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INTRODUCTION: Childhood irritant contact dermatitis (ICD) is the most common cause for developing chronic hand eczema as an adult. The COVID-19 reopening in Denmark included regulations introducing frequent hand washing. The aim of the present study was to evaluate if frequent hand washing increases the incidence of ICD in children.METHODS: We conducted an observational study in Denmark during the reopening of schools and daycare facilities for children aged 0-12 years (April 22nd to May 1st 2020). A questionnaire was sent out to parents in four municipalities consisting of 20 questions about frequency of hand washing, use of hand sanitiser, symptoms of ICD, atopic dermatitis, allergy and predispositions.RESULTS: The study included 6,273 children. In children without any prior symptoms of dermatitis, 42.4% experienced ICD (dry, red and itchy skin) due to increased hand hygiene. Schoolchildren had a 1.5 times greater relative risk of developing ICD than preschool children. Frequency of hand washing was a strong risk factor, whereas this was not the case for alcohol-based hand sanitiser. Hand washing 7-10 times/day and >10 times/day increased the relative risk by 1.83 and 2.23 times, respectively.CONCLUSIONS: A higher frequency of hand washing during the COVID-19 reopening increased the incidence of ICD in children. Hand hygiene is essential in our fight against novel coronavirus, but prophylactic initiatives are important to reduce the possible long-term consequences of ICD in children.FUNDING: none TRIAL REGISTRATION: Clinicaltrials.gov (NCT04375410).

SummaryBackground Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) is highly effective for treating actinic keratosis (AKs) on the face/scalp, but less effective on the extremities. Insufficient accumulation of protoporphyrin IX (PpIX) may cause these inferior efficacy rates. However, it is possible to increase PpIX accumulation by extending MAL application time and/or pretreating the skin with curettage. Objectives To investigate whether increased PpIX accumulation improves the effect of MAL-PDT for AKs in a randomized intraindividual study. Methods Twenty-two patients with 533 AKs on both hands were treated with MAL-PDT. To obtain different concentrations of PpIX, 4 symmetrical areas on each patient were randomly allocated to different regimens: (i) 3h MAL application without prior curettage (3hC-), (ii) 3h with curettage (3hC+), (iii) 21h without curettage (21hC-) and (iv) 21h with curettage (21hC+). Treatment efficacy was evaluated after 3 months, whereas PpIX fluorescence, pain and erythema were assessed during and after PDT. Results Extended MAL application with and without curettage increased PpIX accumulation significantly compared with the standard 3hC+ regimen (P=0.0001 and P=0.002, respectively). However, the median total clearance rates did not improve accordingly: 3hC+ (55.0%), 21hC- (55.0%) and 21hC+ (53.6%). Conversely, insufficient PpIX accumulation in the 3hC- regimen led to a significantly lower clearance rate (33.3%) than the other regimens (P

Rosacea is a field within dermatology with new insight within immunological research and new treatment-algorithm. Patient education on rosacea and appropriate treatments is an important aspect in helping patients succeed with therapy. Treatment should be tailored to each individual patient, taking into account: symptoms, trigger factors, patients’ wishes, most bothersome symptoms, psychological aspect, individual needs. A combination of clinical therapies to treat different symptoms concomitantly may offer the best possible outcomes for the patient. In this review article we describe these aspects.

Tattoos are well known to cause skin problems and the number of reported adverse reactions after tattooing has increased. Illegally imported tattoo ink is unrestrained and can contain unknown ingredients and contamination thereby posing a serious health hazard. We present a case illustrating the risk of pronounced phototoxic allergic reaction and other severe complications after using home kit tattoo ink.

Systemic mastocytosis (SM) is a rare, heterogeneous disorder characterized by infiltration and accumulation of mast cells within multiple organs, most commonly the skin. Given the rarity of the disease and the fact that many of its symptoms are shared by more common disorders, a diagnosis may be delayed or hindered. These patients have an elevated risk of developing potentially life-threatening anaphylactoid reactions, thus underscoring the importance of keeping SM in mind as a differential diagnosis when a patient presents with chronic, itchy skin lesions and a history of multiple allergic reactions to bites, drugs, and anesthesia. We present a case illustrating that features of SM common to many disorders may hinder or delay its diagnosis.

Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy, is a common benign dermatosis of pregnancy mainly affecting primigravidae and multiple pregnancies. We report here two cases of PEP with typical clinical and histological features presenting in the postpartum period.

Wegener´s granulomatosis (WG) is a rare, systemic vasculitis involving multiple organs. The clinical presentation is highly diverse, and there is considerable risk of mortality if diagnosis and treatment are delayed. We present a case illustrating that patients with WG may initially present with localized cutaneous symptoms and signs.

Tattoos with henna colours have become very popular and the prevalence of contact allergy seems to increase.This is a short review article based on our own clinical experience and literature identified through a search in PubMed with the words "henna", "paraphenylendiamin" and "allergic contact dermatitis." A case report is included.It is well documented that many experience skin reactions after henna tattoos. The cause is almost always contact allergy to the azo compound paraphenylendiamin, which is added to speed up the process and make the colour darker. Most people, including children, get henna tattoos during vacations in Asia or the Mediterranean. Established contact allergy is permanent. Many hair-colour products contain paraphenylendiamin, and persons with contact allergy against the product may develop a very strong contact allergic eczema by use of such substances. Acute reactions are treated with local cortisone products, or with systemic steroids. Cross reaction to substances with a similar chemical structure may occur.Tattoos with paraphenylendiamin-containing henna colours should be avoided.

A case of a 15 year-old girl who developed an erythema multiforme-like reaction to para-phenylenediamine (PPD) after Henna tattoos is described. The patient was treated successfully with oral prednisolone and highly potent topical corticosteroids. The patient developed a long-lasting post-inflammatory hyperpigmentation. Potential hyperreactive response was prevented by applying the PPD patch for only 30 minutes, but still there was a significantly positive reaction. This case highlights the need to ban the use of para-phenylenediamine and its derivates in dyes.

We describe a case of adult staphylococcal scalded skin syndrome (SSSS) in a 91-year-old woman. The patient had a Staphylococcus aureus infection in her right ear with redness and yellow secretion. A few days later she developed Nikolsky sign-positive tender enlarged flaccid bullae involving most parts of her body. The bullae ruptured easily and left a erythematous base. The histopathological changes were characteristic for adult SSSS. The patient was well-treated with intravenous dicloxacillin, topical antibiotic and antiseptic treatment. The patient had marked thrombocytosis, but no interest in further examination.

A case of a 33-year-old Caucasian with asymptomatic subdermal dermatofibrosarcomal protuberance of the forehead. Surgical excision with three cm margin and early reconstruction with intraoperative haematurea catheter expansion reducing the defect by 50% and subsequent full thickness skin transplantation of the forehead bone was performed. The case stresses the importance of pathological evaluation of any resected tissue and supports the benefit of intraoperative tissue expansion of the forehead.

Hereditary angioedema (HAE) is often debilitating with a serious effect on quality of life (QOL). Treatment of acute HAE attacks is usually with C1 esterase inhibitor (C1-INH) concentrates; however, treatment can be delayed by patients' travel time for attending emergency units. We assessed the impact of self-administered home therapy with intravenous C1-INH concentrate on QOL in patients with HAE. Nine patients experiencing frequent or severe debilitating HAE attacks were offered self-administration of C1-INH concentrate. QOL was assessed prior to and following home therapy using the Dermatology Life Quality Index (DLQI) and 36-Item Short Form Survey (SF-36) questionnaires. Seven patients were recruited into the study. QOL was assessed at baseline and after 3 to 48 months of home therapy. The mean DLQI score fell from 12.6 +/- 4.65 to 2.7 +/- 1.38 (P < 0.001). Mean SF-36 scores for the individual and combined components also improved significantly. No serious complications were documented during a follow-up period of 27 to 72 months. Self-administration of C1-INH improved QOL on both physical and psychological parameters. Patients were able to resume a normal life without restrictions caused by the condition.

A patient developed depression, weight loss, ulcers and a migrating, denuded erythematous skin area. Punch biopsy revealed necrolytic migrating erythema. Computerised tomography and endoscopic ultrasound showed a solid tumour of the pancreas. A blood sample showed an increased level of glucagon without diabetes. Glucagonoma syndrome is characterized by glucagon overproduction, diabetes, depression, deep venous thrombosis and necrolytic migrating erythema. Glucagonoma is frequently diagnosed late which increases the risk of metastases. It is important not to rule out glucagonoma in patients with a relevant clinical picture but without diabetes.

Vaccination against rotavirus is protective against severe disease. Surveillance of rotavirus infection in developing countries might direct vaccination policy more efficiently. We implemented WHOs generic protocols for hospital- and community-based surveillance of rotavirus gastroenteritis. From April 2001 to May 2002 and from January 2003 to June 2003 we conducted hospital surveillance for rotavirus infection at the only pediatric ward in the capital of Guinea-Bissau. Children less than 5 years of age admitted with diarrhea or developing diarrhea during hospitalization were enrolled in the study. Rotavirus infection was detected in the feces samples using an ELISA assay. Rectal swabs were also obtained and its use was validated against stool specimen. During the surveillance period 161 cases of rotavirus infection were registered. During the season rotavirus accounted for 35% of all hospitalized diarrhea cases. The rate of nosocomial disease was 1.6 per 1000 child-days (95% confidence interval [CI] = 1.02-2.51) with high rates for children aged 12 to 23 months of age (rate: 3.09; 95% CI = 1.47-6.48). Most of the rotavirus cases (93%) were in children less than 2 years of age and only 10 children aged less than 3 months were infected. Fever (risk ratio (RR) 1.56; 95% CI = 1.16-2.10) and vomiting (RR 1.38; 95% CI = 1.11-1.73) were more common in patients with rotavirus than in patients with nonrotavirus diarrhea. The case-fatality was 8%. Results from stool samples and rectal swabs were concordant in 96% of the pairs. Rectal swabs increased the detection of rotavirus cases by 6% and deaths by 33% over stool sample results. Rotavirus infections were confined to a 4-month period each year. It is an important cause of childhood diarrhea with high case-fatality ratio in Guinea-Bissau. The use of rectal swab appeared to increase the detection rate of rotavirus infection and the case-fatality rate. The high rate of nosocomial infections in hospitalized children emphasizes the need for prevention of disease. (authors)

Hennatatoveringer er blitt svaert populaere, og det kan synes som om forekomsten av kontaktallergi oker. Vi har hatt flere pasienter med slike plager og vil gjerne gi en kort oversikt over fenomenet for at allmennleger og hudleger skal kunne stille riktig diagnose og gi adekvate rad til sine pasienter.

Acne vulgaris er en sykdom i talgkjertlenesom skyldes mikroorganismen Propionibac-terium acnes, talgkjertelhyperplasi og over-produksjon av talg (1). Den rammer80–85% av alle tenaringer og forsvinnersom regel for 25 ars alder. De mest alvorligetilfellene ses hos gutter i alderen 17–19 ar.Det er sammenheng mellom alvorlighets-graden av akne og darlig selvbilde, angst ogdepresjon, som igjen kan fore til fravaer fraskole og arbeidsplass. Vellykket behandlinggir markant forbedret psykisk helse (2).I denne artikkelen omtales behandling avmoderat til alvorlig acne vulgaris med saerligvekt pa systemiske legemidler.

This article does not have an abstract.

A middle-aged patient of Greenlandic origin was referred for skin infection of the leg. An initial minor trauma of the skin of the distal right lower extremity was complicated by bullous erysipelas which cultured positive for group A β-hemolytic streptococci (GABHS). The clinical condition deteriorated and necrotizing fasciitis developed despite relevant surgical and antibiotic treatment. Approximately 3 weeks later, the patient developed arthralgia, impaired renal function with azotemia, hypertension and severe nephrotic syndrome with periorbital and peripheral edema. A kidney biopsy demonstrated endocapillary glomerulonephritis. Concomitantly, carditis with chest pain, moderately reduced left ventricular ejection fraction and mitral regurgitation were noted. The patient had no signs of pharyngitis in the whole period. The patient thus contracted poststreptococ glomerulonephritis and furthermore she fulfilled the criteria of acute rheumatic fever following a GABHS skin infection. We suggest a possible relation between a virulent GABHS clone causing NF and ARF.