Eczemaletters

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Entries from March 2008

The effect of wet-wrap dressing on epidermal barrier in patients with atopic dermatitis.

March 19th, 2008 · No Comments

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The effect of wet-wrap dressing on epidermal barrier in patients with atopic dermatitis.

J Eur Acad Dermatol Venereol. 2007 Nov;21(10):1360-8

Authors: Lee JH, Lee SJ, Kim D, Bang D

BACKGROUND: Wet-wrap dressing has been shown to be effective for atopic dermatitis; however, the therapeutic mechanism of wet-wrap dressing is only the hypothesis based on the recovery of decreased epidermal barrier function. OBJECTIVES: To examine the therapeutic efficacy as well as the mechanism of wet-wrap dressing in atopic dermatitis patients. METHODS: To examine the difference of non-lesional and lesional atopic skin and to evaluate the change between epidermal barrier function before and after the treatment, SCORAD, epidermal water content, transepidermal water loss, the lipid amount of skin surface, immunohistochemical staining of filaggrin and loricrin, transmission electron microscopic examination, and calcium ion capture cytochemistry method were done in 10 severe form atopic dermatitis patients. RESULTS: In atopic dermatitis patients, SCORAD was clearly decreased, epidermal water content was increased, and transepidermal water loss was decreased after wet-wrap dressing. After wet-wrap dressing, increased release of lamellar body and the recovery of the damaged lamellar structure of intercellular lipid were observed; nevertheless, neither the change in keratinocyte differentiation nor the change of calcium ion gradient was detected. A week after the termination of wet-wrap dressing, increased water content and decreased transepidermal water loss were still maintained. CONCLUSION: We confirmed the abnormality of the epidermal barrier in atopic dermatitis, and the effects of wet-wrap were associated with the recovery of epidermal barrier. In atopic lesions, wet-wrap dressing induced clinical improvement by the release of lamellar body and the restoration of intercellular lipid lamellar structure.

PMID: 17958842 [PubMed - indexed for MEDLINE]

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Clinical differences between atopic and atopiform dermatitis.

March 18th, 2008 · No Comments

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Clinical differences between atopic and atopiform dermatitis.

J Am Acad Dermatol. 2008 Mar;58(3):407-14

Authors: Brenninkmeijer EE, Spuls PI, Legierse CM, Lindeboom R, Smitt JH, Bos JD

BACKGROUND: Atopic dermatitis (AD) has been divided into the “extrinsic” and “intrinsic” type, in which “intrinsic AD” is characterized by the absence of allergen-specific IgE. Still, there is no consensus whether this “intrinsic type” of AD, which we denominate as atopiform dermatitis (AFD), is a distinct entity. OBJECTIVE: A case-control study was performed to compare the clinical and diagnostic features of AD and AFD. METHODS: Patients with a clinical diagnosis of AD were selected. Cases did not have demonstrable allergen-specific IgE. Matched control subjects were tested positive for allergen-specific IgE. Patients were evaluated for medical history, quality of life, disease severity, and Hanifin and Rajka, U.K. and Millennium diagnostic criteria. RESULTS: Eight percent (n = 34) of the selected patients had, in fact, AFD. Female predominance, absence of atopic diseases, later onset of disease, and milder disease severity were observed in AFD. A history of atopy, recurrent conjunctivitis, palmar hyperlinearity, keratosis pilaris, pityriasis alba, and hand and/or food eczema were significantly less present in AFD. Dennie-Morgan fold was positively associated with AFD. LIMITATIONS: Not all patients with negative allergen-specific IgE participated and a relatively small number of AFD patients were studied. CONCLUSIONS: In addition to the absence of allergen-specific IgE, our findings support that AFD is an entity distinct from AD. With a distinction shown between AFD and AD, patient groups will be better defined and more homogeneous. Implications of this distinction will be of importance for preventive and therapeutic advice; diagnostic processes; and for future research.

PMID: 18280337 [PubMed - indexed for MEDLINE]

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Disease severity, scratching, and sleep quality in patients with atopic dermatitis.

March 18th, 2008 · No Comments

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Disease severity, scratching, and sleep quality in patients with atopic dermatitis.

J Am Acad Dermatol. 2008 Mar;58(3):415-20

Authors: Bender BG, Ballard R, Canono B, Murphy JR, Leung DY

BACKGROUND: The relationship between sleep quality and disease severity in patients with atopic dermatitis has not been clearly defined. METHODS: Sleep efficiency and scratching were measured over 2 nights by polysomnography, actigraphy, and self-report in 20 adults with atopic dermatitis. Tumor necrosis factor, interleukin (IL)-6, and IL-10 were assayed from a subset of 9 participants. RESULTS: Sleep measured by actigraphy and polysomnography were strongly associated with each other. Decreased sleep efficiency was associated with increasing disease severity, scratching, and IL-6. Self-reported sleep quality and quality of life were not significantly correlated with either objective sleep measure. LIMITATIONS: Results in this pilot study await confirmation in a larger investigation. CONCLUSION: Objective measures but not self-report documented that increasing severity of atopic dermatitis results in more scratching and declining sleep quality. Our data also suggest an important relationship between sleep and IL-6.

PMID: 18280338 [PubMed - indexed for MEDLINE]

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Lichenoid and other clinical presentations of atopic dermatitis in an inner city practice.

March 18th, 2008 · No Comments

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Lichenoid and other clinical presentations of atopic dermatitis in an inner city practice.

J Am Acad Dermatol. 2008 Mar;58(3):503-4

Authors: Allen HB, Jones NP, Bowen SE

Atopic dermatitis (AD) has many different clinical presentations. In our inner city practice, we have observed a variant of AD in our heavily pigmented patients that we have termed lichen planus-like atopic dermatitis because of its clinical similarity to lichen planus. Clinically, this variant may be distinguished by the presence on extensor surfaces and a more rapid response to treatment. Histologically, in lichen planus-like AD, a spongiotic dermatitis is present; further, there is no lichenoid dermatitis evident. We compare this presentation with the others seen over an eight-month interval in our practice. We report on a lichen planus-like variant of atopic dermatitis in our African American patients. A limitation to this report is the relatively small sample size. Facial/extensor is the most common presentation of atopic dermatitis in our predominantly minority clinic.

PMID: 18280352 [PubMed - indexed for MEDLINE]

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Prognosis of unclassified eczema: a follow-up study.

March 15th, 2008 · No Comments

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Prognosis of unclassified eczema: a follow-up study.

Arch Dermatol. 2008 Feb;144(2):160-4

Authors: Li LF, Liu G, Wang J

OBJECTIVE: To investigate the outcome of unclassified eczema (UE). Eczema refers to a set of highly heterogeneous clinical conditions including contact dermatitis (CD) and several types of endogenous eczema. In clinics, however, the eczema of a large proportion of patients does not fit any known patterns and has been diagnosed as unclassified eczema. The prognosis of UE is largely unknown. DESIGN: Cohort study with 1-year follow-up. SETTING: Dermatology clinic in Peking University Third Hospital, Beijing, China. Patients All cases of UE in 655 consecutive patients with eczema patch tested with the European Standard series occurring during a 2-year period. Interventions At 1 year after patch testing, all patients were asked to revisit the clinic, and 599 patients returned (91.5%); of these, 192 had UE (32.1%). MAIN OUTCOME MEASURES: The rate of symptom-free skin for at least 3 months without relapse before evaluation. RESULTS: During the follow-up period, only 15.1% of patients with UE had their lesions cleared, which was a much lower rate than for those with CD (50.4%) (P < .001; chi(2) test) but close to the rate of those with atopic dermatitis (7.1%). A total of 11.0% of patients with UE had atopic diathesis, and 72.4% of those with UE had a positive reaction to at least 1 contact allergen, which was a lower rate than that of patients with allergic CD (88.6%) but higher than that for patients with irritant CD (53.8%) (P < .001 and P = .004, respectively; chi(2) test); however, none of these results were relevant to eczema. CONCLUSIONS: Unclassified eczema is a common type of eczema with a very poor prognosis. This important category of eczema should be recognized and studied further.

PMID: 18283172 [PubMed - indexed for MEDLINE]

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Are age-specific high serum IgE levels associated with worse symptomatology in children with atopic dermatitis?

March 15th, 2008 · No Comments

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Are age-specific high serum IgE levels associated with worse symptomatology in children with atopic dermatitis?

Int J Dermatol. 2007 Dec;46(12):1258-62

Authors: Hon KL, Lam MC, Leung TF, Wong KY, Chow CM, Fok TF, Ng PC

BACKGROUND: Atopic dermatitis (AD) is a distressing disease associated with excoriations, pruritus, sleep disturbance, and elevation of serum total immunoglobulin E (IgE) levels. OBJECTIVE: To evaluate whether serum IgE levels correlate with the symptomatology and plasma chemokine levels in children with AD. METHODS: AD patients aged younger than 18 years were recruited from the pediatric dermatology clinic of a university teaching hospital, and the AD severity was evaluated using the SCORing Atopic Dermatitis (SCORAD) index. Concentrations of serum total IgE, eosinophil count, and plasma AD-associated chemokines [cutaneous T-cell-attracting cytokine (CTACK), thymus and activation-regulated chemokine (TARC)] were measured. RESULTS: One hundred and seventeen Chinese children with AD (64 boys and 53 girls), with an age (mean +/- standard deviation) of 10.7 +/- 4.4 years, were recruited. Their overall SCORAD index (mean +/- standard deviation) was 51.1 +/- 22.8. The total serum IgE level divided by the age-specific upper limit (AE) correlated well with the extent and intensity of AD, except for oozing/crusting, which was significant only in males. There was a significant correlation between AE and pruritus or sleep loss only in females. Levels of IgE, CTACK, and TARC, and eosinophil count, differed significantly between patients with mild, moderate, and severe disease. AE correlated well with TARC (r = 0.50, P < 0.001) and eosinophil count (r = 0.41, P < 0.001), but not with CTACK (r = 0.11, P = 0.270). The prediction of moderate to severe eczema by AE gave an area under the receiver-operating characteristic curve of 0.76 (95% confidence interval, 0.65-0.86; P = 0.004). An optimum positive predictive value of 94.2% was achieved with a cut-off point of AE of 2.95, sensitivity of 75.0%, and specificity of 66.7%. CONCLUSION: AE correlates significantly with various objective clinical scores and chemokine markers of AD, and is a useful indicator for predicting moderate to severe AD in children.

PMID: 18173519 [PubMed - indexed for MEDLINE]

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Clinical management of atopic eczema with pimecrolimus cream 1% (Elidel) in paediatric patients.

March 13th, 2008 · No Comments

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Clinical management of atopic eczema with pimecrolimus cream 1% (Elidel) in paediatric patients.

Dermatology. 2007;215 Suppl 1:3-17

Authors: Eichenfield LF, Thaci D, de Prost Y, Puig L, Paul C

Atopic eczema is predominantly a disease of children and infants, and is often a significant burden for both the sufferer and the family. Pimecrolimus cream 1% (Elidel) is a topical calcineurin inhibitor that has been developed for the treatment of inflammatory skin diseases. When applied twice daily, pimecrolimus has been shown to be effective and well tolerated in paediatric patients with mild to moderate atopic eczema, and appears to be particularly suitable for use on the face, the neck and skin folds. Reduction of pruritus or erythema can be seen within 48 hours of initiating treatment, and when used at the first signs or symptoms of recurrence, pimecrolimus can significantly reduce the incidence of flares and the amount of topical corticosteroid used. Long-term pimecrolimus therapy shows that the initial reduction of disease severity (Eczema Area and Severity Index) is sustained and that most patients have minimal residual disease at 2 years. The most common application-site reaction is a mild to moderate, transient, warm/burning sensation occurring in approximately 10% of patients. Blood concentrations of pimecrolimus following topical administration remain low in all patients. Currently there is no evidence for systemic adverse events, immune suppression or alterations in the vaccine response, after short-term or prolonged treatment. In conclusion, pimecrolimus is an effective treatment option for the short-term treatment and long-term control of atopic eczema in paediatric patients.

PMID: 18174689 [PubMed - indexed for MEDLINE]

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The role of pimecrolimus cream 1% (Elidel)) in managing adult atopic eczema.

March 13th, 2008 · No Comments

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The role of pimecrolimus cream 1% (Elidel)) in managing adult atopic eczema.

Dermatology. 2007;215 Suppl 1:18-26

Authors: Meurer M, Lubbe J, Kapp A, Schneider D

In approximately 60% of patients atopic eczema starts in early childhood and persists throughout adolescence. The inadequate treatment of adult patients with recurrent flaring atopic eczema is associated with poor symptom control and diminished quality of life. The prolonged continuous use of topical corticosteroids is not advocated because of the risk of local and systemic adverse events. Pimecrolimus cream 1% (Elidel) is an alternative to topical corticosteroids, particularly for delicate skin, e.g. face and other sensitive skin areas, because it has no atrophogenic potential. The results from clinical trials in adult patients demonstrate that intermittent treatment with pimecrolimus relieves the acute symptoms of atopic eczema and improves disease control and quality of life in the long term.

PMID: 18174690 [PubMed - indexed for MEDLINE]

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Assessment of atopic eczema: clinical scoring and noninvasive measurements.

March 8th, 2008 · No Comments

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Assessment of atopic eczema: clinical scoring and noninvasive measurements.

Br J Dermatol. 2007 Oct;157(4):674-80

Authors: Holm EA, Wulf HC, Thomassen L, Jemec GB

BACKGROUND: Clinical scoring systems are widely used in clinical trials of atopic eczema (AE), while noninvasive methods are more often used for research purposes. Positive correlations between the two types of methods may be used in support of the validity of both in a clinical context. Few studies are available of the association between clinical scores and instrumental assessment of disease severity obtained with noninvasive instruments. OBJECTIVES: To compare clinical scores in AE with biometric data in AE. METHODS: Transepidermal water loss, stratum corneum hydration, erythema, scaling and subepidermal oedema were measured. ‘Scoring of Atopic Dermatitis (SCORAD)’, ‘Eczema Area and Severity Index (EASI)’ and ‘Atopic Dermatitis Severity Index (ADSI)’ were used for clinical scores. Two assessments at 6-month intervals at the antecubital fossa, dorsal forearm and popliteal fossa in 101 patients with AE and 30 controls were carried out. RESULTS: Significant correlations were found within the clinical scores (P < 0.0001 and r = 0.85-0.91) and between instruments and clinical scores (P < 0.0001 and r = 0.61-0.79). CONCLUSIONS: The various instruments and clinical scores showed internal agreement and noninvasive methods correlated significantly with the three different clinical scorings systems. This observation suggests that both methods provide data of clinical (scores) and biological (instrumental measures) relevance, and may be useful in future studies of AE. It is speculated that combined measures including scores and selected instruments may be particularly useful.

PMID: 17672874 [PubMed - indexed for MEDLINE]

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Flexural allergic contact dermatitis to benzalkonium chloride in antiseptic bath oil.

March 8th, 2008 · No Comments

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Flexural allergic contact dermatitis to benzalkonium chloride in antiseptic bath oil.

Br J Dermatol. 2007 Oct;157(4):795-8

Authors: Hann S, Hughes TM, Stone NM

Benzalkonium chloride (BAK) is an acknowledged irritant but has also been identified as a cause of allergic contact dermatitis. The antiseptic bath emollient Oilatum Plus (Stiefel, High Wycombe, U.K.) contains a relatively high concentration of 6% BAK. We describe six patients who presented with flexural eczema, particularly involving the anogenital area, who had a history of using Oilatum Plus. Patch testing showed all six to have a type 4 allergy to BAK as well as other allergens. Avoidance of Oilatum Plus led to a resolution of the flexural eczema in each case.

PMID: 17714561 [PubMed - indexed for MEDLINE]

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