Atopic dermatitis (eczema)

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Topical pimecrolimus for eczema.

Cochrane Database Syst Rev. 2007;(4):CD005500

Authors: Ashcroft D, Chen LC, Garside R, Stein K, Williams H

BACKGROUND: Pimecrolimus was developed as an alternative to topical corticosteroids for treating eczema (atopic dermatitis) but its efficacy and safety compared with existing treatments remains unclear. OBJECTIVES: To assess the effects of topical pimecrolimus for treating eczema. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (to October 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2006), MEDLINE (from 2003 to October 2006), and EMBASE (from 2005 to October 2006). We also contacted researchers and manufacturers in the field. SELECTION CRITERIA: Randomised controlled trials of 1.0% topical pimecrolimus used twice daily compared against other topical comparators for treating eczema. DATA COLLECTION AND ANALYSIS: Two authors independently examined each retrieved study for eligibility and extracted data for efficacy, tolerability and safety. A random-effects model was used to estimate the pooled risk ratios (RRs) and 95% confidence intervals (95% CIs). MAIN RESULTS: We included 31 trials (8019 participants) in the analysis. In short-term (/=6 months), pimecrolimus was significantly better than vehicle in preventing flares (9 trials, 3091 participants, RR 1.47, 95% CI 1.32 to 1.64 at six months) and in improving quality of life.Pimecrolimus was significantly less effective than two topical corticosteroids, i.e. 0.1% triamcinolone acetonide for investigators’ global assessment (1 trial, 658 participants, RR 0.75, 95% CI 0.67 to 0.83) and 0.1% betamethasone valerate for participants’ global assessment (1 trial, 87 participants, RR 0.61, 95% CI 0.45 to 0.81) at three weeks. Pimecrolimus was also associated with significantly more overall withdrawals and skin burning. None of the trials reported on key adverse effects such as thinning of skin.Pimecrolimus was significantly less effective than 0.1% tacrolimus for investigators’ global assessment at six weeks (RR 0.58, 95% CI 0.46 to 0.74) and led to more withdrawals due to lack of efficacy (RR 2.37, 95% CI 1.10 to 5.08) based on two trials involving 639 participants, but there was no significant difference in proportions of participants experiencing any adverse events. AUTHORS’ CONCLUSIONS: Topical pimecrolimus is less effective than moderate and potent corticosteroids and 0.1% tacrolimus. The therapeutic role of topical pimecrolimus is uncertain due to the absence of key comparisons with mild corticosteroids.

PMID: 17943859 [PubMed - in process]

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Photosensitivity dermatitis from inadvertent exposure to aminolevulinic acid.

Cutis. 2007 Aug;80(2):124

Authors: Zeltser R, Gilchrest BA

PMID: 17944169 [PubMed - in process]

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This post was written in response to a question from a subscriber. In reality there are no such thing as a product or ingredients that is “good” for everybody to use. Hypoallergenic is also a relative term. People can be allergic to so-called hypoallergenic products as well. In some cases the words “sensitive” and “hypoallergenic” [...]

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Occupational allergic contact dermatitis to methyldibromoglutaronitrile in hand degreasing toilet paper.

Contact Dermatitis. 2007 Aug;57(2):126-7

Authors: Marcano ME, Heras F, Conde-Salazar L

We inform about a case of occupational allergic contact dermatitis (OACD) to methyldibromoglutaronitrile (MDBGN) in industrial hand degreasing moist toilet paper. To our knowledge, this is the first published case of OACD to MDBGN in industrial hand degreasing toilet papers. A cause-effect relationship seems to be clearly established. We believe that physicians must keep in mind that MDBGN is a strong allergen either mixed or as a single component of industrial moist toilet papers. MDBGN must be taken into account for OACD at an appropriate work environment.

PMID: 17627659 [PubMed - indexed for MEDLINE]

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Allergic contact dermatitis from rabbit’s feed.

Contact Dermatitis. 2007 Aug;57(2):127-8

Authors: Isaksson M, Ahnlide I, Pyk K

PMID: 17627660 [PubMed - indexed for MEDLINE]

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Lymphomatoid contact dermatitis to an exotic wood: a very harmful toilet seat.

Contact Dermatitis. 2007 Aug;57(2):128-30

Authors: Ezzedine K, Rafii N, Heenen M

We report the case of a 58-year-old man who experienced a 2-year history of arciform rash of the buttocks associated with an intense pruritis. The lesion worsened despite several multipotent topical steroid courses. Punch biopsy with immunohistochemistry of the lesion was suggestive of lymphomatoid contact dermatitis, and extensive screening for cutaneous T-cell lymphoma (CTCL) remained totally negative. Lymphomatoid contact dermatitis is an inflammatory disease that can clinically simulate malignant lymphoma. Although the course of the disease is considered to be benign, it should be regarded with attention as it has been hypothesized that the condition could be a precursor of CTCL.

PMID: 17627661 [PubMed - indexed for MEDLINE]

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Cellular phone addiction and allergic contact dermatitis to nickel.

Contact Dermatitis. 2007 Aug;57(2):130-1

Authors: Livideanu C, Giordano-Labadie F, Paul C

PMID: 17627662 [PubMed - indexed for MEDLINE]

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Allergic contact dermatitis due to rubber in sports equipment.

Contact Dermatitis. 2007 Aug;57(2):131-2

Authors: Moritz K, Sesztak-Greinecker G, Wantke F, Götz M, Jarisch R, Hemmer W

PMID: 17627663 [PubMed - indexed for MEDLINE]

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WITHDRAWN: Maternal antigen avoidance during lactation for preventing atopic eczema in infants.

Cochrane Database Syst Rev. 2007;(3):CD000131

Authors: Kramer MS

BACKGROUND: Background pending. OBJECTIVES: To assess the effects of prescribing an antigen avoidance diet to lactating mothers of infants with atopic eczema on the severity of the eczema. SEARCH STRATEGY: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. Date of last search: October 2001. SELECTION CRITERIA: All acceptably controlled comparisons of maternal antigen avoidance prescribed to lactating mothers of infants with atopic eczema, regardless of the degree of antigen avoidance (number of foods eliminated from the diet) or its duration. DATA COLLECTION AND ANALYSIS: Data were extracted by the author from published reports, and supplemented by additional information from trialists contacted by the author. MAIN RESULTS: One trial involving 17 women was included. Based on this single small trial, maternal antigen avoidance was associated with a nonsignificant reduction in eczema severity. AUTHORS’ CONCLUSIONS: The unimpressive results of this single trial should be interpreted with caution both because of its small size (n=17) and because the trial compared exposure to cow milk and egg with exposure to soya milk (soya can itself be allergenic). Maternal reports of changes in the severity of their breast-fed infants’ eczema following ingestion of certain foods should be pursued by performing multiple (preferably double-blinded) challenges and dechallenges with the suspected foods.

PMID: 17636598 [PubMed - in process]

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Psychological and educational interventions for atopic eczema in children.

Cochrane Database Syst Rev. 2007;(3):CD004054

Authors: Ersser SJ, Latter S, Sibley A, Satherley PA, Welbourne S

BACKGROUND: Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. There have been no relevant systematic reviews applicable to children. OBJECTIVES: To assess the effectiveness of psychological and educational interventions in changing outcomes for children with atopic eczema. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (to September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (from 1966-2005), EMBASE (from 1980 to week 3, 2005 ), PsycINFO (from 1872 to week 1, 2005). On-line: National Research Register, Meta-register of Controlled Trials, ZETOC alerts, SIGLE (August 2005). SELECTION CRITERIA: RCTs of psychological or educational interventions, or both, used to manage children with atopic eczema. DATA COLLECTION AND ANALYSIS: Two authors independently applied eligibility criteria, assessed trial quality and extracted data. A lack of comparable data prevented data synthesis. MAIN RESULTS: Five RCTs met the inclusion criteria. Some included studies required clearer reporting of trial procedures. Rigorous established outcome measures were not always used. Interventions described in all 5 RCTs were adjuncts to conventional therapy. Four focused on intervention directed towards the parents; data synthesis was not possible. Psychological interventions remain virtually unevaluated by studies of robust design; the only included study examined the effect of relaxation techniques (hypnotherapy and biofeedback) on severity. Three educational studies identified significant improvements in disease severity between intervention groups. A recent German trial evaluated long term outcomes and found significant improvements in both disease severity (3 months to 7 years, p=0.0002, 8 to 12 years, p=0.003, 13 to 18 years, p=0.0001) and parental quality of life (3 months to 7 years, p=0.0001, 8 to 12 years p=0.002), for children with atopic eczema. One study found video-based education more effective in improving severity than direct education and the control (discussion) (p<0.001). The single psychological study found relaxation techniques improved clinical severity as compared to the control at 20 weeks (t=2.13) but this was of borderline significance (p=0.042). AUTHORS’ CONCLUSIONS: A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi-professional eczema school and nurse-led clinics) require further and comparative evaluation to examine their cost-effectiveness and suitability for different health systems.

PMID: 17636745 [PubMed - in process]

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