Background: Geriatric health care has become a worldwide concern, but relatively few statistical studies are available about geriatric skin diseases. Moreover, no information exists regarding skin disorders among the elderly population in Taiwan that has become a geriatric country. Objective: To determine the characteristic pattern and the prevalence of various skin disorders for the elderly who visited the National Taiwan University in the last 7 years. Methods: Using a database from the Dermatology Outpatient Clinic of the National Taiwan University Hospital, 1993–1999 file, we conducted a retrospective cross-sectional study by evaluating the age, proportion, and gender of each specific cutaneous disease category, χ² tests were used for analyzing statistical significance. The analysis supplied odds ratios and 95% confidence intervals. Results: A total of 16,924 patients aged 65 years and older, which constituted 11% of the total patients seen at the Clinic of Dermatology from 1993 through 1999, were studied. The male to female ratio was 1.3 to 1. The most common cutaneous disorder in the elderly was dermatitis (58.7%), followed by fungal infections (38.0%), pruritus (14.2%), benign tumors (12.8%), and viral infections (12.3%). Cutaneous malignant tumors were found in 2.1%. Basal cell carcinoma occurred in 29.8%, actinic keratosis in 22.4%, Bowen’s disease in 13.3% and squamous cell carcinoma 13.3%. Interestingly, our cases of extramammary Paget’s disease showed a male predominance. Most melanomas were acral lentiginous melanoma located on the soles. The prevalence of common diseases in elderly patients compared with those outpatients of less than 65 years showed a 3-fold increased risk for pruritus. Moreover, the pattern of geriatric skin diseases in Taiwan was significantly different from Western countries. Conclusion: The prevalence of skin diseases in elderly patients emphasizes the importance of health education in geriatric people in Taiwan concerning appropriate use of emollients, proper foot care, sun protection and early detection of skin cancers.

Chinese topical medicaments (CTMs) are commonly used in Taiwan and in Southeast Asia. However, a systematic evaluation of contact sensitization potential from CTM has not been carried out to our knowledge. This study was undertaken to investigate the incidence of contact sensitivity to the components of CTM in patients with contact dermatitis from CTM. A screening series of 27 crude drugs most commonly used in CTM as well as a modified European standard series was patch tested in 30 patients. The herbs with the most frequent positive reactions were Flos Caryophylli (see text), Radix Angelicae Pubescentis (see text), Cortex Cinnamomi (see text), Cortex Radix Acanthopanacis (see text), Caulis Impatientis (see text), Resina Draconis/Sanguis Draconis (see text), Fructus Cnidii (see text), Radix Gentiana Macrophyllae (see text), and Rhizoma Ligustici Chuanxiong (see text). Concomitant allergy to colophonium was found in most of these positive reactions. Reducing the concentration and simplifying the compositions of these components, as well as replacement with those of low allergenicity in CTM, such as Rhizoma Arisaematis (see text), Herba Lycopodii (see text), Radix Cyathulae Officinalis (see text), Rhizoma Pinelliae (see text), Radix Angelicae Dahuricae (see text), Herba Dendrobii (see text), Secretio Moschus (see text), and Stigmata Croci (see text), may be advocated. A precise labelling of the dosage of each component and the exact chemical compounds in CTM products could further improve the safety and therapeutic effects of CTM in the future.

Background: Allergic contact dermatitis from rubber chemicals is frequent but has not been reported form Asia. Objective: To study the pattern of type IV allergy to rubber chemicals in a Chinese-based population. Methods: A retrospective study was conducted by reviewing the patch test results of 2,235 (604 men, 1,631 women) patients from January 1986 to December 2000. Results: Ninety-nine patients (4.4%) had one or more positive reactions, 42 (6.9%) men and 57 (3.5%) women. The incidence did not increase throughout the study period. Among thiuram, mercapto, carba and black-rubber mix, thiuram is the most potent sensitizer, mostly for the hand and mercapto mix for the foot. Thiuram allergy is considered occupation related, while mercapto allergy, mostly from rubber slippers, is not typically related to an occupation. A negative correlation between thiuram and carba was found despite the frequent association between these two mixes. A high risk of rubber sensitization was noted in construction, health service, transportation, agriculture and hairdressing workers. A high frequency of concomitant sensitivity to cobalt was found. Conclusion: This is the first statistically analyzed study of rubber chemical allergy in Asia, which supports major trends concerning rubber chemical allergy from European studies. However, wearing rubber slippers in Taiwan contributes to the high percentage of foot dermatitis. Carba should still be retained in the European standard series because of the coexistence of thiuram and carba in rubber products. The concomitant sensitization to cobalt in rubber-allergic patients needs further evaluations.

TCRgamma PCR allows the diagnosis of MF in patients with lymphocyte-poor lesions, suggestive of MF pathologically. TCRgamma PCR is more likely to be negative with moderate to severe inflammation, particularly with papillary dermal fibrosis. We suggest that the ratio of malignant clonal to reactive T-cells is critical for MF diagnosis.

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