New, simplified versus standard photodynamic therapy (PDT) regimen for superficial and nodular basal cell carcinoma (BCC): A single-blind, non-inferiority, randomised controlled multicentre study

BACKGROUND

Topical photodynamic therapy (PDT) is an approved and widely used treatment for low-risk basal cell carcinoma (BCC), comprising two sessions with an interval of 1 week. Simplification of the treatment course can be cost-effective, easier to organize, and cause less discomfort for the patients.

METHODS AND FINDINGS

We performed an investigator-initiated, single-blind, non-inferiority, randomized controlled multicentre study with the objective of investigating whether a simpler and more flexible PDT regimen was not >10% less effective than the standard double PDT in the treatment of primary, superficial, and nodular ≤2 mm-thick BCC and evaluate the cosmetic outcome. With a non-inferiority margin of 0.1 and an expected probability complete response of 0.85, 190 tumours were required in each group. Histologically verified BCCs from seven centres in Norway were randomly assigned (1:1) to either receive a new regimen of single PDT with one possible re-treatment of non-complete responding tumours, or the standard regimen. The primary endpoint was the number of tumours with complete response or treatment failure at 36 months of follow-up, assessed by investigators blinded to the treatment regimen. Intention-to-treat and per-protocol analyses were performed. The cosmetic outcome was recorded. The study was registered with ClinicalTrials.gov, NCT-01482104, and EudraCT, 2011-004797-28. A total of 402 BCCs in 246 patients were included; 209 tumours assigned to the new and 193 to the standard regimen. After 36 months, there were 61 treatment failures with the new and 34 failures with the standard regimen. Complete response rate was 69.5% in the new and 81.1% in the standard treatment group. The difference was 11.6% (upper 97.5% CI 20.3), i.e. > than the non-inferiority margin of 10%. Cosmetic outcomes were excellent or good in 92% and 89% following the new and standard regimens, respectively.

CONCLUSIONS

Single PDT with possible re-treatment of primary, superficial, and nodular ≤ 2-mm-thick BCC was significantly less effective than the approved standard double treatment. The cosmetic outcome was favorable and comparable between the two treatment groups.

Occupational skin diseases from 1997 to 2004 at the Department of Dermatology, University Hospital of Northern Norway (UNN): an investigation into the course and treatment of occupational skin disease 10-15 years after first consultations with a dermatologist

Objectives

We investigate the impact of occupational skin disease consultations among outpatients at the Dermatological Department, University Hospital, Northern Norway.

Study design

From 1997 until 2004, 386 patients with occupational skin disease were examined and given advice on skin care, skin disease treatment, skin protection in further work, and on the legal rights of patients with this disease. Ten to fifteen years later, we wanted to look at these patients in terms of their work situation, the current status of their disease, the help they received from the labour offices, and their subjective quality of life.

Material and methods

In the autumn of 2011 until the spring of 2012, a number of the patients examined in the period from 1997 to 2004 were selected and sent a questionnaire, which they were asked to answer and return, regarding their work situation and the progress and current status of their occupational disease.

Results

A total of 153 (77%) patients answered the questionnaire; 71% of these patients were still in work, and further 15% had old-age retired, 13% were working until then; 16% had retired early because of disability; 54% had changed jobs because of their occupational skin disease; 86% of the patients indicated that the skin disease had improved since our previous investigation.

Conclusions

Our investigation into patients with occupational skin disease documented that the majority of patients who had received professional dermatological consultation and intervention offers were still in the labour market and had good control of their skin disease 10–15 years later. We discovered that 71% of the patients were still employed. 13% had remained in work until they became old age pensioners. Only 16% dropped out of work because of disability. These high percentages may indicate that our intervention has contributed positively to patients’ work conditions and the course of their skin disease.

Allergic contact sensitization in the general adult population: a population-based study from Northern Norway

Few studies have so far addressed the prevalence and risk factors for contact sensitization in the general adult population; however, many such studies have been conducted in hospitals. We present the prevalence of contact sensitization in a general adult population and its relationship to potential risk factors like smoking, ear piercing and atopic diseases. 1236 adults (44.2% men and 55.8% women) were randomly selected from a cross-section of the population in Sør-Varanger municipality, Norway, and patch tested with TRUE Test (Pharmacia, Hillerød, Denmark). Contact sensitivity to at least 1 out of 24 allergens was found in 35.4% of the women and in 14.8% of the men. The most common allergens were nickel (17.6%), cobalt (2.8%), thiomersal (1.9%), fragrance mix (1.8%) and colophony (1.2%). All other allergens were observed in 1.0% or less. In women, ear piercing was an important risk factor for nickel sensitization. No such significant correlation was seen in men [in women relative risk (RR) = 3.30, 95% confidence interval (CI) = 2.01-5.43, and in men RR = 1.82, 95% CI = 0.66-5.00], and contact sensitivity was associated with atopic dermatitis (AD) [adjusted odds ratio (OR) = 1.58, 95% CI = 1.04-2.40] and smoking (adjusted OR = 1.42, 95% CI = 1.01-1.99) in women but not in men. The prevalence of contact sensitivity was common in this general population, especially in women. Smoking and AD might be a risk factor for contact sensitization.

No association between serum eosinophil cationic protein and atopic dermatitis or allergic rhinitis in an unselected population of children

BACKGROUND

In order to obtain background references when dealing with serum eosinophil cationic protein (s-ECP) measurements in children with allergic diseases, population-based studies are important. The objectives of our study were to explore the strength of associations between the s-ECP level and atopic dermatitis (AD), allergic rhinitis (AR) and asthma in an unselected northern Norwegian schoolchildren population.

METHODS

s-ECP was sampled from 396 schoolchildren aged 7-12 years from Sør-Varanger community, northern Norway as a part of a population-based study of allergy. In advance, anamnestic information concerning a history of AD, AR and asthma were obtained. The children underwent a clinical investigation, including skin prick tests and peak expiratory flow measurements, where the presence of AD, AR and asthma were evaluated. The associations of these diseases to the s-ECP values were examined in bivariate statistical analysis.

RESULTS

No statistical significant associations were detected in bivariate analysis between s-ECP and AD, AR or asthma: the mean s-ECP in children without self-reported AD/AR/asthma was 4.6 microg/L [95% confidence interval (CI) 4.0-5.2]. The mean s-ECP in children with self-reported AD or AR or asthma was 5.2 microg/L (95% CI 4.1-6.2), 4.6 microg/L (95% CI 3.5-5.7) and 6.4 microg/L (95% CI 4.4-8.3), respectively. The highest mean s-ECP level was measured in children with clinically diagnosed asthma; 7.1 microg/L (95% CI 4.0-10.3). Above the 75-percentile level of s-ECP, only 17.2% of the children had a history of asthma.

CONCLUSIONS

In this unselected children population, the occurrence of AD or AR was not reflected by an increase in the s-ECP level. The s-ECP was increased in children with asthma, but was not statistically significant. Furthermore, the majority of children with high s-ECP values were not asthmatics. We conclude that the associations between s-ECP and allergic diseases are weak in an unselected population of children.

Atopic dermatitis and respiratory symptoms in Russian and northern Norwegian school children: a comparison study in two arctic areas and the impact of environmental factors

BACKGROUND

The increase in atopic diseases during recent decades has been related to environmental factors such as indoor and outdoor pollution and the ingestion of certain foods. On the other hand, studies from Eastern Europe (with heavy air pollution) have reported a lower prevalence of atopic diseases and sensitization in their schoolchildren than in children living in Western Europe.

OBJECTIVES

This study compares the frequency of atopic diseases and respiratory symptoms in two geographically close arctic areas and points to possible risk factors for development of the diseases.

METHODS

A total of 1734 schoolchildren (1183 in Nikel and 551 in Sør-Varanger) were studied using identical, four-page, self-administered questionnaires.

RESULTS

Atopic diseases were reported in 38.7% of Norwegian and in 24.2% of Russian children (P < 0.001). Atopic dermatitis (AD) (23.6% vs 7.9%; P < 0.001) and allergic rhinoconjunctivitis (AR) (20.6% vs 14.7%; P < 0.001) occurred more frequently in Sør-Varanger, whereas 'self-reported' asthma (12.3% vs 13.1%) was similar in both areas. However, respiratory symptoms such as coughing, wheezing, breathlessness and bronchitis were 3-4 times more frequent in Nikel (P < 0.001).

CONCLUSION

This study disproves a previous hypothesis, i.e. that air pollution must be a major risk factor for the development of atopic diseases. Nevertheless, respiratory tract symptoms may be provoked by environmental pollution. Possible explanations for the higher frequency of atopic diseases in Sør-Varanger may be found in socio-economic and lifestyle differences between the two populations.

Atopic diseases among schoolchildren in Nikel, Russia, an Arctic area with heavy air pollution

The objective of this study was to describe the prevalence rate of atopic diseases among schoolchildren living in the heavily polluted Arctic town of Nikel, Russia. A self-administered questionnaire was distributed to the parents of 1,800 children aged 8-17 years, 1,684 of whom (93.6%) completed and returned the questionnaire. Atopic diseases were reported in 508 (30.2%) of the children and prevalence was similar for both sexes. Atopic dermatitis occurred most frequently (15.5%), followed by allergic rhinoconjunctivitis (13.9%) and asthma (3.9%). The most pronounced influence on atopic diseases in children was having parents with asthma. Indoor dampness was a significant risk factor eliciting atopic diseases, whereas furred pets, passive smoking and carpets did not influence the prevalence of allergy. We conclude that although atopic diseases are a common health problem in Nikel, they are less prevalent than has been reported in recent studies of Northern European countries. Air pollution does not seem to be a major risk factor for the development of atopic diseases.

Asthma and allergy in Russian and Norwegian schoolchildren: results from two questionnaire-based studies in the Kola Peninsula, Russia, and northern Norway

BACKGROUND

Previous studies have shown that the prevalence of asthma and allergy in children is lower in Eastern than Western Europe.

METHODS

We have compared the prevalence of asthma, respiratory symptoms, allergic rhinoconjunctivitis, and atopic dermatitis in schoolchildren aged 7-13 years in a questionnaire-based study conducted in the city of Nikel on the Kola Peninsula, Russia, in 1994 (n = 1143) and another conducted in northern Norway in 1995 (n = 8676).

RESULTS

The prevalence of diagnosed asthma was 5.1% in Russian children and 8.6% in Norwegian children; RR =0.58 (95% CI: 0.44-0.76). The prevalence of all respiratory symptoms was higher in Russian children. The prevalence of allergic rhinoconjunctivitis was 16.9%, in Russian children and 22.1%, in Norwegian children: RR =0.74 (95% CI: 0.65-0.85). The prevalence of atopic dermatitis was 7.4% in Russian children and 19.7% in Norwegian children; RR=0.38 (95% CI: 0.31-0.46).

CONCLUSIONS

We conclude that the prevalence of diagnosed asthma, allergic rhinoconjunctivitis, and atopic dermatitis was higher in Norwegian than Russian schoolchildren. The higher prevalence of respiratory symptoms in Russian children probably reflects a higher prevalence of undiagnosed, nonallergic asthma.

[UV-B comb versus betamethasone solution in scalp psoriasis]

BACKGROUND

The aim of the study was to assess the effectiveness of a UV-B-comb on scalp psoriasis versus betamethasone valerate solution.

MATERIAL AND METHODS

Of 44 adult patients with scalp psoriasis, 22 were treated with a dermalight 80 psoracomb and 22 with betamethasone valerate solution, five times a week for three weeks.

RESULTS

No difference in effect was found at the end of treatment. Two weeks after end of treatment a higher proportion of patients treated with UV-B-comb (7/22) had remained in remission than those treated with betamethasone valerate solution (3/22; p < 0.05).

INTERPRETATION

Treatment with a UV-B-comb offers a good alternative to topical corticosteroids for patients with scalp psoriasis.

Atopic diseases among adults in the two geographically related arctic areas Nikel, Russia and Sør-Varanger, Norway: possible effects of indoor and outdoor air pollution

BACKGROUND

Previous studies have shown lower prevalence of atopic diseases among adults and school-children in Eastern Europe.

OBJECTIVES

To compare the prevalence of atopic diseases among adults in two geographically related arctic areas, Nikel, Russia and Sør-Varanger, Norway. Nikel is a heavily polluted town on the Kola Peninsula.

METHODS

The prevalence of eczema, asthma and allergic rhinoconjunctivitis (AR) was assessed using two identical questionnaire studies. The study in Sør-Varanger was conducted in the autumn of 1991 and comprised 1102 adults. In the spring of 1994, 3368 adults in Nikel completed the 4-page questionnaire. Results The lifetime prevalence of atopic diseases was significantly higher in Sør-Varanger than in Nikel (25.2% vs. 11.2%; P < 0.001), most pronounced for eczema (15.9% vs. 5.9%; P < 0.001) and AR (10.3% vs. 5.6%; P < 0.001). There was no significant difference in the prevalence of asthma between the two areas (5.6% vs. 4.9%; RR 1.1). Indoor dampness, carpeted floors and outdoor pollution were found to be significantly higher in Nikel than in Sør-Varanger (P < 0.0001). Smoking habits were different in the two areas.

CONCLUSION

Atopic diseases in Sør-Varanger were more than twice that found in Nikel. Western lifestyle and new building techniques resulting in poorly ventilated homes may be the main reasons for these differences. Other factors, such as differences in seeking medical help for physical complaints and in the social and political environment, are also suggested.

Atopic disease among adults in Northern Russia, an area with heavy air pollution

The cumulative incidence of atopic disease among adults was assessed in the heavily polluted Russian town Nikel on the Kola peninsula. The study was conducted in spring 1994 using a self-administered questionnaire. A total of 3,368 (93.6%) of the 3,600 subjects returned a completed questionnaire. Information about atopic diseases, smoking habits and living conditions in the family was also obtained. A cumulative incidence of atopic diseases of 11% was reported in 377 adults. This was significantly more frequent in women (12.7%) than in men (9.7%). Smoking habits differed from other western countries, as 53% of males and only 10% of females smoked. Indoor damp was reported by 13% and the keeping of dogs and cats by 52%. Our study indicates that atopic diseases is less frequent among adults in a heavily polluted Arctic Russian town than in western industrialized countries.

Nickel allergy and its relationship with local nickel pollution, ear piercing, and atopic dermatitis: a population-based study from Norway

BACKGROUND

The north-Norwegian population of Sør-Varanger lives close to 2 Russian nickel smelters.

OBJECTIVE

We studied the importance of the local nickel pollution, as well as ear piercing and atopic dermatitis, on the prevalence of nickel allergy in Sør-Varanger.

METHODS

We patch-tested 1767 adults who were randomly selected from 2 different cross-sectional studies; in Sør-Varanger and the reference city of Tromsø, which has no nickel-polluting industry.

RESULTS

Nickel allergy was diagnosed in 27.5% and 31.1% of the women in Sør-Varanger and Tromsø, respectively, and in 5.1% and 5.0% of the men. In women, ear piercing was a strong risk factor (relative risk = 3.30; 95% confidence interval = 2.01 to 5.43). A history of atopic dermatitis was not associated with nickel sensitization. We found no increased risk of nickel allergy in Sør-Varanger compared with Tromsø in adjusted multivariate analyses.

CONCLUSION

The high prevalence of nickel allergy found in Sør-Varanger could not be attributed to pollution from the nearby nickel industry.

Atopic diseases among adults in Sør-Varanger community, northern Norway. An epidemiological study in an arctic area influenced by Russian industrial pollution

BACKGROUND

Atopic diseases are common in western industrialized countries and their prevalence appears to be increasing. The prevalence seems to be higher in the cold, northerly regions of Europe.

AIM

The aim of the study was to assess the prevalence of atopic diseases among adults in Sør-Varanger community, northern Norway, an arctic area at 70 degrees latitude north influenced by industrial pollution from smelting plants on the Kola peninsula.

PATIENTS AND METHODS

The parents of all 575 schoolchildren aged 7-12 years in Sør-Varanger community (northern Norway) received a four page questionnaire concerning home environment and symptoms of allergy. A total of 1102 adults filled in and returned the questionnaire.

RESULTS

25.2% of the adults reported past and/or present symptoms (prevalence) of atopic diseases, whereas 38.7% of the children reported atopic symptoms. The prevalence of eczema occurred in 15.9%, followed by allergic rhinoconjunctivitis (10.3%) and asthma (5.6%), however, a significant difference between sexes was only found for eczema (p < 0.0005). Women smoked more frequently (45.6%) than men (39.0%). Keeping of furred pets occurred in 54.3% and dampness in 3.6% of the homes.

CONCLUSION

This study indicates that the frequency of atopic diseases among adults is only two thirds of that reported in schoolchildren. Thus, the increased prevalence of atopic diseases over one generation could point towards factors associated with western lifestyle and living conditions (allergens and adjuvant factors).

Allergen content in dust from homes and schools in northern Norway in relation to sensitization and allergy symptoms in schoolchildren

BACKGROUND

Previous studies have shown a high prevalence of atopic diseases among school children in the community of Sør-Varanger. Moreover, animal dander followed by pollen and house dust mite, were the most common allergens in skin prick tests.

OBJECTIVE

To assess the allergen content in homes (living-rooms and mattresses) and classrooms of children living in an arctic area at 70 degrees. The presence of allergens in homes and schools and their relationship to atopy was of particular interest.

METHODS

Dust samples from 38 homes and seven schools in northern Norway were collected by vacuum cleaning. The presence of allergens of dog, birch, timothy, Cladosporium herbarum, codfish and hen egg-white was investigated by radio-allergosorbent test (RAST) inhibition and the presence of major allergens of cat Felis domesticus (Fel d I) and house dust mites (HDM) Dermatophagoides pteronyssinus (Der p I) and Dermatophagoides farinae (Der f I) by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Mattresses contained significantly more dust per unit area than living-rooms and classrooms. No statistically significant differences in allergen content for dog, birch, timothy. Cladosporium, codfish and hen egg-white were seen between HDM-sensitized and non-atopic children. Most dust samples contained dog allergens with the highest allergenic activity found in living-rooms of those keeping dogs. An increased level of Fel d I was detected in only one of 38 samples from living-rooms (this family kept a cat) and in 25 of 38 samples from mattresses with ranges from 24 to 84 ng/m2. The highest concentrations were found in mattresses of children keeping cats. Increased levels (> or = 25 ng/m2) of Der p I were found only in homes and virtually only in mattresses of HDM-sensitized children. An increased level of Der f I was found in only one case, i.e. in the mattress of an HDM-sensitized child where additionally Der p I and HDMs were demonstrated microscopically. When relating Der p I to HDM-sensitization an odds ratio of more than 16 (95% CI: 1.6-394.3) was found. All extracts from living-rooms included codfish allergens. Low RAST inhibition values were detected for hen egg-white. Cladosporium, birch and timothy pollen in most samples. Furthermore, the study demonstrated that dust from schools was relatively free of allergens.

CONCLUSION

Previous findings indicating that the main allergen exposure problem in this geographical area is that of pet allergens were confirmed.

[Role of food in atopic eczema]

Some new aspects of adverse reactions to food are reviewed. People quite often blame food for the development of allergic symptoms. These true reactions can be divided into three groups: Immunological (food allergy--type I-IV reactions), non-immunological (intolerance--result of non-immunologic mechanisms) and toxic/biochemical reactions. The patterns of adverse food reactions are age dependent, especially allergy to cow's milk, hen's egg-white and soya, and symptoms appear most frequently in children under three years of age. 10-20% of children report adverse reactions to food, but only 3-5% have IgE-mediated reactions. In children with moderate to severe atopic dermatitis as many as 30% are reported to have food allergies. In adults, it is believed that 3-12% may have some kind of adverse reaction to specific foods, but only 1-2% have food allergy. The most common symptoms of adverse food reactions appear in the skin and in the gastrointestinal tract, but respiratory symptoms are also observed. Once food allergy has been proven conclusively the identified food should be totally eliminated from the diet. If important foods are eliminated the patient's sensitivity should be reevaluated again after a time.

Serum alpha 2-macroglobulin levels in psoriatic patients treated with UVB and PUVA

BACKGROUND

Abnormalities in proteinase metabolisms have been found in psoriasis and higher concentrations of neutral proteinases in psoriatic skin lesions than in unaffected skin of psoriatic patients have been observed.

AIM

The aim of the study was to determine whether repeated whole body UV-(UVB and PUVA) irradiation is associated with changes in proteinase inhibitor alpha 2-macroglobulin (alpha 2-M) in patients with active plaque psoriasis.

PATIENTS AND METHODS

In this study, the sera alpha 2-M levels were evaluated in cases of active plaque psoriasis before UV-, four weeks UVB (15 patients) and PUVA (11 patients) irradiation, and two weeks after completed treatment.

RESULTS

Both UVB and PUVA treatment had no significant influence on alpha 2-M levels in psoriatic sera, it was, however, sufficient to treat most of the skin lesions.

DISCUSSION

The beneficial effect of phototherapy in psoriasis seems not to be mediated through increased binding of proteinases by proteinases inhibitor alpha 2-M from serum.

Viable fungi in indoor air in homes and schools in the Sør-Varanger community during winter

The present study investigated the content of fungal aerospores in homes and schools of house-dust-mite (HDM)-sensitized and control children in a subarctic area. During winter, airborne microfungi were collected from the homes and schools of 19 HDM-sensitized children and 19 nonatopic controls, all living in the community of Sør-Varanger, northern Norway. The samples were cultivated and microfungal growth was identified microscopically. Indoor humidity, temperature, and carbon dioxide (CO2) concentrations were measured. Housing conditions and sociodemographic and symptom data were obtained by a questionnaire. Penicillium was the most common microfungus in both homes and schools, followed by various yeasts, Aspergillus, Cladosporium, and Mucor. The number of infected homes was equal in the HDM-sensitized group and the control group, but aerospore counts were higher in the HDM-sensitized group than in the control group. The lowest aerospore counts were found in the schools. High aerospore counts also appeared to be related to high indoor humidity. The keeping of pets and damp indoor conditions were more frequent in homes of HDM-sensitized children than in the control group, whereas parental smoking and carpeting occurred with equal frequency in both groups. This indicates that no allergy sanitation measures had been undertaken, especially in the homes of the HDM-sensitized children.

House-dust mite content in mattresses in relation to residential characteristics and symptoms in atopic and nonatopic children living in northern Norway

The occurrence of house-dust mites (HDMs) was investigated in the mattresses of 19 children previously found to be skin prick test (SPT) positive to HDM and in 19 nonatopic children derived from an extensive survey of 424 schoolchildren, all living in northern Norway. Domestic mites were counted and identified microscopically. Mite counts ranging from 10 to 1800 mites per gram mattress dust were found in 10 of the 19 HDM-sensitized children compared to none in the control group, corresponding to an odds ratio of more than 20. Of the 540 domestic mites found, 70 were identified by species. Dermatophagoides pteronyssinus (Dpt) was the only HDM species identified (64 mites), while five were storage mites and one was a Tarsonemus species. Positive radioallergosorbent tests (RAST) to Dpt were demonstrated in 9/10 children with and in 5/9 without mite infestation compared to none in the control group. Elevated IgE levels were also found more frequently in children with mite-infested mattresses than in those without. IgE levels were within normal levels in all 19 children in the control group. Latent atopy was found in four children, three with and one without mite infestation. There was no correlation between the concentration of mites and the degree of sensitization. Poor ventilation, increased humidity, and water leak(s) were associated with the presence of domestic mites in mattresses. As HDM growth is highly dependent on humidity and microhabitat, it should be possible to avoid HDM exposure and allergy in this region.

Contact allergy in relation to hand eczema and atopic diseases in north Norwegian schoolchildren

Patch testing was carried out in 424 schoolchildren (223M, 201F), aged 7-12 years, in northern Norway. In 99 (23.3%) of these children, one or more allergic patch test reactions were demonstrated; 30 children reacted to two and 6 to three or more substances; 53 irritant reactions were recorded in 33 (7.8%) of those tested. From a total of 144 positive tests, the most common allergen was nickel (14.9%), followed by cobalt (5.7%), kathon CG (5.2%), lanolin (1.7%) and neomycin (1.4%). Both allergic and irritant reactions were found twice as frequently in girls as in boys. Positive patch tests were significantly more frequent in atopic (28.8%) than in non-atopic (17.9%) children, being most pronounced in atopic girls (37.4%). Hand eczema was reported to have occurred or to be present in 6.5% of cases. Twenty-nine of 36 children reporting hand eczema participated in the clinical examination. Altogether 15 (3.5%) children had hand eczema at the time of the clinical examination but 12 of these children had no previous history of hand eczema. In 14 of these 15 subjects, the eczema was localized to the back of the hands, with 13 having atopic dermatitis. In 4 of these 15 children, an allergic patch test reaction was found; however, in only 2 of these 4 was the test considered to be clinically relevant for the diagnosis allergic hand eczema. In conclusion, irritant hand eczema may occur in early childhood and is most prevalent in children with atopic dermatitis.

Prevalence and some clinical aspects of atopic dermatitis in the community of Sør-Varanger

A study of the prevalence of atopic dermatitis among 7-12-year-old children was carried out in a rural community in Northern Norway close to the Russian border. Of the 424 children investigated, 37% had a past and/or present history of atopic dermatitis (cumulative incidence), whereas 23% were classified as having atopic dermatitis by clinical examination (point prevalence). A history of atopic dermatitis during the past year was reported by 26% of the children. Flexural lichenified dermatitis was present in 88%, and 12% of the children had facial and extensor involvement with or without hand dermatitis. Two thirds of the children showed mild and one third moderate symptoms; only 3 children had severe symptoms confirmed by clinical examination. The ratio of girls with atopic dermatitis to boys with atopic dermatitis was about 1.3:1. Onset of atopic dermatitis within the first 2 years of life occurred in 64% of cases, with no sex differences. Remission of atopic dermatitis occurred in 1 of 8 before the age of 5, with earlier cessation in boys. Mucous membrane atopy alone was reported by 13% of them and in combination with atopic dermatitis also in 13%. Parental history of atopic diseases was reported by 37% of all children, more frequently in mothers than in fathers. In families with no parental history of atopic diseases, 41% of the children appeared to develop some kind of atopic disease; this increased to 63% with a single and to 75% with a double parental history.(ABSTRACT TRUNCATED AT 250 WORDS)

Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy

In 424 schoolchildren (223 boys and 201 girls) aged 7-12 years undergoing routine patch tests, 21.0% (89 children), 38.8% (78/201) of girls and 4.9% (11/223) of boys, had had their ears pierced. 18.6% (79 children, 55 girls and 24 boys) gave a history of cutaneous reactions to metallic jewelry, and in 17.2% (73 children, 49 girls and 24 boys), sensitivity to one or more metals was confirmed. Metal allergy was confirmed by patch testing in only 34.2% of the children with a history of metal dermatitis, and 13.3% of those without a history of metal reactions had, in fact, positive patch tests to 1 or more metals. The low sensitivity (37.0%) and low positive predictive value (34.2%), together with high specificity (85.2%) and high negative predictive value (86.7%), seem to justify dermatological examination of individuals with a positive symptom-based diagnosis only. Nickel sensitivity was found in 14.9% (63 children, 44 girls and 19 boys). There is clearly a relationship between ear piercing and induction of nickel allergy in girls, as nickel sensitivity in girls with pierced ears was 2x (30.8%) that found in those without (16.3%) pierced ears. In boys, nickel sensitivity was much less frequent and few cases were related to ear piercing. Atopy appeared to influence the propensity for developing metal sensitivity in girls, as atopic girls showed positive metal tests 2x as frequently (30.8%) as non-atopic (17.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

A survey of atopic diseases among school children in Sør-Varanger community. Possible effects of subarctic climate and industrial pollution from Russia

The occurrence of atopic diseases in school children in the community of Sør-Varanger was studied on the basis of a questionnaire sent to the parents of all the 575 children aged 7-12 years. 551 children (95.8%), 266 girls and 285 boys, completed the questionnaire. Atopic diseases were reported to be present or to have occurred in 249 (45.2%) of the 551 children, more frequently in girls (50.4%) than in boys (40.4%) (p < 0.02). Asthma occurred in 68 cases (12.3%), with almost the same frequency in girls (13.2%) and boys (11.2%). Allergic rhinoconjunctivitis was detected in 113 children (20.6%); it was slightly more frequent in boys (21.8%) than in girls (18.9%) but did not reach statistical significance. Urticaria occurred in 72 cases (13.1%), more frequently in girls (17.7%) than in boys (8.8%) (p < 0.002), while atopic dermatitis occurred in 130 cases (23.6%), again more frequently in girls (27.6%) than in boys (19.6%) (p < 0.03). Ninety-four (37.8%) of the children experienced more than one atopic symptom. In 75% of the children with dermatitis the age at onset was under 5 and more than 50% of the children with asthma had experienced symptoms before the age of 3. Parental history of atopic diseases was reported by 35.6% of all children, more frequently in mothers (30.2%) than in fathers (20.1%). On the other hand, 30.6% of children with no parental history of atopic diseases appeared to develop some kind of atopic disease; this increased to 48.0% with a single and to 56.1% with a double parental history.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mycosis fungoides. Clinical characteristics and treatment of 6 patients]

Mycosis fungoides is a low grade malignant cutaneous T-cell lymphoma. It is a rare disorder where diagnosis may be difficult to establish in early stages. Usually several years may pass between onset of disease and confirmation of the diagnosis, which should be confirmed histopathologically. Prognosis is difficult to predict and depends on whether mycosis fungoides is limited to the skin or has spread to lymph nodes or viscera. Based on the confirmation of six new cases of mycosis fungoides during the last 18 months by the Department of Dermatology, University Hospital of Tromsø, we discuss clinicopathological findings and alternative methods of treatment.