Atopic dermatitis (eczema)

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Smokers report more psoriasis, but not atopic dermatitis or hand eczema: results from a Norwegian population survey among adults.

Dermatology. 2008;216(1):40-5

Authors: Bø K, Thoresen M, Dalgard F

BACKGROUND: Many reports indicate that skin diseases are affected by lifestyle factors. OBJECTIVE: To examine the relationship between reported skin diagnoses, smoking and alcohol consumption in an urban population. METHODS: Cross-sectional questionnaire-based health study among 18,747 adults in Oslo. RESULTS: For current smokers, odds ratio for reporting psoriasis was 1.49 (95% CI 1.11-2.00) for males, and 1.48 (95% CI 1.15-1.91) for females, as compared to never smokers. There was no association between reported atopic dermatitis or hand eczema and smoking. High consumption of cigarettes was associated with an increased reporting of psoriasis in men, but not women. Reporting drinking alcohol 4-7 times per week was crudely associated with reporting psoriasis in men, but not in the adjusted model. CONCLUSION: Cigarette smoking was associated with reported psoriasis, but not with atopic dermatitis or hand eczema.

PMID: 18032898 [PubMed - indexed for MEDLINE]

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Pimecrolimus cream (1%) efficacy in perioral dermatitis - results of a randomized, double-blind, vehicle-controlled study in 40 patients.

J Eur Acad Dermatol Venereol. 2007 Oct;21(9):1175-80

Authors: Oppel T, Pavicic T, Kamann S, Bräutigam M, Wollenberg A

BACKGROUND: Perioral dermatitis (POD) is a common skin disease and difficult to treat. Pimecrolimus cream (1%) successfully controls atopic eczema. OBJECTIVE: Our aim was to investigate its efficacy in POD. STUDY DESIGN: Single-centre, randomized, double-blind, vehicle-controlled study including 40 POD patients with a 4-week treatment and a 4-week follow-up. Efficacy was assessed by a novel Perioral Dermatitis Severity Index (PODSI) and Finlay’s Dermatology Life Quality Index (DLQI). SETTING: Outpatient clinics of a large dermatological hospital in Munich, Germany. RESULTS: During treatment, the PODSI was significantly lower in the pimecrolimus group compared with vehicle (P = 0.005-0.02) whereas at follow-up, no significant differences were observed. At week 2, the responder rates (> or = 50% PODSI improvement) were 50% with pimecrolimus cream (1%) and 25% with vehicle (P = 0.095). DLQI was improved in pimecrolimus group compared with vehicle. CONCLUSION: Results suggest that pimecrolimus cream (1%) effectively treats acute-stage POD.

PMID: 17894701 [PubMed - indexed for MEDLINE]

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Oral cyclosporin plus topical corticosteroid therapy diminishes bone mass in children with eczema.

Pediatr Dermatol. 2007 Nov-Dec;24(6):613-20

Authors: Pedreira CC, King E, Jones G, Moore E, Zacharin M, Varigos G, Cameron FJ

Topical corticosteroids remain the most common treatment for eczema; however, it is uncertain whether long-term use of these agents has any adverse effect on bone mass. Cyclosporin is very useful in patients with severe atopic dermatitis who have failed conventional therapy. It has been shown to induce bone loss. We compared 43 children with severe eczema who were using topical corticosteroids with 73 healthy children. Of the 43 patients, six were also taking cyclosporin. Bone mineral density was measured in the lumbar spine and in the femoral neck using dual-energy X-ray absorptiometry. In multivariate analysis, subjects with eczema had lower lumbar spine bone mineral density (-0.03 g/cm(2); p = 0.015) and bone mineral apparent density (-0.01 g/cm(3); p = 0.008) but higher FN BMAD (+0.02 g/cm(3); p = 0.029) compared with controls. Patients with eczema on topical corticosteroids who had used cyclosporin had lower lumbar spine bone mineral apparent density (-0.01; p = 0.006) compared with those only on topical corticosteroids in both adjusted and unadjusted analysis. In conclusion, children with severe eczema have decreased lumbar spine bone mass, which is primarily mediated by cyclosporin use rather than by topical corticosteroid use. This effect is likely to lead to a modest increase in the risk of wrist and forearm fractures in children using this agent.

PMID: 18035982 [PubMed - indexed for MEDLINE]

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Allergic contact dermatitis to topical antibiotics: Epidemiology, responsible allergens, and management.

J Am Acad Dermatol. 2008 Jan;58(1):1-21

Authors: Gehrig KA, Warshaw EM

Topical antibiotics are widely used to treat cutaneous, ocular, and otic infections. Allergic contact dermatitis to topical antibiotics is a rare but well-documented side effect, especially in at-risk populations. The purpose of this article is to review the epidemiology, responsible allergens, and management of allergic contact dermatitis to topical antibiotics. LEARNING OBJECTIVE: After completing this learning activity, participants should be able to describe the epidemiology of allergic contact dermatitis related to topical antibiotics; show knowledge of the most common allergenic topical antibiotics; and understand the allergenic cross-reactivity pattern amongst topical antibiotics.

PMID: 18158924 [PubMed - indexed for MEDLINE]

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The prevalence of atopic triad in children with physician-confirmed atopic dermatitis.

J Am Acad Dermatol. 2008 Jan;58(1):68-73

Authors: Kapoor R, Menon C, Hoffstad O, Bilker W, Leclerc P, Margolis DJ

BACKGROUND: Atopic dermatitis (AD) is often associated with comorbidities such as allergic rhinitis and asthma. OBJECTIVE: We sought to describe the frequency of these comorbidities in children with AD. METHODS: We conducted a cross-sectional study of the first 2270 children with physician-confirmed AD enrolled in a large postmarketing cohort. All were queried for information on comorbidities using a questionnaire from the International Study of Asthma and Allergies in Childhood. RESULTS: In all, 71.3% reported at least one additional form of atopy (symptoms of asthma or allergic rhinitis). A total of 33.3% reported only symptoms of asthma or allergic rhinitis whereas 38.0% reported symptoms of asthma and allergic rhinitis. By age 3 years, nearly 66% reported at least one additional form of atopy. A statistically significant trend toward poorer disease control was observed for those with additional atopic illnesses (P < .001). LIMITATIONS: This is a cross-sectional study. CONCLUSION: Individuals with AD exhibit a predisposition to additional atopic illnesses by age 3 years and in turn the presence of these illnesses correlates with poor disease control.

PMID: 17692428 [PubMed - indexed for MEDLINE]

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The role of furry pets in eczema: a systematic review.

Arch Dermatol. 2007 Dec;143(12):1570-7

Authors: Langan SM, Flohr C, Williams HC

OBJECTIVE: To systematically search, summarize, and critically appraise the literature to examine whether pet exposure in early life is associated with an increased risk of eczema. DATA SOURCES AND STUDY SELECTION: We searched MEDLINE (1950 to June 2006) supplemented by citation lists in retrieved articles and contact with researchers. No language restrictions were imposed. DATA EXTRACTION: Cohort studies were sufficiently similar to allow pooled analysis. Meta-analysis was not possible for cross-sectional studies owing to differences in methods and populations. MAIN OUTCOME MEASURES: Incidence or prevalence of eczema. RESULTS: Evidence from longitudinal studies showed that previous exposure to cats (pooled odds ratio [OR], 0.76; 95% confidence interval [CI], 0.62-0.92), dogs (pooled OR, 0.68; 95% CI, 0.53-0.87), or “any furry pet” (pooled OR, 0.79; 95% CI, 0.74-0.84) is associated with a lower risk of eczema. However, in the only cohort study adjusted for avoidance behavior, this “protective effect” disappeared (for cats: OR, 0.80; 95% CI, 0.33-1.97). Stratified analysis by family history in 2 birth cohort studies showed that dog exposure was protective in patients with atopic families. For cats, 1 study showed reduced risk in atopic families only; the other study showed no effect. Eight cross-sectional studies evaluated past pet exposure; a protective effect was seen in 3 studies for cat, dog, or any pet; no study demonstrated an increased risk. CONCLUSIONS: There was no clear evidence that early pet exposure is associated with increased risks of subsequent eczema. We found some evidence of a possible protective effect of early pet exposure, but this might be explained by avoidance behavior in high-risk families.

PMID: 18087010 [PubMed - indexed for MEDLINE]

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Clinical, pathologic, and immunopathologic features of dermatitis herpetiformis: review of the Mayo Clinic experience.

Int J Dermatol. 2007 Sep;46(9):910-9

Authors: Alonso-Llamazares J, Gibson LE, Rogers RS

BACKGROUND: Dermatitis herpetiformis (DH) is a cutaneous manifestation of gluten sensitivity, occasionally associated with other autoimmune disorders, and reportedly associated with an increased risk of lymphoproliferative disorders. We describe a series of patients with DH, focusing on associated disorders (particularly celiac disease), incidence of lymphoma, histopathology, and sensitivity of direct immunofluorescence (DIF) testing and serologic testing with antiendomysium antibodies for the diagnosis of DH. METHODS: The medical records of 264 patients with DH diagnosed between 1970 and 1996 were reviewed retrospectively. In addition, the records of six patients evaluated before the advent of DIF testing between 1932 and 1969 were reviewed. RESULTS: Established celiac disease was present in 12.6% of patients with DH, autoimmune systemic disorders in 22.2%, malignant neoplasms in 10.4%, sarcoidosis in four patients, and ulcerative colitis in six patients. Lymphoproliferative disorders were found in seven patients. The histopathologic examinations showed a marked predominance of neutrophils in the inflammatory infiltrate. DIF testing was positive in 92.4% of the patients tested. Indirect immunofluorescence assay indicated circulating antiendomysial antibodies in the sera of 40 of the 63 patients tested (63.5%). CONCLUSIONS: In this large series of patients with DH from a single institution, patients had a low incidence of symptomatic gluten-sensitive enteropathy, low risk of lymphoproliferative disorders, and associations with other systemic autoimmune disorders. The value of DIF testing in the diagnosis of DH was confirmed. The detection of antiendomysial antibodies by indirect immunofluorescence was less sensitive than indicated by other reports.

PMID: 17822491 [PubMed - indexed for MEDLINE]

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Characterization of a hapten-induced, murine model with multiple features of atopic dermatitis: structural, immunologic, and biochemical changes following single versus multiple oxazolone challenges.

J Invest Dermatol. 2008 Jan;128(1):79-86

Authors: Man MQ, Hatano Y, Lee SH, Man M, Chang S, Feingold KR, Leung DY, Holleran W, Uchida Y, Elias PM

Atopic dermatitis (AD) is a chronic dermatosis bearing clinical, histological, and immunologic similarities to chronic allergic contact dermatitis (ACD). AD shows a Th2 cell-dominant inflammatory infiltrate, elevated serum IgE levels, a permeability barrier abnormality, and Staphylococcus aureus colonization. Repeated hapten challenges reportedly produce a Th2-like hypersensitivity reaction (Th2-like HR). Here, 9-10 challenges with oxazolone (Ox) to hairless mice also produced a chronic Th2-like HR. Permeability barrier function and expression of differentiation proteins, filaggrin, loricrin, and involucrin, became abnormal. CRTH-positive Th2-dominant inflammatory infiltrate, with increased IL-4 expression, and a large increase in serum IgE levels were observed. The barrier abnormality was associated with decreased stratum corneum (SC) ceramide content and impaired lamellar body secretion, resulting in abnormal lamellar membranes, as in human AD. Furthermore, as in human AD, epidermal serine protease activity in SC increased and expression of two lamellar body-derived antimicrobial peptides, CRAMP and mBD3, declined after Ox challenges, paralleling the decrease of their human homologues in AD. Thus, multiple Ox challenges to normal murine skin produce a chronic Th2-like HR, with multiple features of human AD. Because of its reproducibility, predictability, and low cost, this model could prove useful for evaluating both pathogenic mechanisms and potential therapies for AD.

PMID: 17671515 [PubMed - indexed for MEDLINE]

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Gene expression profiling of lichen planus reflects CXCL9+-mediated inflammation and distinguishes this disease from atopic dermatitis and psoriasis.

J Invest Dermatol. 2008 Jan;128(1):67-78

Authors: Wenzel J, Peters B, Zahn S, Birth M, Hofmann K, Küsters D, Tomiuk S, Baron JM, Merk HF, Mauch C, Krieg T, Bieber T, Tüting T, Bosio A

Here, we present data of a gene expression profiling approach to apply the diagnostic value and pathological significance of this method in different inflammatory skin diseases, using whole skin biopsies. Initially, SAGE was performed to identify frequent tags differentially expressed in various skin diseases. On the basis of these results, a new skin pathology-oriented PIQOR microarray was designed. Lichen planus (LP) was chosen as a model disease to evaluate this system. Controls included healthy skin, atopic dermatitis (AD), and psoriasis (Pso). Gene expression analyses using the topic-defined microarray followed by unclassified clustering was able to discriminate LP from AD and Pso. Genes significantly expressed in LP included type I IFN inducible genes and a specific chemokine expression pattern. The CXCR3 ligand, CXCL9, was the most significant marker for LP. In situ hybridization and immunohistochemistry confirmed the results and revealed that keratinocytes are type I IFN producers in LP skin lesions. Our results show that gene expression profiling using a skin-specific microarray is a reliable method to identify patients with LP in the chosen context and reflect recent models concerning the pathogenesis of this disease. Gene expression profiling might complement the diagnostic spectrum in dermatology and may provide new pathogenetic insights.

PMID: 17703176 [PubMed - indexed for MEDLINE]

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Single nucleotide polymorphism-based genome-wide linkage analysis in Japanese atopic dermatitis families.

BMC Dermatol. 2007;7:5

Authors: Enomoto H, Noguchi E, Iijima S, Takahashi T, Hayakawa K, Ito M, Kano T, Aoki T, Suzuki Y, Koga M, Tamari M, Shiohara T, Otsuka F, Arinami T

BACKGROUND: Atopic dermatitis develops as a result of complex interactions between several genetic and environmental factors. To date, 4 genome-wide linkage studies of atopic dermatitis have been performed in Caucasian populations, however, similar studies have not been done in Asian populations. The aim of this study was to identify chromosome regions linked to atopic dermatitis in a Japanese population. METHODS: We used a high-density, single nucleotide polymorphism genotyping assay, the Illumina BeadArray Linkage Mapping Panel (version 4) comprising 5,861 single nucleotide polymorphisms, to perform a genome-wide linkage analysis of 77 Japanese families with 111 affected sib-pairs with atopic dermatitis. RESULTS: We found suggestive evidence for linkage with 15q21 (LOD = 2.01, NPL = 2.87, P = .0012) and weak linkage to 1q24 (LOD = 1.26, NPL = 2.44, P = .008). CONCLUSION: We report the first genome-wide linkage study of atopic dermatitis in an Asian population, and novel loci on chromosomes 15q21 and 1q24 linked to atopic dermatitis. Identification of novel causative genes for atopic dermatitis will advance our understanding of the pathogenesis of atopic dermatitis.

PMID: 17900373 [PubMed - indexed for MEDLINE]

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