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Pressure ulcers (also called bed sores or pressure sores) are sores on the skin caused by constant pressure or friction. They usually affect people who are immobilised or find it difficult to move themselves, for example the elderly or paralysed. Pressure ulcers frequently occur on bony parts of the body, such as the heels and hips, and also on the coccyx (tail bone). Pressure ulcers do not always heal, and, if they do heal, healing can take a long time.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 11, 2014

Pressure ulcers (also called pressure sores, bed sores or decubitus ulcers) are sores on the body caused by pressure or rubbing. They usually happen to immobile people, on bony parts of their bodies, such as hips, heels and elbows.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 19, 2006

Keratoconus is a condition where the transparent front of the eye (cornea) gets thinner and begins to bulge. This leads to vision problems, usually short‐sightedness (distant objects appear blurred). The condition is more common in children and young adults and can deteriorate over time. Initially glasses and contact lenses can help. If the disease progresses, the only option may be a corneal transplant.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 24, 2015

UV light therapy approaches such as UVB phototherapy and psoralen plus ultraviolet A (PUVA) can effectively reduce psoriasis symptoms. But the treatment involves quite a lot of effort because you need several sessions per week. Repeated and long-term light therapy can also increase the risk of skin cancer. Psoriasis can often be effectively treated with a good skincare routine and medication applied to the affected areas of skin. But this doesn’t always help enough in moderate and severe psoriasis. UV light therapy is then considered. This treatment, also known as phototherapy, can be used on its own or in combination with topical (externally applied) medication or tablets. It involves exposing the affected areas of skin to ultraviolet light (UV light). UV light reduces inflammation and slows the production of skin cells. The treatment is usually given three times a week in a dermatology practice or hospital. It takes place in special cabins with fluorescent lamps that emit UV light of a certain wavelength. There are also lamps that can be used to treat individual parts of your body, such as your head, hands or feet. Tanning beds can't be used for light therapy because they don’t allow you to control the exact spectrum and dose of light you are exposed to.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 18, 2017

Chronic palmoplantar pustulosis is a skin disease where repeated crops of painful yellow pus spots form on the palms and soles, often over many years. Many different treatments have been used including topical creams and ointments, drugs by mouth and ultraviolet radiation. The review of trials found that several treatments improve the symptoms of chronic palmoplantar pustulosis, although no treatment was shown to suppress the condition completely. Oral retinoid therapy (acitretin) appears to be helpful at relieving symptoms, particularly if combined with PUVA. Ciclosporin and tetracycline antibiotics can also provide some relief. Topical treatments were generally less helpful. As yet there is no ideal treatment for chronic palmoplantar pustulosis, though oral retinoids, particularly when combined with psoralens and ultraviolet radiation (PUVA), may help

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 25, 2006

Psoriasis is a common, chronic inflammatory skin disease, with an estimated global prevalence ranging from 0.5% to 4.6%. Based on clinical features, psoriasis is generally divided into the following: chronic plaque psoriasis (CPP); psoriasis associated with psoriatic arthritis; and pustular, erythrodermic, or guttate psoriasis. We also considered psoriasis affecting the palms and soles (palmoplantar psoriasis, or PPP). Although psoriasis is rarely life‐threatening, it can affect a person's quality of life significantly.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 23, 2013

Vitiligo is a chronic skin disorder characterised by patchy loss of skin colour. Some people experience itching before the appearance of a new patch. It affects people of any age or ethnicity, more than half of whom develop it before the age of 20 years. There are two main types: generalised vitiligo, the common symmetrical form, and segmental, affecting only one side of the body. Recent genetic research suggests that generalised vitiligo is, at least in part, an autoimmune condition which destroys melanocytes (pigment cells). Although our understanding of vitiligo has increased, its causes are still poorly understood. Several treatments are available. Some can restore pigment but none can cure it or prevent its spread or recurrence. Vitiligo patches can have a major psychosocial impact, especially for people with dark or tanned skin or when the face or hands are affected. People with vitiligo can be stigmatised, often experiencing low self‐esteem and a lack of self‐confidence. Children with vitiligo may be teased and bullied at school. Despite this, we found only one study assessing psychological therapy for vitiligo.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 24, 2015

Eczema can usually be kept at bay by moisturizing your skin enough, applying anti-inflammatory ointments or creams, and avoiding irritants. If this isn't enough, light therapy with UV rays or treatment with tablets can be considered. Some people have such severe eczema flare-ups that using ointments or creams to reduce the inflammation doesn't relieve the symptoms enough. During acute phases like this, light therapy may be used. If this doesn't work well enough either, tablets that suppress the body's immune response are an option.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 23, 2017

OBJECTIVE: The main objectives for this evidence-based analysis were to determine the safety and effectiveness of photochemical corneal collagen cross-linking with riboflavin (vitamin B(2)) and ultraviolet-A radiation, referred to as CXL, for the management of corneal thinning disease conditions. The comparative safety and effectiveness of corneal cross-linking with other minimally invasive treatments such as intrastromal corneal rings was also reviewed. The Medical Advisory Secretariat (MAS) evidence-based analysis was performed to support public financing decisions. SUBJECT OF THE EVIDENCE-BASED ANALYSIS: The primary treatment objective for corneal cross-linking is to increase the strength of the corneal stroma, thereby stabilizing the underlying disease process. At the present time, it is the only procedure that treats the underlying disease condition. The proposed advantages for corneal cross-linking are that the procedure is minimally invasive, safe and effective, and it can potentially delay or defer the need for a corneal transplant. In addition, corneal cross-linking does not adversely affect subsequent surgical approaches, if they are necessary, or interfere with corneal transplants. The evidence for these claims for corneal cross-linking in the management of corneal thinning disorders such as keratoconus will be the focus of this review. The specific research questions for the evidence review were as follows: TECHNICAL: How technically demanding is corneal cross-linking and what are the operative risks?

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The aim of this review was to assess whether specially treated pathogen‐reduced platelets, work as well as normal platelets when transfused. Specifically, do they stop or prevent bleeding as well as standard platelets; do they produce the same increase in platelet count; and does their use affect further transfusion requirements? This review also assessed whether pathogen‐reduced platelets are as safe as normal platelets, for example are they associated with any difference in the rate of death following transfusion, and are there any side effects associated with the use of these products.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 30, 2017

Psoriasis is a common, chronic disease, which for many people, is associated with profound functional, psychological and social morbidity and important comorbidities. Effective treatments are available. Some treatments are expensive; all require appropriate monitoring and some may only be accessed in specialist care settings. Evidence indicates that a substantial proportion of people with psoriasis are currently dissatisfied with their treatment.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: October 2012

BACKGROUND: UV-based therapies, which include narrow-band (NB) UVB, broad-band (BB) UVB, and psoralen and UVA (PUVA), are well known treatment options for moderate to severe plaque psoriasis. However, there are limited evidence-based reviews on their efficacy, short-term safety, and tolerability.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Topical treatment alone doesn’t always help enough in people with moderate to severe psoriasis. Then medications that have an effect throughout the entire body are considered. They can be taken as tablets or injected. Because of the possible side effects, it is a good idea to be well informed about their pros and cons. Mild plaque psoriasis can usually be effectively treated with topical medications. Additional treatment may be needed for moderate to severe psoriasis. UV light therapy is often tried first. If that doesn't help either, oral medications and injections are considered. This is called "systemic treatment" because the medicines enter the bloodstream and have an effect throughout the entire body (or “system”). The treatment typically begins with one of these drugs: Methotrexate (trade names: Lantarel, Metex, MTX Hexal, Methotrexat AL, for example)Fumaric acid esters (trade name: Fumaderm)Ciclosporin (trade names: Ciclosporin Pro, Ciqorin, Sandimmun, for example)Less common: Acitretin (trade name: Acicutan) If these medications don't provide enough relief for psoriasis or are unsuitable for some other reason, treatment with biological treatments (biologics) is possible. This group of drugs manufactured using biotechnology includes: Adalimumab (Humira)Etanercept (Benepali, Enbrel)Infliximab (Flixabi, Inflextra, Remicade, Remsima)Ixekizumab (Taltz)Secukinumab (Cosentyx)Ustekinumab (Stelara) Another option is apremilast (Otezla). It belongs to a separate class of drugs.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 18, 2017

OBJECTIVE: To summarize the current state of evidence for combination topical and systemic therapies for mild to severe psoriasis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Abstract Objective: To assess the effect and safety of NB-UVB for vitiligo using an evidence-based approach. Methods: Randomized controlled trials (RCTs) on the treatment of vitiligo with NB-UVB were identified by searching PubMed and the Cochrane Library. The primary outcome was re-pigmentation degree. Results: A total of seven RCTs involving 232 participants with vitiligo were included in this systematic review. The methodological qualities of included studies were generally moderate. Two trials compared narrow-band ultraviolet B (NB-UVB) with UVA control, showing no significant differences between two methods on the number of patients who achieved >60% re-pigmentation [relative risk (RR) = 2.50, 95% confidence interval (CI): 0.11-56.97, p > 0.05]. Two trials compared NB-UVB with psoralens plus UVA (PUVA) control, and no difference was seen between the two treatments on the number of patients who achieved >50 re-pigmentation (RR = 1.16, 95% CI: 0.64-2.11, p > 0.05) or >75% re-pigmentation (RR = 2.00, 95% CI: 0.89-4.48, p > 0.05). Three trials compared NB-UVB with 308-nm excimer light/laser (EL) control, and again no significant difference was found between the two methods (p > 0.05). The adverse events of NB-UVB in the included studies were slight and tolerated. Conclusion: NB-UVB showed equivalent efficacies to UVA, PUVA or 308-nm EL control in the treatment of vitiligo. Side effects of NB-UVB were acceptable. More RCTs were needed to validate the results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Psoriasis is a chronic skin disorder affecting up to 2.5% of the world's population. Despite the myriad treatment options available, there is no uniformly accepted therapeutic approach for moderate-to-severe psoriasis. The objective of this review is to evaluate the relative efficacy and safety of available therapeutic options and to formulate general recommendations for the treatment of moderate-to-severe psoriasis. MEDLINE and Evidence Based Medicine (Cochrane) were used to perform a comprehensive search of the literature from 1986 to 2006. The most scientifically rigorous clinical trial published in the literature was selected for Psoriasis Area and Severity Index (PASI 75) comparison. Only information from clinical trials, human subjects and English language journals are reported in this study. The percentage of PASI 75 reduction at approximately 12 weeks obtained by the following treatment options were: Goeckerman and RePUVA, 100%; calcipotriene plus PUVA, 87%; ciclosporin, 78.2-80.3%; infliximab, 80%; adalimumab 40 mg every other week, 53% and 40 mg/week, 80%; PUVA, 63%; methotrexate, 60%; NB-UVB, 55%; acitretin 52%; etanercept 50 mg twice weekly, 49% and 25 mg twice weekly, 34%; efalizumab, 31.4%; and alefacept 21%. Psoriatic treatments with safer profiles compared with other agents include bath PUVA, Goeckerman and RePUVA. Based on the literature review of efficacy and safety of biologics and prebiologic treatment options for moderate-to-severe psoriasis, the risk:benefit ratio seems most favorable for Goeckerman and RePUVA, followed by either etanercept or adalimumab.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Many topical treatments for cutaneous warts exist and previous reviews of trials did not follow intention-to-treat (ITT) principles for analysis. We aimed to perform a meta-analysis and pooled analysis of randomized controlled trials (RCTs) of topical treatment for cutaneous warts using ITT principles. Systematic electronic searches (Cochrane library, Medline, Embase, Clinical trial registers) were conducted in May 2009. Included trials reported completed cure of warts and data were extracted from these trials. We performed random-effects meta-analysis and assessed heterogeneity using the I(2) statistic and conducted a pooled analysis of each treatment. We found 77 relevant studies of which the majority were of low methodological quality. Salicylic acid (SA) was superior to placebo with a risk ratio (RR) for cure of 1·60 [95% confidence interval (CI) 1·15-2·24]. Cryotherapy was not statistically better than placebo, RR 0·89 (95% CI 0·27-2·92), but aggressive cryotherapy was significantly better than gentle cryotherapy with a RR of 2·06 (95% 1·20-3·52). Combined therapy of SA and cryotherapy had a higher cure rate than either SA or cryotherapy alone. The results of the pooled analysis found a cure rate of 23% (5-73%) in placebo trials, 52% (0-87%) in SA trials, 49% (0-69%) in cryotherapy trials, 54% (45-75%) in aggressive cryotherapy trials and 58% (38-78%) in the combined cryotherapy and SA trials. Aside from the use of SA and aggressive cryotherapy there is insufficient evidence from RCTs to support the use of other therapies. Higher quality evidence is needed to evaluate other therapies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

This review compared different phototherapy regimens for treating patients with atopic dermatitis (AD). It concluded that medium doses of ultraviolet A may be effective in treating acute flares of AD, while narrow-band ultraviolet B may be effective for managing chronic AD. Given that the review had several methodological limitations, the authors' conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Contaminated surfaces in healthcare facilities may contribute to the transmission of pathogens implicated in nosocomial infections, such as Clostridium difficile, methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococci (VRE), gram-negative rods (Acinetobacter spp. and Enterobacteriaceae) and Norovirus. While patient rooms are regularly cleaned and disinfected using manual techniques, evidence suggests that the adequacy of cleaning is often suboptimal, particularly when the focus is only on those surfaces perceived to be high-risk or frequently contacted (high-touch). As well, when cleaning, sufficient wet contact time between the surface and disinfectant is needed to ensure adequate disinfection, but is not always achieved. Wiping of all surfaces where there is hand contact, not just those that are considered to be high risk or high-touch areas, and ensuring adequate wet contact time is required for adequate disinfection of the patient environment.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 30, 2014

This review assessed the impact on quality of life of different topically applicable alternatives to corticosteroids for the treatment of atopic dermatitis (AD). The authors concluded that there are a clear lack of randomised controlled studies that have compared different treatments and their impact on quality of life in participants with AD. Although a number of biases might have been introduced into the review, these conclusions appear appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

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