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Notes: Ichthyosis bullosa of Siemens (IBS; MIM: 146800) is an autosomal dominant disorder of keratinization characterized by epidermolytic hyperkeratosis without erythroderma. The clinical features are less marked than those of bullous congenital ichthyosiform erythroderma with relatively mild hyperkeratosis usually limited to the skin flexures. Mutations in the epithelial cytokeratin 2e (K2e), which is expressed in a differentiation-specific fashion in the upper spinous and granular layers of the epidermis, have been shown to cause IBS. We detected a novel mutation in a three generation kindred with IBS (1448T→A) within exon 7 of the KRT2E gene. This is predictive of an I483N substitution in the 2B domain of K2e. This extends the range of mutations reported to date and illustrates the usefulness of molecular genetics in the diagnosis of this disorder.

Notes: Dermatology services are largely outpatient based. Time for satisfactory patient communication is limited, with an average of around 15 min per new patient. The amount of new information that can be retained after verbal communication alone is limited during such consultations. One way to reinforce such information is to send patients a copy of the hospital specialist's letter to the general practitioner. Before advocating this unreservedly, it is important to explore the value patients attach to receiving such a letter and to estimate the cost of this practice. In order to explore patients' views of copy letters more fully, all patients attending dermatology outpatients at Queen's Medical Centre, Nottingham during a week in October 2001 were sent copy letters and later interviewed by telephone using a structured questionnaire that gathered information on content, usage, clarity and perceived usefulness. Direct costs were also calculated. Of 70 patients invited to participate, 59 (85%) could be contacted by telephone at the 2-week follow-up period. Of those 59 patients contacted by telephone, surprisingly only 46 (78%) had actually received a copy letter at 14 days post-consultation. Of the 46 patients receiving a copy letter, 45 (98%) thought the information in the letter was consistent with their consultation; the letter was read a mean number of two times; nine patients (20%) understood most and 36 (78%) all of the letter; 25 (54%) found it useful and a further 21 (46%) found it very useful. Patients' views as to the value in receiving the letter included improved communication, recall and a sense of increased involvement in health care decisions. The direct total cost of sending a copy letter was 25.3 pence per patient. Consultants who participated in the exercise did not perceive any additional difficulties in implementing this practice. This small study found that 100% of patients receiving a copy letter found it useful. The fact that around one-fifth of patients did not receive such copy letters within 2 weeks as intended is worrying, and requires further investigation. Sending a copy letter involves a relatively trivial cost for a practice which patients view as a valuable resource.

Notes: Although research into atopic dermatitis (AD) has been dominated by the study of cells and chemical mechanisms over the last 40 years, the last 7 years has witnessed a respectable growth within the field of AD epidemiology. Significant advances include valid disease definitions that can be used in epidemiological studies, global prevalence studies, and studies which quantify the morbidity and economic cost of the disease. These have all helped to argue the case for more research into AD. Epidemiological studies demonstrating that AD is commoner in wealthier families, linkage with small family size, increased prevalence in migrant groups, and the increasing prevalence of the disease all argue strongly towards an important role for the environment in determining disease expression. Future research gaps include evaluation of gene–environment interactions, better studies of the natural history of AD, and better clinical trials that answer questions that are important to physicians and their patients.

Notes: Virtually nothing is known about the prevalence of skin conditions in children in the general population. Although we know something about the relative frequency of skin conditions seen by dermatologists, we do not know how such referrals are influenced by factors such as social class, accessibility to medical services or educational and cultural background. In order to estimate the burden and relative frequency of dermatological disease in children in the community, we measured the point prevalence of skin conditions in 1114 Romanian schoolchildren aged 6–12 years, using the British Association of Dermatologists diagnostic index. The overall point prevalence of children with one or more skin diseases was 22.8%, with no significant differences according to age group or sex, except for pityriasis alba which showed a male predominance (P = 0.007). The most common diseases were infectious dermatoses such as viral warts and insect bites (6.3%), dermatitis/eczema (5.1%), pityriasis alba (5.1%), keratosis pilaris (4.0%) and urticaria (1.9%). Together, these five groups accounted for more than 84% of the cases. Of the 1114 children, 213 (19.1%) had only one skin disease and 41 (3.7%) had two skin diseases. While acknowledging the limitations in defining which skin conditions can benefit from medical care, this study suggests that skin disorders are common in Romanian schoolchildren, affecting about one-quarter of 6–12 year olds. Such a point prevalence is likely to be conservative because of the tendency of prevalence estimates to exclude many other dermatoses of short duration. The finding that over 80% of the disorders can be grouped into fewer than six categories is important in informing training programmes and delivery of service for primary health care teams. This study provides a baseline for further studies into the morbidity and use of health care services by children with skin disease in the community.

Notes: The aim of this study was to compare the irritancy potential of 2 industrial hand cleansers with a brand leader of “mild” children's hand cleanser and with an emollient. The products were tested using repeated open application tests (ROATs) on the forearms of 40 subjects. Scoring of signs and symptoms (itching or burning), transepidermal water loss (TEWL) and stratum corneum hydration (Corneometer) evaluated responses. On all assessments, the children's hand cleanser was more irritant than the 2 industrial hand cleansers. The children's hand cleanser and industrial hand cleansers were more irritant than the emollient. The finding that a hand cleanser for children was more irritant than 2 industrial hand cleansers was surprising, and one which might hold serious implications for inducing or exacerbating atopic eczema in children. The combination of visual scoring, TEWL and Corneometer readings on ROATs is a potentially useful way of assessing irritancy strength of soap products on human skin.

Notes: Background Allergic diseases, including atopic dermatitis (AD), are increasingly becoming a clinical problem in developing countries.Objective We investigated the prevalence of AD symptoms and the effects of potential environmental aetiologies in rural and urban areas of Jimma in southwestern Ethiopia.Methods Information on allergic disease symptoms and lifestyle factors was gathered in an interviewer-led cross-sectional questionnaire-based population survey of 9844 urban and 3032 rural participants of all ages. A one-in-four subsample underwent skin prick testing for hypersensitivity to Dermatophagoides pteronyssinus, mixed threshings, and aspergillus.Results Around 95% of those eligible took part in the survey. Lifetime cumulative prevalence of AD symptoms was generally low with an overall prevalence of 1.2%, but was higher in the urban (1.5%) than in the rural area (0.3%; odds ratio (OR)=4.45 [95% CI 2.34–8.47]). AD symptoms were strongly associated with wheeze (adjusted OR=22.03 [15.45–31.42]) and rhinitis symptoms (61.94 [42.66–89.95]). Of several environmental exposures assessed, residence in a house made of brick (rather than mud) walls with wooden (rather than clay) floor, exposure to cigarette smoke as a child, having lived outside of Jimma in the past, and being of the Tigrean ethnic group were associated with an increased risk of AD symptoms.Conclusion Although the overall prevalence of AD symptoms was low in this Ethiopian population, a marked urban–rural gradient was evident. Lifestyle factors linked to urbanization were associated with an increased risk of AD symptoms.

Notes: A self-completion questionnaire sent to 2600 Nottinghamshire members of the Graphical Paper and Media Union elicited a 62% response. Forty one per cent of respondents reported suffering a skin complaint at some time and 11% had a current skin problem on the hand. This paper reports the validation stage of the study. Samples of 45 ‘cases’ of self-reported dermatitis and 60 ‘controls’, who reported they had never suffered a skin complaint, were clinically examined. All 45 self-reported cases were clinically confirmed as dermatitis. Occupationally related irritant contact dermatitis (ICD) was diagnosed in 20 (44%); 26 (58%) complaints were thought to be induced or exacerbated by occupation. Of the controls, 21 (35%) were also diagnosed with a skin complaint, the majority being mild, with an occupational association in 17, the majority (15) being ICD. Sixteen ICD cases were patch tested resulting in positive reactions to colophony, neomycin, nickel and potassium dichromate (2 of each). Two cases of basal cell carcinoma on the face were also identified, of which the participants were unaware. Although there was no false positive self-reporting there was a considerable number of false negatives, demonstrating the importance of clinical validation of questionnaires relating to industrial skin disease. This study has highlighted the need for improvement in skin care provision in the printing industry.