In brief

No link between trout and synthetic musk in humans
Danish researchers have found increased quantities of synthetic musk compounds in farmed trout and human milk. The study looked at compounds usually present in detergents and cosmetics that end up in the aquatic environment. As a result, polycyclic musk was found in farmed trout and in human milk from primiparous mothers. The good news is that the concentration of musk xylene in farmed trout has been reducing from 1999 to 2003. There is no link between consumption of farmed trout and the presence of synthetic musk compounds in humans.
Chemosphere 2005; 61 (3):422-31

Simple severity score proves accurate
A study involving a UK dermatology outpatient department and five general practices found that a simple three-item severity score gave as much information to patients about the severity of their atopic eczema than more complicated scoring systems. The three-symptom score – erythema, excoriations and oedema/population – was easy for patients to use, well-tolerated and as accurate as the much more in-depth scoring systems traditionally used. The authors conclude that the three-symptom score is suitable to use as a tool for research studies, or clinical practice.
Arch Dermatol 2005; 141 (9): 1146-51

Exotic mushrooms and dermatitis
Eating exotic mushrooms, particularly shiitake, is very trendy. It is also well-known that eating them raw can cause shiitake dermatitis or toxicodermia. But now Finnish researchers have reported two cases of occupational protein contact dermatitis in growers. Both had immediate IgE-mediated allergy to shiitake and small prick test reactions to fresh shiitake. It had been reported that growers develop specific occupational respiratory and skin diseases unrelated to shiitake dermatitis. The researchers recommend testing for immediate allergy when shiitake contact dermatitis is suspected.
Contact Dermatitis 2005; 53:211-13

Incidence of cancer in atopic eczema cases
The treatment of severe atopic eczema includes some drugs with carcinogenic properties. A Danish follow-up study showed that patients who had been hospitalised with atopic dermatitis during the period 1977 to 1996 had an increased incidence of cancer, with a standard morbidity ratio of 1.5. The majority of excess cancers were keratinocyte carcinomas, but the increase in incidence could be due to detection bias. J Inv Dermatol 2005; 125 (3): 445-49

Patient education in intertrigo
Intertrigo (pictured above) is an inflammation of the skin folds caused by skin-on-skin friction and may present as a nappy rash in children or, in adults, in natural and obesity-created body folds. The authors of a review on this condition explain that the friction in skin folds can lead to a variety of complications, such as secondary bacterial or fungal infections. They recommend minimising moisture and friction with absorptive powders or barrier creams. Patients should also wear light, absorbent clothing, and avoid wool and synthetic fibres. Physicians should educate patients about precautions regarding heat, humidity and outdoor activities. Secondary infections should be treated with antiseptics, antibiotics, or antifungals.
Am Fam Phys 2005; 72 (5): 833-38

Summertime impetigo
A UK retrospective review of 1,552 children with impetigo seen in A&E has concluded that there is a strong correlation between impetigo frequency and seasonal temperature. The eight-year review observed a high number of cases presenting in summer and concluded that this might be caused by more skin-to-skin contact and minor trauma when there is more exposed skin.
Clin Exp Dermatol 2005; 30 (5):512-14

Pressure ulcer and race
Pressure ulcers have long-term health and economical consequences to the patient and society alike. A US study examined the death records of those with pressure ulcer associated deaths from 1990 to 2001. The researchers looked at the burden of pressure ulcer associated morbidity and the racial/ ethnic differences and associated co-morbidities. Of the 114,380 deaths caused by pressure ulcers, 21,365 had pressure ulcers reported as the underlying cause, with about 80 per cent of individuals being at least 75 years old. Other associations were with septicemia (39.7 per cent of pressure ulcer associated deaths), multiple sclerosis, paralysis, Alzheimer’s disease, osteoporosis and Parkinson’s disease. Pressure ulcer associated mortality was higher among black people than among other racial/ethnic groups.
Adv Skin Wound Care 2005; 18(7):367-72

Correct diagnosis of scabies
GPs should have a high index of suspicion to diagnose scabies correctly, an expert review suggests. The authors advise that doctors should consider scabies in any adult with a new onset of widespread eczema or itching. The treatment of choice is permethrin 5% dermal cream, which is well-tolerated and has low toxicity, but it can cause burning and stinging. The authors also advise GPs to ask about family members who experience itching. Treat all close contacts at the same time and also be aware that itching can persist for up to six weeks after treatment.
BMJ 2005; 331:619-22

Allergy in dental patients and staff
Patients presenting with oral or facial symptoms following dental treatment should undergo patch testing and tests for immediate type allergy, according to a UK review. The study also looked at common allergic reactions in dental staff, such as contact allergy to rubber additives, acrylates, formaldehyde and fragrances, and occupational problems such as hand dermatitis, itching, facial eruptions, or respiratory symptoms, and concluded that testing is also beneficial to staff.
Br J Dermatol 2005; 153:479-85

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