Eczemaletters

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Entries from August 2008

House dust mites on skin, clothes, and bedding of atopic dermatitis patients.

August 30th, 2008 · No Comments

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House dust mites on skin, clothes, and bedding of atopic dermatitis patients.

Int J Dermatol. 2008 Aug;47(8):790-5

Authors: Teplitsky V, Mumcuoglu KY, Babai I, Dalal I, Cohen R, Tanay A

BACKGROUND: Atopic dermatitis is a common allergic condition in children, often associated with a positive skin reaction to house dust mite allergens. AIM: To determine the presence of house dust mites on the skin, clothes, and bedding of patients with atopic dermatitis. METHODS: Nineteen patients with atopic dermatitis were examined during a 2-year period. Samples from affected and healthy skin surfaces were obtained with adhesive tape, and dust samples from bedding and clothes were collected with a vacuum cleaner at the start of the study and 3-6 weeks later, and examined for the presence of house dust mites. The findings were compared with those of 21 healthy controls. RESULTS: The most common mite species on skin were Dermatophagoides pteronyssinus and Dermatophagoides farinae, which were found in nine patients and three controls. The patient group showed a significantly larger percentage of samples with mites than did the control group (34.9% and 7.9%, respectively) (P < 0.001), and a significantly larger percentage of individuals with at least one positive sample (84.2% and 14.2%, respectively) (P < 0.0001). No correlation was found between the number of mites on the skin and clothes/bedding of patients, or between patients and controls with regard to the number of mites on the clothes and bedding. CONCLUSIONS: Patients with atopic dermatitis showed a higher prevalence of mites on their skin than did healthy individuals, which could be involved in allergic sensitization and disease exacerbation.

PMID: 18717857 [PubMed - in process]

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Heliotherapy improves vitamin D balance and atopic dermatitis.

August 22nd, 2008 · No Comments

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Heliotherapy improves vitamin D balance and atopic dermatitis.

Br J Dermatol. 2008 Jun;158(6):1323-8

Authors: Vähävihu K, Ylianttila L, Salmelin R, Lamberg-Allardt C, Viljakainen H, Tuohimaa P, Reunala T, Snellman E

BACKGROUND: Vitamin D insufficiency during winter is common in the Nordic countries. Heliotherapy (HT) may heal atopic dermatitis (AD) but its effect on vitamin D balance has not been examined. OBJECTIVES: To study the effect of HT on serum calcidiol (25-hydroxyvitamin D) concentration and on healing of AD. METHODS: Twenty-three adult patients with AD received a 2-week course of HT in the Canary Islands in either January or March 2005. Daily solar ultraviolet (UV) radiation was measured and personal UV exposure calculated as standard erythema doses (SED). Blood samples were taken during HT and during a 1-2 month follow-up. Serum calcidiol concentration was measured by radioimmunoassay. Healing of AD was examined by SCORAD index. RESULTS: Before HT 17 (74%) AD patients had vitamin D insufficiency (calcidiol < 50 nmol L(-1)) and four patients high (> 80 nmol L(-1)) serum calcidiol values. The median personal UV dose during the 2-week HT course was 60 SED in the January group and 109 SED in the March group. Serum calcidiol concentration increased significantly in both groups, by 13.4 and 24.0 nmol/L(-1), respectively, and after HT only four (17%) patients had vitamin D insufficiency. SCORAD improved from 34 to 9 in the January HT group and from 30 to 9 in the March group. CONCLUSIONS: A 2-week course of HT significantly improved vitamin D balance by increasing serum calcidiol concentration, and caused a marked healing of AD. These parallel positive responses should be taken into account when the benefits of HT are considered.

PMID: 18363748 [PubMed - indexed for MEDLINE]

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Profiles of Foxp3+ regulatory T cells in eczematous dermatitis, psoriasis vulgaris and mycosis fungoides.

August 22nd, 2008 · No Comments

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Profiles of Foxp3+ regulatory T cells in eczematous dermatitis, psoriasis vulgaris and mycosis fungoides.

Br J Dermatol. 2008 Jun;158(6):1256-63

Authors: Fujimura T, Okuyama R, Ito Y, Aiba S

BACKGROUND: It is well known that regulatory T cells (Tregs), identified by their expression of CD4, CD25 and Foxp3, play a crucial role in maintaining peripheral tolerance. Recently, it has been demonstrated that a Treg population resides in normal human skin. However, only a few studies have demonstrated the presence of Foxp3+ Tregs in inflammatory skin disorders. OBJECTIVES: In this study, we immunohistologically examined the presence of CD4+ CD25+ Foxp3+ Tregs in the lesional skin of psoriasis vulgaris, mycosis fungoides and eczematous dermatitis. METHODS: We used immunohistochemistry to examine the presence of Foxp3+ Tregs in fixed sections of the lesional skin from 16 patients with psoriasis vulgaris, 17 patients with mycosis fungides and 18 patients with eczematous dermatitis in addition to 10 normal skin samples. RESULTS: In normal skin, epidermal and dermal Foxp3+ cells were rare. The psoriasis vulgaris, mycosis fungoides and eczematous dermatitis samples contained substantial numbers of epidermal and dermal CD3+, CD4+ and CD25+ Foxp3+ Tregs. The epidermis contained a higher percentage of CD3+, CD4+ and CD25+ Foxp3+ cells than the dermis. The percentage of Foxp3+ cells among CD3+ or CD4+ cells was significantly lower in eczematous dermatitis than in psoriasis vulgaris or mycosis fungoides, and that of dermal Foxp3+ cells was significantly lower in psoriasis vulgaris than in eczematous dermatitis or mycosis fungoides. CONCLUSIONS: The lower percentage of epidermal or dermal Foxp3+ cells in eczematous dermatitis or psoriasis vulgaris, respectively, might contribute to their pathogenesis.

PMID: 18363755 [PubMed - indexed for MEDLINE]

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In vitro and clinical immunomodulatory effects of a novel Pentaherbs concoction for atopic dermatitis.

August 22nd, 2008 · No Comments

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In vitro and clinical immunomodulatory effects of a novel Pentaherbs concoction for atopic dermatitis.

Br J Dermatol. 2008 Jun;158(6):1216-23

Authors: Leung TF, Wong KY, Wong CK, Fung KP, Lam CW, Fok TF, Leung PC, Hon KL

BACKGROUND: Our group recently reported a randomized and placebo-controlled clinical trial on the efficacy of a twice-daily concoction of five herbal ingredients (Pentaherbs formulation, PHF) in treating children with atopic dermatitis (AD). OBJECTIVES: To investigate the immunomodulatory effects that may be induced by PHF treatment. METHODS: We investigated the effects of PHF on cytotoxicity and proliferation of phytohaemagglutinin (PHA)- and staphylococcal enterotoxin B (SEB)-stimulated peripheral blood mononuclear cells (PBMC) isolated from buffy coat of blood donors. PHF-induced immunomodulation for five inflammatory mediators in cultured PBMC was measured by reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay. The effects of a 3-month, open-label study of PHF on circulating inflammatory mediators in children with AD were also assessed. RESULTS: PHF at up to 1 mg mL(-1) dose-dependently suppressed PBMC proliferation. The addition of PHF to cultured PBMC reduced supernatant concentrations of brain-derived neurotrophic factor (BDNF), interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha in response to PHA, and BDNF and thymus and activation-regulated chemokine (TARC) following SEB stimulation. PHF increased epithelial cell-derived neutrophil activating peptide-78 levels in culture supernatants. At the RNA level, PHF suppressed the transcription of BDNF, TARC, IFN-gamma and TNF-alpha. Twenty-eight children with AD were treated with PHF for 3 months, and their mean plasma concentrations of BDNF and TARC decreased significantly from 1798 pg mL(-1) and 824 pg mL(-1) at baseline to 1378 pg mL(-1) and 492 pg mL(-1) (P = 0.002 and 0.013, respectively) upon study completion. CONCLUSIONS: PHF possesses in vitro and in vivo immunomodulatory properties that may mediate the clinical efficacy observed in AD treatment.

PMID: 18341655 [PubMed - indexed for MEDLINE]

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Polymorphisms in the interleukin 13 and GATA binding protein 3 genes and the development of eczema during childhood.

August 22nd, 2008 · No Comments

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Polymorphisms in the interleukin 13 and GATA binding protein 3 genes and the development of eczema during childhood.

Br J Dermatol. 2008 Jun;158(6):1315-22

Authors: Arshad SH, Karmaus W, Kurukulaaratchy R, Sadeghnejad A, Huebner M, Ewart S

BACKGROUND: Atopic eczema is characterized by Th2-dominant immunity with the cytokine interleukin 13 and the transcription factor GATA binding protein 3 playing a critical role. OBJECTIVES: We assessed the association of polymorphisms in the IL13 and GATA3 genes with childhood eczema. METHODS: A birth cohort (n = 1456) was established on the Isle of Wight in 1989 and followed at the ages of 1 (n = 1167), 2 (n = 1174), 4 (n = 1218) and 10 years (n = 1373) to determine the prevalence of allergic disease including eczema. At 4 and 10 years, skin prick testing was performed. Whole blood samples (n = 923) were obtained at the 10-year assessment, stored frozen, and genotyped. Five polymorphisms from IL13 and seven from GATA3 were genotyped for this analysis. Repeated measurement analyses were conducted for the occurrence of eczema at ages 1, 2, 4 and 10 years. All analyses were adjusted for maternal and paternal eczema, low birth weight (< 2500 g), breastfeeding >or= 3 months and age. RESULTS: IL13 was not associated with childhood eczema. For GATA3, the single nucleotide polymorphism (SNP) rs2275806 (promoter region) showed an increased odds ratio for atopic eczema independent of whether the comparison group had a positive skin prick test. The SNP rs444762 (intron 3 region) was associated with atopic eczema in comparison with children without eczema. The increased relative risks remained significant after adjustment for multiple testing only for rs2275806 (P < 0.05). CONCLUSIONS: A SNP in GATA3 is associated with atopic eczema. This finding highlights the importance of GATA3 as an immune-modulating gene in atopic eczema.

PMID: 18410415 [PubMed - indexed for MEDLINE]

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Fatal outcome due to bacterial superinfection of eczema herpeticum in a patient with mycosis fungoides.

August 22nd, 2008 · No Comments

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Fatal outcome due to bacterial superinfection of eczema herpeticum in a patient with mycosis fungoides.

Dermatol Online J. 2008;14(6):21

Authors: Mallo-García S, Coto-Segura P, Suárez-Casado H, Caminal L, Sánchez-del-Río J, Santos-Juanes J

Kaposi varicelliform eruption or eczema herpeticum is well known to be associated with several chronic dermatoses, including atopic dermatitis, foliaceus pemphigus, seborrheic dermatitis, Darier disease, and congenital ichthyosiform erythroderma. Although less frequently, it has also been described in cases of mycosis fungoides and Sèzary syndrome. We would like to report an extremely rare case of a woman with a T-cell cutaneous lymphoma who developed disseminated cutaneous herpes simplex with S. aureus sepsis and a fatal outcome.

PMID: 18713601 [PubMed - in process]

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Quality of life in patients with facial steroid dermatitis before and after treatment.

August 14th, 2008 · No Comments

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Quality of life in patients with facial steroid dermatitis before and after treatment.

J Eur Acad Dermatol Venereol. 2008 Jun;22(6):663-9

Authors: Liu ZH, Du XH

BACKGROUND: Improper long-term, even low-dose, topical corticosteroids, especially application to the face, could induce steroid dermatitis, which was refractory and detrimental to the quality of life. OBJECTIVE: To evaluate the quality of life in patients with facial steroid dermatitis before and after the treatment of doxycycline and indomethacin plus support therapy. STUDY DESIGN: A prospective study. SETTING: Outpatients of the Department of dermatology, the Third Hospital of Hangzhou, from August 2, 2004, to April 20, 2005. SUBJECTS: Fifty consecutive outpatients completed the treatment. INTERVENTION: The intervention is doxycycline 10 mg twice a day and indomethacin 25 mg twice a day for 4 weeks, cetirizine or loratadine 10 mg daily if pruritic, topical white petroleum if feeling dry and wet dressing if burning and oedema, plus psychological support and health education. MAIN OUTCOME MEASURE: The efficacy of the treatment was quantified using a 24-point steroid clinical score. The detriment of the quality of life was quantified using a 30-point Dermatology Life Quality Index. RESULTS: The steroid dermatitis clinical score decreased significantly from 15.06 +/- 4.61 at baseline to 4.52 +/- 3.39 at 2 weeks after the end of treatment (week 6; P < 0.001). Twenty-one patients underwent a rebound phenomenon and the steroid dermatitis clinical score increased significantly from 13.71 +/- 4.33 at baseline (week 0) to 19.24 +/- 3.40 at 1 week after treatment (week 1; P < 0.001). Quality of life score decreased significantly from 13.76 +/- 7.68 at baseline to 3.44 +/- 2.57 at 2 weeks after the end of treatment (week 6; P < 0.001). CONCLUSIONS: The quality of life was profoundly affected by facial steroid dermatitis. Doxycycline and indomethacin plus support therapy might be effective in patients with facial steroid dermatitis.

PMID: 18331297 [PubMed - indexed for MEDLINE]

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Long-term management of facial atopic eczema with pimecrolimus cream 1% in paediatric patients with mild to moderate disease.

August 14th, 2008 · No Comments

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Long-term management of facial atopic eczema with pimecrolimus cream 1% in paediatric patients with mild to moderate disease.

J Eur Acad Dermatol Venereol. 2008 Jun;22(6):718-21

Authors: Zuberbier T, Bräutigam M

BACKGROUND: The aim of this post hoc analysis was to evaluate whether treatment of patients with atopic dermatitis (AD) with pimecrolimus cream 1% can decrease the development of flares necessitating the use of a topical corticosteroid on the face and thus reduce the need for use of topical corticosteroids in this sensitive skin area. PATIENTS AND METHODS: In a controlled, double-blind, multicentre study, 140 patients, aged 2 to 17 years, with facial involvement and mild to moderate disease after treatment of the initial flare with prednicarbate 0.25% cream were randomized to an intermittent treatment with pimecrolimus cream 1% twice daily or vehicle for 24 weeks. If a flare occurred, defined as an exacerbation (unacceptable severity of itching/scratching or onset of oozing) not controlled by study medication, patients were treated with prednicarbate 0.25% cream instead. RESULTS: Patients in the vehicle group needed prednicarbate treatment on the face on 20.7% of the days vs. 11.7% of the study days in the pimecrolimus group (P = 0.0024). Fifty per cent of patients in the pimecrolimus group had no flare on the face during the treatment period compared with 37.5% of patients in the vehicle group (P = 0.012). The median time to first flare in pimecrolimus-treated patients was twice as long as in patients receiving vehicle (138 vs. 68 days, P = 0.01). Three adverse events (one case of skin burning) suspected to be related to use of the study medication were reported for three patients (3.9%) in the pimecrolimus group. CONCLUSION: Long-term intermittent treatment of facial AD in children and adolescents with pimecrolimus cream 1% does significantly reduce the need for topical corticosteroids.

PMID: 18312323 [PubMed - indexed for MEDLINE]

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Medical consultations in relation to severity of hand eczema in the general population.

August 11th, 2008 · No Comments

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Medical consultations in relation to severity of hand eczema in the general population.

Br J Dermatol. 2008 Apr;158(4):773-7

Authors: Hald M, Berg ND, Elberling J, Johansen JD

BACKGROUND: Hand eczema is a common disease with a wide severity spectrum. Little information exists concerning the association between the severity of hand eczema and medical consultations. OBJECTIVES: To describe the self-rated severity of hand eczema in a general population and the relationship to seeking medical attention. METHODS: A questionnaire on self-reported hypersensitivity including two questions on hand eczema was sent to a random sample of 6000 individuals, aged 18-69 years, living in Copenhagen, Denmark. A total of 4242 individuals (71%) answered the questionnaire. All individuals who reported hand eczema (n = 752) within the previous 12 months received a more detailed questionnaire focused on hand eczema and a previously validated photographic guide with four groups of severity ranging from almost clear to very severe. RESULTS: Five hundred and sixty-four individuals (75%) returned the second questionnaire. The 1-year period prevalence of hand eczema was estimated to be 14% in the population. Twenty-three per cent rated their hand eczema as moderate to very severe. In total, 67% had consulted their general practitioner and 44% had consulted a dermatologist because of hand eczema. Multivariate analysis showed a positive association (P < 0.05) between severity of hand eczema and medical consultations. Of those individuals (n = 102) who had not consulted a dermatologist 26% had experienced moderate to very severe hand eczema within the previous 12 months. CONCLUSIONS: A considerable proportion of individuals with moderate to very severe hand eczema in the general population miss out on the potential benefit of a dermatological examination, patch testing and a thorough-going exploration of environmental factors.

PMID: 18241259 [PubMed - indexed for MEDLINE]

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Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial.

August 11th, 2008 · No Comments

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Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial.

Br J Dermatol. 2008 Apr;158(4):808-17

Authors: Ruzicka T, Lynde CW, Jemec GB, Diepgen T, Berth-Jones J, Coenraads PJ, Kaszuba A, Bissonnette R, Varjonen E, Holló P, Cambazard F, Lahfa M, Elsner P, Nyberg F, Svensson A, Brown TC, Harsch M, Maares J

BACKGROUND: Patients with severe chronic hand eczema (CHE) refractory to topical corticosteroids currently have limited treatment options suited for chronic use, and few controlled clinical studies have investigated new therapies in this setting. OBJECTIVES: To assess the efficacy and safety of oral alitretinoin (9-cis retinoic acid) taken at 10 mg or 30 mg once daily for up to 24 weeks, compared with placebo control, in the treatment of severe CHE refractory to topical corticosteroids. METHODS: A randomized, double-blind, placebo-controlled, prospective, multicentre trial was conducted in 111 dermatology outpatient clinics in Europe and Canada. A total of 1032 patients with severe refractory CHE were randomized in a 1 : 2 : 2 ratio to placebo, or 10 mg or 30 mg of oral alitretinoin once daily for up to 24 weeks. Safety was assessed for all patients during a follow-up period of 4 weeks, and responders were observed for relapse for 24 weeks after the end of therapy. The primary efficacy parameter was Physician Global Assessment of overall CHE severity, with response defined as clear or almost clear hands. RESULTS: Responses, defined as clear or almost clear hands, were achieved in up to 48% of patients treated with alitretinoin, compared with 17% for placebo (P < 0.001), with up to 75% median reduction in disease signs and symptoms. Treatment was well tolerated, with dose-dependent adverse effects comprising headache, mucocutaneous events, hyperlipidaemia, and decreased free thyroxine and thyroid-stimulating hormone. The median time to relapse, defined as recurrence of 75% of initial signs and symptoms, was 5.5-6.2 months in the absence of anti-eczema medication. CONCLUSIONS: Alitretinoin given at well-tolerated doses induced clearing of CHE in a substantial proportion of patients with severe disease refractory to standard therapy.

PMID: 18294310 [PubMed - indexed for MEDLINE]

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