Prevalence and risk factors for hand eczema among professional hospital cleaners in Denmark: A cross-sectional questionnaire-based study

BACKGROUND

Professional cleaners are commonly affected by hand eczema (HE) due to wet work and exposure to cleaning products in the work environment.

OBJECTIVE

To investigate (1) the prevalence of HE in a group of professional hospital cleaners, (2) the association of HE with various comorbidities and self-reported signs/symptoms of skin lesions and (3) the association of HE with various occupational and personal risk factors in the same population.

METHODS

A cross-sectional questionnaire-based study including all cleaners working in three hospitals in Denmark. The questionnaire was composed of 35 questions. Prevalence is reported using proportions with 95% confidence intervals and compared using difference of proportions and Fisher's exact test.

RESULTS

A total of 122 out of 180 cleaners (response rate = 68%) participated in this study. The self-reported lifetime prevalence of HE among the cleaners was 30.3%, while the 1-year prevalence was 18.9%. HE was significantly associated with a history of atopic diseases. There was a significant correlation between having HE, and self-reported redness and itch of the hands in the last 12 months, as well as the use of hydrochloric acid ≥4 days/week during the last 12 months. Logistic regression analysis found HE significantly associated with washing hands ≥20 times during a working day and a history of atopic dermatitis.

CONCLUSION

Cleaners are at an elevated risk of developing HE. More focus on education/information regarding the prevention and treatment of HE is necessary for the cleaning profession. Self-reported redness and itching of the hands may be a useful prediction of HE in cleaners.

Topical 0.05% clobetasol cream in the treatment of chronic hand eczema: A protocol for systematic review and meta-analysis

BACKGROUND

Chronic hand eczema (CHE) is a recurrent, frequently disabling skin condition that requires daily skin care to prevent transepidermal water loss, posing a significant burden of society and economy. In recent years, topical 0.05% clobetasol cream is widely used for the treatment of CHE for its efficacy, tolerability and safety. Whereas, no systematic review and meta-analysis has been updated up to now. Therefore, this work aims to assess the effectiveness and safety of topical 0.05% clobetasol cream in patients with CHE.

METHODS

Study on topical 0.05% clobetasol cream for CHE will be searched from their inception to December, 2020 with the language restrictions of English and Chinese in 8 databases (PubMed, Cochrane Library, Embase, the web of science, VIP, CNKI, CBM, and WAN FANG). According to the heterogeneity test, a fixed or random-effect model will be used to synthesize data. The primary outcome is the proportion of patients achieving more than 75% reduction in signs and symptoms according to the Hand Eczema Severity Index (HECSI). The secondary outcomes include: scored for 4 different characteristics of the lesions (redness, scaling, lichenification, and pruritus), QoL questionnaire, adverse events, and recurrence events. STATA 13.0 and Review Manager software 5.3 will be used for analysis and synthesis. Two or more reviewers will independently conduct the selection of studies, data extraction, and data analysis.

RESULTS

The results of the study expect to provide a high-quality, evidence-based recommendation on topical 0.05% clobetasol cream in the treatment of CHE for clinicians.

CONCLUSION

The study will provide scientific and useful evidence for better use of topical 0.05% clobetasol cream in treating CHE.

ETHICS AND DISSEMINATION

This study is a protocol for an overview of SRs/MAs that did not involve individual data. Thus, ethical approval is not required.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/SPHVZ.

Sweet syndrome in a patient with chronic hepatitis C

BACKGROUND

Sweet syndrome (SS) is a rare skin condition that is classically idiopathic in etiology, but can also be triggered by malignancy, drug reaction, or infection. Both chronic hepatitis C infection and antiviral agents for the treatment of hepatitis C have been postulated to be possible triggers of SS.

OBJECTIVE

Herein, we present a case of SS in a patient with untreated chronic hepatitis C and cirrhosis but no other significant comorbidities.

Concurrent pyogenic granuloma and bullous impetigo of a pregnant woman's finger

BACKGROUND

Bullous impetigo is a superficial skininfection caused by Staphylococcus aureus (S.aureus). Pyogenic granuloma is a common benigntumor frequently associated with prior trauma.Bullous impetigo and pyogenic granuloma may occurin pregnant women.

PURPOSE

The features of a pregnant womanwith pyogenic granuloma and bullous impetigoconcurrently present in a lesion on her finger aredescribed.

METHODS

PubMed was used to search the followingterms: bullous impetigo, pregnancy, and pyogenicgranuloma. All papers were reviewed; relevantarticles, along with their references, were evaluatedResults: A red ulcerated nodule with a collaretteof epithelium around the tumor and surroundingbullae appeared on the fifth digit of the left hand of a31-year-old woman who was at 36 weeks gestation. Abacterial culture grew methicillin sensitive S. aureus.An excisional biopsy was performed. Histologicfindings revealed not only a benign vascular tumorwith an infiltrate of mixed inflammatory cells, butalso an intraepidermal blister. She received oralantibiotics and there was complete resolution of thefinger lesion and infection with preservation of digitfunction.

CONCLUSION

Albeit uncommon, pyogenic granulomaand bullous impetigo may concurrently occur in thesame lesion. Therapeutic intervention should focuson treating both the benign skin tumor and theinfection.

Dyshidrotic Eczema and Its Relationship to Metal Allergy

Dyshidrotic eczema, also known as dyshidrotic dermatitis or pompholyx, is characterized by pruritic, small tense vesicles mainly on the palmoplantar region and lateral and ventral surfaces of the fingers. While its etiology appears to be related to sweating, as dyshidrotic eczema often occurs in an individual with hyperhidrosis, and the spring allergy season, histologic examination shows an eczematous reaction around the sweat ducts which is not associated with abnormalities of the sweat ducts. More recently, the nomenclature of 'acute and recurrent vesicular hand dermatitis' has been proposed to reflect clinical features of dyshidrotic eczema. Although the exact etiology of dyshidrotic eczema remains unknown, given the presence of metal allergy in patients with dyshidrotic eczema and the improvement of the symptoms by removing metal allergen, metal allergy is regarded as one of the important potential etiologic factors for dyshidrotic eczema.

Milia-like idiopathic calcinosis cutis in a child with Down syndrome

Idiopathic calcinosis cutis refers to progressive deposition of crystals of calcium phosphate in the skin and other areas of the body, in the absence of any inciting factor. Idiopathic calcinosis cutis may sometimes take the form of small, milia-like lesions. Most commonly, such milia like lesions are seen in the setting of Down syndrome. Herein, we report a 5-year-old girl with multiple asymptomatic discrete milia-like firm papules distributed over the face and extremities. A diagnosis of milia-like idiopathic calcinosis cutis associated with Down Syndrome was provisionally made and was confirmed by histopathology and karyotyping.

A case report of crusted scabies in an adult patient with Down syndrome

IMPORTANCE

Crusted (Norwegian) scabies is a severe manifestation of the contagious skin infection caused by Sarcoptes scabiei. Crusted scabies has been well described in patients with known immunocompromised states. Treatment may be complicated by delayed diagnosis and/or inadequate treatment. This infection may not rank highly on one's differential diagnosis in the absence of an immunocompromised state, highlighting the uniqueness of the case being presented. Several papers describe immunocompromised children with Down syndrome who are infected with crusted scabies. We present a case of infection in an adult with Down syndrome without evidence of an immunocompromised state.

OBSERVATIONS

Our patient came to us with a 13-month history of progressively worsening symptoms, the last 4-6 weeks of that time period being most dramatic, despite various treatments. We performed tissue biopsy, culture, and laboratory evaluations, which revealed numerous mites and bacterial superinfection.

CONCLUSIONS AND RELEVANCE

Crusted scabies infection may occur in adult age individuals with Down syndrome regardless of immune status, leading us to encourage practitioners to consider this condition when presented with patients of this population. We also highlight the need for further exploration of disease prevalence in this patient population.

PseudomonasSurgical-Site Infections Linked to a Healthcare Worker With Onychomycosis

Objective:

To determine the etiology ofPseudomonas aeruginosasurgical-site infections following cardiac surgery.

Setting:

University teaching hospital.

Patients:

Those with wound cultures that grewP. aeruginosaafter cardiac surgery performed from 1999 to 2001.

Methods:

Medical records and operating room (OR) records of patients withP. aeruginosacardiac surgical-site infections from 1999 to 2001 were reviewed. Healthcare workers involved with two or more cases were interviewed and examined. Specimens for environmental cultures were obtained from the ORs and cardiac surgical equipment. Cardiac surgery cases were observed and postoperative care and the cleaning of surgical instruments were investigated. OR air handling system records during the epidemic period were reviewed. Molecular fingerprinting of availableP. aeruginosaisolates from infected patients and a healthcare worker was done.

Results:

There were fiveP. aeruginosacardiac surgical-site infections from January to August 2001, compared with no such infections from 1999 to 2000. All were adult patients. One cardiac surgeon with onychomycosis operated on all five cases. He did not routinely double glove. The involved fingernail grewP. aeruginosa.ThreeP. aeruginosapatient isolates were available for pulsed-field gel electrophoresis; two were identical to the isolate from the involved surgeon's onychomycotic nail. No environmental OR cultures grewP. aeruginosa.The surgeon's culture-positive nail was completely removed. There have been noP. aeruginosasurgical-site infections among cardiac surgery patients since this intervention.

Conclusion:

At least two cases of a cluster ofP. aeruginosasurgical-site infections resulted from colonization of a cardiac surgeon's onychomycotic nail.

Characteristics and provision of care in patients with chronic hand eczema: updated data from the CARPE registry

The aim of the CARPE registry is to investigate characteristics and medical care in patients affected by chronic hand eczema. Patients are assessed by dermatological examination and patient questionnaire. Socio-economic and clinical data are collected, and quality of life is measured using the Dermatology Life Quality Index (DLQI). A total of 1,163 patients with chronic hand eczema were eligible for analysis (mean age 47.0 years; 54.6% female; mean disease duration 7.6 years). At inclusion, chronic hand eczema was very severe in 23.4%, severe in 47.0%, moderate in 20.1%, and clear or almost clear in 9.6% of patients. Median DLQI was 8.0. In all, 93.8% of patients reported use of topical corticosteroids, 25.6% systemic antihistamines, 28.3% topical calcineurin-inhibitors, 38.0% ultraviolet phototherapy, and 35.3% systemic treatment (19.7% alitretinoin) prior to inclusion in the registry. A significant proportion of patients may not receive adequate treatment according to the guideline on management of hand eczema.

[A woman with paraneoplastic dermatoses; signs of recurrent malignancy]

BACKGROUND

Paraneoplastic dermatoses may be the first manifestation of a malignancy. Rapid recognition is therefore important.

CASE DESCRIPTION

A 72-year-old woman who had been treated in the past for metastasised neuroendocrine carcinoma and had undergone curative treatment for stage-1c endometrial carcinoma developed three paraneoplastic dermatoses over a 2-year period: acanthosis nigricans, tripe palms and acquired hypertrichosis lanuginosa. Half a year later, cutaneous metastases derived from the endometrial carcinoma treated 12 years prior were discovered.

CONCLUSION

The development of three paraneoplastic dermatoses in a short period of time is rare. Acanthosis nigricans, tripe palms and acquired hypertrichosis lanuginosa can develop in association with both neuroendocrine and endometrial carcinoma. The sudden development of paraneoplastic dermatoses is frequently a forewarning of progression of the malignancy.

Tripe palms associated with malignant acanthosis nigricans in a patient with gastric adenocarcinoma: a case report and review of the literature

Tripe palms (TP) is a rare dermatologic condition. TP alone, or associated with malignant acanthosis nigricans (MAN), in most cases is a cutaneous paraneoplastic disorder and its recognition should prompt a full diagnostic work-up for an underlying malignancy. We report a case of a patient in whom the correct identification of TP and MAN has allowed early diagnosis of gastric cancer. Paraneoplasias are frequently the first sign of an underlying malignant tumor. Although relatively rare, they need to be recognized by dermatologists to make an early diagnosis and improve the prognosis related to the neoplasia.

Stubborn hand rash

Was there a connection between the rash on this patient's hand and another condition he occasionally suffered from?

Blastomycosis-like pyoderma in association with recurrent vesicular hand eczema: good response to acitretin

Blastomycosis-like pyoderma, also known as pyoderma vegetans, is an uncommon disease characterized by vegetating skin lesions mimicking blastomycosis or warty tuberculosis, often associated with staphylococcal and streptococcal infections. It is more commonly observed in elderly patients with impaired immunological capacity, and is often unresponsive to various therapeutic modalities. We describe a case of BLP that occurred on the palmar aspect of the left hand in an elderly female, affected with recurrent vesicular hand eczema. The disease resolved completely following the administration of oral acitretin 25 mg/day for 10 weeks.

Successful treatment of hand and foot psoriasis with infliximab

Hand and foot psoriasis is a disabling condition associated with significant quality-of-life issues. It is characterized by hyperkeratosis and/or the development of recurrent crops of sterile pustules with associated erythema, fissuring, and scaling symmetrically localized on palm and soles. Systemic conventional therapies include retinoids, psoralen-UVA (PUVA), methotrexate, and cyclosporine. So far, only limited evidence supports the use of TNF-alfa blockers. Because there are reports of paradoxical induction of pustular psoriasis following the use or withdrawal of infliximab as well as other TNF inhibitors, the use of these agents in palmoplantar psoriasis has been cautioned. The authors describe the clinical characteristics and evolution of 4 adult patients with severe palmoplantar psoriasis who were treated successfully with infliximab. Patient data is available for a minimum of 10 months and as many as 16. One of them with concomitant HCV infection showed no increased viral replication or progression of liver disease for a follow-up of 10 months; afterwards infliximab was stopped because of an infusion-related urticaria. All other patients displayed a good clinical response (> or =PPPASI 50) and were still receiving this regimen at last observation. This report provides preliminary evidence to support a cautious use of infliximab in patients with palmoplantar psoriasis.

Autologous cytokine-induced killer cells in the treatment of multiple myeloma concomitant with lung cancer and paraneoplastic dermatoses

Cytokine-induced killer (CIK) cells have been shown to be effective in the treatment of advanced cancer and minimal residual diseases. We report a multiple myeloma (MM) patient with concomitant lung cancer and paraneoplastic dermatoses, who received cellular immunotherapy with CIK cells which were derived from peripheral blood mononuclear cells (PBMCs) after being primed with anti-cluster of differentiation 3 (CD3) monoclonal antibody, interleukin-2 (IL-2), interferon-γ (IFN-γ) and IL-1. After treatment MM and lung cancer remained stable and no progression or recurrence was observed. Paraneoplastic dermatoses were obviously improved after treatment, which was first reported. No evident side effects were observed. These findings suggested that cellular immunotherapy with CIK cells was safe and effective in this patient with MM and lung cancer, and it might be a potent therapeutic option for paraneoplastic dermatoses.

Neutrophilic dermatosis of the dorsal hands associated with hypopharyngeal carcinoma

Neutrophilic dermatosis of the dorsal hands (NDDH) is a rare and recently described disorder regarded as a subset of neutrophilic dermatosis, similar to superficial pyoderma gangrenosum and pustular vasculitis. Many currently consider it to be a localized variant of Sweet Syndrome. We describe the case of a 63-year-old male patient with NDDH associated with hypopharyngeal carcinoma. A biopsy demonstrated changes consistent with those seen in Sweet Syndrome, with leukocytoclasia but no signs of true vasculitis. Treatment with oral prednisolone resulted in complete resolution of the lesions in 1 month, with no recurrences. The clinical presentation, the histological features, and the excellent response to oral corticosteroid therapy allowed us to classify this case as NDDH. We emphasize the rare association of this entity with a solid tumor.

Circumscribed acral hypokeratosis

BACKGROUND

Circumscribed acral hypokeratosis (CAH) is an idiopathic condition that typically presents as an acquired, solitary, asymptomatic, well-defined, depressed, flat-based deformity, with a slightly raised border on the palm or, rarely, the sole. Histologically, the lesional epidermis is depressed with a characteristic, abrupt, hyperkeratotic, slightly-raised ridge at the transition from normal skin.

OBJECTIVE

We sought to present 3 additional cases of CAH.

METHODS

A review of 3 cases of CAH was performed. Liquid phase polymerase chain reaction (PCR) was conducted to evaluate for human papillomavirus (HPV).

RESULTS

Three cases of CAH were reviewed. One patient had a history of a burn at the site prior to developing the disorder while another patient, as a child, had a history of verruca plantaris in the same location. Lesions were solitary, involving the palm or sole, in 2 cases and in one case they were multiple involving both the palms and the soles. HPV testing detected HPV type 6 in the lesion of one patient who previously was treated for warts in the same location. Topical fluorouracil, calcipotriol ointment under occlusion, and clobetasol ointment under occlusion were unsuccessful in one patient.

LIMITATIONS

In case 2, we were pathology consultants and unable to evaluate the clinical appearance of the lesion.

CONCLUSIONS

CAH may involve palms and/or soles. Lesions may be solitary or multiple, and vary widely in size. We believe that CAH most likely represents a reaction pattern developing in response to various stimuli, including trauma, HPV, or both.

Evaluation of quality of life in patients with toenail onychomycosis by Polish version of an international onychomycosis-specific questionnaire

BACKGROUND

Onychomycosis is the most frequent nail disease, which could impair the patient's quality of life.

OBJECTIVE

The present study was undertaken to evaluate the impact of toenail onychomycosis on quality of life among Polish population.

PATIENTS AND METHODS

Three thousand nine-hundred and four (3904: 2269 females and 1635 males) individuals fulfilled an international onychomycosis-specific quality-of-life questionnaire consisting of statements regarding social, emotional and symptoms problems. All patients had toenail onychomycosis confirmed by the positive direct microscopic examination and/or by the positive mycologic culture. Seven hundred and sixty-seven patients simultaneously had fingernail onychomycosis. All patients were divided into subgroups according to sex, age, education level, place of living, type of onychomycosis, number of involved toenails, fingernails involvement, duration of illness and previously used antimycotic therapy.

RESULTS

Most of the patients demonstrated significantly reduced quality of life. The degree of life impairment varied between analysed subgroups. Patients with more advanced toenail onychomycosis and with fingernail involvement were more seriously affected. Both social and emotional impairments were more pronounced in female than in male patients, although there were no differences according to symptoms. Moreover, patients with better educational level and people living in towns or cities were more emotionally and socially affected by onychomycosis, although people living in the country or with poorer education level presented with significantly more severe symptoms.

CONCLUSIONS

Toenail onychomycosis is still a serious medical problem, which can significantly reduce the patient's quality of life.

Syndrome of remitting seronegative symmetrical synovitis with pitting oedema (RS3PE)

RS3PE syndrome, often mimicking rheumatoid arthritis (RA) or polymyalgia rheumatica (PMR), has puzzled the rheumatologists until late'80s. Though the nature of the disease still remains illusive, the outcome is excellent. This present study analyzes the clinical, radiological and immunogenetical characteristics of five patients diagnosed with RS3PE syndrome, with review of literature.

Contact sensitivity and atopic dermatitis: association with prognosis, a follow-up study in 801 atopic patients

The influence of contact sensitivities on the course of atopic dermatitis (AD) is not known. The objective of the study is to find the course of AD in atopic patients with and without contact sensitivities. A total of 801 atopic patients were studied and patch tested in 1983/84. A questionnaire focusing on the occurrence of dermatitis was sent to these patients 16 years later. During the follow up the number of symptom-free patients increased from 36.7% to 40.7%. In patients with positive patch-test reactions, 30.1% were symptom free in 1983/84 and 38.3% at the follow up (P= 0.001). Among those with positive patch-test reactions to fragrance mix and/or balsam of Peru, the number of symptom-free patients had increased the most: from 26.9% to 42.6% (P= 0.0095), and a similar tendency was seen among those with nickel allergy. The occurrence of dermatitis did not change among patients without contact sensitivities. Thus, the study concluded that contact allergy does not impair the prognosis of dermatitis in atopic patients.

Calcinosis cutis of the fingertip associated with Raynaud's phenomenon

Cutaneous calcification may be divided into four major categories: (i) dystrophic; (ii) metastatic; (iii) idiopathic; and (iv) iatrogenic. Dystrophic calcification is the most common type of calcinosis cutis and is associated with a variety of diseases. It most notably occurs in connective tissue diseases. Diffuse and limited cutaneous systemic sclerosis is an example of connective tissue diseases that frequently show calcinosis. We experienced a case of fingertip calcinosis cutis associated with Raynaud's phenomenon. The patient had no previous trauma, skin lesion or systemic connective tissue disease. We propose that calcinosis cutis of the fingertip may result from chronic ischemic injury caused by Raynaud's phenomenon.