscopy images and a dermoscopy-naïve observer analysed contact non-polarized dermoscopy images of 221 malignant melanomas and 175 seborrheic keratoses for presence of MLCs. The observers found two different types of MLCs present: large ones described as cloudy and smaller ones described as starry. Starry MLCs were found to be prevalent in both seborrheic keratoses and melanomas. Cloudy MLCs, however, were found to have 99.1% specificity for seborrheic keratoses among this group of seborrheic keratoses and melanomas. Cloudy MLCs can be a useful tool for differentiating between seborrheic keratoses and melanomas. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

  20. New perspectives on dandruff and seborrheic dermatitis: lessons we learned from bacterial and fungal skin microbiota.

    PubMed

    Paulino, Luciana Campos

    2017-06-01

    The human body is inhabited by complex microbial communities, which positively impact different aspects of our health, and might also be related to the development of diseases. Progress in technologies, particularly sequencing methods and bioinformatics tools, has been crucial for the advances in this field. Microbial communities from skin can modulate immune response and protect the host against pathogens, and there are also data supporting their association with several skin conditions; including dandruff and seborrheic dermatitis. For decades, they have been thought to be related to Malassezia yeasts; however, the microbial role has not been elucidated, and their etiology remains poorly understood. This review discusses the recent findings in dandruff and seborrheic dermatitis and their relation to the skin microbiota. Data provided new perceptions to aid in the understanding of these skin disorders, broadening our view of their etiology and the possible roles of microbial communities in symptom development.

  1. Multispectral imaging based on a Smartphone with an external C-MOS camera for detection of seborrheic dermatitis on the scalp

    NASA Astrophysics Data System (ADS)

    Kim, Manjae; Kim, Sewoong; Hwang, Minjoo; Kim, Jihun; Je, Minkyu; Jang, Jae Eun; Lee, Dong Hun; Hwang, Jae Youn

    2017-02-01

    To date, the incident rates of various skin diseases have increased due to hereditary and environmental factors including stress, irregular diet, pollution, etc. Among these skin diseases, seborrheic dermatitis and psoriasis are a chronic/relapsing dermatitis involving infection and temporary alopecia. However, they typically exhibit similar symptoms, thus resulting in difficulty in discrimination between them. To prevent their associated complications and appropriate treatments for them, it is crucial to discriminate between seborrheic dermatitis and psoriasis with high specificity and sensitivity and further continuously/quantitatively to monitor the skin lesions during their treatment at other locations besides a hospital. Thus, we here demonstrate a mobile multispectral imaging system connected to a smartphone for selfdiagnosis of seborrheic dermatitis and further discrimination between seborrheic dermatitis and psoriasis on the scalp, which is the more challenging case. Using the system developed, multispectral imaging and analysis of seborrheic dermatitis and psoriasis on the scalp was carried out. It was here found that the spectral signatures of seborrheic dermatitis and psoriasis were discernable and thus seborrheic dermatitis on the scalp could be distinguished from psoriasis by using the system. In particular, the smartphone-based multispectral imaging and analysis moreover offered better discrimination between seborrheic dermatitis and psoriasis than the RGB imaging and analysis. These results suggested that the multispectral imaging system based on a smartphone has the potential for self-diagnosis of seborrheic dermatitis with high portability and specificity.

  2. Quantitative fluorescence in situ hybridization measurement of telomere length in skin with/without sun exposure or actinic keratosis.

    PubMed

    Ikeda, Hiroyuki; Aida, Junko; Hatamochi, Atsushi; Hamasaki, Yoichiro; Izumiyama-Shimomura, Naotaka; Nakamura, Ken-Ichi; Ishikawa, Naoshi; Poon, Steven S; Fujiwara, Mutsunori; Tomita, Ken-Ichiro; Hiraishi, Naoki; Kuroiwa, Mie; Matsuura, Masaaki; Sanada, Yukihiro; Kawano, Youichi; Arai, Tomio; Takubo, Kaiyo

    2014-03-01

    Chromosomal and genomic instability due to telomere dysfunction is known to play an important role in carcinogenesis. To study telomere shortening in the epidermis surrounding actinic keratosis, we measured telomere lengths of basal, parabasal, and suprabasal cells in epidermis with actinic keratosis (actinic keratosis group, n = 18) and without actinic keratosis (sun-protected, n = 15, and sun-exposed, n = 13 groups) and in actinic keratosis itself as well as in dermal fibroblasts in the 3 groups, using quantitative fluorescence in situ hybridization. Among the 3 cell types, telomeres of basal cells were not always the longest, suggesting that tissue stem cells are not necessarily located among basal cells. Telomeres of basal cells in the sun-exposed group were shorter than those in the sun-protected group. Telomeres in the background of actinic keratosis and in actinic keratosis itself and those of fibroblasts in actinic keratosis were significantly shorter than those in the controls. Our findings demonstrate that sun exposure induces telomere shortening and that actinic keratosis arises from epidermis with shorter telomeres despite the absence of any histologic atypia. © 2014.

  3. Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study.

    PubMed

    Schmitt, Juliano Vilaverde; Lima, Brunno Zeni de; Souza, Monique Carolina Meira do Rosário de; Miot, Hélio Amante

    2014-01-01

    Acne vulgaris has an important genetic predisposition, as well as keratosis pilaris. Clinical observations suggest that patients with keratosis pilaris have less frequent or less severe acne breakouts; however, we found no studies on this regard To determine if the presence of keratosis pilaris is associated with lower prevalence and severity of acne. A cross-sectional study was conducted with dermatology outpatients aged between 14 and 35 years. We evaluated history and clinical grade of acne, demographic variables, history of atopy, smoking, and use of hormonal contraceptives. Two groups were defined by the presence or absence of moderate to severe keratosis pilaris on the arms and were compared by bivariate analysis and by conditional multiple logistic regression. We included 158 patients (66% women), with a median age of 23 ± 11 years. Twenty-six percent of them had keratosis pilaris, which was associated with a history of atopy (odds ratio [OR]=2.80 [1.36 to 5.75]; p<0.01). Acne was present in 66% of subjects, and was related to family history of acne (OR=5.75 [2.47 to 13.37]; p<0.01). In bivariate and multivariate analysis, the group with keratosis pilaris had a less frequent history of acne (OR=0.32 [0.14 to 0.70]; p<0.01). The presence of moderate to severe keratosis pilaris on the arms was associated with lower prevalence of acne vulgaris and lower severity of facial lesions in adolescents and young adults.

  4. Irritants in cigarette smoke plumes

    SciTech Connect

    Ayer, H.E.; Yeager, D.W.

    1982-11-01

    Concentrations of the irritants formaldehyde and acrolein in side stream cigarette smoke plumes are up to three orders of magnitude above occupational limits, readily accounting for eye and nasal irritation. ''Low-tar'' cigarettes appear at least as irritating as other cigarettes. More than half the irritant is associated with the particulate phase of the smoke, permitting deposition throughout the entire respiratory tract and raising the issue of whether formaldehyde in smoke is associated with bronchial cancer.

  5. Clinical efficacies of topical agents for the treatment of seborrheic dermatitis of the scalp: a comparative study.

    PubMed

    Shin, Hyoseung; Kwon, Oh Sang; Won, Chong Hyun; Kim, Beom Joon; Lee, Yang Won; Choe, Yong Beom; Ahn, Kyu Joong; Eun, Hee Chul

    2009-03-01

    Previous studies have shown that topical steroid and shampoo containing zinc pyrithione provide clinical benefits for treatment of scalp seborrheic dermatitis. But the clinical efficacy of topical tacrolimus, a newly developed calcineurin inhibitor on seborrheic dermatitis, is not well investigated yet. We wanted to compare the clinical efficacy of topical tacrolimus with that of conventional treatment (zinc pyrithione shampoo and topical betamethasone) for treatment of seborrheic dermatitis of the scalp. Patients with seborrheic dermatitis of the scalp were randomly allocated to receive topical betamethasone, topical tacrolimus or zinc pyrithione shampoo. Some patients were instructed to continue the treatments for 8 weeks and the others to discontinue the treatments at week 4. We evaluated the efficacy using a clinical severity score, dandruff score and sebum secretion at baseline, week 4 and week 8. All treatment groups showed significant improvements in clinical assessment after 4 weeks. While the patients treated by zinc pyrithione improved continuously even after cessation of the treatment, the patients treated by betamethasone lotion or tacrolimus ointment were aggravated clinically. Topical tacrolimus was as effective as topical betamethasone, and showed more prolonged remission than topical betamethasone. To treat seborrheic dermatitis of the scalp, we think that the combination therapy of topical steroid or topical tacrolimus, and zinc pyrithione is recommended.

  6. A consensus approach to improving patient adherence and persistence with topical treatment for actinic keratosis

    PubMed Central

    Stockfleth, Eggert; Peris, Ketty; Guillen, Carlos; Cerio, Rino; Basset-Seguin, Nicole; Foley, Peter; Sanches, José; Culshaw, Alex; Erntoft, Sandra; Lebwohl, Mark

    2015-01-01

    Background Topical therapy is important in the treatment of actinic keratosis, but guidance for improving adherence/persistence during topical therapy is still lacking. Objectives To utilize expert consensus to generate a list of recommendations to improve real-world efficacy when prescribing topical therapy for actinic keratosis. Methods An expert panel of eight dermatologists was convened to generate recommendations based on facilitated discussion and consensus generation using a modified Delphi session. The recommendations were ratified with the expert panel. Results Facilitated discussion generated 31 issues within five themes, which were prioritized using expert voting. Consensus was achieved on the importance of short and simple treatment regimens for maximizing patient compliance, physician awareness of the progression of actinic keratosis to squamous cell carcinoma, provision of appropriate patient information, and the use of effective communication strategies to educate physicians about actinic keratosis. Based on these key findings, eight recommendations were generated. Conclusions The recommendations will assist physicians when prescribing topical actinic keratosis therapy. Further research should focus on the types of patient outcomes that are influenced by the characteristics of topical field therapy. PMID:25865875

  7. Familial keratosis follicularis spinulosa decalvans associated with woolly hair.

    PubMed

    Lacarrubba, Francesco; Dall'Oglio, Federica; Rossi, Alfredo; Schwartz, Robert A; Micali, Giuseppe

    2007-08-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare inherited disorder of keratinization clinically characterized by diffuse follicular hyperkeratosis, progressive scarring alopecia of scalp, eyebrows and eyelashes, corneal dystrophy and photophobia. Woolly hair is a hereditary condition, transmitted as an autosomal dominant or recessive trait, usually seen in Caucasians at birth or shortly after, in which there are curly, thick, often heavily pigmented hairs. We report two cases, a son and his mother, in whom KFSD occurred in association with woolly hair. In addition, various dental anomalies, including agenesis, inclusions and teeth malformations, were present in the child. Interestingly, both patients simultaneously developed an inflammatory tinea capitis caused by Microsporum canis. To our knowledge, the association of KFSD with woolly hair has not been described. The dental anomalies found in the child are intriguing, as they have never been reported previously in patients with KFSD. Finally, the concomitant onset of inflammatory tinea capitis in both patients may be explained by the enhanced susceptibility to fungal infection in keratinizing disorders.

  8. Regressing basal-cell carcinoma masquerading as benign lichenoid keratosis

    PubMed Central

    Kulberg, Aleksandra; Weyers, Wolfgang

    2016-01-01

    Background Benign lichenoid keratosis (BLK, LPLK) is often misdiagnosed clinically as superficial basal-cell carcinoma (BCC), especially when occurring on the trunk. However, BCCs undergoing regression may be associated with a lichenoid interface dermatitis that may be misinterpreted as BLK in histopathologic sections. Methods In order to assess the frequency of remnants of BCC in lesions interpreted as BLK, we performed step sections on 100 lesions from the trunk of male patients that had been diagnosed as BLK. Results Deeper sections revealed remnants of superficial BCC in five and remnants of a melanocytic nevus in two specimens. In the original sections of cases in which a BCC showed up, crusts tended to be more common, whereas vacuolar changes at the dermo-epidermal junction and melanophages in the papillary dermis tended to be less common and less pronounced. Conclusions Lesions from the trunk submitted as BCC and presenting histopathologically as a lichenoid interface dermatitis are not always BLKs. Although no confident recommendations can be given on the basis of this limited study, deeper sections may be warranted if lesions are crusted and/or associated with only minimal vacuolar changes at the dermo-epidermal junction and no or few melanophages in the papillary dermis. PMID:27867740

  9. Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality

    PubMed Central

    Kirby, Joslyn S.; Scharnitz, Thomas; Seiverling, Elizabeth V.; Ahrns, Hadjh; Ferguson, Sara

    2015-01-01

    Actinic keratosis (AK) is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II) was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document. PMID:26451140

  10. Topical photodynamic therapy of actinic keratosis in renal transplant recipients.

    PubMed

    Piaserico, S; Belloni Fortina, A; Rigotti, P; Rossi, B; Baldan, N; Alaibac, M; Marchini, F

    2007-01-01

    Organ transplant recipients (OTRs) show an increased risk of precancerous (mostly actinic keratosis [AK]) and cancerous (mostly squamous cell carcinomas [SCC] and basal cell carcinomas [BCC]) cutaneous lesions. Their frequency increases with time after transplantation. AKs seem to progress more often and faster to invasive SCC in OTRs compared with the general population. The steady increase of risk of cutaneous premalignancies and malignancies with time after transplantation is an alarming figure because the number of organ allograft recipients who live for many years after transplantion is rapidly growing. This points out the need to devote more resources to skin cancer prevention, detection, and management. Various therapies, including cryotherapy, topical 5-fluorouracil, imiquimod, topical diclofenac, curettage, electrosurgery, carbon dioxide laser, and surgical excision, are available for AKs. However, most of these are limited by frequent relapses and the presence of multiple lesions over a wide area. Topical photodynamic therapy (PDT) represents an innovative therapeutic approach for nonsurgical treatment of cutaneous precancerous lesions and skin cancers. In this study we confirmed the usefulness of PDT in the treatment of AKs in OTRs, even in lesions relapsing or unresponsive to conventional treatment. We showed a complete response rate of 71%, after 2 treatments sessions that were 2 weeks apart. The response rate of scalp/facial lesions (72%) was higher compared with acral lesions (40%). Topical PDT could represent a useful therapeutic alternative for AKs in OTRs because large lesions can be treated with excellent cosmetic outcome.

  11. Nagashima-type palmoplantar keratosis in a Chinese Han population

    PubMed Central

    Zhang, Jia; Zhang, Guolong; Ni, Cheng; Cheng, Ruhong; Liang, Jianying; Li, Ming; Yao, Zhirong

    2016-01-01

    Nagashima-type palmoplantar keratosis (NPPK) is an autosomal recessive form of palmoplantar keratoderma (PPK), which is caused by mutations in the SERPINB7 gene. NPPK has only been reported in Japanese and Chinese populations. The present study was conducted on 12 unrelated Chinese patients who were clinically predicted to suffer from NPPK. Mutation screening was performed by direct sequencing of the entire coding regions of SERPINB7, SLURP1, AQP5, CSTA, KRT1 and KRT9 genes. Direct sequencing of SERPINB7 revealed five homozygous founder mutations (c.796C>T) and four compound heterozygous mutations in nine patients, including one novel mutation (c.122_127delTGGTCC). Nine out of the 12 patients were diagnosed with NPPK due to SERPINB7 pathogenic mutations, and the results expanded the known mutation spectrum of NPPK. Taking the other seven reported Chinese patients, who had been definitively diagnosed with NPPK by genetic testing, into account, the present study further demonstrated that NPPK is a common entity in Mainland China, and c.796C>T is the most prevalent mutation and exerts a founder effect. Furthermore, the NPPK cases described in the current study presented a consistently mild phenotype, as compared with the degrees of phenotypic variability associated with other types of relatively severe PPK, including Mal de Meleda and Olmsted syndrome. PMID:27666198

  12. The developmental psychopathology of irritability

    PubMed Central

    LEIBENLUFT, ELLEN; STODDARD, JOEL

    2015-01-01

    Chronic, severe irritability is common in childhood and is very impairing. Furthermore, childhood irritability predicts suicidality, social impairment, and depressive and anxiety disorders in adulthood. Focusing on both normative and pathologic development, we review the construct of irritability from its origins in aggression and disruptive behavior research to its contemporary relevance for affective psychopathology. We then describe two broad neurocognitive systems that show promise in differentiating irritable from nonirritable youths: aberrant processing of emotional stimuli and impaired context-sensitive regulation. We suggest behavioral, neurocognitive, and physiologic measures that may aid in studying severe irritability and assessing its therapeutics. Finally, we argue for therapeutic trials targeting severe irritability that address emotional aspects of irritability in addition to the associated disruptive behavior. PMID:24342851

  13. The developmental psychopathology of irritability.

    PubMed

    Leibenluft, Ellen; Stoddard, Joel

    2013-11-01

    Chronic, severe irritability is common in childhood and is very impairing. Furthermore, childhood irritability predicts suicidality, social impairment, and depressive and anxiety disorders in adulthood. Focusing on both normative and pathologic development, we review the construct of irritability from its origins in aggression and disruptive behavior research to its contemporary relevance for affective psychopathology. We then describe two broad neurocognitive systems that show promise in differentiating irritable from nonirritable youths: aberrant processing of emotional stimuli and impaired context-sensitive regulation. We suggest behavioral, neurocognitive, and physiologic measures that may aid in studying severe irritability and assessing its therapeutics. Finally, we argue for therapeutic trials targeting severe irritability that address emotional aspects of irritability in addition to the associated disruptive behavior.

  14. Keratosis follicularis spinulosa decalvans. Report of two cases and literature review.

    PubMed

    Rand, R; Baden, H P

    1983-01-01

    We report herein two cases of keratosis follicularis spinulosa decalvans (KFSD) and review the literature on this condition. The entity is one of a group of related disorders that shows keratosis pilaris with inflammation followed by atrophy. The clinical features and course of KFSD are characteristic. During infancy, keratosis pilaris begins on the face and, by childhood, progresses to involve the trunk and extremities. Sometime during childhood or up to the early teenage years, a cicatricial alopecia of the scalp and eyebrows develops and is the hallmark of this disorder. Hyperkeratosis of the palms and soles is a frequently associated finding and is usually manifested during adolescence. Other features occurring with this syndrome include atopy, photophobia, and corneal abnormalities. Sex-linked inheritance has been proposed by several authors.

  15. Spanish adaptation of the European guidelines for the evaluation and treatment of actinic keratosis.

    PubMed

    Ferrándiz, C; Fonseca-Capdevila, E; García-Diez, A; Guillén-Barona, C; Belinchón-Romero, I; Redondo-Bellón, P; Moreno-Giménez, J C; Senán, R

    2014-05-01

    Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

  16. Ingenol Mebutate Topical Gel A Status Report On Clinical Use Beyond Actinic Keratosis

    PubMed Central

    Del Rosso, James Q.

    2016-01-01

    Ingenol mebutate is available as a topical gel formulation approved for the treatment of actinic keratosis. Two different concentrations are available for treatment of actinic keratoses at specific anatomic sites with the advantages of short durations of therapy and limited “down time” related to visible inflammation as compared to other topical agents. Due to the various modes of action of ingenol mebutate, it has also been used for treatment of disease states other than actinic keratosis. This manuscript discusses the suggested modes of action of ingenol mebutate and reviews publications on the use of ingenol mebutate gel for cutaneous disorders other than actinic keratosis, including squamous cell carcinoma in-situ, basal cell carcinoma, actinic cheilitis, anogenital warts, and others. Author commentaries are also included with the goal of providing relevant clinical insights. PMID:28224020

  17. [Irritable bowel syndrome].

    PubMed

    Kocián, J

    1994-04-01

    Irritable bowel is a functional gastrointestinal disorder with chronic or relapsing symptoms of abdominal pain and impaired frequency and consistency of the faeces caused by obscure structural or biochemical deviations. The frequency of the condition in civilized countries is estimated to amount to 15-20% of the population and it accounts for 25-50% of all patients in gastroenterological ambulatory departments. From the clinical aspect the type with dominant diarrhoea, typically in the morning and very compelling, and the type with pain and constipation are known but even combinations of the two types are encountered. A psychosomatic disorder of the motility of the large bowel and its tonus is involved associated with enhanced pain perception. Despite great efforts to find aetiopathogenetic factors, knowledge still is at the level of obscure theories. The diagnosis is still established per exclusion after all organic causes are ruled out, i.e. we always have to differentiate between an irritable bowel from an irritated one. In therapy the patient's confidence in his doctor is most important and it is essential to gain the patient's active cooperation. In case of diarrhoea a low-residue diet is used, calcium carbonate, codeine, loperamide, conversely in constipation adequate dietary fibre, intake metoclopramide or cisapride. Pain is relieved by spasmolytics or Ca channel blockers in the smooth musculature of the large bowel. The associated dysbiosis is transformed into eubiosis by Lactobacillus or other bacterial products.

  18. Treatment of Seborrheic Dermatitis Using a Novel Herbal-based Cream.

    PubMed

    Barak-Shinar, Deganit; Del Río, Ruben; Green, Lawrence J

    2017-04-01

    Objective: Seborrheic dermatitis is a common relapsing inflammatory skin condition occurring in approximately 3 to 5 percent of the general population. Current available therapies control, but do not cure seborrhea. The study's objective was to determine the safety and efficacy of a barrier-based, nonsteroidal cream incorporating herbal extracts as a treatment for facial seborrheic dermatitis. Design: Interventional, open label, safety/efficacy study. Setting: At the baseline visit, the investigator selected a target area on the face. The target area was evaluated for Investigator Static Global Assessment, desquamation (scaling), induration (inflammation), and erythema (redness) as well as self-assessed pruritus. Participants: Thirty-two subjects with seborrheic dermatitis were enrolled in the study. Measurements: Subjects were instructed to use the study medication twice a day, morning and evening, for a consecutive period of 42 days. In addition to the baseline visit (Day 0), subjects visited the clinic for two follow-up visits at Days 14 and 28 and for a final visit at Day 42. At each visit, all parameters were evaluated. Results: A reduction in all parameters evaluated was seen at almost all timepoints, improving more from one timepoint to the next during the study period. In addition, the patients expressed a high degree of satisfaction with the treatment. No adverse events were reported during this study. Conclusion: The study showed that after six weeks of treatment, the face cream provided improvement in Investigator Static Global Assessment, pruritus, desquamation, induration, and erythema. ClinicalTrials.gov Identifier: NCT02656368 (https://clinicaltrials.gov/ct2/sh ow/NCT02656368?term=Kamedis&rank=2).

  19. Actinic keratosis: preventable and treatable like other precancerous and cancerous skin lesions.

    PubMed

    Nicol, N H

    1989-01-01

    Actinic keratosis, like many other precancerous and cancerous skin lesions are preventable and treatable. Nurses, physicians, other health care providers, school teachers, daycare workers, grandparents, parents, and children must assume the role of educating others regarding attitudes and knowledge about sun damage to the skin. Protecting one's skin should be a lifelong process from the newborn period onward. However, if sun damage does occur, the next important step is early detection of skin cancer. Individuals with associated risk factors should be screened routinely by health care personnel with expertise in the area of skin cancer. The best treatment of actinic keratosis, as with most diseases, is prevention.

  20. New Treatment for Seborrheic Alopecia: The Ligature of the Arteries of the Scalp

    PubMed Central

    Marechal, Raymond E.

    1977-01-01

    Bilateral ligature of the superficial temporal arteries and of the posterior auricular arteries is proposed as a treatment for seborrheic alopecia. The arterial circulatory dynamics are, thus, replaced by capillary circulatory dynamics. Hypoxia is produced which inhibits enzymatic systems and lessens nocuous action of androgen and lipid factors on the pilosebaceous effectors. The histologic study shows that the production of sebum is greatly reduced and the condition of the hair follicle is strikingly improved. ImagesFigure 1Figure 2Figure 3 PMID:157397

  1. The natural history of actinic keratosis: a systematic review.

    PubMed

    Werner, R N; Sammain, A; Erdmann, R; Hartmann, V; Stockfleth, E; Nast, A

    2013-09-01

    Knowledge about the development of untreated actinic keratosis (AK) and risk of progression into squamous cell carcinoma (SCC) is important. Therefore, we set out to synthesize primary data on the natural history of AK. We carried out a systematic literature search (Medline, Medline in Process, Embase, Cochrane) of studies on the natural course of AK, regarding (i) progression and regression rates per lesion-year, (ii) changes in total lesion counts over time, and (iii) spontaneous field regression and recurrence rates, taking into account studies on participants without immunosuppression and history of skin cancer, immunosuppressed patients and participants with a history of skin cancer and sunscreen use. Twenty-four eligible studies were identified providing data on at least one of the outcomes. Progression rates of AK to SCC ranged from 0% to 0·075% per lesion-year, with a risk of up to 0·53% per lesion in patients with prior history of nonmelanoma skin cancer. Rates of regression of single lesions ranged between 15% and 63% after 1 year. The data available on recurrence rates of single lesions 1 year after regression indicate a recurrence rate of 15-53%. Data on the relative change of total AK count over time are heterogeneous, and range from -53% to +99·1%. Spontaneous complete field regression rates range from 0% to 21%, with recurrences in 57%. In general, the available data are limited. Important methodological limitations apply. Currently, no reliable estimates concerning the frequency of AK developing into invasive carcinoma can be given, and further studies are needed. © 2013 British Association of Dermatologists.

  2. Non-adherence to topical treatments for actinic keratosis

    PubMed Central

    Shergill, Bav; Zokaie, Simon; Carr, Alison J

    2014-01-01

    Background There is limited information on the patterns of use, adherence rates, and factors that impact adherence with topical treatments for actinic keratosis (AK). Objectives To establish patterns of use and adherence with topical treatments for AK and to identify treatment-related factors that impact on adherence. Methods A community-based, cross-sectional study was performed using a standardized questionnaire completed online or via telephone interview. Patients were stratified according to the presence of AK lesions on the scalp and/or other extremities; and presence of scarring resulting from treatment. Results This study included 305 patients with AK who were currently using a patient-applied topical therapy for AK or had used one within the previous 12 months. In total, 88% (n = 268/305) of patients were either non-adherent, non-persistent or both non-adherent and non-persistent to topical therapy. Duration of treatment was associated with increasing rates of non-adherence (adjusted odds ratio [OR]; for treatment durations greater than 4 weeks, 2.2, P < 0.01): 52% of patients were non-adherent with 3–4 week treatment duration; 69% of patients with 4–8 week treatment duration; and 71% of patients with 6–12 week treatment duration. There were similar increases in non-persistence with increasing treatment duration (adjusted OR; for treatment durations greater than 4 weeks, 2.1, P < 0.05). Conclusion This study found high rates of non-adherence and non-persistence in patients with AK. Duration of treatment was a significant factor contributing to non-adherence and non-persistence to topical treatments. Patient-applied topical therapies that require less frequent application and have shorter treatment duration may be associated with improved adherence rates. PMID:24379656

  3. Irritants and Skin Barrier Function.

    PubMed

    Angelova-Fischer, Irena

    2016-01-01

    The barrier response to irritant challenge involves complex biologic events and can be modulated by various environmental, exposure and host-related factors. Irritant damage to the epidermal barrier elicits a cascade of homeostatic or pathologic responses that could be investigated by both in vitro and in vivo methods providing different information at biochemical and functional level. The present chapter summarizes the changes in key barrier function parameters following irritant exposure with focus on experimental controlled in vivo human skin studies.

  4. Clinical efficacy of a new ciclopiroxolamine/zinc pyrithione shampoo in scalp seborrheic dermatitis treatment.

    PubMed

    Lorette, Gérard; Ermosilla, Valérie

    2006-01-01

    Ciclopiroxolamine (CPO) and Zinc Pirythione (ZP) antifungals are efficient at treating scalp seborrheic dermatitis. This multicentre, single-blind, clinical study was conducted to evaluate the efficacy of a shampoo containing the 1.5% CPO/1% ZP association compared to the vehicle shampoo and to 2% ketoconazole foaming gel in the treatment of seborrheic dermatitis. In 189 patients randomised to apply 1 of the 3 products twice a week for 28 days, the global lesional score, erythema, pruritus, global efficacy, quality of life (SF12 and DLQI questionnaires) and tolerance were measured at 0, 7, 14 and 28 days. The 3 products reduced lesional score, erythema and pruritus from day 7 (p < 0.0001). The 2 antifungal treatments were significantly more efficient than the vehicle in reducing lesional score, erythema and pruritus at day 14 (p < 0.0001). At day 7, the CPO/ZP shampoo was more efficient in reducing pruritus than ketoconazole gel and vehicle (p = 0.032 and p < 0.001, respectively). The global efficacy of the 2 antifungal treatments assessed at day 28 by both investigator and patient was significantly better than that of the vehicle. Only the CPO/ZP shampoo improved all DLQI questionnaire dimensions. The CPO/ZP shampoo was as rapid and efficient as ketoconazole gel in SD treatment.

  5. Evaluation of Expression of Lipases and Phospholipases of Malassezia restricta in Patients with Seborrheic Dermatitis

    PubMed Central

    Lee, Yang Won; Lee, Shin Yung; Lee, Younghoon

    2013-01-01

    Background Malassezia species (spp.) are cutaneous opportunistic pathogens and associated with various dermatological diseases including seborrheic dermatitis, dandruff and atopic dermatitis. Almost all Malassezia spp. are obligatorily lipid-dependent, which might be caused by lack of the myristic acid synthesis. Recent genome analysis of M. restricta and M. globosa suggested that the absence of a gene encoding fatty acid synthesis might be compensated by abundant genes encoding hydrolases, which produce fatty acids, and that lipases and phospholipases may play a role in virulence of the fungus. Objective The current study aimed to investigate the contribution of lipases and phospholipases in virulence of the M. restricta as being the most frequently isolated Malassezia spp. from the human skin. Methods Swap samples of two different body sites of at least 18 patients with seborrheic dermatitis were obtained and in vivo expression of lipases and phospholipases of M. restricta was analyzed by the gene specific two-step nested RT-PCR. Results The results of the current study suggest that majority of the patients display expression of lipase RES_0242. Conclusion These data imply a possible role of lipase in the host environment to produce free fatty acids for the fungus. PMID:24003273

  6. Keratosis follicularis spinulosa decalvans: a rare cause of scarring alopecia in two young Indian girls.

    PubMed

    Maheswari, Uma G; Chaitra, V; Mohan, Subbiah S

    2013-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is an X-linked xenodermatosis characterized by scarring alopecia and follicular hyperkeratosis. This condition mainly affects males with females being carriers and will have milder symptoms. We present two sisters with severe form of KFSD, progressing to scarring alopecia.

  7. Keratosis follicularis spinulosa decalvans: report of a case with ultrastructural study and unsuccessful trial of retinoids.

    PubMed

    Puppin, D; Aractingi, S; Dubertret, L; Blanchet-Bardon, C

    1992-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a genetic disorder characterized by disseminated follicular hyperkeratosis, especially localizated to scalp and face. We report the case of a new patient displaying typical features of KFSD. Ultrastructural study was performed and displayed round keratohyalin granules in follicular keratinocytes. Trial with etretinate, which has not been reported before in this disease, proved to be ineffective.

  8. Keratosis Follicularis Spinulosa Decalvans: A Rare Cause of Scarring Alopecia in Two Young Indian Girls

    PubMed Central

    Maheswari, Uma G; Chaitra, V; Mohan, Subbiah S

    2013-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is an X-linked xenodermatosis characterized by scarring alopecia and follicular hyperkeratosis. This condition mainly affects males with females being carriers and will have milder symptoms. We present two sisters with severe form of KFSD, progressing to scarring alopecia. PMID:23960394

  9. [Keratosis follicularis spinulosa decalvans associated with patent ductus arteriosus and hypospadia in an Asiatic patient].

    PubMed

    Harth, W; Linse, R

    1999-04-01

    Keratosis follicularis spinulosa decalvans (KFSD) appeared sporadically in an Asian boy, who also presented with naevus teleangiectaticus lateralis, patent ductus arteriosus (Botalli) and hypospadia. The association of these findings raises the question of a new syndrome. In addition, this is the first report of KFSD in a patient of Asian origin.

  10. Lumican as a novel marker for differential diagnosis of Bowen disease and actinic keratosis.

    PubMed

    Takayama, Ryoko; Ishiwata, Toshiyuki; Ansai, Shin-ichi; Yamamoto, Tetsushi; Matsuda, Yoko; Naito, Zenya; Kawana, Seiji

    2013-12-01

    Lumican, a member of the small leucine-rich proteoglycan family, regulates the assembly and diameter of collagen fibers in the extracellular matrix of various tissues. Lumican expression correlates with pathological conditions, including skin fragility, corneal opacification, and corneal and cardiac wound healing. Lumican is overexpressed in tumor cells, including in the breast, colorectal, neuroendocrine cell, uterine cervical, and pancreatic cancers. Lumican expression also correlates with the growth and metastasis of various malignancies. For example, lumican expression is lower in the dermis of malignant melanoma cases than in early-stage melanomas. However, the expression patterns and roles of lumican in nonmelanoma skin cancer have not been elucidated. In this study, we used immunohistochemistry and in situ hybridization to examine the expression patterns of lumican in normal skin, Bowen disease, and actinic keratosis. In normal skin, lumican was expressed in the collagen fibers in the dermis, acrosyringium, follicular epithelium, and sebocytes but not in epidermal keratinocytes. In Bowen disease, lumican was expressed in 34 (91.8%) of 37 patients. Notably, all cases of actinic keratosis were negative for lumican. These findings suggest that lumican plays an important role in the pathogenesis of Bowen disease and actinic keratosis and might be useful as an adjunct to the diagnosis for subtypes of 2 diseases: bowenoid actinic keratosis and Bowen disease in sun-exposed areas.

  11. The Impact of the Current United States Guidelines on the Management of Actinic Keratosis

    PubMed Central

    2010-01-01

    Actinic keratosis is one of the most common diagnoses made by dermatologists. Many experts recommend treating all actinic keratoses because of their potential to progress to invasive squamous cell carcinoma. Physicians have a large armamentarium of actinic keratosis treatment modalities available to them, including destructive therapies, such as cryotherapy, curettage and electrodessication, chemical peels, photodynamic therapy, and topical therapies, including 5-fluorouracil, imiquimod, and diclofenac. In addition to standardized monotherapy regimens, combinations of two concomitant or sequential therapies and alternative topical dosing regimens have been studied in a number of clinical trials. Such therapeutic courses are used to maintain or enhance efficacy while improving tolerability, convenience, and/or patient adherence. This abundance of treatment options prompted development of several actinic keratosis management guidelines. Whereas two sets of treatment guidelines were published by European organizations within the past three years, the most recent United States-based guidelines for dermatologists were published by the American Academy of Dermatology in 1995. Because they are not up to date, the 1995 United States guidelines lack recent clinical developments and an evidence rating system and can no longer effectively guide practitioners. While there are benefits and potential limitations to developing an updated set of United States-based guidelines, there is a clearly defined need for a unified, comprehensive, evidence-based guideline approach to actinic keratosis treatment that balances the need to tailor long-term management of the disease to the needs of the individual patient. PMID:21103312

  12. Treatment of Facial Seborrheic Dermatitis with Pimecrolimus Cream 1%: An Open-Label Clinical Study in Korean Patients

    PubMed Central

    Kim, Byung-Soo; Kim, Su-Han; Oh, Chang-Keun; Jang, Ho-Sun; Kwon, Kyung-Sool

    2007-01-01

    Pimecrolimus cream 1% has shown to be effective in patients with a variety of inflammatory cutaneous disorders. And it might be a useful modality in the treatment of seborrheic dermatitis. This prospective study was aimed at assessing the efficacy and tolerability of pimecrolimus cream 1% in the treatment of facial seborrheic dermatitis. Twenty patients were instructed to apply pimecrolimus cream 1% for 4 consecutive weeks. Assessment of the disease severity was performed at baseline and at week 1, 2, and 4. Clinical assessments of erythema, scaling, and pruritus were measured using a 4-point scale (0-3). Global assessments of the disease severity by patients and investigators were performed at each visit. Mean clinical scores of erythema, scaling, and pruritus significantly improved by 87.4%, 91.9%, and 91.5% respectively at week 4 (p<0.001). Improvements in the global assessment of disease severity determined by patients and investigators also showed excellent results. No specific adverse events other than transient burning and tingling sensations were noted. The relapse of facial seborrheic dermatitis was mostly observed between 3 to 8 weeks after the discontinuation of pimecrolimus. We suggest that the topical application of pimecrolimus cream 1% can be an effective and safe alternative for treatment of facial seborrheic dermatitis. PMID:17982237

  13. Treatment of facial seborrheic dermatitis with pimecrolimus cream 1%: an open-label clinical study in Korean patients.

    PubMed

    Kim, Byung-Soo; Kim, Su-Han; Kim, Moon-Bum; Oh, Chang-Keun; Jang, Ho-Sun; Kwon, Kyung-Sool

    2007-10-01

    Pimecrolimus cream 1% has shown to be effective in patients with a variety of inflammatory cutaneous disorders. And it might be a useful modality in the treatment of seborrheic dermatitis. This prospective study was aimed at assessing the efficacy and tolerability of pimecrolimus cream 1% in the treatment of facial seborrheic dermatitis. Twenty patients were instructed to apply pimecrolimus cream 1% for 4 consecutive weeks. Assessment of the disease severity was performed at baseline and at week 1, 2, and 4. Clinical assessments of erythema, scaling, and pruritus were measured using a 4-point scale (0-3). Global assessments of the disease severity by patients and investigators were performed at each visit. Mean clinical scores of erythema, scaling, and pruritus significantly improved by 87.4%, 91.9%, and 91.5% respectively at week 4 (p<0.001). Improvements in the global assessment of disease severity determined by patients and investigators also showed excellent results. No specific adverse events other than transient burning and tingling sensations were noted. The relapse of facial seborrheic dermatitis was mostly observed between 3 to 8 weeks after the discontinuation of pimecrolimus. We suggest that the topical application of pimecrolimus cream 1% can be an effective and safe alternative for treatment of facial seborrheic dermatitis.

  14. Menthol attenuates respiratory irritation responses to multiple cigarette smoke irritants

    PubMed Central

    Willis, Daniel N.; Liu, Boyi; Ha, Michael A.; Jordt, Sven-Eric; Morris, John B.

    2011-01-01

    Menthol, the cooling agent in peppermint, is added to almost all commercially available cigarettes. Menthol stimulates olfactory sensations, and interacts with transient receptor potential melastatin 8 (TRPM8) ion channels in cold-sensitive sensory neurons, and transient receptor potential ankyrin 1 (TRPA1), an irritant-sensing channel. It is highly controversial whether menthol in cigarette smoke exerts pharmacological actions affecting smoking behavior. Using plethysmography, we investigated the effects of menthol on the respiratory sensory irritation response in mice elicited by smoke irritants (acrolein, acetic acid, and cyclohexanone). Menthol, at a concentration (16 ppm) lower than in smoke of mentholated cigarettes, immediately abolished the irritation response to acrolein, an agonist of TRPA1, as did eucalyptol (460 ppm), another TRPM8 agonist. Menthol's effects were reversed by a TRPM8 antagonist, AMTB. Menthol's effects were not specific to acrolein, as menthol also attenuated irritation responses to acetic acid, and cyclohexanone, an agonist of the capsaicin receptor, TRPV1. Menthol was efficiently absorbed in the respiratory tract, reaching local concentrations sufficient for activation of sensory TRP channels. These experiments demonstrate that menthol and eucalyptol, through activation of TRPM8, act as potent counterirritants against a broad spectrum of smoke constituents. Through suppression of respiratory irritation, menthol may facilitate smoke inhalation and promote nicotine addiction and smoking-related morbidities.— Willis, D. N., Liu, B., Ha, M. A., Jordt, S.-E., Morris, J. B. Menthol attenuates respiratory irritation responses to multiple cigarette smoke irritants. PMID:21903934

  15. Driver irritation and aggressive behaviour.

    PubMed

    Björklund, Gunilla M

    2008-05-01

    A sample of 98 drivers responded to a Swedish version of the UK Driving Anger Scale [UK DAS; [Lajunen, T., Parker, D., Stradling, S.G., 1998. Dimensions of driver anger, aggressive and highway code violations and their mediation by safety orientation in UK drivers. Transport. Res. Part F 1, 107-121]. The results indicated that the Swedish version, like the British original, measures three sources of driver irritation: "progress impeded", "reckless driving", and "direct hostility". Structural equation modelling was used to investigate the relationships between the three sources of self-reported driver irritation, aggressive actions, speed, sex, age, and annual mileage. The models suggested a positive relationship between the amount of driver irritation and frequency of aggressive actions for all three sources of irritation. Female drivers tended to become more irritated than male drivers, while the male drivers tended to act aggressively more often. Surprisingly, drivers who reported that they enjoy fast speeds did not become more irritated than slower drivers when obstructed. The important conclusions are that experienced irritation often leads to openly aggressively actions, and that expression of aggressive behaviours may be a cause of other drivers' feeling of irritation.

  16. Definition and Facts for Irritable Bowel Syndrome

    MedlinePlus

    ... For Reporters Calendar of Events Follow Us Home Health Information Digestive Diseases Irritable Bowel Syndrome (IBS) Definition & Facts Related Topics Irritable Bowel Syndrome (IBS) Definition & ...

  17. [Irritable bowel syndrome].

    PubMed

    Truninger, K

    2007-04-01

    Irritable bowel syndrome (IBS) is one of the most frequent functional gastrointestinal disorders. The main symptoms are abdominal pain associated with a change in bowel habit. Headache and psychiatric disorders such as mood or anxiety disorders are often associated with IBS. Genetic predisposition, sensomotoric dysfunction, altered enteric inflammation and immune activation and disturbance of the brain-gut interaction are the most important pathogenetic factors. The diagnosis requires the new symptom-based Rome-III-criteria. Diagnostic testing primarily depends on the patients complaints, clinical and laboratory features and is then guided by the patient's age, symptom's severity and duration, alarm symptoms, psychosocial factors, and the family history for tumors. Treatment of IBS is based on an individualized evaluation and depends on disease severity, predominant symptoms and associated disorders. Treatment options include lifestyle modifications, drug therapy aimed at predominant symptoms and various forms of psychological treatments.

  18. A comprehensive pathophysiology of dandruff and seborrheic dermatitis - towards a more precise definition of scalp health.

    PubMed

    Schwartz, James R; Messenger, Andrew G; Tosti, Antonella; Todd, Gail; Hordinsky, Maria; Hay, Roderick J; Wang, Xuemin; Zachariae, Claus; Kerr, Kathy M; Henry, James P; Rust, Rene C; Robinson, Michael K

    2013-03-27

    Despite an increasing knowledge of dandruff and seborrheic dermatitis (D/SD), the pathophysiological understanding is still incomplete but suggests a role of Malassezia yeasts in triggering inflammatory and hyper-proliferative epidermal responses. The objective of this report is to review published literature from in vivo studies of D/SD populations to provide a more complete description of overall scalp health. New biomolecular capabilities establish a depth of pathophysiological understanding not previously achievable with traditional means of investigation. Biomarkers representing inflammation, hyper-proliferation and barrier function are all perturbed by the D/SD condition and robustly respond to therapeutic resolution. These biomarkers can be sampled noninvasively, enabling their use in routine clinical evaluations as either surrogate endpoints or complementary ones to classical signs/symptoms to broaden the etiological learning.

  19. [Diagnostic difficulties in differentiation between atopic dermatitis and seborrheic dermatitis in infants].

    PubMed

    Rotsztejn, Helena; Kamer, Barbara; Raczy'nska, Jolanta; Pyziak, Konrad

    2005-11-01

    On the basis of two children with coexistence of atopic and seborrhoeic dermatitis, authors emphasize similarity of clinical symptoms and chronic, recurrent course of these diseases. Atopic dermatitis and seborrheic dermatitis are most common reasons of skin disorders in infants. Location and character of atopic lesions are atypical during infancy. Most often they occur on face and have erythematous-exfoliative and papulovesicular character. Pruritus and anxiety, especially in younger children are often seen. On the contrary seborrhoeic lesions are mostly seen in typical spots, including hairy head skin, where they form characteristic yellow seborrhoeic scales. Usually pruritus is not seen. Authors pay attention to heterogeneous etiopathogenesis of these diseases and underline the importance of early differentiation, which allows application of proper therapy.

  20. Seborrheic dermatitis, increased sebum excretion, and Parkinson's disease: a survey of (im)possible links.

    PubMed

    Mastrolonardo, M; Diaferio, A; Logroscino, G

    2003-06-01

    The concept of skin as a mirror of parkinsonism, dates back at the beginning of the last century. Since then, much evidence has been accumulated supporting a causal association between the neurological disturbance and changes detectable on areas of the integument with the richest sebaceous gland supply, namely seborrheic dermatitis and/or seborrhea. However, the many persisting sources of perplexity weighing on some general aspects of the skin condition itself (lack of standardized diagnostic criteria, high variability of estimates of prevalence, and controversies on etiology and pathomechanisms) must have to date hampered assessment of the real nature, and significance (if any) of the links observed. The three major pathogenical pathways so far conceived in this context will be critically reviewed on the basis of evidences provided in the literature.

  1. MBTPS2 mutation in a British pedigree with keratosis follicularis spinulosa decalvans.

    PubMed

    Fong, K; Wedgeworth, E K; Lai-Cheong, J E; Tosi, I; Mellerio, J E; Powell, A M; McGrath, J A

    2012-08-01

    Keratosis follicularis spinulosa decalvans (KFSD; OMIM 308800) is an X-linked disorder characterized by widespread hyperkeratotic follicular papules (including keratosis pilaris-like lesions), facial erythema, hypotrichosis and scarring alopecia. KFSD results from mutations in the MBTPS2 gene. Mutations in this gene also underlie ichthyosis follicularis, alopecia and photophobia syndrome. We report a British pedigree with KFSD resulting from the mutation p.Asn508Ser. This particular mutation has been reported in three other pedigrees with KFSD (Dutch, American, British) and is the only pathogenic mutation reported in this disorder to date. However, the same mutation has also been reported in a Chinese pedigree with IFAP syndrome, highlighting the clinical heterogeneity and overlapping molecular pathology of these two disorders.

  2. Keratosis follicularis spinulosa decalvans. An infant with failure to thrive, deafness, and recurrent infections.

    PubMed

    Britton, H; Lustig, J; Thompson, B J; Meyer, S; Esterly, N B

    1978-05-01

    A 10-month-old male infant had keratosis follicularis spinulosa decalvans, an X-linked dominant disorder. His cutaneous abnormalities consisted of generalized hyperkeratosis, spiny follicular papular lesions, universal alopecia, and hypoplastic nails. Ocular changes characteristic of the disease were also present. Unusual findings included deafness, failure to thrive, predisposition to bacterial infections without demonstrable immune defect, and transient hepatomegaly with abnormal liver function studies.

  3. Keratosis spinulosa developing in borderline-tuberculoid lesions during type I lepra reaction: two case reports.

    PubMed

    Thankappan, T P; Sulochana, G

    1991-03-01

    Two cases of borderline-tuberculoid leprosy which developed keratosis spinulosa over the anaesthetic areas alone during type I lepra reactions are described. Both patients only developed spiny papules during the period of reaction and subsided with control of the reaction. The probable mechanism of this peculiar phenomenon might be due to the generation of epidermal growth factors by local T cell activation during the type I lepra reaction.

  4. Adaptation and validation of the Spanish version of the Actinic Keratosis Quality of Life questionnaire.

    PubMed

    Longo Imedio, Isabel; Serra-Guillén, Carlos

    2016-01-01

    While there are questionnaires for evaluating the effects of skin cancer on patient quality of life, there are no specific questionnaires available in Spanish for evaluating quality of life in patients with actinic keratosis. The aim of this study was to translate and culturally adapt the Actinic Keratosis Quality of Life (AKQoL) questionnaire into Spanish. The original questionnaire was translated into Spanish following the guidelines for the cross-cultural adaptation of self-report measures. Several measures of general reliability and validity were calculated, including Cronbach α for internal consistency and the Spearman rank-order correlation coefficient and a Bland-Altman plot for test-retest reliability. To test concurrent validity, we used the Pearson correlation coefficient to measure the correlation between AKQoL and Skindex-29 scores. The final version of the questionnaire was administered to 621 patients with actinic keratosis, who scored a mean (SD) of 5.25 (4.73) points (total possible score, 0-25). The Cronbach α reliability coefficient analysis was 0.84. The correlation between the mean (SD) score on the Skindex-29 (1.87 [4.07]) and on the AKQoL (1.97 [2.98] was 0.344 (P=.002, Spearman's rho), with a proportion of shared variance of 11.8%. The translation, cross-cultural adaptation, and validation of the original AKQoL produced a reliable, easily understandable questionnaire for evaluating the impact of actinic keratosis on the quality of life of patients in our setting. Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

  5. Follicular keratosis of the chin treated with 1.24R-dihydroxyvitamin D3 ointment.

    PubMed

    Yanagihara, Makoto; Takeda, Kiminobu; Tanabe, Hiroshi; Abe, Shinya; Ishizaki, Hiroshi

    2007-01-01

    In follicular keratosis of the chin, keratotic follicular papules occur on the chin and jaw due to localized prolonged pressure and friction on the naked skin. We present one patient with this disorder. The dermatoscopic examination revealed many well-demarcated yellow spindle bodies in the patchy lesion. Therapy with 1.24R-dihydroxyvitamin D3 ointment was effective during the treatment but had no residual positive effect.

  6. Hypotrichosis with keratosis pilaris: electrophoretical study of hair fibrous proteins from a patient.

    PubMed

    Dekio, S; Nagashima, T; Watanabe, Y; Jidoi, J

    1989-01-01

    S-carboxymethylated (SCM) fibrous proteins from the scalp hair of a patient with hypotrichosis with keratosis pilaris (HTKP) and from that of a normal individual were analyzed using two-dimensional electrophoresis. One SCM fibrous protein component was different electrophoretically in the HTKP patient. It is suggested that the brittleness of the HTKP hair might result from this alteration of the fibrous protein composition of the hair.

  7. Irritable bowel syndrome

    PubMed Central

    Enck, Paul; Aziz, Qasim; Barbara, Giovanni; Farmer, Adam D.; Fukudo, Shin; Mayer, Emeran A.; Niesler, Beate; Quigley, Eamonn M. M.; Rajilić-Stojanović, Mirjana; Schemann, Michael; Schwille-Kiuntke, Juliane; Simren, Magnus; Zipfel, Stephan; Spiller, Robin C.

    2016-01-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain–gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer. PMID:27159638

  8. New developments in the treatment of actinic keratosis: focus on ingenol mebutate gel

    PubMed Central

    Berman, Brian

    2012-01-01

    Actinic keratosis is a common disease in older, fair-skinned people, and is a consequence of cumulative ultraviolet exposure. It is part of a disease continuum in photodamaged skin that may lead to invasive squamous cell carcinoma. Treatment options frequently used include cryosurgery and topical pharmacologic agents, which are examples of lesion-directed and field-directed strategies. Ingenol mebutate gel was recently approved by the US Food and Drug Administration for topical treatment of actinic keratosis. While the mechanism of action of ingenol mebutate is not fully understood, in vitro and in vivo studies using tumor models indicate it has multiple mechanisms. Ingenol mebutate directly induces cell death by mitochondrial swelling and loss of cell membrane integrity preferentially in transformed keratinocytes. It promotes an inflammatory response characterized by infiltration of neutrophils and other immunocompetent cells that kills remaining tumor cells. The ability of ingenol mebutate to eliminate mutant p53 patches in ultraviolet-irradiated mouse skin suggests that it may have the potential to treat chronically ultraviolet-damaged skin. In human studies, ingenol mebutate achieved high clearance of actinic keratosis on the head and body after 2–3 consecutive daily treatments when measured by complete or partial clearance of lesions. Localized inflammatory skin responses were generally mild to moderate and resolved in less than a month. PMID:22956883

  9. Evaluation of a Topical Anti-inflammatory/Antifungal Combination Cream in Mild-to-moderate Facial Seborrheic Dermatitis

    PubMed Central

    Dall’Oglio, Federica; Tedeschi, Aurora; Guardabasso, Vincenzo

    2015-01-01

    Objective: To evaluate if nonprescription topical agents may provide positive outcomes in the management of mild-to-moderate facial seborrheic dermatitis by reducing inflammation and scale production through clinical evaluation and erythema-directed digital photography. Setting: Open-label, prospective, not-blinded, intra-patient, controlled, clinical trial (target area). Participants: Twenty adult subjects affected by mild-to-moderate facial seborrheic dermatitis were enrolled and instructed to apply the study cream two times daily, initially on a selected target area only for seven days. If the subject developed visible improvement, it was advised to extend the application to all facial affected area for 21 additional days. Measurement: Efficacy was evaluated by measuring the grade of erythema (by clinical examination and by erythema-directed digital photography), desquamation (by clinical examination), and pruritus (by subject-completed visual analog scale). Additionally, at the end of the protocol, a Physician Global Assessment was carried out. Results: Eighteen subjects completed the study, whereas two subjects were lost to follow-up for nonadherence and personal reasons, respectively. Day 7 data from target areas showed a significant reduction in erythema. At the end of study, a significant improvement was recorded for erythema, desquamation, and pruritus compared to baseline. Physician Global Assessment showed improvement in 89 percent of patients, with a complete response in 56 percent of cases. Conclusion: These preliminary results indicate that the study cream may be a viable nonprescription therapeutic option for patients affected by facial seborrheic dermatitis able to determine early and significant improvement. This study also emphasizes the advantages of using an erythema-directed digital photography system for assisting in a simple, more accurate erythema severity grading and therapeutic monitoring in patients affected by seborrheic dermatitis. PMID

  10. Efficiency of terbinafine 1% cream in comparison with ketoconazole 2% cream and placebo in patients with facial seborrheic dermatitis.

    PubMed

    Azimi, Hamideh; Golforoushan, Farideh; Jaberian, Mahnaz; Talghini, Shhla; Goldust, Mohamad

    2013-06-06

    Objective: Different medicines have been used to treat seborrheic dermatitis but efficiency of most of them has not been confirmed. This study compared the efficiency of terbinafine 1% cream in comparison with ketoconazole 2% cream and placebo in patients with facial seborrheic dermatitis. Methods: Ninety patients were randomly divided into three groups (there were 30 persons in each group). The patients consumed one of the medicines twice a day and for 4 weeks. The scores were recorded at the trial beginning, and in the 4th and 12th weeks. Demographic features and disease severity of all three groups were normal at the beginning of the study. Results: Mean of total score in terbinafine, ketoconazole and placebo groups was decreased from 5.04 ± 2.02, 5.04 ± 1.50 and 4.97 ± 1.71 at the beginning of the study to 1.78 ± 2.47, 1.81 ± 2.43 and 3.73 ± 1.74 at the 12th week. As compared with the placebo group, mean total score significantly decreased in ketoconazole and terbinafine groups (p = 0.003). However, there was not any meaningful difference between ketoconazole and terbinafine groups (p > 0.05). There was not any serious side effect and the recurrence rate and side effects was not meaningfully different in all three groups. Conclusion: Terbinafine 1% and ketoconazole 2% creams are safe and effective in treating seborrheic dermatitis.

  11. Irritable bowel syndrome.

    PubMed

    Spinelli, Antonella

    2007-01-01

    Irritable bowel syndrome (IBS) is a disease of unclear, complex pathophysiology characterised by abdominal pain and discomfort and altered bowel activity. It affects an estimated 10-15% of individuals worldwide and has a large impact on quality of life (QOL) and both direct and indirect healthcare costs. Symptoms of IBS are usually triggered by disruption of gastrointestinal (GI) function secondary to infection, dietary factors, lifestyle changes or psychological stress. While most currently available pharmacological treatments of IBS focus on symptomatic treatment of the syndrome, agents that attempt to address the pathophysiology of the disease, in particular the role of serotonin, have received much attention in recent years. However, there is growing concern that serotonergic agents as a class may be associated with rare, but serious, episodes of ischaemic colitis, with several cases of this complication having been reported in association with use of serotonergic agents that have reached the market. Thus, there remains an important need for safe and effective agents that treat the symptoms of IBS. Otilonium bromide, a spasmolytic agent, has been widely used worldwide and has been found to be effective and safe for managing abdominal pain. Clinical trials indicate that it improves baseline abdominal pain and distension, and is particularly effective in reducing diarrhoea. Combining otilonium bromide with benzodiazepines, such as diazepam, may improve the efficacy of the agent with respect to GI symptoms, while also treating underlying anxiety disorders. More research is required to confirm the efficacy and mechanisms of action associated with this combination therapy in IBS. Safety data from clinical trials and postmarketing sources indicate that otilonium bromide is well tolerated, with a safety profile comparable to placebo in clinical trials and only two reported cases of adverse reactions (urticaria) among 10-year postmarketing data. This article reviews

  12. High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis

    PubMed Central

    An, Qian; Sun, Meng; Qi, Rui-Qun; Zhang, Li; Zhai, Jin-Long; Hong, Yu-Xiao; Song, Bing; Chen, Hong-Duo; Gao, Xing-Hua

    2017-01-01

    Background: Seborrheic dermatitis (SD) is a common inflammatory skin condition. The etiology is unclear, although overgrowth of Malassezia on the skin has been suggested to cause SD. This study investigated whether colonization with Staphylococcus plays a role in facial SD, which was not well addressed previously. Methods: The study was conducted from September 1, 2011 to February 20, 2012 in the First Hospital of China Medical University. In the first phase, the study evaluated the level of transepidermal water loss (TEWL) and the number of colony-forming units (CFU) of Staphylococcus in defined skin areas of SD patients who were human immunodeficiency virus (HIV) seropositive (HIV [+] SD [+] group, n = 13), classical SD (HIV [−] SD [+] group, n = 24) patients, HIV seropositive-non-SD (HIV [+] SD [−] group, n = 16) patients, and healthy volunteers (HIV [−] SD [−] group, n = 16). In the second phase, we enrolled another cohort of HIV (−) SD (+) patients who applied topical fusidic acid (n = 15), tacrolimus (n = 16), or moisturizer (n = 12). Changes in the Seborrheic Dermatitis Area Severity Index (SDASI), TEWL, and Staphylococcus density were evaluated 2 weeks later. Comparisons of each index were performed using analysis of variance (ANOVA) and least significant difference method. Results: The level of TEWL was greater through lesional sites in the HIV (+) SD (+) group than that in HIV (+) SD (−) and HIV (−) SD (−) groups (95% confidence interval [CI]: 18.873–47.071, P < 0.001 and 95% CI: 28.755–55.936, P < 0.001, respectively). The number of CFU of Staphylococcus was greater in the HIV (+) SD (+) group than that in HIV (+) SD (−) and HIV (−) SD (−) groups (95% CI: 37.487–142.744, P = 0.001 and 95% CI: 54.936–156.400, P < 0.001, respectively). TEWL was significantly more improved in patients treated with tacrolimus and fusidic acid than that in those treated with moisturizers (95% CI: 7.560–38.987, P = 0.004 and 95% CI: 4.659–37

  13. Evaluation of the efficacy and tolerability of 0.5% fluorouracil cream and 5% fluorouracil cream applied to each side of the face in patients with actinic keratosis.

    PubMed

    Loven, Keith; Stein, Linda; Furst, Katharine; Levy, Sharon

    2002-06-01

    A new 0.5% fluorouracil cream has been developed that provides an alternative to the more highly concentrated topical formulations of fluorouracil that are currently available. This was a comparison of the tolerability and efficacy of the 0.5% and 5% fluorouracil creams in the treatment of actinic keratosis (AK). During this single-blind, randomized study, patients with > or =6 AK lesions were treated for 4 weeks with the 0.5% (once daily) and 5% (twice daily) fluorouracil creams applied to opposite sides of the face. After the end of treatment, patients were followed for an additional 4 weeks. Efficacy variables included absolute and percent reductions in AK lesions from baseline and total clearance of AK lesions. A questionnaire was used to evaluate patients' treatment preferences. Tolerability was evaluated through continuous monitoring of adverse events. Treatment with 0.5% fluorouracil cream reduced the number of AK lesions from 11.3 at baseline to 2.5 at the end of the 4-week follow-up phase, compared with a reduction from 10.3 to 4.2 lesions after treatment with 5% fluorouracil cream. The reduction was significantly greater with the 0.5% cream compared with the 5% cream (P = 0.044). The 0.5% cream was as effective as the 5% cream in terms of the percent reduction in AK lesions from baseline (67% and 47%, respectively) and in achieving total clearance of AK lesions (both treatments, approximately 43% of patients). Both treatments were associated with similar degrees of investigator-rated irritation; however, patients preferred the 0.5% cream because they felt it was more tolerable (P = 0.003), easier to apply, and had a once-daily application schedule. Although all patients experienced facial irritation in association with both creams, fewer patients treated with the 0.5% cream reported symptoms of facial irritation. In this study, 0.5% fluorouracil cream once daily was at least as effective as 5% fluorouracil cream twice daily in terms of the percent

  14. Treatment of seborrheic dermatitis: comparison of sertaconazole 2 % cream versus pimecrolimus 1 % cream.

    PubMed

    Goldust, M; Rezaee, E; Raghifar, R

    2013-12-01

    Seborrheic dermatitis (SD) is an inflammatory skin disorder affecting the scalp, face, and trunk. The treatment of SD is an important issue in dermatology. This study aimed at comparing the efficacy of sertaconazole 2 % cream versus pimecrolimus 1 % cream in the treatment of SD. In this clinical trial study, 60 patients suffering from SD were studied. Thirty patients received local sertaconazole 2 % cream and in control group, 30 patients received pimecrolimus 1 % cream. Patients were recommended to use the cream twice a day for 4 weeks. At the beginning of referring and also 2 and 4 weeks after first visit, the patients were examined by a dermatologist to control improvement of clinical symptoms. The mean age of members of the sertaconazole and pimecrolimus groups was 30.12 ± 12.56 and 34.67 ± 10.98 years, respectively. The highest level of satisfaction (90 %) was observed 28 days after sertaconazole application since it was 80 % in pimecrolimus group. The relationship between patients' satisfaction and receipt of sertaconazole cream (on the 28th day) was statistically significant (P = 0.006). Sertaconazole 2 % cream may be an excellent alternative therapeutic modality for treating SD.

  15. Comprehensive pyrosequencing analysis of the bacterial microbiota of the skin of patients with seborrheic dermatitis.

    PubMed

    Tanaka, Akiomi; Cho, Otomi; Saito, Chie; Saito, Mami; Tsuboi, Ryoji; Sugita, Takashi

    2016-08-01

    Seborrheic dermatitis (SD) is a chronic inflammatory dermatologic condition in which erythema and itching develop on areas of the body with sebaceous glands, such as the scalp, face and chest. The inflammation is evoked directly by oleic acid, which is hydrolyzed from sebum by lipases secreted by skin microorganisms. Although the skin fungal genus, Malassezia, is thought to be the causative agent of SD, analysis of the bacterial microbiota of skin samples of patients with SD is necessary to clarify any association with Malassezia because the skin microbiota comprises diverse bacterial and fungal genera. In the present study, bacterial microbiotas were analyzed at non-lesional and lesional sites of 24 patients with SD by pyrosequencing and qPCR. Principal coordinate analysis revealed clear separation between the microbiota of non-lesional and lesional sites. Acinetobacter, Corynebacterium, Staphylococcus, Streptococcus and Propionibacterium were abundant at both sites. Propionibacterium was abundant at non-lesional sites, whereas Acinetobacter, Staphylococcus and Streptococcus predominated at lesional sites; however, the extent of Propionibacterium colonization did not differ significantly between lesional and non-lesional sites according to qPCR. Given that these abundant bacteria hydrolyze sebum, they may also contribute to SD development. To the best of our knowledge, this is the first comprehensive analysis of the bacterial microbiotas of the skin of SD patients.

  16. Seborrheic dermatitis flare in a Dutch male due to commensal Malassezia furfur overgrowth.

    PubMed

    Ran, Yuping; He, Xiaodan; Zhang, Hao; Dai, Yaling; Li, Lina; Bulmer, G S

    2008-09-01

    This is a case of seborrheic dermatitis (SD) barbae from which Malassezia furfur (M. furfur) was isolated. The patient was a 57-year-old Dutch male, who was hospitalized for fever and weakness of extremities. He presented with symmetrical erythema with an abundance of greasy chaffy scales on his beard area. No reasons were detected for his fever following a routine search. M. furfur was identified through mycological examination, including direct microscopic examination, culture, Tween test, esculine splitting test and DNA sequencing, of samples from the skin lesions. The patient was treated with oral itraconazole capsules (200 mg, b.i.d. for 8 days, then 200 mg o.d. for 13 days), washing his scalp and face with 2% ketoconazole shampoo (once a day) and topical application of a cream containing 1% naftifine hydrochloride and 0.25% ketoconazole (b.i.d.). After treatment the fever subsided and the SD lesion gradually healed. M. furfur was not isolated again from skin scrapings and 7 days later therapy was terminated and no recurrence was noted after one week follow-up since the cessation of treatment.

  17. Effectiveness of erbium:YAG laser and cryosurgery in seborrheic keratoses: Randomized, prospective intraindividual comparison study.

    PubMed

    Gurel, Mehmet Salih; Aral, Burcak Bozdemir

    2015-10-01

    Seborrheic keratoses (SK) are benign cutaneous lesions frequently seen in old age. The aim of the study is to compare the efficiency of Er:YAG lasers with cryotherapy in the treatment of SK. The study was carried out on 42 patients with SK sized 0.5-3 cm, located on the back, chest, face and neck. Lesions with a similar size and location on the same patient were matched. In the same session, half of the lesions were treated with cryotherapy, while the other half were treated with Er:YAG lasers. All of the patients were clinically evaluated in two recalls with a one-month interval between appointments. The efficiency of the treatments was clinically evaluated. Following the first treatment, complete healing was detected in all of the lesions (100%) treated with Er:YAG lasers, while the healing rate was 68% in the cryotherapy group (p < 0.01). In the Er:YAG laser-treated group, hyperpigmentation was significantly lower and more erythema developed than in the cryotherapy group. Er:YAG lasers offer a one-step procedure which is a very simple and economic treatment and provides an alternative treatment method with better cosmetic results compared to cryotherapy.

  18. Investigation of hair shaft in seborrheic dermatitis using atomic force microscopy.

    PubMed

    Kim, Kyung Sook; Shin, Min Kyung; Ahn, Jae-Jun; Haw, Choong-Rim; Park, Hun-Kuk

    2011-08-01

    We have investigated the changes of seborrheic dermatitis (SD) on the hair shaft in the morphological and physical properties using atomic force microscopy (AFM). Hair samples were obtained from the lesional and perilesional regions in 15 patients with SD. Fifteen healthy adults were included as the control group. From the topography of hair obtained by AFM, the height of the scale, step height, roughness, diameter, and pit were determined. The scale thickness of the SD-affected hair was sevenfold more than in the control hair showing statistically significance. The lesional hair showed greater roughness parameters of Sa, Sq, and Sz than the perilesional and the control hair, but this difference was not significant. The cuticle of the lesional hair was significantly damaged while perilesional hair showed a very distinct cuticle structure with smooth edges and a regular interval between the cuticles. The diameter of the lesional hair was significantly lesser by 10-35% than that of the perilesional hair. The pit was rarely observed in the SD-affected hair collected from both the lesional and perilesional regions. The changes in the hair shaft affected SD was measured using AFM non-invasively. AFM could be a useful tool in monitoring the treatment response and the severity of SD. © 2011 John Wiley & Sons A/S.

  19. Comparative study of actinic keratosis treatment with 3% diclofenac sodium and 5% 5-fluorouracil*

    PubMed Central

    Segatto, Majoriê Mergen; Dornelles, Sérgio Ivan Torres; Silveira, Vera Bauer; Frantz, Gabriela de Oliveira

    2013-01-01

    BACKGROUND Actinic keratosis is a frequent lesion which occurs in sunlight exposed areas. Diclofenac sodium and 5-Fluorouracil are effective, non-invasive and easy-to-apply topical treatment options. OBJECTIVES To assess and compare the effectiveness of 3% diclofenac sodium associated with 2.5% hyaluronic acid and of 5% 5-Fluorouracil for the treatment of actinic keratosis, as well as the patient's degree of satisfaction and tolerability. METHODS 28 patients with a clinical diagnosis of actinic keratosis were randomized to receive diclofenac sodium or 5-Fluorouracil and were clinically assessed before and after treatment as well as 8 weeks after the end of treatment. Modified versions of the Investigator and Patient Global Improvement Scores were used. RESULTS The average number of lesions in the diclofenac sodium group before and after treatment was 13.6 and 6.6 (p<0,001), respectively, while it was 17.4 and 3.15 (p<0.001) in the 5-Fluorouracil group. There was a significant reduction in the number of lesions in the 5-Fluorouracil group in relation to the diclofenac sodium group (p<0.001). To the non-blinded physician, there was a higher satisfactory therapeutic response in the 5-Fluorouracil group (p<0.001); to the blinded physician, there was a higher satisfactory response in this same group, although not statistically significant (p=0.09). There was a high degree of satisfaction in both groups (73% in the diclofenac sodium group and 77% in the 5-Fluorouracil group; p=0.827). Regarding adverse effects, the diclofenac sodium group presented a higher degree of satisfaction (93.3% vs 38.4%; p=0.008). Erythema, edema, crusts and itching were significantly higher in the 5-Fluorouracil group. CONCLUSION We concluded that 5-Fluorouracil was more effective; however, it showed lower tolerability than diclofenac sodium. PMID:24173178

  20. Evaluation of the therapeutic results of actinic keratosis treated with topical 5% fluorouracil by reflectance confocal laser microscopy: preliminary study*

    PubMed Central

    Ishioka, Priscila; Maia, Marcus; Rodrigues, Sarita Bartholomei; Marta, Alessandra Cristina; Hirata, Sérgio Henrique

    2015-01-01

    Topical treatment for actinic keratosis with 5% fluorouracil has a recurrence rate of 54% in 12 months of follow-up. This study analyzed thirteen actinic keratoses on the upper limbs through confocal microscopy, at the time of clinical diagnosis and after 4 weeks of treatment with fluorouracil. After the treatment was established and evidence of clinical cure was achieved, in two of the nine actinic keratoses, confocal microscopy enabled visualization of focal areas of atypical honeycomb pattern in the epidermis indicating therapeutic failure. Preliminary data suggest the use of confocal microscopy as a tool for diagnosis and therapeutic control of actinic keratosis. PMID:26131881

  1. Keratosis follicularis spinulosa decalvans: confirmation of linkage to Xp22.13-p22.2.

    PubMed

    Porteous, M E; Strain, L; Logie, L J; Herd, R M; Benton, E C

    1998-04-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare, X linked disorder with skin and eye involvement (MIM 308800). We have studied a large British family with KFSD using polymorphic markers from Xp21-p23 and obtained a lod score of 2.056 at theta=0 with markers proximal and distal to the KFSD candidate region Xp22.13-p22.2 identified by Oosterwijk et al. Our data confirm the linkage to Xp22.13-p22.2 observed in the previously reported Dutch family, but fail to narrow the candidate interval for the KFSD locus.

  2. Keratosis follicularis spinulosa decalvans: confirmation of linkage to Xp22.13-p22.2.

    PubMed Central

    Porteous, M E; Strain, L; Logie, L J; Herd, R M; Benton, E C

    1998-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare, X linked disorder with skin and eye involvement (MIM 308800). We have studied a large British family with KFSD using polymorphic markers from Xp21-p23 and obtained a lod score of 2.056 at theta=0 with markers proximal and distal to the KFSD candidate region Xp22.13-p22.2 identified by Oosterwijk et al. Our data confirm the linkage to Xp22.13-p22.2 observed in the previously reported Dutch family, but fail to narrow the candidate interval for the KFSD locus. PMID:9598732

  3. Folliculitis spinulosa decalvans: an uncommon entity within the keratosis pilaris atrophicans spectrum.

    PubMed

    Di Lernia, Vito; Ricci, Cinzia

    2006-01-01

    Folliculitis spinulosa decalvans is an uncommon condition characterized by follicular hyperkeratosis, followed by scarring alopecia. We report a 12-year-old boy affected by keratotic papules of the scalp and keratosis pilaris of the limbs who developed erythema, pustules, and scale crusts on the scalp associated with scarring alopecia. Histologic examination showed follicular and interfollicular hyperkeratosis, follicular plugging, mild inflammation, and focal scarring. A transient remission of the inflammatory changes on the scalp was obtained after treatment with isotretinoin. The follicular spinulous hyperkeratosis persisted. A severe relapse of the scalp inflammation was observed during a 2-year follow-up.

  4. Treatment of irritable bowel syndrome.

    PubMed

    Hadley, Susan K; Gaarder, Stephen M

    2005-12-15

    Irritable bowel syndrome affects 10 to 15 percent of the U.S. population to some degree. This condition is defined as abdominal pain and discomfort with altered bowel habits in the absence of any other mechanical, inflammatory, or biochemical explanation for these symptoms. Irritable bowel syndrome is more likely to affect women than men and is most common in patients 30 to 50 years of age. Symptoms are improved equally by diets supplemented with fiber or hydrolyzed guar gum, but more patients prefer hydrolyzed guar gum. Antispasmodic agents may be used as needed, but anticholinergic and other side effects limit their use in some patients. Loperamide is an option for treatment of moderately severe diarrhea. Antidepressants have been shown to relieve pain and may be effective in low doses. Trials using alosetron showed a clinically significant, although modest, gain over placebo, but it is indicated only for women with severe diarrhea-predominant symptoms or for those in whom conventional treatment has failed. Tegaserod has an advantage over placebo in constipation-predominant irritable bowel syndrome; it is indicated for up to 12 weeks of treatment in women. However, postmarketing reports of severe diarrhea and ischemic colitis further limit its use. Herbal therapies such as peppermint oil also may be effective in the treatment of irritable bowel syndrome. Therapies should focus on specific gastrointestinal dysfunctions (e.g., constipation, diarrhea, pain), and medications only should be used when nonprescription remedies do not work or when symptoms are severe.

  5. Efficacy and Safety of a Low-Molecular Weight Hyaluronic Acid Topical Gel in the Treatment of Facial Seborrheic Dermatitis

    PubMed Central

    Rowland Powell, Callie

    2012-01-01

    Objective: Hyaluronic acid sodium salt gel 0.2% is a topical device effective in reducing skin inflammation. Facial seborrheic dermatitis, characterized by erythema and or flaking/scaling in areas of high sebaceous activity, affects up to five percent of the United States population. Despite ongoing studies, the cause of the condition is yet unknown, but has been associated with yeast colonization and resultant immune-derived inflammation. First-line management typically is with topical steroids as well as the immunosuppressant agents pimecrolimus and tacrolimus. The objective of this study was to evaluate the efficacy and safety of a topical anti-inflammatory containing low-molecular weight hyaluronic acid. Design and setting: Prospective, observational, non-blinded safety and efficacy study in an outpatient setting. Participants: Individuals 18 to 75 years of age with facial seborrheic dermatitis. Measurements: Outcome measures included scale, erythema, pruritus, and the provider global assessment, which were all measured on a five-point scale. Subjects were assessed at Baseline, Week 2, Week 4, and Week 8. Results: Interim data for 7 of 15 subjects are presented. Hyaluronic acid sodium salt gel 0.2% was shown through visual grading assessments to improve the provider global assessment by 47.62 percent from Baseline to Week 4. Reductions in scale, erythema, and pruritus were 66.67, 50, and 60 percent, respectively at Week 4. At Week 8, the provider global assessment was improved from baseline in 100 percent of subjects. Conclusion: Treatment with topical low-molecular weight hyaluronic acid resulted in improvement in the measured endpoints. Topical low-molecular weight hyaluronic acid is another option that may be considered for the treatment of facial seborrheic dermatitis in the adult population. Compliance and tolerance were excellent. PMID:23125886

  6. Treatment of macular seborrheic keratoses using a novel 1927-nm fractional thulium fiber laser.

    PubMed

    Polder, Kristel D; Mithani, Anum; Harrison, April; Bruce, Suzanne

    2012-07-01

    Macular seborrheic keratoses (SK) are common, benign growths. A novel fractionated 1927-nm thulium fiber laser was selected to investigate efficacy and safety in the clearance of macular SK in nonfacial areas at a private dermatologic laser center. Six subjects (average age 56.8 ± 9.5) with at least four 3-mm or larger macular SK on one extremity, neck, or chest were enrolled and provided informed consent. Subjects received three treatments at 3- to 4-week intervals. Subjects were treated at settings of 10 to 20 mJ with 30% to 55% surface area coverage and four to eight passes at each session. Investigators performed a global extremity SK count, an SK count within a 5- by 5-cm (25 cm(2)) square on transparency mapping, and lesion thickness grading. Side effects were assessed. Patients rated pain using a visual analog scale. At baseline, average global SK count was 43.2 ± 27.3. At 1-month follow-up, 20.7 ± 16.6 lesions remained. At 3- and 6-month follow-up, 17.7 ± 23.8 and 14.7 ± 18.6 lesions remained, respectively. A decrease in thickness and SK counts within the 5- by 5-cm square was also observed. Moderate erythema and mild edema were post-treatment responses. Nonablative fractional resurfacing using the 1927-nm thulium fiber laser is a safe and effective treatment modality to decrease nonfacial macular SK. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  7. Maintenance Therapy of Facial Seborrheic Dermatitis with 0.1% Tacrolimus Ointment

    PubMed Central

    Kim, Hye One; Yang, Yoon Seok; Ko, Hyun Chang; Kim, Gyung Moon; Cho, Sang Hyun; Seo, Young Joon; Son, Sang Wook; Lee, Jong Rok; Lee, Joong Sun; Chang, Sung Eun; Che, Jae We

    2015-01-01

    Background Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment. Objective The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD. Methods During the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect. Results The time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well. Conclusion The results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations. PMID:26512166

  8. Comparison of three light doses in the photodynamic treatment of actinic keratosis using mathematical modeling

    NASA Astrophysics Data System (ADS)

    Vignion-Dewalle, Anne-Sophie; Betrouni, Nacim; Tylcz, Jean-Baptiste; Vermandel, Maximilien; Mortier, Laurent; Mordon, Serge

    2015-05-01

    Photodynamic therapy (PDT) is an emerging treatment modality for various diseases, especially for cancer therapy. Although high efficacy is demonstrated for PDT using standardized protocols in nonhyperkeratotic actinic keratoses, alternative light doses expected to increase efficiency, to reduce adverse effects or to expand the use of PDT, are still being evaluated and refined. We propose a comparison of the three most common light doses in the treatment of actinic keratosis with 5-aminolevulinic acid PDT through mathematical modeling. The proposed model is based on an iterative procedure that involves determination of the local fluence rate, updating of the local optical properties, and estimation of the local damage induced by the therapy. This model was applied on a simplified skin sample model including an actinic keratosis lesion, with three different light doses (red light dose, 37 J/cm2, 75 mW/cm2, 500 s blue light dose, 10 J/cm2, 10 mW/cm2, 1000 s and daylight dose, 9000 s). Results analysis shows that the three studied light doses, although all efficient, lead to variable local damage. Defining reference damage enables the nonoptimal parameters for the current light doses to be refined and the treatment to be more suitable.

  9. Dermoscopy of Pigmented Actinic Keratosis of the Face: A Study of 232 Cases.

    PubMed

    Kelati, A; Baybay, H; Moscarella, E; Argenziano, G; Gallouj, S; Mernissi, F Z

    2017-07-11

    The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings' abnormalities (FSA) and follicular keratosis' abnormalities (FKA). FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p≤0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Effect of a low-fat diet on the incidence of actinic keratosis.

    PubMed

    Black, H S; Herd, J A; Goldberg, L H; Wolf, J E; Thornby, J I; Rosen, T; Bruce, S; Tschen, J A; Foreyt, J P; Scott, L W

    1994-05-05

    Actinic keratoses are premalignant lesions and are a sensitive and important manifestation of sun-induced skin damage. Studies in animals have shown that dietary fat influences the incidence of sun-induced skin cancer, but the effect of diet on the incidence of actinic keratosis in humans is not known. We randomly assigned 76 patients with nonmelanoma skin cancer either to continue their usual diet (control group) or to eat a diet with 20 percent of total caloric intake as fat (dietary-intervention group). For 24 months, the patients were examined for the presence of new actinic keratoses by physicians unaware of their assigned diets. At base line, the mean (+/- SD) percentage of caloric intake as fat was 40 +/- 4 percent in the control group and 39 +/- 3 percent in the dietary-intervention group. After 4 months of dietary therapy the percentage of calories as fat had decreased to 21 percent in the dietary-intervention group, and it remained below this level throughout the 24-month study period. The percentage of calories as fat in the control group did not fall below 36 percent at any time. The cumulative number of new actinic keratoses per patient from months 4 through 24 was 10 +/- 13 in the control group and 3 +/- 7 in the dietary-intervention group (P = 0.001). In patients with a history of nonmelanoma skin cancer, a low-fat diet reduces the incidence of actinic keratosis.

  11. Comparison of three light doses in the photodynamic treatment of actinic keratosis using mathematical modeling.

    PubMed

    Vignion-Dewalle, Anne-Sophie; Betrouni, Nacim; Tylcz, Jean-Baptiste; Vermandel, Maximilien; Mortier, Laurent; Mordon, Serge

    2015-05-01

    Photodynamic therapy (PDT) is an emerging treatment modality for various diseases, especially for cancer therapy. Although high efficacy is demonstrated for PDT using standardized protocols in nonhyperkeratotic actinic keratoses, alternative light doses expected to increase efficiency, to reduce adverse effects or to expand the use of PDT, are still being evaluated and refined. We propose a comparison of the three most common light doses in the treatment of actinic keratosis with 5-aminolevulinic acid PDT through mathematical modeling. The proposed model is based on an iterative procedure that involves determination of the local fluence rate, updating of the local optical properties, and estimation of the local damage induced by the therapy. This model was applied on a simplified skin sample model including an actinic keratosis lesion, with three different light doses (red light dose, 37 J∕cm2, 75 mW∕cm2, 500 s; blue light dose, 10 J∕cm2, 10 mW∕cm2, 1000 s; and daylight dose, 9000 s). Results analysis shows that the three studied light doses, although all efficient, lead to variable local damage. Defining reference damage enables the nonoptimal parameters for the current light doses to be refined and the treatment to be more suitable.

  12. IRRITABILITY IN CHILD AND ADOLESCENT ANXIETY DISORDERS

    PubMed Central

    Stoddard, Joel; Stringaris, Argyris; Brotman, Melissa A; Montville, Daniel; Pine, Daniel S; Leibenluft, Ellen

    2014-01-01

    Background Our objective was to compare self- and parent-reported irritability in youths with anxiety disorders, healthy youths, and those with mood disorders characterized by irritability. Irritability is a common but relatively understudied psychiatric symptom in child and adolescent anxiety disorders. In anxious youths, little is known about the severity of irritability, its impact on functioning, or the effect of informant source on reports of irritability. Methods We compared parent- and self-report forms of the Affective Reactivity Index (ARI), a validated measure of irritability, in youths ages 8–17 years with no psychopathology (healthy comparison, HC; n = 38), anxiety disorders (ANX; n = 42), bipolar disorder (BD; n = 35), or severe mood dysregulation (SMD; n = 61; a phenotype characterized by chronic, severely impairing irritability). Results Irritability was significantly higher in ANX than HC youths by both parent and self-report (partial η2 = 0.24 and 0.22, respectively, P’s < 0.001). Informant effects differed among ANX, BD, and SMD. Overall, parent-reported irritability was higher in BD with comorbid anxiety disorders and SMD with or without comorbid anxiety disorders than ANX (P’s < 0.007), but self-reported irritability was not significantly different among the three patient groups. Discussion By both parent and self-report, youths with anxiety disorders exhibit significantly more irritability and associated impairment than healthy subjects. Self-reported irritability in youths with anxiety disorders is comparable to that observed in youths with severe mood disorders, although parental reports of irritability differ among the disorders. Future research should examine the pathophysiology of anxiety-associated irritability, as well as its prognostic and treatment implications. PMID:23818321

  13. Comparative study of trichloroacetic acid vs. photodynamic therapy with topical 5-aminolevulinic acid for actinic keratosis of the scalp.

    PubMed

    Di Nuzzo, Sergio; Cortelazzi, Chiara; Boccaletti, Valeria; Zucchi, Alfredo; Conti, Maria Luisa; Montanari, Paola; Feliciani, Claudio; Fabrizi, Giuseppe; Pagliarello, Calogero

    2015-09-01

    Photodynamic therapy with 5-methyl-aminolevulinate and photodynamic therapy with trichloroacetic acid 50% are the two techniques utilized in the management of actinic keratosis. This study was planned to compare the efficacy, adverse effects, recurrence and cosmetic outcome of these option therapies in patients with multiple actinic keratosis of the scalp. Thirteen patients with multiple actinic keratosis were treated with one of the two treatments on half of the scalp at baseline, while the other treatment was performed on the other half 15 days apart, randomly. Efficacy, adverse effects, cosmetic outcome and recurrence were recorded at follow-up visit at 1, 3, 6 and 12 months. Photodynamic therapy with 5 methyl-aminolevulinate was more effective than trichloroacetic acid although less tolerated by patients as it was more painful. Early adverse effects were almost the same even if trichloroacetic acid leads also to crust formation and to a worse cosmetic outcome characterized by hypopigmentation. Recurrence was lower in the area treated with photodynamic therapy. Trichloroacetic acid 50% is less effective than photodynamic therapy with 5 methyl-aminolevulinate in the treatment of multiple actinic keratosis of the scalp although better tolerated by patients. As this technique is less painful and less expensive than photodynamic therapy, we hypothesize and suggest that more sequential treatments could lead to better results. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. The impact of the current United States guidelines on the management of actinic keratosis: is it time for an update?

    PubMed

    Martin, George

    2010-11-01

    Actinic keratosis is one of the most common diagnoses made by dermatologists. Many experts recommend treating all actinic keratoses because of their potential to progress to invasive squamous cell carcinoma. Physicians have a large armamentarium of actinic keratosis treatment modalities available to them, including destructive therapies, such as cryotherapy, curettage and electrodessication, chemical peels, photodynamic therapy, and topical therapies, including 5-fluorouracil, imiquimod, and diclofenac. In addition to standardized monotherapy regimens, combinations of two concomitant or sequential therapies and alternative topical dosing regimens have been studied in a number of clinical trials. Such therapeutic courses are used to maintain or enhance efficacy while improving tolerability, convenience, and/or patient adherence. This abundance of treatment options prompted development of several actinic keratosis management guidelines. Whereas two sets of treatment guidelines were published by European organizations within the past three years, the most recent United States-based guidelines for dermatologists were published by the American Academy of Dermatology in 1995. Because they are not up to date, the 1995 United States guidelines lack recent clinical developments and an evidence rating system and can no longer effectively guide practitioners. While there are benefits and potential limitations to developing an updated set of United States-based guidelines, there is a clearly defined need for a unified, comprehensive, evidence-based guideline approach to actinic keratosis treatment that balances the need to tailor long-term management of the disease to the needs of the individual patient.

  15. MAL Daylight Photodynamic Therapy for Actinic Keratosis: Clinical and Imaging Evaluation by 3D Camera.

    PubMed

    Cantisani, Carmen; Paolino, Giovanni; Pellacani, Giovanni; Didona, Dario; Scarno, Marco; Faina, Valentina; Gobello, Tommaso; Calvieri, Stefano

    2016-07-11

    Non-melanoma skin cancer is the most common skin cancer with an incidence that varies widely worldwide. Among them, actinic keratosis (AK), considered by some authors as in situ squamous cell carcinoma (SCC), are the most common and reflect an abnormal multistep skin cell development due to the chronic ultraviolet (UV) light exposure. No ideal treatment exists, but the potential risk of their development in a more invasive form requires prompt treatment. As patients usually present with multiple AK on fields of actinic damage, there is a need for effective, safe, simple and short treatments which allow the treatment of large areas. To achieve this, daylight photodynamic therapy (DL-PDT) is an innovative treatment for multiple mild actinic keratosis, well tolerated by patients. Patients allocated to the PDT unit, affected by multiple mild-moderate and severe actinic keratosis on sun-exposed areas treated with DL-PDT, were clinically evaluated at baseline and every three months with an Antera 3D, Miravex(©) camera. Clinical and 3D images were performed at each clinical check almost every three months. In this retrospective study, 331 patients (56.7% male, 43.3% female) were treated with DL-PDT. We observed a full clearance in more than two-thirds of patients with one or two treatments. Different responses depend on the number of lesions and on their severity; for patients with 1-3 lesions and with grade I or II AK, a full clearance was reached in 85% of cases with a maximum of two treatments. DL-PDT in general improved skin tone and erased sun damage. Evaluating each Antera 3D images, hemoglobin concentration and pigmentation, a skin color and tone improvement in 310 patients was observed. DL-PDT appears as a promising, effective, simple, tolerable and practical treatment for actinic damage associated with AK, and even treatment of large areas can be with little or no pain. The 3D imaging allowed for quantifying in real time the aesthetic benefits of DL

  16. MAL Daylight Photodynamic Therapy for Actinic Keratosis: Clinical and Imaging Evaluation by 3D Camera

    PubMed Central

    Cantisani, Carmen; Paolino, Giovanni; Pellacani, Giovanni; Didona, Dario; Scarno, Marco; Faina, Valentina; Gobello, Tommaso; Calvieri, Stefano

    2016-01-01

    Non-melanoma skin cancer is the most common skin cancer with an incidence that varies widely worldwide. Among them, actinic keratosis (AK), considered by some authors as in situ squamous cell carcinoma (SCC), are the most common and reflect an abnormal multistep skin cell development due to the chronic ultraviolet (UV) light exposure. No ideal treatment exists, but the potential risk of their development in a more invasive form requires prompt treatment. As patients usually present with multiple AK on fields of actinic damage, there is a need for effective, safe, simple and short treatments which allow the treatment of large areas. To achieve this, daylight photodynamic therapy (DL-PDT) is an innovative treatment for multiple mild actinic keratosis, well tolerated by patients. Patients allocated to the PDT unit, affected by multiple mild−moderate and severe actinic keratosis on sun-exposed areas treated with DL-PDT, were clinically evaluated at baseline and every three months with an Antera 3D, Miravex© camera. Clinical and 3D images were performed at each clinical check almost every three months. In this retrospective study, 331 patients (56.7% male, 43.3% female) were treated with DL-PDT. We observed a full clearance in more than two-thirds of patients with one or two treatments. Different responses depend on the number of lesions and on their severity; for patients with 1–3 lesions and with grade I or II AK, a full clearance was reached in 85% of cases with a maximum of two treatments. DL-PDT in general improved skin tone and erased sun damage. Evaluating each Antera 3D images, hemoglobin concentration and pigmentation, a skin color and tone improvement in 310 patients was observed. DL-PDT appears as a promising, effective, simple, tolerable and practical treatment for actinic damage associated with AK, and even treatment of large areas can be with little or no pain. The 3D imaging allowed for quantifying in real time the aesthetic benefits of DL

  17. Large-cell acanthoma is a solar lentigo.

    PubMed

    Roewert, H J; Ackerman, A B

    1992-04-01

    On the basis of a study of 54 specimens each of large-cell acanthoma, solar lentigo, reticulated seborrheic keratosis, and lichen planus-like keratosis, it is concluded that clinically, histopathologically, and biologically, large-cell acanthoma is a variant of solar lentigo, and solar lentigo (including the large-cell variant) is a stage in the evolution of reticulated seborrheic keratosis and of lichen planus-like keratosis.

  18. Eye irritation response of humans to formaldehyde

    SciTech Connect

    Bender, J.R.; Mullin, L.S.; Graepel, G.J.; Wilson, W.E.

    1983-01-01

    Human panelists sensitive to formaldehyde eye irritation were exposed to low concentrations of formaldehyde vapor (0.35 to 1.0 ppM) for 6 minutes. Eye irritation was evaluated by time to detection of the first trace of irritation and by subjective ranking of severity. Both time to response and severity appeared to be functions of formaldehyde concentration. Severity of response was above slight only with highest test concentration, 1.0 ppM.

  19. Skin irritation and sensitization: mechanisms and new approaches for risk assessment. 1. Skin irritation.

    PubMed

    Fluhr, J W; Darlenski, R; Angelova-Fischer, I; Tsankov, N; Basketter, D

    2008-01-01

    Cutaneous irritation presents a major health problem with serious social and occupational impact. The interaction between an irritant and the human skin depends on multiple factors: the intrinsic properties and the nature of the irritant itself, and specific individual- and environment-related variables. The main pathological mechanisms of irritancy include skin barrier disruption, induction of a cytokine cascade and involvement of the oxidative stress network; all of them resulting in a visible or subclinical inflammatory reaction. In vivo, different non-invasive parameters for the evaluation of skin irritation and irritant potential of compounds and their specific formulations have been introduced, such as epidermal barrier function, skin hydration, surface pH, lipid composition, skin colour and skin blood flow. The diverse physiological changes caused by irritating agents require implementation of a multiparametric approach in the evaluation of cutaneous irritancy.

  20. Keratosis follicularis spinulosa decalvans: a family study of seven male cases and six female carriers.

    PubMed

    van Osch, L D; Oranje, A P; Keukens, F M; van Voorst Vader, P C; Veldman, E

    1992-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare X linked disease which is characterised by follicular hyperkeratosis of the skin and corneal dystrophy. Seven male patients and six female carriers are described. Special attention has been paid to the dermatological and ophthalmic markers of KFSD in patients and carriers. The most prominent features present in the male patients were follicular hyperkeratosis, hyperkeratosis of the calcaneal regions of the soles, scarring alopecia of the scalp, absence of eyebrows and eyelashes, and corneal dystrophy accompanied by photophobia. They also had high cuticles on the fingernails which has not been described before. Carriers often have dry skin, minimal follicular hyperkeratosis, and mild hyperkeratosis of the calcaneal areas of the soles. Mild corneal dystrophy without photophobia was observed in one female carrier.

  1. Keratosis follicularis spinulosa decalvans: a family study of seven male cases and six female carriers.

    PubMed Central

    van Osch, L D; Oranje, A P; Keukens, F M; van Voorst Vader, P C; Veldman, E

    1992-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare X linked disease which is characterised by follicular hyperkeratosis of the skin and corneal dystrophy. Seven male patients and six female carriers are described. Special attention has been paid to the dermatological and ophthalmic markers of KFSD in patients and carriers. The most prominent features present in the male patients were follicular hyperkeratosis, hyperkeratosis of the calcaneal regions of the soles, scarring alopecia of the scalp, absence of eyebrows and eyelashes, and corneal dystrophy accompanied by photophobia. They also had high cuticles on the fingernails which has not been described before. Carriers often have dry skin, minimal follicular hyperkeratosis, and mild hyperkeratosis of the calcaneal areas of the soles. Mild corneal dystrophy without photophobia was observed in one female carrier. Images PMID:1552542

  2. Can video thermography improve differential diagnosis and therapy between basal cell carcinoma and actinic keratosis?

    PubMed

    Di Carlo, Aldo; Elia, Fulvia; Desiderio, Flora; Catricalà, Caterina; Solivetti, Francesco M; Laino, Luigi

    2014-01-01

    Various noninvasive techniques (dermoscopy, confocal microscopy, etc.) have been introduced to help the clinical diagnosis in nonmelanoma skin cancer. Among them, the high definition video thermographic technique (VTG) has recently been proposed. The aim of this study is to define the VTG patterns, respectively of actinic keratosis (AK) and basal cell carcinoma (BCC), and to compare these data with them of dermoscopy. The study included 36 patients with a total number of 135 lesions who underwent clinical, VTG, and dermoscopic examination. The VTG showed the presence of a hyperthermic pattern in all the cases of AK, while in the case of the BCC, the pattern was hypothermic. Dermoscopy also showed distinct pattern for AK and for BCC, but in 22% of them the data were not conclusive. Our study permits us to define two specific VTG patterns, BCC and AK respectively. © 2014 Wiley Periodicals, Inc.

  3. Pharmacogenetics in irritable bowel syndrome.

    PubMed

    Acosta, Andres; Camilleri, Michael

    2015-01-01

    Irritable bowel syndrome (IBS) is a chronic disease characterized by complex interactions between genetic predisposition and the environment. Current treatments for IBS are characterized by a highly variable response. Gene variations may result from insertions or deletions, gene rearrangements, splice variants or copy number variants, or, more commonly, from substitutions in the DNA of one (single nucleotide polymorphism [SNPs]) or more than one nucleotide. The objective of this editorial is to review the potential importance of pharmacogenetics in the treatment of IBS based on current evidence.

  4. [Non-irritating skin protector].

    PubMed

    Gago Fornells, Manuel; García González, R Fernando; Gaztelu Valdés, Victoriana

    2002-05-01

    In this article, the authors describe the multiple uses a non irritating cutaneous protector has as an effective tool against the aggressions which peri-lesion skin and other at risk skins suffer when they are subject to constant and direct contact with secretions and liquids resulting from the use of dressings based on wet cures, or systems of continence related to ostomias, or in those patients who suffer mixed incontinence where diaper rash makes it difficult to maintain and care for the skin.

  5. Keratosis pilaris

    MedlinePlus

    ... very dry skin, or who have atopic dermatitis (eczema). The condition is generally worse in winter and ... A.M. Editorial team. Related MedlinePlus Health Topics Eczema Skin Conditions Browse the Encyclopedia A.D.A. ...

  6. Mycosis fungoides patient accompanied actinic keratosis, actinic keratosis with squamous cell carcinoma transformation, and porokeratosis after NBUVB therapy - 1st case report and review of the literature.

    PubMed

    Zhao, Meng-Jie; Abdul-Fattah, Bilal; Qu, Xiao-Ying; Wang, Cui-Yan; Wang, Xia; Ran, Yi; Lai, Ting; Chen, Si-Yuan; Huang, Chang-Zheng

    2016-10-01

    Mycosis fungoides (MF) is the most common form of primary cutaneous T cell lymphoma. Narrowband ultraviolet B light (NBUVB) is used increasingly in treating MF because of its good toleration and well-established management. To discuss the risk factors and underlying pathogenic factors in the patients with secondary skin diseases after NBUVB therapy. We report in details the first case of a patient with MF accompanied with actinic keratosis (AK), AK with squamous cell carcinoma (SCC) transformation and porokeratosis after NBUVB therapy. Meanwhile, Sequence variants in tumor suppressor p53 gene in the patient's specimens were detected. A literature search of the key word "narrowband ultraviolet B light "and "side effects" was performed on PubMed, 14 cases of this entity were found. A total of 15 patients including our case were reviewed in this study and meaningful conclusion could be drawn. The mean age at diagnosis of secondary skin dermatoses after NBUVB therapy was 62.08 years with a male to female ratio of 2:1. The cases were reported more in Europeans than in Asians (2.75:1), and the Fitzpatrick skin type was mainly Ito III (12/15). The mean cumulative number and cumulative dose of UVB treatments were 43.71 and 42, 400 (mJ/cm), respectively. There was a positive relationship between Fitzpatrick skin type and cumulative dose of UVB treatments. Among the secondary skin diseases after NBUVB treatment, 12 were tumors, 2 were non-tumorous dermatoses. Only our patient presented with both. By polymerase chain reaction-single nucleotide polymorphism (PCR-SNP) analysis, C-G mutation of exon 4 of p53 was found in AK and MF specimens in our patient. To our knowledge, our case is the first MF patient accompanied with AK, AK with SCC transformation and Porokeratosis after NBUVB treatment. Lower Fitzpatrick skin type may be the risk factor of secondary skin diseases after NBUVB treatment.

  7. Irritable bowel syndrome: contemporary nutrition management strategies.

    PubMed

    Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E

    2014-09-01

    Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome.

  8. Pediatric Irritability: A Systems Neuroscience Approach.

    PubMed

    Leibenluft, Ellen

    2017-04-01

    Irritability, defined as an increased propensity to exhibit increased anger relative to one's peers, is a common clinical problem in youth. Irritability can be conceptualized as aberrant responses to frustration (where frustration is the emotional response to blocked goal attainment) and/or aberrant 'approach' responses to threat. Irritable youth show hyper-reactivity to threat mediated by dysfunction in amygdala, medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, and association cortex. Irritable youth also show abnormalities in reward learning, cognitive control, and responses to frustration. These abnormalities are mediated by circuitry that includes the inferior frontal gyrus (iFG), striatum, ACC, and parietal cortex. Effective treatments for irritability are lacking, but pathophysiological research could lead to more precisely targeted interventions.

  9. Epithelial Stem Cells of the Skin Contribute to the Histopathologic Umbrella-like Appearance in Actinic Keratosis.

    PubMed

    Mihara, Motoyuki

    2014-09-01

    Although the histopathologic umbrella-like appearance of the epidermis in actinic keratosis (AK) is well known, its histopathogenesis has remained unknown. The author suggests that the penetration depth of ultraviolet B (UVB) radiation can account for such a histopathologic feature by affecting specific epidermal stem cell pools, as the stem cells in the epidermis and the bulge stem cells and sebocyte stem cells in the mid-dermis reside at different depths.

  10. A strategy for skin irritation testing.

    PubMed

    Robinson, Michael K; Perkins, Mary A

    2002-03-01

    Skin irritation safety testing and risk assessment for new products, and the ingredients they contain, is a critical requirement before market introduction. In the past, much of this skin testing required the use of experimental animals. However, new current best approaches for skin corrosion and skin irritation testing and risk assessment are being defined, obviating the need for animal test methods. Several in vitro skin corrosion test methods have been endorsed after successful validation and are gaining acceptance by regulatory authorities. In vitro test methods for acute, cumulative (repeat exposure), and chronic (prolonged exposure) skin irritation are under development. Though not yet validated, many are being used successfully for testing and risk assessment purposes as documented through an expanding literature. Likewise, a novel acute irritation patch test in human subjects is providing a valid and ethical alternative to animal testing for prediction of chemical skin irritation potential. An array of other human test methods also have been developed and used for the prediction of cumulative/chronic skin irritation and the general skin compatibility of finished products. The development of instrumental methods (e.g., transepidermal water loss, capacitance, and so on) has provided the means for analyzing various biophysical properties of human skin and changes in these properties caused by exposure to irritants. However, these methods do not directly measure skin inflammation. A recently introduced skin surface tape sampling procedure has been shown to detect changes in skin surface cytokine recovery that correlate with inflammatory skin changes associated with chemical irritant exposures or existing dermatitis. It holds promise for more objective quantification of skin irritation events, including subclinical (sensory) irritation, in the future.

  11. Probiotics and irritable bowel syndrome

    PubMed Central

    Dai, Cong; Zheng, Chang-Qing; Jiang, Min; Ma, Xiao-Yu; Jiang, Li-Juan

    2013-01-01

    Irritable bowel syndrome (IBS) is common gastrointestinal problems. It is characterized by abdominal pain or discomfort, and is associated with changes in stool frequency and/or consistency. The etiopathogenesis of IBS may be multifactorial, as is the pathophysiology, which is attributed to alterations in gastrointestinal motility, visceral hypersensitivity, intestinal microbiota, gut epithelium and immune function, dysfunction of the brain-gut axis or certain psychosocial factors. Current therapeutic strategies are often unsatisfactory. There is now increasing evidence linking alterations in the gastrointestinal microbiota and IBS. Probiotics are living organisms which, when ingested in certain numbers, exert health benefits beyond inherent basic nutrition. Probiotics have numerous positive effects in the gastrointestinal tract. Recently, many studies have suggested that probiotics are effective in the treatment of IBS. The mechanisms of probiotics in IBS are very complex. The purpose of this review is to summarize the evidence and mechanisms for the use of probiotics in the treatment of IBS. PMID:24106397

  12. Probiotics and irritable bowel syndrome.

    PubMed

    Dai, Cong; Zheng, Chang-Qing; Jiang, Min; Ma, Xiao-Yu; Jiang, Li-Juan

    2013-09-28

    Irritable bowel syndrome (IBS) is common gastrointestinal problems. It is characterized by abdominal pain or discomfort, and is associated with changes in stool frequency and/or consistency. The etiopathogenesis of IBS may be multifactorial, as is the pathophysiology, which is attributed to alterations in gastrointestinal motility, visceral hypersensitivity, intestinal microbiota, gut epithelium and immune function, dysfunction of the brain-gut axis or certain psychosocial factors. Current therapeutic strategies are often unsatisfactory. There is now increasing evidence linking alterations in the gastrointestinal microbiota and IBS. Probiotics are living organisms which, when ingested in certain numbers, exert health benefits beyond inherent basic nutrition. Probiotics have numerous positive effects in the gastrointestinal tract. Recently, many studies have suggested that probiotics are effective in the treatment of IBS. The mechanisms of probiotics in IBS are very complex. The purpose of this review is to summarize the evidence and mechanisms for the use of probiotics in the treatment of IBS.

  13. Contact dermatitis: allergic and irritant.

    PubMed

    Tan, Cher-Han; Rasool, Sarah; Johnston, Graham A

    2014-01-01

    Facial contact dermatitis is frequently encountered in medical practice in both male and female patients. Identifying the underlying cause can be challenging, and the causative agent may be overlooked if it is not considered during the assessment of a patient. The two main types of contact dermatitis are irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). The mechanisms and common causative agents vary for both ICD and ACD, but the clinical picture is often similar, particularly for chronic disease. Facial contact dermatitis can be successfully treated by avoiding the causative agent. In this review, we focus on the clinical assessment of a patient with facial contact dermatitis and the mechanisms of both ICD and ACD. Common causative agents, including emerging allergens, are discussed in detail, and suggestions are made regarding the management of patients with proven ICD or ACD of the face.

  14. IN VIVO EVALUATION OF SKIN IRRITATION POTENTIAL, MELASMA AND SEBUM CONTENT FOLLOWING LONG TERM APPLICATION OF SKIN CARE CREAM IN HEALTHY ADULTS, USING NON-INVASIVE BIOMETROLOGICAL TECHNIQUES.

    PubMed

    Arshad, Atif I; Khan, Shoaib H M; Akhtar, Naveed; Mahmood, Asif; Sarfraz, Rai Muhammad

    2016-01-01

    The present investigation was conducted to evaluate non-invasively, various functional skin parameters i.e., irritation potential, melasma and sebum contents following long term application of topical cream (w/o) loaded with 2% methanolic extract of Ananas comosus L. versus placebo control (base) in healthy adults. Healthy human volunteers (n = 11, aged 20-30 years) were recruited for investigation and written informed consent was taken from each volunteer. In this single blinded study every volunteer applied formulation on one side of face and placebo on the other side of face twice daily for a period of 12 weeks (three months). Different skin parameters i.e., skin irritancy, melasma, and sebum contents were measured on both sides of face at baseline and after two weeks interval, using photometric device Mexameter and Sebumeter in a draught free room with modulated conditions of temperature (22-25°C) and humidity (55-60%). It was evident from the results that no primary skin irritancy was observed with patch test. Besides, statistical interpretation indicates that treatment with formulation is superior to placebo because it significantly (p ≤ 0.05) reduced the skin irritancy, melasma and sebum secretions throughout the study and reaching maximum -20.76 ± 0.89, -54.2 ± 0.37 and -40.71 ± 0.75%, respectively, at the end of study period. Antioxidant activity of extract was 92% compared to standard antioxidant. Conclusively, active cream loaded with fruit extract was well tolerated by all the volunteers and suitable to treat contact dermatitis, greasy skin, acne and seborrheic dermatitis and augmenting beauty and attraction by depigmentation of human skin. So, in the future, there is need to clinically evaluate these formulations in patients with compromised skin functions i.e., contact dermatitis, melasma, and acne vulgaris in order to explore the actual potential of this fruit.

  15. Treatment of irritable bowel syndrome.

    PubMed

    Trinkley, K E; Nahata, M C

    2011-06-01

    The complexity and diversity of irritable bowel syndrome's (IBS) presentation make treatment difficult. Although there are reviews and guidelines for treating IBS, they focus on the efficacy of medications for IBS symptoms using high-priority endpoints, leaving those of lower priority largely unreported. Therefore, the aim of this review is to provide a comprehensive evidence-based review of the efficacy of medications to treat IBS symptoms, reported by IBS subtype, including secondary symptom endpoints that are often underreported. A review of PubMed for articles published through December 2009 using the keywords: 'irritable bowel syndrome', 'therapeutics', 'antidiarrhoeals', 'laxatives', 'loperamide', 'dietary fibre', 'psyllium', 'calcium polycarbophil', 'bulking agents', 'lubiprostone', 'antidepressant agents, tricyclics' and its representative entities, 'serotonin reuptake inhibitors' and its representative entities, 'dicyclomine', hyoscyamine', 'peppermint oil', 'parasympatholytics' and its representative entities, 'rifaximin', 'pregabalin', 'gabapentin', 'clonidine', 'octreotide', 'atropine' and 'probiotics' is provided. Placebo-controlled trials were evaluated for the strength of evidence supporting the efficacy of each medication for explicit IBS symptoms. The efficacy of each medication for the symptoms of abdominal pain, bloating, stool form, mucus, urgency, feeling of incomplete evacuation, flatulence, frequency, or borborgymi and overall symptoms are reported by IBS subtype. The literature search identified 58 placebo-controlled trials of the efficacy of medications for treating IBS symptoms, which were critically evaluated and reported. The available studies suggest improvement in various IBS symptoms with loperamide, fibre supplements, lubiprostone, tricyclic antidepressants (TCAs), selective serotonin receptor inhibitors (SSRIs), antispasmotics, rifaximin, pregabalin, gabapentin, clonidine, octreotide and probiotic treatments. This review is the

  16. p16INK4a expression in actinic keratosis and Bowen's disease.

    PubMed

    Salama, M E; Mahmood, M N; Qureshi, H S; Ma, C; Zarbo, R J; Ormsby, A H

    2003-11-01

    Progression of cutaneous squamous neoplasms from actinic keratosis (AK) to Bowen's disease (BD; squamous cell carcinoma in situ) has important implications for clinical management and treatment, thus requiring accurate diagnosis. p16INK4a is a cell cycle regulatory tumour suppressor protein that negatively regulates D-type cyclins in the G1 cell cycle phase via intimate interplay with the retinoblastoma gene. Expression of a paraffin-reactive p16INK4a marker has recently been shown to increase in cervical squamous neoplasms as lesions progress from low-grade dysplasia to squamous cell carcinoma in situ. p16INK4a expression in the progression of squamous cutaneous neoplasia, however, has not been evaluated. To evaluate p16INK4a expression in the progression of squamous cutaneous neoplasia. Biopsies of 203 squamous cutaneous neoplasms with unequivocal features of AK (n = 87) and BD (n = 116) as well as a benign squamous control group (verruca vulgaris: n = 10; seborrhoeic keratosis: n = 11; scar tissue: n = 8) obtained between January and December 2001 at Henry Ford Hospital (Detroit, MI, U.S.A.) were immunostained for p16INK4a (Dako; clone E6H4; dilution 1 : 50) using large core (1.5 mm) tissue microarray analysis. Nuclear/cytoplasmic immunoreactivity in > 10% of neoplastic cells was considered positive. Of 203 cases, 166 (81.8%) were interpretable (AK 59; BD 107). Mean patient age was 71.0 years (range 33-93); 57% were male. Sites of involvement were: head and extremities 75.9%, trunk/buttocks 21.7%, genital region 2.4%. p16INK4a immunostaining was positive in 90 of 107 (84.1%) BD cases, four of 59 (6.8%) AK cases and none of 29 benign squamous controls. The sensitivity and specificity of p16INK4a for a diagnosis of BD (vs. benign squamous controls/AK) was 84.1% and 95.5%, respectively (P < 0.0001, Fisher's exact test, two-sided). p16INK4a is a sensitive and specific marker for distinguishing BD from AK/benign squamous cutaneous lesions and may be helpful as an

  17. Mycosis fungoides patient accompanied actinic keratosis, actinic keratosis with squamous cell carcinoma transformation, and porokeratosis after NBUVB therapy – 1st case report and review of the literature

    PubMed Central

    Zhao, Meng-jie; Abdul-fattah, Bilal; Qu, Xiao-ying; Wang, Cui-yan; Wang, Xia; Ran, Yi; Lai, Ting; Chen, Si-yuan; Huang, Chang-zheng

    2016-01-01

    Abstract Introduction: Mycosis fungoides (MF) is the most common form of primary cutaneous T cell lymphoma. Narrowband ultraviolet B light (NBUVB) is used increasingly in treating MF because of its good toleration and well-established management. Concerns: To discuss the risk factors and underlying pathogenic factors in the patients with secondary skin diseases after NBUVB therapy. Methods: We report in details the first case of a patient with MF accompanied with actinic keratosis (AK), AK with squamous cell carcinoma (SCC) transformation and porokeratosis after NBUVB therapy. Meanwhile, Sequence variants in tumor suppressor p53 gene in the patient's specimens were detected. A literature search of the key word “narrowband ultraviolet B light ”and “side effects” was performed on PubMed, 14 cases of this entity were found. A total of 15 patients including our case were reviewed in this study and meaningful conclusion could be drawn. Outcomes: The mean age at diagnosis of secondary skin dermatoses after NBUVB therapy was 62.08 years with a male to female ratio of 2:1. The cases were reported more in Europeans than in Asians (2.75:1), and the Fitzpatrick skin type was mainly Ito III (12/15). The mean cumulative number and cumulative dose of UVB treatments were 43.71 and 42, 400 (mJ/cm2), respectively. There was a positive relationship between Fitzpatrick skin type and cumulative dose of UVB treatments. Among the secondary skin diseases after NBUVB treatment, 12 were tumors, 2 were non-tumorous dermatoses. Only our patient presented with both. By polymerase chain reaction-single nucleotide polymorphism (PCR-SNP) analysis, C–G mutation of exon 4 of p53 was found in AK and MF specimens in our patient. Conclusion: To our knowledge, our case is the first MF patient accompanied with AK, AK with SCC transformation and Porokeratosis after NBUVB treatment. Lower Fitzpatrick skin type may be the risk factor of secondary skin diseases after NBUVB treatment. PMID

  18. Irritability in Pediatric Patients: Normal or Not?

    PubMed Central

    Hameed, Usman; Dellasega, Cheryl A.

    2016-01-01

    The goal of this article is to describe the concept of irritability in children and youth, which has been revisited in the DSM-5. Traditionally, this behavior has been more commonly associated with mood disorders, which may account for the rising incidence of bipolar disorder diagnosis and overuse of mood-stabilizing medications in pediatric patients. While not predictive of mania, persistent nonepisodic irritability, if undetected, may escalate to violent behavior with potentially serious outcomes. It is therefore important to educate clinicians about how to accurately assess irritability in pediatric patients. PMID:27486529

  19. [Spotlight on sensory irritation and its treatment].

    PubMed

    Piérard-Franchimont, C; Piérard, G E

    2005-10-01

    Sensory irritation is directly bound to the concept of sensitive skin. A large proportion of the population, in particular young women, is affected. The reported symptoms are those of skin discomfort without any visible alteration of the skin. According to the subjects, the timing and the cutaneous sites, various perceptions occur, including pruritus, burning and stinging sensations. Sensory irritation is difficult to quantify because it remains subjective by essence. The condition is sometimes aggravated by some cosmetics, cleaning and cleansing products, wool contact and exposure to cold and dry climate. The responsible ingredients are often agents affecting functions of stratum corneum without being obvious chemical irritants.

  20. Seborrheic Keratoses as the First Sign of Bladder Carcinoma: Case Report of Leser-Trélat Sign in a Rare Association with Urinary Tract Cancer

    PubMed Central

    Rosario, Bernardo Augusto; Mayer, Bruna Loise; Frandoloso, Gibran Avelino; Magalhães, Francisco Luiz Gomide Mafra; Marques, Gustavo Lenci

    2016-01-01

    Introduction. Skin disorders can be the first manifestation of occult diseases. The recognition of typical paraneoplastic dermatoses may anticipate the cancer diagnosis and improve its prognosis. Although rarely observed, the sudden appearance and/or rapid increase in number and size of seborrheic keratoses can be associated with malignant neoplasms, known as the sign of Leser-Trélat. The aim of this report is to unveil a case of a patient whose recently erupted seborrheic keratoses led to investigation and consequent diagnosis of bladder cancer. Case Presentation. A 67-year-old man was admitted to the intensive care unit due to an exacerbation of chronic obstructive pulmonary disease (COPD). On physical examination, multiple seborrheic keratoses on the back of the hands, elbows, and trunk were observed; the patient had a 4-month history of these lesions yet was asymptomatic. The possibility of Leser-Trélat syndrome justified the investigation for neoplasia, and a bladder carcinoma was detected by CT-scan. The patient denied previous hematuria or any other related symptoms. Many of the lesions regressed during oncologic treatment. Conclusion. Despite the critics on the validity of the sign of Leser-Trélat, our patient fulfills the description of the disease, though urinary malignancy is a rare association. That corroborates the need of further investigation when there is a possibility of paraneoplastic manifestation. PMID:27999595

  1. Ingenol mebutate in low amounts for the treatment of actinic keratosis in Korean patients.

    PubMed

    Joe, Hyun Jae; Oh, Byung Ho

    2017-01-01

    Ingenol mebutate (IM), a novel agent for field therapy of actinic keratosis (AK), has a drawback of inducing local skin reactions (LSRs), which may cause discomfort in patients. To reduce the LSRs, we tried the application of IM in low amounts. The purpose of this study was to review Korean patients with AK being treated with IM and evaluate the LSRs and therapeutic outcomes of low amounts of IM. We retrospectively reviewed 47 patients with AK on the face. A total of 20 and 27 patients were treated by applying recommended amount of 18.8 mg/cm(2) and the lower amount of 10 mg/cm(2), respectively. The mean composite LSR score for the low amount group (LAG; 12.18±3.29) was significantly lower than that for the recommended amount group (RAG; 15.45±2.70) (P<0.01, independent sample t-test). The 2-month clearance rate calculated by the number of AKs before and after treatment in each patient was significantly higher for RAG (88.16%), compared with 75.56% for LAG (P<0.001). Low amount of IM for the treatment of facial AK significantly reduced LSRs in Korean patients. Minimizing LSRs may allow for a secondary targeting treatment of IM for the residual lesions, depending on initial treatment outcomes.

  2. Atopic dermatitis is not associated with actinic keratosis: cross-sectional results from the Rotterdam study.

    PubMed

    Hajdarbegovic, E; Blom, H; Verkouteren, J A C; Hofman, A; Hollestein, L M; Nijsten, T

    2016-07-01

    Epidermal barrier impairment and an altered immune system in atopic dermatitis (AD) may predispose to ultraviolet-induced DNA damage. To study the association between AD and actinic keratosis (AK) in a population-based cross-sectional study. AD was defined by modified criteria of the U.K. working party's diagnostic criteria. AKs were diagnosed by physicians during a full-body skin examination, and keratinocyte cancers were identified via linkage to the national pathology database. The results were analysed in adjusted multivariable and multinomial models. A lower proportion of subjects with AD had AKs than those without AD: 16% vs. 24%, P = 0·002; unadjusted odds ratio (OR) 0·60, 95% confidence interval (CI) 0·42-0·83; adjusted OR 0·74, 95% CI 0·51-1·05; fully adjusted OR 0·69, 95% CI 0·47-1·07. In a multinomial model patients with AD were less likely to have ≥ 10 AKs (adjusted OR 0·28, 95% CI 0·09-0·90). No effect of AD on basal cell carcinoma or squamous cell carcinoma was found: adjusted OR 0·71, 95% CI 0·41-1·24 and adjusted OR 1·54, 95% CI 0·66-3·62, respectively. AD in community-dwelling patients is not associated with AK. © 2016 British Association of Dermatologists.

  3. Laser-mediated Photodynamic Therapy: An Alternative Treatment for Actinic Keratosis?

    PubMed

    Kessels, Janneke P H M; Nelemans, Patty J; Mosterd, Klara; Kelleners-Smeets, Nicole W J; Krekels, Gertruud A M; Ostertag, Judith U

    2016-03-01

    Photodynamic therapy (PDT) with light emitting diode (LED) illumination is a frequently used treatment modality for actinic keratosis (AK) with excellent cosmetic outcome. A major disadvantage, however, is the high pain score. Pulsed dye laser (PDL) illumination has been suggested, but the long-term efficacy of this treatment is unknown. In this split-face study we prospectively treated 61 patients with AK, with both LED-PDT and PDL-PDT. The mean change in the number of lesions between the end of follow-up and start of therapy was -4.25 (95% confidence interval (95% CI) -5.07; -3.43) for LED-PDT and -3.88 (95% CI -4,76; -2.99) for PDL-PDT, with a non-significant difference (p = 0.258) of -0.46 (95% CI -1.28; 0.35). The percentage decrease from baseline in the total number of AK was 55.8% and 47.8%, respectively, at 12-month follow-up. Visual analogue scale pain score was lower after PDL (mean 2.64) compared with LED illumination (mean 6.47). These findings indicate that PDL-PDT is an effective alternative illumination source fo.

  4. Predisposing factors of actinic keratosis in a North-West German population.

    PubMed

    Hensen, Peter; Müller, Marcel L; Haschemi, Ramin; Ständer, Hartmut; Luger, Thomas A; Sunderkötter, Cord; Schiller, Meinhard

    2009-01-01

    The growing incident rates of skin cancer and their corresponding precursor lesions, e.g. actinic keratosis (AK), among Caucasians have become an important public health problem. A multicenter case-control study was conducted to identify the risk factors of AK of a prototypical Central European population. The study population comprised a total of 331 cases and 383 controls. Using multivariate analysis we identified ten independent variables predicting the AK risk. The five most crucial were age (OR 1.11; 95% CI 1.08-1,14), gender (OR 3.92; 95% CI 2.42-6.36), history of previous skin malignancies (OR 6.47; 95% CI 3.21-13.03), pale skin phototype (OR 2.5; 95% CI 1.53-4.06), and sun exposure for occupational reasons (OR 1.72; 95% CI 1.01-2.92). Additionally, sun exposure for recreational reasons, denial of the use of sunscreens, painful sunburn episodes before the age of 20, and a familial history of skin malignancies are also significant independent correlates of AK. Our epidemiological data suggest that constitutional susceptibility and sunlight exposure are equally involved in the onset of AK. Additional prophylactic and educational efforts should focus on increasing sun protection policies and educational programs especially aimed at outdoor workers, men, fair skinned individuals and patients with a history of previous skin malignancies. These measures should be able to reduce the excessive incidence rates of AK among Caucasians in Central Europe.

  5. Clinical effect of imiquimod 5% cream in the treatment of actinic keratosis.

    PubMed

    Persaud, Andrea N; Shamuelova, Eleonora; Sherer, Daniel; Lou, Wendy; Singer, Giselle; Cervera, Christina; Lamba, Sumedha; Lebwohl, Mark G

    2002-10-01

    Actinic keratosis (AK) is the earliest clinical manifestation of squamous cell carcinoma. Metastatic SCC causes the majority of the 1300 to 2300 deaths attributed to nonmelanoma skin cancer in the United States each year. Recent studies have shown that intralesional administration of interferon can be used successfully in the treatment of AK. Imiquimod is an immune response modifier, currently approved for the treatment of genital warts. The topically applied immune response modifier acts by up-regulating interferon and other cytokines involved in the cell-mediated immune response at the site of application. The aim of this was to determine the efficacy and safety of imiquimod 5% cream for the treatment of AK. Twenty-two patients with AK lesions were treated with imiquimod 5% cream, initially at 3 times per week for 8 weeks, or until total clearance of lesions. Patients applied imiquimod to lesions on one side of the body and vehicle cream to the other side. A total of 17 patients who completed treatment were evaluated for number of lesions and adverse reactions before treatment and at weeks 2, 4, 6, and 8 after initiation of treatment. AK lesions were also assessed 4 and 8 weeks after treatment. A significant reduction in the average number of lesions per patient was observed for patients treated with imiquimod. The most frequent reactions to treatment were erythema, itching, and scabbing; however, all adverse events were mild to moderate. Imiquimod 5% cream may be a promising treatment for AK.

  6. Pain evaluation in patients affected by cutaneous squamous cell carcinoma and actinic keratosis: an observational study.

    PubMed

    Dika, Emi; Vaccari, Sabina; Fanti, Pier A; Piraccini, Bianca M; Barisani, Alessia; Baraldi, Carlotta; Patrizi, Annalisa

    2017-10-01

    Pain is a frequent symptom in cancer patients. The aim of our study was to evaluate the presence of pain in histopathologically-diagnosed hypertrophic actinic keratosis (AK) or cutaneous squamous cell carcinoma (SCC). An observational study evaluating pain presence and intensity in skin cancer was performed, including patients affected either by SCC or by hypertrophic AK. Pain intensity was assessed using the 11-point Numeric Rating Scale, ranging from 0 (absence of pain) to 10 (most intense pain). Both spontaneous pain and pressure-related pain intensity, due to local digital pressure, were evaluated. In patients with SCC, spontaneous pain was present in 57.5% of the cases, while pressure-related pain was revealed in 80.0% of the cases. In hypertrophic AK patients, spontaneous pain was detected only in 15.0% of the cases, while pressure-related pain was present in 25.0% of the cases. A statistically significant difference between the 2 groups was found in the evaluation of spontaneous and pressure-related pain values, these values being significantly higher in the SCC group. No significant correlations between the degree of inflammation, the histotype or invasiveness of SCCs, and the intensity of pain were found. The recognition of pain as a symptom, more frequently associated with SCC, might prove useful in the clinical practice. Further research is needed, in order to better understand and characterize pain associated with different skin neoplasms.

  7. Reduced P53 Staining in Actinic Keratosis is Associated with Squamous Cell Carcinoma: A Preliminary Study

    PubMed Central

    Neto, Pimentel DR; Alchorne, MMA; Michalany, NS; Abreu, MAMM; Borra, RC

    2013-01-01

    Background: Actinic keratosis (AK) is a cutaneous neoplasm caused by prolonged sun exposure, and may progress into squamous cell carcinoma (SCC). The p53 gene plays a central role in the development of SCC, and mutations in this gene are found in 90% of SCC and up to 100% of AK cases. Objective: To identify AK cases that are highly susceptible to developing SCC. Materials and Methods: Fifty-six AK cases were classified into two groups: AK adjacent to “normal” skin and AK adjacent to SCC. The groups were compared based on epithelial atypia, inflammation, solar elastosis, histopathological AK classification and p53 protein expression. Results: Of the 56 AK cases analyzed, 23% were associated with SCC. The types of AK observed were classified as follows: common, hypertrophic, atrophic, acantholytic, pigmented and bowenoid. SCC was associated with common and hypertrophic AK, and p53 staining was observed in 78% of AK cases. The mean difference in p53 immunopositivity between common AK cases associated with SCC (17%) and not associated with SCC (45.4%) was significant (p=0.011). Conclusions: Hypertrophic and common AK are associated with SCC, and the low percentage of p53 immunopositivity in the common type indicates a greater probability of developing into SCC. PMID:23919015

  8. Expression of Podoplanin in Non-melanoma Skin Cancers and Actinic Keratosis.

    PubMed

    Wojciechowska-Zdrojowy, Marta; Szepietowski, Jacek C; Matusiak, Łukasz; Dzięgiel, Piotr; Puła, Bartosz

    2016-04-01

    Recent studies have indicated that expression of podoplanin changes during the neoplastic processes, we therefore aimed at assessing its expression in cancer and stromal cells of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and actinic keratosis (AK). Formalin-fixed paraffin-embedded tissue samples of 134 patients (38 BCC, 57 SCC, 20 AK and from 19 healthy volunteers) were analyzed. Podoplanin-immunoreactivity was detected in 32.1%/44.7%, 70%/20% and 87.7%/79% for BCC, AK and SCC tumour/stroma cells, respectively. Mean podoplanin expression in tumour cells was 1.2±1.8, 1.4±1.1 and 5.6±3.9 for BCC, AK and SCC, respectively. Mean podoplanin expression in stromal cells was 1.5±2.3, 0.65±1.57 and 3.2±2.4 for BCC, AK and SCC, respectively. Podoplanin expression was significantly higher in SCC stromal cells compared to the rest of the analyzed groups (p<0.001), suggesting a potential role of podoplanin in the development and progression of this malignancy. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  9. Ingenol mebutate in low amounts for the treatment of actinic keratosis in Korean patients

    PubMed Central

    Joe, Hyun Jae; Oh, Byung Ho

    2017-01-01

    Background Ingenol mebutate (IM), a novel agent for field therapy of actinic keratosis (AK), has a drawback of inducing local skin reactions (LSRs), which may cause discomfort in patients. To reduce the LSRs, we tried the application of IM in low amounts. Objective The purpose of this study was to review Korean patients with AK being treated with IM and evaluate the LSRs and therapeutic outcomes of low amounts of IM. Methods We retrospectively reviewed 47 patients with AK on the face. A total of 20 and 27 patients were treated by applying recommended amount of 18.8 mg/cm2 and the lower amount of 10 mg/cm2, respectively. Results The mean composite LSR score for the low amount group (LAG; 12.18±3.29) was significantly lower than that for the recommended amount group (RAG; 15.45±2.70) (P<0.01, independent sample t-test). The 2-month clearance rate calculated by the number of AKs before and after treatment in each patient was significantly higher for RAG (88.16%), compared with 75.56% for LAG (P<0.001). Conclusion Low amount of IM for the treatment of facial AK significantly reduced LSRs in Korean patients. Minimizing LSRs may allow for a secondary targeting treatment of IM for the residual lesions, depending on initial treatment outcomes. PMID:28408848

  10. Nuclear morphometry and molecular biomarkers of actinic keratosis, sun-damaged, and nonexposed skin.

    PubMed

    Carpenter, Philip M; Linden, Kenneth G; McLaren, Christine E; Li, Kuo-Tung; Arain, Shehla; Barr, Ronald J; Hite, Pamela; Sun, Joannie D; Meyskens, Frank L

    2004-12-01

    Computer-assisted image analysis is useful for quantifying the histologic and molecular changes of sun-induced squamous cell carcinoma progression. We used the CAS 200 image analysis system to measure nuclear morphometric parameters, p53 expression, and proliferation markers in actinic keratosis (AK), sun-exposed, and normal skin in 51 patients. Nuclear morphometry revealed significant increases in nuclear absorbance, irregularity of nuclear shape, and nuclear size in AK compared with normal and sun-damaged skin. These parameters showed significantly greater variability in AK nuclei. Argyrophyllic nucleolar organizer area and number were also significantly greater in AK compared with sun-damaged skin and normal skin. Ki67 and p53 expressions were both increased in sun-damaged skin relative to normal and greater still in AK. These data are evidence that sun damage induces proliferation and p53 abnormalities before the appearance of nuclear abnormalities and their associated DNA instability. Following these changes during a skin cancer chemopreventative trial can then help assess the efficacy of the agent and help determine where in the progression of neoplastic changes it exerts its biological effects.

  11. [Keratosis follicularis spinulosa decalvans. Therapy with isotretinoin and etretinate in the inflammatory stage].

    PubMed

    Richard, G; Harth, W

    1993-08-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare X-linked disorder of keratinization of the hair follicle associated with corneal dystrophy. The clinical picture is characterized by solid follicular hyperkeratosis, especially on the exposed skin, sparse eyebrows/eyelashes, follicular scaling and scarring alopecia of the scalp, dry skin and ocular symptoms with keratitis and photophobia. We describe the three stages of the disease: onset, inflammation and partial remission and the treatment appropriate in each. Two patients in the inflammatory stage of KFSD, with recurrent deep, fibrosing folliculitis and perifolliculitis followed by spreading and scarring alopecia on the scalp, responded to oral therapy with retinoids. In both cases there was a distinct and lasting remission of the inflammation and stabilization of the spreading alopecia after treatment with etretinate (Tigason), up to 0.8 mg/kg body weight, or isotretinoin (Roaccutan), 0.5 mg/kg body weight, for 12 weeks. The follicular spinulous hyperkeratosis became softer, but persisted. Thus, oral therapy with retinoids appears helpful in the inflammatory stage of KFSD, even though there is little improvement in the follicular hyperkeratosis.

  12. Keratosis Follicularis Spinulosa Decalvans is caused by mutations in MBTPS2.

    PubMed

    Aten, Emmelien; Brasz, Lisa C; Bornholdt, Dorothea; Hooijkaas, Ingeborg B; Porteous, Mary E; Sybert, Virginia P; Vermeer, Maarten H; Vossen, Rolf H A M; van der Wielen, Michiel J R; Bakker, Egbert; Breuning, Martijn H; Grzeschik, Karl-Heinz; Oosterwijk, Jan C; den Dunnen, Johan T

    2010-10-01

    Keratosis Follicularis Spinulosa Decalvans (KFSD) is a rare genetic disorder characterized by development of hyperkeratotic follicular papules on the scalp followed by progressive alopecia of the scalp, eyelashes, and eyebrows. Associated eye findings include photophobia in childhood and corneal dystrophy. Due to the genetic and clinical heterogeneity of similar disorders, a definitive diagnosis of KFSD is often challenging. Toward identification of the causative gene we reanalyzed a large Dutch KFSD family. SNP arrays (1 M) redefined the locus to a 2.9-Mb region at Xp22.12-Xp22.11. Screening of all 14 genes in the candidate region identified MBTPS2 as the candidate gene carrying a c.1523A>G (p.Asn508Ser) missense mutation. The variant was also identified in two unrelated X-linked KFSD families and cosegregated with KFSD in all families. In symptomatic female carriers, skewed X-inactivation of the normal allele matched with increased severity of symptoms. MBTPS2 is required for cleavage of sterol regulatory element-binding proteins (SREBPs). In vitro functional expression studies of the c.1523A>G mutation showed that sterol responsiveness was reduced by half. Other missense mutations in MBTPS2 have recently been identified in patients with IFAP syndrome. We postulate that both phenotypes are in the spectrum of one genetic disorder with a partially overlapping phenotype.

  13. Physicians' opinions and clinical practice patterns for actinic keratosis management in Italy.

    PubMed

    Peris, K; Neri, L; Calzavara Pinton, P; Catricalà, C; Pellacani, G; Pimpinelli, N; Peserico, A

    2014-04-01

    We report dermatologists' opinions and clinical practice patterns about clinical factors driving decision making in the management of actinic keratosis (AK) in Italy. We carried out a cross-sectional survey among 33 Italian dermatologists. Physicians were asked to report their management choices in consecutive patients with AK seen at their practice within 2 weeks since study initiation. We collected patients' clinical and socio-demographic characteristics with a standardized data collection form and assessed physicians' opinions on AK management with a self-reported questionnaire. Six hundred fifty-seven patients with new, single AK lesions without evidence of photo-damaged skin in the surrounding areas, were predominantly treated with lesion-directed therapies (primarily cryotherapy). In contrast, physicians preferentially prescribed field-directed therapies to patients with multiple lesions and evidence of photo-damaged skin in AK surrounding areas. However we observed a wide variation in treatment choices and physicians' opinions on AK management. Dermatologists underlined the importance of fostering patients' adherence and minimize therapy side effects. Overall, our results show that current guidelines regarding management of AK are only partially integrated in dermatology practice. The active dissemination of up-to-date national guidelines might help harmonize clinical decision making in this complex and fast growing therapeutic area.

  14. Sebaceous gland, hair shaft, and epidermal barrier abnormalities in keratosis pilaris with and without filaggrin deficiency.

    PubMed

    Gruber, Robert; Sugarman, Jeffrey L; Crumrine, Debra; Hupe, Melanie; Mauro, Theodora M; Mauldin, Elizabeth A; Thyssen, Jacob P; Brandner, Johanna M; Hennies, Hans-Christian; Schmuth, Matthias; Elias, Peter M

    2015-04-01

    Although keratosis pilaris (KP) is common, its etiopathogenesis remains unknown. KP is associated clinically with ichthyosis vulgaris and atopic dermatitis and molecular genetically with filaggrin-null mutations. In 20 KP patients and 20 matched controls, we assessed the filaggrin and claudin 1 genotypes, the phenotypes by dermatoscopy, and the morphology by light and transmission electron microscopy. Thirty-five percent of KP patients displayed filaggrin mutations, demonstrating that filaggrin mutations only partially account for the KP phenotype. Major histologic and dermatoscopic findings of KP were hyperkeratosis, hypergranulosis, mild T helper cell type 1-dominant lymphocytic inflammation, plugging of follicular orifices, striking absence of sebaceous glands, and hair shaft abnormalities in KP lesions but not in unaffected skin sites. Changes in barrier function and abnormal paracellular permeability were found in both interfollicular and follicular stratum corneum of lesional KP, which correlated ultrastructurally with impaired extracellular lamellar bilayer maturation and organization. All these features were independent of filaggrin genotype. Moreover, ultrastructure of corneodesmosomes and tight junctions appeared normal, immunohistochemistry for claudin 1 showed no reduction in protein amounts, and molecular analysis of claudin 1 was unremarkable. Our findings suggest that absence of sebaceous glands is an early step in KP pathogenesis, resulting in downstream hair shaft and epithelial barrier abnormalities.

  15. Fractional Carbon Dioxide Laser for Keratosis Pilaris: A Single-Blind, Randomized, Comparative Study.

    PubMed

    Vachiramon, Vasanop; Anusaksathien, Pattarin; Kanokrungsee, Silada; Chanprapaph, Kumutnart

    2016-01-01

    Objective. Keratosis pilaris (KP) is a common condition which can frequently be cosmetically disturbing. Topical treatments can be used with limited efficacy. The objective of this study is to evaluate the effectiveness and safety of fractional carbon dioxide (CO2) laser for the treatment of KP. Patients and Methods. A prospective, randomized, single-blinded, intraindividual comparative study was conducted on adult patients with KP. A single session of fractional CO2 laser was performed to one side of arm whereas the contralateral side served as control. Patients were scheduled for follow-up at 4 and 12 weeks after treatment. Clinical improvement was graded subjectively by blinded dermatologists. Patients rated treatment satisfaction at the end of the study. Results. Twenty patients completed the study. All patients stated that the laser treatment improved KP lesions. At 12-week follow-up, 30% of lesions on the laser-treated side had moderate to good improvement according to physicians' global assessment (p = 0.02). Keratotic papules and hyperpigmentation appeared to respond better than the erythematous component. Four patients with Fitzpatrick skin type V developed transient pigmentary alteration. Conclusions. Fractional CO2 laser treatment may be offered to patients with KP. Dark-skinned patients should be treated with special caution.

  16. Efficacy of ingenol mebutate gel for actinic keratosis in patients treated by thiazide diuretics

    PubMed Central

    Campione, Elena; Di Prete, Monia; Diluvio, Laura; Bianchi, Luca; Orlandi, Augusto

    2016-01-01

    Actinic keratosis (AK) is considered as superficial squamous cell carcinoma. Chronic sun exposure plays a central role in its pathogenesis. In particular, ultraviolet B radiation causes direct damage to the DNA, producing pyrimidine dimers that suppress the protective role of p53. Other risk factors include advanced age, male sex, and fair skin type. Even some drugs used for treating blood hypertension, such as thiazide diuretics, can increase the risk of developing AK. Their photosensitizing action seems to be connected with reactive oxygen species production. We report our experience with ten patients affected by multiple AK, in therapy with thiazide diuretics, treated by ingenol mebutate gel. AK was clinically and dermoscopically evaluated at baseline and after 30 days from the beginning of the treatment. Moreover, patients were screened for vitamin D3 values and reported a general hypovitaminosis status. To our knowledge, we report for the first time the efficacy of ingenol mebutate gel in this group of patients, particularly at risk of developing AK. PMID:27853385

  17. Real-world approach to actinic keratosis management: practical treatment algorithm for office-based dermatology.

    PubMed

    Dirschka, Thomas; Gupta, Girish; Micali, Giuseppe; Stockfleth, Eggert; Basset-Séguin, Nicole; Del Marmol, Véronique; Dummer, Reinhard; Jemec, Gregor B E; Malvehy, Josep; Peris, Ketty; Puig, Susana; Stratigos, Alexander J; Zalaudek, Iris; Pellacani, Giovanni

    2016-11-13

    Actinic keratosis (AK) is a chronic skin disease in which multiple clinical and subclinical lesions co-exist across large areas of sun-exposed skin, resulting in field cancerisation. Lesions require treatment because of their potential to transform into invasive squamous cell carcinoma. This article aims to provide office-based dermatologists and general practitioners with simple guidance on AK treatment in daily clinical practice to supplement existing evidence-based guidelines. Novel aspects of the proposed treatment algorithm include differentiating patients according to whether they have isolated scattered lesions, lesions clustered in small areas or large affected fields without reference to specific absolute numbers of lesions. Recognising that complete lesion clearance is rarely achieved in real-life practice and that AK is a chronic disease, the suggested treatment goals are to reduce the number of lesions, to achieve long-term disease control and to prevent disease progression to invasive squamous cell carcinoma. In the clinical setting, physicians should select AK treatments based on local availability, and the presentation and needs of their patients. The proposed AK treatment algorithm is easy-to-use and has high practical relevance for real-life, office-based dermatology.

  18. Field cancerization: from molecular basis to selective field-directed management of actinic keratosis.

    PubMed

    Philipp-Dormston, Wolfgang G

    2015-01-01

    The incidence of non-melanoma skin cancer (NMSC), including actinic keratosis (AK), squamous cell carcinoma (SCC), Bowen's Disease (BD) and basal cell carcinoma (BCC), is increasing. UVA and UVB radiation lead to genetic alterations in keratinocytes, which eventually result in skin cancer. In the concept of field cancerization of the skin, genetically altered keratinocytes accumulate over an area exposed to UV radiation. Field treatment not only clears clinically visible NMSC lesions but also potentially targets subclinical 'sleeping' cell patches and fields. Topical treatments are available for the field-directed management of NMSC. They are either self-administered by the patient (ingenol mebutate, diclofenac, imiquimod or 5-FU) or administered by the dermatologist (photodynamic therapy (PDT)). This article discusses the treatment options with respect to their efficacy, tolerability and selectivity. Selective treatment options for atypic keratinocytes include imiquimod, ingenol mebutate, diclofenac and PDT. PDT yields 100% treatment compliance because it is always administered by the treating dermatologist. The efficacy rates achieved with PDT significantly exceed those of the patient-administered topicals. The first clinical trials assessing the effects of PDT on field cancerization clinically, histologically and immunochemically have been conducted and have yielded promising results. Preventive effects and a delay in the re-occurrence of NMSC have been observed in animal experiments of ingenol mebutate and PDT, whereas for the latter, clinical data are already available.

  19. Grading keratinocyte atypia in actinic keratosis: a correlation of reflectance confocal microscopy and histopathology.

    PubMed

    Pellacani, G; Ulrich, M; Casari, A; Prow, T W; Cannillo, F; Benati, E; Losi, A; Cesinaro, A M; Longo, C; Argenziano, G; Soyer, H P

    2015-11-01

    Actinic Keratosis (AK) is the clinical manifestation of cutaneous dysplasia of epidermal keratinocytes, with progressive trend towards squamous cell carcinoma. To evaluate the strength of the correlation between keratinocyte atypia, as detected by Reflectance Confocal Microscopy (RCM) and histopathology, and to develop a more objective atypia grading scale for RCM quantification, through a discrete ranking. A total of 48 AKs and two control areas (photodamaged and non-photodamaged skin) were selected for this study. All these areas were documented by RCM and biopsied for histopathology. One representative image of the epidermis was selected for RCM and for histopathology and used for side-by-side comparison with purpose written software. The assessor chose which of two images displayed more keratinocyte atypia, and an ordered list from the image showing the least to the most keratinocyte atypia was generated. Three evaluations were obtained for RCM and two for histopathology. Good interobserver correlation was obtained for RCM and histopathology grading, with high concordance between RCM and histopathology grading. Expert rater scan consistently distinguish different grades of cytological atypia. Non-invasive RCM data from in vivo imaging can be graded for keratinocyte atypia, comparable to histopathological grading. © 2015 European Academy of Dermatology and Venereology.

  20. Fractional Carbon Dioxide Laser for Keratosis Pilaris: A Single-Blind, Randomized, Comparative Study

    PubMed Central

    Vachiramon, Vasanop; Anusaksathien, Pattarin; Kanokrungsee, Silada; Chanprapaph, Kumutnart

    2016-01-01

    Objective. Keratosis pilaris (KP) is a common condition which can frequently be cosmetically disturbing. Topical treatments can be used with limited efficacy. The objective of this study is to evaluate the effectiveness and safety of fractional carbon dioxide (CO2) laser for the treatment of KP. Patients and Methods. A prospective, randomized, single-blinded, intraindividual comparative study was conducted on adult patients with KP. A single session of fractional CO2 laser was performed to one side of arm whereas the contralateral side served as control. Patients were scheduled for follow-up at 4 and 12 weeks after treatment. Clinical improvement was graded subjectively by blinded dermatologists. Patients rated treatment satisfaction at the end of the study. Results. Twenty patients completed the study. All patients stated that the laser treatment improved KP lesions. At 12-week follow-up, 30% of lesions on the laser-treated side had moderate to good improvement according to physicians' global assessment (p = 0.02). Keratotic papules and hyperpigmentation appeared to respond better than the erythematous component. Four patients with Fitzpatrick skin type V developed transient pigmentary alteration. Conclusions. Fractional CO2 laser treatment may be offered to patients with KP. Dark-skinned patients should be treated with special caution. PMID:27247936

  1. Dermatological Feasibility of Multimodal Facial Color Imaging Modality for Cross-Evaluation of Facial Actinic Keratosis

    PubMed Central

    Bae, Youngwoo; Son, Taeyoon; Nelson, J. Stuart; Kim, Jae-Hong; Choi, Eung Ho; Jung, Byungjo

    2010-01-01

    Background/Purpose Digital color image analysis is currently considered as a routine procedure in dermatology. In our previous study, a multimodal facial color imaging modality (MFCIM), which provides a conventional, parallel- and cross-polarization, and fluorescent color image, was introduced for objective evaluation of various facial skin lesions. This study introduces a commercial version of MFCIM, DermaVision-PRO, for routine clinical use in dermatology and demonstrates its dermatological feasibility for cross-evaluation of skin lesions. Methods/Results Sample images of subjects with actinic keratosis or non-melanoma skin cancers were obtained at four different imaging modes. Various image analysis methods were applied to cross-evaluate the skin lesion and, finally, extract valuable diagnostic information. DermaVision-PRO is potentially a useful tool as an objective macroscopic imaging modality for quick prescreening and cross-evaluation of facial skin lesions. Conclusion DermaVision-PRO may be utilized as a useful tool for cross-evaluation of widely distributed facial skin lesions and an efficient database management of patient information. PMID:20923462

  2. Sebaceous Gland, Hair Shaft, and Epidermal Barrier Abnormalities in Keratosis Pilaris with and without Filaggrin Deficiency

    PubMed Central

    Gruber, Robert; Sugarman, Jeffrey L.; Crumrine, Debra; Hupe, Melanie; Mauro, Theodora M.; Mauldin, Elizabeth A.; Thyssen, Jacob P.; Brandner, Johanna M.; Hennies, Hans-Christian; Schmuth, Matthias; Elias, Peter M.

    2016-01-01

    Although keratosis pilaris (KP) is common, its etiopathogenesis remains unknown. KP is associated clinically with ichthyosis vulgaris and atopic dermatitis and molecular genetically with filaggrin-null mutations. In 20 KP patients and 20 matched controls, we assessed the filaggrin and claudin 1 genotypes, the phenotypes by dermatoscopy, and the morphology by light and transmission electron microscopy. Thirty-five percent of KP patients displayed filaggrin mutations, demonstrating that filaggrin mutations only partially account for the KP phenotype. Major histologic and dermatoscopic findings of KP were hyperkeratosis, hypergranulosis, mild T helper cell type 1-dominant lymphocytic inflammation, plugging of follicular orifices, striking absence of sebaceous glands, and hair shaft abnormalities in KP lesions but not in unaffected skin sites. Changes in barrier function and abnormal paracellular permeability were found in both interfollicular and follicular stratum corneum of lesional KP, which correlated ultrastructurally with impaired extracellular lamellar bilayer maturation and organization. All these features were independent of filaggrin genotype. Moreover, ultrastructure of corneodesmosomes and tight junctions appeared normal, immunohistochemistry for claudin 1 showed no reduction in protein amounts, and molecular analysis of claudin 1 was unremarkable. Our findings suggest that absence of sebaceous glands is an early step in KP pathogenesis, resulting in downstream hair shaft and epithelial barrier abnormalities. PMID:25660180

  3. Monitoring blood volume and saturation using superficial fibre optic reflectance spectroscopy during PDT of actinic keratosis.

    PubMed

    Middelburg, Tom A; Kanick, Stephen C; de Haas, Ellen R M; Sterenborg, Henricus J C M; Amelink, Arjen; Neumann, Martino H A M; Robinson, Dominic J

    2011-10-01

    Optically monitoring the vascular physiology during photodynamic therapy (PDT) may help understand patient-specific treatment outcome. However, diffuse optical techniques have failed to observe changes herein, probably by optically sampling too deep. Therefore, we investigated using differential path-length spectroscopy (DPS) to obtain superficial measurements of vascular physiology in actinic keratosis (AK) skin. The AK-specific DPS interrogation depth was chosen up to 400 microns in depth, based on the thickness of AK histology samples. During light fractionated aminolevulinic acid-PDT, reflectance spectra were analyzed to yield quantitative estimates of blood volume and saturation. Blood volume showed significant lesion-specific changes during PDT without a general trend for all lesions and saturation remained high during PDT. This study shows that DPS allows optically monitoring the superficial blood volume and saturation during skin PDT. The patient-specific variability supports the need for dosimetric measurements. In DPS, the lesion-specific optimal interrogation depth can be varied based on lesion thickness.

  4. 16 CFR 1500.42 - Test for eye irritants.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Test for eye irritants. 1500.42 Section 1500... eye irritants. Guidelines for in vivo and in vitro testing of ocular irritation of substances... eye irritation. Both eyes of each animal in the test group shall be examined before testing, and...

  5. Irritable bowel syndrome in Croatia.

    PubMed

    Grubić, Petra; Jurcić, Dragan; Ebling, Barbara; Gmajnić, Rudika; Nikolić, Bojana; Pribić, Sanda; Bilić, Ante; Levak, Maja Tolusić

    2014-06-01

    There are three epidemiological studies of irritable bowel syndrome (IBS) that were conducted in Croatia (in the area of Zagreb in 2002, Bjelovarsko-bilogorska County in 2008, and finally in Osjecko-baranjska County in 2011). The aim of this study is to analyze the anthropometric, demographic and socioeconomic characteristics of IBS in Croatia comparing these three studies. The studies included a questionnaire based on Rome criteria. Study population matched the adult population of Croatia according last available census (1991, 2001 resp.). Studies showed a high prevalence of IBS and some common factors relevant for development of IBS were determined such as gender, body mass index and lower level of education. There is a need for further investigations in coastal Croatia applying a uniform questionnaire on anthropometric, demographic and socioeconomic characteristics of IBS and Rome III criteria, diagnostic questionnaires and scoring algorithm for functional gastrointestinal disorders developed by Rome Foundation applicable in clinical practice and population studies, regarding the significant high prevalence of IBS in our country.

  6. Biomarkers of Irritable Bowel Syndrome

    PubMed Central

    Kim, Jae Hak; Lin, Eugenia; Pimentel, Mark

    2017-01-01

    Traditionally, irritable bowel syndrome (IBS) has not been regarded as an organic disease, and the pathophysiology of IBS is heterogeneous. Currently, the diagnosis of IBS is based upon the Rome diagnostic criteria. The performance of these criteria is only modest in predicting IBS, and moreover their validation is lacking. Additionally, as functional symptoms are common in the general population, healthy controls or volunteers are difficult to define and there is currently no definition of “normal” in the Rome criteria. Due to the weaknesses of the current diagnostic criteria, patients and doctors expect new gold standard diagnostic tools. Various etiologic mechanisms result in potential biomarkers. The focus of this research has been to find non-invasive biomarkers from serum, breath gas, and fecal materials. Though biomarkers should be based on biological and pathogenic processes, most biomarkers for IBS have been developed to identify organic diseases and therefore eliminate IBS. To date, these types of biomarkers for IBS have been disappointing. The purposes of developing biomarkers include improvement of diagnosis, differentiation from other organic diseases, and discrimination of IBS subtypes. A true mechanistic biomarker would make it possible to rule in IBS, rather than to rule out other organic diseases. New serologic biomarkers for diarrhea-predominant IBS have been introduced based on the pathophysiologic findings from a rat model and validation in a large-scale clinical trial. Further investigations of abnormal organic findings from each subtype of IBS would enable the development of new, simple subtype-specific biomarkers. PMID:27817184

  7. [Parasitosis and irritable bowel syndrome].

    PubMed

    Ibarra, Catalina; Herrera, Valentina; Pérez de Arce, Edith; Gil, Luis Carlos; Madrid, Ana María; Valenzuela, Lucía; Beltrán, Caroll J

    2016-06-01

    Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterised by multi-factorial aetiology. In IBS physiopathology are involved diverse factors between them biological, psychosocial, and environmental components which affect the immune activation status of gut mucosa. Among these factors is recognized the intestinal parasitosis. Post-infection IBS (PI-IBS) is recognised as a subgroup of functional disorders whose symptoms onset appear after a symptomatic intestinal infection caused by microbial agents. There are few studies regarding of relationship between IBS and intestinal parasitosis in Chile. However, is has been well described a positive association between IBS and Blastocystis hominis infections, one of prevalent parasites in Chile. In other countries, is also described a relationship between IBS and amebiasis and giardiasis. Both, characterized by a common mode of transmission through water as well as contaminated food. Because the high prevalence of parasitosis in our country it is necessary to expand the association studies to clarify the strength of the parasites ethiology in IBS.

  8. Focus on irritable bowel syndrome.

    PubMed

    Scalera, A; Loguercio, C

    2012-09-01

    The Irritable bowel syndrome (IBS) is a clinical syndrome characterized by chronic abdominal dis-comfort associated with changes in bowel habits and these symptoms can't be explained by any biochemical or organic abnormalities. The review summarizes the relevant findings that have emerged in recent years on the pathogenesis of this syndrome. The most important mechanisms recently implicated in the genesis of IBS symptoms are the abnormal intestinal motility, the incongruous intestinal gas production and the enhanced intestinal nociception. A lot evidence confirms the presence of dysfunction of the intrinsic enteric nervous system (ENS) as demonstrated by the presence of altered expression of transient receptor potential vanilloid 1 (TRPV1), acid sensing ion channel 3 (ASIC3), putinergic receptor P2X, ligand-gated ion channel 3 (P2X3r), tetrodoxin-sensitive receptor 2 (TTRX2), protease activated receptors (PPARs) and others. There are different assumption that explain these phenomena, and the impairment of the immune system is one of the most reliable. In IBS subjects it was found that the immune system is altered in both the cellular composition and its activation. Many studies have shown that inflammation and immune dysregulation affect the sensitivity of nerve fibers so it is vital to build on this argument for the development of effective therapies to control the symptoms of this syndrome.

  9. Hand disinfection: how irritant are alcohols?

    PubMed

    Löffler, Harald; Kampf, Günter

    2008-10-01

    Irritant contact dermatitis is commonly found on hands of healthcare employees and is often explained by contact to water and detergents. Studies on the dermal tolerance clearly show that the degree of skin irritation is significantly lower after application of alcohol in comparison to detergents. It has also been shown in standardised wash tests using a foam roller that the application of alcohol or water immediately after a detergent-based wash can significantly decrease the degree of skin irritation, probably due to a wash-off of residual detergent. If evidence-based hand hygiene is taught early during nurses training it can substantially reduce irritant contact dermatitis supporting initiatives of primary prevention among healthcare employees. The irritant potential of commonly used alcohols in hand antiseptics is very low. If the skin is pre-irritated, e.g. by detergents or water, alcohols can cause a burning sensation which is, however, not an allergic reaction and does not further harm the skin. True allergic reactions to alcohols have so far not been confirmed. From the dermatological point of view the use of alcohols for hand hygiene has clear advantages over washing with water and detergents.

  10. Irritable bowel syndrome: Is it “irritable brain” or “irritable bowel”?

    PubMed Central

    Padhy, Susanta Kumar; Sahoo, Swapnajeet; Mahajan, Sonali; Sinha, Saroj Kumar

    2015-01-01

    Irritable bowel syndrome (IBS) has been recognized as one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. In the Western world, IBS appears to affect up to 20% of the population at any given time but in Asian countries, the median value of IBS prevalence defined by various criteria ranges between 6.5% and 10.1%, and community prevalence of 4% is found in North India. Those attending gastroenterology clinics represent only the tip of the iceberg. The disorder substantially impairs the quality of life, and the overall health-care costs are high. IBS has therefore gained increased attention from clinicians, researchers, and pharmaceutical industries. It is often frustrating to both patients and physicians as the disease is usually chronic in nature and difficult to treat. However, the understanding of IBS has been changing from time to time and still most of its concepts are unknown. In this review we have discussed, debated, and synthesized the evidence base, focusing on underlying mechanisms in the brain and bowel. We conclude that it is both brain and bowel mechanisms that are responsible. The clinical implication of such mechanisms is discussed. PMID:26752904

  11. Diet in irritable bowel syndrome.

    PubMed

    El-Salhy, Magdy; Gundersen, Doris

    2015-04-14

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that is characterized by intermittent abdominal pain/discomfort, altered bowel habits and abdominal bloating/distension. This review aimed at presenting the recent developments concerning the role of diet in the pathophysiology and management of IBS. There is no convincing evidence that IBS patients suffer from food allergy/intolerance, and there is no evidence that gluten causes the debated new diagnosis of non-coeliac gluten sensitivity (NCGS). The component in wheat that triggers symptoms in NCGS appears to be the carbohydrates. Patients with NCGS appear to be IBS patients who are self-diagnosed and self-treated with a gluten-free diet. IBS symptoms are triggered by the consumption of the poorly absorbed fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) and insoluble fibre. On reaching the distal small intestine and colon, FODMAPS and insoluble fibre increase the osmotic pressure in the large-intestine lumen and provide a substrate for bacterial fermentation, with consequent gas production, abdominal distension and abdominal pain or discomfort. Poor FODMAPS and insoluble fibres diet reduces the symptom and improve the quality of life in IBS patients. Moreover, it changes favourably the intestinal microbiota and restores the abnormalities in the gastrointestinal endocrine cells. Five gastrointestinal endocrine cell types that produce hormones regulating appetite and food intake are abnormal in IBS patients. Based on these hormonal abnormalities, one would expect that IBS patients to have increased food intake and body weight gain. However, the link between obesity and IBS is not fully studied. Individual dietary guidance for intake of poor FODMAPs and insoluble fibres diet in combination with probiotics intake and regular exercise is to be recommended for IBS patients.

  12. Pagetoid variant of actinic keratosis with or without squamous cell carcinoma of sun-exposed skin: a lesion simulating extramammary Paget's disease.

    PubMed

    Mai, K T; Alhalouly, T; Landry, D; Stinson, W A; Perkins, D G; Yazdi, H M

    2002-10-01

    Extramammary Paget's disease usually occurs in anogenital skin. We present five cases of squamous cell carcinoma in situ of sun-exposed skin and non-squamous cell carcinoma in situ actinic keratosis that displayed atypical keratinocytes disposed in intraepithelial cell nests and immunohistochemical staining simulating extramammary Paget's disease. Two pilot cases--one squamous cell carcinoma in situ and one non-squamous cell carcinoma in situ actinic keratosis with formation of intra-epidermal nests of atypical keratinocytes with a pagetoid spread pattern--were encountered at our institution. Fifty-four consecutive cases of squamous cell carcinoma in situ including bowenoid actinic keratosis and 34 cases of non-squamous cell carcinoma in situ actinic keratosis were reviewed to identify pagetoid spread of atypical cells. Representative sections of all cases with pagetoid spread of atypical keratinocytes were submitted for special stains for mucin, and immunostaining for cytokeratin 7 (CK7), cytokeratin 20 (CK20), cytokeratin CAM 5.2 (CAM 5.2), carcinoembryonic antigen (CEA), vimentin and S100 protein. In the group of squamous cell carcinoma in situ, 10 cases displayed pagetoid spread of atypical keratinocytes with cytoplasm ranging from clear to pale and atypical hyperchromatic nuclei. One review squamous cell carcinoma in situ was multicentric with three separate lesions. The atypical keratinocytes tended to form well to poorly defined cell groups extending from the basal cell layer to the corneal layer. No similar cases were identified in the group of non-squamous cell carcinoma in situ actinic keratosis. Two pilot cases and three of 10 review cases with a total of seven separate lesions displayed a moderate to marked immunohistochemical reactivity for CK7 similar to extramammary Paget's disease. CEA immunoreactivity was also detected in two of these cases. In addition, two of 44 squamous cell carcinomas in situ without pagetoid spread of atypical keratinocytes

  13. The Brief Irritability Test (BITe): a measure of irritability for use among men and women.

    PubMed

    Holtzman, Susan; O'Connor, Brian P; Barata, Paula C; Stewart, Donna E

    2015-02-01

    Elevated levels of irritability have been reported across a range of psychiatric and medical conditions. However, research on the causes, consequences, and treatments of irritability has been hindered by limitations in existing measurement tools. This study aimed to develop a brief, reliable, and valid self-report measure of irritability that is suitable for use among both men and women and that displays minimal overlap with related constructs. First, 63 candidate items were generated, including items from two recent irritability scales. Second, 1,116 participants (877 university students and 229 chronic pain outpatients) completed a survey containing the irritability item pool and standardized measures of related constructs. Item response theory was used to develop a five-item scale (the Brief Irritability Test) with a strong internal structure. All five items displayed minimal conceptual overlap with related constructs (e.g., depression, anger), and test scores displayed negligible gender bias. The Brief Irritability Test shows promise in helping to advance the burgeoning field of irritability research. © The Author(s) 2014.

  14. Clobetasol propionate shampoo 0.05% in the treatment of seborrheic dermatitis of the scalp: results of a pilot study.

    PubMed

    Reygagne, Pascal; Poncet, Michel; Sidou, Farzaneh; Soto, Pascale

    2007-05-01

    Seborrheic dermatitis (SD), a common dermatosis associating hyperseborrhea, erythema, itching, and dandruff, has frequent scalp involvement. Malassezia furfur infection seems to play an important role in the condition's etiopathology. Treatment of SD usually consists of corticosteroids or antifungals, such as ketoconazole. The aim of this multicenter, randomized, investigator-blinded, parallel-group pilot study was to evaluate the efficacy and safety of clobetasol propionate shampoo 0.05% after different short-contact application times compared with its vehicle and ketoconazole foaming gel 2% in the treatment of SD of the scalp. For 4 weeks, 55 subjects received one of the following treatments twice weekly: clobetasol propionate shampoo for 2.5, 5, or 10 minutes; clobetasol propionate vehicle for 10 minutes; or ketoconazole foaming gel for 5 minutes before rinsing off. Efficacy criteria included total severity score (TSS) and individual scores of signs such as itching and global improvement. Safety included reporting of burning, overall tolerance, and adverse events. Results showed that an application of clobetasol propionate for 5 and 10 minutes provided a similar mean percentage decrease of TSS, and the mean percentage decrease of TSS for all active groups was significantly superior to that of the vehicle (P < .01). Overall and local safety were good for all treatment groups. The present pilot study demonstrated that a short-contact application of clobetasol propionate shampoo is effective and safe in the treatment of SD of the scalp.

  15. Malassezia arunalokei sp. nov., a Novel Yeast Species Isolated from Seborrheic Dermatitis Patients and Healthy Individuals from India.

    PubMed

    Honnavar, Prasanna; Prasad, Gandham S; Ghosh, Anup; Dogra, Sunil; Handa, Sanjeev; Rudramurthy, Shivaprakash M

    2016-07-01

    The majority of species within the genus Malassezia are lipophilic yeasts that colonize the skin of warm-blooded animals. Two species, Malassezia globosa and Malassezia restricta, are implicated in the causation of seborrheic dermatitis/dandruff (SD/D). During our survey of SD/D cases, we isolated several species of Malassezia and noticed vast variations within a few lipid-dependent species. Variations observed in the phenotypic characteristics (colony morphology, absence of catalase activity, growth at 37°C, and precipitation surrounding wells containing Tween 20 or Cremophor EL) suggested the possible presence of a novel species. Sequence divergence observed in the internal transcribed spacer (ITS) region, the D1/D2 domain, and the intergenic spacer 1 (IGS1) region of rDNA and the TEF1 gene, PCR-restriction fragment length polymorphism (RFLP) analysis of the ITS2 region, and fluorescent amplified fragment length polymorphism analysis support the existence of a novel species. Based on phenotypic and molecular characterization of these strains, we propose a new species, namely, M. arunalokei sp. nov., and we designate NCCPF 127130 (= MTCC 12054 = CBS 13387) as the type strain. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

  16. Hydrocortisone 1% cream and sertaconazole 2% cream to treat facial seborrheic dermatitis: A double-blind, randomized clinical trial.

    PubMed

    Balighi, K; Ghodsi, S Z; Daneshpazhooh, M; Ghale-Baghi, S; Nasimi, M; Azizpour, A

    2017-06-01

    Seborrheic dermatitis (SD) is a chronic dermatitis with periods of remission and relapse that requires long-term treatment. We compared the efficacy and safety of treatment with sertaconazole with standard corticosteroid medications in adults with facial SD. In this double-blind, randomized controlled trial, 60 patients with a diagnosis of SD were enrolled. Patients were instructed to apply either sertaconazole 2% cream (30 patients) or hydrocortisone 1% cream (30 patients) twice daily to the affected area of the face. The severity of facial SD was assessed at 0, 2, and 4 weeks of treatment. Secondary efficacy measures included patient assessment of seborrhea, adverse events, and improvement percentage (IP). SD lesions cleared significantly (p < .05) and similarly in both treatment groups (p > .05). Both treatments resulted in significant improvement of SD lesions and the rate of adverse events was similar in both groups. The IP was higher for treatment with hydrocortisone in Week 2 and similar in both groups at the end of the study. Limitations include the small number of patients who were recruited for this study and the lack of evaluation of time to relapse. Treatment with topical sertaconazole may be regarded as a substitute for topical corticosteroid medications due to the fewer adverse events and similar efficacy.

  17. Malassezia arunalokei sp. nov., a Novel Yeast Species Isolated from Seborrheic Dermatitis Patients and Healthy Individuals from India

    PubMed Central

    Honnavar, Prasanna; Prasad, Gandham S.; Ghosh, Anup; Dogra, Sunil; Handa, Sanjeev

    2016-01-01

    The majority of species within the genus Malassezia are lipophilic yeasts that colonize the skin of warm-blooded animals. Two species, Malassezia globosa and Malassezia restricta, are implicated in the causation of seborrheic dermatitis/dandruff (SD/D). During our survey of SD/D cases, we isolated several species of Malassezia and noticed vast variations within a few lipid-dependent species. Variations observed in the phenotypic characteristics (colony morphology, absence of catalase activity, growth at 37°C, and precipitation surrounding wells containing Tween 20 or Cremophor EL) suggested the possible presence of a novel species. Sequence divergence observed in the internal transcribed spacer (ITS) region, the D1/D2 domain, and the intergenic spacer 1 (IGS1) region of rDNA and the TEF1 gene, PCR-restriction fragment length polymorphism (RFLP) analysis of the ITS2 region, and fluorescent amplified fragment length polymorphism analysis support the existence of a novel species. Based on phenotypic and molecular characterization of these strains, we propose a new species, namely, M. arunalokei sp. nov., and we designate NCCPF 127130 (= MTCC 12054 = CBS 13387) as the type strain. PMID:27147721

  18. Novel MBTPS2 missense mutation causes a keratosis follicularis spinulosa decalvans phenotype: mutation update and review of the literature.

    PubMed

    Zhang, J; Wang, Y; Cheng, R; Ni, C; Liang, J; Li, M; Yao, Z

    2016-10-01

    Keratosis follicularis spinulosa decalvans (KFSD) is an X-linked condition characterized by keratotic follicular papules and progressive alopecia, which is caused by mutations in the MBTPS2 gene. We carried out a genetic study on a child who was suspected clinically to have KFSD. Sanger sequencing was performed to detect mutations in the entire coding region of MBTPS2. A novel missense mutation (c.599C>T) was identified in the patient, confirming a diagnosis of KFSD. We reviewed related cases with MBTPS2 mutations for evidence of genotype-phenotype correlations.

  19. Successful cochlear implantation in a child with Keratosis, Icthiosis and Deafness (KID) Syndrome and Dandy-Walker malformation.

    PubMed

    Cushing, Sharon L; MacDonald, Laurie; Propst, Evan J; Sharma, Alok; Stockley, Tracy; Blaser, Susan L; James, Adrian L; Papsin, Blake C

    2008-05-01

    Keratosis, Icthiosis, and Deafness (KID) Syndrome is a rare congenital disorder associated with dominant connexin 26 mutations, affecting epidermis, corneal epithelium, and inner ear. Given eventual visual impairment, cochlear implantation is an important consideration despite an increased risk of wound complications. We present a child with KID Syndrome and bilateral profound sensorineural hearing loss associated with a novel heterozygous missense D50A connexin 26 mutation (c.149A > C). Imaging revealed mild cochlear malformation and Dandy-Walker malformation. She received a cochlear implant at the age of 12 months, using a small incision approach. Following an immediate minor wound infection, implantation has been successful without further complication over 4 years.

  20. [Irritant contact dermatitis. Part II. Evaluation evaluation of skin irritation potential of chemicals].

    PubMed

    Chomiczewska, Dorota; Kieć-Swierczyńska, Marta; Krecisz, Beata

    2009-01-01

    The evaluation of skin irritation potential of chemicals is essential to secure the safety of individuals exposed to several substances designed for industrial, pharmaceutical or cosmetic use. Until recently, preclinical safety assessment of chemicals was largely based on animal experiments. Ethical concerns and the limited value of animal models in evaluating human skin irritation potential resulted in the development of alternative in vitro methods, such as EpiDerm, EPISKIN or SkinEthic, to assess irritation, i.e. cell cultures and human epidermis models. International organizations like the European Centre for the Validation of Alternative Methods (ECVAM) promotes and monitors the development of nonanimal tests. Human patch tests and use tests also provide an opportunity to identify substances with significant skin irritation potential without recourse to the use of animals. These tests are useful to assess skin irritation potential of cosmetics and detergents.

  1. Eyebrow hairs from actinic keratosis patients harbor the highest number of cutaneous human papillomaviruses.

    PubMed

    Schneider, Ines; Lehmann, Mandy D; Kogosov, Vlada; Stockfleth, Eggert; Nindl, Ingo

    2013-04-24

    Cutaneous human papillomavirus (HPV) infections seem to be associated with the onset of actinic keratosis (AK). This study compares the presence of cutaneous HPV types in eyebrow hairs to those in tissues of normal skin and skin lesions of 75 immunocompetent AK patients. Biopsies from AK lesions, normal skin and plucked eyebrow hairs were collected from each patient. DNA from these specimens was tested for the presence of 28 cutaneous HPV (betaPV and gammaPV) by a PCR based method. The highest number of HPV prevalence was detected in 84% of the eyebrow hairs (63/75, median 6 types) compared to 47% of AK lesions (35/75, median 3 types) (p< 0.001) and 37% of normal skin (28/75, median 4 types) (p< 0.001), respectively. A total of 228 HPV infections were found in eyebrow hairs compared to only 92 HPV infections in AK and 69 in normal skin. In all three specimens HPV20, HPV23 and/or HPV37 were the most prevalent types. The highest number of multiple types of HPV positive specimens was found in 76% of the eyebrow hairs compared to 60% in AK and 57% in normal skin. The concordance of at least one HPV type in virus positive specimens was 81% (three specimens) and 88-93% of all three combinations with two specimens. Thus, eyebrow hairs revealed the highest number of cutaneous HPV infections, are easy to collect and are an appropriate screening tool in order to identify a possible association of HPV and AK.

  2. Eyebrow hairs from actinic keratosis patients harbor the highest number of cutaneous human papillomaviruses

    PubMed Central

    2013-01-01

    Background Cutaneous human papillomavirus (HPV) infections seem to be associated with the onset of actinic keratosis (AK). This study compares the presence of cutaneous HPV types in eyebrow hairs to those in tissues of normal skin and skin lesions of 75 immunocompetent AK patients. Methods Biopsies from AK lesions, normal skin and plucked eyebrow hairs were collected from each patient. DNA from these specimens was tested for the presence of 28 cutaneous HPV (betaPV and gammaPV) by a PCR based method. Results The highest number of HPV prevalence was detected in 84% of the eyebrow hairs (63/75, median 6 types) compared to 47% of AK lesions (35/75, median 3 types) (p< 0.001) and 37% of normal skin (28/75, median 4 types) (p< 0.001), respectively. A total of 228 HPV infections were found in eyebrow hairs compared to only 92 HPV infections in AK and 69 in normal skin. In all three specimens HPV20, HPV23 and/or HPV37 were the most prevalent types. The highest number of multiple types of HPV positive specimens was found in 76% of the eyebrow hairs compared to 60% in AK and 57% in normal skin. The concordance of at least one HPV type in virus positive specimens was 81% (three specimens) and 88-93% of all three combinations with two specimens. Conclusions Thus, eyebrow hairs revealed the highest number of cutaneous HPV infections, are easy to collect and are an appropriate screening tool in order to identify a possible association of HPV and AK. PMID:23618013

  3. In vivo confocal microscopy efficacy assessment of daylight photodynamic therapy in actinic keratosis patients.

    PubMed

    Seyed Jafari, S M; Timchik, T; Hunger, R E

    2016-08-01

    Reflectance confocal microscopy (RCM) is a noninvasive diagnostic technique with an acceptable sensitivity and specificity for actinic keratosis (AK). We evaluated efficacy of daylight photodynamic therapy (DL-PDT) in patients with AK using a new RCM atypia scoring system. All patients with AK lesions (Grade I-II) were included in our study (2012-15). Baseline clinical, dermoscopy and RCM evaluations were followed by DL-PDT. In the first follow-up, clinical examination, dermoscopy and RCM imaging of the treated area were carried out. Atypia scoring and cell size measurements were used to compare before and after RCM images. From 40 lesions (20 patients with mean age of 75·5 years), complete resolution and partial response of the actinic damage was detected in 80% and 17·5% of lesions, respectively. No cellular atypia was seen in the follow-up RCM images of 57·5% of lesions (n = 23), while in 40% of lesions (n = 16) minimal changes to the honeycomb pattern of the epidermis were seen in the follow-up RCM images (atypia score 1). Only one lesion showed minimal or no clinical response, and a persistent moderate amount of atypia in RCM. Furthermore, atypia score and mean cell size decreased significantly in the follow-up DL-PDT RCM images (P < 0·001, P = 0·001, respectively). RCM features of actinic damage at cellular level have been shown to correlate well with the results of a clinical assessment of AK lesions. This study confirms that in vivo RCM technology might be an additional technique to monitor the efficacy of DL-PDT for AK. © 2016 British Association of Dermatologists.

  4. Histopathology and reflectance confocal microscopy features of photodamaged skin and actinic keratosis.

    PubMed

    Tan, J M; Lambie, D; Sinnya, S; Sahebian, A; Soyer, H P; Prow, T W; Ardigò, M

    2016-11-01

    Actinic keratosis (AK) usually co-exists in areas of severe photodamage, but the clinical applicability of reflectance confocal microscopy (RCM) in diagnosing AK currently depends on a set of parameters yet to be defined in comparison to photodamaged skin (PD). To correlate the RCM features of PD and AK with histopathology. Twenty participants with a mean age of 64 years and skin phototype I and II were studied. RCM was performed on two PD and one AK within a field of 25 cm(2) on the left dorsal forearm, followed by shave biopsies. Blinded evaluation of the histopathological and RCM images using established parameters in AK were performed retrospectively in consensus with an expert confocalist, correlated with the histopathological diagnosis by a board-certified dermatopathologist. A total of 57/60 areas were included. There were 43/57 (75%) and 14/57 (25%) histopathologically confirmed PD and AK respectively. Individual corneocytes, stratum corneum disruption, dermal inflammatory cells, increased vascularity/dilated vessels and solar elastosis were detected in PD and AK upon histopathology and RCM. The features in favour of AK were parakeratosis, hyperkeratosis, more severe keratinocyte pleomorphism and architectural disruption, and the presence of epidermal inflammatory cells. PD also demonstrated keratinocyte pleomorphism and architectural disruption though this was generally less severe than AK. A small subset of PD exhibited a comparable degree of keratinocyte pleomorphism and architectural disruption to the AKs in the cohort. The viable epidermis demonstrates PD and AK to be part of a disease continuum corresponding to field cancerization. Individual corneocytes, stratum corneum disruption, dermal inflammatory cells, increased vascularity/dilated vessels and solar elastosis may be present in PD; whereas, parakeratosis and hyperkeratosis may represent the key to distinguishing AK from PD using RCM. The significance of epidermal inflammatory cells in the RCM

  5. Pigmentation-Independent Susceptibility Loci for Actinic Keratosis Highlighted by Compound Heterozygosity Analysis.

    PubMed

    Zhong, Kaiyin; Verkouteren, Joris A C; Jacobs, Leonie C; Uitterlinden, Andre G; Hofman, Albert; Liu, Fan; Nijsten, Tamar; Kayser, Manfred

    2017-01-01

    Actinic keratosis (AK) is a skin disease frequently found in European elderly, and it represents the precursor of cutaneous squamous cell carcinoma. Our recent genome-wide association study highlighted DNA variants in two pigmentation genes, IRF4 and MC1R, that confer AK risk in Europeans. Here, we performed a genome-wide search for relaxed forms of compound heterozygosity in association with AK using our recently developed software CollapsABEL. In a discovery dataset of 3,193 Dutch Europeans, a total of 15 genetic loci showed genome-wide significant association with AK (P < 1.25 × 10(-10)). Of those, three loci (6p21.2, 6p12.2, and 6q13) were confirmed in a replication dataset that included 624 additional Dutch Europeans (P < 0.05). These replicated loci harbored six genes (KCNK5/KCNK17, PAQR8/GSTA2, and KCNQ5/KHDC1), none of them known to be involved in pigmentation. A candidate compound heterozygosity analysis for 12 pigmentation loci highlighted SLC24A4 at 14q32.12 as showing significant association with AK (P = 8.83 × 10(-9)). The four significantly AK-associated compound heterozygosity single-nucleotide polymorphism pairs together explained 4.37% of the total AK variation, which was 2.62 times greater than the two top-associated individual single nucleotide polymorphisms together (1.67%) identified in the previous conventional genome-wide association study. In conclusion, CollapsABEL showed compound heterozygosity in non-pigmentation- and pigmentation-related loci conferring genetic risk of AK. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Diagnostic accuracy of optical coherence tomography in actinic keratosis and basal cell carcinoma.

    PubMed

    Olsen, J; Themstrup, L; De Carvalho, N; Mogensen, M; Pellacani, G; Jemec, G B E

    2016-12-01

    Early diagnosis of non-melanoma skin cancer (NMSC) is potentially possible using optical coherence tomography (OCT) which provides non-invasive, real-time images of skin with micrometre resolution and an imaging depth of up to 2mm. OCT technology for skin imaging has undergone significant developments, improving image quality substantially. The diagnostic accuracy of any method is influenced by continuous technological development making it necessary to regularly re-evaluate methods. The objective of this study is to estimate the diagnostic accuracy of OCT in basal cell carcinomas (BCC) and actinic keratosis (AK) as well as differentiating these lesions from normal skin. A study set consisting of 142 OCT images meeting selection criterea for image quality and diagnosis of AK, BCC and normal skin was presented uniformly to two groups of blinded observers: 5 dermatologists experienced in OCT-image interpretation and 5 dermatologists with no experience in OCT. During the presentation of the study set the observers filled out a standardized questionnaire regarding the OCT diagnosis. Images were captured using a commercially available OCT machine (Vivosight (®), Michelson Diagnostics, UK). Skilled OCT observers were able to diagnose BCC lesions with a sensitivity of 86% to 95% and a specificity of 81% to 98%. Skilled observers with at least one year of OCT-experience showed an overall higher diagnostic accuracy compared to inexperienced observers. The study shows an improved diagnostic accuracy of OCT in differentiating AK and BCC from healthy skin using state-of-the-art technology compared to earlier OCT technology, especially concerning BCC diagnosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Rifaximin for Irritable Bowel Syndrome

    PubMed Central

    Li, Jun; Zhu, Wenhua; Liu, Wenhui; Wu, Yingqiao; Wu, Benyan

    2016-01-01

    Abstract The current treatments for irritable bowel syndrome (IBS) are suboptimal. The findings of previous studies of rifaximin treatment for IBS may have differed due to variations in study design. Our study aimed to determine the therapeutic and adverse effects of rifaximin treatment for IBS based on a meta-analysis of published randomized controlled trials (RCTs). We searched the MEDLINE, EMBASE, EBSCO, Springer, Ovid, and Cochrane Library databases for RCTs investigating the effects of rifaximin on IBS. Data from each selected RCT was evaluated individually based on an intention-to-treat analysis, and a meta-analysis was performed in which the odds ratios (ORs) and 95% confidence intervals (CIs) of clinical outcomes and adverse events were calculated using fixed-effects models. Four eligible studies were identified. Overall relief of IBS symptoms in the rifaximin groups was greater than that in the placebo groups at the ends of both the treatment and follow-up periods (OR = 1.19; 95% CI: 1.08–1.32 and OR = 1.36; 95% CI: 1.18–1.58, respectively, P < 0.05 for both). Significant relief of abdominal distention was observed at the follow-up endpoint (OR = 1.69; 95% Cl: 1.27–2.23; P < 0.05), but not at the treatment endpoint (OR = 1.19; 95% CI: 0.96–1.49; P > 0.05). Abdominal pain (OR = 1.01; 95% CI: 0.98–1.03; P > 0.05), nausea (OR = 1.00; 95% CI: 0.98–1.02; P > 0.05), vomiting (OR: 0.99; 95% CI: 0.98–1.01; P > 0.05), and headache (OR = 1.01; 95% CI: 0.98–1.03; P > 0.05) did not differ significantly between the rifaximin and placebo groups. In the RCTs selected, our meta-analysis showed that the efficacy of rifaximin for the resolution of overall IBS symptoms was greater than that of the placebos, and that rifaximin was well-tolerated. The course of relief from abdominal distention in IBS patients treated with rifaximin may be delayed in some patients, compared with that of overall IBS symptom

  8. The upper respiratory tract: mucous membrane irritation.

    PubMed Central

    Bascom, R

    1991-01-01

    Despite the widespread recognition that mucosal irritation is a cardinal feature of "sick-building syndrome," few data exist on the cause, natural history, or pathophysiology of upper respiratory mucous membrane irritation. The baseline prevalence of nasal symptoms among building occupants is often 20%, but in some studies it is as high as 50 to 60%. New techniques of nasal challenge and analysis of cells and mediators in nasal lavage fluid have proved useful in the assessment of rhinitis caused by antigens, cold air, and viruses, and these techniques are now being applied to the study the response to irritants. Human inhalation challenge studies have recently demonstrated a spectrum of sensitivity to environmental tobacco smoke, but the basis for this difference requires additional investigation. Animal and in vitro studies indicate that the chemosensitive neurons and airway epithelium may be critical targets for irritants that participate in the induction of inflammation. New research methods are needed, particularly to evaluate complaints of nasal congestion, drying, and irritation. Techniques should be developed that may be useful for field studies, where the health effects of a complex mixture are being assessed in a specific indoor environment. There exists a group of individuals who report a variety of symptoms on exposure to low levels of common volatile organic mixtures such as perfume, cigarette smoke, and cleaning agents. Some of these individuals report having occupied "sick buildings" during the time their symptoms began. Research is needed to understand the basis of their complaints, their etiology, and treatment. PMID:1821376

  9. Ocular irritation: microscopic changes occurring over time in the rat with surfactants of known irritancy.

    PubMed

    Maurer, J K; Parker, R D; Carr, G J

    1998-01-01

    The pathology of surfactant-induced ocular irritation, especially in the context of accidental human exposures and animal tests used to assess a surfactant's potential ocular irritation, is not well understood. The purpose of this study was to characterize the microscopic changes in rats at 3 hr and on days 1, 2, 3, 4, 7, 14, and 35 following treatment with anionic, cationic, and nonionic surfactants of differing irritancy. The right eye of each rat was treated by placing 10 microliters of a surfactant directly on the cornea. Untreated left eyes served as the controls. At each time point, eyes and eyelids were macroscopically examined and collected for microscopic examination. Macroscopically, the differing levels of irritation were characterized by differences in incidence and magnitude of scores, reflecting involvement of the cornea, conjunctiva, and iris, as well as by the incidence of neovascularization and time to recovery. Microscopically, differences in the area and depth of injury paralleled the differences seen grossly and the relative irritancy of the various surfactants. All surfactants affected the corneal and conjunctival epithelium. All surfactants, except the slightly irritating anionic surfactant, caused corneal stromal changes, with this involvement being proportional to their overall level of irritation. Corneal endothelial cell effects principally occurred with only the severely irritating cationic surfactant. Over time, responses to surfactants of differing irritancy were qualitatively and quantitatively different, and these differences correlated with the extent of initial injury. Qualitative differences in response included presence of keratocyte regeneration, corneal neovascularization, and conjunctivalization of the corneal epithelium with all of the surfactants except the slight irritant. Quantitative differences in response occurred in the extent of epithelial regeneration, edema, and inflammation for surfactants of slight to severe

  10. The irritancy of soaps and syndets.

    PubMed

    Strube, D D; Nicoll, G

    1987-06-01

    The use of soaps and synthetic detergent (syndet) bars has been associated with skin dryness and aggravation of dermatologic conditions. A number of factors, including chemical structure, pH, and cleansing ability, have been implicated in this phenomenon. Many bars contain agents designed to ameliorate the irritancy of the bar and/or provide a skin benefit. Clinical studies have shown that soaps are generally quite irritating while syndets can range from mild to harsh. The addition of skin benefit/mildness agents such as glycerin, cocoa butter, mineral oil, or lanolin has little effect on the irritancy potential of a bar since minimal amounts of these agents are deposited on the skin. The excessive removal of skin lipids by harsh soaps and detergents can result in superficial dryness. The key to gentle cleansing is to start with a mild cleansing product and avoid overuse.

  11. Mascaras may cause irritant contact dermatitis.

    PubMed

    Lodén, M; Wessman, C

    2002-10-01

    The majority of adverse effects of cosmetics have been attributed to soaps in Dutch and English studies, but to eye makeup in a recent Swedish study. The reactions may be caused by irritants or by sensitizing substances. The aim of the present study was to evaluate the irritation potential of commercially available mascaras. The mascaras were exposed to the skin in aluminium chambers. The skin reaction was evaluated using both visual assessments of erythema and non-invasive measurements of the skin reaction. Seven mascaras were tested on 15 healthy individuals in a randomized and blinded fashion. Two of the seven tested mascaras induced pronounced skin inflammation, when applied to normal skin under occlusion. These two mascaras were based on volatile petroleum distillate, in contrast to the other five mascaras that were conventional emulsions with stearate as the main emulsifier. The findings suggest that solvent-based mascaras might induce contact dermatitis due to its content of irritating substances.

  12. [Cutaneous signs of Noonan's syndrome. Apropos of a case with ulerythema ophyogenes, disseminated pilar and sudoral keratosis and progressive alopecia].

    PubMed

    Grob, J J; Laure, M; Berge, G; Taramasco, M; Bore, P; Benderitter, T; Andrac, L; Collet, A M; Bonerandi, J J

    1988-01-01

    A case of typical Noonan syndrome (NS) with eye abnormalities, pterygium colli, cryptorchid testes, lymphoedema and asymmetrical cardiac septal hypertrophy is reported in a 8-month old infant. This case was particularly interesting since it included skin manifestations which enabled an early diagnosis to be made. Ulerythema ophryogenes has already been proposed as a cutaneous marker of NS, but the keratinization disorders in our patient also included disseminated keratosis of both hair follicles and sweat glands orifices. Abnormally brittle short curly hair has already been reported, but our patient exhibited progressive alopecia which is very rare in NS. Biochemical hair analysis did not show any abnormalities of aminoacids. All these features were suggestive of keratosis follicularis spinulosa decalvans. It therefore seems very likely that NS is associated with keratinization disorders but ulerythema ophryogenes might only be the limited form of these disorders. The other skin manifestations of NS are reviewed. Since the patient had 4 "café au lait" spots, the relation of NS with Von Recklinghausen syndrome, and neurofibromatosis-Noonan syndrome is discussed. Watson's Leopard and cardio-facial syndromes overlap with, and may represent subsets of NS.

  13. Mutations in SERPINB7, encoding a member of the serine protease inhibitor superfamily, cause Nagashima-type palmoplantar keratosis.

    PubMed

    Kubo, Akiharu; Shiohama, Aiko; Sasaki, Takashi; Nakabayashi, Kazuhiko; Kawasaki, Hiroshi; Atsugi, Toru; Sato, Showbu; Shimizu, Atsushi; Mikami, Shuji; Tanizaki, Hideaki; Uchiyama, Masaki; Maeda, Tatsuo; Ito, Taisuke; Sakabe, Jun-ichi; Heike, Toshio; Okuyama, Torayuki; Kosaki, Rika; Kosaki, Kenjiro; Kudoh, Jun; Hata, Kenichiro; Umezawa, Akihiro; Tokura, Yoshiki; Ishiko, Akira; Niizeki, Hironori; Kabashima, Kenji; Mitsuhashi, Yoshihiko; Amagai, Masayuki

    2013-11-07

    "Nagashima-type" palmoplantar keratosis (NPPK) is an autosomal recessive nonsyndromic diffuse palmoplantar keratosis characterized by well-demarcated diffuse hyperkeratosis with redness, expanding on to the dorsal surfaces of the palms and feet and the Achilles tendon area. Hyperkeratosis in NPPK is mild and nonprogressive, differentiating NPPK clinically from Mal de Meleda. We performed whole-exome and/or Sanger sequencing analyses of 13 unrelated NPPK individuals and identified biallelic putative loss-of-function mutations in SERPINB7, which encodes a cytoplasmic member of the serine protease inhibitor superfamily. We identified a major causative mutation of c.796C>T (p.Arg266(∗)) as a founder mutation in Japanese and Chinese populations. SERPINB7 was specifically present in the cytoplasm of the stratum granulosum and the stratum corneum (SC) of the epidermis. All of the identified mutants are predicted to cause premature termination upstream of the reactive site, which inhibits the proteases, suggesting a complete loss of the protease inhibitory activity of SERPINB7 in NPPK skin. On exposure of NPPK lesional skin to water, we observed a whitish spongy change in the SC, suggesting enhanced water permeation into the SC due to overactivation of proteases and a resultant loss of integrity of the SC structure. These findings provide an important framework for developing pathogenesis-based therapies for NPPK.

  14. The chamber-scarification test for irritancy.

    PubMed

    Frosch, P J; Kligman, A M

    1976-12-01

    A procedure has been designed (the chamber-scarification test), which possesses greatly increased sensitivity for assessing the irritancy of topically applied materials. A forearm test site is criss-cross scarified by drawing a 30-gauge needle over the skin with just enough pressure to cleave the epidermis without drawing blood. The test agent is applied in an aluminum chamber once daily for 3 days. The advantages of the method over conventional patch testing are: enhanced capacity to measure mild irritants, reduced time (3 days versus 10 to 21 days), less effort, less cost, less discomfort for the volunteers and greater reproducibility.

  15. Defining and measuring irritability: Construct clarification and differentiation.

    PubMed

    Toohey, Michael J; DiGiuseppe, Raymond

    2017-04-01

    Irritability is a symptom of 15 disorders in the DSM-5 and is included in Mood Disorders, Addictive Disorders, Personality Disorders, and more (American Psychiatric Association, 2013). However, the term irritability is defined and measured inconsistently in the scholarly literature. In this article, we reviewed the scholarly definitions of irritability and the item content of irritability measures. Components of definitions and items measuring irritability were divided into three categories: a) causes, b) experience, and c) consequences. We also reviewed potential causes and biomarkers of irritability. We found much overlap between definitions and measures of irritability and related constructs such as anger and aggression. Consequently, the validity of research on irritability needs to be questioned including the role of irritability in psychopathology and the presence of irritability as a symptom in any disorder. Research on irritability's role in behavioral disorders needs to be repeated after more well defined measures are developed. We proposed a more precise definition of irritability that clearly differentiates it from related constructs. Suggested items for measuring irritability are also provided. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. [Intelligence and irritable bowel syndrome].

    PubMed

    Díaz-Rubio García, Manuel

    2006-01-01

    The Syndrome of Irritable Intestine (SII) is a chronic functional dysfunction that it is characterized by abdominal pain and changes of intestinal rhythm without demonstrable organic alteration. It is avery prevelent dysfunction in the developed countries, there being involved in its physiopathology, among other, the psychosocial factors (illness behavior, social situation, stress, vital events, neuroticism, anxiety and somatization). However no study has been carried out on the Rational Intelligence and Experiential Intelligence or Constructive Thought in patient with SII in spite of knowing that the cognitive processes participate in its genesis. On the hypothesis that the patients with SII would have an experiencial intelligence smaller that the fellows controls, 100 cases of SII and 100 controls have been studied, being excluded of both patients groups with intellectual deficit or psychiatric illness in the last year. The cases of SII were distributed in two groups, one of 50 cases that habitually consulted with the doctor and other 50 that didn't make it. All the participants completed specific tests to evaluate all the psychological factors and Rational Intelligence and the Constructive Thought. The results show an alteration of the psychological factors in the SII, expressed by the antecedents of vital events, m even significant of anxiety feature and anxiety and a neuroticism statistically significant. As for Rational Intelligence and Experiential Intelligence in the SII, it was observed that to Rational Intelligence is same in the patients with SII that in the controls. Only in the group of SII that habitually consulted with the doctor a slightly significant decrease of the intellectual coefficient it was observed. As for the Experiential Intelligence a significant decrease of the Constructive Thought was observed in the patients with SII in comparison with the group control. Of their components a decrease of the emotionality exists and of the

  17. Efficacy and Safety of a Low Molecular Weight Hyaluronic Acid Topical Gel in the Treatment of Facial Seborrheic Dermatitis Final Report

    PubMed Central

    Rowland Powell, Callie

    2014-01-01

    Objective: Hyaluronic acid sodium salt gel 0.2% is a topical device effective in reducing skin inflammation. Facial seborrheic dermatitis, characterized by erythema and or flaking/scaling in areas of high sebaceous activity, affects up to five percent of the United States population. Despite ongoing study, the cause of the condition is yet unknown, but has been associated with yeast colonization and resultant immune derived inflammation. First-line management typically is with keratolytics, topical steroids, and topical antifungals as well as the targeted immunosuppressant agents pimecrolimus and tacrolimus. The objective of this study was to evaluate the efficacy and safety of a novel topical antiinflammatory containing low molecular weight hyaluronic acid. Design and setting: Prospective, observational, non-blinded safety and efficacy study in an outpatient setting. Participants: Individuals 18 to 75 years of age with facial seborrheic dermatitis. Measurements: Outcome measures included scale, erythema, pruritus, and the provider global assessment, all measured on a five-point scale. Subjects were assessed at baseline, Week 2, Week 4, and Week 8. Results: Final data with 13 of 17 subjects are presented. Hyaluronic acid sodium salt gel 0.2% was shown through visual grading assessments to improve the provider global assessment by 65.48 percent from baseline to Week 4. Reductions in scale, erythema, and pruritus were 76.9, 64.3, and 50 percent, respectively, at Week 4. At Week 8, the provider global assessment was improved from baseline in 92.3 percent of subjects. Conclusion: Treatment with topical low molecular weight hyaluronic acid resulted in improvement in the measured endpoints. Final data reveal continued improvement from that seen in the interim data shown previously. Topical low molecular weight hyaluronic acid is another option that may be considered for the treatment of facial seborrheic dermatitis in the adult population. Compliance and tolerance were

  18. Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 1% ointment compared with tacrolimus 0.1% ointment in adults.

    PubMed

    Papp, Kim A; Papp, Alexine; Dahmer, Betty; Clark, Christina S

    2012-07-01

    Tacrolimus is a topical calcineurin inhibitor with immunomodulatory, anti-inflammatory, and fungicidal properties that may be beneficial in the treatment of facial seborrheic dermatitis. We sought to compare the efficacy and safety of tacrolimus with standard corticosteroid treatment in adults with facial seborrheic dermatitis in a phase II, single-blind, randomized controlled trial. Adult patients were enrolled in a 12-week study. Subjects were randomized to tacrolimus 0.1% ointment (n = 16) or hydrocortisone 1% ointment (n = 14) applied twice daily to symptomatic regions of the face. The primary efficacy measure was the severity of facial seborrhea at the end of treatment (day 84) as measured by the Seborrhea Area and Severity Index-Face. Secondary efficacy measures included physician and patient assessment of seborrhea, the frequency of medication application, and adverse events. The severity of facial seborrhea was similarly improved in both treatment groups (P = .86). Tacrolimus 0.1% ointment was used on significantly fewer days than 1% hydrocortisone ointment (mean missed doses per patient at first visit: 15.6 vs 7.6, P < .05; at last visit: 13.5 vs 7.7, P = .08). The majority of doses were missed because of lack of symptoms. The adverse event profile for both agents was similar; however, there was a numerically higher incidence of adverse events in the hydrocortisone group. This was a small, open-label study. Tacrolimus 0.1% ointment required significantly fewer applications compared with hydrocortisone 1% ointment to achieve a comparable clinical response in adults with facial seborrheic dermatitis. Tacrolimus was generally well tolerated. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  19. Dandruff, seborrheic dermatitis, and psoriasis drug products containing coal tar and menthol for over-the-counter human use; amendment to the monograph. Final rule

    SciTech Connect

    2006-03-15

    The Food and Drug Administration (FDA) is issuing a final rule amending the final monograph (FM) for over-the-counter (OTC) dandruff, seborrheic dermatitis, and psoriasis drug products to include the combination of 1.8 percent coal tar solution and 1.5 percent menthol in a shampoo drug product to control dandruff. FDA did not receive any comments or data in response to its previously proposed rule to include this combination. This final rule is part of FDA's ongoing review of OTC drug products.

  20. Oncogenic PIK3CA mutations occur in epidermal nevi and seborrheic keratoses with a characteristic mutation pattern

    PubMed Central

    Hafner, Christian; López-Knowles, Elena; Luis, Nuno M.; Toll, Agustí; Baselga, Eulàlia; Fernández-Casado, Alex; Hernández, Silvia; Ribé, Adriana; Mentzel, Thomas; Stoehr, Robert; Hofstaedter, Ferdinand; Landthaler, Michael; Vogt, Thomas; Pujol, Ramòn M.; Hartmann, Arndt; Real, Francisco X.

    2007-01-01

    Activating mutations of the p110 α subunit of PI3K (PIK3CA) oncogene have been identified in a broad spectrum of malignant tumors. However, their role in benign or preneoplastic conditions is unknown. Activating FGF receptor 3 (FGFR3) mutations are common in benign skin lesions, either as embryonic mutations in epidermal nevi (EN) or as somatic mutations in seborrheic keratoses (SK). FGFR3 mutations are also common in low-grade malignant bladder tumors, where they often occur in association with PIK3CA mutations. Therefore, we examined exons 9 and 20 of PIK3CA and FGFR3 hotspot mutations in EN (n = 33) and SK (n = 62), two proliferative skin lesions lacking malignant potential. Nine of 33 (27%) EN harbored PIK3CA mutations; all cases showed the E545G substitution, which is uncommon in cancers. In EN, R248C was the only FGFR3 mutation identified. By contrast, 10 of 62 (16%) SK revealed the typical cancer-associated PIK3CA mutations E542K, E545K, and H1047R. The same lesions displayed a wide range of FGFR3 mutations. Corresponding unaffected tissue was available for four EN and two mutant SK: all control samples displayed a WT sequence, confirming the somatic nature of the mutations found in lesional tissue. Forty of 95 (42%) lesions showed at least one mutation in either gene. PIK3CA and FGFR3 mutations displayed an independent distribution; 5/95 lesions harbored mutations in both genes. Our findings suggest that, in addition to their role in cancer, oncogenic PIK3CA mutations contribute to the pathogenesis of skin tumors lacking malignant potential. The remarkable genotype–phenotype correlation as observed in this study points to a distinct etiopathogenesis of the mutations in keratinocytes occuring either during fetal development or in adult life. PMID:17673550

  1. Comparing the efficacy of Emu oil with clotrimazole and hydrocortisone in the treatment of seborrheic dermatitis: A clinical trial

    PubMed Central

    Attarzadeh, Yalda; Asilian, Ali; Shahmoradi, Zabihollah; Adibi, Neda

    2013-01-01

    Background: Seborrheic dermatitis (SD) is a common, chronic inflammatory disease. Inflammatory reaction and oxidative stress are thought to be effective in the pathogenesis of SD. Based on anti-inflammatory and anti-oxidant properties of emu oil, this study was designed to evaluate effects of emu oil on patients suffering from SD, and to compare it with routine treatments of SD with topical steroids and antifungal agents. Materials and Methods: This clinical trial was conducted on126 patients who were randomly allocated to 2 groups: 62 in the clotrimazole vs. emu oil (group-1) and 64 in the hydrocortisone vs. emu oil (group-2). The right side of the face in both groups was treated with topical emu oil. The left side was treated with topical clotrimazole in the first group and with topical hydrocortisone in the second group. One month after the treatment, pre and post treatment symptom severity scores of pruritus, erythema and scales were compared. Results: All 3 medications significantly improved pruritus, erythema and scales (P < 0. 01). However, topical clotrimazole and hydrocortisone were significantly more effective than emu oil in improving scales (P < 0.01), and hydrocortisone was significantly more effective than emu oil in reducing pruritus (P < 0. 01). Comparing with topical clotrimazole, emu oil resulted in significantly more improvement of erythema (p:0.01). Conclusion: Emu oil is a potentially useful agent that significantly improves itching, erythema and scales associated with SD; however, it was less effective than hydrocortisone and clotrimazole which are routinely prescribed to treat SD. PMID:24250695

  2. Influence of Information Framing on Patient Decisions to Treat Actinic Keratosis.

    PubMed

    Berry, Katherine; Butt, Melissa; Kirby, Joslyn S

    2017-05-01

    Actinic keratosis (AK) is a skin growth induced by UV light exposure that requires long-term management because a small proportion of the disease can progress to squamous cell carcinoma. The influence of how clinicians frame or present information to patients may affect decision making about AK. To evaluate the differences in patients' decisions on whether to receive treatment for AK related to information presentation or choice framing. A prospective survey study was performed from June 1 to July 31, 2016, in participants who were able to read English. Participants were recruited through the Penn State Milton S. Hershey Dermatology Clinic and an online survey site. The survey was conducted through an online portal. A total of 571 individuals were recruited. Regression analysis, correlation coefficient analysis, and test-retest validation were conducted. The proportions of patients choosing to receive treatment for AK. Analyses were performed to adjust for age, sex, educational level, history of skin cancer, and history of AK. Of the 571 recruited participants, 539 (94.4%) returned completed surveys. The mean (SD) age of respondents was 42.9 (17.8) years; 306 (56.8%) were women. The decision to receive treatment for AK varied from 57.7% (n = 311) to 92.2% (n = 497) for the 5 scenarios presented in the questions (P < .001). The question that presented AK as a "precancer" had the highest proportion of participants who preferred treatment (497 [92.2%]). Two questions that presented the risk of AK as not progressing to cancer had the lowest proportion of individuals who chose treatment (311 [57.7%] and 328 [60.9%]). Participants from the clinic and from the online portal were significantly different in age (mean [SD] age, 56.1 [17.6] vs 33.3 [10.0] years), sex (145 [63.6%] vs 161 [51.8%] were females), educational level (40 [17.5%] vs 80 [25.7%] had completed some graduate school), history of AK (46 [20.2%] vs 19 [6.1%] answered yes), and history of skin

  3. Evaluation of Resource Utilization and Treatment Patterns in Patients with Actinic Keratosis in the United States.

    PubMed

    Asche, Carl V; Zografos, Panagiotis; Norlin, Jenny M; Urbanek, Bill; Mamay, Carl; Makin, Charles; Erntoft, Sandra; Chen, Chi-Chang; Hines, Dionne M; Mark Siegel, Daniel

    2016-01-01

    To compare health care resource utilization and treatment patterns between patients with actinic keratosis (AK) treated with ingenol mebutate gel (IngMeb) and those treated with other field-directed AK therapies. A retrospective, propensity-score-matched, cohort study compared refill/repeat and adding-on/switching patterns and outpatient visits and prescriptions (health care resource utilization) over 6 months in patients receiving IngMeb versus those receiving imiquimod, 5-fluorouracil, diclofenac sodium, and methyl aminolevulinate or aminolevulinic acid photodynamic therapy (MAL/ALA-PDT). The final sample analyzed included four matched treatment cohort pairs (IngMeb and comparator; n = 790-971 per treatment arm). Refill rates were similar except for imiquimod (15% vs. 9% for imiquimod and IngMeb, respectively; P < 0.05). MAL/ALA-PDT treatment repetition rates were higher than IngMeb refill rates (20% vs. 10%; P < 0.05). Topical agent add-on/switch rates were comparable. PDT had higher switch rates than did IngMeb (5% vs. 2%; P < 0.05). The IngMeb cohort had a significantly lower proportion of patients with at least one AK-related outpatient visit during the 6-month follow-up than did any other cohort: versus imiquimod (50% vs. 66%; P < 0.0001), versus 5-fluorouracil (50% vs. 69%; P < 0.0001), versus diclofenac sodium (51% vs. 56%; P = 0.034), and versus MAL/ALA-PDT (50% vs. 100%; P < 0.0001). There were significantly fewer AK-related prescriptions among patients receiving IngMeb than among patients in other cohorts. Results based on the first 6 months after treatment initiation suggested that most field-directed AK therapies had clinically comparable treatment patterns except imiquimod, which was associated with higher refill rates, and PDT, which was associated with significantly more frequent treatment sessions and higher switching rates. IngMeb was also associated with significantly fewer outpatient visits than were other field-directed therapies. Copyright

  4. Genetic heterogeneity in families with non-epidermolytic palmar plantar keratosis

    SciTech Connect

    Spurr, N.K.; Kelshell, D.P.; Stevens, H.

    1994-09-01

    Following reports of linkage close to the keratin gene cluster in families with tylosis and the detection of mutations in the keratin 9 gene cosegregating in families with epidermolytic palmar plantar keratoderma (EPPK, and EPPK associated with breast and ovarian cancer), we have identified families with three phenotypically distinct forms of non-epidermolytic keratosis with either punctate, diffuse or focal keratoderma, one with diffuse lesions and one with punctate and malignancies. Initially we typed these families with 17q markers close to the keratin gene cluster; this included a dinucleotide repeat marker within the keratin 9 gene. Two point linkage analysis of the focal keratoderma family showed a positive lod score of 3.2 at a theta of 0 from the marker D17S855. The lod score for the diffuse family was -6.0 at a theta of 0.05 from the marker D17S776. The second focal keratoderma family showed a haplotype consistent with linkage to 17q close to the keratin gene cluster. A second keratin gene cluster has been mapped in humans on 12q, and we decided to test the unlinked diffuse and punctate keratoderma families with markers in that region. We used the markers: D12S87-D12S85-D12S368-D12S96-D12S90. Linkage analysis of the diffuse family gave a lod score of 3.1 at a theta of 0 from the marker D12S368. Currently studies are underway to look for mutations in specific keratin genes in the clusters on 17q and 12q that segregate with the observed phenotypes. The punctate keratoderma family gave lod scores of -3.9 at a theta of 0.55 with D17S855 and -6.0 at a theta of 0.05 with D12S90/D12S83. This would lead us to the conclusion that a separate susceptibility locus must exist for the punctate family associated with malignancy. Investigations of candidate regions are in progress.

  5. Developmental Trajectories of Irritability and Bidirectional Associations With Maternal Depression

    PubMed Central

    Wiggins, Jillian Lee; Mitchell, Colter; Stringaris, Argyris; Leibenluft, Ellen

    2014-01-01

    Objective Irritability is a dimensional trait in typical development and a common presenting symptom in many psychiatric disorders, including depression. However, little is known about the developmental trajectory of irritability or how child irritability interacts with maternal depression. The present study (1) identifies classes of irritability trajectories from toddlerhood to middle childhood; (2) characterizes maternal depression and other family, social environment, and child variables within each irritability trajectory class; and (3) as a more exploratory analysis, examines bidirectional associations between maternal depression and child irritability. Method 4,898 families from the Fragile Families and Child Wellbeing Study reported on irritability symptoms at ages 3, 5, and 9, assessed with items from the Child Behavior Checklist. Parental major depressive episode was assessed using the Composite International Diagnostic Interview – Short Form at child ages 1, 3, 5, 9. Results A latent class growth analysis identified five irritability classes: low decreasing; moderate decreasing; high steady; initially very high, then decreasing; and high increasing. Children with more severe irritability trajectories are more likely to have mothers with recurrent depression, and, with the exception of the most severe (high increasing irritability) class, were more likely to have mothers who were exposed to violence. Moreover, paternal depression and alcohol use, as well as maternal drug and alcohol use, were also risk factors for membership in the more severe irritability classes. A latent auto-regressive cross-lag model showed that child irritability at ages 3 and 5 is associated with increased mother depression at 5 and 9, respectively. Conversely, mother depression at child ages 1 and 3 is associated with increased child irritability at 3 and 5. Conclusion Irritability development across toddlerhood and middle childhood has five main trajectory types, which differ on

  6. Irritable Bowel Syndrome: A Misunderstood Psychophysiological Affliction.

    ERIC Educational Resources Information Center

    Moser, Rosemarie Scolaro

    1986-01-01

    Irritable bowel syndrome is benign, chronic, gastrointestinal disorder that affects much of the general population. Misunderstanding and lack of patient education often result in increased anxiety and physical distress. Counselors can be instrumental in recognizing the condition in afflicted clients and providing emotional support and stress…

  7. Cognitive Therapy for Irritable Bowel Syndrome.

    ERIC Educational Resources Information Center

    Greene, Barbara; Blanchard, Edward B.

    1994-01-01

    Randomly assigned 20 patients with irritable bowel syndrome to intensive, individualized cognitive therapy or to daily gastrointestinal symptom monitoring. Pre- to posttreatment evaluations showed significantly greater gastrointestinal symptom reduction for those receiving cognitive therapy than for those in symptom monitoring. At posttreatment,…

  8. 16 CFR 1500.42 - Test for eye irritants.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Test for eye irritants. 1500.42 Section 1500... eye irritants. (a)(1) Six albino rabbits are used for each test substance. Animal facilities for such... materials that might produce eye irritation. Both eyes of each animal in the test group shall be...

  9. 16 CFR 1500.42 - Test for eye irritants.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Test for eye irritants. 1500.42 Section 1500... eye irritants. (a)(1) Six albino rabbits are used for each test substance. Animal facilities for such... materials that might produce eye irritation. Both eyes of each animal in the test group shall be...

  10. Successful prevalidation of the slug mucosal irritation test to assess the eye irritation potency of chemicals.

    PubMed

    Adriaens, E; Bytheway, H; De Wever, B; Eschrich, D; Guest, R; Hansen, E; Vanparys, P; Schoeters, G; Warren, N; Weltens, R; Whittingham, A; Remon, J P

    2008-08-01

    A previous 'in house' validation study showed that the SMI assay can be used as an alternative to the in vivo Draize eye irritation test. The aim of this multi-centre study with four participating laboratories was to assess the transferability and inter-laboratory variability of the assay using 20 reference chemicals covering the whole irritancy range. The eye irritation potency of the chemicals was assessed by measuring the amount of mucus produced during a 60-min contact period with a 1% dilution, and a second 60-min treatment with a 3.5% dilution. After each contact period the protein release from the mucosal surface was measured. Linear discriminant equations were used to convert the results into the corresponding EU eye irritation categories (NI, R36 and R41). All the non-irritants were predicted correctly by the four laboratories resulting in a 100% specificity. For the R36 compounds a correct classification rate of 89% (VITO) and 100% (SPL, JNJ and UGent) was obtained. The R41 compounds were classified correctly in 78% of the cases for VITO, 89% for SPL and JNJ and 100% for UGent. We can conclude that the SMI assay is a relevant, easily transferable and reproducible alternative to predict the eye irritation potency of chemicals.

  11. An open, randomized, prospective, comparative study of topical pimecrolimus 1% cream and topical ketoconazole 2% cream in the treatment of seborrheic dermatitis.

    PubMed

    Koc, Erol; Arca, Ercan; Kose, Osman; Akar, Ahmet

    2009-01-01

    Seborrheic dermatitis (SD) is a chronic inflammatory disorder that mainly affects the seborrheic region. While ketoconazole is often used, pimecrolimus has been used successfully in SD. To compare the efficacy and tolerability of pimecrolimus in comparison with ketoconazole in the treatment of SD. A total of 48 patients with SD were included in the study. Patients were randomized into two groups: 23 and 25 patients in the pimecrolimus and ketoconazole groups, respectively. Clinical measures were assessed by erythema, scaling and infiltration, which were evaluated using a four-point scale (0 to 3) at 2, 6, and 12 weeks. Of these 48 patients, 38 completed the study (18 and 20 patients in the pimecrolimus and ketoconazole groups, respectively). The mean percentage decrease in clinical severity scores from baseline to the last follow-up period was 86.2% and 86.1% in the pimecrolimus and ketoconazole groups, respectively. Both pimecrolimus and ketoconazole were effective in SD. Differences between the two groups were not statistically significant. Side effects were observed more frequently with pimecrolimus than with ketoconazole and this difference was statistically significant. Our study showed that pimecrolimus had a comparable efficacy profile with that of ketoconazole, but side effects appeared more frequently in the pimecrolimus group than in the ketoconazole group.

  12. Relative irritancy of free fatty acids of different chain length.

    PubMed

    Stillman, M A; Maibach, H I; Shalita, A R

    1975-01-01

    Free fatty acids of human skin surface lipids have previously been implicated in the pathogenesis of acne vulgaris because of their apparent irritant and comedogenic properties. Prior studies on the relative irritancy of free fatty acids revealed the saturated C8 to C14 fatty acids and a C18 dienoic unsaturated fatty acid (linoleic) to be most irritating. Saturated free fatty acids from C3 to C18, and unsaturated C18 free fatty acids were applied daily under occlusive patch tests to human skin until detectable erythema appeared. The most irritating fatty acids were C8 through C12. Of the unsaturated fatty acids tested, only linoleic acid produced irritation.

  13. [Irritant contact dermatitis. Part I. Epidemiology, etiopathogenesis and clinical manifestation].

    PubMed

    Chomiczewska, Dorota; Kieć-Swierczyńska, Marta; Krecisz, Beata

    2008-01-01

    Irritant contact dermatitis is a frequent problem in dermatology. It compromises the majority of all occupational skin diseases in most countries. It develops as a result of the environmental or work-related exposure to irritants. Cutaneous reaction depends on the intrinsic properties of the irritant, individual skin susceptibility and environmental conditions. A great morphological variety of irritant contact dermatitis and difficulties in diagnosis may lead to misdiagnosis and inadequate treatment. The prognosis is variable. Preventive measures, including education, individual skin protection and proper skin care may contribute to the reduced incidence of occupational irritant contact dermatitis.

  14. Irritability and Anxiety Severity Among Youth With Anxiety

    PubMed Central

    Cornacchio, Danielle; Crum, Kathleen I.; Coxe, Stefany; Pincus, Donna B.; Comer, Jonathan S.

    2015-01-01

    Objective Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations. Method Structural equation modeling (SEM) examined associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N=663, ages 7–19 years, M=12.25), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status. Results There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Further, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety–irritability link is relevant across child anxiety disorders and not circumscribed to youth with GAD. Conclusion Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Further, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Moreover, treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability. PMID:26703910

  15. Molecular genetic analysis of two families with keratosis follicularis spinulosa decalvans: refinement of gene localization and evidence for genetic heterogeneity.

    PubMed

    Oosterwijk, J C; Richard, G; van der Wielen, M J; van de Vosse, E; Harth, W; Sandkuijl, L A; Bakker, E; van Ommen, G J

    1997-10-01

    X-linked keratosis follicularis spinulosa decalvans (KFSD) is a rare disorder affecting both skin and eyes. In the two extended KFSD families analysed to date, the gene was mapped to Xp22.13-p22.2. By analyzing several new markers in this region, we were able to narrow the candidate region to a 1-Mb interval between DXS7161 and (DXS7593, DXS7105) in the large Dutch pedigree. In addition, we analyzed 23 markers in Xp21.2-p22.2 in a German family with KFSD. Haplotype and recombination analysis positioned the KFSD gene in this family most likely outside the candidate region on Xp22.13-p22.2. This finding is suggestive for genetic heterogeneity: in this pedigree there is either another locus on the X-chromosome, or KFSD is transmitted here as an autosomal dominant trait with variable expression.

  16. Histopathological analysis of the therapeutic response to cryotherapy with liquid nitrogen in patients with multiple actinic keratosis*

    PubMed Central

    de Oliveira, Marina Câmara; Trevisan, Flávia; Pinto, Clovis Antônio Lopes; Xavier, Célia Antônia; Pinto, Jaqueline Campoi Calvo Lopes

    2015-01-01

    Actinic keratoses are premalignant lesions of the skin caused by excessive sun exposure. Lesions may become mainly squamous cell carcinoma. Cryotherapy with liquid nitrogen is one of the main treatments. In order to evaluate the response of actinic keratosis to cryotherapy by histopathology, two lesions were selected in each of 14 patients with multiple actinic keratoses. In one lesion a biopsy was performed and in the other lesion a biopsy was performed after cryotherapy. Subsequently, both biopsies were compared histologically. Of the thirteen patients who completed the study, the best results were obtained in lesions undergoing cryotherapy concerning the atypia of keratinocytes, epithelial thickness and corneal layer and lymphocytic infiltrate. Despite the small number of patients, it was concluded that, if performed correctly, cryotherapy has high efficacy in the treatment of actinic keratoses. PMID:26131870

  17. Histopathological analysis of the therapeutic response to cryotherapy with liquid nitrogen in patients with multiple actinic keratosis.

    PubMed

    Oliveira, Marina Câmara de; Trevisan, Flávia; Pinto, Clovis Antônio Lopes; Xavier, Célia Antônia; Pinto, Jaqueline Campoi Calvo Lopes

    2015-01-01

    Actinic keratoses are premalignant lesions of the skin caused by excessive sun exposure. Lesions may become mainly squamous cell carcinoma. Cryotherapy with liquid nitrogen is one of the main treatments. In order to evaluate the response of actinic keratosis to cryotherapy by histopathology, two lesions were selected in each of 14 patients with multiple actinic keratoses. In one lesion a biopsy was performed and in the other lesion a biopsy was performed after cryotherapy. Subsequently, both biopsies were compared histologically. Of the thirteen patients who completed the study, the best results were obtained in lesions undergoing cryotherapy concerning the atypia of keratinocytes, epithelial thickness and corneal layer and lymphocytic infiltrate. Despite the small number of patients, it was concluded that, if performed correctly, cryotherapy has high efficacy in the treatment of actinic keratoses.

  18. Irritable bowel syndrome: focus on otilonium bromide.

    PubMed

    Boeckxstaens, Guy; Clavé, Pere; Corazziari, Enrico S; Tack, Jan

    2014-02-01

    Irritable bowel syndrome is a prevalent and chronic disorder, characterized by recurrent abdominal pain/discomfort, bloating and altered bowel habits. This condition affects an estimated 10-15% of the population worldwide and impacts heavily on a patient's daily life and ability to work, as well as healthcare resource utilization. Drug therapy aimed at correcting the primary symptoms of diarrhea/constipation/bloating may have little effect on abdominal pain, which results from visceral hypersensitivity. Smooth muscle relaxants or antispasmodics decrease the tone and contractility of intestinal smooth muscle, effectively managing abdominal pain. Otilonium bromide has been widely used worldwide and has been found to be safe and well tolerated, and superior to placebo for the reduction of symptoms and the prevention of symptom relapse in patients with irritable bowel syndrome.

  19. Proretinal nanoparticles: stability, release, efficacy, and irritation

    PubMed Central

    Pisetpackdeekul, Pimolphan; Supmuang, Piyapan; Pan-In, Porntip; Banlunara, Wijit; Limcharoen, Benchaphorn; Kokpol, Chayada; Wanichwecharungruang, Supason

    2016-01-01

    Despite many potent biological activities, retinoids such as retinoic acid (RA) and retinal possess dose-related broad side effects. In this study, we show that this problem, which has been unsolvable for a long time, can be tackled through a controlled release strategy in which retinal is continuously delivered to the skin via sustained release from proretinal nanoparticles. The water dispersible proretinal nanoparticles are stable when kept in water at neutral pH and at room temperature for 8 months under light-proof conditions, and show sustained release of retinal into human synthetic sebum at a pH of 5. In the daily topical application tests performed for 4 weeks on rats’ skin, the nanoparticles showed superior ability to increase epidermal thickness compared to RA and retinal, with no skin irritation observed for the proretinal particles, but severe skin irritation observed for RA and free retinal. When tested under occlusion conditions in human volunteers, insignificant skin irritation was observed for the proretinal nanoparticles. The 12-week, double-blind, split-face study on human volunteers indicates better antiaging efficacy of the particles as compared to the free RA. PMID:27499622

  20. Irritable bowel syndrome; update on pathophysiology and management.

    PubMed

    Quigley, Eamonn M M; Craig, Orla F

    2012-08-01

    The description of the de novo development of irritable bowel syndrome following an episode of bacterial gastroenteritis (pos-infectious irritable bowel syndrome) illustrated the potential for a luminal factor (a bacterial pathogen) to cause this common gastrointestinal ailment. As a consequence of these and other observations, as well as results of experiments involving animal models, the enteric flora and the immune response that it generates in the host have, somewhat surprisingly, come centre-stage in irritable bowel syndrome research, given their potential to induce the pathophysiological changes that are associated with irritable bowel syndrome. While evidence for immune dysfunction both in the mucosa and systemically continues to accumulate, methodological limitations have hampered a full delineation of the nature of the microbiota in irritable bowel syndrome. The latter is eagerly awaited and may yet provide a firm rationale for the use of certain probiotics and antibiotics in irritable bowel syndrome, whose benefits have now been described with some consistency. Despite its prevalence, there is a striking lack of effective therapeutic options for irritable bowel syndrome. While there is reason for optimism in the management of irritable bowel syndrome with several promising new agents currently undergoing clinical trials, confirmation of the efficacy and safety of these agents in wider patient populations is awaited. A clearer understanding of the physiopathologic mechanisms underlying irritable bowel syndrome, as well as of interrelationships between irritable bowel syndrome and other gastrointestinal and non-gastrointestinal disorders, will likely be required before effective drug therapies can be found.

  1. Confirmation of X-linked inheritance and provisional mapping of the keratosis follicularis spinulosa decalvans gene on Xp in a large Dutch family.

    PubMed

    Oosterwijk, J C; Nelen, M; Van Zandvoort, P M; Van Osch, L D; Oranje, A P; Wittebol-Post, D; Van Oost, B A

    1992-03-01

    In a large Dutch family with keratosis follicularis spinulosa decalvans (KFSD, MIM 308800), DNA linkage analysis was performed in order to locate the gene. Pedigree analysis and lod score calculation confirmed X-linked inheritance and revealed significant linkage to DNA markers on Xp. A maximum lod score of 5.70 at theta = 0.0 was obtained with DXS41 (p99.6). The KFSD gene is tentatively located on Xp21.2-p22.2.

  2. [Immunohistochemical study of the specific features of expression of matrix metalloproteinases 1, 9 in the photoaged skin, the foci of actinic keratosis and basal cell carcinoma].

    PubMed

    Kuznetsova, E V; Snarskaya, E S; Zavalishina, L E; Tkachenko, S B

    Matrix metalloproteinases (MMPs) mediate the degradation of all types of collagens and other extracellular matrix components (elastin, proteoglycans, and laminin), their synthesis and accumulation play a key role in the hydrolysis of basement membrane. MMPs are involved in a wide range of proteolytic processes in the presence of different physiological and pathological changes, including inflammation, wound healing, angiogenesis, and carcinogenesis. to study the specific features of MMP-1 and MMP-9 expression in different stages of skin photoaging, in the foci of actinic keratosis and basal cell carcinoma by immunohistochemical examination. 12 samples of the healthy skin (6 samples of the eyelid skin with Glogau grade II photoaging; 6 ones of eyelid skin with Glogau grades III-IV photoaging) and biopsies from 8 foci of actinic keratosis and from 8 ones of basal cell carcinoma were examined. A positive reaction to MMPs was shown as different brown staining intensity in the cytoplasm of keratinocytes/tumor cells. MMP-1 and MMP-9 expression was recorded in 67% of the histological specimens of the Glogau grade III photoaged skin and in 100% of those of Glogau grade IV. In the foci of actinic keratosis, the expression of MMP-1 was observed in 62.5% of cases and that of MMP-9 was seen in 87.5%. In basal cell carcinoma, the expression of MMP-1 and MMP-9 was detected in all investigated samples. The immunomorphological findings are indicative of the important role of the level of MMP-1 and MMP-9 expression that is associated with the degree of progression of skin photoaging processes. Minimal MMP-1 and MMP-9 expression was recorded even in grades III-IV photoaging and in the foci of actinic keratosis. Intense MMP-1 and MMP-9 expression was detected in malignant skin epithelial neoplasms as different clinicomorphological types of basal cell carcinoma.

  3. [Irritant stability of raphides and tubers from Pinellia ternate].

    PubMed

    Yu, Hong-Li; Wu, Hao; Zhang, Xing-De; Liu, Fu-Yan

    2010-06-01

    To investigate the irritation stability of raphides from Pinellia ternata and the contribution of raphides proteins on irritation. The irritation of raphides and tubers from P. ternata treated with different solvents or protease digestion were evaluated by the Draize test. The shape and appearance of raphides treated with immersion in different solvents were showed by scanning electron microscopy, and protein bands from raphides before and after protease digestion were showed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The raphides gradually lost the irritation when immersed in methanol and ethanol, while scanning electron micrograph showed the fragility of the methanol and ethanol treated raphides. The crude tubers of P. ternata immersed in 75% solution of ethanol also lost the acridity. When treated with protease digestion, raphides lost the irritation as well as the many protein bands on the SDS-PAGE gel gradually disappeared. Protein of the raphides could be involved in the raphides irritation.

  4. Pulmonary alterations associated with inhalation of occupational and environmental irritants.

    PubMed

    Castranova, V; Frazer, D G; Manley, L K; Dey, R D

    2002-02-01

    Many gases, vapors, or particles found in occupational and/or environmental settings can act as irritants. In the present study, sensory irritants are characterized by the stimulation of neuropeptide release from sensory nerves in the nasal mucosa, while pulmonary irritants are characterized by recruitment of PMN into bronchoalveolar airspaces, elevation of breathing frequency, and neuropeptide release from sensory fibers innervating the epithelium of the conducting airways. A review of data from our laboratory as well as results from others indicate that asphalt fume is a sensory irritant; toluene diisocyanate (TDI), methyl isocyanate, and machining fluid act as both sensory and pulmonary irritants; while cotton dust, agricultural dusts, microbial products, leather conditioner, and ozone exhibit responses characteristic of pulmonary irritants.

  5. Revisit the 21-day cumulative irritation test - statistical considerations.

    PubMed

    Zhang, Paul; Li, Qing

    2017-03-01

    The 21-day cumulative irritation test is widely used for evaluating the irritation potential of topical skin-care products. This test consists of clinician's assessment of skin reaction of the patch sites and a classification system to categorize the test product's irritation potential. A new classification system is proposed which enables us to control the estimation error and provides a statistical confidence with regard to the repeatability of the classification.

  6. Investigating the genetic underpinnings of early-life irritability.

    PubMed

    Riglin, L; Eyre, O; Cooper, M; Collishaw, S; Martin, J; Langley, K; Leibenluft, E; Stringaris, A; Thapar, A K; Maughan, B; O'Donovan, M C; Thapar, A

    2017-09-26

    Severe irritability is one of the commonest reasons prompting referral to mental health services. It is frequently seen in neurodevelopmental disorders that manifest early in development, especially attention-deficit/hyperactivity disorder (ADHD). However, irritability can also be conceptualized as a mood problem because of its links with anxiety/depressive disorders; notably DSM-5 currently classifies severe, childhood-onset irritability as a mood disorder. Investigations into the genetic nature of irritability are lacking although twin studies suggest it shares genetic risks with both ADHD and depression. We investigated the genetic underpinnings of irritability using a molecular genetic approach, testing the hypothesis that early irritability (in childhood/adolescence) is associated with genetic risk for ADHD, as indexed by polygenic risk scores (PRS). As a secondary aim we investigated associations between irritability and PRS for major depressive disorder (MDD). Three UK samples were utilized: two longitudinal population-based cohorts with irritability data from childhood (7 years) to adolescence (15-16 years), and one ADHD patient sample (6-18 years). Irritability was defined using parent reports. PRS were derived from large genome-wide association meta-analyses. We observed associations between ADHD PRS and early irritability in our clinical ADHD sample and one of the population samples. This suggests that early irritability traits share genetic risk with ADHD in the general population and are a marker of higher genetic loading in individuals with an ADHD diagnosis. Associations with MDD PRS were not observed. This suggests that early-onset irritability could be conceptualized as a neurodevelopmental difficulty, behaving more like disorders such as ADHD than mood disorders.

  7. The aetiology and management of irritant diaper dermatitis.

    PubMed

    Atherton, D J

    2001-09-01

    Irritant diaper dermatitis (IDD) is a common condition caused by the combination of wearing diapers, and incontinence of urine and faeces. The available evidence suggests that maceration of the stratum corneum by water increases susceptibility to frictional damage, and epidermal permeation of irritants. The most important irritants underlying IDD appear to be digestive enzymes persisting in faeces, particularly when these are activated by a high pH.

  8. Developmental trajectories of irritability and bidirectional associations with maternal depression.

    PubMed

    Wiggins, Jillian Lee; Mitchell, Colter; Stringaris, Argyris; Leibenluft, Ellen

    2014-11-01

    Irritability is a dimensional trait in typical development and a common presenting symptom in many psychiatric disorders, including depression. However, little is known about the developmental trajectory of irritability or how child irritability interacts with maternal depression. The present study identifies classes of irritability trajectories from toddlerhood to middle childhood; characterizes maternal depression and other family, social environment, and child variables within each irritability trajectory class; and, as a more exploratory analysis, examines bidirectional associations between maternal depression and child irritability. A total of 4,898 families from the Fragile Families and Child Wellbeing Study reported on irritability symptoms at ages 3, 5, and 9 years, assessed with items from the Child Behavior Checklist. Parental major depressive episode was assessed using the Composite International Diagnostic Interview-Short Form at child ages 1, 3, 5, and 9 years. A latent class growth analysis identified 5 irritability classes: low decreasing; moderate decreasing; high steady; initially very high, then decreasing; and high increasing. Children with more severe irritability trajectories are more likely to have mothers with recurrent depression, and, with the exception of the most severe (high increasing irritability) class, were more likely to have mothers who were exposed to violence. Moreover, paternal depression and alcohol abuse, as well as maternal drug and alcohol abuse, were also risk factors for membership in the more severe irritability classes. A latent auto-regressive cross-lag model showed that child irritability at ages 3 and 5 years is associated with increased mother depression at ages 5 and 9, respectively. Conversely, mother depression at child ages 1 and 3 years is associated with increased child irritability at 3 and 5. Irritability development across toddlerhood and middle childhood has 5 main trajectory types, which differ on maternal

  9. What environmental factors irritate people with acquired brain injury?

    PubMed

    Pryor, Julie

    2004-08-19

    This study aims to determine the environmental factors nurses identify as being irritating to people with acquired brain injury. This was a qualitative study. An experienced interviewer used the Critical Decision Method to interview 28 nurses working in 10 inpatient brain injury rehabilitation units in Australia on a one to one basis for 1-1.5 h on two consecutive days. Transcripts of interviews were analysed using thematic analysis. Nurses identified five groups of irritants that acted as triggers for aggression: The nurses in this study identified many environmental factors that irritate people with acquired brain injury. Some irritants appeared unavoidable but others could be addressed by staff expertise.

  10. TRPA1 receptors mediate environmental irritant-induced meningeal vasodilatation

    PubMed Central

    Kunkler, Phillip Edward; Ballard, Carrie Jo; Oxford, Gerry Stephen; Hurley, Joyce Harts

    2010-01-01

    The TRPA1 receptor is a member of the transient receptor potential (TRP) family of ion channels expressed in nociceptive neurons. TRPA1 receptors are targeted by pungent compounds from mustard and garlic and environmental irritants such as formaldehyde and acrolein. Ingestion or inhalation of these chemical agents causes irritation and burning in the nasal and oral mucosa and respiratory lining. Headaches have been widely reported to be induced by inhalation of environmental irritants, but it is unclear how these agents produce headache. Stimulation of trigeminal neurons releases CGRP and substance P and induces neurogenic inflammation associated with the pain of migraine. Here we test the hypothesis that activation of TRPA1 receptors are the mechanistic link between environmental irritants and peptide mediated neurogenic inflammation. Known TRPA1 agonists and environmental irritants stimulate CGRP release from dissociated rat trigeminal ganglia neurons and this release is blocked by a selective TRPA1 antagonist, HC-030031. Further, TRPA1 agonists and environmental irritants increase meningeal blood flow following intranasal administration. Prior dural application of the CGRP antagonist, CGRP8–37, or intranasal or dural administration of HC-030031, blocks the increases in blood flow elicited by environmental irritants. Together these results demonstrate that TRPA1 receptor activation by environmental irritants stimulates CGRP release and increases cerebral blood flow. We suggest that these events contribute to headache associated with environmental irritants. PMID:21075522

  11. Seborrheic Dermatitis and Rosacea

    MedlinePlus

    ... System Vascular Changes Demodex & Microbes Bibliography Genetics The Ecology of Your Face It Works for Me: Patient ... Tips Skin Care & Cosmetics Causes of Rosacea The Ecology of Your Face It Works for Me: Patient ...

  12. Hypnotherapy for treatment of irritable bowel syndrome.

    PubMed

    Webb, A N; Kukuruzovic, R H; Catto-Smith, A G; Sawyer, S M

    2007-10-17

    Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder of unknown aetiology. Current pharmacological treatments have limited value. Hypnotherapy has been reported to have beneficial effects for IBS symptoms. To evaluate the efficacy of hypnotherapy for the treatment of irritable bowel syndrome. Published and unpublished randomised clinical trials and quasi-randomised clinical trials were identified through structured searches of MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), PsycINFO (1806 to March 2006), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to March 2006), AMED (Allied and Complementary Medicine Database, 1985 to March 2006) and The Cochrane Central Register of Controlled trials. Conference proceedings from Digestive Disease Week (1980 to 2005) were also searched. Eligible studies included all randomised and quasi-randomised clinical studies comparing hypnotherapy for the treatment of irritable bowel syndrome with no treatment or another therapeutic intervention. All studies were evaluated for eligibility for inclusion. Included studies were assessed for quality and data were extracted independently by four authors. The primary outcome measure of interest was the overall bowel symptom severity score which combines abdominal pain, diarrhoea or constipation and bloating. Secondary outcomes included abdominal pain, diarrhoea, constipation, bloating, quality of life, patient's overall assessment of well-being, psychological measures as per validated questionnaires, and adverse events. Four studies including a total of 147 patients met the inclusion criteria. Only one study compared hypnotherapy to an alternative therapy (psychotherapy and placebo pill), two studies compared hypnotherapy with waiting-list controls and the final study compared hypnotherapy to usual medical management. Data were not pooled for meta-analysis due to differences in outcome measures and study design. The therapeutic

  13. The effect of damaged skin barrier induced by subclinical irritation on the sequential irritant contact dermatitis.

    PubMed

    Yan-yu, Wu; Xue-min, Wang; Yi-Mei, Tan; Ying, Cheng; Na, Liu

    2011-12-01

    Skin damage caused by a single specific stimulus has been extensively studied. However, many additional mild skin irritants are experienced every day before obvious irritant contact dermatitis (ICD) appears. The effect that these previously experienced mild irritations have on the incidence and severity of sequential ICD remains undefined. The purpose of this work was to explore whether the effects of skin barrier damage induced by either the open patch test with 1% sodium lauryl sulfate (SLS), tape stripping test (TAP) (10×), or irradiation with 0.75 median erythemal dose UVB (MED) will affect the severity of sequential irritant dermatitis induced by a 0.5% SLS occlusive patch test (PT). Nine treatments were applied to nine different locations of the ventral forearm of each subject at random. The nine treatment types were as follows: open patch test with 1% SLS; 10× TAP; UVB irradiation with 0.75 MED; open patch test with 1% SLS + PT with 0.5% SLS (SLSPT); 10× TAP + PT with 0.5% SLS (TAPPT); UVB irradiation with 0.75 MED + PT with 0.5% SLS (UVPT); PT with distilled water (DISPT); PT with 0.5% SLS (PT); and the CONTROL (no treatment). After 5 days of subclinical irritation, the PT was applied on day 6. Transepidermal water loss (TEWL), capacitance (CAP), and skin color (a*) were measured at baseline and on days 6, 7, and 8. After the PT, indices of irritancy of PT, UVPT, SLSPT, and TAPPT were 60, 80, 87 and 100%, respectively. The index of irritancy of TAPPT and SLSPT were significantly higher than that of PT (p < 0.05). Clinical scores of SLSPT and TAPPT were also significantly higher than PT (p < 0.05). After 5 days of irritation, TEWL of SLS, TAP, SLSPT, and TAPPT were increased significantly compared to that of baseline. After the PT, D-value of TEWL between day 8 and day 6 ((≥6-8)TEWL) of SLSPT and TAPPT were greater than that of PT, and D-value of TEWL between day 8 and day 7 ((≥7-8)TEWL) of SLSPT and TAPPT were less than that of PT values. After the

  14. Actinic keratosis: a cross-sectional study of disease characteristics and treatment patterns in Danish dermatology clinics.

    PubMed

    Erlendsson, Andrés M; Egekvist, Henrik; Lorentzen, Henrik F; Philipsen, Peter A; Stausbøl-Grøn, Birgitte; Stender, Ida M; Haedersdal, Merete

    2016-03-01

    The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists. A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week. A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P < 0.0001). The majority of AK patients in Danish dermatology clinics have a history of skin cancer, and NMSC is suspected in almost 10% of AK-affected regions. Cryotherapy is the most frequently used treatment overall, except in instances of severe actinic damage, in which PDT is the first-choice treatment. © 2015 The International Society of Dermatology.

  15. Dietary fiber in irritable bowel syndrome (Review).

    PubMed

    El-Salhy, Magdy; Ystad, Synne Otterasen; Mazzawi, Tarek; Gundersen, Doris

    2017-09-01

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly fermentable dietary fiber, such as oligosaccharides results in rapid gas production that can cause abdominal pain/discomfort, abdominal bloating/distension and flatulence in patients with IBS. By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS. Dietary fiber acts on the gastrointestinal tract through several mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation byproducts, particularly short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management.

  16. Dietary fiber in irritable bowel syndrome (Review)

    PubMed Central

    El-Salhy, Magdy; Ystad, Synne Otterasen; Mazzawi, Tarek; Gundersen, Doris

    2017-01-01

    Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly fermentable dietary fiber, such as oligosaccharides results in rapid gas production that can cause abdominal pain/discomfort, abdominal bloating/distension and flatulence in patients with IBS. By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS. Dietary fiber acts on the gastrointestinal tract through several mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation byproducts, particularly short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management. PMID:28731144

  17. In vitro alternatives for ocular irritation.

    PubMed Central

    Curren, R D; Harbell, J W

    1998-01-01

    The necessity of using animals to test whether new chemicals and products are eye irritants has been questioned with increasing frequency and fervor over the last 20 years. During this time many new nonanimal methods have been proposed as reliable alternatives to the traditional rabbit (Draize) test. To date, however, none of these nonanimal (in vitro) tests have become universally accepted as a complete replacement for the Draize test. To understand why a complete replacement has not been found, one has to first understand the reasonably complex structure of the eye, the standard Draize scoring scale--which is based on a qualitative evaluation of three different tissues--the differences between human and rabbit eyes, the intrinsic variability of the animal test, and the details of the different in vitro tests that have been proposed as replacements. The in vitro tests vary from relatively simple assays using single cells to more sophisticated assays that use discarded animal tissue or artificially constructed human tissue. It is clear that appropriately designed in vitro tests will eventually give more useful mechanistic information about ocular injury from which we can more comfortably predict the risk of human eye irritation from new products and ingredients. Images Figure 1 Figure 2 PMID:9599696

  18. [Irritable bowel syndrome: a functional disorder?].

    PubMed

    Man, Fernando; Bustos Fernández, Luis María

    2013-12-01

    Irritable bowel syndrome is a highly prevalent condition responsible for almost one third of visits to the gastroenterologist and huge expenses for diagnosis, treatment and loss of working days. A unique pathophysiologic mechanism has not been elucidated yet and several possibilities have been proposed such as senso-perception and motor disturbances, the effect of stress and anxiety, serotonin receptor failures, activation of abnormal brain areas and pain modulation differences, among others. The absence of a biological marker has led the investigators to consider this syndrome as an exclusion diagnostic condition, once the organic diseases have been discarded The changes in gut microbiota have recently raised great interest among gastroenterologists. The study of the small intestinal bowel overgrowth syndrome, the effect of antibiotics upon the flora, the recognition of post-infectious irritable bowel syndrome and the action of probiotics, together with the effect of malabsortion of diet carbohydrates have brought some new light in our knowledge. The present update will focus on the published evidence about the subject, bearing in mind that the mechanisms elicited here are only suitable for a subgroup of patients.

  19. In vitro alternatives for ocular irritation.

    PubMed

    Curren, R D; Harbell, J W

    1998-04-01

    The necessity of using animals to test whether new chemicals and products are eye irritants has been questioned with increasing frequency and fervor over the last 20 years. During this time many new nonanimal methods have been proposed as reliable alternatives to the traditional rabbit (Draize) test. To date, however, none of these nonanimal (in vitro) tests have become universally accepted as a complete replacement for the Draize test. To understand why a complete replacement has not been found, one has to first understand the reasonably complex structure of the eye, the standard Draize scoring scale--which is based on a qualitative evaluation of three different tissues--the differences between human and rabbit eyes, the intrinsic variability of the animal test, and the details of the different in vitro tests that have been proposed as replacements. The in vitro tests vary from relatively simple assays using single cells to more sophisticated assays that use discarded animal tissue or artificially constructed human tissue. It is clear that appropriately designed in vitro tests will eventually give more useful mechanistic information about ocular injury from which we can more comfortably predict the risk of human eye irritation from new products and ingredients.

  20. Zebrafish Locomotor Responses Predict Irritant Potential of ...

    EPA Pesticide Factsheets

    Over the past few decades, the drying and warming trends of global climate change have increased wildland fire (WF) season length, as well as geographic area impacted. Consequently, exposures to WF fine particulate matter (PM2.5; aerodynamic diameter <2.5 µm) are likely to increase in frequency and duration, contributing to a growing public health burden. Given the influence of fuel type and combustion conditions on WFPM2.5 composition, there is pressing need to identify the biomass fuel sources and emission constituents that drive toxicity. Previously, we reported the utility of 6-day post-fertilization (dpf) zebrafish larvae in evaluating diesel exhaust PM-induced irritation, demonstrating responses analogous to those in mammals. In the present study, combustions, separated by smoldering or flaming conditions, of pine needles, red oak, pine, eucalyptus, and peat were achieved using an automated tube furnace paired with a cryo-trapping apparatus to collect condensates of emissions. The condensates were extracted and prepared for use in zebrafish assays. We hypothesized that 1) the extractable organic fractions of biomass smoke PM will elicit dose-dependent irritant responses in 6-dpf zebrafish larvae, and 2) the relative potencies will vary across biomass emissions, potentially driven by varying chemical composition of fuel sources. Six-dpf zebrafish (n= 28-32/group) were exposed acutely to PM extracts (5 concentrations; 0.3-30 µg/ml; half-log intervals) and

  1. Childhood Sexual Abuse and Psychosomatic Symptoms in Irritable Bowel Syndrome

    ERIC Educational Resources Information Center

    Ross, Colin A.

    2005-01-01

    Irritable bowel syndrome is characterized by chronic gastrointestinal symptoms without a demonstrable physical cause. In a subgroup of patients, irritable bowel syndrome may be part of a cluster of psychosomatic symptoms related to childhood sexual abuse. To investigate this possibility, the Dissociative Disorders Interview Schedule (DDIS), the…

  2. Acute irritant reaction to an antiseptic bath emollient.

    PubMed

    Saw, N K; Hindmarsh, J R

    2005-02-01

    Antiseptic bath emollients are commonly prescribed for treatment of eczema and are generally safe for frequent application. Although acute irritant reactions are uncommon it is nevertheless recognised and could have significant morbidity. This case describes a young male patient who developed an acute irritant reaction localised to the external genitalia, mimicking Fournier's gangrene, after overnight application of Oilatum Plus antiseptic bath emollients.

  3. Acute irritant reaction to an antiseptic bath emollient

    PubMed Central

    Saw, N; Hindmarsh, J

    2005-01-01

    Antiseptic bath emollients are commonly prescribed for treatment of eczema and are generally safe for frequent application. Although acute irritant reactions are uncommon it is nevertheless recognised and could have significant morbidity. This case describes a young male patient who developed an acute irritant reaction localised to the external genitalia, mimicking Fournier's gangrene, after overnight application of Oilatum Plus antiseptic bath emollients. PMID:15701748

  4. Childhood Sexual Abuse and Psychosomatic Symptoms in Irritable Bowel Syndrome

    ERIC Educational Resources Information Center

    Ross, Colin A.

    2005-01-01

    Irritable bowel syndrome is characterized by chronic gastrointestinal symptoms without a demonstrable physical cause. In a subgroup of patients, irritable bowel syndrome may be part of a cluster of psychosomatic symptoms related to childhood sexual abuse. To investigate this possibility, the Dissociative Disorders Interview Schedule (DDIS), the…

  5. Lurasidone for the Treatment of Irritability Associated with Autistic Disorder

    ERIC Educational Resources Information Center

    Loebel, Antony; Brams, Matthew; Goldman, Robert S.; Silva, Robert; Hernandez, David; Deng, Ling; Mankoski, Raymond; Findling, Robert L.

    2016-01-01

    The aim of this study was to evaluate the short-term efficacy and safety of lurasidone in treating irritability associated with autistic disorder. In this multicenter trial, outpatients age 6-17 years who met DSM-IV-TR criteria for autistic disorder, and who demonstrated irritability, agitation, and/or self-injurious behaviors were randomized to…

  6. Lurasidone for the Treatment of Irritability Associated with Autistic Disorder

    ERIC Educational Resources Information Center

    Loebel, Antony; Brams, Matthew; Goldman, Robert S.; Silva, Robert; Hernandez, David; Deng, Ling; Mankoski, Raymond; Findling, Robert L.

    2016-01-01

    The aim of this study was to evaluate the short-term efficacy and safety of lurasidone in treating irritability associated with autistic disorder. In this multicenter trial, outpatients age 6-17 years who met DSM-IV-TR criteria for autistic disorder, and who demonstrated irritability, agitation, and/or self-injurious behaviors were randomized to…

  7. Rare case of external dental fistula of the submental region misdiagnosed as inverted follicular keratosis and thyroglossal duct cyst

    PubMed Central

    Sato, Toshihisa; Suenaga, Hideyuki; Igarashi, Masaki; Hoshi, Kazuto; Takato, Tsuyoshi

    2015-01-01

    Introduction Odontogenic cutaneous sinus tract is a relatively rare occurrence that can be complicated to diagnose. The presence of a cutaneous lesion is often not even partly associated with a dental etiology because of the less frequency of occurrence in the case of dental symptoms. Consequently, the underlying dental cause is often missed leading to inappropriate diagnosis and treatment. Case presentation Here, we report the case of a 45-year-old man who presented with a persistent lesion of the cervical region. At the time of presentation, the lesion had been present for approximately one year with a gradual increase in size but no specific symptoms. The patient had previously undergone punch resection under local anesthesia, which resulted in a histopathological diagnosis of inverted follicular keratosis. A diagnosis was made of an odontogenic cutaneous sinus tract secondary to chronic apical periodontitis of the left mandibular second molar. Discussion Cutaneous sinus tract in the face and neck is most likely to develop intraorally. Root canal treatment or surgical extractions are the common treatment choices. A previously reported review of 137 cases found that 106 (77%) were treated by extraction and 27 (20%) were treated by surgical or conservative nonsurgical endodontic therapy. Conclusion Early diagnosis of cutaneous sinus tract using proper aid is responsible for shortening the treatment duration and avoiding unnecessary treatment. PMID:26413920

  8. A new, objective, quantitative scale for measuring local skin responses following topical actinic keratosis therapy with ingenol mebutate.

    PubMed

    Rosen, Robert; Marmur, Ellen; Anderson, Lawrence; Welburn, Peter; Katsamas, Janelle

    2014-12-01

    Local skin responses (LSRs) are the most common adverse effects of topical actinic keratosis (AK) therapy. There is currently no method available that allows objective characterization of LSRs. Here, the authors describe a new scale developed to quantitatively and objectively assess the six most common LSRs resulting from topical AK therapy with ingenol mebutate. The LSR grading scale was developed using a 0-4 numerical rating, with clinical descriptors and representative photographic images for each rating. Good inter-observer grading concordance was demonstrated in peer review during development of the tool. Data on the use of the scale are described from four phase III double-blind studies of ingenol mebutate (n = 1,005). LSRs peaked on days 4 (face/scalp) or 8 (trunk/extremities), with mean maximum composite LSR scores of 9.1 and 6.8, respectively, and a rapid return toward baseline by day 15 in most cases. Mean composite LSR score at day 57 was generally lower than at baseline. The LSR grading scale is an objective tool allowing practicing dermatologists to characterize and compare LSRs to existing and, potentially, future AK therapies.

  9. Rosettes in actinic keratosis and squamous cell carcinoma: distribution, association to other dermoscopic signs and description of the rosette pattern.

    PubMed

    Lozano-Masdemont, B; Polimón-Olabarrieta, I; Marinero-Escobedo, S; Gutiérrez-Pecharromán, A; Rodríguez-Lomba, E

    2017-07-14

    Rosettes, a dermoscopic structure characterized by four white points arranged as a 4-leaf clover, supports the dermoscopic diagnosis of actinic keratosis (AK) or squamous cell carcinoma (SCC). The association of rosettes with other dermoscopic structures in AK or SCC and their distribution has not been analysed yet. We conducted a prospective study of patients with histologically proven AK or SCC who presented dermoscopic rosettes at initial evaluation. A total of 56 tumours were collected (94.6% AK and 5.4% SCC). Thirty-seven (66.1%) lesions were non-pigmented and 19 (33.9%) pigmented. The most common dermoscopic findings were erythema (53; 94.6%) and scale (42; 75%). White circles were present in 21 lesions (37.5%); pigmented pseudonetwork in 18 (32.1%) and multiple grey to brown dots and globules in 14 (25%). Rosettes were distributed focally in 9 (16.1%) and generalized in 47 (83.9%). The rosette pattern (rosettes as the main structure) was observed only in AK (19; 35.8%). The analysis was not blinded. The distinction between focal distribution (up to 3 rosettes) or generalized could be considered arbitrary. The rosette pattern identified in AK may be a specific pattern for AK. © 2017 European Academy of Dermatology and Venereology.

  10. A survey of office visits for actinic keratosis as reported by NAMCS, 1990-1999. National Ambulatory Medical Care Survey.

    PubMed

    Gupta, Aditya K; Cooper, Elizabeth A; Feldman, Steven R; Fleischer, Alan B

    2002-08-01

    Although actinic keratosis (AK) has been linked to the development of nonmelanoma skin cancer (NMSC), particularly squamous cell carcinoma (SCC), increased awareness regarding diagnosis and treatment may be an important component for reducing morbidity and even mortality from AK and NMSC. We used the National Ambulatory Medical Care Survey (NAMCS) data from 1990 to 1999 to evaluate the diagnosis and treatment of AKs among a wide variety of patients by physicians across the United States. To our knowledge, no widespread surveys of North American populations have been performed recently to determine the epidemiology of AK. AK was diagnosed in more than 47 million visits over the 10-year period surveyed and was found to occur in 14% of patients visiting dermatologists. The diagnosis of AK as determined by NAMCS does not reflect the true prevalence of AK because only patients seeking physician diagnosis were surveyed. This suggests that the actual number of patients in the United States with AK is much higher than 14%. Rates of AK diagnosis in the standard metropolitan statistical areas (SMSAs) and non-standard metropolitan statistical areas (non-SMSAs) of the West states are higher than in other states, but geographic location may not be a direct risk factor for the development of AKs. Procedures were undertaken at 70% of visits where AK was the primary diagnosis. Destruction of lesions was the most frequently performed procedure found in the survey considering only the 1993 and 1994 NAMCS data. Biopsy was the second most frequently performed procedure.

  11. Genetic linkage evaluation of twenty-four loci in an eastern Canadian family segregating Darier’s disease (keratosis follicularis)

    PubMed Central

    Sidenberg, Deborah Gayle; Berg, Daniel; Bassett, Anne Susan; King, Nicole; Petronis, Arturas; Kamble, Arvind Baburao; Kennedy, James Lowery

    2011-01-01

    Background Darier’s disease (keratosis follicularis) is known to have a genetic cause as evidenced by its autosomal dominant transmission in families. The gene causing this disease has not been discovered. Objective During an ongoing linkage study of schizophrenia, a family segregating Darier’s disease was found. This family is being studied in an attempt to locate prospective regions that may contain the Darier’s disease gene. Methods Two genetic strategies are being employed: (1) testing candidate genes for the disorder and (2) scanning the entire genome with polymerase chain reaction–based microsatellite markers. Results Thirty-nine marker systems located on chromosomes 1, 2, 4, 5, 6, 9, 11, 12, 16, 17, 22, X, and Y have been genotyped. Slightly positive lod scores were achieved between six markers and Darier’s disease. The remaining 33 markers were nonsegregating or indeterminate, or revealed an obligate recombinant. Conclusion Linkage analysis can lead to localization of the gene causing Darier’s disease. In these preliminary studies low positive lod scores were obtained, potentially pointing to the chromosomal location of the Darier’s disease gene. PMID:8021367

  12. IRF4, MC1R and TYR genes are risk factors for actinic keratosis independent of skin color.

    PubMed

    Jacobs, Leonie C; Liu, Fan; Pardo, Luba M; Hofman, Albert; Uitterlinden, André G; Kayser, Manfred; Nijsten, Tamar

    2015-06-01

    Actinic keratosis (AK) is a pre-malignant skin disease, highly prevalent in elderly Europeans. This study investigates genetic susceptibility to AK with a genome-wide association study (GWAS). A full body skin examination was performed in 3194 elderly individuals from the Rotterdam Study (RS) of exclusive north-western European origin (aged 51-99 years, 45% male). Physicians graded the number of AK into four severity levels: none (76%), 1-3 (14%), 4-9 (6%) and ≥10 (5%), and skin color was quantified using a spectrophotometer on sun-unexposed skin. A GWAS for AK severity was conducted, where promising signals at IRF4 and MC1R (P < 4.2 × 10(-7)) were successfully replicated in an additional cohort of 623 RS individuals (IRF4, rs12203592, Pcombined = 6.5 × 10(-13) and MC1R, rs139810560, Pcombined = 4.1 × 10(-9)). Further, in an analysis of ten additional well-known human pigmentation genes, TYR also showed significant association with AK (rs1393350, P = 5.3 × 10(-4)) after correction for multiple testing. Interestingly, the strength and significance of above-mentioned associations retained largely the same level after skin color adjustment. Overall, our data strongly suggest that IRF4, MC1R and TYR genes likely have pleiotropic effects, a combination of pigmentation and oncogenic functions, resulting in an increased risk of AK.

  13. Sensory irritation. Relation to indoor air pollution.

    PubMed

    Cometto-Muñiz, J E; Cain, W S

    1992-04-30

    All mucosae of the body possess chemical sensitivity provided by the CCS. Airborne chemicals can stimulate the CCS through the ocular, nasal, and respiratory mucosae, evoking different pungent sensations, for example, stinging, irritation, burning, piquancy, prickling, freshness, and tingling. Pungent sensations elicited in the nose differ from odor sensations in various characteristics. They are achieved at considerably higher concentrations than those necessary to elicit odor, but they increase with the concentration of the stimulus in a steeper fashion than odor. Pungent sensations from mixtures of compounds show a higher degree of addition--relative to the pungency of the individual components--than that of odor sensations. Pungency is more resistant to adaptation than odor, and, unlike it, displays considerable temporal integration with continuous stimulation. Measurement of a reflex, transitory apnea produced upon inhalation of pungent chemicals holds promise as an objective indicator of the functional status of the CCS. Results from the measurement of this reflex have agreed quantitatively with sensory data in a number of studies, and have shown higher common chemical sensitivity in nonsmokers (compared to smokers), in females (compared to males), and in young adults (compared to the elderly). Research issues mentioned here include the following: 1. We can rarely validate the symptoms putatively caused by indoor air pollution objectively. Without such means, we will always have the potential problem of overreporting and embellishment. Although one person may seem more sensitive than another, the difference may lie in a greater proclivity to complain. 2. Studies of anosmic persons offer a simple means to understand the functional characteristics of the nasal CCS. Studies of chemical series in such subjects should eventually allow construction of quantitative structure-activity models for human pungency perception. The human data can be compared with relevant

  14. Correlates of irritability in college students with depressive symptoms.

    PubMed

    Pedrelli, Paola; Nyer, Maren; Holt, Daphne; Bakow, Brianna R; Fava, Maurizio; Baer, Lee; Cassiello, Clair; Mulligan, Maura; Cusin, Cristina; Farabaugh, Amy

    2013-11-01

    Depression is a prevalent psychiatric disorder associated with significant personal and societal burden. There is accumulating evidence for the presence of a subtype of depression characterized by the presence of irritability that is associated with increased morbidity, risk for suicidal ideation, and functional impairments in adults. Little is known about the features of depressive symptoms with and without irritability among young adults in college. The primary aim of this study was to characterize the presentation of college students with depressive symptoms and irritability. Two-hundred eighty-seven undergraduate college students with depressive symptoms with and without irritability were compared across several psychiatric and functional outcome variables. Independent samples t-tests or logistic regressions were conducted for each outcome variable using the irritability item of the Beck Depression Inventory as a dichotomous grouping variable. Analyses were conducted separately for the men and the women. Both male and female students with depressive symptoms and severe irritability reported a greater severity of depressive symptoms compared with their peers with no or mild irritability. In the women, the presence of irritability was associated with greater symptoms of anxiety, whereas in the men, it was associated with increased likelihood of engaging in risky behaviors, including compulsive use of alcohol, illicit drugs, and prescription drugs. The male and female college students with depressive symptoms with and without irritability did not differ on severity of suicidal ideation, hopelessness, or cognitive functioning. The findings from this study suggest that depressive symptoms and irritability may characterize a subtype of college students who have a greater symptom burden and with the potential need for more aggressive and prompt treatment.

  15. Correlates of Irritability in College Students With Depressive Symptoms

    PubMed Central

    Pedrelli, Paola; Nyer, Maren; Holt, Daphne; Bakow, Brianna R.; Fava, Maurizio; Baer, Lee; Cassiello, Clair; Mulligan, Maura; Cusin, Cristina; Farabaugh, Amy

    2015-01-01

    Depression is a prevalent psychiatric disorder associated with significant personal and societal burden. There is accumulating evidence for the presence of a subtype of depression characterized by the presence of irritability that is associated with increased morbidity, risk for suicidal ideation, and functional impairments in adults. Little is known about the features of depressive symptoms with and without irritability among young adults in college. The primary aim of this study was to characterize the presentation of college students with depressive symptoms and irritability. Two-hundred eighty-seven undergraduate college students with depressive symptoms with and without irritability were compared across several psychiatric and functional outcome variables. Independent samples t-tests or logistic regressions were conducted for each outcome variable using the irritability item of the Beck Depression Inventory as a dichotomous grouping variable. Analyses were conducted separately for the men and the women. Both male and female students with depressive symptoms and severe irritability reported a greater severity of depressive symptoms compared with their peers with no or mild irritability. In the women, the presence of irritability was associated with greater symptoms of anxiety, whereas in the men, it was associated with increased likelihood of engaging in risky behaviors, including compulsive use of alcohol, illicit drugs, and prescription drugs. The male and female college students with depressive symptoms with and without irritability did not differ on severity of suicidal ideation, hopelessness, or cognitive functioning. The findings from this study suggest that depressive symptoms and irritability may characterize a subtype of college students who have a greater symptom burden and with the potential need for more aggressive and prompt treatment. PMID:24177482

  16. [Importance of diet in irritable bowel syndrome].

    PubMed

    Mearin, Fermín; Peña, Enrique; Balboa, Agustín

    2014-05-01

    About two-thirds of irritable bowel syndrome (IBS) patients associate their symptoms with certain foods. We reviewed food-related factors putatively associated with manifestations of IBS. Soluble fiber may improve constipation but frequently increases bloating and abdominal pain. Carbohydrate malabsorption seems to be more frequent in IBS. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet significantly reduces IBS symptoms and has been suggested as a therapeutic option. Serological screening for celiac disease should be done in patients without constipation. Moreover, non-celiac disease gluten sensitivity, defined as gluten intolerance once celiac disease and wheat allergy have been ruled out, should be considered in these patients. There is no specific diet for IBS patients but small and frequent meals, avoiding greasy foods, dairy products, many carbohydrates, caffeine and alcohol, is recommended.

  17. Irritable Bowel Syndrome: Yoga as Remedial Therapy

    PubMed Central

    Kavuri, Vijaya; Raghuram, Nagarathna; Malamud, Ariel; Selvan, Senthamil R.

    2015-01-01

    Irritable bowel syndrome (IBS) is a group of symptoms manifesting as a functional gastrointestinal (GI) disorder in which patients experience abdominal pain, discomfort, and bloating that is often relieved with defecation. IBS is often associated with a host of secondary comorbidities such as anxiety, depression, headaches, and fatigue. In this review, we examined the basic principles of Pancha Kosha (five sheaths of human existence) concept from an Indian scripture Taittiriya Upanishad and the pathophysiology of a disease from the Yoga approach, Yoga Vasistha's Adhi (originated from mind) and Vyadhi (ailment/disease) concept. An analogy between the age old, the most profound concept of Adhi-Vyadhi, and modern scientific stress-induced dysregulation of brain-gut axis, as it relates to IBS that could pave way for impacting IBS, is emphasized. Based on these perspectives, a plausible Yoga module as a remedial therapy is provided to better manage the primary and secondary symptoms of IBS. PMID:26064164

  18. Changing face of irritable bowel syndrome

    PubMed Central

    Quigley, Eamonn MM

    2006-01-01

    Recent years have witnessed tremendous progress in our understanding of irritable bowel syndrome (IBS). It is evident that this is a truly global disease associated with significant symptoms and impairments in personal and social functioning for afflicted individuals. Advances in our understanding of gut flora-mucosal interactions, the enteric nervous system and the brain-gut axis have led to substantial progress in the pathogenesis of symptoms in IBS and have provided some hints towards the basic etiology of this disorder, in some subpopulations, at the very least. We look forward to a time when therapy will be addressed to pathophysiology and perhaps, even to primary etiology. In the meantime, a model based on a primary role for intestinal inflammation serves to integrate the various strands, which contribute to the presentation of IBS PMID:16440408

  19. Optical Biopsy of Human Skin in Conjunction With Laser Treatment

    ClinicalTrials.gov

    2017-02-08

    Malignant Melanoma; Merkel Cell Carcinoma; Basal Cell Carcinoma; Squamous Cell Carcinoma; Atypical Nevi; Congenital Nevi; Seborrheic Keratosis; Paget's Disease; Dermatofibroma; Kaposi's Sarcoma; Port Wine Stain; Hemangioma; Tattoos; Scleroderma; Burns

  20. Irritable bowel syndrome in women undergoing hysterectomy and tubular ligation

    PubMed Central

    Khoshbaten, Manouchehr; Melli, Manigheh Syah; Fattahi, Monireh Jabar; Sharifi, Nasrin; Mostafavi, Seyed Abolfazl

    2011-01-01

    Aim The aim of this study was to assess the incidence of irritable bowel syndrome in women undergoing hysterectomy and tubular ligation. Background The results of previous studies have shown an increased incidence of irritable bowel syndrome after gynecological surgeries. Patients and methods Participants were patients of Alzahra and Taleghani University hospitals in Tabriz. One hundred and seventy two women without gastrointestinal symptoms or a diagnosis of the irritable bowel syndrome underwent tubular ligation and 164 women underwent hysterectomy. Patients were assessed every 3 month after hysterectomy and tubular ligation for 12 months. Irritable bowel syndrome was diagnosed by a questionnaire based on Rome II criteria. Results During 12 months after surgeries, 19 (11%) patients in tubular ligation group and 19 (11%) in hysterectomy group had abdominal pain with at least two symptoms of irritable bowel syndrome. Irritable bowel syndrome was diagnosed in 9 (5%) patients in the tubular ligation and 13 (8%) patients in hysterectomy groups (P>0.05). In both studied groups, the most prevalent symptoms along with abdominal pain were chronic constipation and abnormal bowel movement and the least prevalent were diarrhea and passage of mucus. Conclusion These results suggest that gynecological surgeries (tubular ligation and hysterectomy) may predispose to the development of the irritable bowel syndrome. PMID:24834172

  1. Cumulative irritation patch test of sanitary pads on sensitive skin.

    PubMed

    Farage, Miranda; Stadler, Angela

    2005-09-01

    Tools are needed to assess the effects of various products on sensitive skin. To investigate the cutaneous compatibility of various sanitary pads in people with self-declared sensitive skin. Eight subjects, who considered their skin to be sensitive and who reported adverse skin responses to everyday products or clothing, were patch tested on the arm with two, low-irritancy sanitary pads for four consecutive 24-hour periods. Test products differed only in their surface covering. Sodium lauryl sulfate solution (0.1% w/v) and physiological saline served as standard irritant and nonirritant controls, respectively. Skin irritation (erythema) was graded after each 24-hour period. No significant difference in skin erythema scores was observed between groups (scores on day 4: 1.06 +/- 0.11 vs. 1.25 +/- 0.13, on a five-point scale, P < 0.05). The temporal development of cumulative irritation associated with the pads was comparable to that observed with the nonirritant control (a plateau in maximal group scores) and distinct from that of the irritant control (continuously rising scores). Sanitary pads under investigation elicited negligible cumulative irritation in a four-day patch test on subjects with self-declared sensitive skin. The temporal pattern of cumulative response was consistent with the inherently low irritation potential of the products.

  2. Defining Field Cancerization of the Skin Using Noninvasive Optical Coherence Tomography Imaging to Detect and Monitor Actinic Keratosis in Ingenol Mebutate 0.015%- Treated Patients

    PubMed Central

    Schwartz, Michelle; Feldman, Eleanor; Bieber, Amy; Bienenfeld, Amanda; Nandanan, Naveen; Siegel, Daniel M.

    2016-01-01

    Objective: The objective of this study was to assess the ability of optical coherence tomography to detect clinical and subclinical actinic keratoses confirmed by histopathology. The efficacy of ingenol mebutate treatment of actinic keratosis was also evaluated using optical coherence tomography, and correlation of treatment efficacy with severity of local skin reactions was determined. Design: Single-arm, open-label, split-face study. Setting: Hospital outpatient clinic. Participants: Male subjects (N=30) with seven actinic keratoses. Measurements: A suspected actinic keratosis and the normal-appearing, perilesional skin were imaged, biopsied for histopathologic analysis, and the results compared with the clinical and a blinded optical coherence tomography diagnosis. Treatment with ingenol mebutate gel 0.015% was randomly administered to three clinically suspected actinic keratoses and the perilesional skin; three additional, suspected actinic keratoses lesions and perilesional areas were left untreated. Clinical and optical coherence tomography images were obtained for all lesions. Severity of local skin reactions was recorded to evaluate the relationship between local skin reaction and treatment effect. Results: Optical coherence tomography analysis had a 100-percent (28/28) correlation with the clinical diagnosis of actinic keratosis and detected 16 of 22 (73%) histopathologically confirmed subclinical lesions from perilesional skin sites. By optical coherence tomography assessment, the clearance rate for clinically observed lesions was 76 percent for ingenol mebutate-treated areas versus 11 percent for untreated areas; the clearance rate for treated subclinical lesions was 88 percent versus 43 percent for untreated areas. Clearance rates did not vary with the severity of the local response. Conclusion: Optical coherence tomography is effective at detecting clinical and subclinical actinic keratoses and monitoring their response to treatment. PMID:27386042

  3. RELATIVE IRRITANT PROPERTIES OF THE CHLORINE GROUP OF ANTISEPTICS

    PubMed Central

    Cullen, Glenn E.; Taylor, Herbert D.

    1918-01-01

    1. The use of the ears of rabbits is proposed in testing the irritant effect of antiseptics. 2. It is necessary, because of individual variations, to use solutions having definite irritant actions as controls. 3. 0.5 per cent sodium hypochlorite solutions have minimum irritant effects over a range of alkalinity of from about 100 to 1,000 times that of water (pH about 9 to 10). Solutions may be adjusted within these limits by use of the end-points of powdered phenolphthalein, of alcoholic solutions of either o-cresolphthalein or phenolphthalein. 4. Sodium hypochlorite solutions kept within the above range of alkalinity by either borate or carbonate buffer salts, i.e. Dakin's solution, show the same irritative properties whether made from bleaching powder and sodium carbonate, or from chlorine and sodium carbonate. 5. Electrolytically prepared solutions of the same concentration have similar irritant action. 6. Solutions, however, that have an alkalinity less than that indicated by the end-point of alcoholic phenolphthalein solutions (pH of 8.5 to 8.8) or greater than that indicated by the end-point to powdered phenolphthalein (pH of 10.2) are intensely irritating. 7. 0.5 per cent sodium hypochlorite solution from which most of the calcium has been precipitated and calcium hypochlorite solution of equivalent hypochlorite concentration are only slightly irritating. 8. 2 per cent chloramine-T solution has no irritant action. 9. 5 per cent dichloramine-T in chlorcosane and chlorcosane alone irritate rabbit ears to a slight degree only. PMID:19868288

  4. Irritable bowel syndrome: modern concepts and management options.

    PubMed

    Sayuk, Gregory S; Gyawali, C Prakash

    2015-08-01

    Irritable bowel syndrome is the most common functional gastrointestinal disorder, manifesting as abdominal pain/discomfort and altered bowel function. Despite affecting as many as 20% of adults, a lack of understanding of etiopathogenesis and evaluation strategies results in diagnostic uncertainty, and in turn frustration of both the physician and the patient. This review summarizes the current literature on the diagnosis and management of irritable bowel syndrome, with attention to evidence-based approaches. A 4-step treatment strategy that has been used successfully in our tertiary referral practice is presented and should lead to successful therapeutic outcomes in the majority of patients with irritable bowel syndrome.

  5. Effective sunscreen ingredients and cutaneous irritation in patients with rosacea.

    PubMed

    Nichols, K; Desai, N; Lebwohl, M G

    1998-06-01

    Patients with rosacea are particularly susceptible to the irritation caused by sunscreen ingredients. The purpose of this bilateral comparison study was to examine the effects of different ingredients found in sunscreen on facial cutaneous irritancy in patients with rosacea. patients clinically diagnosed with rosacea were asked to test different preparations of common sunscreens on their faces. The results show that the presence or absence of appropriate protective ingredients, such as dimethicone and cyclomethicone in the vehicle, may prevent irritation from other sunscreen ingredients in patients with inflammatory conditions such as rosacea.

  6. Efficacy and safety of ingenol mebutate 0.015% gel after cryosurgery of actinic keratosis: 12-month results.

    PubMed

    Berman, Brian; Goldenberg, Gary; Hanke, C William; Tyring, Stephen K; Werschler, Wm Philip; Knudsen, Kim Mark; Larsson, Thomas; Swanson, Neil

    2014-06-01

    Recurrence rates of actinic keratosis (AK) lesions after cryosurgery are high, and this treatment does not address field cancerization. We investigated the efficacy and safety of field treatment of AKs with ingenol mebutate gel following cryosurgery. In this phase 3, randomized, double-blind, vehicle-controlled study (NCT01541553), patients ≥18 years with four to eight clinically typical, visible, discrete AKs within a contiguous 25-cm2 treatment area on the face or scalp underwent cryosurgery followed 3 weeks later by once-daily ingenol mebutate 0.015% or vehicle gel for 3 consecutive days. Endpoints included complete clearance at week 11 and safety and efficacy over 12 months. In 329 randomized patients, complete clearance rates were greater with ingenol mebutate than vehicle (week 11: 60.5% vs 49.4%; P=.04; month 12: 30.5% vs 18.5%; P=.01). Fewer patients experienced the emergence of new lesions with ingenol mebutate than with vehicle (38.9% vs 51.9%; P =.02). At month 12, mean percentage reduction of AKs was higher with ingenol mebutate than with vehicle (68.2% vs 54.1%; P =.002). The probability of remaining free of lesions was sustained longer with ingenol mebutate compared with vehicle gel: 78% vs 68% at 6 months; 64% vs 57% at 9 months; 55% vs 40% at month 12, respectively. Ingenol mebutate 0.015% gel was well tolerated and no unexpected adverse events occurred; all adverse events resolved within 2 weeks of starting treatment. Field treatment with ingenol mebutate 0.015% gel following cryosurgery significantly enhanced clearance of baseline lesions, and was well tolerated. Furthermore, ingenol mebutate 0.015% gel following cryosurgery reduced development of new lesions in the treated field.

  7. Cost-effectiveness analysis of topical treatments for actinic keratosis in the perspective of the Italian health care system.

    PubMed

    Colombo, G L; Chimenti, S; Di Matteo, S; Fargnoli, M C; Frascione, P; Silipo, V; Peris, K

    2010-10-01

    Actinic keratosis (AK) is the most common cutaneous malignant neoplasm and its prevalence continues to increase. According to the most recent findings, AK is currently considered the initial stage, in situ, of squamous cell carcinoma. Field-directed therapies for AKs are the preferred treatment since they have the advantage to clear the clinically visible lesions and also subclinical lesions within the cancerous field. We assessed the cost-effectiveness of topical treatments for AKs including 3% diclofenac in 2.5% hyaluronic acid (HA) gel, imiquimod 5% cream and photodynamic therapy with methyl aminolevulinate (MAL-PDT) in the perspective of the Italian Health Care System (SSN). We used a decision tree analytical approach and efficacy data were drawn from published clinical trials. Cost was evaluated from the SSN perspective during a time horizon of 3 months. A responder was defined as a patient with all lesions clinically cleared and showing an excellent cosmetic result. Based on the applied model, the cost per complete responder was calculated. Diclofenac 3% in HA was less expensive (Euro 256) than MAL-PDT (Euro 320) and imiquimod (Euro 342). Effectiveness was similar and better for diclofenac 3% in HA and MAL-PDT (0.813%) in comparison to 0.734% of imiquimod, respectively. The one-way and probabilistic sensitivity analyses confirmed the results of base case scenario. Based on this cost-effectiveness model, diclofenac 3% in HA can be considered the treatment of choice for AK lesions and surrounding field under a pharmacoeconomic point of view.

  8. Eating, Diet, and Nutrition for Irritable Bowel Syndrome

    MedlinePlus

    ... Treatment Eating, Diet, & Nutrition Clinical Trials Eating, Diet, & Nutrition for Irritable Bowel Syndrome How can my diet ... Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información de la ...

  9. Climate Change May Up Asthma Irritant, Study Says

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_166391.html Climate Change May Up Asthma Irritant, Study Says Researchers warn ... 8, 2017 THURSDAY, June 8, 2017 (HealthDay News) -- Climate change may increase people's exposure to an outdoor fungus ...

  10. Esophageal irritation due to alendronate sodium tablets: possible mechanisms.

    PubMed

    Peter, C P; Handt, L K; Smith, S M

    1998-09-01

    Animal studies were done using an in vivo dog model to examine the possible mechanism for the esophageal adverse events reported with alendronate sodium tablets. These studies showed that under low pH conditions alendronate sodium can cause esophageal irritation. No esophageal irritation occurred at pH 3.5 or higher where the drug exists primarily as the sodium salt. The animal studies also showed that alendronate sodium can exacerbate preexisting esophageal damage. Exposure of the esophageal mucosa for a prolonged period to alendronate sodium tablet can also cause mild esophageal irritation. These findings suggest that the esophageal irritation in patients taking Fosamax can be from prolonged contact with the tablet, reflux of acidic gastric contents with alendronate sodium, and exacerbation of preexisting esophageal damage. The findings also suggest that other bisphosphonates can cause esophageal injury under similar conditions.

  11. Efficacy and Safety of Cream Containing Climbazole/Piroctone Olamine for Facial Seborrheic Dermatitis: A Single-Center, Open-Label Split-Face Clinical Study

    PubMed Central

    Youn, Hae Jeong; Kim, Soo Young; Park, Minji; Jung, Won Hee; Choe, Yong Beom; Ahn, Kyu Joong

    2016-01-01

    Background Seborrheic dermatitis (SD) is a multifactorial disease; Malassezia species play an important role in its pathogenesis. Objective We aimed to determine whether a cream containing climbazole/piroctone olamine (C/P cream), antifungal agents with expected efficacy against Malassezia species, could improve SD symptoms. Methods We instructed 24 patients with mild-to-moderate SD to apply the C/P cream and emollient cream on the right and left sides of the face, respectively, every morning and evening for 4 weeks. The casual sebum level (measured with Sebumeter®; Courage & Khazaka Electronic GmbH, Germany) and the extent of erythema (measured with Mexameter®; Courage & Khazaka Electronic GmbH) on the face were measured at baseline and after 4 weeks. The minimal inhibitory concentration (MIC) was determined to demonstrate the antifungal activity of the C/P cream. Results The casual sebum level and erythema were measured at week 4, and the median values demonstrated a quantitative improvement on the C/P cream-treated right side of the face compared to the emollient cream-treated left side. For the C/P cream, the MICs were 0.625, 5, 0.625, and 2.5 mg/ml for Malassezia restricta, M. globosa, M. sympodialis, and M. slooffiae, respectively. Conclusion Based on the reduced casual sebum level and extent of erythema, the antifungal activity of C/P cream against Malassezia species seems useful for the treatment of mild to moderate SD. PMID:27904273

  12. Effect of itraconazole on the quality of life in patients with moderate to severe seborrheic dermatitis: a randomized, placebo-controlled trial

    PubMed Central

    Abbas, Zaheer; Ghodsi, Seyedeh Z.; Abedeni, Robabeh

    2016-01-01

    Background: Few studies have examined the effect of seborrheic dermatitis (SD) and/or its consequent therapy on a patient’s quality of life. Itraconazole has been suggested as an effective therapy for severe SD but its impact on Quality of Life (QoL) in these patients has never been studied before. Objective: The study aimed to verify the efficacy of the itraconazole on the quality of life in patients with moderate to severe SD. Methods: A randomized, double-blind, placebo controlled trial was planned to describe the effect of SD per se on QoL and to determine the impact of oral itraconazole or placebo on QoL of SD patients. Sixty-eight patients with moderate to severe SD participated in the study to receive either itraconazole or placebo. Dermatology Life Quality Index was used to evaluate their quality of life before and after treatment. Itraconazole 200 mg/daily or placebo was prescribed for one week and then the first two days of every month for the following three months. Fifty-seven patients completed the study. Results: Significant improvement was observed in QoL of both itraconazole and placebo groups, but itraconazole group showed significantly higher improvement as compared to placebo (p=0.001). QoL was impaired significantly with high disease severity (p=0.002) and facial involvement (p=0.017). Conclusions: Itraconazole significantly improves the QoL in patients with moderate to severe SD. PMID:27648378

  13. Malassezia Intra-Specific Diversity and Potentially New Species in the Skin Microbiota from Brazilian Healthy Subjects and Seborrheic Dermatitis Patients

    PubMed Central

    Soares, Renan Cardoso; Zani, Marcelo Bergamin; Arruda, Ana Carolina Belini Bazán; de Arruda, Lucia Helena Fávaro; Paulino, Luciana Campos

    2015-01-01

    Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD). The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases. PMID:25695430

  14. Malassezia intra-specific diversity and potentially new species in the skin microbiota from Brazilian healthy subjects and seborrheic dermatitis patients.

    PubMed

    Soares, Renan Cardoso; Zani, Marcelo Bergamin; Arruda, Ana Carolina Belini Bazán; Arruda, Lucia Helena Fávaro de; Paulino, Luciana Campos

    2015-01-01

    Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD). The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases.

  15. Efficacy and Safety of Cream Containing Climbazole/Piroctone Olamine for Facial Seborrheic Dermatitis: A Single-Center, Open-Label Split-Face Clinical Study.

    PubMed

    Youn, Hae Jeong; Kim, Soo Young; Park, Minji; Jung, Won Hee; Lee, Yang Won; Choe, Yong Beom; Ahn, Kyu Joong

    2016-12-01

    Seborrheic dermatitis (SD) is a multifactorial disease; Malassezia species play an important role in its pathogenesis. We aimed to determine whether a cream containing climbazole/piroctone olamine (C/P cream), antifungal agents with expected efficacy against Malassezia species, could improve SD symptoms. We instructed 24 patients with mild-to-moderate SD to apply the C/P cream and emollient cream on the right and left sides of the face, respectively, every morning and evening for 4 weeks. The casual sebum level (measured with Sebumeter®; Courage & Khazaka Electronic GmbH, Germany) and the extent of erythema (measured with Mexameter®; Courage & Khazaka Electronic GmbH) on the face were measured at baseline and after 4 weeks. The minimal inhibitory concentration (MIC) was determined to demonstrate the antifungal activity of the C/P cream. The casual sebum level and erythema were measured at week 4, and the median values demonstrated a quantitative improvement on the C/P cream-treated right side of the face compared to the emollient cream-treated left side. For the C/P cream, the MICs were 0.625, 5, 0.625, and 2.5 mg/ml for Malassezia restricta, M. globosa, M. sympodialis, and M. slooffiae, respectively. Based on the reduced casual sebum level and extent of erythema, the antifungal activity of C/P cream against Malassezia species seems useful for the treatment of mild to moderate SD.

  16. Epidemiologic Study of Malassezia Yeasts in Seborrheic Dermatitis Patients by the Analysis of 26S rDNA PCR-RFLP

    PubMed Central

    Oh, Byung Ho; Choe, Yong Beom; Ahn, Kyu Joong

    2010-01-01

    Background This case-control study concerns a molecular biological method based on the data gathered from a group of Korean subjects to examine the distribution of Malassezia yeasts in seborrheic dermatitis (SD) patients. Cultures for Malassezia yeasts were taken from the foreheads, cheeks and chests of 60 patients with SD and in 60 healthy controls of equivalent age. Objective The purpose of this study is to identify the relationship between certain species of Malassezia and SD. This was done by analyzing the differences in the distribution of Malassezia species in terms of age and body parts of the host with healthy controls. Methods 26S rDNA PCR-RFLP, a fast and accurate molecular biological method, was used to overcome the limits of morphological and biochemical methods. Results The positive Malassezia culture rate was 51.7% in patients with SD, which was lower than that of healthy adults (63.9%). M. restricta was dominant in patients with SD (19.5%). Likewise, M. restricta was identified as a common species (20.5%) in healthy controls. In the ages 31~40, M. restricta was found to be the most common species (31.6%) among SD patients. Conclusion According to the results of the study, the most frequently isolated species was M. restricta (19.5%) in patients with SD. There was no statistically significant difference in the distribution of Malassezia species between the SD patients and healthy control groups. PMID:20548904

  17. Malassezia globosa and restricta: breakthrough understanding of the etiology and treatment of dandruff and seborrheic dermatitis through whole-genome analysis.

    PubMed

    Dawson, Thomas L

    2007-12-01

    Dandruff and seborrheic dermatitis (D/SD) share an etiology dependent upon three factors: sebum, microbial metabolism (specifically, Malassezia yeasts), and individual susceptibility. Advances in microbiological and analytical techniques permit a more detailed understanding of these etiologic factors, especially the role of Malassezia. Malassezia are lipid-dependent and demonstrate adaptation allowing them to exploit a narrow niche on sebum-rich skin. Work in our and our collaborators' laboratories has focused on understanding these adaptations by detailed analysis of biochemistry and gene expression. We have shown that Malassezia globosa and M. restricta predominate on dandruff scalp, that oleic acid alone can initiate dandruff-like desquamation, that M. globosa is the most likely initiating organism by virtue of its high lipase activity, and that an M. globosa lipase is expressed on human scalp. Considering the importance of M. globosa in D/SD (and the overall importance of commensal fungi), we have sequenced the M. globosa and M. restricta genomes. Genomic analysis indicates key adaptations to the skin environment, several of which yield important clues to the role Malassezia play in human disease. This work offers the promise of defining new treatments to D/SD that are targeted at changing the level or activities of Malassezia genes.

  18. AhR ligands, malassezin, and indolo[3,2-b]carbazole are selectively produced by Malassezia furfur strains isolated from seborrheic dermatitis.

    PubMed

    Gaitanis, George; Magiatis, Prokopios; Stathopoulou, Konstantina; Bassukas, Ioannis D; Alexopoulos, Evangelos C; Velegraki, Aristea; Skaltsounis, Alexios-Leandros

    2008-07-01

    Malassezia yeasts are connected with seborrheic dermatitis (SD) whereas M. furfur pathogenicity is associated with the production of bioactive indoles. In this study, the production of indoles by M. furfur isolates from healthy and diseased skin was compared, the respective HPLC patterns were analyzed, and substances that are preferentially synthesized by strains isolated from SD lesions were isolated and characterized. Malassezin, pityriacitrin, indole-3-carbaldehyde, and indolo[3,2-b]carbazole (ICZ) were isolated by HPLC from extracts of M. furfur grown in L-tryptophan agar, and identified by nuclear magnetic resonance and mass spectroscopy. Of these, ICZ, a potent ligand of the aryl hydrocarbon receptor (AhR), is described for the first time to our knowledge as a M. furfur metabolite. HPLC-photodiode array detection analysis of strain extracts from 7 healthy subjects and 10 SD patients showed that M. furfur isolates from only SD patients consistently produce malassezin and ICZ. This discriminatory production of AhR agonists provides initial evidence for a previously unreported mechanism triggering development of SD and indicates that the variable pathogenicity patterns recorded for M. furfur-associated SD conditions may be attributed to selective production (P<0.001) of measurable bioactive indoles.

  19. Dietary treatment of irritable bowel syndrome.

    PubMed

    Ahmad, O F; Akbar, A

    2015-03-01

    Food is a recognized trigger for most patients with irritable bowel syndrome (IBS). In recent years, an emerging evidence base has identified dietary manipulation as an important therapeutic approach in IBS. Original and review articles were identified through selective searches performed on PubMed and Google Scholar. Randomized controlled trials have supported the use of a diet that restricts a group of short-chain carbohydrates known collectively as fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). There is evidence that specific probiotics may improve symptoms in IBS. The role of a high-fibre diet remains subject to ongoing debate with a lack of high-quality evidence. The long-term durability and safety of a low FODMAP diet are unclear. A paradigm shift has led to a focus on the relationship between diet and pathophysiological mechanisms in IBS such as effects on intestinal microbiota, inflammation, motility, permeability and visceral hypersensitivity. Future large, randomized controlled trials with rigorous end points are required. In addition, predictors of response need to be identified to offer personalized therapy. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Is irritable bowel syndrome an infectious disease?

    PubMed

    Thompson, John Richard

    2016-01-28

    Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases. While many mechanisms have been postulated to explain its etiology, no single mechanism entirely explains the heterogeneity of symptoms seen with the various phenotypes of the disease. Recent data from both basic and clinical sciences suggest that underlying infectious disease may provide a unifying hypothesis that better explains the overall symptomatology. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis. Clinical evidence from treatment trials with both probiotics and antibiotics also support this etiology. Probiotics appear to restore the imbalance in the microflora and improve IBS-specific quality of life. Antibiotic trials with both neomycin and rifaximin show improvement in global IBS symptoms that correlates with breath test normalization in diarrhea-predominant patients. The treatment response to two weeks of rifaximin is sustained for up to ten weeks and comparable results are seen in symptom reduction with retreatment in patients who develop recurrent symptoms.

  1. Irritable bowel syndrome: emerging paradigm in pathophysiology.

    PubMed

    Lee, Yoo Jin; Park, Kyung Sik

    2014-03-14

    Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, characterized by abdominal pain, bloating, and changes in bowel habits. These symptoms cannot be explained by structural abnormalities and there is no specific laboratory test or biomarker for IBS. Therefore, IBS is classified as a functional disorder with diagnosis dependent on the history taking about manifested symptoms and careful physical examination. Although a great deal of research has been carried out in this area, the pathophysiology of IBS is complex and not completely understood. Multiple factors are thought to contribute to the symptoms in IBS patients; altered gastrointestinal motility, visceral hypersensitivity, and the brain-gut interaction are important classical concepts in IBS pathophysiology. New areas of research in this arena include inflammation, postinfectious low-grade inflammation, genetic and immunologic factors, an altered microbiota, dietary factors, and enteroendocrine cells. These emerging studies have not shown consistent results, provoking controversy in the IBS field. However, certain lines of evidence suggest that these mechanisms are important at least a subset of IBS patients, confirming that IBS symptoms cannot be explained by a single etiological mechanism. Therefore, it is important to keep in mind that IBS requires a more holistic approach to determining effective treatment and understanding the underlying mechanisms.

  2. Genetic epidemiology of irritable bowel syndrome.

    PubMed

    Makker, Jasbir; Chilimuri, Sridhar; Bella, Jonathan N

    2015-10-28

    Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder characterized by presence of abdominal pain or discomfort associated with altered bowel habits. It has three main subtypes - constipation predominant IBS (C-IBS), diarrhea predominant IBS (D-IBS) and IBS with mixed features of both diarrhea as well as constipation (M-IBS). Its pathophysiology and underlying mechanisms remain elusive. It is traditionally believed that IBS is a result of multiple factors including hypersensitivity of the bowel, altered bowel motility, inflammation and stress. Initial studies have shown familial aggregation of IBS suggesting shared genetic or environmental factors. Twin studies of IBS from different parts of world have shown higher concordance rates among monozygotic twins than dizygotic twins, and thus suggesting a genetic component to this disorder. Multiple studies have tried to link single-nucleotide polymorphisms (SNPs) to IBS but there is little evidence that these SNPs are functional. Various molecules have been studied and investigated by the researchers. Serotonin, a known neurotransmitter and a local hormone in the enteric nervous system, has been most extensively explored. At this time, the underlying gene pathways, genes and functional variants linked with IBS remain unknown and the promise of genetically-determined risk prediction and personalize medicine remain unfulfilled. However, molecular biological technologies continue to evolve rapidly and genetic investigations offer much promise in the intervention, treatment and prevention of IBS.

  3. The Intestinal Microbiota and Irritable Bowel Syndrome.

    PubMed

    Ringel, Yehuda; Ringel-Kulka, Tamar

    2015-01-01

    Irritable bowel syndrome (IBS) is the most prevalent and the best studied functional gastrointestinal disorder. The etiology and the pathogenesis of IBS are still not clear; however, recent studies have implicated a role for alterations in the intestinal microbiota (dysbiosis) in the pathophysiology of the disorder. Epidemiological observations have demonstrated that the development of IBS symptoms is often preceded by a disruption of the individual's normal intestinal microbiota, and microbiological studies have demonstrated compositional differences in the intestinal microbiota between patients with IBS patients and healthy controls. In addition, animal studies and a few recent human clinical studies have demonstrated that compositional changes in the intestinal microbiota in IBS are associated with relevant abnormal gastrointestinal and brain-gut axis functions that are often observed in patients with IBS. This article discusses points of interest from the current research on the microbiota-gut-brain interactions in IBS and highlights the relevance of the emerging data to our understanding of the disorder and the clinical implications for patients' care.

  4. Irritable bowel syndrome: Diagnosis and pathogenesis

    PubMed Central

    El-Salhy, Magdy

    2012-01-01

    Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) disorder that considerably reduces the quality of life. It further represents an economic burden on society due to the high consumption of healthcare resources and the non-productivity of IBS patients. The diagnosis of IBS is based on symptom assessment and the Rome III criteria. A combination of the Rome III criteria, a physical examination, blood tests, gastroscopy and colonoscopy with biopsies is believed to be necessary for diagnosis. Duodenal chromogranin A cell density is a promising biomarker for the diagnosis of IBS. The pathogenesis of IBS seems to be multifactorial, with the following factors playing a central role in the pathogenesis of IBS: heritability and genetics, dietary/intestinal microbiota, low-grade inflammation, and disturbances in the neuroendocrine system (NES) of the gut. One hypothesis proposes that the cause of IBS is an altered NES, which would cause abnormal GI motility, secretions and sensation. All of these abnormalities are characteristic of IBS. Alterations in the NES could be the result of one or more of the following: genetic factors, dietary intake, intestinal flora, or low-grade inflammation. Post-infectious IBS (PI-IBS) and inflammatory bowel disease-associated IBS (IBD-IBS) represent a considerable subset of IBS cases. Patients with PI- and IBD-IBS exhibit low-grade mucosal inflammation, as well as abnormalities in the NES of the gut. PMID:23066308

  5. Irritable bowel syndrome: Emerging paradigm in pathophysiology

    PubMed Central

    Lee, Yoo Jin; Park, Kyung Sik

    2014-01-01

    Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, characterized by abdominal pain, bloating, and changes in bowel habits. These symptoms cannot be explained by structural abnormalities and there is no specific laboratory test or biomarker for IBS. Therefore, IBS is classified as a functional disorder with diagnosis dependent on the history taking about manifested symptoms and careful physical examination. Although a great deal of research has been carried out in this area, the pathophysiology of IBS is complex and not completely understood. Multiple factors are thought to contribute to the symptoms in IBS patients; altered gastrointestinal motility, visceral hypersensitivity, and the brain-gut interaction are important classical concepts in IBS pathophysiology. New areas of research in this arena include inflammation, postinfectious low-grade inflammation, genetic and immunologic factors, an altered microbiota, dietary factors, and enteroendocrine cells. These emerging studies have not shown consistent results, provoking controversy in the IBS field. However, certain lines of evidence suggest that these mechanisms are important at least a subset of IBS patients, confirming that IBS symptoms cannot be explained by a single etiological mechanism. Therefore, it is important to keep in mind that IBS requires a more holistic approach to determining effective treatment and understanding the underlying mechanisms. PMID:24627583

  6. [Irritable bowel syndrome, celiac disease and gluten].

    PubMed

    Mearin, Fermín; Montoro, Miguel

    2014-08-04

    For many years irritable bowel syndrome (IBS) and celiac disease (CD) have been considered 2 completely separate entities, with CD being clearly related to a permanent gluten intolerance and IBS having no relation with gluten ingestion. However IBS and CD symptoms may be indistinguishable, especially when diarrhea, bloating or abdominal pain predominate. In the last decade several studies have shown that the separation between CD and IBS is not so clear. Thus, some patients who have been diagnosed of IBS suffer in fact from CD. In addition, it seems that there is a group of patients who, without having CD, suffer gluten intolerance that cause them digestive symptoms similar to those of IBS. Gluten sensitivity is defined as the spectrum of morphological, immunological and functional abnormalities that respond to a gluten-free diet. This concept includes histological, immunological and clinical manifestations in the absence of evident morphological abnormalities. Therefore, it is mandatory to establish in a scientific way in which patients a gluten-free diet will be beneficial as well as when this is not justified. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  7. Is irritable bowel syndrome an organic disorder?

    PubMed

    El-Salhy, Magdy; Gundersen, Doris; Gilja, Odd Helge; Hatlebakk, Jan Gunnar; Hausken, Trygve

    2014-01-14

    Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thought to play an important role in IBS. The gut neuroendocrine system (NES), which regulates all functions of the gastrointestinal tract, consists of endocrine cells that are scattered among the epithelial cells of the mucosa, and the enteric nervous system. Although it is capable of operating independently from the central nervous system (CNS), the gut NES is connected to and modulated by the CNS. This review presents evidence for the presence of an anatomical defect in IBS patients, namely in the gastrointestinal endocrine cells. These cells have specialized microvilli that project into the lumen and function as sensors for the luminal content and respond to luminal stimuli by releasing hormones into the lamina propria, which starts a chain reaction that progresses throughout the entire NES. The changes in the gastrointestinal endocrine cells observed in IBS patients are highly consistent with the other abnormalities reported in IBS patients, such as visceral hypersensitivity, dysmotility, and abnormal secretion.

  8. Is irritable bowel syndrome an organic disorder?

    PubMed Central

    El-Salhy, Magdy; Gundersen, Doris; Gilja, Odd Helge; Hatlebakk, Jan Gunnar; Hausken, Trygve

    2014-01-01

    Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thought to play an important role in IBS. The gut neuroendocrine system (NES), which regulates all functions of the gastrointestinal tract, consists of endocrine cells that are scattered among the epithelial cells of the mucosa, and the enteric nervous system. Although it is capable of operating independently from the central nervous system (CNS), the gut NES is connected to and modulated by the CNS. This review presents evidence for the presence of an anatomical defect in IBS patients, namely in the gastrointestinal endocrine cells. These cells have specialized microvilli that project into the lumen and function as sensors for the luminal content and respond to luminal stimuli by releasing hormones into the lamina propria, which starts a chain reaction that progresses throughout the entire NES. The changes in the gastrointestinal endocrine cells observed in IBS patients are highly consistent with the other abnormalities reported in IBS patients, such as visceral hypersensitivity, dysmotility, and abnormal secretion. PMID:24574708

  9. Emerging treatments for irritable bowel syndrome.

    PubMed

    Ahn, Joseph; Ehrenpreis, Eli D

    2002-01-01

    Irritable bowel syndrome (IBS) is a functional GI disorder that is associated with abdominal discomfort and altered bowel habits. It accounts for up to 28% of patients presenting to a gastroenterology practice and poses a significant personal, societal and economic burden internationally. The Manning, Rome I and Rome II criteria were developed to identify appropriate IBS patients for entry into IBS studies in a consistent manner. Refinements in the understanding of the physiology of the enteric nervous system (ENS), which controls motility, secretion and sensation, provided the basis for our comprehension of the pathophysiology of IBS. Visceral hypersensitivity and neurotransmitter imbalance currently receive the most attention as possible mechanisms of IBS. This article outlines conventional treatments and reviews the data on emerging and experimental therapies for IBS. Emerging therapies for IBS using 5-HT mediation include 5-HT(3) antagonists, such as ondasetron, granisetron and alosetron, as well as 5-HT(4) agonists such as tegaserod and prucalopride. In addition to opioid agonists (e.g. fedotozine) several other drugs that act on other ENS receptors are being studied. In spite of significant progress in IBS research, these emerging therapies require more studies before they can be utilised as clinical treatments.

  10. Diagnosis and treatment of irritable bowel syndrome.

    PubMed

    Suares, Nicole C; Ford, Alexander C

    2011-05-01

    Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract. The exact cause is unknown. The diagnosis should be made on clinical grounds, using symptom-based criteria such as the Manning or Rome criteria, unless symptoms are thought to be atypical. Excluding celiac disease in all patients consulting with symptoms suggestive of IBS is worthwhile, but evidence for performing other investigations to exclude organic disease is not convincing. No medical therapy for IBS has been shown to alter the disease course, and treatment has traditionally been directed towards symptom relief. The aim should be to improve the predominant symptom reported by the patient. Fiber, peppermint oil, or antispasmodic agents are beneficial as first-line therapies in some patients. Where these fail, emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS. There are a number of novel therapies under development that show promise, including non-absorbable antibiotics, lubiprostone, and linaclotide. This article will provide a summary of diagnostic criteria for IBS, evidence to support investigations to exclude organic disease, and current and emerging therapies in this field.

  11. Irritable bowel syndrome and food interaction.

    PubMed

    Cuomo, Rosario; Andreozzi, Paolo; Zito, Francesco Paolo; Passananti, Valentina; De Carlo, Giovanni; Sarnelli, Giovanni

    2014-07-21

    Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders in Western countries. Despite the high prevalence of this disorders, the therapeutic management of these patients is often unsatisfactory. A number of factors have been suggested to be involved in the pathogenesis of IBS, including impaired motility and sensitivity, increased permeability, changes in the gut microbiome and alterations in the brain-gut axis. Also food seems to play a critical role: the most of IBS patients report the onset or the exacerbation of their symptoms after the meals. Recently, an increasing attention has been paid to the role of food in IBS. In this review we summarize the most recent evidences about the role of diet on IBS symptoms. A diet restricted in fermentable, poorly absorbed carbohydrates and sugar alcohols has beneficial effects on IBS symptoms. More studies are needed to improve our knowledge about the relationship between food and IBS. However, in the foreseeable future, dietary strategies will represent one of the key tools in the therapeutic management of patients with IBS.

  12. Is irritable bowel syndrome an infectious disease?

    PubMed Central

    Thompson, John Richard

    2016-01-01

    Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases. While many mechanisms have been postulated to explain its etiology, no single mechanism entirely explains the heterogeneity of symptoms seen with the various phenotypes of the disease. Recent data from both basic and clinical sciences suggest that underlying infectious disease may provide a unifying hypothesis that better explains the overall symptomatology. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis. Clinical evidence from treatment trials with both probiotics and antibiotics also support this etiology. Probiotics appear to restore the imbalance in the microflora and improve IBS-specific quality of life. Antibiotic trials with both neomycin and rifaximin show improvement in global IBS symptoms that correlates with breath test normalization in diarrhea-predominant patients. The treatment response to two weeks of rifaximin is sustained for up to ten weeks and comparable results are seen in symptom reduction with retreatment in patients who develop recurrent symptoms. PMID:26819502

  13. Genetic epidemiology of irritable bowel syndrome

    PubMed Central

    Makker, Jasbir; Chilimuri, Sridhar; Bella, Jonathan N

    2015-01-01

    Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder characterized by presence of abdominal pain or discomfort associated with altered bowel habits. It has three main subtypes - constipation predominant IBS (C-IBS), diarrhea predominant IBS (D-IBS) and IBS with mixed features of both diarrhea as well as constipation (M-IBS). Its pathophysiology and underlying mechanisms remain elusive. It is traditionally believed that IBS is a result of multiple factors including hypersensitivity of the bowel, altered bowel motility, inflammation and stress. Initial studies have shown familial aggregation of IBS suggesting shared genetic or environmental factors. Twin studies of IBS from different parts of world have shown higher concordance rates among monozygotic twins than dizygotic twins, and thus suggesting a genetic component to this disorder. Multiple studies have tried to link single-nucleotide polymorphisms (SNPs) to IBS but there is little evidence that these SNPs are functional. Various molecules have been studied and investigated by the researchers. Serotonin, a known neurotransmitter and a local hormone in the enteric nervous system, has been most extensively explored. At this time, the underlying gene pathways, genes and functional variants linked with IBS remain unknown and the promise of genetically-determined risk prediction and personalize medicine remain unfulfilled. However, molecular biological technologies continue to evolve rapidly and genetic investigations offer much promise in the intervention, treatment and prevention of IBS. PMID:26525775

  14. Molecular basis of the irritable bowel syndrome

    PubMed Central

    Vaiopoulou, Anna; Karamanolis, Georgios; Psaltopoulou, Theodora; Karatzias, George; Gazouli, Maria

    2014-01-01

    Irritable bowel syndrome (IBS) is a functional disorder characterized by abdominal pain, discomfort and bloating. The pathophysiology of IBS is poorly understood, but the presence of psychosocial basis is now known. There is an increasing number of publications supporting the role of genetics in IBS. Most of the variations are found in genes associated with the brain-gut axis, revealing the strong correlation of brain-gut axis and IBS. miRNAs, which play critical roles in physiological processes, are not well studied in IBS. However, so far there is found an involvement of alterations in miRNA expression or sequence, in IBS symptoms. IBS phenotype is affected by epigenetic alteration and environment. Changes in DNA and histone methylation are observed in patients who suffered childhood trauma or abuse, resulting in altered gene expression, such as the glucocorticoid receptor gene. Finally, diet is another factor associated with IBS, which may contribute to symptom onset. Certain foods may affect on bacterial metabolism and epigenetic modifications, predisposing to IBS. PMID:24574707

  15. Motility abnormalities in irritable bowel syndrome.

    PubMed

    DuPont, Andrew W; Jiang, Zhi-Dong; Harold, Stephen A; Snyder, Ned; Galler, Greg W; Garcia-Torres, Francisco; DuPont, Herbert L

    2014-01-01

    The intestinal pathophysiology in irritable bowel syndrome (IBS) is largely unknown. The lactulose breath test has been used to identify small bowel bacterial overgrowth in these patients. We studied intestinal transit in patients with IBS using of the SmartPill® (SP) wireless pH/pressure recording capsule and performed lactulose breath tests to look for physiologic abnormalities. A total of 35/46 (76%) of the IBS patients had prolonged gastric emptying times. Constipation-predominant disease was associated with prolonged gut transit times. The mean hours ± SD for colonic transit time in the constipation group was 71.7 ± 61.1 (n = 13) compared with 22.5 ± 14.9 (n = 14) for diarrhea-predominant and 26.4 ± 21.5 (n = 20) for mixed clinical subtype (p = 0.0010). No correlation between small bowel transit time and abnormal breath hydrogen or methane excretion in the 46 combined patients with IBS was seen. Delayed gastric emptying was identified in IBS and in some patients may contribute to at least a component of their symptoms. Constipation-predominant IBS is associated with prolonged gut transit times. Otherwise, transit abnormalities do not appear to be important in IBS. Intestinal transit did not correlate with breath test results.

  16. Asian consensus on irritable bowel syndrome.

    PubMed

    Gwee, Kok-Ann; Bak, Young-Tae; Ghoshal, Uday Chand; Gonlachanvit, Sutep; Lee, Oh Young; Fock, Kwong Ming; Chua, Andrew Seng Boon; Lu, Ching-Liang; Goh, Khean-Lee; Kositchaiwat, Chomsri; Makharia, Govind; Park, Hyo-Jin; Chang, Full-Young; Fukudo, Shin; Choi, Myung-Gyu; Bhatia, Shobna; Ke, Meiyun; Hou, Xiaohua; Hongo, Michio

    2010-07-01

    Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.

  17. The Treatment of Irritable Bowel Syndrome

    PubMed Central

    Weiser, Kirsten; De Lee, Ryan

    2009-01-01

    Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder routinely encountered by healthcare providers. Although not life-threatening, this chronic disorder reduces patients’ quality of life and imposes a significant economic burden to the healthcare system. IBS is no longer considered a diagnosis of exclusion that can only be made after performing a battery of expensive diagnostic tests. Rather, IBS should be confidently diagnosed in the clinic at the time of the first visit using the Rome III criteria and a careful history and physical examination. Treatment options for IBS have increased in number in the past decade and clinicians should not be limited to using only fiber supplements and smooth muscle relaxants. Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom. This paper will review therapeutic options for the treatment of IBS using a tailored approach based on the predominant symptom. Abdominal pain, bloating, constipation and diarrhea are the four main symptoms that can be addressed using a combination of dietary interventions and medications. Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin. Each class of agent will be reviewed using the latest data from the literature. PMID:21180545

  18. Irritable bowel syndrome and food interaction

    PubMed Central

    Cuomo, Rosario; Andreozzi, Paolo; Zito, Francesco Paolo; Passananti, Valentina; De Carlo, Giovanni; Sarnelli, Giovanni

    2014-01-01

    Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders in Western countries. Despite the high prevalence of this disorders, the therapeutic management of these patients is often unsatisfactory. A number of factors have been suggested to be involved in the pathogenesis of IBS, including impaired motility and sensitivity, increased permeability, changes in the gut microbiome and alterations in the brain-gut axis. Also food seems to play a critical role: the most of IBS patients report the onset or the exacerbation of their symptoms after the meals. Recently, an increasing attention has been paid to the role of food in IBS. In this review we summarize the most recent evidences about the role of diet on IBS symptoms. A diet restricted in fermentable, poorly absorbed carbohydrates and sugar alcohols has beneficial effects on IBS symptoms. More studies are needed to improve our knowledge about the relationship between food and IBS. However, in the foreseeable future, dietary strategies will represent one of the key tools in the therapeutic management of patients with IBS. PMID:25083057

  19. Irritable bowel syndrome, gut microbiota and probiotics.

    PubMed

    Lee, Beom Jae; Bak, Young-Tae

    2011-07-01

    Irritable bowel syndrome (IBS) is a complex disorder characterized by abdominal symptoms including chronic abdominal pain or discomfort and altered bowel habits. The etiology of IBS is multifactorial, as abnormal gut motility, visceral hypersensitivity, disturbed neural function of the brain-gut axis and an abnormal autonomic nervous system are all implicated in disease progression. Based on recent experimental and clinical studies, it has been suggested that additional etiological factors including low-grade inflammation, altered gut microbiota and alteration in the gut immune system play important roles in the pathogenesis of IBS. Therefore, therapeutic restoration of altered intestinal microbiota may be an ideal treatment for IBS. Probiotics are live organisms that are believed to cause no harm and result in health benefits for the host. Clinical efficacy of probiotics has been shown in the treatment or prevention of some gastrointestinal inflammation-associated disorders including traveler's diarrhea, antibiotics-associated diarrhea, pouchitis of the restorative ileal pouch and necrotizing enterocolitis. The molecular mechanisms, as cause of IBS pathogenesis, affected by altered gut microbiota and gut inflammation-immunity are reviewed. The effect of probiotics on the gut inflammation-immune systems and the results from clinical trials of probiotics for the treatment of IBS are also summarized.

  20. Common gastrointestinal symptoms: irritable bowel syndrome.

    PubMed

    Fashner, Julia; Gitu, Alfred Chege

    2013-10-01

    The diagnosis of irritable bowel syndrome (IBS) should be considered when patients have had abdominal pain/discomfort, bloating, and change in bowel habits for 6 months. Patients may experience variation between periods of constipation and diarrhea. When evaluating patients with IBS, physicians should be alert for red flag symptoms, such as rectal bleeding, anemia, nighttime pain, and weight loss. Physicians also should consider other medical conditions that manifest similarly to IBS. Clinicians who are confident in diagnosing IBS based on symptoms typically do not obtain many tests unless the patient has red flag symptoms. Various etiologic mechanisms have been proposed for IBS, including abnormal bowel motility, inflammation, altered mucosal permeability, genetic predisposition, and visceral hypersensitivity. Lack of certainty about the etiology makes it difficult to develop effective management approaches; thus, management is directed toward symptom relief. Dietary changes, such as avoiding fermentable carbohydrates, may benefit some patients, especially those with bloating. Constipation-dominant IBS can be managed with antispasmodics, lubiprostone, or linaclotide, whereas diarrhea-dominant IBS can be managed with loperamide or alosetron, though the latter drug can cause ischemic colitis. For long-term therapy, tricyclic antidepressants or selective serotonin reuptake inhibitors have good efficacy. Peppermint oil and probiotics also may provide benefit. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  1. Pustular irritant contact dermatitis caused by dexpanthenol in a child.

    PubMed

    Gulec, Ali Ihsan; Albayrak, Hulya; Uslu, Esma; Başkan, Elife; Aliagaoglu, Cihangir

    2015-03-01

    Pustular irritant contact dermatitis is rare and unusual clinic form of contact dermatitis. Dexpanthenol is the stable alcoholic analogue of pantothenic acid. It is widely used in cosmetics and topical medical products for several purposes. We present the case of 8-year-old girl with pustules over erythematous and eczematous areas on the face and neck. To the best of our knowledge, this is the first case reported that is diagnosed as pustular irritant contact dermatitis caused by dexpanthenol.

  2. [Correlation of the microbiota and intestinal mucosa in the pathophysiology and treatment of irritable bowel, irritable eye, and irritable mind syndrome].

    PubMed

    Fehér, János; Kovács, Illés; Pacella, Elena; Radák, Zsolt

    2014-09-14

    Accumulating clinical evidence supports co-morbidity of irritable bowel, irritable eye and irritable mind symptoms. Furthermore, perturbation of the microbiota-host symbiosis (dysbiosis) is considered a common pathogenic mechanism connecting gastrointestinal, ocular and neuropsychiatric symptoms. Consequently, maintaining or restoring microbiota-host symbiosis represents a new approach to treat these symptoms or to prevent their relapses. Current treatment approach assigned a primary role to live probiotics alone or in combination with prebiotics to enhance colonization of beneficial bacteria and to strengthen the symbiosis. However, several papers showed major benefits of heat-killed probiotics as compared to their live counterparts on both intestinal and systemic symptoms. Recently, in addition to killing probiotics, in a proof of concept study lysates (fragments) of probiotics in combination with vitamins A, B, D and omega 3 fatty acids were successfully tested. These findings suggested a conceptual change in the approach addressed to both the microbiota and host as targets for intervention.

  3. Executive functioning, irritability, and alcohol-related aggression.

    PubMed

    Godlaski, Aaron J; Giancola, Peter R

    2009-09-01

    The purpose of this investigation was to examine (a) whether irritability mediates the relation between executive functioning (EF) and alcohol-related aggression and (b) whether the alcohol-aggression relation is better explained by the interactive effects of EF and irritability above and beyond the effects of either variable alone. EF was measured using seven well-established neuropsychological tests. Irritability was assessed with the Caprara Irritability Scale. Participants were 313 male and female social drinkers between 21 and 35 years of age. Following the consumption of an alcohol or a placebo beverage, participants were tested on a laboratory aggression task in which electric shocks were given to and received from a fictitious opponent under the guise of a competitive reaction-time task. Aggression was operationalized as the shock intensities administered to the fictitious opponent. Results indicated that irritability successfully mediated the relation between EF and intoxicated aggression for men only. Despite the fact that irritability and EF both independently moderated the alcohol-aggression relation in previous studies, no significant interaction for their combined effect was detected here. The findings are discussed, in part, within a cognitive neoassociationistic framework for aggressive behavior.

  4. A comparison of the irritant and allergenic properties of antiseptics.

    PubMed

    Lachapelle, Jean-Marie

    2014-01-01

    Over recent years, interest in the use of antiseptics has been reinforced as these molecules are not concerned by the problem of bacterial resistance. Whereas the in vitro efficacy of antiseptics has been well-studied, much less is known regarding their irritant and allergenic properties. This review provides an update on the comparative irritant and allergenic properties of commonly-used antiseptics in medicine nowadays. All antiseptics have irritant properties, especially when they are misused. Povidone-iodine has an excellent profile in terms of allergenicity. Allergic contact dermatitis is uncommon but is often misdiagnosed by practitioners, who confuse allergy and irritation. Chlorhexidine has been incriminated in some cases of allergic contact dermatitis; it is considered a relatively weak allergen, although it may rarely cause immunological contact urticaria and even life-threatening anaphylaxis. Octenidine is considered a safe and efficient antiseptic when used for superficial skin infections, however, aseptic tissue necrosis and chronic inflammation have been reported following irrigation of penetrating hand wounds. Polihexanide is an uncommon contact allergen as regards irritant and/or allergic contact dermatitis but cases of anaphylaxis have been reported. Considering the data available comparing the irritant and allergenic properties of major antiseptics currently in use, it should be acknowledged that all antiseptics may induce cutaneous side-effects. The present article reviews the most recent safety data that can guide consumers' choice.

  5. Executive Functioning, Irritability, and Alcohol-Related Aggression

    PubMed Central

    Godlaski, Aaron J.; Giancola, Peter R.

    2009-01-01

    The purpose of this investigation was to examine: a) whether irritability mediates the relation between executive functioning (EF) and alcohol-related aggression and b) whether the alcohol-aggression relation is better explained by the interactive effects of EF and irritability above and beyond the effects of either variable alone. EF was measured using seven well-established neuropsychological tests. Irritability was assessed with the Caprara Irritability Scale. Participants were 313 male and female social drinkers between 21 and 35 years of age. Following the consumption of an alcohol or a placebo beverage, participants were tested on a laboratory aggression task in which electric shocks were given to and received from a fictitious opponent under the guise of a competitive reaction-time task. Aggression was operationalized as the shock intensities administered to the fictitious opponent. Results indicated that irritability successfully mediated the relation between EF and intoxicated aggression for men only. Despite the fact that irritability and EF both independently moderated the alcohol-aggression relation in previous studies, no significant interaction for their combined effect was detected here. The findings are discussed, in part, within a cognitive neoassociationistic framework for aggressive behavior. PMID:19769424

  6. Behavioral evaluation of the irritating properties of ozone

    SciTech Connect

    Tepper, J.S.; Wood, R.W.

    1985-05-01

    The sensory irritant properties of ozone have been considered to be responsible for symptoms that occur in humans after exposure. This assumption has not been studied explicitly. One way to assess the aversive properties of airborne irritants is to give the exposed individual an opportunity to control the duration of exposure, i.e., escape from the irritant. Mice were trained to turn off 1000-ppm ammonia, a concentration that, in humans, is irritating to the upper airways. Each mouse could terminate irritant delivery for 1 min by inserting its nose five times into one of two conical response sensors. After the determination of ammonia concentration-effect curves, ozone was substituted for ammonia. Ozone exposures were alternated every other day with ammonia as a control for any changes that might occur as a result of repeated ozone exposure. Ozone reliably maintained escape behavior. Additional mice with no history of ammonia termination were trained to terminate ozone exposure, indicating that the aversive properties of ozone were not dependent on previous experience with other airborne irritants. As the concentration of ozone increased from 0.25 to 24 ppm, the number of escape responses increased, and the duration of ozone tolerated decreased. Ozone concentrations of 0.5 ppm or greater were significantly more aversive than control.

  7. Significance of hair-dye base-induced sensory irritation.

    PubMed

    Fujita, F; Azuma, T; Tajiri, M; Okamoto, H; Sano, M; Tominaga, M

    2010-06-01

    Oxidation hair-dyes, which are the principal hair-dyes, sometimes induce painful sensory irritation of the scalp caused by the combination of highly reactive substances, such as hydrogen peroxide and alkali agents. Although many cases of severe facial and scalp dermatitis have been reported following the use of hair-dyes, sensory irritation caused by contact of the hair-dye with the skin has not been reported clearly. In this study, we used a self-assessment questionnaire to measure the sensory irritation in various regions of the body caused by two model hair-dye bases that contained different amounts of alkali agents without dyes. Moreover, the occipital region was found as an alternative region of the scalp to test for sensory irritation of the hair-dye bases. We used this region to evaluate the relationship of sensitivity with skin properties, such as trans-epidermal water loss (TEWL), stratum corneum water content, sebum amount, surface temperature, current perception threshold (CPT), catalase activities in tape-stripped skin and sensory irritation score with the model hair-dye bases. The hair-dye sensitive group showed higher TEWL, a lower sebum amount, a lower surface temperature and higher catalase activity than the insensitive group, and was similar to that of damaged skin. These results suggest that sensory irritation caused by hair-dye could occur easily on the damaged dry scalp, as that caused by skin cosmetics reported previously.

  8. A new, female-specific irritability rating scale

    PubMed Central

    Born, Leslie; Koren, Gideon; Lin, Elizabeth; Steiner, Meir

    2008-01-01

    Objective Irritability is a prominent symptom in the spectrum of female-specific mood disorders, and in some women, irritability is serious enough to disrupt their lives and warrant treatment. The objective of this research was to develop a new, female-specific state measure of irritability. Methods We constructed self-rating and observer rating scales using items derived from spontaneous descriptions of irritability by women with mood disturbances related to the menstrual cycle, childbearing or menopause. Following a pretest, the scales were shortened to the core items of irritability (annoyance, anger, tension, hostility, sensitivity to noise and touch) and tested on a new cohort of patients. Results The 14-item Self-Rating Scale and the 5-item Observer Rating Scale showed evidence for internal consistency (Self-Rating: n = 36 patients, Cronbach's α = 0.9257, mean interitem correlation = 0.4690; Observer Rating: Cronbach's α = 0.7418, mean interitem correlation = 0.3616), Self-Rating test–retest reliability (n = 29 patients, rs = 0.704, p = 0.01) and interrater reliability (n = 20 patients; τb = 1.000, p = 0.001). Conclusion This new, female-specific scale for rating irritability has the potential to further the evaluation of this prominent symptom cluster and increase specificity in clinical assessments of emotional disturbances related to reproductive cyclicity in women. PMID:18592028

  9. Isolation and characterization of irritant components of Euphorbia pilulifera L.

    PubMed

    Saeed-ul-Hassan, Syed; Khalil-ur-Rehman, Muhammad; Niaz, Uzma; Saeed, Muhammad Asif; Hussain, Khalid; Rao, Saeed Ahmed; Ahmed, Irshad

    2013-01-01

    Euphorbia pilulifera is commonly found weed along road sides and loamy soils. This weed is commonly used as treatment of female disorders and respiratory problems. The latex of this weed causes irritation on hand on contact. To evaluate its irritant potentials, the dermatological investigation of irritant principles from locally occurring Euphorbia pilulifera was carried out. For this purpose, after collection and drying, a series of solvents with increasing polarity were used for the successive extraction of non-polar compounds (petroleum ether extract), constituents of intermediate polarities (chloroform extract) and polar constituents (methanol extract) from the whole herb of Euphorbia pilulifera. The chloroform extract of this weed was found most irritant to rabbit ' s skin. Chloroform extract was further subjected to column chromatography; four fractions Ep 1 to Ep 4 were isolated from active chloroform extract by column and thin layer chromatography. The irritant potentials of these isolated fractions were evaluated on rabbit 's skin. Two fractions out of the four, Ep 1 and Ep 3 appeared to be the most irritant than others. A possible structure activity relationship of these active compounds was discussed in order to establish their activity.

  10. Protein expression of MMP-2 and MT1-MMP in actinic keratosis, squamous cell carcinoma of the skin, and basal cell carcinoma.

    PubMed

    de Oliveira Poswar, Fabiano; de Carvalho Fraga, Carlos Alberto; Gomes, Emisael Stênio Batista; Farias, Lucyana Conceição; Souza, Linton Wallis Figueiredo; Santos, Sérgio Henrique Souza; Gomez, Ricardo Santiago; de-Paula, Alfredo Maurício Batista; Guimarães, André Luiz Sena

    2015-02-01

    Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are 2 skin neoplasms with distinct potentials to invasion and metastasis. Actinic keratosis (AK) is a precursor lesion of SCC. Immunohistochemistry was performed to evaluate the expression of MMP-2 and MT1-MMP in samples of BCC (n = 29), SCC (n = 12), and AK (n = 13). The ratio of positive cells to total cells was used to quantify the staining. Statistical significance was considered under the level P < .05. We found a higher expression of MMP-2 in tumor stroma and parenchyma of SCC as compared to BCC. The expression of this protein was also similar between SCC and its precursor actinic keratosis, and it was higher in the stroma of high-risk BCC when compared to low-risk BCC. MT1-MMP, which is an activator of MMP-2, was similarly expressed in all groups. Our results suggest that MMP-2 expression may contribute to the distinct invasive patterns seen in SCC and BCC.

  11. Irritable bowel syndrome: a clinical review.

    PubMed

    Soares, Rosa L S

    2014-09-14

    Irritable bowel syndrome (IBS) remains a clinical challenge in the 21(st) century. It's the most commonly diagnosed gastrointestinal condition and also the most common reason for referral to gastroenterology clinics. Its can affect up to one in five people at some point in their lives, and has a significantly impact of life quality and health care utilization. The prevalence varies according to country and criteria used to define IBS. Various mechanisms and theories have been proposed about its etiology, but the biopsychosocial model is the most currently accepted for IBS. The complex of symptoms would be the result of the interaction between psychological, behavioral, psychosocial and environmental factors. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria III is the current gold-standard for the diagnoses of IBS. Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis. There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS. However, a number of different changes in IBS patients were demonstrated in recent years, some of which can be used in the future as a diagnostic support. IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs, stressor conditions and changes in dietary habits.The traditional pharmacologic management of IBS has been symptom based and several drugs have been used. However, the cornerstone of its therapy is a solid patient physician relationship. This review will provide a summary of pathophysiology, diagnostic criteria and current and emerging therapies for IBS.

  12. Role of infection in irritable bowel syndrome.

    PubMed

    Spiller, Robin C

    2007-01-01

    Infection by pathogenic organisms leads to mucosal damage and disruption of the gut's extensive commensal flora, factors which may lead to prolonged bowel dysfunction. Six to 17% of unselected irritable bowel syndrome (IBS) patients believe their symptoms began with an infection, which is supported by prospective studies showing a 4%-31% incidence of postinfectious IBS-(PI) following bacterial gastroenteritis. The wide range of incidence can be accounted for by differences in risk factors, which include in order of magnitude; severity of initial illness > bacterial toxigenicity > hypochondriasis, depression and neuroticism, and adverse life events in the previous 3 months. PI-IBS has been reported after Campylobacter, Salmonella, and Shigella infections. Serial biopsies after Campylobacter jejuni gastroenteritis show an initial inflammatory infiltrate, with an increase in enterochromaffin (EC) cells, which in most cases subsides over the next 6 months. Those who go on to develop IBS show increased numbers of EC and lymphocyte cell counts at 3 months compared with those who do not develop IBS. Interleukin-1beta mRNA levels are increased in the mucosa of those who develop PI-IBS, who also show increased gut permeability. Recover can be slow, with approximately 50% still having symptoms at 5 years. Recent studies suggest an increase in peripheral blood mononuclear cell cytokine production in unselected IBS, an abnormality that may be ameliorated by probiotic treatment. The role of small-bowel bacterial overgrowth in IBS is controversial, but broad-spectrum antibiotics do have a temporary benefit in some patients. More acceptable long-term treatments altering gut flora are awaited with interest.

  13. Role of alimentation in irritable bowel syndrome.

    PubMed

    Dapoigny, M; Stockbrügger, R W; Azpiroz, F; Collins, S; Coremans, G; Müller-Lissner, S; Oberndorff, A; Pace, F; Smout, A; Vatn, M; Whorwell, P

    2003-01-01

    Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients. Copyright 2003 S. Karger AG, Basel

  14. Breath tests and irritable bowel syndrome

    PubMed Central

    Rana, Satya Vati; Malik, Aastha

    2014-01-01

    Breath tests are non-invasive tests and can detect H2 and CH4 gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H2 breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients. PMID:24976698

  15. Irritable bowel syndrome: A clinical review

    PubMed Central

    Soares, Rosa LS

    2014-01-01

    Irritable bowel syndrome (IBS) remains a clinical challenge in the 21st century. It’s the most commonly diagnosed gastrointestinal condition and also the most common reason for referral to gastroenterology clinics. Its can affect up to one in five people at some point in their lives, and has a significantly impact of life quality and health care utilization. The prevalence varies according to country and criteria used to define IBS. Various mechanisms and theories have been proposed about its etiology, but the biopsychosocial model is the most currently accepted for IBS. The complex of symptoms would be the result of the interaction between psychological, behavioral, psychosocial and environmental factors. The diagnosis of IBS is not confirmed by a specific test or structural abnormality. It is made using criteria based on clinical symptoms such as Rome criteria, unless the symptoms are thought to be atypical. Today the Rome Criteria III is the current gold-standard for the diagnoses of IBS. Secure positive evidence of IBS by means of specific disease marker is currently not possible and cannot be currently recommended for routine diagnosis. There is still no clinical evidence to recommend the use of biomarkers in blood to diagnose IBS. However, a number of different changes in IBS patients were demonstrated in recent years, some of which can be used in the future as a diagnostic support. IBS has no definitive treatment but could be controlled by non-pharmacologic management eliminating of some exacerbating factors such certain drugs, stressor conditions and changes in dietary habits.The traditional pharmacologic management of IBS has been symptom based and several drugs have been used. However, the cornerstone of its therapy is a solid patient physician relationship. This review will provide a summary of pathophysiology, diagnostic criteria and current and emerging therapies for IBS. PMID:25232249

  16. The Immune System in Irritable Bowel Syndrome

    PubMed Central

    Cremon, Cesare; Carini, Giovanni; Bellacosa, Lara; Zecchi, Lisa; De Giorgio, Roberto; Corinaldesi, Roberto; Stanghellini, Vincenzo

    2011-01-01

    The potential relevance of systemic and gastrointestinal immune activation in the pathophysiology and symptom generation in the irritable bowel syndrome (IBS) is supported by a number of observations. Infectious gastroenteritis is the strongest risk factor for the development of IBS and increased rates of IBS-like symptoms have been detected in patients with inflammatory bowel disease in remission or in celiac disease patients on a gluten free diet. The number of T cells and mast cells in the small and large intestine of patients with IBS is increased in a large proportion of patients with IBS over healthy controls. Mediators released by immune cells and likely from other non-immune competent cells impact on the function of enteric and sensory afferent nerves as well as on epithelial tight junctions controlling mucosal barrier of recipient animals, isolated human gut tissues or cell culture systems. Antibodies against microbiota antigens (bacterial flagellin), and increased levels of cytokines have been detected systemically in the peripheral blood advocating the existence of abnormal host-microbial interactions and systemic immune responses. Nonetheless, there is wide overlap of data obtained in healthy controls; in addition, the subsets of patients showing immune activation have yet to be clearly identified. Gender, age, geographic differences, genetic predisposition, diet and differences in the intestinal microbiota likely play a role and further research has to be done to clarify their relevance as potential mechanisms in the described immune system dysregulation. Immune activation has stimulated interest for the potential identification of biomarkers useful for clinical and research purposes and the development of novel therapeutic approaches. PMID:22148103

  17. Breath tests and irritable bowel syndrome.

    PubMed

    Rana, Satya Vati; Malik, Aastha

    2014-06-28

    Breath tests are non-invasive tests and can detect H₂ and CH₄ gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H₂ breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients.

  18. Acupuncture treatment in irritable bowel syndrome

    PubMed Central

    Schneider, A; Enck, P; Streitberger, K; Weiland, C; Bagheri, S; Witte, S; Friederich, H‐C; Herzog, W; Zipfel, S

    2006-01-01

    Background and aims Despite occasional positive reports on the efficacy of acupuncture (AC) on functions of the gastrointestinal tract, there is no conclusive evidence that AC is effective in the treatment of irritable bowel syndrome (IBS). Patients and methods Forty three patients with IBS according to the Rome II criteria were randomly assigned to receive either AC (n = 22) or sham acupuncture (SAC) (n = 21) using the so‐called “Streitberger needle”. Treatment duration was 10 sessions with an average of two AC sessions per week. The primary end point was improvement in quality of life (QOL) using the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF‐36), compared with baseline assessments. QOL measurements were repeated three months after treatment. Results Both the AC and SAC groups improved significantly in global QOL, as assessed by the FDDQL, at the end of treatment (p = 0.022), with no differences between the groups. SF‐36 was insensitive to these changes (except for pain). This effect was partially reversed three months later. Post hoc comparison of responders and non‐responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL (sleep, coping) (F = 6.746, p = 0.003) in a stepwise regression model. Conclusions Acupuncture in IBS is primarily a placebo response. Based on the small differences found between the AC and SAC groups, a study including 566 patients would be necessary to prove the efficacy of AC over SAC. The placebo response may be predicted by high coping capacity and low sleep quality in individual patients. PMID:16150852

  19. The Mexican consensus on irritable bowel syndrome.

    PubMed

    Carmona-Sánchez, R; Icaza-Chávez, M E; Bielsa-Fernández, M V; Gómez-Escudero, O; Bosques-Padilla, F; Coss-Adame, E; Esquivel-Ayanegui, F; Flores-Rendón, Á R; González-Martínez, M A; Huerta-Iga, F; López-Colombo, A; Méndez-Gutiérrez, T H; Noble-Lugo, A; Nogueira-de Rojas, J R; Raña-Garibay, R H; Remes-Troche, J M; Roesch-Dietlen, F; Schmulson, M J; Soto-Pérez, J C; Tamayo, J L; Uscanga, L F; Valdovinos, M Á; Valerio-Ureña, J; Zavala-Solares, M R

    2016-01-01

    Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  20. Peppermint oil in irritable bowel syndrome.

    PubMed

    Grigoleit, H G; Grigoleit, P

    2005-08-01

    In a literature search 16 clinical trials investigating 180-200 mg enteric-coated peppermint oil (PO) in irritable bowel syndrome (IBS) or recurrent abdominal pain in children (1 study) with 651 patients enrolled were identified. Nine out of 16 studies were randomized double blind cross over trials with (n = 5) or without (n = 4) run in and/or wash out periods, five had a randomized double blind parallel group design and two were open labeled studies. Placebo served in 12 and anticholinergics in three studies as comparator. Eight out of 12 placebo controlled studies show statistically significant effects in favor of PO. Average response rates in terms of "overall success" are 58% (range 39-79%) for PO and 29% (range 10-52%) for placebo. The three studies versus smooth muscle relaxants did not show differences between treatments hinting for equivalence of treatments. Adverse events reported were generally mild and transient, but very specific. PO caused the typical GI effects like heartburn and anal/perianal burning or discomfort sensations, whereas the anticholinergics caused dry mouth and blurred vision. Anticholinergics and 5HT3/4-ant/agonists do not offer superior improvement rates, placebo responses cover the range as in PO trials. Taking into account the currently available drug treatments for IBS PO (1-2 capsules t.i.d. over 24 weeks) may be the drug of first choice in IBS patients with non-serious constipation or diarrhea to alleviate general symptoms and to improve quality of life.

  1. Efficacy and Safety of Imiquimod 3.75% from Lmax in Actinic Keratosis According to Fitzpatrick Skin Type.

    PubMed

    Alomar, Agustin; Stockfleth, Eggert; Dirschka, Thomas; Gupta, Girish; Aractingi, Selim; Dakovic, Rada; Peris, Ketty

    2016-03-01

    Imiquimod 3.75% is an effective actinic keratosis (AK) treatment that detects and clears clinical and subclinical lesions across an entire sun-exposed field such as the full face or balding scalp. To determine the efficacy and safety of imiquimod 3.75% according to patients' Fitzpatrick skin type. Data were pooled from two identical 14-week, double-blind studies. Patients were randomized to imiquimod 3.75% or placebo and applied study medication to the full face or balding scalp each day for 2 two-week treatment cycles separated by a two-week treatment-free interval. End of study (EOS) was eight weeks after the last treatment application. Patients were subgrouped according to whether they had Fitzpatrick skin types I or II (FST I/II), or types III or IV (FST III/IV). Efficacy was analyzed using the reduction in lesions from Lmax (maximum lesion count during treatment) to EOS. This assesses whether clinical lesions, and subclinical lesions which become detectable during treatment, are cleared. Safety was assessed by monitoring local skin reactions. In total, 173 patients with FST I/II and 142 with FST III/IV were included. The median percentage reductions in lesions from Lmax to EOS were similar in patients treated with imiquimod 3.75% with FST I/II and FST III/IV (94.2% and 89.7%, respectively) as were the median absolute reductions in lesions from Lmax to EOS (19.0 and 17.0, respectively). These reductions were significantly greater with imiquimod 3.75% versus placebo in the two respective FST subgroups (P<0.0001). The frequency of local skin reactions was similar in the two imiquimod 3.75% FST subgroups. Imiquimod 3.75% is well tolerated and effective at clearing clinical and subclinical lesions across large areas of sun-exposed skin in patients with FST I-IV, and so can be considered for AK patients with any of these skin types.

  2. A cost-utility analysis of ingenol mebutate gel for the treatment of actinic keratosis: a Scottish perspective.

    PubMed

    Tolley, Keith; Kemmett, Danny; Thybo, Signe; Nasr, Ruth; Smethurst, Helen

    2016-04-01

    Actinic keratosis (AK) is a UV-induced, pre-malignant skin condition that is common in adults over 60 years of age with fair skin in Scotland. The most commonly prescribed first-line treatment for AK in Scotland is currently diclofenac gel (3 %). Ingenol mebutate gel is a recently developed topical therapy available in two strengths for the treatment of AK lesions on the face and scalp (150 mcg/g once daily for 3 consecutive days) or trunk and extremities (500 mcg/g once daily for 2 consecutive days). To compare the cost-effectiveness of two strengths of ingenol mebutate gel developed to treat AK lesions on the face and scalp (150 mcg/g once daily for 3 consecutive days) or trunk and extremities (500 mcg/g once daily for 2 consecutive days) with other first-line AK therapies including diclofenac gel, 5-FU, 5-FU/salicylic acid, and cryotherapy for the first-line treatment of AK in adult patients, from the perspective of the National Health Service (NHS) in Scotland. A cost-utility analysis was conducted using a decision-tree approach to calculate the costs and benefits of different treatment strategies for AK on the face and scalp or trunk and limbs over a 12-month time horizon. Data on the relative efficacy of treatments were obtained from a systematic literature review and meta-analysis. Utility scores and resource-use data were obtained from published sources. Over 12 months, ingenol mebutate 150 mcg/g gel and 500 mcg/g gel were cost-effective compared with the most commonly used topical therapy in Scotland, diclofenac (3 %) gel, at a willingness-to-pay threshold of £20,000 per QALY, with a minimal additional cost of £43 and £105, respectively per QALY gained. Ingenol mebutate gel is a cost-effective therapy for the first-line treatment of AK from a Scottish NHS perspective.

  3. Eye irritation potential: palm-based methyl ester sulphonates.

    PubMed

    Yusof, Nor Zuliana; Azizul Hasan, Zafarizal Aldrin; Abd Maurad, Zulina; Idris, Zainab

    2017-07-31

    To evaluate eye irritation potential of palm-based methyl ester sulphonates (MES) of different chain lengths; C12, C14, C16, C16:18. The Bovine Corneal Opacity and Permeability test method (BCOP), OECD Test Guideline 437, was used as an initial step to study the inducing effect of palm-based MES on irreversible eye damage. The second assessment involved the use of reconstructed human corneal-like epithelium test method, OECD Test Guideline 492 using SkinEthic™ Human Corneal Epithelium to study the potential effect of palm-based MES on eye irritancy. The palm-based MES were prepared in 10% solution (w/v) in deionized water and tested as a liquid and surfactant test substances whereby both test conducted according to the liquid/surfactant treatment protocol. The preliminary BCOP results showed that palm-based MES; C12, C14, C16, C16:18 were not classified as severe eye irritants test substances with in vitro irritancy score between 3 and the threshold level of 55. The second evaluation using SkinEthic™ HCE model showed that palm-based MES; C12, C14, C16, C16:18 and three commercial samples were potentially irritants to the eyes with mean tissue viability ? 60% and classified as Category 2 according to United Nations Globally Harmonized System of Classification and Labelling of Chemicals. However, there are some limitations of the proposed ocular irritation classification of palm-based MES due to insolubility of long chain MES in 10% solution (w/v) in deionized water. Therefore, future studies to clarify the eye irritation potential of the palm-based MES will be needed, and could include; methods to improve the test substance solubility, use of test protocol for solids, and/or inclusion of a benchmark anionic surfactant, such as sodium dodecyl sulphate within the study design.

  4. Irritable bowel syndrome in childhood: visceral hypersensitivity and psychosocial aspects.

    PubMed

    Iovino, P; Tremolaterra, F; Boccia, G; Miele, E; Ruju, F M; Staiano, A

    2009-09-01

    Visceral hypersensitivity is often considered to play a major etiologic role in the pathophysiology of irritable bowel syndrome in adults, and some authors argue that this increased sensitivity is mainly due to psychological factors. In contrast, there are no data in children with irritable bowel syndrome which confirm this relationship. The aim of the study was to evaluate the relationship between psychosocial aspects and sensorymotor function in children affected by irritable bowel syndrome. Ten children fulfilling the Rome II criteria for irritable bowel syndrome and seven healthy controls were enrolled. We studied the thresholds and the perception of visceral stimuli in the rectum by means of an electronic barostat (isobaric phasic distentions, 3 mmHg/1 min, interval 1 min) and a validated questionnaire. Personality features were evaluated by means of the Big Five Questionnaire for Children. Sleep, mood disturbance, anxiety and individual performance (missed school days, school results and social activities) were also evaluated. Children with irritable bowel syndrome showed significantly lower thresholds for discomfort (14.8 +/- 3.5 vs 22.3 +/- 6.9 mmHg, P = 0.010) and a higher cumulative perception score (28.2 +/- 11.1 vs 12.3 +/- 8.0, P = 0.005) compared with healthy controls. A higher emotional instability (57.8 +/- 7.0 vs 48.7 +/- 10.1, P = 0.047), sleep disturbance (7.2 +/- 1.0 vs 9.3 +/- 0.5, P = 0.004) and anxiety (6.3 +/- 2.0 vs 2.3 +/- 1.7, P = 0.009) were observed in irritable bowel syndrome patients. Moreover, in a multivariate analysis, the cumulative perception score was significantly related to emotional instability (P = 0.042). In conclusion children with irritable bowel syndrome exhibit visceral hypersensitivity and psychosocial impairment. Emotional instability, as a personality feature in these children, seems to modulate the perception response to visceral stimulations.

  5. Effect of topically applied lipids on surfactant-irritated skin.

    PubMed

    Lodén, M; Andersson, A C

    1996-02-01

    Moisturizers are used daily by many people to alleviate symptoms of dry skin. All of them contain lipids. It has been suggested that topically applied lipids may interfere with the structure and function of the permeability barrier. The influence of a single application of nine different lipids on normal skin and skin irritated by sodium lauryl sulphate (SLS) was studied in 21 healthy subjects. Parameters assessed were visible signs of irritation, and objectively measured cutaneous blood flow and transepidermal water loss (TEWL). The substances tested were hydrocortisone, petrolatum, fish oil, borage oil, sunflower seed oil, canola oil, shea butter, and fractions of unsaponifiable lipids from canola oil and shea butter. Water was included as a control. On normal skin, no significant differences in the effects of the test substances were found, whereas significant differences were observed when they were applied to SLS-irritated skin. The visible signs of SLS-induced irritation were significantly less pronounced after treatment with the sterol-enriched fraction from canola oil than after treatment with water. This fraction, and hydrocortisone, reduced cutaneous blood flow. Furthermore, application of hydrocortisone, canola oil, and its sterol-enriched fraction, resulted in significantly lower TEWL than with water. The other lipids had no effect on the degree of irritation. In conclusion, lipids commonly used in moisturizers may reduce skin reactions to irritants. Previous studies have shown that, in barrier perturbed skin, the synthesis of sterols is increased. The observed effects of canola oil and its fraction of unsaponifiable lipids on SLS-induced irritation suggest the possibility that they assisted the skin in supplying the damaged barrier with adequate lipids.

  6. Trajectories of Oppositional Defiant Disorder Irritability Symptoms in Preschool Children.

    PubMed

    Ezpeleta, Lourdes; Granero, Roser; de la Osa, Núria; Trepat, Esther; Domènech, Josep M

    2016-01-01

    This study traces the developmental course of irritability symptoms in oppositional defiant disorder (ODD) from ages 3-5 and examines the psychopathological outcomes of the different trajectories at age 6. A sample of 622 3-year-old preschoolers (311 were boys), followed up until age 6, was assessed yearly with a semi-structured diagnostic interview with parents and at age 6 with questionnaires answered by parents, teachers and children. Growth-Mixture-Modeling yielded five trajectories of irritability levels for the whole sample (high-persistent 3.5%, decreasing 3.8%, increasing 2.6%, low-persistent 44.1% and null 46.0%). Among the children who presented with ODD during preschool age, three trajectories of irritability symptoms resulted (high-persistent 31.9%, decreasing 34.9% and increasing 33.2%). Null, low-persistent and decreasing irritability courses in the sample as a whole gave very similar discriminative capacity for children's psychopathological state at age 6, while the increasing and high-persistent categories involved poorer clinical outcomes than the null course. For ODD children, the high-persistent and increasing trajectories of irritability predicted disruptive behavior disorders, comorbidity, high level of functional impairment, internalizing and externalizing problems and low anger control at age 6. Irritability identifies a subset of ODD children at high risk of poorer longitudinal psychopathological and functional outcomes. It might be clinically relevant to identify this subset of ODD children with a high number of irritability symptoms throughout development with a view to preventing comorbid and future adverse longitudinal outcomes.

  7. Eye irritation of low-irritant cosmetic formulations: correlation of in vitro results with clinical data and product composition.

    PubMed

    Debbasch, Caroline; Ebenhahn, Catherine; Dami, Nadia; Pericoi, Marc; Van den Berghe, Christine; Cottin, Martine; Nohynek, Gerhard J

    2005-01-01

    Alternative methods to the Draize eye irritation test, such as the hen's egg test-chorioallantoic membrane (HET-CAM) or the bovine corneal opacity and permeability (BCOP) tests, are currently used to evaluate the irritant potential of cosmetic or consumer products. Although, for strong irritants, the results of these tests correlate well with those of the Draize test, they appear to be less suited to identify mild irritants. In order to improve the sensitivity of alternative eye irritation tests, we developed a novel method that uses a human corneal epithelial cell line (CEPI), and the endpoints of cytotoxicity and IL-8 release. Twelve make-up removers were assessed by the HET-CAM, BCOP and CEPI tests, as well as in a clinical in-use test under ophthalmological control after their application to the external eye lid. In addition, we investigated the impact of osmolality and raw material composition on in vitro and clinical results and compared the in vitro results with those of clinical studies. Overall, although HET-CAM results were unrelated to eye discomfort and adverse clinical signs, they correlated mainly with the presence and concentration of surfactants in the test articles. BCOP scores were unrelated to clinical signs, but related mainly to glycol and sodium lactate content and concentration in the test articles. Cytotoxicity in CEPI mainly correlated with presence and concentrations of surfactants, and IL-8 release to clinical signs and/or glycol and sodium lactate concentrations. Overall, IL-8 release appeared to be the most sensitive and reliable endpoint to predict human eye tolerance to mildly irritant products. Although our results suggest that the IL-8 assay appears to be a promising screen for borderline-irritant formulations, further experiments are required to confirm and validate these preliminary results.

  8. The impact of intolerance of uncertainty, worry and irritability on quality of life in persons with epilepsy: irritability as mediator.

    PubMed

    Barahmand, Usha; Haji, Afsar

    2014-10-01

    Epilepsy is a neurological disorder afflicting many people in the world. The impact of epilepsy on the quality of life of those afflicted with epilepsy is greater than the limitations imposed by the seizures alone. Among the several psychological disorders found to be comorbid with epilepsy are anxiety and depression, both of which impair quality of life in epilepsy. Some studies have reported that the anxiety seen in epilepsy is characterized by worry while the depression seen is characterized by irritability. A concept common to both anxiety and depression is intolerance of uncertainty. Therefore, the study explores the relationship between intolerance of uncertainty, worry and irritability and their association to quality of life in epilepsy. A descriptive-correlational research method was used and the research sample comprised 60 consecutive referrals seeking outpatient neurological services for epilepsy at Alavi Hospital in Ardebil. Data were collected by administering the Penn State Worry Questionnaire, Intolerance of Uncertainty Scale, Irritability Questionnaire and Quality of Life in Epilepsy Inventory. Data were analyzed using Pearson's correlation coefficients and multivariate regression analysis. Mediation and moderation analyses were conducted. Findings indicated that intolerance of uncertainty, worry and irritability have unique significant effects on quality of life. The implications are that interventions aimed at improving the quality of life of patients with epilepsy should address their feelings of uncertainty, worry and irritability. Furthermore, irritability seems to mediate the impact of both intolerance of uncertainty and worry on quality of life of individuals with epilepsy. No significant moderation effects were noted. Results underscore the important role of irritability in the quality of life of persons with epilepsy. The findings are discussed with reference to the possibility of particular predisposing temperaments and add credence to

  9. The Influence of Humidity on Assessing Irritation Threshold of Ammonia.

    PubMed

    Monsé, Christian; Sucker, Kirsten; Hoffmeyer, Frank; Jettkant, Birger; Berresheim, Hans; Bünger, Jürgen; Brüning, Thomas

    2016-01-01

    A large number of occupational exposure limit values (OELs) are based on avoiding of sensory irritation of the eyes and the upper respiratory tract. In order to investigate the chemosensory effect range of a chemical, odor and sensory irritation thresholds (lateralization thresholds, LTs) can be assessed. Humidity affects olfactory function and thus influences odor thresholds; however, a similar effect has not been shown for sensory irritation thresholds. The purpose of the present study was to explore whether LTs for ammonia vapor vary depending on the water vapor content of the inspired stimulus. Eight healthy nonsmoking volunteers were simultaneously exposed to ammonia vapor through one nostril and clean air through the other and were asked to determine which nostril received the chemical. Within experimental runs, ascending ammonia concentrations (60-350 ppm) that were either dry or humidified were administered at fixed time intervals. Geometric mean LTs obtained at wet (181 ppm) or dry (172 ppm) conditions did not differ significantly (P = 0.19) and were within the range of those reported by previous studies. These results suggest that humidity is not a critical factor in determining sensory irritation thresholds for ammonia, and future studies will examine if these findings are transferable to sensory irritation thresholds for other chemicals.

  10. Molecular restrictions for human eye irritation by chemical vapors

    SciTech Connect

    Cometto-Muniz, J. Enrique . E-mail: ecometto@ucsd.edu; Cain, William S.; Abraham, Michael H.

    2005-09-15

    Previous research showed a cut-off along homologous volatile organic compounds (VOCs) in their ability to produce acute human mucosal irritation. The present study sought to specify the particular cut-off homolog for sensory eye irritation in an acetate and n-alcohol series. A 1900-ml glass vessel system and a three-alternative forced-choice procedure served to test nonyl, decyl, and dodecyl acetate, and 1-nonanol, 1-decanol, and 1-undecanol. Flowrate to the eye ranged from 2 to 8 L/min and time of exposure from 3 to 24 s. Decyl acetate and 1-undecanol were the shortest homologs that failed to produce eye irritation under all conditions, producing a cut-off effect. Increasing the vapor concentration of decyl acetate and 1-undecanol by 3 and 8 times, respectively, via heating them to 37 deg C made either or both VOCs detectable to only half of the 12 subjects tested, even though the higher vapor concentration was well above a predicted eye irritation threshold. When eye irritation thresholds for homologous acetates and n-alcohols were plotted as a function of the longest unfolded length of the molecule, the values for decyl acetate and 1-undecanol fell within a restricted range of 18 to 19 A. The outcome suggests that the basis for the cut-off is biological, that is, the molecule lacks a key size or structure to trigger transduction, rather than physical, that is, the vapor concentration is too low to precipitate detection.

  11. The Influence of Humidity on Assessing Irritation Threshold of Ammonia

    PubMed Central

    Sucker, Kirsten; Jettkant, Birger; Berresheim, Hans; Brüning, Thomas

    2016-01-01

    A large number of occupational exposure limit values (OELs) are based on avoiding of sensory irritation of the eyes and the upper respiratory tract. In order to investigate the chemosensory effect range of a chemical, odor and sensory irritation thresholds (lateralization thresholds, LTs) can be assessed. Humidity affects olfactory function and thus influences odor thresholds; however, a similar effect has not been shown for sensory irritation thresholds. The purpose of the present study was to explore whether LTs for ammonia vapor vary depending on the water vapor content of the inspired stimulus. Eight healthy nonsmoking volunteers were simultaneously exposed to ammonia vapor through one nostril and clean air through the other and were asked to determine which nostril received the chemical. Within experimental runs, ascending ammonia concentrations (60–350 ppm) that were either dry or humidified were administered at fixed time intervals. Geometric mean LTs obtained at wet (181 ppm) or dry (172 ppm) conditions did not differ significantly (P = 0.19) and were within the range of those reported by previous studies. These results suggest that humidity is not a critical factor in determining sensory irritation thresholds for ammonia, and future studies will examine if these findings are transferable to sensory irritation thresholds for other chemicals. PMID:27379250

  12. Temperature dependent primary irritant dermatitis from lemon perfume.

    PubMed

    Rothenborg, H W; Menné, T; Sjolin, K E

    1977-02-01

    In a recent outbreak of hand eczema amongst cleaning personnel after the introduction of a new, lemon-scented detergent, it was noted that the patients complained of a burning, stinging sensation when their hands were submerged in hot detergent solutions. Since routine patch testing with the Standard Series and perfume components was of no help in pinpointing the responsible agent, testing with selected perfume components was repeated at higher temperatures. Identical tests were placed on both forearms for 20 min, one arm being exposed to 43 degrees C, the other to 23-25 degrees C. Little or no reaction was seen on the "cold" arm, whereas the lemon perfume component Citral proved to be a strong primary irritant at higher temperatures. Histological examination of the test sites showed the reaction to be of a toxic (primary irritant) nature. Surprisingly, the toxic character could still be recongized in biopsies taken as late as 48 h after exposure. It is suggested that: 1. Heat plays an important part in the outbreak of primary irritant (toxic) dermatitis and can be used as an accelerating factor when testing for primary irritants. 2. It is important to be sure that detergents and detergent perfumes do not contain substances which act as irritants at the temperatures at which they are habitually used (45-50 degrees C). 3. We probably ought to use lukewarm rather than hot water for manual dishwashing and cleaning whenever it is possible.

  13. The Expression of BAFF, APRIL and TWEAK Is Altered in Eczema Skin but Not in the Circulation of Atopic and Seborrheic Eczema Patients

    PubMed Central

    Chen, Yunying; Lind Enoksson, Sara; Johansson, Catharina; Karlsson, Maria A.; Lundeberg, Lena; Nilsson, Gunnar

    2011-01-01

    The TNF family cytokines BAFF (B-cell activating factor of the TNF family) and APRIL (a proliferation-inducing ligand) are crucial survival factors for B-cell development and activation. B-cell directed treatments have been shown to improve atopic eczema (AE), suggesting the involvement of these cytokines in the pathogenesis of AE. We therefore analyzed the expression of these TNF cytokines in AE, seborrheic eczema (SE) and healthy controls (HC). The serum/plasma concentration of BAFF, APRIL and a close TNF member TWEAK (TNF-like weak inducer of apoptosis) was measured by ELISA. The expression of these cytokines and their receptors in skin was analyzed by quantitative RT-PCR and immunofluorescence. Unlike other inflammatory diseases including autoimmune diseases and asthma, the circulating levels of BAFF, APRIL and TWEAK were not elevated in AE or SE patients compared with HCs and did not correlate with the disease severity or systemic IgE levels in AE patients. Interestingly, we found that the expression of these cytokines and their receptors was altered in positive atopy patch test reactions in AE patients (APT-AE) and in lesional skin of AE and SE patients. The expression of APRIL was decreased and the expression of BAFF was increased in eczema skin of AE and SE, which could contribute to a reduced negative regulatory input on B-cells. This was found to be more pronounced in APT-AE, the initiating acute stage of AE, which may result in dysregulation of over-activated B-cells. Furthermore, the expression levels of TWEAK and its receptor positively correlated to each other in SE lesions, but inversely correlated in AE lesions. These results shed light on potential pathogenic roles of these TNF factors in AE and SE, and pinpoint a potential of tailored treatments towards these factors in AE and SE. PMID:21765951

  14. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. Methods to assess visceral hypersensitivity in irritable bowel syndrome.

    PubMed

    Keszthelyi, D; Troost, F J; Masclee, A A

    2012-07-15

    Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, characterized by recurrent abdominal pain or discomfort in combination with disturbed bowel habits in the absence of identifiable organic cause. Visceral hypersensitivity has emerged as a key hypothesis in explaining the painful symptoms in IBS and has been proposed as a "biological hallmark" for the condition. Current techniques of assessing visceral perception include the computerized barostat using rectal distensions, registering responses induced by sensory stimuli including the flexor reflex and cerebral evoked potentials, as well as brain imaging modalities such as functional magnetic resonance imaging and positron emission tomography. These methods have provided further insight into alterations in pain processing in IBS, although the most optimal method and condition remain to be established. In an attempt to give an overview of these methods, a literature search in the electronic databases PubMed and MEDLINE was executed using the search terms "assessment of visceral pain/visceral nociception/visceral hypersensitivity" and "irritable bowel syndrome." Both original articles and review articles were considered for data extraction. This review aims to discuss currently used modalities in assessing visceral perception, along with advantages and limitations, and aims also to define future directions for methodological aspects in visceral pain research. Although novel paradigms such as brain imaging and neurophysiological recordings have been introduced in the study of visceral pain, confirmative studies are warranted to establish their robustness and clinical relevance. Therefore, subjective verbal reporting following rectal distension currently remains the best-validated technique in assessing visceral perception in IBS.

  15. Irritability in children and adolescents: past concepts, current debates, and future opportunities

    PubMed Central

    Krieger, Fernanda Valle; Leibenluft, Ellen; Stringaris, Argyris; Polanczyk, Guilherme V.

    2015-01-01

    Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts. PMID:24142126

  16. Alternative methods for the replacement of eye irritation testing.

    PubMed

    Lotz, Christian; Schmid, Freia F; Rossi, Angela; Kurdyn, Szymon; Kampik, Daniel; De Wever, Bart; Walles, Heike; Groeber, Florian K

    2016-01-01

    In the last decades significant regulatory attempts were made to replace, refine and reduce animal testing to assess the risk of consumer products for the human eye. As the original in vivo Draize eye test has been criticized for limited predictivity, costs and ethical issues, several animal-free test methods have been developed to categorize substances according to the global harmonized system (GHS) for eye irritation.This review summarizes the progress of alternative test methods for the assessment of eye irritation. Based on the corneal anatomy and the current knowledge of the mechanisms causing eye irritation, different ex vivo and in vitro methods will be presented and discussed in regard of possible limitations and their status of regulatory acceptance. In addition to established in vitro models, this review will also highlight emerging, full thickness cornea models that might be applicable to predict all GHS categories.

  17. Diagnosis of Irritable Bowel Syndrome: Role of Potential Biomarkers

    PubMed Central

    Plavšić, Ivana; Hauser, Goran; Tkalčić, Mladenka; Pletikosić, Sanda; Salkić, Nermin

    2015-01-01

    Irritable bowel syndrome is a disorder diagnosed on symptom-based criteria without inclusion of any objective parameter measurable by known diagnostic methods. Heterogeneity of the disorder and overlapping with more serious organic diseases increase uncertainty for the physician's work and increase the cost of confirming the diagnosis. This paper is an attempt to summarize the efforts to find adequate biomarkers for irritable bowel syndrome, which should shorten the time to diagnosis and reduce the cost. Most of the reviewed papers were observational studies from secondary care institutions. Since publication of the Rome III criteria in 2006, most recent studies use these for the recruitment of IBS patients. This is a positive step forward as future studies should use the same criteria, facilitating comparison of their results. Among the studied biomarkers, most evidence is provided for fecal calprotectin. Cutoff values for fecal calprotectin have still to be investigated prior to inclusion in the irritable bowel syndrome diagnostic algorithm. PMID:26170833

  18. Associations of excessive irritability with common illnesses and food intolerance.

    PubMed

    Price, C E; Rona, R J; Chinn, S

    1990-04-01

    In a national study of almost 7000 primary school children, parents' perceptions were used to test the hypothesis that the child's irritability was associated with food intolerance independently of other symptoms. After adjustment in a multiple regression analysis for asthma or wheeze, cough, eczema, hives, diarrhoea and vomiting, rhinitis, hay fever and headache, and the social factors of father's social class, maternal education and maternal age, a highly significant association between perception of food intolerance and irritability (P less than 0.001) remained. Though we cannot rule out that irritable children's parents could be biased towards diagnosing food intolerance the possibility that some children do have behavioural disturbance associated with reactions to food needs to be explored further, preferably with a double blind challenge assessment.

  19. The transport of colonic contents in the irritable colon syndrome.

    PubMed

    Ritchie, J A

    1970-08-01

    The mean distance of travel and hourly incidence of propulsive and retropulsive movements of colonic contents have been assessed by means of time-lapse cinefluorography and compared in 98 patients with the irritable colon syndrome and in 90 control subjects.Net propulsion in patients with the irritable colon syndrome was less than in the controls at rest, similar to the controls after feeding, and greater than in the controls after an injection of carbachol. In both clinical groups, food and carbachol increased the incidence of propulsive and retropulsive movements but did not alter the average distance over which they travelled.The figures suggest that at least two-thirds of all net propulsion of colonic contents in the irritable colon syndrome takes place under circumstances not reproduced in the present study.

  20. Eye and respiratory irritants in jet engine exhaust.

    PubMed

    Miyamoto, Y

    1986-11-01

    It has been noted that eye and respiratory irritation frequently occurred in the ground crews and pilots working on the field behind an aircraft with a low smoke combustor (LSC) engine. This study was attempted to analyze the exhaust sampled at about 50 m behind the LSC J79 engines at idle power setting by means of a high performance liquid chromatography (HPLC) technique. Nine kinds of lower aliphatic carbonyl compound (seven aldehydes and two ketones) were identified. The concentration of formaldehyde was the highest among them, showing the value above the threshold reported by previous investigators. Concentration of NOx was simultaneously measured by a gas detector tube in the same sample. The exhaust of a conventional J79 engine, which has rarely caused irritation, was also analyzed by the same technique and the results were compared. It was concluded that formaldehyde plays a major role in causing irritation.

  1. Sensory irritation and pulmonary irritation of cumene and n-propanol: mechanisms of receptor activation and desensitization.

    PubMed

    Kristiansen, U; Hansen, L; Nielsen, G D; Holst, E

    1986-07-01

    Cumene and n-propanol, model substances for alcohols and alkylbenzenes, were investigated for sensory irritation in mice. The concentrations within the first 2 min. depressing the respiratory rate by 50% due to the effect in the upper respiratory tract were 2,058 p.p.m. and 22,080 p.p.m., respectively. Activation of the sensory irritant receptor followed the dynamics of reversible bimolecular reactions. The extrapolated maximum response and the apparent dissociation constant were 114.3% and 2,723 p.p.m. for cumene and 68.4% and 8,178 p.p.m. for propanol, respectively. Later on desensitization was observed. The effect was weak for cumene but conspicuous for propanol. For cumene desensitization had the origin in the rise of a threshold. No change in the dissociation constant or the maximum response was found. For propanol a decrease in the maximum response, which may be explained by an allosteric effect, was observed. The pulmonary irritation response was weak for cumene but was for propanol more important than sensory irritation at high concentrations. The following hypotheses are put forward: the effect of pulmonary irritation on the tidal volume is mediated via the stretch receptors while the effect on the respiratory frequency is mediated via the J-receptors.

  2. In vitro and human testing strategies for skin irritation.

    PubMed

    Robinson, M K; Osborne, R; Perkins, M A

    2000-01-01

    Prior to the manufacture, transport, and marketing of chemicals or products, it is critical to assess their potential for skin toxicity (corrosion or irritation), thereby protecting the worker and consumer from adverse skin effects due to intended or accidental skin exposure. Traditionally, animal testing procedures have provided the data needed to assess the more severe forms of skin toxicity, and current regulations may require animal test data before permission can be obtained to manufacture, transport, or market chemicals or the products that contain them. In recent years, the use of animals to assess skin safety has been opposed by some as inhumane and unnecessary. The conflicting needs of the industrial toxicologist to (1) protect human safety, (2) comply with regulations, and (3) reduce animal testing have led to major efforts to develop alternative, yet predictive, test methods. A variety of in vitro skin corrosion test methods have been developed and several have successfully passed initial international validation. These have included skin or epidermal equivalent assays that have been shown to distinguish corrosive from noncorrosive chemicals. These skin/epidermal equivalent assays have also been modified and used to assess skin irritation potential relative to existing human exposure test data. The data show a good correlation between in vitro assay data and different types of human skin irritation data for both chemicals and consumer products. The effort to eliminate animal tests has also led to the development of a novel human patch test for assessment of acute skin irritation potential. A case study shows the benefits of in vitro and human skin irritation tests compared to the animal tests they seek to replace, and strategies now exist to adequately assess human skin irritation potential without the need to rely on animal test methods.

  3. An alternative test battery in detecting ocular irritancy of agrochemicals.

    PubMed

    Tavaszi, J; Budai, P; Pálovics, A; Kismányoki, A

    2008-01-01

    Using animals in toxicological screening is a controversial issue. To get knowledge about eye irritation, recently only the in vivo Draize-test is accepted, which is one of the most criticized methods because of the injuries inflicted on the test animals. In recent years various in vitro methods have been developed to replace the primary irritation test. Most of these tests are in process of validation. The Draize rabbit eye test, or some modification of this test is essentially the only method for determining ocular irritation that is accepted by authorities. Several in vitro methods have been used to investigate the toxicity of potential eye irritants with the aim of replacing in vitro eye irritation testing. This study reports the results of an alternative approach for predicting irritation potential of agrochemicals. The approach was a two-stage test battery in vitro. The first stage was a cytotoxicity test, the MTT assay. The second stage was the HET-CAM test. The chick chorioallantoic membrane (CAM), being a connective tissue sheet with a visible blood supply, has been proposed as a substrate to identify the eye irritation potential of chemicals. During the HET-CAM test the chemicals are placed directly onto the chorioallantoic membrane. The changes of the vascular injury (haemorrhage, lysis or coagulation) are indications of the potential of the chemical to damage mucous membranes in vivo. MTT assay is a simple method to determine the viability of cells in the presence of a chemical. Cells are cultured with several concentrations of a substance or product, then the ratio of cell destruction is determined. LCC50 (concentration lethal for the 50 % of the cells) is assessed. This is in correlation of the eye irrigative potential of the chemical. In our studies comparative screening was performed with 6 agrochemicals to establish parallel data on alternative test battery (HET-CAM, MTT) and in vivo (Draize) results. In most cases, this study showed a good

  4. Maternal blood pressure in pregnancy and newborn irritability.

    PubMed

    Chisholm, J S; Woodson, R H; da Costa Woodson, E M

    1978-07-01

    The neonatal period is being recognized as an important period for the development of patterns of interaction between mother and infant, and infant state has been shown to have a significant impact on mother--infant interactions. A major dimension of infant state, with implications for this interaction and for the development of later behaviour disorders, is the infant's irritability. Research with Navajo, Malay, Chinese and Tamil mothers and infants showed that normal variation in maternal blood pressure during pregnancy was related to newborn irritability as assessed with the Brazelton Scale. This relationship is discussed in terms of possible underlying mechanisms.

  5. Current medical treatments of dyspepsia and irritable bowel syndrome.

    PubMed

    Camilleri, Michael; Tack, Jan F

    2010-09-01

    Dyspepsia is a highly prevalent condition characterized by symptoms originating in the gastroduodenal region without underlying organic disorder. Treatment modalities include acid-suppressive drugs, gastroprokinetic drugs, Helicobacter pylori eradication therapy, tricyclic antidepressants, and psychological therapies. Irritable bowel syndrome is a multifactorial, lower functional gastrointestinal disorder involving disturbances of the brain-gut axis. The pathophysiology provides the basis for pharmacotherapy: abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, intraluminal changes, and mucosal immune activation. Medications targeting chronic constipation or diarrhea may also relieve irritable bowel syndrome. Novel approaches to treatment require approval, and promising agents are guanylate cyclase cagonists, atypical benzodiazepines, antibiotics, immune modulators, and probiotics.

  6. Prospective, case-based assessment of sequential therapy with topical Fluorouracil cream 0.5% and ALA-PDT for the treatment of actinic keratosis.

    PubMed

    Martin, George

    2011-04-01

    The sequential use of topical therapies and short-incubation photodynamic therapy for actinic keratosis (AK) has not been extensively studied. The author reports on treatment with sequential 5-fluorouracil (5-FU) cream 0.5% and 5-aminolevulinic acid?photodynamic therapy (ALA-PDT) in three older men with photodamaged skin and a history of AK. These findings suggest that this combination therapy, when compared with short-contact (1 hour) ALA-PDT alone, is more effective, minimizes the recurrence of areas of field cancerization and improves the appearance of the skin. The use of 5-FU cream 0.5% before and after photodynamic therapy is effective in revealing the presence of both clinical and subclinical AK lesions.

  7. An Exploration of Maitland's Concept of Pain Irritability in Patients with Low Back Pain

    PubMed Central

    Barakatt, Edward T.; Romano, Patrick S.; Riddle, Daniel L.; Beckett, Laurel A.; Kravitz, Richard

    2009-01-01

    Maitland's construct of musculoskeletal pain irritability is widely used by physical therapists for making decisions about the vigor of examination and treatment, but this construct has not been defined to the extent that its measurement properties can be tested. The purposes of this study were to 1) determine if physical therapists utilize low back pain (LBP) irritability judgments to make treatment decisions, 2) identify LBP characteristics appropriate for an LBP irritability construct, and 3) develop a measurement construct of LBP irritability. Physical therapists evaluated and treated 183 subjects with LBP. The therapists judged the subjects' LBP as irritable or non-irritable, and recorded treatments provided at the initial visit. A principal-components analysis (PCA) was performed on 14 patient-reported LBP characteristics to identify potential components of a measurement construct of LBP irritability. The therapists' irritability judgments were found to be associated with the types of treatments prescribed. Five dimensions of LBP irritability were identified by the PCA from the 14 LBP characteristics considered. Four of these dimensions were associated with the therapists' LBP irritability judgments. The Roland-Morris Disability Questionnaire, presence of distal symptoms, and forward bending tolerance were found to have a stronger association with the irritability judgments than the dimensions of irritability identified in this study. Validated measures of LBP characteristics in current clinical use may adequately capture Maitland's concept of irritability. PMID:20140150

  8. Cost-Effectiveness and Cost-Utility Analysis of Ingenol Mebutate Versus Diclofenac 3% and Imiquimod 5% in the Treatment of Actinic Keratosis in Spain.

    PubMed

    Elías, I; Ortega-Joaquín, N; de la Cueva, P; Del Pozo, L J; Moreno-Ramírez, D; Boada, A; Aguilar, M; Mirada, A; Mosquera, E; Gibbons, C; Oyagüez, I

    2016-01-01

    To perform a cost-effectiveness and cost-utility analysis of ingenol mebutate in the treatment of actinic keratosis in Spain. We used an adapted Markov model to simulate outcomes in a cohort of patients (mean age, 73 years) with actinic keratosis over a 5-year period. The comparators were diclofenac 3% and imiquimod 5%. The analysis was performed from the perspective of the Spanish National Health System based on direct costs (2015 retail price plus value added tax less the mandatory discount). A panel of experts estimated resources, taking unit costs from national databases. An annual discount rate of 3% was applied. Deterministic and probabilistic sensitivity analyses were performed. The effectiveness of ingenol mebutate-with 0.192 and 0.129 more clearances gained in treatments for face and scalp lesions and trunk and extremity lesions, respectively-was superior to diclofenac's. The total costs of treatment with ingenol mebutate were lower at € 551.50 (face and scalp) and € 622.27 (trunk and extremities) than the respective costs with diclofenac (€ 849.11 and € 844.93). The incremental cost-effectiveness and cost-utility ratios showed that ingenol mebutate was a dominant strategy vs diclofenac. Ingenol mebutate also proved to be more effective than imiquimod, based on 0.535 and 0.503 additional clearances, and total costs of € 551.50 and € 527.89 for the two drugs, respectively. The resulting incremental cost-effectiveness ratio was € 728.64 per clearance gained with ingenol mebutate vs imiquimod. Ingenol mebutate was a dominant treatment option vs diclofenac and was efficient vs imiquimod (i.e., more effective at a higher cost, achieving an incremental cost-utility ratio of<€30000/quality-adjusted life-years). Copyright © 2016 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

  9. Sensory irritation as a basis for setting occupational exposure limits.

    PubMed

    Brüning, Thomas; Bartsch, Rüdiger; Bolt, Hermann Maximillian; Desel, Herbert; Drexler, Hans; Gundert-Remy, Ursula; Hartwig, Andrea; Jäckh, Rudolf; Leibold, Edgar; Pallapies, Dirk; Rettenmeier, Albert W; Schlüter, Gerhard; Stropp, Gisela; Sucker, Kirsten; Triebig, Gerhard; Westphal, Götz; van Thriel, Christoph

    2014-10-01

    There is a need of guidance on how local irritancy data should be incorporated into risk assessment procedures, particularly with respect to the derivation of occupational exposure limits (OELs). Therefore, a board of experts from German committees in charge of the derivation of OELs discussed the major challenges of this particular end point for regulatory toxicology. As a result, this overview deals with the question of integrating results of local toxicity at the eyes and the upper respiratory tract (URT). Part 1 describes the morphology and physiology of the relevant target sites, i.e., the outer eye, nasal cavity, and larynx/pharynx in humans. Special emphasis is placed on sensory innervation, species differences between humans and rodents, and possible effects of obnoxious odor in humans. Based on this physiological basis, Part 2 describes a conceptual model for the causation of adverse health effects at these targets that is composed of two pathways. The first, "sensory irritation" pathway is initiated by the interaction of local irritants with receptors of the nervous system (e.g., trigeminal nerve endings) and a downstream cascade of reflexes and defense mechanisms (e.g., eyeblinks, coughing). While the first stages of this pathway are thought to be completely reversible, high or prolonged exposure can lead to neurogenic inflammation and subsequently tissue damage. The second, "tissue irritation" pathway starts with the interaction of the local irritant with the epithelial cell layers of the eyes and the URT. Adaptive changes are the first response on that pathway followed by inflammation and irreversible damages. Regardless of these initial steps, at high concentrations and prolonged exposures, the two pathways converge to the adverse effect of morphologically and biochemically ascertainable changes. Experimental exposure studies with human volunteers provide the empirical basis for effects along the sensory irritation pathway and thus, "sensory

  10. Fruit acids do not enhance sodium lauryl sulphate-induced cumulative irritant contact dermatitis in vivo.

    PubMed

    Schliemann-Willers, Sibylle; Fuchs, Silke; Kleesz, Peter; Grieshaber, Romano; Elsner, Peter

    2005-01-01

    Combined exposure to different irritants in the workplace may lead to irritant contact dermatitis, which is the main type of occupational dermatitis among bakers and confectioners. Following previous work on "tandem irritation", a panel of healthy volunteers was exposed twice daily for 4 days to the organic fruit acids: citric, malic, and lactic acid, either alone or in tandem application with 0.5% sodium lauryl sulphate (SLS) in a repetitive irritation test. Irritant cutaneous reactions were quantified by visual scoring and non-invasive measurement of transepidermal water loss and skin colour reflectance. Twice daily application of either citric or malic acid alone did not induce a significant irritant reaction. Combined exposure to one of the fruit acids and SLS caused marked barrier disturbance, but the latter irritant effect was smaller than that obtained by combined exposure to SLS and water. Thus, combined exposure to the above-mentioned fruit acids and SLS did not enhance cumulative skin irritation.

  11. Urinary proteome analysis of irritable bowel syndrome (IBS) symptom subgroups

    USDA-ARS?s Scientific Manuscript database

    Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder characterized by chronic abdominal pain associated with alterations in bowel function. Given the heterogeneity of the symptoms, multiple pathophysiologic factors are suspected to play a role. We classified women with IBS i...

  12. Conditioned pain modulation in women with irritable bowel syndrome

    USDA-ARS?s Scientific Manuscript database

    Evidence suggests that patients with irritable bowel syndrome (IBS) are more vigilant to pain-associated stimuli. The aims of this study were to compare women with IBS (n = 20) to healthy control (HC, n = 20) women on pain sensitivity, conditioned pain modulation (CPM) efficiency, and salivary corti...

  13. Postanaesthetic tear production and ocular irritation in cats.

    PubMed

    Peche, N; Köstlin, R; Reese, S; Pieper, K

    2015-01-01

    General anaesthesia significantly reduces tear production and normal values are not immediately re-established on ending anaesthesia. Therefore, adequate protection of the cornea has to be assured during the perianaesthetic period. There are various methods available, including taping of the eyelids and the application of eye ointments, gels and drops. In human medicine studies, different formulations were found to induce signs of ocular irritation. The aim of the present study was to determine tear production in cats after general anaesthesia, and to identify possible causes of irritation. Tear production was determined in 41 cats after general anaesthesia and eyes were examined for signs of irritation. Two different anaesthetic protocols were used. To protect the cornea, an ointment and gel were applied to the right and left eyes, respectively. Postoperatively, tear production was significantly reduced for 6 hours and 18 hours in the right and left eyes, respectively. Two hours after anaesthesia, blepharospasm of the right eye was observed in 92.7% (n = 38) of the cats. In contrast, the left eye was always held open. This study demonstrated that tear production in cats is significantly decreased both during and after anaesthesia. The degree of reduction was independent of the anaesthetic protocol. Both the eye ointment and gel proved effective in protecting the corneal surface. However, eye gel use is recommended because the eye ointment consistently caused an irritation comparable to the foreign-body sensation reported in humans.

  14. Gastrointestinal microbiome signatures of pediatric patients with irritable bowel syndrome

    USDA-ARS?s Scientific Manuscript database

    The intestinal microbiomes of healthy children and pediatric patients with irritable bowel syndrome (IBS) are not well defined. Studies in adults have indicated that the gastrointestinal microbiota could be involved in IBS. We analyzed 71 samples from 22 children with IBS (pediatric Rome III criteri...

  15. Crystal deodorant dermatitis: irritant dermatitis to alum-containing deodorant.

    PubMed

    Gallego, H; Lewis, E J; Crutchfield, C E

    1999-07-01

    Two patients developed an irritant dermatitis of the axillae shortly after using an over-the-counter "natural deodorant crystal" product containing alum. We discuss this previously unreported, untoward reaction to alum, an ancient agent with newfound popularity as an alternative health product.

  16. Underlying molecular and cellular mechanisms in childhood irritable bowel syndrome

    USDA-ARS?s Scientific Manuscript database

    Irritable bowel syndrome (IBS) affects a large number of children throughout the world. The symptom expression of IBS is heterogeneous, and several factors which may be interrelated within the IBS biopsychosocial model play a role. These factors include visceral hyperalgesia, intestinal permeability...

  17. Relation between hysterectomy and the irritable bowel: a prospective study.

    PubMed Central

    Prior, A; Stanley, K M; Smith, A R; Read, N W

    1992-01-01

    Some women with irritable bowel syndrome date the onset of symptoms to previous hysterectomy. To assess prospectively the incidence of gastrointestinal symptomatology arising de novo after hysterectomy, and to study the effect of surgery on pre-existing symptoms, 205 women completed a symptom questionnaire before and six weeks and six months after surgery. Beforehand, symptoms suggestive of irritable bowel syndrome occurred in 22% of patients. At six months after operation, 60% of these had improved or were symptom free while 20% had increased symptomatology. New gastrointestinal symptoms were present more than once per week in 10% of previously asymptomatic women. Constipation predominant irritable bowel syndrome was the commonest symptom complex seen de novo, occurring more than once per week in 5% of the group. No relation was found between new symptomatology and the type of hysterectomy, oophorectomy, or the administration of perioperative antibiotics. This study suggests that many women with pre-existing gastrointestinal symptomatology improve after hysterectomy. However, symptoms suggestive of irritable bowel syndrome do arise de novo in 10%. As hysterectomy is common, gastroenterologists can expect to see women presenting with post-hysterectomy problems. PMID:1624165

  18. Acute inhalation toxicity and sensory irritation of dimethylamine. [Rats, mice

    SciTech Connect

    Steinhagen, W.H.; Swenberg, J.A.; Barrow, C.S.

    1982-06-01

    The sensory irritation potential of dimethylamine (DMA) inhalation on male Fischer-344 rats and male Swiss-Webster mice was evaluated by measuring the reflex decrease in respiratory rate. In addition, the six hour LC/sub 50/ for rats exposed to dimetylamine was established. Groups of 3 or 4 rats and mice were exposed for 10 minutes to concentrations of DMA ranging from 49 to 1576 ppm during which time the respiratory rate was monitored and recorded. Sensory irritation concentration-response curves were obtained and RD/sub 50/ values (concentration which elicits a 50% decrease in respiratory rate) were determined to be 573 and 511 ppm for rats and mice, respectively. In another set of experiments seven groups of male rats were exposed to concentrations of DMA ranging from 600 to 6119 ppm for six hours. Mortality counts were made during and for 48 hours post exposure. The six hour LC/sub 50/ was determined to be 4540 ppm. Histopathologic examination of the respiratory tract revealed concentration related changes ranging from ulceration and necrosis to rhinitis, tracheitis, and emphysema. Overall, DMA was found to be less potent as a sensory irritant than other airborne irritants.

  19. Irritable Bowel Syndrome - Multiple Languages: MedlinePlus

    MedlinePlus

    ... of All Topics All Irritable Bowel Syndrome - Multiple Languages To use the sharing features on this page, please enable JavaScript. French (français) Russian (Русский) Somali (af Soomaali) Spanish (español) Ukrainian (Українська) ...

  20. Subtypes of irritable bowel syndrome in children and adolescents

    USDA-ARS?s Scientific Manuscript database

    Pharmacologic treatments for irritable bowel syndrome (IBS) and medical management of symptoms are increasingly based on IBS subtype, so it is important to accurately differentiate patients. Few studies have classified subtypes of pediatric IBS, and conclusions have been challenged by methodologic l...

  1. Anti-irritative effect of methylrosaniline chloride (Gentian violet).

    PubMed

    Gloor, M; Wolnicki, D

    2001-01-01

    There are no published studies of the effect of methylrosaniline chloride (MRC) on inflammation when used at the concentration recommended in the New German Formulary. A tissue-damaging effect has been described in animal studies and at higher concentrations in humans. To determine whether 0.5% MRC increases or reduces skin damage in irritative dermatitis. The study was carried out on the sodium lauryl sulfate (SLS) skin irritation model in 18 healthy volunteers. The impact of intermittent treatment with 0.5% MRC or drug-free vehicle on three SLS exposure effects was determined: reduction of stratum corneum water content (corneometry), increase in subpapillary blood flow (laser Doppler method) and barrier damage (transepidermal water loss). MRC produced significant reductions in all three SLS exposure effects. Treatment of irritative dermatitis with 0.5% MRC is expected to produce a high clinical efficacy not only because of the compound's established antimicrobial activity, but also because of its anti-irritative effect. Copyright 2001 S. Karger AG, Basel

  2. Effect of different moisturizers on SLS-irritated human skin.

    PubMed

    Held, E; Lund, H; Agner, T

    2001-04-01

    Moisturizers are widely used to treat irritant contact dermatitis (ICD). Their use is, however, not well-documented and standardized models for testing skin care products are needed to acquire documentation of their efficacy. The present study was undertaken to evaluate the effect of 6 commonly-used moisturizers on the recovery of irritated human skin. No commercial interests were involved in the study. 36 healthy volunteers had patch tests with SLS 0.5% applied on their forearms/upper arms for 24 h. After irritation of the skin, all volunteers had a moisturizer applied on one forearm/upper arm, respectively, 3 x daily for the following 5 days. The other forearm/upper arm served as an untreated control. Each moisturizer was tested on 12 volunteers and each volunteer tested 2 moisturizers at the same time. Evaluation was done on days 1, 3 and 8 by transepidermal water loss, electrical capacitance, laser Doppler flowmetry, DermaSpectrometry and clinical scoring. All 6 moisturizers were found to accelerate regeneration of the skin barrier function when compared to irritated non-treated skin. The most lipid-rich moisturizers improved barrier restoration more rapidly than the less lipid-rich moisturizers. We suggest this experimental model for further moisturizer efficacy testing.

  3. Perceived Informativeness of and Irritation with Local Advertising.

    ERIC Educational Resources Information Center

    Pasadeos, Yorgo

    1990-01-01

    Surveys mall shoppers to determine the relative informativeness of retail advertising. Finds that newspaper advertisements are considered the most informative with radio commercials next and television commercials least. Finds that newspaper ads are more irritating than radio or television advertising. Finds older and wealthier shoppers more…

  4. Acupuncture for treatment of irritable bowel syndrome

    PubMed Central

    Manheimer, Eric; Cheng, Ke; Wieland, L. Susan; Min, Li Shih; Shen, Xueyong; Berman, Brian M; Lao, Lixing

    2013-01-01

    Background Irritable bowel syndrome (IBS) is a common, costly, and difficult to treat disorder that impairs health-related quality of life and work productivity. Evidence-based treatment guidelines have been unable to provide guidance on the effects of acupuncture for IBS because the only previous systematic review included only small, heterogeneous and methodologically unsound trials. Objectives The primary objectives were to assess the efficacy and safety of acupuncture for treating IBS. Search methods MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Cumulative Index to Nursing and Allied Health, and the Chinese databases Sino-Med, CNKI, and VIP were searched through November 2011. Selection criteria Randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture, other active treatments, or no (specific) treatment, and RCTs that evaluated acupuncture as an adjuvant to another treatment, in adults with IBS were included. Data collection and analysis Two authors independently assessed the risk of bias and extracted data. We extracted data for the outcomes overall IBS symptom severity and health-related quality of life. For dichotomous data (e.g. the IBS Adequate Relief Question), we calculated a pooled relative risk (RR) and 95% confidence interval (CI) for substantial improvement in symptom severity after treatment. For continuous data (e.g. the IBS Severity Scoring System), we calculated the standardized mean difference (SMD) and 95% CI in post-treatment scores between groups. Main results Seventeen RCTs (1806 participants) were included. Five RCTs compared acupuncture versus sham acupuncture. The risk of bias in these studies was low.We found no evidence of an improvement with acupuncture relative to sham (placebo) acupuncture for symptom severity (SMD-0.11, 95%CI −0.35 to 0.13; 4 RCTs; 281 patients) or quality of life (SMD = −0.03, 95%CI −0.27 to 0.22; 3 RCTs; 253 patients). Sensitivity analyses based on study

  5. Homeopathy for treatment of irritable bowel syndrome.

    PubMed

    Peckham, Emily J; Nelson, E Andrea; Greenhalgh, Joanne; Cooper, Katy; Roberts, E Rachel; Agrawal, Anurag

    2013-11-13

    Irritable bowel syndrome (IBS) is a common, chronic disorder that leads to decreased health-related quality of life and work productivity. Evidence-based treatment guidelines have not been able to give guidance on the effects of homeopathic treatment for IBS because no systematic reviews have been carried out to assess the effectiveness of homeopathic treatment for IBS. Two types of homeopathic treatment were evaluated in this systematic review. In clinical homeopathy a specific remedy is prescribed for a specific condition. This differs from individualised homeopathic treatment, where a homeopathic remedy based on a person's individual symptoms is prescribed after a detailed consultation. To assess the effectiveness and safety of homeopathic treatment for treating IBS. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), Cochrane IBD/FBD Group Specialised Register, Cochrane Complementary Medicine Field Specialised Register and the database of the Homeopathic Library (Hom-inform) from inception to February 2013. Randomised controlled trials (RCTs), cohort and case-control studies that compared homeopathic treatment with placebo, other control treatments, or usual care, in adults with IBS were considered for inclusion. Two authors independently assessed the risk of bias and extracted data. The primary outcome was global improvement in IBS. The overall quality of the evidence supporting this outcome was assessed using the GRADE criteria. We calculated the mean difference (MD) and 95% confidence interval (CI) for continuous outcomes and the risk ratio (RR) and 95% CI for dichotomous outcomes. Three RCTs (213 participants) were included. No cohort or case-control studies were identified. Two studies published in 1976 and 1979 compared clinical homeopathy (homeopathic remedy) to placebo for constipation-predominant IBS

  6. Newborn Irritability Moderates the Association between Infant Attachment Security and Toddler Exploration and Sociability

    ERIC Educational Resources Information Center

    Stupica, Brandi; Sherman, Laura J.; Cassidy, Jude

    2011-01-01

    This longitudinal investigation of 84 infants examined whether the effect of 12-month attachment on 18- and 24-month exploration and sociability with unfamiliar adults varied as a function of newborn irritability. As expected, results revealed an interaction between attachment (secure vs. insecure) and irritability (highly irritable vs. moderately…

  7. Comparison of objective and sensory skin irritations of several cosmetic preservatives.

    PubMed

    Lee, Eunyoung; An, Susun; Choi, Dongwon; Moon, Seongjoon; Chang, Ihseop

    2007-03-01

    There are many cosmetic ingredients, such as preservatives and fragrances, known to elicit adverse effects. The aim of this study was to investigate the side-effects of cosmetic preservatives, by evaluating objective and subjective skin irritation. The method comprised of 2 parts. In part 1, we tried to compare 24-hr patch test results with the sensory irritation potential of several preservatives. In part 2, skin cumulative irritation test for 21 days and sensory irritation test were performed to compare various combinations of preservatives in 4 types of formulations. Our data showed that methylparaben, ethylparaben, propylparaben, butylparaben, phenoxyethanol (PE) and chlorphenesin (CPN) have similar objective skin irritation potential at the minimal inhibitory concentration of each preservative, but CPN has higher potential than other preservatives in subjective irritation. Sensory irritation of preservatives changed according to formulation type, and PE combined with CPN highly increased irritation. There was correlation between antimicrobial activity and skin objective irritation but not sensory irritation. Influence on skin sensory irritation varies with the combination of preservatives. Therefore, for the development of new preservatives and cosmetics, it is important to evaluate skin sensory irritation of preservatives used in cosmetic products according to the type of formulations.

  8. Newborn Irritability Moderates the Association between Infant Attachment Security and Toddler Exploration and Sociability

    ERIC Educational Resources Information Center

    Stupica, Brandi; Sherman, Laura J.; Cassidy, Jude

    2011-01-01

    This longitudinal investigation of 84 infants examined whether the effect of 12-month attachment on 18- and 24-month exploration and sociability with unfamiliar adults varied as a function of newborn irritability. As expected, results revealed an interaction between attachment (secure vs. insecure) and irritability (highly irritable vs. moderately…

  9. [Current issues on irritable bowel syndrome: diet and irritable bowel syndrome].

    PubMed

    Kim, Jeong Hwan; Sung, In-Kyung

    2014-09-25

    Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS.

  10. Irritable bowel syndrome: methods, mechanisms, and pathophysiology. Genetic epidemiology and pharmacogenetics in irritable bowel syndrome.

    PubMed

    Camilleri, Michael; Katzka, David A

    2012-05-15

    The objectives of this review are twofold. Our first objective is to evaluate the evidence supporting a role for genetics in irritable bowel syndrome (IBS). Specific examples of the associations of genetic variation and symptoms, syndromes, and intermediate phenotypes, including neurotransmitter (serotonergic, α(2)-adrenergic, and cannabinoid) mechanisms, inflammatory pathways (IL-10, TNFα, GNβ3, and susceptibility loci involved in Crohn's disease), and bile acid metabolism, are explored. The second objective is to review pharmacogenetics in IBS, with the focus on cytochrome P-450 metabolism of drugs used in IBS, modulation of motor and sensory responses to serotonergic agents based on the 5-hydroxytryptamine (5-HT) transporter-linked polymorphic region (5-HTTLPR) and 5-HT(3) genetic variants, responses to a nonselective cannabinoid agonist (dronabinol) based on cannabinoid receptor (CNR1) and fatty acid amide hydrolase (FAAH) variation, and responses to a bile acid (sodium chenodeoxycholate) and bile acid binding (colesevelam) based on klothoβ (KLB) and fibroblast growth factor receptor 4 (FGFR4) variation. Overall, there is limited evidence of a genetic association with IBS; the most frequently studied association is with 5-HTTLPR, and the most replicated association is with TNF superfamily member 15. Most of the pharmacogenetic associations are reported with intermediate phenotypes in relatively small trials, and confirmation in large clinical trials using validated clinical end points is still required. No published genome-wide association studies in functional gastrointestinal or motility disorders have been published.

  11. A laboratory-based study on patients with Parkinson's disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production.

    PubMed

    Arsic Arsenijevic, Valentina S; Milobratovic, Danica; Barac, Aleksandra M; Vekic, Berislav; Marinkovic, Jelena; Kostic, Vladimir S

    2014-03-14

    Seborrheic dermatitis (SD) and Parkinson's disease (PD) are frequently associated conditions. Aims of this study were: to determine severity of SD, presence of different species and density of Malassezia yeasts; to assess yeast lipases and phosphatases production in vitro and to compare these results between SD patients with and without PD. This case-control prospective study was conducted at the Dermatology and Neurology Units, Clinical Centre of Serbia and at the National Medical Mycology Reference Laboratory, University of Belgrade Medical School, Serbia. A total of 90 patients and 70 healthy controls (HC) were investigated: 60 patients with SD (SDN) and 30 patients with SD and PD (SDP). Culture-based mycological examination was carried out on lesional skin (LS) and non-lesional skin (NLS). A yeasts density was determined by counting the Malassezia colony forming units per tape (CFU/tape). Enzymes production by isolated Malassezia was investigated. The most patients with SD were male (76.7%; SDP and 63.3%; SDN) and the intensity of SD was dominantly severe or moderate (76.7%; SDP and 75%; SDN). The presence of Malasseziа was high on LS in both groups (87.3%; SDP and 86.7%; SDN) (p=0.667).The highest yeasts density (mean CFU/tape=67.8) was detected on LS in 53% of SDP group and in 21.7% of SDN group (mean CFU/tape=31.9) (p < 0.01). The presence of negative cultures was lower in SDP group (13.3%) in comparison to HC and SDN groups (37% and 31.7%, respectively). Malassezia density on NLS in SDP group (mean CFU/tape=44.3) was significantly higher in comparison to SDN and HC (p=0.018). M. globosa was the most abundant species identified amongst isolates from the SDP group (42.3%) and exhibited high production of phosphatase and lipase in vitro. From this laboratory-based study a positive correlation between SD, PD, M. globosa incidence, high yeast density and high phosphatase and lipase activity was established. Our data lead to conclusion that local skin

  12. A laboratory-based study on patients with Parkinson’s disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production

    PubMed Central

    2014-01-01

    Background Seborrheic dermatitis (SD) and Parkinson’s disease (PD) are frequently associated conditions. Aims of this study were: to determine severity of SD, presence of different species and density of Malassezia yeasts; to assess yeast lipases and phosphatases production in vitro and to compare these results between SD patients with and without PD. Methods This case–control prospective study was conducted at the Dermatology and Neurology Units, Clinical Centre of Serbia and at the National Medical Mycology Reference Laboratory, University of Belgrade Medical School, Serbia. A total of 90 patients and 70 healthy controls (HC) were investigated: 60 patients with SD (SDN) and 30 patients with SD and PD (SDP). Culture-based mycological examination was carried out on lesional skin (LS) and non-lesional skin (NLS). A yeasts density was determined by counting the Malassezia colony forming units per tape (CFU/tape). Enzymes production by isolated Malassezia was investigated. Results The most patients with SD were male (76.7%; SDP and 63.3%; SDN) and the intensity of SD was dominantly severe or moderate (76.7%; SDP and 75%; SDN). The presence of Malasseziа was high on LS in both groups (87.3%; SDP and 86.7%; SDN) (p=0.667). The highest yeasts density (mean CFU/tape=67.8) was detected on LS in 53% of SDP group and in 21.7% of SDN group (mean CFU/tape=31.9) (p < 0.01). The presence of negative cultures was lower in SDP group (13.3%) in comparison to HC and SDN groups (37% and 31.7%, respectively). Malassezia density on NLS in SDP group (mean CFU/tape=44.3) was significantly higher in comparison to SDN and HC (p=0.018). M. globosa was the most abundant species identified amongst isolates from the SDP group (42.3%) and exhibited high production of phosphatase and lipase in vitro. Conclusion From this laboratory-based study a positive correlation between SD, PD, M. globosa incidence, high yeast density and high phosphatase and lipase activity was established. Our data

  13. Effects of disinfectants and detergents on skin irritation.

    PubMed

    Slotosch, Caroline M; Kampf, Günter; Löffler, Harald

    2007-10-01

    We investigated the biological response of regular human skin to alcohol-based disinfectants and detergents in a repetitive test design. Using non-invasive diagnostic tools such as transepidermal water loss, laser-Doppler flowmetry and corneometry, we quantified the irritative effects of a propanol-based hand disinfectant (Sterillium), its propanol mixture (2-propanol 45% w/w and 1-propanol 30% w/w), sodium lauryl sulfate (SLS) 0.5% and distilled water. The substances were applied in a 2-D patch test in a repetitive occlusive test design to the back. Additionally, we performed a wash test on the forearms that was supposed to mimic the skin affection in the normal daily routine of health care workers. In this controlled half-side test design, we included the single application of the hand rub, SLS 0.5% and water as well as a tandem application of the same substances. Patch test and wash test showed similar results. The alcohol-based test preparations showed minimal irritation rather comparable to the application of water. However, the detergent SLS produced stronger barrier disruption, erythema and dryness than the alcohol-based preparations. There was no additional irritation at the combined use of SLS and disinfectants. By contrary, there was even a decrease in barrier disruption and erythema induced by the tandem application of SLS followed by alcohol-based disinfection compared with the use of SLS alone. These findings show a less irritant effect of alcohol-based disinfectants on the skin than detergents. Our study shows that there is no summation of irritating effects of a common detergent and propanol and that the combination of washing and disinfection has a rather protective aspect compared with washing alone.

  14. From topical antidote against skin irritants to a novel counter-irritating and anti-inflammatory peptide.

    PubMed

    Brodsky, Berta; Erlanger-Rosengarten, Avigail; Proscura, Elena; Shapira, Elena; Wormser, Uri

    2008-06-15

    The primary purpose of the present study was to investigate the mechanism of the counter-irritating activity of topical iodine against skin lesions induced by chemical and thermal stimuli. The hypothesis that iodine exerts its activity by inducing an endogenous anti-inflammatory factor was confirmed by exposing guinea pig skin to heat stimulus followed by topical iodine treatment and skin extraction. Injection of the extract into naïve guinea pigs reduced heat-induced irritation by 69%. The protective factor, identified as a new nonapeptide (histone H2A 36-44, H-Lys-Gly-Asn-Tyr-Ala-Glu-Arg-Ileu-Ala-OH), caused reduction of 40% in irritation score in heat-exposed guinea pigs. The murine analog (H-Lys-Gly-His-Tyr-Ala-Glu-Arg-Val-Gly-OH, termed IIIM1) reduced sulfur mustard (SM)-induced ear swelling at a dose-dependent bell-shape manner reaching peak activity of 1 mg/kg. Cultured keratinocytes transfected with the peptide were more resistant towards SM than the control cells. The peptide suppressed oxidative burst in activated neutrophils in a concentration-dependent manner. In addition, the peptide reduced glucose oxidase-induced skin edema in mice at a dose-dependent bell-shape manner. Apart from thermal and chemical-induced skin irritation this novel peptide might be of potential use in chronic dermal disorders such as psoriasis and pemphigus as well as non-dermal inflammatory diseases like multiple sclerosis, arthritis and colitis.

  15. Comparison of human skin irritation patch test data with in vitro skin irritation assays and animal data.

    PubMed

    Jírová, Dagmar; Basketter, David; Liebsch, Manfred; Bendová, Hana; Kejlová, Kristina; Marriott, Marie; Kandárová, Helena

    2010-02-01

    Efforts to replace the rabbit skin irritation test have been underway for many years, encouraged by the EU Cosmetics Directive and REACH. Recently various in vitro tests have been developed, evaluated and validated. A key difficulty in confirming the validity of in vitro methods is that animal data are scarce and of limited utility for prediction of human effects, which adversely impacts their acceptance. This study examines whether in vivo or in vitro data most accurately predicted human effects. Using the 4-hr human patch test (HPT) we examined a number of chemicals whose EU classification of skin irritancy is known to be borderline, or where in vitro methods provided conflicting results. Of the 16 chemicals classified as irritants in the rabbit, only five substances were found to be significantly irritating to human skin. Concordance of the rabbit test with the 4-hr HPT was only 56%, whereas concordance of human epidermis models with human data was 76% (EpiDerm) and 70% (EPISKIN). The results confirm observations that rabbits overpredict skin effects in humans. Therefore, when validating in vitro methods, all available information, including human data, should be taken into account before making conclusions about their predictive capacity.

  16. From topical antidote against skin irritants to a novel counter-irritating and anti-inflammatory peptide

    SciTech Connect

    Brodsky, Berta; Erlanger-Rosengarten, Avigail; Proscura, Elena; Shapira, Elena; Wormser, Uri

    2008-06-15

    The primary purpose of the present study was to investigate the mechanism of the counter-irritating activity of topical iodine against skin lesions induced by chemical and thermal stimuli. The hypothesis that iodine exerts its activity by inducing an endogenous anti-inflammatory factor was confirmed by exposing guinea pig skin to heat stimulus followed by topical iodine treatment and skin extraction. Injection of the extract into naive guinea pigs reduced heat-induced irritation by 69%. The protective factor, identified as a new nonapeptide (histone H2A 36-44, H-Lys-Gly-Asn-Tyr-Ala-Glu-Arg-Ileu-Ala-OH), caused reduction of 40% in irritation score in heat-exposed guinea pigs. The murine analog (H-Lys-Gly-His-Tyr-Ala-Glu-Arg-Val-Gly-OH, termed IIIM1) reduced sulfur mustard (SM)-induced ear swelling at a dose-dependent bell-shape manner reaching peak activity of 1 mg/kg. Cultured keratinocytes transfected with the peptide were more resistant towards SM than the control cells. The peptide suppressed oxidative burst in activated neutrophils in a concentration-dependent manner. In addition, the peptide reduced glucose oxidase-induced skin edema in mice at a dose-dependent bell-shape manner. Apart from thermal and chemical-induced skin irritation this novel peptide might be of potential use in chronic dermal disorders such as psoriasis and pemphigus as well as non-dermal inflammatory diseases like multiple sclerosis, arthritis and colitis.

  17. The Ex Vivo Eye Irritation Test as an alternative test method for serious eye damage/eye irritation.

    PubMed

    Spöler, Felix; Kray, Oya; Kray, Stefan; Panfil, Claudia; Schrage, Norbert F

    2015-07-01

    Ocular irritation testing is a common requirement for the classification, labelling and packaging of chemicals (substances and mixtures). The in vivo Draize rabbit eye test (OECD Test Guideline 405) is considered to be the regulatory reference method for the classification of chemicals according to their potential to induce eye injury. In the Draize test, chemicals are applied to rabbit eyes in vivo, and changes are monitored over time. If no damage is observed, the chemical is not categorised. Otherwise, the classification depends on the severity and reversibility of the damage. Alternative test methods have to be designed to match the classifications from the in vivo reference method. However, observation of damage reversibility is usually not possible in vitro. Within the present study, a new organotypic method based on rabbit corneas obtained from food production is demonstrated to close this gap. The Ex Vivo Eye Irritation Test (EVEIT) retains the full biochemical activity of the corneal epithelium, epithelial stem cells and endothelium. This permits the in-depth analysis of ocular chemical trauma beyond that achievable by using established in vitro methods. In particular, the EVEIT is the first test to permit the direct monitoring of recovery of all corneal layers after damage. To develop a prediction model for the EVEIT that is comparable to the GHS system, 37 reference chemicals were analysed. The experimental data were used to derive a three-level potency ranking of eye irritation and corrosion that best fits the GHS categorisation. In vivo data available in the literature were used for comparison. When compared with GHS classification predictions, the overall accuracy of the three-level potency ranking was 78%. The classification of chemicals as irritating versus non-irritating resulted in 96% sensitivity, 91% specificity and 95% accuracy. 2015 FRAME.

  18. Irritability and Severity of Anxious Symptomatology Among Youth With Anxiety Disorders.

    PubMed

    Cornacchio, Danielle; Crum, Kathleen I; Coxe, Stefany; Pincus, Donna B; Comer, Jonathan S

    2016-01-01

    Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations. Structural equation modeling (SEM) was used to examine associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N = 663, aged 7-19 years, mean = 12.25 years), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status. There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Furthermore, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety-irritability link is relevant across child anxiety disorders and not confined to youth with GAD. Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Moreover, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  19. CBT-Enhanced Emotion Regulation as a Mechanism of Improvement for Childhood Irritability.

    PubMed

    Derella, Olivia J; Johnston, Oliver G; Loeber, Rolf; Burke, Jeffrey D

    2017-02-02

    Research supports the clinical importance of childhood irritability, as well as its developmental implications for later anxiety and depression. Appropriate treatment may prevent this progression; however, little evidence exists to guide clinician decision making regarding treatment for chronic irritability symptoms. Given the empirical support for irritability as a dimension of oppositional defiant disorder (ODD), behavioral interventions that improve ODD symptoms, especially through emotion regulation training, are strong candidates for identifying effective treatment strategies for irritability. Data from a randomized controlled effectiveness trial were used to assess hypotheses regarding irritability. The Stop Now and Plan (SNAP) Program was developed for preadolescent youths demonstrating clinically high rates of conduct problems. Participants (252 boys, ages 6-11) were assigned to participate in either SNAP or standard services; data were collected at 4 time points over 15 months. Although lower irritability scores over time were seen for the SNAP group compared to standard services, the main effect for treatment was small and did not reach statistical significance. However, a significant indirect effect of SNAP treatment on irritability via improved emotion regulation skills was found; improved emotion regulation skills were associated with significant and substantial reductions in irritability. Specific effects of SNAP for the improvement of emotion regulation skills function as a mechanism for subsequent reductions in irritability, supporting the distinction between emotion regulation and irritability symptoms. Enhancing increased emotion regulation skills within existing evidence-based interventions for children with ODD should provide a strong foundation for treatments to target irritability symptoms.

  20. Newborn Irritability Moderates the Association between Infant Attachment Security and Toddler Exploration and Sociability

    PubMed Central

    Stupica, Brandi; Sherman, Laura J.; Cassidy, Jude

    2011-01-01

    This longitudinal investigation of 84 infants examined whether the effect of 12-month attachment on 18- and 24-month exploration and sociability with unfamiliar adults varied as a function of newborn irritability. As expected, results revealed an interaction between attachment (secure vs. insecure) and irritability (highly irritable vs. moderately irritable) in predicting both exploration and sociability with unfamiliar adults. For exploration, results supported a dual-risk model; that is, toddlers who had been both highly irritable and insecurely attached were less exploratory than other toddlers. For sociability, results supported the differential-susceptibility hypothesis; that is, highly irritable infants, compared to moderately irritable infants, were both less sociable as toddlers when they had been insecurely attached and more sociable when they had been securely attached. PMID:21883159

  1. New and emerging therapies for the treatment of irritable bowel syndrome: an update for gastroenterologists.

    PubMed

    Foxx-Orenstein, Amy E

    2016-05-01

    Irritable bowel syndrome is a functional bowel disorder with gastrointestinal symptoms (e.g. abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating) that occur alongside bowel function alterations (i.e. constipation, diarrhea, or both). Patients with irritable bowel syndrome may also experience comorbid anxiety and depression. Irritable bowel syndrome is common, with a prevalence estimated between 3% and 28%, affecting patient health and quality of life. Patients with moderate or severe irritable bowel syndrome generally seek medical care, whereas those with milder symptoms may choose self-management. Most patients with irritable bowel syndrome receive outpatient care, but irritable bowel syndrome-related hospitalizations do occur. The pathophysiology of irritable bowel syndrome is multifactorial (i.e. genetics, immune components, changes in the gut microbiota, disturbances in physiologic stress response systems, and psychosocial factors). Management of irritable bowel syndrome can include lifestyle changes, dietary interventions, counseling, psychologic medication, and agents that affect gastrointestinal motility. A number of therapies have emerged in recent years with clinical trial data demonstrating efficacy and safety for patients with irritable bowel syndrome, including agents that target gastrointestinal motility (i.e. linaclotide), gastrointestinal opioid receptors (i.e. asimadoline, eluxadoline), and gut microbiota (i.e. rifaximin). Linaclotide has been shown to significantly improve stool frequency and abdominal pain compared with placebo in constipation-predominant irritable bowel syndrome (number needed to treat, 5.1). Asimadoline shows efficacy in patients with moderate-to-severe irritable bowel syndrome-related pain. Rifaximin provided adequate relief of global irritable bowel syndrome symptoms versus placebo for a significantly greater percentage of patients with diarrhea-predominant irritable bowel syndrome (p < 0

  2. New and emerging therapies for the treatment of irritable bowel syndrome: an update for gastroenterologists

    PubMed Central

    Foxx-Orenstein, Amy E.

    2016-01-01

    Irritable bowel syndrome is a functional bowel disorder with gastrointestinal symptoms (e.g. abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating) that occur alongside bowel function alterations (i.e. constipation, diarrhea, or both). Patients with irritable bowel syndrome may also experience comorbid anxiety and depression. Irritable bowel syndrome is common, with a prevalence estimated between 3% and 28%, affecting patient health and quality of life. Patients with moderate or severe irritable bowel syndrome generally seek medical care, whereas those with milder symptoms may choose self-management. Most patients with irritable bowel syndrome receive outpatient care, but irritable bowel syndrome-related hospitalizations do occur. The pathophysiology of irritable bowel syndrome is multifactorial (i.e. genetics, immune components, changes in the gut microbiota, disturbances in physiologic stress response systems, and psychosocial factors). Management of irritable bowel syndrome can include lifestyle changes, dietary interventions, counseling, psychologic medication, and agents that affect gastrointestinal motility. A number of therapies have emerged in recent years with clinical trial data demonstrating efficacy and safety for patients with irritable bowel syndrome, including agents that target gastrointestinal motility (i.e. linaclotide), gastrointestinal opioid receptors (i.e. asimadoline, eluxadoline), and gut microbiota (i.e. rifaximin). Linaclotide has been shown to significantly improve stool frequency and abdominal pain compared with placebo in constipation-predominant irritable bowel syndrome (number needed to treat, 5.1). Asimadoline shows efficacy in patients with moderate-to-severe irritable bowel syndrome-related pain. Rifaximin provided adequate relief of global irritable bowel syndrome symptoms versus placebo for a significantly greater percentage of patients with diarrhea-predominant irritable bowel syndrome (p < 0

  3. [Splenic flexure and irritable colon syndromes: conjugate conditions].

    PubMed

    Osipenko, M F; Bikbulatova, E A; Mut-Gusaim, V I

    2008-01-01

    To investigate phenotypical and clinical characteristics in individuals with high fixation of the splenic angle (HFSA). The study group included 82 patients with HFSA, the comparison group--76 patients with irritable colon syndrome (ICS), control group--19 patients without colon pathology. the results of the following examinations were analysed: the disease history, detailed intestinal investigation, rectal sensitivity, constitution, connective tissue weakness, vegetative dysfunction and regulation. HFSA is encountered mainly in persons with hyperstenic constitution. Some HFSA patients have pain on the left side--splenic flexure syndrome (SFS). The pain corresponds most to clinical criteria of irritable colon syndrome diagnosis and is accompanied with reduced threshold of pain sensitivity to balloon extension. Provoking factors of the symptoms are stress situations in childhood. SFS can be considered as a variant of ICS arising in HFSA. The treatment should be based on the principles of ICS treatment.

  4. Current and novel therapeutic options for irritable bowel syndrome management.

    PubMed

    Camilleri, M; Andresen, V

    2009-12-01

    Irritable bowel syndrome is a functional gastrointestinal disorder affecting up to 3-15% of the general population in western countries. It is characterised by unexplained abdominal pain, discomfort, and bloating in association with altered bowel habits. The pathophysiology of irritable bowel syndrome is multifactorial involving disturbances of the brain-gut axis. The pathophysiology provides the rationale for pharmacotherapy: abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, autonomic dysfunction, and mucosal immune activation. Understanding the mechanisms, and their mediators or modulators including neurotransmitters and receptors have led to several therapeutic approaches including agents acting on the serotonin receptor or serotonin transporter system, antidepressants, novel selective anticholinergics, alpha-adrenergic agonists, opioid agents, cholecystokinin-antagonists, neurokinin-antagonists, somatostatin receptor agonists, corticotropin releasing factor antagonists, chloride channel activators, guanylate cyclase-c agonists, melatonin, atypical benzodiazepines, antibiotics, immune modulators and probiotics. The mechanisms and current evidence regarding efficacy of these agents are reviewed.

  5. Nasal pungency, odor, and eye irritation thresholds for homologous acetates.

    PubMed

    Cometto-Muñiz, J E; Cain, W S

    1991-08-01

    We measured detection thresholds for nasal pungency (in anosmics), odor (in normosmics) and eye irritation employing a homologous series of acetates: methyl through octyl acetate, decyl and dodecyl acetate. All anosmics reliably detected the series up to heptyl acetate. Only the anosmics without smell since birth (congenital) reliably detected octyl acetate, and only one congenital anosmic detected decyl and dodecyl acetate. Anosmics who lost smell from head trauma proved to be selectively less sensitive. As expected, odor thresholds lay well below pungency thresholds. Eye irritation thresholds for selected acetates came close to nasal pungency thresholds. All three types of thresholds decreased logarithmically with carbon chain length, as previously seen with homologous alcohols and as seen in narcotic and toxic phenomena. Results imply that nasal pungency for these stimuli rests upon a physical, rather than chemical, interaction with susceptible mucosal structures. When expressed as thermodynamic activity, nasal pungency thresholds remain remarkably constant within and across the homologous series of acetates and alcohols.

  6. Laundry detergents and skin irritancy--a comprehensive review.

    PubMed

    Crawford, Charles; Zirwas, Matthew J

    2014-01-01

    Surface-active agents (surfactants) form the foundation of an effective detergent formulation. As such, surfactants are a major component of laundry detergents. Depending on multiple factors, the amount of residual detergent surfactants in clothing after washing varies but may be sufficient to elicit skin irritation in susceptible individuals and in patients with existing dermatologic disorders. The goal of this review is to examine the relationship between surfactants commonly used in laundry detergent formulations and their potential for skin irritancy. In this context, the role of surfactants in achieving broad-spectrum cleaning performance in laundry is discussed, and currently available methodologies to evaluate and measure the effect of surfactant exposure on the skin are reviewed.

  7. Biomimetic proopiomelanocortin suppresses capsaicin-induced sensory irritation in humans

    PubMed Central

    Fatemi, Sayed Ali; Jafarian-Dehkordi, Abbas; Hajhashemi, Valiollah; Asilian-Mahabadi, Ali

    2016-01-01

    Sensitive skin is a frequently mentioned cosmetic complaint. Addition of a biomimetic of neuromediator has recently appeared as a promising new way to cure skin care product problems. This study was aimed to assess the inhibitory effect of a biomimetic lipopeptide derived from proopiomelanocortin (bPOMC) on capsaicin-induced sensory irritation in human volunteers and also to compare its protective effect with that of the well-known anti irritant strontium chloride. The effect of each test compound was studied on 28 selected healthy volunteers with sensitive skin in accordance with a double-blind vehicle-controlled protocol. From day 1 to day 13 each group was applied the test compound (bPOMC or strontium chloride) to one wing of the nose and the corresponding placebo (vehicle) to the other side twice daily. On days 0 and 14, acute skin irritation was induced by capsaicin solution and quantified using clinical stinging test assessments. Following the application of capsaicin solution, sensory irritation was evaluated using a 4-point numeric scale. The sensations perceived before and after treatment (on days 0 and 14) was calculated for the two zones (test materials and vehicle). Ultimately the percentage of variation between each sample and the placebo and also the inhibitory effect of bPOMC compared to that of strontium chloride were reported. Clinical results showed that after two weeks treatment, the levels of skin comfort reported in the group treated with bPOMC were significantly higher than those obtained in the placebo group and the inhibitory effect of bPOMC was about 47% higher than that of strontium chloride. The results of the present study support the hypothesis that biomimetic peptides may be effective on sensitive skin. PMID:28003842

  8. [Treatment of irritable bowel syndrome with dicetelium and spasmomen].

    PubMed

    Nedogoda, S V; Parshev, V V

    2000-01-01

    The aim of the study was to compare clinical efficacy of new spasmolytics--pinaverium bromide (dicetel, Solvay Pharma) and otilonium bromide (spasmomen, Menarini-Berlin-Chemie)--in the treatment of irritable bowel syndrome. Effects appearing during the treatment with anxiolytic drug tofisopam (grandaxin, Egis) after using dicetel and spasmomen were also studied. The results indicate marked clinical efficiency of dicetel and spasmomen which improve vegetative functions and psychoemotional status. Grandaxin provides further improvement of clinical symptoms and additionally corrects psychoemotional status.

  9. Irritant contact facial dermatitis due to nebulizer therapy.

    PubMed Central

    Eedy, D. J.; Barton, K.; Stanford, C. F.

    1988-01-01

    A case is reported of a patient with long-standing, severe airflow obstruction requiring long-term nebulizer therapy developing a facial dermatitis in the area bounded by the nebulizer mask. The facial dermatitis seems to be the result of the combined irritancy of the nebulizer solutions and moisture, and prophylactic measures are suggested for patients requiring long-term nebulizer therapy. Images Figure 1 PMID:2973007

  10. Treatment of pain symptoms in irritable bowel syndrome patients.

    PubMed

    Gupta, Vishal; Moshiree, Baharak; Verne, G Nicholas

    2004-10-01

    Irritable bowel syndrome represents a common gastrointestinal disorder that significantly impacts patients' lives. It is defined by Rome II criteria and characterized by abdominal pain and bloating associated with changes in bowel habit. Visceral hypersensitivity is currently considered a biological marker for the disease. Current therapeutic treatments include the use of fiber supplements, antidiarrheal agents, laxatives, antispasmodics, tricyclic antidepressants and serotonergic agents. Through a proper understanding of the diagnostic criteria, pathophysiology and treatment options, this disorder can be treated effectively in many patients.

  11. Baclofen Withdrawal Presenting as Irritability in a Developmentally Delayed Child

    PubMed Central

    Lim, C. Anthoney; Cunningham, Sandra J.

    2012-01-01

    Irritability in children has a broad differential diagnosis, ranging from benign processes to life-threatening emergencies. In children with comorbid conditions and developmental delay, the diagnostic process becomes more challenging. This case report describes a developmentally delayed 14-year-old boy who presented with pain and crying caused by a malfunction of a surgically implanted baclofen pump. We describe recommendations concerning the diagnostic evaluation, medical management, and surgical repair. PMID:23251718

  12. Impact of psychological stress on irritable bowel syndrome.

    PubMed

    Qin, Hong-Yan; Cheng, Chung-Wah; Tang, Xu-Dong; Bian, Zhao-Xiang

    2014-10-21

    Psychological stress is an important factor for the development of irritable bowel syndrome (IBS). More and more clinical and experimental evidence showed that IBS is a combination of irritable bowel and irritable brain. In the present review we discuss the potential role of psychological stress in the pathogenesis of IBS and provide comprehensive approaches in clinical treatment. Evidence from clinical and experimental studies showed that psychological stresses have marked impact on intestinal sensitivity, motility, secretion and permeability, and the underlying mechanism has a close correlation with mucosal immune activation, alterations in central nervous system, peripheral neurons and gastrointestinal microbiota. Stress-induced alterations in neuro-endocrine-immune pathways acts on the gut-brain axis and microbiota-gut-brain axis, and cause symptom flare-ups or exaggeration in IBS. IBS is a stress-sensitive disorder, therefore, the treatment of IBS should focus on managing stress and stress-induced responses. Now, non-pharmacological approaches and pharmacological strategies that target on stress-related alterations, such as antidepressants, antipsychotics, miscellaneous agents, 5-HT synthesis inhibitors, selective 5-HT reuptake inhibitors, and specific 5-HT receptor antagonists or agonists have shown a critical role in IBS management. A integrative approach for IBS management is a necessary.

  13. Calcium polycarbophil compared with placebo in irritable bowel syndrome.

    PubMed

    Toskes, P P; Connery, K L; Ritchey, T W

    1993-02-01

    Calcium polycarbophil was compared with placebo in 23 patients with irritable bowel syndrome in a six-month, randomized double-blind crossover study. Patients received polycarbophil tablets at a dosage of 6 g/day (twelve 0.5-g tablets) or matching placebo tablets. At study end, among patients expressing a preference, 15 of 21 (71%) chose polycarbophil over placebo for relief of the symptoms of irritable bowel syndrome. Statistically significant differences favouring polycarbophil were found among the following patient subgroups: 15 (79%) of 19 with constipation: all six with alternating diarrhoea and constipation; 13 (87%) of 15 with bloating: and 11 (92%) of 12 with two or more symptoms. Polycarbophil was rated better than placebo in monthly global responses to therapy. Patient diary entries showed statistically significant improvement for ease of passage with polycarbophil. Polycarbophil was rated better than placebo for relief of nausea, pain, and bloating. The data suggest that calcium polycarbophil can benefit irritable bowel syndrome patients with constipation or alternating diarrhoea and constipation and may be particularly useful in patients with bloating as a major complaint.

  14. Effect of moisturizers on skin susceptibility to irritants.

    PubMed

    Held, E; Agner, T

    2001-05-01

    Moisturizers are used for the treatment of dry and irritated skin. The benefit of moisturizers when used on normal skin has recently been challenged, since an earlier study indicated that the increased hydration that follows long-term use of moisturizers on normal skin may facilitate penetration of irritants. The aim of the present study was to evaluate short-term use of 2 different moisturizers used on normal skin: cream A (high lipid content) and B (moderate/low lipid content). Nineteen healthy volunteers applied the moisturizers on the upper arm/forearm 3 times daily for 5 days, while the other upper arm/forearm served as symmetrical control. The day after moisturizer treatment was stopped the skin was challenged with a patch test of sodium lauryl sulphate. Skin reactions were evaluated by bioengineering measuring methods and clinical scoring. Skin response to sodium lauryl sulphate was increased on moisturizer-treated arms compared to controls for one of the moisturizer (cream A), while this was not statistically significant for the other moisturizer (cream B). Data confirm previous indications that some moisturizers when used on normal skin may increase skin susceptibility to irritants.

  15. Testing ocular irritancy in vitro with the silicon microphysiometer.

    PubMed

    Bruner, L H; Miller, K R; Owicki, J C; Parce, J W; Muir, V C

    1991-01-01

    The silicon microphysiometer, an instrument based on the light-addressable potentiometric sensor, was evaluated as an in vitro alternative for assessing ocular irritancy potential. It indirectly and non-invasively measures cell metabolism by determining the rate of acid metabolite production from cells, in this case human epidermal keratinocytes, placed inside the microphysiometer chamber. The 17 materials used for the evaluation included bar soaps, a liquid hand soap, shampoos, dishwashing liquids, laundry detergents, a fabric softener and several single chemicals. All materials tested were in liquid form. The in vivo irritancy potential of the materials was obtained from historical data using the rabbit low-volume eye test. There was a positive correlation between the in vivo irritancy potential of the test materials and the concentration of test material that decreased the acidification rate of cells by 50% (MRD(50); r = 0.86, P < 0.0001). Preliminary studies suggest other endpoints obtainable from the system may also provide useful information for making ocular safety assessments. Because the method is non-invasive, it is possible to determine whether cells recover from a treatment with the test material. The metabolic rate of the cells also increases at sub-inhibitory concentrations of some of the test materials. Because of the good correlation between the in vivo and in vitro data, the ease with which test materials can be applied to the system, and the multiple endpoints available from the system, it holds great potential as a useful in vitro alternative for ocular safety testing.

  16. Modulation of oral heat and cold pain by irritant chemicals.

    PubMed

    Albin, Kelly C; Carstens, Mirela Iodi; Carstens, E

    2008-01-01

    Common food irritants elicit oral heat or cool sensations via actions at thermosensitive transient receptor potential (TRP) channels. We used a half-tongue, 2-alternative forced-choice procedure coupled with bilateral pain intensity ratings to investigate irritant effects on heat and cold pain. The method was validated in a bilateral thermal difference detection task. Capsaicin, mustard oil, and cinnamaldehyde enhanced lingual heat pain elicited by a 49 degrees C stimulus. Mustard oil and cinnamaldehyde weakly enhanced lingual cold pain (9.5 degrees C), whereas capsaicin had no effect. Menthol significantly enhanced cold pain and weakly reduced heat pain. To address if capsaicin's effect was due to summation of perceptually similar thermal and chemical sensations, one-half of the tongue was desensitized by application of capsaicin. Upon reapplication, capsaicin elicited little or no irritant sensation yet still significantly enhanced heat pain on the capsaicin-treated side, ruling out summation. In a third experiment, capsaicin significantly enhanced pain ratings to graded heat stimuli (47 degrees C to 50 degrees C) resulting in an upward shift of the stimulus-response function. Menthol may induce cold hyperalgesia via enhanced thermal gating of TRPM8 in peripheral fibers. Capsaicin, mustard oil, and cinnamaldehyde may induce heat hyperalgesia via enhanced thermal gating of TRPV1 that is coexpressed with TRPA1 in peripheral nociceptors.

  17. Complementary and alternative medicine for treatment of irritable bowel syndrome

    PubMed Central

    Shen, Yi-Hao A.; Nahas, Richard

    2009-01-01

    Abstract OBJECTIVE To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS). QUALITY OF EVIDENCE MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions. MAIN MESSAGE Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses. CONCLUSION Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance. PMID:19221071

  18. Complementary and alternative medicine for treatment of irritable bowel syndrome.

    PubMed

    Shen, Yi-Hao A; Nahas, Richard

    2009-02-01

    To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS). MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions. Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses. Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance.

  19. Lubiprostone for constipation and irritable bowel syndrome with constipation.

    PubMed

    Tuteja, Ashok K; Rao, Satish S C

    2008-12-01

    Chronic constipation and irritable bowel syndrome are heterogeneous disorders characterized by altered bowel habits, abdominal discomfort and/or difficult defecation. These conditions have a significant impact on patients' quality of life, as well as on the US economy, both in terms of healthcare costs and lost productivity. Treatment typically begins with lifestyle changes, increased fiber intake and osmotic and stimulant laxative intake. However, treatments for constipation vary in terms of their efficacy and safety. Furthermore, surveys of physicians and patients have revealed a strong desire for improved therapeutic options. Lubiprostone is a synthetic bicyclic fatty acid that is gut selective and stimulates type 2 chloride channels, resulting in increased chloride, sodium and water secretion into the lumen. The increased fluid secretion causes luminal distension, secondary peristalsis and laxation. Randomized Phase III trials have shown that lubiprostone is efficacious in the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation. The US FDA has approved lubiprostone at a dose of 24 microg twice daily for the treatment of chronic idiopathic constipation in adults, and at a dose of 8 microg twice daily for irritable bowel syndrome with constipation in adult women. Nausea, diarrhea and headaches are the most commonly reported side effects. In long-term studies, lubiprostone appears to be safe.

  20. Assessment of the Dermal and Ocular Irritation Potential of Lomefloxacin by Using In Vitro Methods

    PubMed Central

    Ahn, Jun-Ho; Eum, Ki-Hwan

    2010-01-01

    The evaluation of eye and skin irritation potential is essential to ensuring the safety of human in contact with a wide variety of substances. Despite this importance of irritation test, little is known with respect to the irritation potency of lomefloxacin, a fluoroquinolone antibiotic, which has been known to cause phototoxicity with an abnormal reaction of the skin. Thus, to investigate the tendency of lomefloxacin to cause eye and skin irritation, we carried out in vitro eye irritation test using Balb/c 3T3, and in vitro skin irritation test using KeraSkinTM human skin model system. 3T3 neutral red uptake assay has been proposed as a potential replacement alternative for the Draize Eye irritation test. In this study, the IC50 value obtained for lomefloxacin was 375 μg. According to the classification model used for determining in vitro categories, lomefloxacin was classified as moderately irritant. For evaluation of skin irritation, engineered epidermal equivalents (KeraSkinTM) were subjected to 10 and 25 mg of lomefloxacin for 15 minutes. Tissue damage was assessed by tissue viability evaluation, and by the release of a pro-inflammatory mediator, interleukin-1α. Lomefloxacin increased the interleukin-1α release after 15 minutes of exposure and 42 hours of post incubation, although no decrease in viability was observed. Therefore, lomefloxacin is considered to be moderately irritant to skin and eye. PMID:24278500

  1. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact.

    PubMed

    Hungin, A P S; Chang, L; Locke, G R; Dennis, E H; Barghout, V

    2005-06-01

    The impact of irritable bowel syndrome, a gastrointestinal motility disorder, is underestimated and poorly quantified, as clinicians may see only a minority of sufferers. To determine the prevalence, symptom patterns and impact of irritable bowel syndrome in the US. This two-phase community survey used quota sampling and random-digit telephone dialing (screening interview) to identify individuals with medically diagnosed irritable bowel syndrome or individuals not formally diagnosed, but fulfilling irritable bowel syndrome diagnostic criteria (Manning, Rome I or II). Information on irritable bowel syndrome symptoms, general health status, lifestyle and impact of symptoms on individuals' lives was collected using in-depth follow-up interviews. Data were also collected for healthy controls identified in the screening interviews. The total prevalence of irritable bowel syndrome in 5009 screening interviews was 14.1% (medically diagnosed: 3.3%; undiagnosed, but meeting irritable bowel syndrome criteria: 10.8%). Abdominal pain/discomfort was the most common symptom prompting consultation. Most sufferers (74% medically diagnosed; 63% undiagnosed) reported alternating constipation and diarrhoea. Previously diagnosed gastrointestinal disorders occurred more often in sufferers than non-sufferers. Irritable bowel syndrome sufferers had more days off work (6.4 vs. 3.0) and days in bed, and reduced activities to a greater extent than non-sufferers. Most (76.6%) irritable bowel syndrome sufferers in the US are undiagnosed. Irritable bowel syndrome has a substantial impact on sufferers' well-being and health, with considerable socioeconomic consequences.

  2. Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population.

    PubMed

    Locke, G R; Yawn, B P; Wollan, P C; Melton, L J; Lydick, E; Talley, N J

    2004-05-01

    The incidence of irritable bowel syndrome is uncertain. We aimed to determine the incidence of clinically diagnosed irritable bowel syndrome in the community. Using the Rochester Epidemiology Project, all diagnoses of irritable bowel syndrome made among adult residents of Olmsted County, Minnesota, over a 3-year period were identified. The complete medical records of a random sample of the potential subjects were reviewed for the 10 years prior to the irritable bowel syndrome diagnosis and any patient who had received a previous diagnosis of irritable bowel syndrome was excluded (prevalent cases). The diagnostic index listed 1245 possible irritable bowel syndrome patients; 416 patient charts were reviewed and, of these, 149 were physician diagnosed incident cases of irritable bowel syndrome. The age- and sex-adjusted incidence rate was 196 per 100,000 person-years and increased with age (P = 0.006). The age-adjusted annual incidence per 100,000 in women was higher than in men: 238 vs. 141 (ratio 3:2; P = 0.005). The overall symptom frequency at the time of diagnosis was abdominal pain (73%), diarrhoea (41%) and constipation (16%). The incidence of a clinical diagnosis of irritable bowel syndrome in adults was estimated to be two per 1000 per year, increased with age and was higher in women than men. As many people with irritable bowel syndrome do not seek care, the true incidence of irritable bowel syndrome is likely to be higher.

  3. Dissecting the role of TRPV1 in detecting multiple trigeminal irritants in three behavioral assays for sensory irritation.

    PubMed

    Saunders, C J; Li, Winston Y; Patel, Tulsi D; Muday, Jeffrey A; Silver, Wayne L

    2013-01-01

    Polymodal neurons of the trigeminal nerve innervate the nasal cavity, nasopharynx, oral cavity and cornea. Trigeminal nociceptive fibers express a diverse collection of receptors and are stimulated by a wide variety of chemicals. However, the mechanism of stimulation is known only for relatively few of these compounds. Capsaicin, for example, activates transient receptor potential vanilloid 1 (TRPV1) channels. In the present study, wildtype (C57Bl/6J) and TRPV1 knockout mice were tested in three behavioral assays for irritation to determine if TRPV1 is necessary to detect trigeminal irritants in addition to capsaicin. In one assay mice were presented with a chemical via a cotton swab and their response scored on a 5 level scale. In another assay, a modified two bottle preference test, which avoids the confound of mixing irritants with the animal's drinking water, was used to assess aversion. In the final assay, an air dilution olfactometer was used to administer volatile compounds to mice restrained in a double-chambered plethysmograph where respiratory reflexes were monitored. TRPV1 knockouts showed deficiencies in the detection of benzaldehyde, cyclohexanone and eugenol in at least one assay. However, cyclohexanone was the only substance tested that appears to act solely through TRPV1.

  4. Dissecting the role of TRPV1 in detecting multiple trigeminal irritants in three behavioral assays for sensory irritation

    PubMed Central

    Saunders, CJ

    2013-01-01

    Polymodal neurons of the trigeminal nerve innervate the nasal cavity, nasopharynx, oral cavity and cornea. Trigeminal nociceptive fibers express a diverse collection of receptors and are stimulated by a wide variety of chemicals. However, the mechanism of stimulation is known only for relatively few of these compounds. Capsaicin, for example, activates transient receptor potential vanilloid 1 (TRPV1) channels. In the present study, wildtype (C57Bl/6J) and TRPV1 knockout mice were tested in three behavioral assays for irritation to determine if TRPV1 is necessary to detect trigeminal irritants in addition to capsaicin. In one assay mice were presented with a chemical via a cotton swab and their response scored on a 5 level scale. In another assay, a modified two bottle preference test, which avoids the confound of mixing irritants with the animal’s drinking water, was used to assess aversion. In the final assay, an air dilution olfactometer was used to administer volatile compounds to mice restrained in a double-chambered plethysmograph where respiratory reflexes were monitored. TRPV1 knockouts showed deficiencies in the detection of benzaldehyde, cyclohexanone and eugenol in at least one assay. However, cyclohexanone was the only substance tested that appears to act solely through TRPV1. PMID:24358880

  5. Dual-channel red/blue fluorescence dosimetry with broadband reflectance spectroscopic correction measures protoporphyrin IX production during photodynamic therapy of actinic keratosis

    NASA Astrophysics Data System (ADS)

    Kanick, Stephen Chad; Davis, Scott C.; Zhao, Yan; Hasan, Tayyaba; Maytin, Edward V.; Pogue, Brian W.; Chapman, M. Shane

    2014-07-01

    Dosimetry for aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy of actinic keratosis was examined with an optimized fluorescence dosimeter to measure PpIX during treatment. While insufficient PpIX generation may be an indicator of incomplete response, there exists no standardized method to quantitate PpIX production at depths in the skin during clinical treatments. In this study, a spectrometer-based point probe dosimeter system was used to sample PpIX fluorescence from superficial (blue wavelength excitation) and deeper (red wavelength excitation) tissue layers. Broadband white light spectroscopy (WLS) was used to monitor aspects of vascular physiology and inform a correction of fluorescence for the background optical properties. Measurements in tissue phantoms showed accurate recovery of blood volume fraction and reduced scattering coefficient from WLS, and a linear response of PpIX fluorescence versus concentration down to 1.95 and 250 nM for blue and red excitations, respectively. A pilot clinical study of 19 patients receiving 1-h ALA incubation before treatment showed high intrinsic variance in PpIX fluorescence with a standard deviation/mean ratio of >0.9. PpIX fluorescence was significantly higher in patients reporting higher pain levels on a visual analog scale. These pilot data suggest that patient-specific PpIX quantitation may predict outcome response.

  6. Efficacy, safety and tolerability of field treatment of actinic keratosis with ingenol mebutate 0.015 % gel: a single center case series.

    PubMed

    Bobyr, Ivan; Campanati, Anna; Consales, Veronica; Giuliodori, Katia; Scalise, Alessandro; Offidani, Annamaria

    2016-01-01

    Actinic keratosis (AK) is a cutaneous intraepithelial neoplasm appearing within areas referred as 'fields of cancerization'. AK can progress to invasive squamous cell carcinoma. Treatments that target both clinically visible and subclinical AKs in cancerization fields are able to reduce the risk of malignant progression. Ingenol mebutate gel is a new effective topical therapy for AK, used once daily for 2 or 3 days depending on the location of lesions. Three elderly patients with multiple non-hypertrophic AKs within a contiguous 25-cm(2) treatment area on the face or scalp were treated with ingenol mebutate 0.015 % gel once daily for three consecutive days and followed up over a period of 57 days. Although individual local responses to treatment varied, all patients had total clearance of AK lesions without any sign of recurrence. In addition, all patients said that they were satisfied with the effectiveness of ingenol mebutate treatment and the aesthetic outcome, and would be prepared to use this agent again to treat AK in the future, if necessary. These three cases demonstrate that ingenol mebutate 0.015 % gel is effective and well tolerated in a clinical setting, with effective clearance of AK lesions present on the face and scalp, and good patient acceptability.

  7. Imiquimod 5% cream for the treatment of actinic keratosis: results from a phase III, randomized, double-blind, vehicle-controlled, clinical trial with histology.

    PubMed

    Szeimies, Rolf-Markus; Gerritsen, Marie-Jeanne P; Gupta, Girish; Ortonne, Jean Paul; Serresi, Stefano; Bichel, Jens; Lee, James H; Fox, Terry L; Alomar, Agustín

    2004-10-01

    Increasing evidence suggests imiquimod may be a safe therapeutic option for the treatment of actinic keratosis (AK). The diagnosis and assessment of most AK lesions is made clinically, without histologic confirmation. A phase III, randomized, double-blind, parallel group, vehicle-controlled study evaluated the efficacy of imiquimod 5% cream compared with vehicle in the treatment of AK lesions on the face and balding scalp including pretreatment and posttreatment biopsy specimens. A total of 286 patients at 18 centers in 6 European countries with histologically confirmed AK were randomized to either imiquimod 5% cream or vehicle cream. Study cream was applied once per day, 3 days per week, for 16 weeks. Clearance of AK lesions was clinically and histologically assessed at an 8-week posttreatment visit. The complete clearance rate for the imiquimod group was 57.1% versus 2.2% for the vehicle group (P <.001). The partial clearance rate (> or =75% reduction in baseline lesions) for the imiquimod group was 72.1% versus 4.3% for the vehicle group (P <.001). The most common side effects were erythema, scabbing/crusting, and erosions/ulceration. For the imiquimod group the incidence of severe erythema, scabbing/crusting, or erosions/ulceration was 30.6%, 29.9%, and 10.2%, respectively. Imiquimod 5% cream used 3 times per week for 16 weeks is an effective treatment for AK. Clinical clearance was established by both clinical observation and histologic analysis.

  8. Refinement of the localisation of the X linked keratosis follicularis spinulosa decalvans (KFSD) gene in Xp22.13-p22.2.

    PubMed Central

    Oosterwijk, J C; van der Wielen, M J; van de Vosse, E; Voorhoeve, E; Bakker, E

    1995-01-01

    X-linked keratosis follicularis spinulosa decalvans (KFSD) is a rare disorder affecting the skin and eyes. The disease was previously mapped in an extended Dutch family to Xp21.2-p22.2 between DXS16 and DXS269. Using five DNA probes and 14 CA repeat polymorphisms spanning this region an extensive linkage study was performed in the same pedigree. The highest lod scores were 12.07 for DXS365 (pRX-314) at 0 = 0, 11.72 for DXS418 (P122) at 0 = 0.015, and 10.93 for DXS989 (AFM135xe7) at 0 = 0.045. Analysis of recombination events locates the gene for KFSD between AFM291wf5 and DXS1226 (AFM316yf5). This is region Xp22.13-p22.2, an area covering approximately 1 Mb. These data confirm and greatly refine the regional localisation of KFSD and greatly improve reliability of carrier detection. PMID:8544196

  9. Refinement of the localisation of the X linked keratosis follicularis spinulosa decalvans (KFSD) gene in Xp22.13-p22.2.

    PubMed

    Oosterwijk, J C; van der Wielen, M J; van de Vosse, E; Voorhoeve, E; Bakker, E

    1995-09-01

    X-linked keratosis follicularis spinulosa decalvans (KFSD) is a rare disorder affecting the skin and eyes. The disease was previously mapped in an extended Dutch family to Xp21.2-p22.2 between DXS16 and DXS269. Using five DNA probes and 14 CA repeat polymorphisms spanning this region an extensive linkage study was performed in the same pedigree. The highest lod scores were 12.07 for DXS365 (pRX-314) at 0 = 0, 11.72 for DXS418 (P122) at 0 = 0.015, and 10.93 for DXS989 (AFM135xe7) at 0 = 0.045. Analysis of recombination events locates the gene for KFSD between AFM291wf5 and DXS1226 (AFM316yf5). This is region Xp22.13-p22.2, an area covering approximately 1 Mb. These data confirm and greatly refine the regional localisation of KFSD and greatly improve reliability of carrier detection.

  10. Linkage analysis of keratosis follicularis spinulosa decalvans, and regional assignment to human chromosome Xp21.2-p22.2.

    PubMed

    Oosterwijk, J C; Nelen, M; van Zandvoort, P M; van Osch, L D; Oranje, A P; Wittebol-Post, D; van Oost, B A

    1992-04-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare X-chromosomal disorder. It consists of follicular hyperkeratosis of the skin, scarring alopecia of the scalp, absence of the eyebrows, and corneal degeneration. There is photophobia in childhood, but the symptoms tend to diminish after puberty, and prognosis for vision is good. Some heterozygotes do show clinical symptoms. In a large Dutch pedigree we performed DNA analysis in order to localize the KFSD gene. In 54 individuals, including 21 affected males, RFLP analysis was done using DNA probes covering the X chromosome. Two-point linkage analyses with 19 informative DNA markers revealed significant linkage to DNA probes on Xp21.1-p22.3. The highest lod scores of 5.70 and 4.38 were obtained with DXS41 and DXS16 at a recombination fraction of zero and 4 cM, respectively. Multipoint linkage data place KFSD between DXS16 and DXS269. Our data confirm X linkage of KFSD in this family and tentatively map the gene on Xp22.2-p21.2. Combined with clinical investigation, RFLP analysis may become an important tool in carrier detection.

  11. Randomized, Controlled Trial of Fractional Carbon Dioxide Laser Resurfacing Followed by Ultrashort Incubation Aminolevulinic Acid Blue Light Photodynamic Therapy for Actinic Keratosis.

    PubMed

    Alexiades, Macrene

    2017-08-01

    Aminolevulinic acid (ALA) photodynamic therapy (PDT) is an established treatment option for actinic keratosis (AK), and recently fractional carbon dioxide (CO2) laser was shown to improve outcomes; but studies of short incubation photosensitizer are lacking. Assess the efficacy of short incubation ALA followed by blue light PDT with and without previous fractional CO2 treatment for the treatment of AK. Randomized, paired split-design, controlled trial of fractional CO2 followed by ultrashort 15-minute versus 30-minute incubation ALA and blue light PDT for the treatment of AK on the face. The complete clearance rates (CRs) at 8 weeks after ALA PDT with and without FxCO2 at 30- and 15-minute ALA incubation times were 89.78% (+FxCO2) versus 71.20% CR (-FxCO2) at 30', and 86.38% (+FxCO2) versus 69.23% (-FxCO2) at 15' ALA incubation. All lesion improvements were statistically significant. This randomized, comparative paired group controlled clinical study demonstrates that ultrashort 15- and 30-minute incubation ALA PDTs are of limited efficacy for the treatment of AK. Pretreatment with fractional ablative resurfacing yields statistically significant greater AK clearance with ALA-PDT at ultrashort ALA incubations followed by blue light.

  12. Bucher's indirect comparison of daylight photodynamic therapy with methyl aminolevulinate cream versus diclofenac plus hyaluronic acid gel for the treatment of multiple actinic keratosis.

    PubMed

    Calzavara-Pinton, Piergiacomo; Zane, Cristina; Pacou, Maud; Szeimies, Rolf-Markus

    2016-10-01

    Actinic keratosis (AK) is a pre-cancerous condition characterised by patches of thick, scaly skin developing on sun-exposed areas of the body. When multiple AKs develop on severely photodamaged skin, commonly used treatments include photodynamic therapy and diclofenac plus hyaluronic acid gel (DHA). Methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) is an alternative to conventional photodynamic therapy (MAL c-PDT). Trials have indicated that MAL DL-PDT is as effective as MAL c-PDT but reduces treatment-related pain and dermatological side effects. To indirectly compare between MAL DL-PDT and DHA in patients with AK. A total of three randomised trials were collected using a systematic literature review. An adjusted indirect comparison was conducted on complete lesion response rate at 12 weeks. The data indicated that mild lesions, moderate lesions, and mild and moderate lesions treated with MAL DL-PDT were more than four times more likely to undergo a complete response than lesions treated with DHA at 12 weeks, with ORs ranging from 4.23 to 4.81. Results were all statistically significant. This is the first indirect comparison demonstrating the effectiveness of MAL-PDT over DHA for the treatment of AK, and further research is needed to assess the long-term efficacy of these interventions (i.e. six months and beyond), as well as safety and patient-reported outcomes.

  13. Immunohistochemical analysis of TIMP-3 and MMP-9 in actinic keratosis, squamous cell carcinoma of the skin, and basal cell carcinoma.

    PubMed

    Poswar, Fabiano O; Fraga, Carlos A C; Farias, Lucyana C; Feltenberger, John D; Cruz, Vitória P D; Santos, Sérgio H S; Silveira, Christine M; de Paula, Alfredo M B; Guimarães, André L S

    2013-11-01

    The expression of metalloproteinases and their inhibitors has been related to different invasive and metastatic potentials in cancer. This study aims to investigate the immunohistochemical expression of TIMP-3 and MMP-9 in samples of basal cell carcinoma (BCC), squamous cell carcinoma of the skin (SCC), and actinic keratosis (AK). Immunohistochemistry was performed to evaluate the expression of TIMP-3 and MMP-9 in samples of BCC (n=22), SCC (n=10), and AK (n=15). Ten fields of both tumor parenchyma and tumor stroma were photographed and counted in image software. The ratio of positive cells to total cells was used to quantify the staining. A higher expression of MMP-9 was found in tumor stroma of SCC compared to BCC and AK. No significant differences in TIMP-3 expression were observed among the groups. Considering the well-described differences between these neoplasms, these results provide additional evidence of the role of MMP-9 in tumor invasiveness of keratinocyte-derived tumors.

  14. Linkage analysis of keratosis follicularis spinulosa decalvans, and regional assignment to human chromosome Xp21.2-p22.2.

    PubMed Central

    Oosterwijk, J C; Nelen, M; van Zandvoort, P M; van Osch, L D; Oranje, A P; Wittebol-Post, D; van Oost, B A

    1992-01-01

    Keratosis follicularis spinulosa decalvans (KFSD) is a rare X-chromosomal disorder. It consists of follicular hyperkeratosis of the skin, scarring alopecia of the scalp, absence of the eyebrows, and corneal degeneration. There is photophobia in childhood, but the symptoms tend to diminish after puberty, and prognosis for vision is good. Some heterozygotes do show clinical symptoms. In a large Dutch pedigree we performed DNA analysis in order to localize the KFSD gene. In 54 individuals, including 21 affected males, RFLP analysis was done using DNA probes covering the X chromosome. Two-point linkage analyses with 19 informative DNA markers revealed significant linkage to DNA probes on Xp21.1-p22.3. The highest lod scores of 5.70 and 4.38 were obtained with DXS41 and DXS16 at a recombination fraction of zero and 4 cM, respectively. Multipoint linkage data place KFSD between DXS16 and DXS269. Our data confirm X linkage of KFSD in this family and tentatively map the gene on Xp22.2-p21.2. Combined with clinical investigation, RFLP analysis may become an important tool in carrier detection. PMID:1550124

  15. Feasibility of daylight-mediated photodynamic therapy for actinic keratosis throughout the year in Central and South America: a meteorological study.

    PubMed

    Grinblat, Beni; Galimberti, Gaston; Pantoja, Gonzalo; Sanclemente, Gloria; Lopez, Miguel; Alcala, Daniel; Torezan, Luís; Kerob, Delphine; Pascual, Thierry; Chouela, Edgardo

    2016-09-01

    Daylight-mediated photodynamic therapy (DL-PDT) is an efficacious treatment option for thin actinic keratosis (AK) that offers advantages over conventional PDT in terms of tolerability, treatment duration, and cost. A clinical study conducted in Australia determined the mean irradiance during a 2-hour exposure to be 305.8 W/m(2) (range: 40-585 W/m(2) ). The protoporphyrin IX light dose is influenced by latitude, weather conditions, and time of year. A recent study of meteorological data concluded that DL-PDT can be performed effectively throughout the year in Australia. Based on the same hypothesis and applying the same methodology, the present study investigated the suitability of daylight to perform DL-PDT in Central and South America. Solar radiation and weather data were gathered and analyzed to assess daylight irradiance (light intensity) throughout a full year across 32 geographical locations in Central and South America. The minimum average daily solar irradiance reported was above 305.8 W/m(2) in all locations investigated throughout the year. Annual averages of daily irradiance ranged from 578 W/m(2) in Chihuahua, Mexico, to 321 W/m(2) in Puerto Montt, Chile. Daylight-mediated PDT for AK can be performed effectively throughout the year in Central and South America given that weather conditions permit a comfortable 2-hour direct exposure to daylight. © 2016 The Authors. International Journal of Dermatology published by John Wiley & Sons Ltd on behalf of International Society of Dermatology.

  16. Palmoplantar keratosis in oculodentodigital dysplasia with a GJA1 point mutation out of the C-terminal region of connexin 43.

    PubMed

    Kogame, Toshiaki; Dainichi, Teruki; Shimomura, Yutaka; Tanioka, Miki; Kabashima, Kenji; Miyachi, Yoshiki

    2014-12-01

    Gap junction proteins are composed of 21 genes of the connexin (Cx) family. They play important roles in cell-cell contact by exchange of small molecules through hemichannels. Hence, mutations of Cx family genes affect various tissues of a body. The mutation of the GJA1 gene, which codes Cx43, causes oculodentodigital dysplasia (ODDD), commonly in an autosomal dominant manner with phenotypic variability. It has been believed that gene mutations causing truncation of the Cx43 C-terminus is necessary and sufficient for palmoplantar keratosis (PPK) development in ODDD patients. Here, we report a case of an ODDD patient developing PPK with a GJA1 gene mutation (c.412G>A/p.Gly138Ser), which was previously reported in a case of ODDD without PPK and expected not to result in C-terminal truncation of Cx43. This case suggests not only C-terminal truncation, but also that a point mutation in the cytoplasmic region of Cx43 can cause PPK in ODDD patients.

  17. Combination of 595-nm pulsed dye laser, long-pulsed 755-nm alexandrite laser, and microdermabrasion treatment for keratosis pilaris: retrospective analysis of 26 Korean patients.

    PubMed

    Lee, Sang Ju; Choi, Min Ju; Zheng, Zhenlong; Chung, Won Soon; Kim, Young Koo; Cho, Sung Bin

    2013-06-01

    Keratosis pilaris (KP) has beenpresented as small keratotic follicular papules with or without surrounding erythema. Various treatments with laser or light therapy have been used for the management of KP with various clinical outcomes. In the present study, we investigated the efficacy and safety of a combination therapy for KP. A total of 29 anatomical sites with KP in 26 patients were treated using a 595-nm pulsed dye laser (PDL) with nonpurpuragenic fluences, a long-pulsed 755-nm alexandrite laser, and microdermabrasion. Clinical improvement was assessed by comparing preand posttreatment clinical photographs and patient satisfaction rates. Evaluation of the clinical results three months after the treatments showed that 12 of the 29 anatomical sites (41.4%) demonstrated Grade 3 clinical improvement, ten (34.5%) had Grade 2 clinical improvement, four (13.8%) showed Grade 1 improvement, and three (10.3%) showed Grade 4 improvement. We observed that KP lesions improved not only in erythema and skin texture, but also in brownish dyschromias. Potential adverse events were not observed, except prolonged posttherapy scaling. Our observations demonstrate that combination therapy using a 595-nm PDL, a long-pulsed 755-nm alexandrite laser, and microdermabrasion can have a positive therapeutic effect on KP.

  18. A study of topical methyl-aminolaevulinate red-light photodynamic therapy in the treatment of actinic keratosis in Chinese patients: a Singaporean experience.

    PubMed

    Oh, C C; Theng, T S C; Chong, W S

    2015-07-01

    The incidence of skin cancers has been increasing in Singapore, owing to the country's location near the equator and its ageing population. Topical photodynamic therapy (PDT) is a treatment method employing light and a topical photosensitizer to treat actinic keratosis (AK). Most published data to date on PDT have been drawn from studies of patient with Fitzpatrick skin phototypes I and II. To evaluate the effectiveness of PDT in the treatment of AK in patients with skin phototype IV in Singapore. This was a retrospective analysis of 13 East Asian patients with AK treated with PDT at the National Skin Centre, Singapore, from 2006 to 2013. The overall clearance rate of AK at 3 months was 81.8% (9 of 11 patients; the other 2 were lost to follow-up). Mild to moderate pain during therapy was a common adverse event. PDT is a useful treatment method for AK in East Asian patients with skin phototype IV. Further larger prospective studies will be needed to evaluate its overall efficacy in East Asian patients. © 2015 British Association of Dermatologists.

  19. Electrospun poly-l-lactide scaffold for the controlled and targeted delivery of a synthetically obtained Diclofenac prodrug to treat actinic keratosis.

    PubMed

    Piccirillo, Germano; Bochicchio, Brigida; Pepe, Antonietta; Schenke-Layland, Katja; Hinderer, Svenja

    2016-11-02

    Actinic Keratosis' (AKs) are small skin lesions that are related to a prolonged sun-damage, which can develop into invasive squamous cell carcinoma (SCC) when left untreated. Effective, specific and well tolerable therapies to cure AKs are still of great interest. Diclofenac (DCF) is the current gold standard for the local treatment of AKs in terms of costs, effectiveness, side effects and tolerability. In this work, an electrospun polylactic acid (PLA) scaffold loaded with a synthetic DCF prodrug was developed and characterized. Specifically, the prodrug was successfully synthetized by binding DCF to a glycine residue via solid phase peptide synthesis (SPPS) and then incorporated in an electrospun PLA scaffold. The drug encapsulation was verified using multiphoton microscopy (MPM) and its scaffold release was spectrophotometrically monitored and confirmed with MPM. The scaffold was further characterized with scanning electron microscopy (SEM), tensile testing and contact angle measurements. Its biocompatibility was verified by performing a cell proliferation assay and compared to PLA scaffolds containing the same amount of DCF sodium salt (DCFONa). Finally, the effect of the electrospun scaffolds on human dermal fibroblasts (HDFs) morphology and metabolism was investigated by combining MPM with fluorescence lifetime imaging microscopy (FLIM). The obtained results suggest that the obtained scaffold could be suitable for the controlled and targeted delivery of the synthesized prodrug for the treatment of AKs.

  20. Dual-channel red/blue fluorescence dosimetry with broadband reflectance spectroscopic correction measures protoporphyrin IX production during photodynamic therapy of actinic keratosis

    PubMed Central

    Kanick, Stephen Chad; Davis, Scott C.; Zhao, Yan; Hasan, Tayyaba; Maytin, Edward V.; Pogue, Brian W.; Chapman, M. Shane

    2014-01-01

    Abstract. Dosimetry for aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy of actinic keratosis was examined with an optimized fluorescence dosimeter to measure PpIX during treatment. While insufficient PpIX generation may be an indicator of incomplete response, there exists no standardized method to quantitate PpIX production at depths in the skin during clinical treatments. In this study, a spectrometer-based point probe dosimeter system was used to sample PpIX fluorescence from superficial (blue wavelength excitation) and deeper (red wavelength excitation) tissue layers. Broadband white light spectroscopy (WLS) was used to monitor aspects of vascular physiology and inform a correction of fluorescence for the background optical properties. Measurements in tissue phantoms showed accurate recovery of blood volume fraction and reduced scattering coefficient from WLS, and a linear response of PpIX fluorescence versus concentration down to 1.95 and 250 nM for blue and red excitations, respectively. A pilot clinical study of 19 patients receiving 1-h ALA incubation before treatment showed high intrinsic variance in PpIX fluorescence with a standard deviation/mean ratio of >0.9. PpIX fluorescence was significantly higher in patients reporting higher pain levels on a visual analog scale. These pilot data suggest that patient-specific PpIX quantitation may predict outcome response. PMID:24996661