Patterns in contacts with primary health care centres in Greenland

The aim of this study was to evaluate the activity within the primary health care (PHC) in Greenland by identifying the patterns of all registered contacts made by patients in 2021, and to compare the most frequently used types of contacts and diagnostic codes in Nuuk to the rest of Greenland. The study was designed as a cross-sectional register study using data from the national electronic medical records (EMR) and diagnostic codes from the ICPC-2-system. In 2021, 83.7% (46,522) of the Greenlandic population were in contact with the PHC, resulting in 335,494 registered contacts. The majority of the contacts with PHC was made by females (61.3%). On average, females were in contact with PHC 8.4 times per patient per year, while males were in contact with PHC 5.9 times per patient per year. The most frequently used diagnostic group was "General and unspecified", followed by "Musculoskeletal" and "Skin". The results are in line with studies from other northern countries and indicate an easily accessible PHC system, with a predominance of female contacts.

Low prevalence of patients diagnosed with psoriasis in Nuuk: a call for increased awareness of chronic skin disease in Greenland

The objective of this study was to estimate the age- and gender-specific prevalence of psoriasis in Nuuk. Furthermore, we aimed to explore the common risk factors and comorbidities for patients with psoriasis compared to an age- and gender-matched control group. The study was designed as a cross- sectional case-control study based on national high-quality data from medical and population registers in Nuuk. A total of 175 patients (0.9%) were diagnosed with psoriasis in Nuuk by January 1 January 2022, of which 79 were females and 96 were males. The prevalence of patients diagnosed with psoriasis in the adult population aged 20 years old or more in Nuuk was 1.1%. No overall gender-specific difference in prevalence was observed. Chronic diseases including diabetes, hypertension, and obstructive lung disease were observed more frequently among patients with diagnosed psoriasis (28.6%) in Nuuk compared to controls (20.9%) (p < 0.05). We found a low prevalence of patients with psoriasis in Nuuk. We speculate that the prevalence found in this study is underestimated and thus, call for increased awareness of chronic skin disease in Nuuk, Greenland. Chronic co-morbidity to psoriasis was common.

COVID-19 reopening causes high risk of irritant contact dermatitis in children

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).

Rosacea: a Clinical Review

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.

Severe scratcher-reaction: an unknown health hazard?

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.

Delayed diagnosis of adult indolent systemic mastocytosis

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 developing postpartum: 2 case reports

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.

Dermatofibrosarcoma protuberans diagnosed by a single biopsy

This brief report is about a 9 year old girl presenting with a 2.5 cm circular blue to violet discoloration on the anterolateral upper left thigh. The first biopsy taken revealed the diagnosis dermatofibrosarcoma protuberans. The patient underwent surgery at a specialized sarcoma center with post operative histology showing free wide resection margin. Preoperative chest x-ray showed no sign of metastasis. This brief report emphasizes the significance of the use of biopsy when cutaneous elements look suspicious and diagnosis is unclear.

Wegener´s granulomatosis in a young patient preceded by localized cutaneous manifestations

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.

[Erythema multiforme-like reaction to para-phenylenediamine]

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.

[Staphylococcal scalded skin syndrome in adults]

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.

[Dermatofibrosarcoma protuberance]

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.

[Carotinaemia in patient with excessive beta-carotene food-intake and dysregulated diabetes mellitus]

A case of carotinaemia in a patient with excessive beta-carotene food-intake, diabetes mellitus and physiological amenorrhea is reported. The patient developed yellow discolouration in the palms and the soles of her feet. Blood samples showed a significantly increased lever of serum beta-carotene, but normal vitamine A value and liver enzymes. The patient reported an excessive intake of carrots (approximately 1 kg per day). The status of physiological amenorrhoea and dysregulated diabetes mellitus may have deteriorated the yellow discolouration of the skin.

[Glucagonoma syndrome without diabetes mellitus]

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.

Hospital surveillance of rotavirus infection and nosocomial transmission of rotavirus disease among children in Guinea-Bissau

BACKGROUND

Vaccination against rotavirus is protective against severe disease. Surveillance of rotavirus infection in developing countries might direct vaccination policy more efficiently.

METHODS

We implemented WHO's 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.

RESULTS

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.

CONCLUSION

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.