Size Of Erythema Research Articles

A Prospective Randomized Controlled Pilot Study to Assess the Response and Tolerability of Cold Atmospheric Plasma for Rosacea

Introduction: Rosacea is a common, facial, chronic inflammatory skin disease. Due to its complex pathogenesis, adequate therapy of rosacea can be challenging. An innovative recent therapeutic tool is cold atmospheric plasma (CAP), which is already established in the treatment of chronic wounds and promising in different other skin diseases. Methods: In a split-face pilot study we investigated dielectric-barrier-discharged CAP in erythemato-telangiectatic (ETR) and/or papulopustular rosacea (PPR). CAP treatment was applied on lesional skin of a randomized side once daily (90 s/area) for 6 weeks. The other untreated side served as control. Co-primary endpoints were ≥1 improvement of the Investigator Global Assessment (IGA) score on the treated side compared to control and a decline of the Dermatology Life Quality Index (DLQI) after 6 weeks. Secondary endpoints included inflammatory lesion count (papules and pustules), skin redness intensity and erythema size. Adverse events (AEs) were recorded constantly. Additionally, participants were weekly assessed for symptoms, skin condition, trigger factors, skin care, treatment success, and local tolerance parameters. All p values were calculated using the Wilcoxon signed-rank test. Results: Twelve subjects (ETR, n = 3; ETR and PPR, n = 9) completed the study. DLQI was significantly improved after 6 weeks (p = 0.007). On the CAP-treated side, lesions (p = 0.007) and erythema size (p = 0.041) were significantly reduced compared to the control. IGA (p = 0.2) and skin redness intensity (p = 0.5) did not differ significantly between control and CAP-treated side. No serious AEs occurred and treatment was well tolerated. Conclusion: CAP is a promising new treatment of rosacea, especially for PPR.

Diurnal Variations in Skin Prick Testing.

Background: Prior research suggests that skin prick testing (SPT) might be larger in the afternoon, with unclear clinical significance. Methods: This retrospective chart review analyzed SPT results from patients between June 2008 and June 2017, organized into 4 time groups for analysis (Group 1: 7:00 AM -10:29 AM, Group 2: 10:30 AM -11:59 AM, Group 3: 12:00 PM -2:29 PM, and Group 4: 2:30 PM -8:15 PM). Results: In total, 12,982 (n) patient test results had positive histamine and were included in final analysis. Histamine wheal size was not significantly increased in the PM compared with AM (P = 0.89). Food allergen and aeroallergen wheal sizes were not significantly increased in PM. Histamine erythema size was increased in the PM compared with AM (P ≤ 0.01). Food allergen and aeroallergen erythema sizes trended toward an increase in the PM. Conclusions: There were not significant differences in SPT wheal size based on time of day for histamine, food allergens, or aeroallergens. SPT can be reliably performed at any time of day.

Specificity of tuberculin skin test improved by BCG immunization schedule change in Japan

IntroductionTuberculin skin test (TST) has been used to diagnose tuberculosis (TB) and latent tuberculosis infection (LTBI). However, in Bacillus Calmette-Guérin (BCG) vaccinated patients, TST tends to produce false-positive results. According to the previous vaccination schedule, Japanese people were mandated to receive up to three doses of BCG-vaccine. The vaccination schedule was changed in 2003 and as per the new schedule, only infants are administered a dose of BCG vaccine. Our hypothesis is that this change can lead to a reduction in the cross-reaction to TST. MethodsWe evaluated the TST results obtained from 1097 recruits from six defense camps and 667 recruits from an air base. These TST data were divided into two groups according to the date of birth: a new group and an old group according to the BCG immunization schedule. We then analyzed positive and negative reaction of TST and erythema sizes. ResultsWe confirmed that the change in BCG-vaccination schedule significantly decreased TST false-positive reaction (Pmeta = 1.4 × 10−18; risk ratio = 0.83; 95% confidence interval: 0.80–0.87) and erythema size (Pmeta = 1.1 × 10−4; mean difference = 6.6 mm; 95% confidence interval: 3.2 mm–9.9 mm). ConclusionsWe showed the reduction in BCG cross-reaction to TST, in the new BCG vaccination schedule group, compared to the old group, we also have extracted information on the improvement in the specificity of TST for LTBI and TB diagnosis, which resulted from BCG schedule change.

Microvascular effects of microneedles with subsequent histamin application in the skin prick test.

Since decades, histamin applications are routinely performed in skin prick tests using a lancet. However, this technique is associated with various drawbacks. In healthy human subjects, we investigated the effects of microneedle-enhanced histamin delivery (wheal size, erythema size) in the skin microvasculature using polarized light spectroscopy imaging (Tissue Viability imaging, TiVi). Histamin was applied on microneedle-pretreated skin or on -untreated skin, to assess the microvascular response in the local skin. In our results, histamin was delivered more rapidly into the skin after microneedle pretreatment compared to passive diffusion, visible as wheal and erythema. The here presented technique might be useful for a personalized drug-testing system in the future.

DIURNAL VARIATIONS IN SKIN PRICK TESTING

Introduction Skin prick testing (SPT) can reliably diagnose food and environmental allergies. Previous studies have shown mixed results on the diurnal pattern for SPT, which has not been evaluated in food allergens. Methods Retrospective chart review of pediatric patients at one institution from 6/2008- 6/2017 who received SPT to food and/or environmental allergens. Our hypothesis was that SPT wheal and erythema size would be higher in PM (12:00-19:30) vs. AM (7:00-11:59). Results We reviewed 15,960 charts; 13,077 had adequate histamine response without antihistamine use within 5 days of SPT (58% male, PM µ±SD=6.3±4.4 years vs. AM 5.7±4.2). Wheal size for histamine SPT was not significantly increased in PM vs. AM (µ±SD=5.7± 1.9 mm, n=6562 vs. 5.7±1.9, n=6388; p=0.76), nor for the most common food allergens. Significantly increased erythema for histamine SPT was noted in PM vs. AM (µ±SD=14.6±6.3, n= 6501 vs. 14.2±6.1, n=6352; p14.7(14.3-14.5). There was no significant difference in wheal size in this sub-analysis. Conclusions SPT in the PM is associated with increase erythema size for histamine and several other allergens, but without a significant difference in wheal size. Diurnal cortisol variations likely influence erythema size, but do not influence clinical outcomes of SPT. Thus, SPT can be reliably performed at any time of day. Skin prick testing (SPT) can reliably diagnose food and environmental allergies. Previous studies have shown mixed results on the diurnal pattern for SPT, which has not been evaluated in food allergens. Retrospective chart review of pediatric patients at one institution from 6/2008- 6/2017 who received SPT to food and/or environmental allergens. Our hypothesis was that SPT wheal and erythema size would be higher in PM (12:00-19:30) vs. AM (7:00-11:59). We reviewed 15,960 charts; 13,077 had adequate histamine response without antihistamine use within 5 days of SPT (58% male, PM µ±SD=6.3±4.4 years vs. AM 5.7±4.2). Wheal size for histamine SPT was not significantly increased in PM vs. AM (µ±SD=5.7± 1.9 mm, n=6562 vs. 5.7±1.9, n=6388; p=0.76), nor for the most common food allergens. Significantly increased erythema for histamine SPT was noted in PM vs. AM (µ±SD=14.6±6.3, n= 6501 vs. 14.2±6.1, n=6352; p14.7(14.3-14.5). There was no significant difference in wheal size in this sub-analysis. SPT in the PM is associated with increase erythema size for histamine and several other allergens, but without a significant difference in wheal size. Diurnal cortisol variations likely influence erythema size, but do not influence clinical outcomes of SPT. Thus, SPT can be reliably performed at any time of day.

An Exploratory Analysis of the Correlation Between Erythema Size and Total Nasal Symptom Scores in the Environmental Exposure Unit

An Exploratory Analysis of the Correlation Between Erythema Size and Total Nasal Symptom Scores in the Environmental Exposure Unit

Comparing safety of abrasion and tape-stripping as skin preparation in allergen-specific epicutaneous immunotherapy

Comparing safety of abrasion and tape-stripping as skin preparation in allergen-specific epicutaneous immunotherapy

Variability In Measurement Of Allergen Skin Testing Results Among Allergy-Immunology Specialists

Epicutaneous skin testing for sensitization to aero-allergens in patients with allergic diseases requires measurement of skin wheal and erythema in response to antigens. This may be variable between different providers especially among patients with dark skin pigmentation. Purpose of this study is to determine whether Allergy-Immunology specialists vary in their measurement of epicutaneous skin tests in patients with differential skin pigmentation. 3 patients with differing skin tones were skin tested using various concentrations of histamine to produce increasing sizes of skin wheal and erythema reaction. High quality photographs of these were taken and sent to 20 board certified/eligible Allergy-Immunologists to measure the wheal and erythema size. There was poor agreement among specialists in measurement of both wheal and flare sizes from patient with darkest skin tone. In contrast in patients with lighter skin tones there was fair to good agreement and excellent agreement from specialists in measurement of wheal and flare sizes respectively. Measurement of skin test results in patients with dark skin pigmentation may have significant variability even among specialists and in vitro tests may be more appropriate in these patients.

A comparative evaluation of recombinant Mycobacterium tuberculosis ESAT6-CFP10 and PPD as the antigen ci reagents for skin test in guinea pigs

Objective To comparatively evaluate the effects of a recombinant Mtb protein ESAT 6-CFP10 （ rESAT6-CFP10 ） and a purified protein derivative （ PPD ） as skin test reagents in guinea pigs . Methods Guinea pigs were sensitized with different Mycobacteria species .After sensitization , all guinea pigs were intradermally injected with rESAT6-CFP10 and PPD.At 48 h after the injection, the size of ery-thema at injection sites was measured by using a double-blind method .For guinea pigs sensitized with viable Mtb, the size of erythema at injection sites were measured at 24 h after the injection .The positive conversion rates of skin test with rESAT 6-CFP10 and PPD were calculated .Results The results of PPD skin test were positive in all guinea pigs sensitized with viable Mtb , killed Mtb and BCG with erythema diameters of （11.4 ±0.9） mm, （11.8±1.1） mm and （13.2±0.8） mm, respectively.Positive skin test with rESAT6-CFP10 was only observed in guinea pigs infected by viable Mtb-showing erythema diameters of （13.7±5.7） mm. The skin test with rESAT6-CFP10 was negative in guinea pigs sensitized by killed Mtb-and vaccinated by BCG.The skin tests by using rESAT6-CFP10 and PPD were performed on randomly selected guinea pigs at ninth day after infection by Mycobacterium tuberculosis H37Rv.At the 2nd week, totally 24 selected guinea pigs showed positive skin test results with rESAT6-CFP10 （24/24） with erythema diameters of （19.9± 3.0） mm, while only 15 out of 24 had positive PPD skin test with erythema diameters of （6.1±5.5） mm. At the 4th week, all guinea pigs showed positive PPD skin test （3/3） with erythema diameters of （12.7± 2.5） mm.Conclusion The skin test by using recombinant ESAT 6-CFP10 protein can effectively distin-guish viable Mtb infection from BCG vaccination and killed Mtb sensitization , which is a more suitable anti-gen than PPD for the early diagnosis of Mtb infection . Key words: Recombinant protein; Mycobacterium tuberculosis; Guinea pig; Skin test

Two-step tuberculin skin test in nurse students

The tuberculin skin test (TST) was conducted in 243 nurse students (19.4 +/- 1.3 years old). The second TST were carried out in 240 students who did not show blister or necrosis in the first TST. The size of erythema was 16.5 +/- 9.4 mm in the first TST (T1) and 24.3 +/- 15.6 mm in the second TST (T2). The negative reactors, whose size of erythema was below 10 mm, were decreased from 53 to 25, whereas, the strong reactors, whose size of erythema was more than 30 mm, were increased from 11 to 71. The difference of the size of erythema (T2-T1) was 9.7 +/- 11.9 mm in the group I (190 students) who received the latest TST in junior high school, whereas, that was 0.5 +/- 9.2 mm in the group II (50 students) who received the latest TST 14 months before this study. T2-T1 in the group I was weakly correlated with T1. Twenty-four negative reactors received BCG vaccination, and 23 of them converted to positive. Seventy-one strong reactors were checked by chest X-ray, and none showed the findings of tuberculosis, and required the administration of anti-TB drug. The two-step TST is an essential means to know the baseline reactivity to TST, and to distinguish newly infected tuberculosis from booster phenomenon.

The transmission of tuberculosis in a cram school

The specificity of the tuberculin skin test (TST) is influenced by the previous BCG vaccination during childhood in Japan. The QuantiFERON (QFT) is expected to detect latent infection among tuberculosis contacts, however, its use is still limited. We report a case of TB outbreak that caused by a private lesson teacher. His sputum was found to be acidfast bacillus-positive (Gaffky 4) by smears examination. We evaluated the risk factors of TB infection using TST among contacts. A total of 184 persons were examined by a TST. These results were used to estimate the rate of TB infection by a mixture model. Logit analysis was also performed to estimate the number of infected person by using the relation between the positive rate of QFT and the size of erythema using a past report. We applied the Wells-Riley mathematical model of airborne transmission to calculate the risk of infection. As compared with persons who had less contact with the index TB case, the estimated rate of TB infection was higher among persons who had close contact during the month before the index case started medical treatment (5% vs 23%). According to the model, the case added 1.1-4.0 quanta per hour (qph) to the room during a month before starting the treatment. These results suggest the importance of an early diagnosis of the index case to prevent TB infection.

THE ANALYSIS ON THE RESULTS OF TB SKIN TEST IN MEDICAL STUDENTS

To obtain baseline, medical students are recommended to make two-step tuberculin skin tests when they are in good physical health, as the baseline information to detect later tuberculosis infection. We investigated a method to obtain appropriate baseline data, because the accurate method of this test was not yet established. The subjects were the tuberculin skin test results of 1066 medical students who were subjected to different methods of tuberculin skin test (58% tested once, 37% tested twice, and 5% tested three times). We retrospectively made multi-dimensional analysis about these data. (i) In the first tuberculin skin test, 20% of the results were negative. (ii) When repeated with intervals between one to four years, the diameters of erythema gradually increased due to the effect of prior tests. (iii) The difference in size of erythema between the first tuberculin skin test and the repeated tests was less than 10 mm. (iv) When two-step tuberculin skin test was repeated, significant increase in the diameters of erythema were demonstrated in the second test (P = 0.0048). (v) Regarding booster phenomenon, it apparently lasted for one year, and it also remained after two years or over. CONSIDERATION: Thus, repeated tuberculin skin tests performed in good physical health was difficult to interpret measuring the diameters of erythema to detect tuberculosis infection. Thus, the diagnostic value of a tuberculin skin test was reduced while it requires unnecessary time and expenditure for its implementation. It seems to be appropriate for medical students to make a two-step tuberculin skin tests, soon after their enrollment, and the results should be used as a baseline to detect possible later tuberculosis infection.

Study of the two-step tuberculin tests and gamma-interferon assays in elderly persons

Recently, an outbreak of lung tuberculosis among elderly residents happened in the home for aged, and it has become a social problem. To analyze the problem of tuberculosis in the elderly persons, we performed two-step tuberculin tests at two weeks interval and gamma-interferon assays for diagnosis of human tuberculosis to residents in the home for aged. 45 males (age; 77.3 +/- 8.9 SD) and 118 females (age; 81.9 +/- 8.6 SD) elderly persons (> or = 60) were examined. Standard dose of PPD was injected intracutaneously, and read at 48 hours. Erythema of 10 mm diameter or more was considered positive. The results were as follows. (1) The percentages of positive reactors in the 1st (T1) and the 2nd (T2) tuberculin tests were 50.3% and 68.1%, respectively. (2) The diameters of erythema and percentage of positive reactors (T1) did not very with age, but the size of erythema increased from 13.5 mm (T1) to 21.2 mm (T2) among those below 80 years, and from 13.0 mm (T1) to 16.4 mm (T2) among those 80 years or higher (p < 0.01). (3) The percentage of positive reactors (T1) varied by sex, namely males react stronger than females. (4) A dose of interferon-gamma released specifically in response to PPD stimulation of whole blood cultures showed no close relation with the diameters of erythema. In conclusion, tuberculin reactivity waned among elderly persons, and the fact suggests that they would have lower resistance against new infections, and as a result, they might have higher risk of developing tuberculosis. Elderly residents should be performed two-step tuberculin tests at the time of their entrance to the home for aged, and negative reactors should carefully be followed up.

Usefulness of a novel diagnostic method of tuberculosis infection, QuantiFERON TB-2G, in an outbreak of tuberculosis

The purpose of this study was to evaluate QuantiFERON TB-2G (QFT), a novel method of detecting tuberculosis infection among contacts of a tuberculosis patient by determining the whole-blood interferongamma response to the specific antigens. A teacher of a college who had been coughing for the preceding two months was diagnosed with smear-positive tuberculosis. About 270 students of the college were considered to have been exposed to tuberculosis infection, of whom 73 were in closer contact with the index case because they participated in a one-week group excursion attended by the teacher. Two of the contact students developed active tuberculosis shortly thereafter. Tuberculin tests were conducted to almost all students, and QFT was performed for only those with tuberculin reactions having erythema diameters of 30 mm or larger. Tuberculin tests of students, all of whom had been vaccinated with BCG at least once, revealed that the distribution of the close contact group was slightly shifted to right (larger side) than those with less close contacts. The QFT positive rate for close contacts was 45.5%, while that for less close contacts was only 7.1%, which obviously indicates that QFT is hardly affected by the tuberculin allergy due to past BCG vaccination. The distribution of interferon-gamma measurements (log-transformed) of the close contacts showed typical bimodality, one mode representing the infected, another the non-infected. This was not clear for the less close contacts. The correlation of interferon-gamma measurements (log-transformed) with tuberculin reaction erythema size was weak, if not non-significant. It was concluded that QFT was a useful method for diagnosing tuberculosis infection and was unaffected by the BCG-caused tuberculin allergy. In the case of the outbreak mentioned above, QFT greatly reduced the indication of chemoprophylaxis, from 28% of all the contacts solely based on tuberculin test to only 7%. Although there remains some problems to be overcome for QFT to be widely used with high confidence, this technology will provide a high possibility for wider and more accurate indication of chemoprophylaxis and will be one of the essential tools of tuberculosis control of the 21st century in Japan.

Cost-effectiveness analysis of QuantiFERON-TB 2nd generation used for detection of tuberculosis infection in contact investigations

QuantiFERON-TB-2nd Generation (QFT) has recently been developed as an accurate tool for detecting tuberculosis infection regardless of past history of BCG vaccination. A cost-effectiveness analysis was made on the usefulness of QFT that was used in the contacts investigation of a group of subject exposed to tuberculosis infection. A model was built assuming that a group of youngsters was exposed to an infection source with different degrees of intensity. The distribution of the tuberculin reaction of this group was assumed to be variable according to the history of BCG vaccination and tuberculin testing. Also, the distribution of tuberculin reaction size after the recent exposure is assumed to be different, as has been observed previously. The strategies for investigating this group included giving QFT to subjects having erythema size exceeding 30 mm, 20 mm, and 10 mm as compared with the strategy with the tuberculin test only, or the QFT only. The outcome variables calculated for each strategy were sensitivity and specificity, and predictive values in detecting tuberculosis infection; the number of indications for chemoprophylaxis, the number of tuberculosis patients averted, and the costs incurred in treating tuberculosis patients and chemoprophylaxis cases and testing with tuberculin and QFT were also considered. The sensitivity (specificity) of the QFT employed in the analysis was 89% (98%) based on our observations. It was confirmed that the additional use of QFT would greatly reduce the number of indications for chemoprophylaxis cases that have never been infected and that the use of QFT is cost effective in spite of its relatively high unit cost. It will be useful to decide on the eligibility of QFT testing, i.e., the minimal tuberculin reaction size of subjects to whom QFT is given, based on the assumption of pre-exposure distribution of tuberculin reaction size of the group.

Screening of tuberculosis by interferon-γ assay before biologic therapy for rheumatoid arthritis

Infection with Mycobacterium tuberculosis (M. tuberculosis) is a critical complication in anti-TNF therapies. In 141 BCG vaccinated healthy individuals and 71 rheumatoid arthritis (RA) patients as screening before anti-TNF therapies, M. tuberculosis specific immune responses were evaluated by tuberculin skin test (TST) and enzyme-linked immunospot assay (ELISPOT), which detected antigen specific IFN-gamma secreting cells in peripheral blood mononuclear cells simulated with either purified protein derivative (PPD), early secretory antigen target 6 (ESAT-6) or culture filtrate protein 10 (CFP-10). Induration over 5 mm in TST was found in 87.9% of controls and 21.4% of RA patients. Erythema size in TST was significantly suppressed in RA patients, especially those receiving prednisolone (PSL), whereas the PPD specific IFN-gamma secretion was less attenuated. Significant responses to either ESAT-6 or CFP-10 in ELISPOT were detected in 14.1% of RA patients including those having positive TST, while the ELISPOT assay was negative in all healthy individuals and 73.3% of RA patients having positive TST. Of ELISPOT positive RA patients, mean dosage of PSL was 4.58 mg and 1.25 mg in TST negative and positive patients, respectively. Thus, ELISPOT is useful for screening of tuberculosis in RA patients, even in those receiving corticosteroids.

Liposomal Heparin Spray: A New Formula in Adjunctive Treatment of Superficial Venous Thrombosis

The objective of this study was to assess the efficacy and safety of liposomal heparin spray-a new formula of topical heparin delivery. This was a randomized, multicenter, controlled open clinical trial with 2 parallel groups. Forty-six outpatients with clinical signs of superficial venous thrombosis (SVT) were treated with either topical liposomal heparin spraygel (LHSG) (Lipohep Forte Spraygel, 4 puffs of 458 IU tid (n = 22) or with low-molecular-weight heparin (LMWH) (Clexane 40 mg once a day (n = 24), administered subcutaneously (sc). Main outcome measures were efficacy parameters (improvement of local symptoms-pain control and planimetric evaluation of erythema size, duplex Doppler assessment of thrombus regression) and safety parameters (documentation of adverse events, with particular reference to deep vein thrombosis [DVT] by duplex sonography, and patients' and investigators' assessment of drug tolerance). Patients' and investigators' subjective assessment of efficacy of treatment and change in basic biochemical parameters were defined as secondary outcome measures. Statistical analysis was performed with use of Wilcoxon test, Mann-Whitney U-test and Chi-square test. Regression of SVT-related symptoms, including pain, erythema, and thrombus presence, was shown as comparable in LHSG and LMWH groups. These results were corroborated by efficacy assessment by investigators and patients. Three cases of deep venous thrombosis in heparin spraygel and 1 in heparin sc group were reported. No significant adverse reactions were observed in the spraygel group, but 1 serious allergic reaction was observed in the LMWH group. Tolerance of new formula heparin was assessed as good. Heparin spraygel-a new topical mode of heparin application, seems a promising method of heparin delivery. This initial study has demonstrated comparable efficacy and safety of LHSG and LMWH in local treatment of SVT. These findings should be confirmed by further extensive study that will reach appropriate statistical power to support such conclusion, for despite heparin treatment, significant risk of DVT was demonstrated in both groups.

Improvement on chest X-ray findings after two months of antituberculous treatment

To detect factors that affected the improvement on chest X-ray findings after two months of antituberculous treatment. We assessed the chest X-ray findings of 72 patients with sputum culture positive to determine whether findings showed improvement after two months treatment with antituberculous drugs, and we compared the differences in disease status between the improved group (I group) and the non-improved group (N group). The I group consisted of 43 pts. and the N group consisted of 29 pts. The mean age in the N group was higher than that in the I group. There were no differences in sex or body weight. Though the mortality rate in the N group was 20.7% and that in the I group was 9.3%, it was not statistically significant. The erythema size of tuberculin skin test in the I group was larger than that in the N group. There were no differences in the type or extent of lesion on Gakkai classification between the two groups, and there were no remarkable blood biochemistry findings in either group. Though there were no differences in the rates of side effects or discontinuation of treatment, the incidence rate of complications in the N group was higher than that ih the I group. Older patients with complications and smaller erythema size of tuberculin skin test reaction showed a delay in chest X-ray findings improvement after two months of antituberculous drug treatment.

The effect of semipermeable dressings on smallpox vaccine site evolution

Many hospital systems in the United States are contemplating the implementation of a smallpox vaccination program. The Centers for Disease Control and Prevention and other organizations recommend use of occlusive dressings over the vaccination site of health care workers in contact with patients. Minimal data are available on the impact of an occlusive dressing on the evolution of the vaccinia inoculation site. We conducted a prospective observational study in which subjects were instructed to cover their vaccination site with either a semipermeable dressing over gauze or gauze alone. We recorded the duration of semipermeable dressing use and parameters pertaining to vaccination site evolution, to include time until scab separation. The increased use of a semipermeable dressing is associated with increased time until scab separation (n = 41, r =.48, P =.001 by regression analysis). This analysis predicts a 9-day difference in time until scab separation between patients that wore semipermeable dressings 100% of the time versus not at all. No significant correlation was observed between semipermeable dressing use and size of maximum erythema, time until maximum erythema, size of erythema on day 6 or 8, nor time until pustule formation. Semipermeable dressing use appears to prolong the time until scab separation and possibly the duration of infectivity and risk of secondary transmission. Health care organizations may wish to consider this information when instituting a smallpox vaccination program.

Analysis of tuberculin skin test in employees of Nagasaki University Hospital

The tuberculin skin test (TST) was conducted in 1,087 employees of Nagasaki University Hospital. The size of erythema (T1) was 27.3 +/- 17.0 mm, and 8.6% of all participants showed < = 9 mm, 49.9% showed 10-29 mm, 41.5% showed > = 30 mm. Laboratory technologists showed significantly larger reactions than other groups. Doctors and nurses working on the tuberculosis ward showed larger reactions than those working on the non-tuberculosis wards. Reactions tended to be larger with aging, and the younger employees in their 20s showed significantly smaller reactions than those in their 40s. The second TST was carried out in 253 employees whose T1 was below 30 mm. The size of erythema enlarged from 16.1 +/- 6.6 mm (T1) to 26.4 +/- 15.4 mm (T2), with the difference (booster phenomenon) of 10.2 +/- 14.4 mm. T2 and T2-T1 were larger in nurses working on the tuberculosis ward than those on the non-tuberculosis wards. It was suggested that laboratory technologists, nurses and doctors especially working on the tuberculosis ward are at risk of tuberculosis infection, and the two-step TST was an essential means to know the baseline reactivity, and to determine recent tuberculosis infection.