Atopic dermatitis (eczema)

Interstitial granulomatous dermatitis.

Dermatol Online J. 2008;14(5):18

Authors: Johnson H, Mengden S, Brancaccio RR

A 59-year-old woman with arthritis presented to the Skin Institute of New York with a 2-month history of asymptomatic, small, skin-colored papules that erupted symmetrically on the chest, back, and proximal extremities. Histopathologic examination of a biopsy specimen showed findings of interstitial granulomatous dermatitis. Clinical correlation suggested a diagnosis of interstitial granulomatous dermatitis with arthritis. No change in the lesions resulted from application of clobetasol 0.05 percent ointment to the affected areas.

PMID: 18627754 [PubMed - indexed for MEDLINE]

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Chronic actinic dermatitis.

Dermatol Online J. 2008;14(5):25

Authors: Booth AV, Mengden S, Soter NA, Cohen D

A 71-year-old man presented with a six-year history of a pruritic, erythematous, blistering eruption of the face, chest, and arms. Clinical findings, histopathologic features, and phototests were consistent with a diagnosis of chronic actinic dermatitis. The patient also had contact allergy and photocontact allergy to multiple allergens. A discussion of chronic actinic dermatitis is presented.

PMID: 18627761 [PubMed - indexed for MEDLINE]

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Lymphocyte proliferation testing in chromium allergic contact dermatitis.

Clin Exp Dermatol. 2008 Jul;33(4):472-7

Authors: Martins LE, Duarte AJ, Aoki V, Nunes RS, Ogusuku S, Reis VM

BACKGROUND: Lymphocyte proliferation testing (LPT) has some advantages over patch testing to diagnose allergic contact dermatitis. It is harmless, objective and can be used in clinical situations where patch testing is not recommended. Unfortunately, significant success has only been achieved with nickel. There are few studies on chromium LPT and they were performed with different methods, leading to inconsistent results. METHODS: To determine the best parameters for chromium LPT, we tested 20 patients with allergic contact dermatitis to the metal and 20 controls, using various protocols. RESULTS: The best sensitivity and specificity ratios were achieved with 6-day cultures stimulated with a range from 7.5 x 10(-4) to 5 x 10(-3) mol/L of nonfiltered chromium chloride solutions. The sensitivity, specificity and accuracy values found within this range were 65%, 95% and 80%, respectively. CONCLUSION: Further investigation is necessary to achieve better sensitivity values.

PMID: 18582233 [PubMed - indexed for MEDLINE]

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Serum IgE autoantibodies target keratinocytes in patients with atopic dermatitis.

J Invest Dermatol. 2008 Sep;128(9):2232-9

Authors: Altrichter S, Kriehuber E, Moser J, Valenta R, Kopp T, Stingl G

Previous studies have shown that sera of patients with severe atopic dermatitis (AD) contain IgE specific for self-proteins, supporting the hypothesis of autoreactivity as a pathogenic factor in AD. In this study, we screened a large panel of AD patients (n=192) by western blotting (WB) for IgE reactivity not only against the human epithelial cell line A431 but also against primary keratinocytes (KCs). To investigate autoantigenic cell structures in detail, normal human skin and primary KCs were incubated with sera from both WB-reactive patients and, for control purposes, healthy individuals, and analyzed by immunohistology, confocal laser microscopy, and flow cytometry. Our analysis revealed that 28% of AD patients, but not healthy individuals, display serum IgE autoreactivity by WB analysis. The individual IgE reaction patterns of the sera pointed to the existence of unique as well as common specificities against epidermal or A431-derived proteins. Immunostainings identified cytoplasmic and, occasionally, also cell membrane-associated moieties as targets for autoreactive IgE antibodies. Interestingly, in certain autoreactive patients, the surface-staining pattern was accentuated at cellular contact sites. We conclude that IgE autoreactivity is common, particularly among severe AD patients, and that non-transformed primary cells are needed for characterization of the entire spectrum of IgE-defined autoantigens.

PMID: 18480840 [PubMed - indexed for MEDLINE]

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Amyopathic dermatomyositis resembling stasis dermatitis.

J Am Acad Dermatol. 2008 Sep;59(3):515-8

Authors: Seidler AM, Wasserman DI, González-Serva A, Konnikov N

This case describes an unusual presentation of dermatomyositis in a patient with ovarian carcinoma. The eruption appeared as a venous stasislike dermatitis. The temporal sequence of onset after chemotherapy administration suggested a possible drug-induced process. However, in the context of underlying ovarian carcinoma, a paraneoplastic process offered an alternative explanation for the dermatomyositis.

PMID: 18571770 [PubMed - indexed for MEDLINE]

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The value of patch testing patients with a scattered generalized distribution of dermatitis: retrospective cross-sectional analyses of North American Contact Dermatitis Group data, 2001 to 2004.

J Am Acad Dermatol. 2008 Sep;59(3):426-31

Authors: Zug KA, Rietschel RL, Warshaw EM, Belsito DV, Taylor JS, Maibach HI, Mathias CG, Fowler JF, Marks JG, DeLeo VA, Pratt MD, Sasseville D, Storrs FJ

BACKGROUND: A scattered generalized distribution (SGD) of dermatitis is a challenging problem; patch testing is a strategy for evaluating allergic contact dermatitis as a relevant factor. OBJECTIVE: We sought to analyze patient characteristics and most frequently relevant positive allergens in patients presenting for patch testing with SGD. METHODS: We conducted retrospective cross-sectional analysis of North American Contact Dermatitis Group 2001 to 2004 data. Patients with SGD were compared with patients without SGD. RESULTS: Of 10,061 patients, 14.9% (n = 1497) had only a SGD. Men and patients with a history of atopic eczema were more likely to have dermatitis in a SGD (P < .001). Preservatives, fragrances, propylene glycol, cocamidopropyl betaine, ethyleneurea melamine formaldehyde, tixocortol pivalate, and budesonide were among the more frequently relevant positive allergens. Top allergen sources included cosmetics/beauty preparations/skin and health care products, clothing, and topical corticoids. LIMITATIONS: This was a retrospective analysis of patch-tested patients with SGD suspected to have allergy. CONCLUSIONS: A total of 49% of patients with SGD had at least one relevant positive allergen, thus demonstrating the benefit of patch testing these patients.

PMID: 18597890 [PubMed - indexed for MEDLINE]

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A pilot study showing pulsed-dye laser treatment improves localized areas of chronic atopic dermatitis.

Clin Exp Dermatol. 2008 May;33(3):243-8

Authors: Syed S, Weibel L, Kennedy H, Harper JI

BACKGROUND: Eczematous skin changes overlying port-wine stains have been reported to improve with pulsed-dye laser (PDL) treatment. However, PDL has not as yet been evaluated for the treatment of atopic dermatitis (AD; eczema). AIM: To evaluate in a controlled trial the effects and safety of PDL treatment in children with AD who had chronic localized lesions. METHODS: Twelve children with localized, chronic eczema were treated with PDL (595 nm), with untreated areas used as an intrapatient control. Treatment was given at baseline and patients were followed up at 2 and 6 weeks. Clinical outcome measures were localized Eczema Severity Score (ESS), a visual analogue scale (VAS) indicating eczema severity assessed by photographs, and adverse events. RESULTS: After 2 and 6 weeks, a significant decrease in ESS was seen for the PDL-treated areas compared with the control areas (mean +/- SEM reduction in ESS 7.0 +/- 1.0 vs. 3.3 +/- 0.8 at 2 weeks, P = 0.003, and 7.8 +/- 1.4 vs. 4.9 +/- 1.3 at 6 weeks, P = 0.002). A significant difference in eczema severity assessed by VAS at 6 weeks was seen in favour of PDL (mean +/- SEM improvement 78% +/- 20% vs. 52% +/- 10%, P = 0.003). Treatment was well-tolerated. CONCLUSIONS: In this pilot study, PDL treatment was effective in treating small areas of chronic localized eczema. This may suggest that in AD dermal vasculature plays an important role or that PDL may have an effect on cutaneous immunological activation.

PMID: 18201257 [PubMed - indexed for MEDLINE]

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Periorbital dermatitis-a recalcitrant disease: causes and differential diagnoses.

Br J Dermatol. 2008 Aug 20;

Authors: Feser A, Plaza T, Vogelgsang L, Mahler V

Background Periorbital dermatitis is common and frequently recalcitrant to treatment. Due to the exposed and visible location, patients often suffer severely from periorbital dermatitis. Objectives To determine the frequency and causes of periorbital dermatitis including contact sensitizers. Methods We investigated two cohorts of patients (Erlangen and IVDK without Erlangen) between 1999 and 2004. Results The differences between the two cohorts with periorbital dermatitis [Department of Dermatology at University Hospital Erlangen (n = 88) and the German Information Network of Departments of Dermatology (IVDK) collective (n = 2035)] were determined by the MOAHLFA (male, occupational dermatosis, atopic eczema, hand dermatitis, leg dermatitis, facial dermatitis, age >/= 40 years) index. Statistically significant factors for periocular eczema are female sex, atopic skin diathesis and age >/= 40 years. In both cohorts allergic contact dermatitis was the main cause of periorbital eczema (Erlangen 44.3%, IVDK 31.6%), followed by periorbital atopic dermatitis (Erlangen 25%, IVDK 14.1%), airborne dermatitis (Erlangen 10.2%, IVDK 1.9%), irritant contact dermatitis (Erlangen 9.1%, IVDK 7.6%), periorbital rosacea (Erlangen 4.5%, IVDK 2.2%), allergic conjunctivitis (Erlangen 2.3%, IVDK included in ‘others’) and psoriasis (Erlangen 2.3%, IVDK included in ‘others’). The most relevant allergens/allergen sources inducing periorbital eczema were consumers’ products (facial cream, eye shadow and ophthalmic therapeutics) (31%), fragrance mix (19%), balsam of Peru (10%), thiomersal (10%) and neomycin sulphate (8%); 12.5% of patients with allergic periocular dermatitis could be exclusively elucidated by testing patients’ own products. Conclusions Our data demonstrate the multiplicity of causes for periorbital eczematous disease manifestation, which requires patch testing of standard trays as well as consumers’ products to elucidate the relevant contact sensitization.

PMID: 18721191 [PubMed - as supplied by publisher]

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Sustained efficacy and safety of pimecrolimus cream 1% when used long-term (up to 26 weeks) to treat children with atopic dermatitis.

Pediatr Dermatol. 2008 May-Jun;25(3):301-7

Authors: Langley RG, Eichenfield LF, Lucky AW, Boguniewicz M, Barbier N, Cherill R

Atopic dermatitis is a chronic, inflammatory condition affecting up to 20% of children. Here, we report the long-term extension study of previously published pivotal phase III studies with pimecrolimus cream 1%. Two identical, 26-week studies (6-week, double-blind, followed by 20-week, open-label phases) were conducted in children aged 2 to 17 years with atopic dermatitis. Pooled efficacy and safety analyses were performed. At day 43, 34.8% pimecrolimus-treated patients versus 18.4% in the vehicle group (p < 0.001) were clear/almost clear (Investigators’ Global Assessment 0/1) of disease, with significant differences (p < 0.05) between treatment groups for all double-blind visits in all parameters. Pimecrolimus was significantly more effective (based on the Eczema Area and Severity Index) in treating the face and neck versus the rest of the body (p < 0.0001) and versus vehicle (p < 0.0001) in the double-blind phase. Disease control was sustained in the pimecrolimus group throughout the whole study. Patients treated with vehicle during the double-blind phase experienced rapid, marked improvement when switched to pimecrolimus in the open-label phase. The incidence of adverse events was low and comparable between treatment groups. In conclusion, pimecrolimus cream 1% is effective and well tolerated in the long-term control of children with mild to moderately severe atopic dermatitis.

PMID: 18577032 [PubMed - indexed for MEDLINE]

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ILVEN-like persistent psoriasiform dermatitis confined to a congenital Becker nevus.

Pediatr Dermatol. 2008 May-Jun;25(3):390-1

Authors: Abbasi N, Fangman WL, Rosenman KS, Schaffer JV

A 10-year-old boy presented with a 5-year history of an intractably pruritic, recalcitrant psoriasiform plaque in a broad vertical band on the left buttock, with histologic as well as clinical features suggestive of an inflammatory linear verrucous epidermal nevus. This lesion was completely superimposed upon a congenital Becker nevus. We postulate that the restricted distribution and persistence of the psoriasiform plaque reflected an inflammatory response limited to the aberrant clone of cells composing the Becker nevus, a manifestation of cutaneous mosaicism that could be characterized as an “inflammatory Becker nevus.”

PMID: 18577054 [PubMed - indexed for MEDLINE]

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