Rødovre, Denmark
Rødovre, Denmark

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Thyssen J.P.,National Allergy Research Center | Johansen J.D.,National Allergy Research Center | Menne T.,Gentofte University Hospital | Nielsen N.H.,Dermatology Clinic | Linneberg A.,Copenhagen University
Acta Dermato-Venereologica | Year: 2010

There is evidence that stimulants such as alcohol and tobacco have an effect on the immune system, but little is known about how these lifestyle factors affect the prevalence of contact sensitization. This study investigated whether smoking and alcohol consumption were associated with contact sensitization and nickel sensitization. A random sample of adults (n=3460) from the general population of Copenhagen was invited to participate in a general health examination including patch-testing. Alcohol consumption was not associated with nickel sensitization, whereas a significant trend (p<0.05) was identified between smoking status and nickel sensitization in an adjusted model; i.e. nickel sensitization was higher among both previous smokers (odds ratio (OR)=1.19; confidence interval (CI)=0.81-1.76), current light smokers (OR=1.50; CI=0.94-2.37) and current heavy smokers (OR=1.56; CI=0.87-2.80) compared with never smokers. This study confirmed that smoking is associated with nickel sensitization, but rejected an association with alcohol consumption. © 2010 The Authors.

Thyssen J.P.,Copenhagen University | Linneberg A.,Copenhagen University | Menne T.,Gentofte University Hospital | Nielsen N.H.,Dermatology Clinic | Johansen J.D.,Copenhagen University
British Journal of Dermatology | Year: 2010

Background Hand eczema is a prevalent disorder that leads to high health care costs as well as a decreased quality of life. Important risk factors include atopic dermatitis, contact allergy and wet work whereas the role of null mutations in the filaggrin gene complex remains to be clarified. It has been debated whether life-style factors such as tobacco smoking and alcohol consumption are associated with hand eczema. Objectives The current study aimed to investigate whether self-reported hand eczema was associated with smoking and alcohol consumption in the general population. Methods Between June 2006 and May 2008, a cross-sectional study was performed in the general population in Copenhagen, the capital of Denmark. A random sample of 7931 subjects aged 18-69 years old was invited to participate in a general health examination including a questionnaire; 3471 (44%) participated. Data were analysed with logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CI). Results The prevalence of hand eczema was higher among previous smokers (OR = 1·13; CI = 0·90-1·40), current light smokers (OR = 1·51; CI = 1·14-2·02) and current heavy smokers (OR = 1·38; CI = 0·99-1·92) compared with never-smokers. Conclusions Tobacco smoking was positively associated with hand eczema among adults from the general population in Denmark. Apparently, current light smokers (< 15 g daily) had a higher prevalence of hand eczema than current heavy smokers (> 15 g daily) but this needs to be reconfirmed. Alcohol consumption was not associated with hand eczema. © 2009 British Association of Dermatologists.

Rich P.,Oregon Health And Science University | Bourcier M.,Dermatology Clinic | Sofen H.,University of California at Los Angeles | Fakharzadeh S.,Janssen Biotech Inc. | And 5 more authors.
British Journal of Dermatology | Year: 2014

Background Most patients with psoriasis have nail changes, and treating nail psoriasis is challenging. Objectives To assess improvement in fingernail psoriasis with ustekinumab treatment in the PHOENIX 1 trial. Methods Patients received ustekinumab 45 mg or 90 mg, or placebo at weeks 0 and 4. Ustekinumab-randomized patients continued maintenance dosing every 12 weeks, while patients receiving placebo crossed over to receive ustekinumab 45 mg or 90 mg at weeks 12/16 followed by dosing every 12 weeks. At week 40, initial responders [those with ≥ 75% improvement from baseline in Psoriasis Area and Severity Index (PASI 75)] were rerandomized either to continue maintenance dosing or to withdraw from treatment. Nail involvement was evaluated using the Nail Psoriasis Severity Index (NAPSI) on a target fingernail, Nail Physician's Global Assessment (Nail PGA) and mean number of nails involved. Results Of 766 randomized patients, 545 (71·1%) had nail psoriasis. At week 24, the percentage improvement from baseline NAPSI score was 46·5% (ustekinumab 45 mg) and 48·7% (ustekinumab 90 mg). Percentage improvements in NAPSI ranged from 29·7% (PASI < 50) to 57·3% (PASI ≥ 90). Mean NAPSI scores improved from 4·5 at baseline to 2·4 at week 24 (45 mg) and from 4·4 to 2·2 (90 mg). Nail PGA scores and the mean number of psoriatic nails improved by week 24. Further improvement was observed for all end points among initial responders continuing maintenance treatment through week 52. Conclusions Ustekinumab significantly improves nail psoriasis, and improvements continue over time until up to 1 year of treatment in those receiving maintenance treatment. What's already known about this topic? The majority of patients with moderate-to-severe psoriasis have nail manifestations, for which limited therapies are available. What does this study add? Beyond the recognized benefit to the skin in psoriasis, ustekinumab significantly improves nail psoriasis over time. Both nail and skin manifestations of psoriasis should be considered when choosing treatment. © 2013 British Association of Dermatologists.

Menne T.,Copenhagen University | Johansen J.D.,Copenhagen University | Sommerlund M.,Aarhus University Hospital | Veien N.K.,Dermatology Clinic
Contact Dermatitis | Year: 2011

Background. Classification of hand eczema has traditionally been based both on aetiology and clinical appearance. For 20% of cases, the aetiology is unknown. Objectives. To suggest a classification based on well-defined aetiology as well as on predefined clinical patterns and on the dynamics of hand eczema. Methods. Literature studies and discussions among members of the Danish Contact Dermatitis Group. Results. Criteria are given for the aetiological diagnoses of allergic contact dermatitis of thehands, irritant contact dermatitis of the hands, protein contact dermatitis of thehands, atopic hand eczema and aetiologically unclassifiable hand eczema. Six different clinical patterns are described and illustrated. Suggestions for general treatment principles are given. Conclusion. Operational guidelines for the diagnosis and treatment of hand eczema are described. © 2011 John Wiley & Sons A/S.

Xia Y.,San Antonio Uniformed Services Health Education Consortium | Cho S.,Dermatology Clinic | Howard R.S.,U.S. Army | Maggio K.L.,U.S. Army
Journal of the American Academy of Dermatology | Year: 2012

Background: Pseudofolliculitis barbae (PFB) significantly impacts the military population, especially deployed personnel. Objective: This study was designed to determine whether the addition of topical eflornithine to hair laser treatment would improve efficacy in treating PFB. Methods: This was a randomized, double-blinded, placebo-controlled, paired (right and left neck) comparison study examining a combination of eflornithine and hair laser versus placebo and hair laser for the treatment of PFB. In all, 27 male patients with clinical PFB were treated with a long-pulsed neodymium:yttrium-aluminum-garnet laser with an energy fluence of 25 to 30 J/cm2, a pulse duration of 20 to 30 milliseconds, and a 10-mm spot size to the entire bearded neck region. The laser treatment was performed every 4 weeks for a total of 16 weeks. Between laser treatments, patients applied eflornithine and placebo creams twice daily to opposite sides of the bearded neck region. The number of hairs and inflammatory papules were counted bilaterally at each visit. Results: The eflornithine side had a statistically significant decrease in the number of hairs and inflammatory papules compared with the placebo side. At 16 weeks, the eflornithine side had a median hair reduction of 99.5% from baseline (range 48.5%-100.0%), whereas the placebo side had an 85.0% median hair reduction from baseline (range 50.5%-94.5%), P less than.001. Limitations: Patients were not followed up beyond 16 weeks. Conclusion: The addition of topical eflornithine to hair laser treatment decreased hairs and inflammatory papules faster when compared with hair laser therapy alone in the treatment of PFB.

Veien N.K.,Dermatology Clinic
International Journal of Dermatology | Year: 2011

Systemic contact dermatitis is an inflammatory skin disease that may occur in persons with contact allergy when they are exposed to the hapten orally, transcutaneously, per rectum, intravesically, intravenously, or by inhalation. The most common causes of systemic contact dermatitis are drugs used both topically and systemically. Other causes are ubiquitously occurring haptens, such as the metals nickel, cobalt, gold, and chromate, and aromatic substances such as spices. Avoidance of the offending hapten is the most obvious treatment. For some haptens, such as nickel, diet treatment may be effective. Chelation therapy with disulfiram is another therapeutic option in nickel-allergic patients with systemic contact dermatitis. Hyposensitization therapy has been attempted with some success in systemic contact dermatitis caused by nickel and Parthenium hysterophorus. © 2011 The International Society of Dermatology.

Erdem O.,Gazi University | Wyatt A.J.,Dermatology Clinic | Lin E.,University of Texas M. D. Anderson Cancer Center | Wang X.,University of Texas M. D. Anderson Cancer Center | Prieto V.G.,University of Texas M. D. Anderson Cancer Center
American Journal of Dermatopathology | Year: 2012

Dermatofibrosarcoma protuberans (DFSP) is a relatively rare low-grade sarcoma. Local control can usually be achieved by wide local excision, but some patients still develop recurrences. The aim of this study was to investigate the correlation between clinicopathologic factors and recurrence-free survival (RFS)/overall survival (OS) in a large series of DFSP patients from a single institution. The study group included sections and medical records of 122 patients (63 women and 59 men, median age of 43) with primary DFSP from UT-MD Anderson Cancer Center between 1976 and 2005. Fibrosarcomatous change was detected in 24 (20.9%) patients. Thirty-eight of 120 patients (31.7%) recurred with a median RFS of 10.2 years. The 5-year RFS rate was 64.2%. Based on univariate analyses, fibrosarcomatous change, mitotic count, metastasis at time of diagnosis, and acral location were significantly associated with shorter RFS. On multivariate analysis, acral location and fibrosarcomatous change remained significant for shorter RFS. Five-year OS was 95.5% (95% confidence interval: 75.42%-99.3%). On univariate analysis, mitotic count per square millimeter, presence of necrosis, and metastasis at time of diagnosis were significantly associated with lower OS. On multivariate analysis, only presence of metastasis remained significantly associated with shorter OS. DFSP-FS variant and acral site are associated with shorter recurrence-free interval after wide local excision. Therefore, patients with tumors on acral sites or those with a fibrosarcomatous component may benefit from aggressive therapies other than wide local excision. The only factor that remains significantly associated with decreased OS is detection of metastasis. Copyright © 2012 by Lippincott Williams & Wilkins.

Mollerup A.,Copenhagen University | Veien N.K.,Dermatology Clinic | Johansen J.D.,Copenhagen University
Contact Dermatitis | Year: 2014

Summary Background Hand eczema is a common disease, and continuous preventive skin protection and skin care must be adopted to prevent a chronic course. Hand eczema is not a uniform disease, and counselling must therefore be individually tailored.Objectives To evaluate the effectiveness of a nurse-led counselling programme, the Healthy Skin Clinic, emphasizing the patient's self-management, resources, and risks.Patients and methods Patients (n = 306) referred for diagnostic work-up and treatment of hand eczema were randomized and allocated either to the programme or to usual care. The primary outcome was clinical disease severity at follow-up. Secondary outcomes were quality of life, burden of disease, skin protective behaviours, and self-reported medication adherence.Results Patients in the intervention group had greater reductions in clinical severity and reported more beneficial behavioural changes at follow-up than those in the usual-care group. This was especially true of patients who were treated solely with topical corticosteroids and who had a primarily exogenous aetiology of hand eczema. However, the effect was very dependent on baseline disease severity. No differences in quality of life or burden of disease were found between the two groups.Conclusion A tailored nurse-led programme of skin protection counselling may be recommended as an essential part of hand eczema treatment. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Mollerup A.,Copenhagen University | Veien N.K.,Dermatology Clinic | Johansen J.D.,Copenhagen University
Contact Dermatitis | Year: 2014

Background Hand eczema is often related to high-risk occupations and aggravating exposures in everyday life. The disease is twice as frequent in women as in men, partly because of diverse exposure patterns. Other gender differences may be relevant for treatment and prevention. Objectives To gain insights into the common features and differences between men and women with hand eczema. Methods The clinical disease severity of patients (n = 306) attending for dermatological treatment at two settings was assessed with the Hand Eczema Severity Index (HECSI). Self-reported medication adherence, aggravating factors, hand eczema-related consequences and quality of life were obtained from a questionnaire. Results Men and women had equal clinical severities of disease, with an overall median HECSI of 43. Self-reported medication adherence was equal between the genders, but, among patients aged > 40 years, more reported higher adherence. The impact of disease was larger in women than in men. Women reported significantly more aggravating factors and sick leave. Also, women had a more impaired quality of life than men at equal levels of disease severity, and this could be associated with the higher number of aggravating factors. Conclusion Gender differences in hand eczema need to be considered in the dermatological treatment and counselling of patients. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Colombo D.,Dermatology Clinic
International journal of immunopathology and pharmacology | Year: 2010

For the past 25 years, cyclosporine A (CyA) has played a pivotal role in transplant immunosuppressant therapy. From the availability of the 2 primary marketed formulations (Sandimmun® and Sandimmun Neoral®, Novartis), confusion has existed with regard to whether these two formulations are bioequivalent. Due to the underlying clinical relevance of this information, we therefore conducted a meta-analysis of all available comparative pharmacokinetic studies to assess whether the two different CyA formulations, Sandimmun® and Sandimmun Neoral®, can be considered bioequivalent. All clinical studies that compared the bioavailability of the 2 formulations in organ transplant recipients were considered for analysis. We searched computerised databases (Embase/Excerpta Medica and Medline/PubMed) from their inception to May 2010. Only studies with AUC values determined at 12 hours were considered for analysis. Relative bioavailability was calculated with 90 percent confidence intervals (CI) for Sandimmun® (test substance) versus Sandimmun Neoral® (reference substance) according to Schuirmann?s Two One-Sided Tests Procedure and the Classical Shortest CI. Homogeneity of data was tested using the Χ(2) test. Fifteen studies were considered for meta-analysis and none of these studies reported AUC values in the 80-125 percent range required for the bioequivalence of two formulations. The overall bioavailability for Sandimmun® versus the microemulsion formulation Sandimmun Neoral® was 76 percent, with upper CI limits lower than 80 percent in some cases. Mean AUC values for Sandimmun® were significantly lower than those for Sandimmun Neoral® (p<0.01). This study demonstrates that the 2 main cyclosporine formulations, Sandimmun® and Sandimmun Neoral®, cannot be considered bioequivalent.

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