Atopic dermatitis (eczema)

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Autoimmune progesterone dermatitis. Case report with histologic overlap of erythema multiforme and urticaria.

Int J Dermatol. 2008 Apr;47(4):380-2

Authors: Walling HW, Scupham RK

BACKGROUND: Autoimmune progesterone dermatitis is a rare eruption that recurs monthly as progesterone levels peak during the menstrual cycle. Clinical and histologic features are variable, and the eruption is thought to represent a hypersensitivity response to endogenous progesterone. METHODS: We present the case of a 38-year-old woman with a pruritic intermittent facial eruption of 18 months’ duration that recurred predictably in the days surrounding menses. RESULTS: The histology showed interface dermatitis with features of both erythema multiforme and urticaria. Intradermal injection of medroxyprogesterone acetate was positive. Her symptoms responded to antihistamine therapy. CONCLUSION: This unusual case is particularly distinctive both in terms of the histologic findings and the response to therapy.

PMID: 18377604 [PubMed - indexed for MEDLINE]

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Generalized xerotic dermatitis with neutrophilic spongiosis induced by erlotinib (Tarceva).

Dermatology. 2008;216(3):247-9

Authors: Lübbe J, Masouyé I, Dietrich PY

Erlotinib is a small molecule tyrosine kinase inhibitor that is used as an anticancer agent. Most patients develop a pustular facial dermatitis within the first week of treatment. Pyogenic granulomas of the nail folds are another typical adverse event occurring in about 10-15% of cases. We report on a patient who developed a generalized dermatitis characterized by neutrophilic spongiosis. Neutrophilic inflammation has been observed in several drugs that interfere with EGFR signaling, suggesting a class effect. The present case may be yet another manifestation of this particular reaction pattern.

PMID: 18182820 [PubMed - indexed for MEDLINE]

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Assessment of health state utilities of controlled and uncontrolled psoriasis and atopic eczema: a population-based study.

Br J Dermatol. 2008 Feb;158(2):351-9

Authors: Schmitt J, Meurer M, Klon M, Frick KD

BACKGROUND: Health utilities are used to express relevant trade-offs for resource allocation. The absence of valid and generalizable utilities for atopic eczema (AE) and psoriasis limits the validity of previous cost-utility analyses. OBJECTIVES: (i) To assess health utilities of standardized scenarios of controlled and uncontrolled AE and psoriasis in participants from the general population and in patients using the time trade-off (TTO) method; (ii) to test the association of the utilities obtained with demographic and patient characteristics; and (iii) to compare these utilities with other health economic outcomes [utilities assessed on visual analogue scale (VAS), willingness to pay (WTP)]. METHODS: A single-centre study conducted in 2006 at the Department of Dermatology, Dresden, Germany. Standardized interactive computer-assisted interviews in a random sample from the general population (n=139), and patients with AE (n=58) and psoriasis (n=62). Information on health states included characteristic clinical pictures and a short text explaining aetiology, signs, symptoms and quality of life impact. RESULTS: In participants from the general population median utilities (TTO) of controlled and uncontrolled AE were 0.97 and 0.64, respectively. For psoriasis the corresponding utilities were 0.93 and 0.56. Utilities were independent of sex and socioeconomic position, and tended to be lower in patients with psoriasis. Correlations between TTO, VAS and WTP responses were weak. CONCLUSIONS: To avoid uncontrolled psoriasis or eczema participants chose an approximately 40% shorter life expectancy. This indicates that severe chronic inflammatory skin diseases may be considered as severe as angina pectoris, chronic anxiety, rheumatoid arthritis, multiple sclerosis or regional oesophageal cancer. The different economic outcomes assessed are not interchangeable.

PMID: 18070214 [PubMed - indexed for MEDLINE]

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Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups.

J Eur Acad Dermatol Venereol. 2008 Apr 15;

Authors: Blessmann Weber M, de Tarso da Luz Fontes Neto P, Prati C, Soirefman M, Mazzotti NG, Barzenski B, Cestari TF

Introduction Atopic dermatitis places a large burden on patients and their families, with greater risk of emotional disorders and behavioural problems. Preliminary evidence suggests that support groups and educational programs are helpful in reducing stress, disease and pruritus severity and improves quality of life (QoL). Objectives To evaluate the intensity of pruritus and the QoL in children with atopic dermatitis and their families after joining support groups. Material and methods Subjects were randomly assigned to intervention or control group and completed the Children’s Dermatology Life Quality Index (CDLQI) and Family Dermatitis Impact (FDI). Pruritus was evaluated by the Yosipovitch’s questionnaire for pruritus. Each patient/family unit was considered as one ‘patient’. Participants were divided into two different groups: one with children under 16 years and the second with patients’ relatives. Each unit was accompanied during 6 months. Results Thirty-two patients and their relatives completed the questionnaires satisfactorily. After intervention, pruritus intensity was similar (P = 0.42), but the pattern of pruritus improved in the intervention group. Overall QoL for CDLQI instruments improved significantly (P < 0.01) and, when specific domains were analysed, personal relationships (P = 0.02) and leisure (P = 0.04) showed marked enhancement. FDI scores failed to demonstrate differences in the QoL of patients’ relatives after treatment. Conclusion The improvement on pruritus and QoL showed that atopic dermatitis patients had benefits with the attendance to support groups. We consider that these non-pharmacological approaches can be a very effective accessory tools in the management of recalcitrant forms of the disease.

PMID: 18422535 [PubMed - as supplied by publisher]

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Repetitive scratching and noxious heat do not inhibit histamine-induced itch in atopic dermatitis.

Br J Dermatol. 2008 Jan;158(1):78-83

Authors: Ishiuji Y, Coghill RC, Patel TS, Dawn A, Fountain J, Oshiro Y, Yosipovitch G

BACKGROUND: Repetitive scratching is the most common behavioural response to itch in atopic dermatitis (AD). Patients with chronic itch often report that very hot showers inhibit itch. We recently reported that scratching and noxious heat stimuli inhibit histamine-induced itch in healthy subjects. However, no psychophysical studies have been performed in AD to assess the effects of repetitive heat pain stimuli and scratching on histamine-induced itch. OBJECTIVES: To examine the effects of repetitive noxious heat and scratching on itch intensity in patients with AD using quantitative sensory testing devices. METHODS: Itch was induced with histamine iontophoresis in 16 patients with AD in both lesional and nonlesional skin as well as in 10 healthy subjects. Repetitive noxious heat and scratching were applied 3 cm distal to the area of histamine iontophoresis. Subjects rated their perceived intensity of histamine-induced itch with a computerized visual analogue scale. RESULTS: Our results demonstrate that repetitive noxious heat and scratching do not inhibit itch intensity in lesional and nonlesional AD skin but do so in healthy skin. Of note, both these stimuli increase itch intensity in lesional AD skin. CONCLUSIONS: Our results strongly suggest that scratching and noxious thermal stimuli have a different effect upon histamine-induced itch perception in patients with AD when compared with healthy controls. This difference may be associated with both peripheral and central sensitization of nerve fibres in AD.

PMID: 17986304 [PubMed - indexed for MEDLINE]

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Irritant contact dermatitis: a review.

Australas J Dermatol. 2008 Feb;49(1):1-9; quiz 10-1

Authors: Slodownik D, Lee A, Nixon R

Irritant contact dermatitis is the most common form of contact dermatitis, and yet is often overlooked. Recent progress in understanding the pathogenesis has reignited the interest of clinicians in this area of dermatology. Irritant contact dermatitis is not a homogenous entity, but rather a number of subtypes contributing to different clinical presentations. The diagnosis of irritant contact dermatitis is often clinical, and may only be possible after the exclusion of allergic contact dermatitis with patch testing. There is no readily available diagnostic test. There is an incomplete understanding of the factors which lead to the development of cumulative irritant contact dermatitis and persistent postoccupational dermatitis. We have used the experience from our tertiary referral occupational dermatology clinic to illustrate various aspects of irritant contact dermatitis, and to highlight the difficulty sometimes encountered in making this diagnosis. We believe that increased awareness of the often pivotal role of irritant contact dermatitis, as well as all the other factors contributing to occupational dermatitis, will lead to improvement in outcomes for patients.

PMID: 18186838 [PubMed - indexed for MEDLINE]

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Fingertip dermatitis refractory to topical corticosteroids associated with nail-patella syndrome.

Australas J Dermatol. 2008 Feb;49(1):55-6

Authors: Sakata S, Opie J, Howard A

A 14-year-old girl and her 47-year-old father presented with fingernails that were hypoplastic, spoon-shaped and ridged since birth. Fingertip dermatitis and paronychia were also observed in the daughter, which had been present since birth and had progressively worsened. The daughter denied trauma to her fingernails or chronic exposure to irritants and allergens. She had previously tried topical corticosteroids for 18 months without any benefit. We put forward the possibility of chronic paronychia and fingertip dermatitis, refractory to topical corticosteroids, as associations of digital nail-patella syndrome.

PMID: 18186852 [PubMed - indexed for MEDLINE]

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Filaggrin null alleles are not associated with hand eczema or contact allergy.

Br J Dermatol. 2007 Dec;157(6):1199-204

Authors: Lerbaek A, Bisgaard H, Agner T, Ohm Kyvik K, Palmer CN, Menné T

BACKGROUND: The filaggrin protein is a key component of stratum corneum and homo- or heterozygotes for the filaggrin variant alleles R501X and 2282del4 have varying degrees of impaired skin barrier. The variant alleles have repeatedly been shown to be associated with atopic dermatitis. Any possible association with hand eczema or contact allergy are unexplored. OBJECTIVES: To explore associations between the variant alleles, hand eczema, contact allergy and atopic dermatitis. METHODS: In total, 183 adult individuals participated in a clinical examination of the hands, patch testing and filaggrin genotyping. Children without any evidence of atopic dermatitis from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) study were used as controls. The chi(2) test was used for comparison of allele frequencies. RESULTS: The majority (73%) had hand eczema, 25% had contact allergy and 14% had a diagnosis of atopic dermatitis. The association between atopic dermatitis and the filaggrin variant alleles was confirmed (odds ratio 3.5, P = 0.015). Allele frequencies in individuals with hand eczema or contact allergy were not statistically significantly increased. CONCLUSION: There is no association between the variant alleles and hand eczema or contact allergy.

PMID: 17970802 [PubMed - indexed for MEDLINE]

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Environmental factors, parental atopy and atopic eczema in primary-school children: a cross-sectional study in Taiwan.

Br J Dermatol. 2007 Dec;157(6):1217-24

Authors: Lee YL, Li CW, Sung FC, Yu HS, Sheu HM, Guo YL

BACKGROUND: Parental atopy and environmental exposure are recognized risk factors for atopic eczema (AE) in childhood. However, the relative contributions of specific risk factors and the overall contributions of hereditary and environmental exposure remain unexplored. OBJECTIVES: To identify risk factors, estimate the population attributable risk (PAR) of environmental exposure, and compare the AE data for boys vs. girls in primary-school children. METHODS: During a February to June 2001 cross-sectional, Taiwan-based questionnaire survey, we investigated 23 980 children from 22 primary schools, all located within 1 km of an air-monitoring station. RESULTS: The 12-month prevalence of AE was reported as 6.1% in boys and 4.9% in girls. In both sexes, the risk of AE was strongly associated with parental atopy and perceived ambient air pollution. The presence of cockroaches [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.00-1.40] and visible mould on walls at home (OR 1.46, 95% CI 1.22-1.70) were also significantly related to AE for girls; however, only visible mould on walls (and not the presence of cockroaches) at home was related to AE for boys (OR 1.40, 95% CI 1.18-1.66). While mutually adjusted models were applied, we found adjusted ORs and PARs were similar in boys and girls in hereditary and outdoor environmental factors. The PAR of indoor environmental factors was higher in girls (8.4%) than in boys (5.5%). There was no interaction between parental atopy and environmental factors. CONCLUSIONS: Parental atopy contributed more to AE than indoor or outdoor environmental factors. Girls may be more susceptible to indoor environmental factors than boys.

PMID: 17916197 [PubMed - indexed for MEDLINE]

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Cutaneous Malassezia flora in atopic dermatitis differs between adults and children.

Br J Dermatol. 2007 Dec;157(6):1178-82

Authors: Takahata Y, Sugita T, Kato H, Nishikawa A, Hiruma M, Muto M

BACKGROUND: Malassezia species are suspected to be involved in the development of skin lesions in atopic dermatitis (AD) when the response of adult AD to anti-inflammatory treatments is poor. However, a comparative analysis of Malassezia flora between adults and children with AD has not been performed. OBJECTIVES: To compare the cutaneous Malassezia flora between adults and children with AD. METHODS: Scale samples were collected from skin lesions of 58 patients with AD in the head and neck regions (28 males and 30 females; 31 children and 27 adults), and fungal DNA was extracted from the samples directly. The number and identities of the Malassezia species were analysed with high accuracy using a polymerase chain reaction-based culture-independent method. The in vivo level of anti-Malassezia IgE antibody was also assayed. RESULTS: Malassezia restricta was the predominant species in the children with AD, while both M. restricta and M. globosa predominated in the adults. The adults showed increased sensitization in terms of anti-Malassezia-specific IgE responses in the sera to both M. globosa and M. restricta in comparison with the children. CONCLUSIONS: The cutaneous Malassezia flora differs significantly between the two age groups.

PMID: 17916215 [PubMed - indexed for MEDLINE]

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