Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial): study protocol for a randomised controlled trial.

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Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial): study protocol for a randomised controlled trial.

Trials. 2018 Oct 20;19(1):575

Authors: Miah IP, Holl DC, Peul WC, Walchenbach R, Kruyt N, de Laat K, Koot RW, Volovici V, Dirven CMF, van Kooten F, Kho KH, den Hertog HM, van der Naalt J, Jacobs B, Groen RJM, Lingsma HF, Dammers R, Jellema K, van der Gaag NA, Dutch Subdural Hematoma Research Group (DSHR)

Abstract
BACKGROUND: Chronic subdural haematoma (CSDH) is a common neurological disease with a rapidly rising incidence due to increasing age and widespread use of anticoagulants. Surgical intervention by burr-hole craniotomy (BHC) is the current standard practice for symptomatic patients, but associated with complications, a recurrence rate of up to 30% and increased mortality. Dexamethasone (DXM) therapy is, therefore, used as a non-surgical alternative but considered to achieve a lower success rate. Furthermore, the benefit of DXM therapy appears much more deliberate than the immediate relief from BHC. Lack of evidence and clinical equipoise among caregivers prompts the need for a head-to-head randomised controlled trial. The objective of this study is to compare the effect of primary DXM therapy versus primary BHC on functional outcome and cost-effectiveness in symptomatic patients with CSDH.
METHODS/DESIGN: This study is a prospective, multicentre, randomised controlled trial (RCT). Consecutive patients with a CSDH with a Markwalder Grading Scale (MGS) grade 1 to 3 will be randomised to treatment with DXM or BHC. The DXM treatment scheme will be 16 mg DXM per day (8 mg twice daily, days 1 to 4) which is then halved every 3 days until a dosage of 0.5 mg a day on day 19 and stopped on day 20. If the treatment response is insufficient (i.e. persistent or progressive symptomatology due to insufficient haematoma resolution), additional surgery can be performed. The primary outcomes are the functional outcome by means of the modified Rankin Scale (mRS) score at 3 months and cost-effectiveness at 12 months. Secondary outcomes are quality of life at 3 and 12 months using the Short Form Health Survey (SF-36) and Quality of Life after Brain Injury Overall Scale (QOLIBRI), haematoma thickness after 2 weeks on follow-up computed tomography (CT), haematoma recurrence during the first 12 months, complications and drug-related adverse events, failure of therapy within 12 months after randomisation and requiring intervention, mortality during the first 3 and 12 months, duration of hospital stay and overall healthcare and productivity costs. To test non-inferiority of DXM therapy compared to BHC, 210 patients in each treatment arm are required (assumed adjusted common odds ratio DXM compared to BHC 1.15, limit for inferiority <?0.9). The aim is to include a total of 420 patients in 3 years with an enrolment rate of 60%.
DISCUSSION: The present study should demonstrate whether treatment with DXM is as effective as BHC on functional outcome, at lower costs.
TRIAL REGISTRATION: EUCTR 2015-001563-39 . Date of registration: 29 March 2015.

PMID: 30342554 [PubMed – indexed for MEDLINE]

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Handekzeme bei niederländischen Imkern – eine Querschnittsuntersuchung.

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Handekzeme bei niederländischen Imkern – eine Querschnittsuntersuchung.

J Dtsch Dermatol Ges. 2019 Feb;17(2):158-166

Authors: Oosterhaven JAF, Verbist J, Schuttelaar MA

PMID: 30762965 [PubMed – in process]

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Hand eczema among Dutch beekeepers – a cross-sectional study.

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Hand eczema among Dutch beekeepers – a cross-sectional study.

J Dtsch Dermatol Ges. 2019 Feb;17(2):158-166

Authors: Oosterhaven JAF, Verbist J, Schuttelaar MA

Abstract
BACKGROUND AND OBJECTIVES: Studies of beekeepers have mostly focused on contact allergy to propolis. The overall prevalence of hand eczema (HE) in beekeepers has not been studied. Our objectives were to gain insight into the prevalence of HE in the Dutch beekeeper population; to define the impact of beekeeping activities on HE and vice versa; and to determine associated factors.
PATIENTS AND METHODS: We used a cross-sectional online survey. Dutch beekeepers answered questions on beekeeping activities, the prevalence and characteristics of HE, including severity, and the impact of the disease on beekeeping.
RESULTS: We analyzed 833 surveys (12 % of Dutch beekeepers). The one-year prevalence of HE was 13.2 %, and the lifetime prevalence was 20.5 %. In 28 patch-tested beekeepers with hand eczema, eight (28.6 %) were allergic to propolis. Atopic dermatitis was the only variable associated with HE: the odds ratio was 4.53 (95 % confidence interval 2.78-7.38). One in three beekeepers reported that HE was caused or worsened by beekeeping, although only 3.8 % reported working less at beekeeping because of HE, and the impact of HE on beekeeping activities (as perceived by beekeepers) is low.
CONCLUSIONS: In this sample of Dutch beekeepers, hand eczema was more prevalent than in the general population, but seems to have had little impact on the beekeeping activities of the majority of beekeepers.

PMID: 30762971 [PubMed – in process]

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[Pruritus in elderly: diagnosis and treatment].

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[Pruritus in elderly: diagnosis and treatment].

Ned Tijdschr Geneeskd. 2018 Dec 20;163:

Authors: Leus AJG, Meijer JM, Zuidema SU, Jonkman MF

Abstract
Pruritus is the most common dermatological complaint in elderly people and may have a significant negative influence on quality of life. In elderly, the identification of the underlying cause of pruritus can be difficult, due to the broad differential diagnosis and the frequent occurence of comorbidities and polypharmacy. In daily practice, a classification can be used of ‘pruritus with primary skin lesions’ and ‘pruritus without primary skin lesions’ for a more specific search to the underlying cause. The most common cause of pruritus in elderly is dry skin (xerosis). In primary care pruritis is more often caused by a dermatosis and systemic causes are more rare. Besides treatment directed at the underlying cause, it is recommended in elderly to always treat xerosis with topical emollients. Topical therapy consists of corticosteroids, anaesthetics and anti-inflammatory agents. Systemic treatments include antihistamines, antidepressants and neuroactive medications.

PMID: 30604601 [PubMed – in process]

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Response to ‘Serological diagnostics in the detection of IgG autoantibodies against human collagen VII in epidermolysis bullosa acquisita: a multicentre analysis’.

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Response to ‘Serological diagnostics in the detection of IgG autoantibodies against human collagen VII in epidermolysis bullosa acquisita: a multicentre analysis’.

Br J Dermatol. 2018 02;178(2):573

Authors: Jonkman MF, Meijer JM, Diercks GFH, Pas HH

PMID: 28977674 [PubMed – indexed for MEDLINE]

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KLHL24: Beyond Skin Fragility.

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KLHL24: Beyond Skin Fragility.

J Invest Dermatol. 2019 Jan;139(1):22-24

Authors: Bolling MC, Jonkman MF

Abstract
KLHL24 mutations have recently been associated with epidermolysis bullosa simplex. Initial studies focused on skin fragility. However, the picture of KLHL24 mutations causing extracutaneous human disease is emerging, with dilated cardiomyopathy as a strong association. In addition, neurological disease is suspected as well. Careful clinical follow-up and functional studies of (mutated) KLHL24 in these tissues are needed.

PMID: 30579426 [PubMed – in process]

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Immediate hypersensitivity to p-phenylenediamine.

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Immediate hypersensitivity to p-phenylenediamine.

Contact Dermatitis. 2018 Nov 13;:

Authors: Wilkinson M, Solman L, Coenraads PJ, Goebel C

PMID: 30426523 [PubMed – as supplied by publisher]

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Contact sensitization to hydroperoxides of limonene and linalool: Results of consecutive patch testing and clinical relevance.

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Contact sensitization to hydroperoxides of limonene and linalool: Results of consecutive patch testing and clinical relevance.

Contact Dermatitis. 2018 Oct 31;:

Authors: Dittmar D, Schuttelaar MLA

Abstract
BACKGROUND: Hydroperoxides of limonene and linalool are potent sensitizers.
OBJECTIVES: To investigate the prevalence of contact allergy to both hydroperoxides of limonene and hydroperoxides of linalool, to report clinical relevance, and to investigate patient demographics.
METHODS: A total of 821 patients (35.6% male, mean age 42.4 years?±?17.8?years) were consecutively patch tested with our departmental baseline series and our fragrance series, including hydroperoxides of limonene 0.3% pet. and hydroperoxides of linalool 1.0% pet. The clinical relevance was assessed for all positive reactions.
RESULTS: Positive patch test reactions to hydroperoxides of limonene and to hydroperoxides of linalool were observed in 77 patients (9.4%, 95% confidence interval [CI]: 7.4%-11.4%) and in 96 patients (11.7%, 95%CI: 9.5%-13.9%), respectively; 38 of these patients (4.6%, 95%CI: 3.2%-6.0%) reacted to both. Most reactions were considered to be possibly or probably clinically relevant (66.3% and 68.8%, respectively), and a small proportion were deemed to be of certain clinical relevance (18.2% and 19.8%, respectively).
CONCLUSION: As compared with previous studies, high numbers of positive reactions to both hydroperoxides of limonene and hydroperoxides of linalool were observed, the majority of which were clinically relevant, supporting their inclusion in the European baseline series.

PMID: 30378131 [PubMed – as supplied by publisher]

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[A woman with a growing mass close to the fingernail].

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[A woman with a growing mass close to the fingernail].

Ned Tijdschr Geneeskd. 2018 Sep 24;162:

Authors: Ferrari BR, Terra JB, van der Beek ESJ

Abstract
A 23-year-old woman had a painful, growing mass close to the nail of her left index finger. The differential diagnosis consisted of acquired digital fibrokeratoma, digital fibromyxoma, periungual fibroma or verruca vulgaris. Surgical excision of the mass was performed, and histopathological analysis revealed a subungual exostosis.

PMID: 30358362 [PubMed – in process]

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Allergic contact dermatitis caused by acrylic acid used in transcutaneous electrical nervous stimulation.

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Allergic contact dermatitis caused by acrylic acid used in transcutaneous electrical nervous stimulation.

Contact Dermatitis. 2017 Dec;77(6):409-412

Authors: Dittmar D, Dahlin J, Persson C, Schuttelaar ML

PMID: 29164695 [PubMed – indexed for MEDLINE]

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Cutaneous adverse drug reaction after apomorphine infusion, possibly caused by a systemic type IV hypersensitivity reaction to sodium metabisulfite: Report of 2 cases.

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Cutaneous adverse drug reaction after apomorphine infusion, possibly caused by a systemic type IV hypersensitivity reaction to sodium metabisulfite: Report of 2 cases.

Contact Dermatitis. 2018 Aug 19;:

Authors: Borgemeester RWK, van Laar T, Schuttelaar MLA

PMID: 30123968 [PubMed – as supplied by publisher]

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Cutaneous adverse drug reaction after apomorphine infusion, possibly caused by a systemic type IV hypersensitivity reaction to sodium metabisulfite: Report of 2 cases.

Related Articles

Cutaneous adverse drug reaction after apomorphine infusion, possibly caused by a systemic type IV hypersensitivity reaction to sodium metabisulfite: Report of 2 cases.

Contact Dermatitis. 2018 Aug 19;:

Authors: Borgemeester RWK, van Laar T, Schuttelaar MLA

PMID: 30123968 [PubMed – as supplied by publisher]

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Complete remission of skin lesions in a patient with subcorneal pustular dermatosis (Sneddon-Wilkinson disease) treated with antimyeloma therapy: association with disappearance of M-protein.

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Complete remission of skin lesions in a patient with subcorneal pustular dermatosis (Sneddon-Wilkinson disease) treated with antimyeloma therapy: association with disappearance of M-protein.

Br J Dermatol. 2017 May;176(5):1341-1344

Authors: von dem Borne PA, Jonkman MF, van Doorn R

Abstract
Subcorneal pustular dermatosis (SPD), or Sneddon-Wilkinson disease, is a rare pustular skin disease that follows a chronic relapsing course. A well-known association exists between SPD and IgA monoclonal gammopathy of undetermined significance (MGUS), which exists in up to 40% of cases. SPD has also been observed in patients with IgA myeloma. In SPD, direct and indirect immunofluorescence studies do not reveal in vivo bound IgA to the epithelial cell surface, in contrast to IgA pemphigus, which has similar clinicopathological features. Here we describe the case of a male patient with SPD and a concurrent IgA MGUS who had been treated with dapsone for 20 years with frequent relapses. Following development of multiple myeloma, the patient was treated with intensive antimyeloma treatment consisting of high-dose melphalan with autologous stem cell transplantation. This resulted in a complete remission of the myeloma with disappearance of the M-protein. In addition, a sustained remission of SPD was achieved without further treatment. Twenty-eight months after melphalan therapy the M-protein reappeared in the serum, and 2 months later SPD reappeared with histopathologically proven skin lesions at predilection sites. Presence and absence of skin lesions was found to correlate with the presence and absence of the M-protein in the serum. This is the first report of antimyeloma therapy inducing a long-lasting remission in SPD. The findings in this patient strongly suggest a causal role for circulating IgA antibodies in the pathogenesis of SPD. Antimyeloma treatment should be considered in patients with IgA MGUS-associated SPD refractory to other therapies.

PMID: 27516004 [PubMed – indexed for MEDLINE]

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Topical Gentamicin for the Treatment of Genetic Skin Diseases.

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Topical Gentamicin for the Treatment of Genetic Skin Diseases.

J Invest Dermatol. 2018 Apr;138(4):731-734

Authors: Pasmooij AMG

Abstract
Clinical application of topical gentamicin is a worthwhile option to investigate further for Nagashima-type palmoplantar keratosis and other genetic skin diseases caused by nonsense mutations. It is especially interesting to study gentamicin 1B because it may be more efficacious than other gentamicin components. Topical gentamicin has an acceptable safety profile, although prospective tracking of antibiotic resistance is warranted.

PMID: 29579455 [PubMed – in process]

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Image Gallery: Paraneoplastic pemphigus and follicular dendritic cell sarcoma.

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Image Gallery: Paraneoplastic pemphigus and follicular dendritic cell sarcoma.

Br J Dermatol. 2018 Feb;178(2):e146

Authors: Jonkman MF, Pas HH

PMID: 29441554 [PubMed – in process]

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