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COVID-19 has been associated with acral ischemia and digital necrosis. Standard treatment of acral ischemia and digital or acral necrosis includes ongoing therapy with vasodilators and anticoagulants. However, these treatments are not always efficient to avoid the progression of necroses, which in the worst case can lead to amputation. Here, we report a case in which interdigital Botox ® (botulinum toxin type A) nerve cord injection stopped the progression of acral necroses arising from an underlying vasculopathy due to COVID-19. Moreover, Botox ® injection eliminated inflammation in the affected acral area within 2 weeks. This is the first case report to suggest Botox ® injection as a new and improving treatment for acral necroses due to COVID-19.

Background Rates of keratinocyte carcinoma (KC) across Europe are impacted by population demographics and geography. Regional differences in KC occurrence exist, but few European studies investigate incidences of specific subtypes in the secondary healthcare sector on a national level. Objectives To determine geographical differences in incidence rate and lifetime risk of KC subtypes across Denmark, including nodular and superficial basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and the KC precursor, Bowen's disease (BD), identified in office‐based dermatological practice. Methods Based on a nationwide registry (The Danish Skin Cancer Registry), all patients in Denmark's five regions with a histologically‐ or clinically verified KC or BD registered in a state‐funded office‐based dermatology practice between 2013 and 2022 were included. Trends in national‐ and region‐specific age and sex standardised tumour incidence rates (STIR) were calculated. Further, national lifetime risk of each tumour subtype was estimated. Results Between 2013 and 2022, the combined STIR for KC/BD rose 172% nationally from 180 to 489 per 100,000 person‐years (PY). This increase reflected rising rates of nodular BCC, SCC, and BD, while superficial BCC incidence was relatively stable. Regional differences in STIR for combined KC/BD were observed, with the Capital Region and North Jutland generally demonstrating higher rates than Zealand, Southern‐ and Central Denmark (e.g., North Jutland vs. Southern Denmark: 714 vs. 405/100,000PY). While the estimated lifetime risk of developing at least one KC or BD tumour was 21.8%, risk varied with tumour subtype, resulting in subtype‐specific risks of 16.4%, 5.1%, 1.9% and 1.3% for nodular BCC, superficial BCC, SCC, and BD, respectively. Conclusions In Denmark's secondary dermatological care sector, incidence of nodular BCC, SCC and BD continues to rise with an overall lifetime risk nearing 22%. While KC incidence is increasing in Denmark, the study detected differences in geographical trends and rate increases of specific tumour subtypes.

Remember EPFI as a differential diagnosis in children with a rash on the scalp and no effect of antibiotic treatment. Remember EPFI as a differential diagnosis in children with a rash on the scalp and no effect of antibiotic treatment.

The purpose of this study was to investigate the completeness of TNM (Tumor, Node, Metastasis) staging of melanoma in the Danish Cancer Registry (DCR). We identified 8762 patients with a first primary diagnosis of melanoma from the DCR between 2004 and 2009. We obtained information on level of comorbidity, defined according to the Charlson Comorbidity Index, through the Danish National Patient Register. We computed the completeness of TNM staging overall and by each stage component. Analyses were stratified by gender, age, year of diagnosis, and level of comorbidity. We designed an algorithm that categorized melanoma stage as localized, regional, distant, or unknown. Owing to knowledge on clinical coding practice, we allowed for categorization of tumors with certain missing stage components. The overall completeness of the TNM staging was 78.4% (95% confidence interval [CI] 77.5-79.3). Completeness varied little by gender and year of diagnosis. However, completeness decreased from 83.5% (95% CI 81.7-85.3) in patients aged 0-39 years to 68.7% (95% CI 65.7-71.6%) in patients 80 years or older, and from 80.3% (95% CI 79.4-81.3) among patients with a low level of comorbidity to 67.4% (95% CI 63.1-71.4) among patients with a high level of comorbidity. Using the algorithm, 87.3% of cases could be assigned to one of the defined stage categories. The overall completeness of the TNM registration for melanoma was fairly high but varied with age and level of comorbidity. Thus, data on TNM stage should be used with caution in epidemiological and other research.

Up to two-thirds of children with atopic dermatitis have IgE-mediated allergic reactions and a Th2 immune reactivity pattern with low production of interferon gamma and high production of interleukin 4 after allergen stimulation of T lymphocytes. Insulin-dependent diabetes mellitus (IDDM) seems to be associated with a Th1 immune reactivity pattern. We therefore postulated that these diseases may be inversely associated. We designed a case-control study including 920 children with IDDM, registered in the Danish Registry for Childhood Diabetes, and a sample of 9732 non-diabetic children registered in the Danish Medical Birth Registry. The children were aged 3–15 years. Information on atopic dermatitis was obtained by questionnaires. The cumulative incidence of atopic dermatitis up to age 15 years was 13·1% among children with IDDM and 19·8% in non-diabetic children (p<0·0001). Among children who developed IDDM, the incidence of atopic dermatitis was significantly lower than in the controls before onset of IDDM (73 cases in 5314 person-months vs 1375 in 57 432 person-months; odds ratio 0·49 [0·39–0·63]). After onset of IDDM, diabetic and non-diabetic groups did not differ in incidence of atopic dermatitis (1·36 [0·89–2·07]). Our findings may be explained by different acquired or inherited reactivity patterns associated with atopic dermatitis (Th2) and IDDM (Th1). The results do not allow us to find out whether early development of atopic dermatitis reduces the risk of IDDM, or a propensity for IDDM reduces the risk of early-onset atopic dermatitis.

Abstract Objective: To study if factors at birth are associated with later development of atopic dermatitis. Design: Historical follow up by record linkage from Danish medical birth register. Children were followed up for 5.5 to 8.5 years. Second historical follow up study comprising questionnaire to mothers of singleborn children 6.5 to 9.5 years after birth. Setting: Private dermatology clinics and dermatology and paediatric departments in the municipality of Aarhus, Denmark. Subjects: 7862 singletons born in hospital between 1 January 1984 and 31 December 1986 to mothers living in the municipality of Aarhus. Questionnaires sent to 985 mothers. Main outcome measures: Gestational age, birth weight, parity, and age of mother at the time of birth. Atopy in children diagnosed by specialists in dermatology and physicians. Family size; diagnosis of atopic dermatitis, allergic rhinitis, and asthma; family predisposition; and mothers' smoking habits during pregnancy determined from questionnaires. Results: Of 7862 children, 403 were diagnosed as having atopic dermatitis by a specialist; the cumulative incidence at age 7 was 5.6%. High gestational age and low parity were associated with an increased risk of atopic dermatitis. Among 985 children atopic dermatitis had been diagnosed by any physician in 184; the cumulative incidence at age 7 was 18.7%. High birth weight, high gestational age, and family history of atopy were associated with increased risk of atopic dermatitis. Conclusion: In both studies the incidence of atopic dermatitis was associated with high gestational age and in one with high birth weight also. The causes for these associations are at present unknown but may indicate that even during gestation factors associated with atopic dermatitis influence maturation. Key messages This Danish study found that the cumulative incidence of atopic dermatitis at the age of 7 years was 18.7% in 1993 Children born after term had a significantly increased risk of developing atopic dermatitis Children whose birth weight was high for their sex and gestational age also had an increased risk of developing atopic dermatitis These findings suggest that a genetically determined predisposition to developing atopic dermatitis is expressed in utero

Vitamin D deficiency is associated with osteoporotic fractures, such as hip fracture. Sun exposure, the natural source of vitamin D, is the main risk factor for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In this study, we examined the association between a history of hip fracture and risk of BCC and SCC. We conducted a population-based case-controlled study using data on BCC and SCC cases registered in the Danish Cancer Registry from 1990-2005. For each case, we selected five population controls matched by age and gender. We used conditional logistic regression to compute odds ratios (OR) and 95% confidence intervals (CI), while adjusting for chronic diseases and socioeconomic status. A history of hip fracture was associated with a decreased risk of BCC (OR 0.90, 95% CI 0.85-0.94), which was most pronounced in cases of tumors on the trunk, extremities, or at multiple sites. We found no association for SCC (OR 1.07, 95% CI 0.98-1.17). Our study showed an inverse association between history of hip fracture and risk of BCC, but not of SCC. Sun exposure, resulting in vitamin D synthesis, may explain the link between the two diseases.

Background: The Danish Gerda Frentz Cohort (GFC) was created for registering all incident and new subsequent cases of non-melanoma skin cancer (NMSC) among patients seen by Danish dermatologists in 1995. We have recently found, in this cohort, a lower 10-year mortality than in the general population in patients with basal cell carcinoma (BCC). Differences in mortality between incident and new subsequent cases, incomplete registration or selection bias may be responsible for this finding. Methods: We aimed to quantify differences in mortality between incident and new subsequent cases of NMSC in the GFC and to compare mortality among incident cases recorded in the GFC and those recorded in the Danish Cancer Registry (DCR). We followed 10,830 skin cancer patients and 106,696 age-, gender- and residence-matched population controls through 2006 and computed their cumulative mortality and mortality rate ratio (MRR). Results: One-, 5-, and 10-year cumulative mortality of incident and new subsequent cases of BCC and SCC in the GFC were similar. Likewise, MRR for incident BCC (MRR = 0.91; 95% CI 0.84–0.98) and incident SCC (MRR = 1.29; 95% CI 1.05–1.56) among patients registered in the GFC were similar to their counterparts in the DCR (MRR = 0.96; 95% CI 0.91–1.00 and MRR = 1.36; 95% CI 1.22–1.52). Conclusion: Mortality of incident and new subsequent cases of NMSC was similar and thus did not explain the reduced mortality of BCC patients.

Background: Phosphodiesterase 5A inhibitors (PDEIs), a common treatment for erectile dysfunction, were recently linked to an increased risk of melanoma. Methods: We conducted two parallel case–control studies, using the Danish Nationwide Health Registries (DNHR) and the Kaiser Permanente Northern California (KPNC) electronic health records. Identifying men with histologically verified melanoma (cases) matched on birth year to 10 cancer-free controls, we estimated odds ratios (OR) for melanoma associated with high use of PDEIs (⩾100 tablets filled), adjusting for available confounders. Results: We identified 7045 DNHR and 2972 KPNC cases with invasive melanoma. The adjusted OR for invasive melanoma associated with high PDEI use was 1.22 (95% confidence interval (CI), 0.99–1.49) in DNHR and 0.95 (95% CI, 0.78–1.14) in KPNC. Odds ratios were highest for localised invasive melanoma in DNHR (OR, 1.21) and melanoma in situ in KPNC (OR, 1.15), and lowest for non-localised disease in both populations (ORs 0.75 and 0.61, respectively). The increased ORs were slightly attenuated upon adjustment for markers of health-care utilisation. Conclusions: We found little evidence for a causal association between PDEI use and risk of melanoma. The marginally increased risk of early stage disease likely resulted from more frequent health-care contacts among PDEI users.

ObjectivesIncreased risks of rheumatoid arthritis, small vessel vasculitis, systemic lupus erythematosus, and systemic sclerosis have been observed following crystalline silica exposure. Our aims are to estimate pooled risk estimates and assess the impact of study quality.MethodsWe followed the PRISMA criteria, identified 1162 articles, and included 21 studies that we classified according to eight quality parameters (high vs. low). We estimated pooled overall and disease specific odds ratios (ORs) with random effects meta-regressions.ResultsWe observed an increased overall OR of 2.3 (1.7–3.1, 21 studies) and for rheumatoid arthritis (OR 1.7, 95% CI 0.8–3.41, 6 studies), small vessel vasculitis (OR 2.4, 95% CI 1.2–4.7, 6 studies), systemic lupus erythematosus (OR 2.8, 95% CI 0.5–14.7, 3 studies), and systemic sclerosis (OR) 2.9, 1.7–4.9, 6 studies). The following high-quality characteristics were associated with decreased ORs: appropriate control group, high response rate, appropriate confounder control, independent exposure information, and many participants; and with increased ORs: quantitative or semi-quantitative exposure measure, hospital based diagnosis, and well-defined diagnostic criteria. Only the latter was statistically significant (p<0.05). When we consecutively excluded low quality studies, the overall OR value decreased to 1.3 (0.4–4.2, 3 studies) but this exercise was sensitive to the order. Egger’s test of no small study effect was highly statistically significant (p<0.01).ConclusionThis review provides some evidence that crystalline silica is associated with systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and small vessel vasculitis. However, more high-quality studies are needed to confirm or refute if this represents causal associations.