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  • 1. Boysen, Lene
    et al.
    Sörensen, Per
    Larsen, Morten
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Kristensen, Flemming
    Evaluation of skin erythema by use of chromametry and image analysis of digital photographs after intradermal administration of histamine in dogs2002In: American Journal of Veterinary Research, ISSN 0002-9645, E-ISSN 1943-5681, Vol. 63, 565-569 p.Article in journal (Refereed)
  • 2.
    Carlsen, K H
    et al.
    University of Copenhagen.
    Carlsen, K M
    University of Copenhagen.
    Serup, Jörgen
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Dermatology and Venerology in Östergötland.
    Non-attendance rate in a Danish University Clinic of Dermatology2011In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 25, no 11, 1269-1274 p.Article in journal (Refereed)
    Abstract [en]

    Aim To clarify the rate of non-attendance (NA) in an out-patient clinic. less thanbrgreater than less thanbrgreater thanMethods Attendance lists of 3592 patients were collected daily from 21 July-21 August and 21 October-21 November, 2009. NA patients were contacted to determine extenuations. To study NA in relation to diagnosis and age, a control group of patients who attended before or after a NA was established. Furthermore, two time periods from 8:00-11:30 AM and 11:30 AM-3:00 PM were compared. less thanbrgreater than less thanbrgreater thanResults In total, 13% NA gave no cancellation (54.2% females and 45.8% males). Divided into age groups, 496 patients 0-25 years old had appointments, but 87 (18.6%) showed NA. In the 26-65 years old, 2188 patients were planned, but 313 (14.1%) showed NA. Over 65 years old, 878 patients were planned, but 69 patients (7.9%) showed NA. NA was higher (P andlt; 0.05) in patients 0-25 years old in comparison with the other age groups. Diagnoses had no influence on the rate of NA (P andgt; 0.05), neither had seasons nor time of the day. The main explanations reported by the NA were: forgetfulness (34.3%), erroneous scheduling (27.7%) and various reasons (38.0%). However, 18.5% had shown NA before while 17.1% were NA first timers. less thanbrgreater than less thanbrgreater thanConclusion The NA rate 13% of 3592 patients was mostly patient-related. Erroneous scheduling was estimated to be 3.6%. NA was more frequent among young patients. NA rate is small in comparison with non-adherence to medicines, however, of major practical and economic consequence for the health system. SMS or e-mail notification and improved scheduling are potential actions to improve NA in the routine.

  • 3. Faergemann, J
    et al.
    Diehl, U
    Bergfelt, L
    Brodd, A
    Edmar, B
    Hersle, K
    Lindemalm, B
    Nordin, P
    Ringdahl, IR
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Scalp psoriasis: synergy between the Malassezia yeasts and skin irritation due to calcipotriol2003In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 83, 438-441 p.Article in journal (Refereed)
  • 4. Fullerton, A
    et al.
    Stücker, M
    Wilhelm, K-P
    Wårdell, K
    Anderson, Chris
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Fischer, T
    Nilsson, GE
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Guidelines for visualization of cutaneous blood flow by laser Doppler perfusion imaging. A report from the Standardization Group of the European Society of Contact Dermatitis* based upon the HIRELADO European community project2002In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 46, no 3, 129-140 p.Article in journal (Refereed)
    Abstract [en]

    This report reviews how to set up a laser Doppler perfusion imaging system intended for visualization of skin blood perfusion, capture images and evaluate the results obtained. A brief summary of related papers published in the literature within the areas of skin irritant and allergy patch testing, microdialysis and skin tumour circulation is presented, as well as early applications within other fields such as diabetology, wound healing and microvascular research. ⌐ Blackwell Munksgaard, 2002.

  • 5. Fullerton, AB
    et al.
    Rode, J
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Studies of cutaneous blood flow of normal forearm skin and irritated forearm skin based on high-resolution laser Doppler perfusion imaging (HR-LDPI)2002In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 8, 32-40 p.Article in journal (Refereed)
  • 6. Fullerton, Ann
    et al.
    Rode, Birgitte
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Skin irritation typing and grading based on laser Doppler perfusion imaging2002In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 8, 23-31 p.Article in journal (Refereed)
  • 7. Gniadecka, Monika
    et al.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Suction chamber method for measuring skin mechanical properties: The dermaflex2006In: Handbook of non-invasive methods and the skin, second edition / [ed] Gregor B.E. Jemec ,Gary L. Grove and Jorgen Serup, Boca Raton, Florida: Taylor & Francis , 2006, 2, 571-577 p.Chapter in book (Other academic)
    Abstract [en]

    Firmly established as the leading international reference in this field, Non-Invasive Methods and the Skin broke new ground with its comprehensive coverage of methods used in both clinical and experimental dermatology. Completely revised and updated, containing more than twice as much information, the Second Edition continues the tradition. The authors' thorough research and clear organization make this book a baseline reference for those using noninvasive biophysical methods to study the skin.  Arranged by physical modality and structured to provide educational and practical information, the second edition, like its predecessor, will prove to be of value to young researchers and senior scientists alike. The coverage of major evaluation and measurement methods share a consistent format, including scope, sources of error, application, and validity. This edition incorporates 69 revised chapters with more than 90 new chapters covering topics such as computer technique, imaging techniques, skin friction, barrier functions, and more.New chapters provide coverage of: computers, computer techniques, and image analysis imaging techniques, including clinical photography legal situations and guidelines behind instrumental use skin friction barrier functions important new techniques such as in vitro confocal microscopy, OCT, and Raman spectroscopy veterinary/animal research use of methods  The truly interdisciplinary, international panel of contributors includes experts from the specialties of dermatology, bioengineering, pathology, manufacturing engineering, medical physics, pharmacology, microbiology, neurology, surgery, obstetrics and gynecology, cardiovascular research, and pharmacy from academic institutions and hospitals in countries such as Denmark, Germany, the United Kingdom, the United States, Japan, Israel, Taiwan, and Singapore. The revision is extensive and covers a broad spectrum of methods while providing the same caliber of authoritative information that made the previous edition so popular. Application oriented, practical, and instructive, this Second Edition will meet the needs of the researchers today, and in years to come.

  • 8. Gniadecki, Robert
    et al.
    Gniadecka, Monika
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Examination of periodic fluctuations in cutaneous blood flow2006In: Handbook of non-invasive methods and the skin, second edition / [ed] Gregor B.E. Jemec ,Gary L. Grove and Jorgen Serup, Boca Raton, Florida: Taylor & Francis , 2006, 2, 697-707 p.Chapter in book (Other academic)
    Abstract [en]

    Firmly established as the leading international reference in this field, Non-Invasive Methods and the Skin broke new ground with its comprehensive coverage of methods used in both clinical and experimental dermatology. Completely revised and updated, containing more than twice as much information, the Second Edition continues the tradition. The authors' thorough research and clear organization make this book a baseline reference for those using noninvasive biophysical methods to study the skin.  Arranged by physical modality and structured to provide educational and practical information, the second edition, like its predecessor, will prove to be of value to young researchers and senior scientists alike. The coverage of major evaluation and measurement methods share a consistent format, including scope, sources of error, application, and validity. This edition incorporates 69 revised chapters with more than 90 new chapters covering topics such as computer technique, imaging techniques, skin friction, barrier functions, and more.New chapters provide coverage of: computers, computer techniques, and image analysis imaging techniques, including clinical photography legal situations and guidelines behind instrumental use skin friction barrier functions important new techniques such as in vitro confocal microscopy, OCT, and Raman spectroscopy veterinary/animal research use of methods  The truly interdisciplinary, international panel of contributors includes experts from the specialties of dermatology, bioengineering, pathology, manufacturing engineering, medical physics, pharmacology, microbiology, neurology, surgery, obstetrics and gynecology, cardiovascular research, and pharmacy from academic institutions and hospitals in countries such as Denmark, Germany, the United Kingdom, the United States, Japan, Israel, Taiwan, and Singapore. The revision is extensive and covers a broad spectrum of methods while providing the same caliber of authoritative information that made the previous edition so popular. Application oriented, practical, and instructive, this Second Edition will meet the needs of the researchers today, and in years to come.

  • 9. Ivens, U.
    et al.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    O'goshi, K.
    Allergy patch test reading from photographic images: Disagreement on ICDRG grading but agreement on simplified tripartite reading2007In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 13, no 1, 110-113 p.Article in journal (Refereed)
    Abstract [en]

    Background/aims: The International Contact Dermatitis Research Group (ICDRG) system for clinical scoring of allergic patch test reactions is well established in clinical dermatology for detailed scoring of allergic reactions. The degree of redness and the presence of swelling, papules, vesicles and bullae are assessed based on visual examination and palpation of reactions. In photographic assessment used in research and tele-dermatology, the scoring is solely based on visual examination of photos. The aim of the study was to evaluate inter-expert variation in patch test reading using photographic images, with ICDRG reading as a reference. Material and methods: Five experienced senior dermatologists each scored 55 positive patch test reactions from 16 slides in an office environment. The slides showed pictures of patch tests with different allergens. The scoring system by ICDRG with six categories for scoring was used. Results: The five dermatologists performed the scoring very differently. When the scoring system was simplified to a tripartite scoring system, the scoring was performed almost similarly by the five clinicians. Conclusion: Based on the present results, it is proposed that the number of scoring categories should be minimized and simplified into negative (including doubtful) reactions, positive reactions and irritant reactions. Such simplified tripartite reading is proposed for research purposes and for tele-dermatology, when scoring is based on photographic images. © Blackwell Munksgaard 2007.

  • 10.
    Kettis Lindblad, Åsa
    et al.
    Uppsala University, Sweden.
    Kjellgren, Karin I.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Ring, Lena
    Uppsala University, Sweden.
    Maroti, Marianne
    Ryhov Hospital, Jönköping, Sweden.
    Serup, Jörgen
    Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    The role of dermatologists, nurses and pharmacists in chronic dermatological treatment: patient and provider views and experiences2006In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 86, no 3, 202-208 p.Article in journal (Refereed)
    Abstract [en]

    Effectively co-ordinated treatment support from healthcare providers (doctors, nurses and pharmacists) may improve patients' adherence to treatment. The objective of this study was to identify patients' and providers' perceptions of the roles of different Healthcare providers in dermatological treatment. Focus groups were used in two types of fora: patients with chronic dermatological diseases (n =2×6) and healthcare providers (n =2×6), including doctors, nurses and pharmacists working in dermatological care. Data were analysed according to the Consensual Qualitative Research approach. The respondents viewed the roles of the providers as complementary, but poorly co-ordinated. Treatment support is provided mainly by the nurse. During the doctor's appointment, diagnosis and treatment decisions are often prioritized, leaving limited time for treatment support. The pharmacist's provision of support is constrained by the lack of privacy and clinical history of individual patients. The most apparent "gap" in the chain of treatment support was between the pharmacist and the other providers. There was a wish for improved interprofessional collaboration to avoid giving conflicting advice. There is a need to improve interprofessional collaboration in dermatology, in order to optimize treatment support in clinical practice.

  • 11. Kjellgren, Karin I
    et al.
    Ring, Lena
    Lindblad, Åsa Kettis
    Maroti, Marianne
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    To follow dermatological treatment regimens - Patients' and providers' views2004In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 84, no 6, 445-450 p.Article in journal (Refereed)
    Abstract [en]

    Adherence to long-term therapy for chronic illness is on average 50%. However, regarding adherence to dermatological treatment the existing literature is limited. The aim of the study was to acquire an understanding of issues associated with adherence to dermatological therapy. Focus group interviews were used in two types of fora: patients with chronic dermatological diseases and health care providers, including doctors, nurses and pharmacists working in dermatological care. Results reveal the providers' view of a suboptimal rate of adherence. According to both providers and patients, factors affecting adherence were patients' expectations and experiences of therapeutic effect, possibilities for the patient to take active part in treatment decisions, as well as mode of administration and type of medication. Suggested strategies for improvement are individualized patient education, continuous treatment support with assessment of medication-taking behaviour and enhanced communication skills among the providers.

  • 12.
    Loden, Marie
    et al.
    Research and Development, ACO HUD Nordic AB, Upplands Väsby, Sweden, ACO Hud Nordic AB, Box 622, SE-194 26 Upplands Väsby, Sweden.
    Ungerth, Louise
    Stockholm Consumer Cooperative Society, Stockholm, Sweden.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Changes in European legislation make it timely to introduce a transparent market surveillance system for cosmetics2007In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 87, no 6, 485-492 p.Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Marketing of cosmetics often makes strong claims linked to active ingredients. This is especially so for anti-ageing products, where the presentation and content of "active" ingredients may create new difficulties in their classification as cosmetics or medicinal products. A recent change in European legislation classifies a product as medicinal by virtue of its "function", in addition to the previous definition of "presentation" (i.e. marketing linked to diseases). Thus, formulations that also restore, correct or modify physiological functions by exerting a pharmacological, immunological or metabolic action should henceforth be covered by the Medicinal Products Directive. A cosmetic product must be suitable for its purpose and should not lead to adverse reactions that are disproportional in relation to its intended effect. However, the forthcoming ban on animal testing of cosmetic ingredients and the new European regulation, REACH (Registration, Evaluation and Authorisation of Chemicals), which aims to ensure a high level of chemical safety to protect human health and the environment, will probably have limited impact on the safety assessment of cosmetics. In order to enable consumers to make informed purchasing decisions, greater transparency in the process of assessing the performance of cosmetics is needed. Introduction of a more transparent system, enabling consumers and professionals to examine the scientific evidence for the claimed effect and the safety assessment of cosmetics, is therefore timely. Lack of transparency increases the risk of consumers wasting money on cosmetics that do not deliver the desired effects. This may jeopardize public trust in the cosmetic industry.

  • 13.
    Ogoshi, Ken-ichiro
    et al.
    Bispebjerg Hospital, Copenhagen.
    Serup, Jörgen
    Bispebjerg Hospital, Copenhagen.
    Safety of sodium fluorescein for in vivo study of skin2006In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 12, no 3, 155-161 p.Article in journal (Refereed)
    Abstract [en]

    Background/purpose: Epicutaneous labeling or intradermal injection of the fluorescent sodium fluorescein is being used increasingly to investigate skin conditions in vivo when using non-invasive devices such as confocal scanning laser microscopy. Sodium fluorescein was used intravenously for decades for the examination of the vasculature of the ocular fundus (fluorescein angiography) and as eye drops for diagnosis of corneal erosions. The objective of this article is to systematically review the literature on fluorescein and conclude its safety in cutaneous research to support research planning and evaluations by ethics committees.

    Methods: A number of databases and the literature about safety and toxicity of fluorescein in animal and human studies were searched and analyzed.

    Results: Side effects or adverse events reported in the literature were related to intravenous bolus injection. Transient nausea and vomiting may occur. Other adverse events such as vasovagal reaction, cardiac or respiratory effects and anaphylaxes are extremely rare but may be fatal. Intradermal injection may cause mild itch or pain; systemic adverse event was reported. Epicutaneous labeling is associated with no reported problem. A typical local dose is several magnitudes of order smaller than a typical intravenous dose.

    Conclusion: Fluorescein has been used for many years in medicine for diagnostic purposes and is widely safe, albeit intravenous bolus injection may cause serious adverse reactions. In the literature, we could not trace reports of local or systemic side effects of topical sodium fluorescein except itch and pain on intradermal injection, however, dependent on the fluorescein preparation used. Local dermal application of fluorescein for in vivo study of skin may be considered widely safe.

  • 14. Ogoshi, Ken-ichiro
    et al.
    Suihko, Christian
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    In vivo imaging of intradermal tattoos by confocal scanning laser microscopy2006In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 12, no 2, 94-98 p.Article in journal (Refereed)
    Abstract [en]

    Background/aims: In vivo confocal laser scanning microscopy (CLSM) is a new method for high-resolution imaging of intact skin in situ. Horizontal mapping of the outer skin is provided (magnification × 1000). Objectives: Tattooing is popular all over the world, however, tattooed skin has not been studied in using CLSM. Results: Tattoos in two volunteers were studied using the Vivascope1500® of Lucid Inc. Subepidermal massive deposits of dense, clustered pigment granules up to about 3 μm in size corresponding to black tattoos, and more scarce and diffuse deposits, corresponding to red, blue and green tattoos, were observed. Diffuse pigment granules tended to accumulate in the outer dermis underneath the level of the basement membrane zone. Conclusion: Dermal pigments from tattoos can be imaged in vivo using CLSM. This application of CLSM has an important future potential for pre-evaluation of tattoos before laser removal, predicting good or poor outcome of laser removal. Copyright © Blackwell Munksgaard 2006.

  • 15.
    O'Goshi, K.-I.
    et al.
    Department of Dermatology, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Inter-instrumental variation of skin capacitance measured with the Corneometer®2005In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 11, no 2, 107-109 p.Article in journal (Refereed)
    Abstract [en]

    Background/purpose: Measurement of skin surface and stratum corneum (SC) hydration during clinical and/or experimental trials needs devices with acceptable reproducibility and sensitivity under conditions ranging from increased and normal to low hydration. A previous study comparing Corneometer® instruments (European group for Efficacy Measurement of Cosmetics and Other products - EEMCO) used for measurement of electrical capacitance of skin indicated a major difference among Corneometer® instruments. The aim of this study was to assess threee inter-instrumental similar Corneometer® instruments (two pieces of CM820 and one CM810) in normal skin. We named them CM-A(CM820), CM-B(CM820), and CM-C(CM810). Methods: The hydration state of SC measured as electrical capacitance of six body sites were measured in 53 subjects with three Corneometer® instruments. Result: We found that the Corneometer® instruments displayed close capacitance levels. When one Corneometer® was plotted against another the regression line indicated a good correlation among instruments albeit a major and random disagreement could appear in individual sites as an exception. Conclusion: Three Corneometer® instruments evaluated in this study gave close measurements and correlated well. Nevertheless, pretest validation of instruments should be undertaken in multicenter studies where capacitance data are compared or pooled, and concordance among instruments should be documented prior to study. © Blackwell Munksgaard, 2005.

  • 16.
    Ring, L.
    et al.
    Uppsala University, Sweden.
    Kettis-Lindblad, A.
    Uppsala University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Kindell, Y.
    Uppsala University, Sweden.
    Maroti, M.
    Ryhov Hospital, Jönköping, Sweden.
    Serup, Jörgen
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Living with skin diseases and topical treatment: patients' and providers' perspectives and priorities2007In: Journal of dermatological treatment (Print), ISSN 0954-6634, E-ISSN 1471-1753, Vol. 18, no 4, 209-218 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    Relationship-centred care stresses the importance of taking both patients' and health-care providers' values, expectations and preferences into account to improve health outcomes. The aim of this qualitative study was to identify patients' and providers' views and experiences of skin disease and topical treatment.

    METHODS:

    Two types of focus group were used: (i) patients with chronic dermatological diseases and (ii) doctors, nurses and pharmacists working in dermatological care.

    RESULTS:

    Three major categories emerged: (i) problems related to the disease, (ii) problems related to the treatment and (iii) strategies for improving everyday life for patients.

    CONCLUSION:

    Patients and providers made several suggestions for improving everyday life. Future research needs to focus on how to achieve preference-matched shared decision-making, or concordance, between patients and health-care providers, taking different perspectives into account and how to evaluate the effect of the final, clinical, economical and humanistic outcomes of care and treatment. More seamless care and an increasingly shared understanding between patients and providers of their values, expectations and preferences for care and treatment may contribute to better health and better daily lives for patients.

  • 17.
    Said, Lilian
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Rebel, Carl
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry.
    Epidermal calcium release (ECR) in vivo sampled with a simple washout chamber technique. Experimental studies in normal and barrier pertubated skin2002In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 8, no 4, 219-226 p.Article in journal (Refereed)
    Abstract [en]

    Background/aims: Epidermis forms the protective barrier of the skin by its outermost layer, stratum corneum. The purpose of this study was to investigate the epidermal barrier in view of epidermal calcium release (ECR), phosphate release, transepidermal water loss (TEWL) and skin surface pH. Calcium is mainly an intracellular ion. Calcium was sampled introducing a new and simple washout chamber technique for the study of epidermal release in vivo. Methods: Test sites on forearms of 13 healthy subjects were pre-treated with 24 h water occlusion, 24 h 2% sodium lauryl sulphate (SLS) or tape stripped. Both untreated and pretreated test sites were exposed to a water washout chamber with 200╡ deionized water as a solvent. Water washout chambers were removed after two hours and calcium and phosphate in the water was analyzed. Transepidermal water loss and pH were measured before and after the trial. Results: pH increased after tape stripping and after exposure to SLS. Transepidermal water loss increased significantly at all test sites. Calcium was significantly released from SLS-treated sites but not from tape stripped sites. There was generally a correlation between ECR, phosphate release, TEWL and pH. In this study ECR is showed to be a barrier marker of high reproducibility. Conclusions: Epidermal calcium release or ECR is found useful as an indicator of skin barrier function. Calcium release and increase of pH appear mainly to illustrate direct and corrosive damage to epidermal cells and functions contrasting TEWL, in this experiment probably reflecting intercellular damage of fracturing as exemplified by mechanical damage resulting from surface stripping. This new distinction of skin barrier damage into cellular damage resulting from a corrosive chemical trauma and intercellular damage and fracturing resulting from a mechanical trauma is exemplified in SLS provocative testing and tape stripping, the former characterized by increased ECR. The washout chamber technique was deemed technically reliable and reproducible, and has a major potential in experimental dermatology and skin pharmacology for the study of in vivo epidermal release of a range of endogenous and exogenous substances.

  • 18.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Efficacy testing of cosmetic products2001In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 7, no 3, 141-151 p.Article in journal (Refereed)
    Abstract [en]

    Background/aims: Regulations for cosmetic products primarily address safety of the products that may be used by large populations of healthy consumers. Requirements for documentation of efficacy claims are only fragmentary. This synopsis aims to review and conclude a set of standards that may be acceptable to the European Community, and the cosmetic industry, as a legal standard for efficacy documentation in Europe in the future. Methods and Results: Ethical, formal, experimental, statistical and other aspects of efficacy testing are described, including validation, quality control and assurance. The importance of user relevant clinical end points, a controlled randomized trial design and evidence-based cosmetic product documentation, validation of methods, statistical power estimation and proper data handling, reporting and archiving is emphasized. The main principles of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) good clinical practice (GCP) should be followed by the cosmetics industry in a spirit of good documentation standard and scientific soundness, but full GCP is not considered mandatory in the field of cosmetics. Documentation by validated bio-instrumental methods may be acceptable, but efficacy documentation based on information about raw materials, reference to literature and laboratory experiments are only acceptable in exceptional cases. Conclusions: Principles for efficacy substantiation of cosmetic products in Europe, as described in this synopsis, are officially proposed by the Danish Ministry of Environment and Energy to the European Community as a basis for an amendment to the Cosmetics Directive or otherwise implemented as a European Community regulation.

  • 19.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Hardware and measuring principles: The dermaflex A2001In: Bioengineering of the Skin: Skin Biomechanics, Volume V / [ed] Peter Elsner, Enzo Berardesca, Klaus P. Wilhelm and Howard I Maibach, CRC Press, 2001, 111-115 p.Chapter in book (Other academic)
    Abstract [en]

    Since skin forms the interface between the human body and the environment, its mechanical properties are important in health and disease. Bioengineering of the Skin: Skin Biomechanics gives a thorough introduction in the biological basis of skin biomechanics. It explains the non-invasive methods that allow measurement of the mechanical properties of the skin focusing on commercially available instruments. Written by internationally leading experts in the field of non-invasive measurement technology of the skin, this volume describes the anatomy, biochemistry, physiology, and pathology of skin biomechanics. It explains in detail how to measure skin mechanic properties and how to use these measurements in the development of drugs and cosmetics.

  • 20.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Hardware and measuring principles: The dermaLab2001In: Bioengineering of the skin : skin biomechanics / [ed] Peter Elsner, Enzo Berardesca, Klaus-Peter Wilhelm, Linköping: Linköpings universitet , 2001, 117-121 p.Chapter in book (Other academic)
    Abstract [en]

    Since skin forms the interface between the human body and the environment, its mechanical properties are important in health and disease. Bioengineering of the Skin: Skin Biomechanics gives a thorough introduction in the biological basis of skin biomechanics. It explains the non-invasive methods that allow measurement of the mechanical properties of the skin focusing on commercially available instruments. Written by internationally leading experts in the field of non-invasive measurement technology of the skin, this volume describes the anatomy, biochemistry, physiology, and pathology of skin biomechanics. It explains in detail how to measure skin mechanic properties and how to use these measurements in the development of drugs and cosmetics.

  • 21.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    How to choose and use non-invasive methods2006In: Handbook of non-invasive methods and the skin, second edition / [ed] Jorgen Serup,Gregor B. E. Jemec,Gary L. Grove, Boca Raton, Florida: Taylor & Francis , 2006, 2, -1056 p.Chapter in book (Other academic)
    Abstract [en]

    Firmly established as the leading international reference in this field, Non-Invasive Methods and the Skin broke new ground with its comprehensive coverage of methods used in both clinical and experimental dermatology. Completely revised and updated, containing more than twice as much information, the Second Edition continues the tradition. The authors' thorough research and clear organization make this book a baseline reference for those using noninvasive biophysical methods to study the skin.Arranged by physical modality and structured to provide educational and practical information, the second edition, like its predecessor, will prove to be of value to young researchers and senior scientists alike. The coverage of major evaluation and measurement methods share a consistent format, including scope, sources of error, application, and validity. This edition incorporates 69 revised chapters with more than 90 new chapters covering topics such as computer technique, imaging techniques, skin friction, barrier functions, and more.New chapters provide coverage of:

    • computers, computer techniques, and image analysis
    • imaging techniques, including clinical photography
    • legal situations and guidelines behind instrumental use
    • skin friction
    • barrier functions
    • important new techniques such as in vitro confocal microscopy, OCT, and Raman spectroscopy
    • veterinary/animal research use of methodsThe truly interdisciplinary, international panel of contributors includes experts from the specialties of dermatology, bioengineering, pathology, manufacturing engineering, medical physics, pharmacology, microbiology, neurology, surgery, obstetrics and gynecology, cardiovascular research, and pharmacy from academic institutions and hospitals in countries such as Denmark, Germany, the United Kingdom, the United States, Japan, Israel, Taiwan, and Singapore. The revision is extensive and covers a broad spectrum of methods while providing the same caliber of authoritative information that made the previous edition so popular. Application oriented, practical, and instructive, this Second Edition will meet the needs of the researchers today, and in years to come.
  • 22.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Mechanical properties of human skin: Elasticity parameters and their relevance2002In: Bioengineering of the skin. Skin biomechanics / [ed] Peter Elsner;, Linköpings universitet , 2002, 41-47 p.Chapter in book (Other academic)
    Abstract [en]

    Since skin forms the interface between the human body and the environment, its mechanical properties are important in health and disease. Bioengineering of the Skin: Skin Biomechanics gives a thorough introduction in the biological basis of skin biomechanics. It explains the non-invasive methods that allow measurement of the mechanical properties of the skin focusing on commercially available instruments. Written by internationally leading experts in the field of non-invasive measurement technology of the skin, this volume describes the anatomy, biochemistry, physiology, and pathology of skin biomechanics. It explains in detail how to measure skin mechanic properties and how to use these measurements in the development of drugs and cosmetics.

  • 23.
    Serup, Jörgen
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Jemec, Gregor BEGrove, Gary L
    Handbook of non-invasive methods and the skin, second edition2006Collection (editor) (Other academic)
    Abstract [en]

    Firmly established as the leading international reference in this field, Non-Invasive Methods and the Skin broke new ground with its comprehensive coverage of methods used in both clinical and experimental dermatology. Completely revised and updated, containing more than twice as much information, the Second Edition continues the tradition. The authors' thorough research and clear organization make this book a baseline reference for those using noninvasive biophysical methods to study the skin.

    Arranged by physical modality and structured to provide educational and practical information, the second edition, like its predecessor, will prove to be of value to young researchers and senior scientists alike. The coverage of major evaluation and measurement methods share a consistent format, including scope, sources of error, application, and validity. This edition incorporates 69 revised chapters with more than 90 new chapters covering topics such as computer technique, imaging techniques, skin friction, barrier functions, and more.New chapters provide coverage of:

    • computers, computer techniques, and image analysis
    • imaging techniques, including clinical photography- legal situations and guidelines behind instrumental use- skin friction
    • barrier functions- important new techniques such as in vitro confocal microscopy, OCT, and Raman spectroscopy
    • veterinary/animal research use of methods

    The truly interdisciplinary, international panel of contributors includes experts from the specialties of dermatology, bioengineering, pathology, manufacturing engineering, medical physics, pharmacology, microbiology, neurology, surgery, obstetrics and gynecology, cardiovascular research, and pharmacy from academic institutions and hospitals in countries such as Denmark, Germany, the United Kingdom, the United States, Japan, Israel, Taiwan, and Singapore. The revision is extensive and covers a broad spectrum of methods while providing the same caliber of authoritative information that made the previous edition so popular. Application oriented, practical, and instructive, this Second Edition will meet the needs of the researchers today, and in years to come.

  • 24.
    Serup, Jörgen
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Keiding, Jens
    Fullerton, Ann
    Gniadecka, Monika
    Gniadecki, Robert
    High-frequency ultrasound examination of skin: Introduction and guide2006In: Handbook of non-invasive methods and the skin, second edition / [ed] Serup, Jorgenm,Grove, Gary Lee, Jemec, Gregor B. E., Boca Raton, Florida: Taylor & Francis , 2006, 2, 473-491 p.Chapter in book (Other academic)
    Abstract [en]

    Firmly established as the leading international reference in this field, Non-Invasive Methods and the Skin broke new ground with its comprehensive coverage of methods used in both clinical and experimental dermatology. Completely revised and updated, containing more than twice as much information, the Second Edition continues the tradition. The authors' thorough research and clear organization make this book a baseline reference for those using noninvasive biophysical methods to study the skin.  Arranged by physical modality and structured to provide educational and practical information, the second edition, like its predecessor, will prove to be of value to young researchers and senior scientists alike. The coverage of major evaluation and measurement methods share a consistent format, including scope, sources of error, application, and validity. This edition incorporates 69 revised chapters with more than 90 new chapters covering topics such as computer technique, imaging techniques, skin friction, barrier functions, and more.New chapters provide coverage of: computers, computer techniques, and image analysis imaging techniques, including clinical photography legal situations and guidelines behind instrumental use skin friction barrier functions important new techniques such as in vitro confocal microscopy, OCT, and Raman spectroscopy veterinary/animal research use of methods  The truly interdisciplinary, international panel of contributors includes experts from the specialties of dermatology, bioengineering, pathology, manufacturing engineering, medical physics, pharmacology, microbiology, neurology, surgery, obstetrics and gynecology, cardiovascular research, and pharmacy from academic institutions and hospitals in countries such as Denmark, Germany, the United Kingdom, the United States, Japan, Israel, Taiwan, and Singapore. The revision is extensive and covers a broad spectrum of methods while providing the same caliber of authoritative information that made the previous edition so popular. Application oriented, practical, and instructive, this Second Edition will meet the needs of the researchers today, and in years to come.

  • 25.
    Serup, Jörgen
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Kettis Lindblad, Åsa
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Maroti, Marianne
    Ryhov Hospital, Jönköping, Sweden.
    Kjellgren, Karin I
    Institute of Nursing Faculty of Health and Caring Sciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Niklasson, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Dermatology and Venerology.
    Ring, Lena
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Ahlner, Johan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences.
    To follow or not to follow dermatological treatment: A review of the literature2006In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 86, no 3, 193-197 p.Article, review/survey (Refereed)
    Abstract [en]

    Creams, ointments and solutions applied to the skin surface by patients as part of a daily routine might be expected to provide a more variable dosage than do standard tablets. However, adherence to treatment in dermatology has been little studied. This article reviews recent publications in the field. These are dominated by questionnaire-based studies, which tend to over-estimate adherence. Reduced adherence to dermatological treatment is noted in 34-45% of patients. It is likely that the percentage of patients who practice truly optimal treatment in their daily life is even lower considering the variable practice of self-treatment. Self-reported psychiatric morbidity contributes to poor adherence to dermatological treatment, while a well-functioning doctor-patient interaction is a major determinant of good adherence, as is patient satisfaction. In conclusion, adherence to dermatological treatment is unsatisfactory and there is a need for intervention and change in clinical routines. The therapeutic and economic benefits may be considerable. The immediate challenge is to stimulate a change in patient behaviour and improve self-treatment at home. © 2006 Acta Dermato-Venereologica.

  • 26. Sloth Andersen, Ellen
    et al.
    Bermark, Susan
    Wahlers, Britt
    Karlsmark, Tonny
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    High-frequency ultrasound of a patient with pressure ulcers2006In: Forum for Nordic Dermato-venereology, ISSN 1402-2915, Vol. 11, 71-72 p.Article in journal (Refereed)
    Abstract [en]

      

  • 27.
    Suihko, Christian
    et al.
    Linköping University, Faculty of Health Sciences.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Fluorescence confocal laser scanning microscopy for in vivo imaging of epidermal reactions to two experimental irritants2008In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 14, no 4, 498-503 p.Article in journal (Refereed)
    Abstract [en]

    Background: Fibre-optic fluorescence confocal laser scanning microscopy (CLSM) is a novel non-invasive technique for in vivo imaging of skin. The cellular structure of the epidermis can be studied. A fluorophore, e.g. fluorescein sodium, is introduced by an intradermal injection or applied to the skin surface before scanning. Images are horizontal optical sections parallel to the skin surface. Fluorescence CLSM has hitherto not been applied to experimental contact dermatitis. Objective: The aim was to study the applicability of fluorescence CLSM for in situ imaging of irritant contact dermatitis reactions caused by established model irritants, e.g. sodium lauryl sulphate (SLS) and pelargonic acid (PA). Methods: Twelve healthy individuals volunteered. The flexor aspect of the right and the left forearm was exposed to SLS in water and PA in isopropanol and occluded under Finn Chambers for 24h. The reactions were rated clinically and, following epicutaneous and intra-dermal application of fluorescein sodium, studied by fluorescence CLSM, magnification ×1000. Results: Both irritants disturbed the epidermal intercellular borders, which became blurred, thickened and variably altered. This was interpreted as being a result of chemical damage to cellular membranes. Cell borders might show a double contour as a result of inter-cellular oedema. PA might increase the size of individual keratinocytes interpreted as a result of intra-cellular disturbance with oedema. SLS-exposed sites showed clusters of keratinocytes with visible nuclei in the outer layers of the epidermis, e.g. a parakeratotic shift supposed to be due to increased cell proliferation elicited by SLS. The isopropanol vehicle and PA did not interfere with the CLSM imaging technique or the experimental procedures. SLS, being a detergent, however, modified the physico-chemical properties of the skin surface and both disturbed epicutaneous labelling with the flurophore and immersion oil coupling between the skin surface and the optical system. Thus, SLS was technically more difficult to study by CLSM than PA. Conclusions: This preliminary study demonstrated the applicability of fluorescence CLSM for a detailed study of experimental skin irritants in vivo. Essential findings were disturbed and widened cell borders, swelling of keratinocytes by PA and induction of a parakeratotic shift by SLS with clusters of keratinocytes holding nuclei in the epidermis. Fluorescence CLSM offers a unique opportunity to study the inter- and intracellular water compartments directly in the epidermis in situ and an opportunity to visualize cell proliferation manifested as parakeratosis. Fibre-optic fluorescence CLSM of irritant reactions is, however, technically more complicated than reflectance CLSM and may not be applicable to any irritant. SLS applied epicutaneously interacted with the skin surface and coupling to the microscope and was thus found to be more difficult to study technically than PA. PA dissolved in isopropanol is for technical reasons, and with SLS as alternative, considered the preferred model irritant. © Journal compilation © 2008 Blackwell Munksgaard.

  • 28. Suihko, Christian
    et al.
    Swindle, Lucinda D
    Thomas, Steven G
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of dermatology and venereology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Fluorescence fibre-optic confocal microscopy of skin in vivo: Microscope and fluorophores2005In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 11, no 4, 254-267 p.Article in journal (Refereed)
    Abstract [en]

    Background/aims: Fibre-optic confocal imaging in vivo is a new approach in the assessment of human skin. The objective is to describe a novel instrument and its operation and use in combination with fluorophores. Methods: The Stratum® is a fibre-optic fluorescence confocal microscope especially developed for the study of skin and mucous membranes. The system is flexible and any body site can be studied with a hand-held scanner. The light source is a 488 nm argon ion laser. Horizontal (en face) images of the epidermis and outer dermis are produced with cellular resolution. Magnification is approximately 1000x. Fluorescein sodium is routinely used as fluorophore (intradermal injection or application to the skin surface). This fluorophore is safe for human use in vivo, but other substances (rhodamine B, Acridine Orange, green fluorescent protein, curcumin) have also been studied. Results: The instrument produces sharp images of epidermal cell layers from the epidermal surface to the sub-papillary dermis, with sub-cellular resolution. The scanner is flexible in use. The technique of intradermal fluorophore injection requires some skill. Conclusions: We consider this fibre-optic instrument a potentially important tool in skin research for non-invasive optical biopsy of primarily the epidermis. Present use is focussed on research applications, where the fluorophore distribution in the skin may illustrate morphological changes in the epidermis. © Blackwell Munksgaard, 2005.

  • 29.
    Tagami, H.
    et al.
    Department of Dermatology, Tohoku University, Tohoku, Japan.
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology . Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Hachiro Tagami, MD: Japanese dermatologist in a global community2003In: Skin research and technology, ISSN 0909-752X, E-ISSN 1600-0846, Vol. 9, no 1Other (Other academic)
    Abstract [en]

    [No abstract available]

  • 30. Thomsen, JS
    et al.
    Benfeldt, E
    Jensen, SB
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Menné, T
    Topically applied aspirin decreases histamine-induced wheal and flare reactions in normal and SLS-inflamed skin, but does not decrase itch. A randomized, double-blind and placebo-controlled human study2002In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 82, 30-35 p.Article in journal (Refereed)
  • 31. Thomsen, JS
    et al.
    Benfeldt, E
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Suppression of spontaneous scratching in hairless rats by sedatives but not by antipruritics2002In: Skin pharmacology and applied skin physiology, ISSN 1422-2868, E-ISSN 1422-2906, Vol. 15, no 4, 218-224 p.Article in journal (Refereed)
    Abstract [en]

    Experimental scratching in animals has hitherto been provoked by substances injected into the skin or central nervous system. We aimed to investigate if spontaneous scratching in the rat can be reduced by sedatives and antipruritics, and to assess if spontaneous scratching is elicited from the skin or the central nervous system. It may also be a complex behaviour related to the rat species, different from clinical itch. Eight male hairless rats were studied for 6 weeks. The animals were recorded on videotape in the middle of the day and at night, and the scratching activity was counted. The following substances were tested sequentially: midazolam, mepyramine, a eutectic mixture of lignocaine and prilocaine (EMLA«), betamethasone dipropionate and a vehicle. On days 1-3 of each sequence, the test material was applied to a 42-cm2 area on the rostral part of the back. Subsequent treatment of the whole body was made on day 4. Midazolam was injected intraperitoneally from day 1 to day 4. After 4 days of treatment, there was a washout phase of 3 days until the next sequence. We found a positive correlation between minutes awake and number of scratch episodes. Spontaneous scratching was lower after mepyramine on day 4 (p = 0.046) and after midazolam injections on days 1-3 (p = 0.009) and day 4 (p = 0.003). The local anaesthetic, EMLA, did not significantly influence spontaneous scratching. In conclusion, only the drugs with sedative properties suppressed spontaneous scratching, which is probably a cerebral phenomenon or otherwise explained general behaviour, rather than a reaction to skin stimuli. Thus, for testing of topically applied antipruritics, spontaneous scratching cannot be used as an animal model. Furthermore, evaluation of provocative scratching should eliminate/exclude spontaneous scratching.

  • 32. Thomsen, JS
    et al.
    Simonsen, L
    Benfeldt, E
    Jensen, SB
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    The effect of topically applied salicylic compounds on serotonin-induced scratching behaviour in hairless rats2002In: Experimental dermatology, ISSN 0906-6705, E-ISSN 1600-0625, Vol. 11, no 4, 370-375 p.Article in journal (Refereed)
    Abstract [en]

    There is a strong need for antipruritic substances for treating itch in clinical dermatology. In one recent human study, topically applied acetylsalicylic acid has been described to rapidly decrease histamine-induced itch. We have established a model for periferally elicited pruritus by injecting serotonin into the rostral back area (neck) in rats. Using this model, we aimed to investigate the antipruritic potential of four different salicylic compounds, which all possess different skin penetration characteristics. Eighteen rats were studied for 6 weeks. Prior to serotonin injections (2mg/ml, 50 ╡l), 10 ╡l of test substances was applied to a circular area 18 mm in diameter. The four substances were salicylic acid, butyl salicylate, diethylamine salicylate and salicylamide, all solubilized in dimethyl isosorbide to a concentration of 5% w/w. Diethylamine salicylate and salicylamide were previously shown to be slowly absorbed through rat skin in contrast to salicylic acid and butyl salicylate. After serotonin injections, scratching was monitored by video recording for 1.5h. Compared with the vehicle, a lower number of scratch sequences were seen when diethylamine salicylate (P< 0.001) and salicylamide (P = 0.005) had been applied. The numbers of scratch sequences were lower with diethylamine salicylate and salicylamide than with the vehicle throughout the 1.5-h study period. We conclude that topical application of diethylamine salicylate and salicylamide could suppress serotonin-induced scratching in rats. The antipruritic effect seems to be related to the slow drug release of the two substances. The results may be clinically relevant as serotonin induces itch in humans.

  • 33. Thomsen, JS
    et al.
    Sonne, M
    Benfeldt, E
    Jensen, SB
    Serup, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Menné, T
    Experimental itch in sodium lauryl sulphate-inflamed and normal skin in humans: A randomized, double-blind, placebo-controlled study of histamine and other inducers of itch2002In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 146, no 5, 792-800 p.Article in journal (Refereed)
    Abstract [en]

    Background: Investigations of pruritogenic substances in humans have involved intradermal injections in normal skin, itching of inflamed skin has been little studied. Objectives: To develop an itch model with provocation of itch in experimentally inflamed skin as well as in normal skin, using subjects as self-controls. Methods: In 32 non-atopic volunteers aged 21-30 years, the skin of five selected test sites on one volar forearm was pretreated for 24 h with large Finn chambers containing 1% sodium lauryl sulphate (SLS) used as a standard contact irritant to induce inflammation. Twenty microlitres of different pruritogenic substances [histamine, substance P, neurokinin A, neurokinin B, trypsin, platelet-activating factor (PAF) and serotonin] and saline as control were injected intradermally into the inflamed test sites and in corresponding non-treated sites on the opposite forearm. The test individuals scored itch intensity on a visual analogue scale for 20 min, and weal area was then measured. Results: Histamine and substance P induced itch in both normal and inflamed skin compared with a saline reference. Neurokinin A, trypsin, PAF and serotonin only elicited itch in normal skin, and neurokinin B neither elicited itch in normal skin nor in inflamed skin. Itch was induced in normal and SLS-inflamed skin to a similar magnitude. However, weal area after histamine was significantly (P<0.001) larger in inflamed skin when compared with normal skin. Conclusions: Histamine and substance P elicited itch to the same degree in normal skin and inflamed skin pretreated with SLS despite a stronger weal response in inflamed skin. Mediators present in inflamed skin did not potentiate itch, a c-fibre-mediated neuronal response. The weal reaction is based on enhanced vascular permeability (protein extravasation). A greater skin perfusion in inflamed skin may therefore have increased the weal size. We propose an experimental model in humans for testing of itch involving both normal and inflamed skin. The model has the potential for use in evaluating new topical and systemic treatments of itch.

  • 34.
    Ulff, E.
    et al.
    Ryhov Hospital, Jönköping, Sweden.
    Maroti, M.
    Ryhov Hospital, Jönköping, Sweden.
    Kettis-Lindblad, A.
    Uppsala University, Sweden.
    Kjellgren, Karin
    Sahlgrenska Academy, Göteborg University, Sweden.
    Ahlner, Johan
    Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Ring, L.
    Uppsala University, Sweden.
    Serup, Jörgen
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Single application of a fluorescent test cream by healthy volunteers: assessment of treated and neglected body sites2007In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 156, no 5, 974-978 p.Article in journal (Refereed)
    Abstract [en]

    Background: Management of dermatological self-treatment is demanding. Imperfect application of creams and ointments and poor adherence to topical treatment are common, resulting in unsatisfactory treatment outcome. Objectives: To assess the technique and precision of test subjects' self-application of a test cream. Treated and neglected skin sites were measured after intended widespread single application of a fluorescent test cream. Methods: Twenty healthy volunteers (10 women, 10 men) were included. They were asked to treat their whole skin surface with the fluorescent test cream, except the head and neck and skin covered by underwear. Treated and untreated sites were subsequently measured under Wood's ultraviolet radiation. Results: Thirty-one per cent of the skin surface that was a target for application did not show any fluorescence and thus was assumed to have been untreated. Typical neglected sites included the central back, the upper breast, the axilla with surrounding skin, the legs and the feet, particularly the sole. The posterior aspect of both trunk and extremities, not easily inspected, was more often neglected. In the treated sites the fluorescence was typically uneven. Conclusions: Qualified and motivated persons with no obvious physical limitations practised imperfect self-application of a test cream mimicking a therapeutic cream product. As much as 31% of the skin surface was neglected. Sites especially prone to nonapplication were identified. This might imply that dermatological patients on long-term self-treatment may practise local application very poorly, a problem of major therapeutic and economic importance. A fluorescent test cream can be used for research, and as an educational tool in the training of dermatological patients on how to apply local treatment.

  • 35.
    Ulff, Eva
    et al.
    Ryhov County Hospital, Sweden .
    Maroti, Marianne
    Ryhov County Hospital, Sweden .
    Serup, Jörgen
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Dermatology and Venerology in Östergötland.
    Fluorescent cream used as an educational intervention to improve the effectiveness of self-application by patients with atopic dermatitis2013In: Journal of dermatological treatment (Print), ISSN 0954-6634, E-ISSN 1471-1753, Vol. 24, no 4, 268-271 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the study was to assess if a fluorescent cream, in a self-application educational session, could increase the effectiveness of cream application in practice and serve as a therapeutic intervention. Methods: 30 adults with atopic dermatitis were enrolled. They applied a fluorescent test cream on two occasions. Effectiveness of application was checked under ultraviolet illumination. At baseline, the patients greased their skin as they normally do. After 2 weeks, the patients were instructed to grease the whole body area. The results were commented on and visualised to the patients on both occasions. Results: At the baseline visit, 29% of the target skin was untreated, and at the follow-up visit after education, this improved to 13.6% (mean values, p andlt; 0.05). Women performed better than men at baseline; however, men performed similar to women at the follow-up visit. Conclusions: The Fluorescent-cream Educational Session (FES) is an educational instrument for therapeutic intervention based on interaction between patient and provider. It includes hard endpoints, that is, visualisation and measurement of treated area, time spend on treatment and amount of cream used.

  • 36.
    Ulff, Eva
    et al.
    Ryhov County Hospital, Sweden .
    Maroti, Marianne
    Ryhov County Hospital, Sweden .
    Serup, Jörgen
    Linköping University, Department of Clinical and Experimental Medicine, Dermatology and Venerology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Dermatology and Venerology.
    Falkmer, Ursula
    Ryhov County Hospital, Sweden .
    A potent steroid cream is superior to emollients in reducing acute radiation dermatitis in breast cancer patients treated with adjuvant radiotherapy. A randomised study of betamethasone versus two moisturizing creams2013In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 108, no 2, 287-292 p.Article in journal (Refereed)
    Abstract [en]

    Background and purpose: The aim was to investigate whether treatment with potent local steroids can reduce signs and symptoms of acute radiation dermatitis in breast cancer patients undergoing adjuvant radiotherapy (RT) compared to emollient creams. less thanbrgreater than less thanbrgreater thanMaterial and methods: The study was randomised and double-blinded. Patients with breast cancer who had undergone mastectomy or breast-conserving surgery were included when they started adjuvant 3D planned RT. In all, 104 patients were randomised 2:1:1 to three treatment groups, i.e. betamethasone + Essex (R) cream, Essex (R) cream or Canoderm (R) cream. The patients themselves treated the irradiated area during the radiation period (5 weeks) and two weeks after cessation of RT. Signs of RT dermatitis were measured qualitatively with RTOG clinical scoring and quantitatively by colorimeter. In addition, the patients symptoms were recorded as well as the Fitzpatrick skin type. less thanbrgreater than less thanbrgreater thanResults: There was a statistically significant difference (p = 0.05) in skin reactions when assessed with RTOG in favour of the group treated with the potent steroid. Patient-related symptoms did not differ between the treatment groups. The effect of the steroid was prominent in three subgroups, i.e. (i) patients treated with ablation of the breast, (ii) patients receiving RT to the armpit and the supraclavicular fossa, and (iii) patients with Fitzpatrick skin type 1. less thanbrgreater than less thanbrgreater thanConclusions: Treatment with betamethasone cream is more efficient than moisturizers for the control of acute RT dermatitis in patients treated with adjuvant RT for breast cancer.

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