Atopic dermatitis (eczema)

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Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis.

Br J Dermatol. 2008 Jul;159(1):120-4

Authors: Hull CM, Liddle M, Hansen N, Meyer LJ, Schmidt L, Taylor T, Jaskowski TD, Hill HR, Zone JJ

BACKGROUND: Dermatitis herpetiformis (DH) is a papulovesicular eruption caused by ingestion of gluten. It is characterized by the deposition of IgA in the dermal papillae. IgA antibodies directed at tissue transglutaminase (TG2) are elevated in gluten-sensitive diseases including DH and coeliac disease (CD). More recently, antibodies directed at epidermal transglutaminase (TG3) were identified in patients with DH, and this may be the dominant autoantigen in this disease. OBJECTIVES: To measure IgA antibodies to TG3 and TG2 in patients with DH and CD, and control populations. METHODS: Serum IgA antibodies against TG2 and TG3 were measured from adults with DH, adults and children with CD, patients with psoriasis, adult Red Cross blood donors, and paediatric controls. RESULTS: Patients with DH and CD had elevated levels of IgA anti-TG2 antibodies compared with control populations. The levels in the patients with DH and adults with CD were similar. IgA anti-TG2 antibodies were higher in the children with CD compared with adults with DH and CD, and with control populations. Patients with DH and adults with CD had elevated levels of IgA anti-TG3 antibodies compared with children with CD and control populations. There was a trend towards higher levels in the patients with DH compared with adults with CD. CONCLUSIONS: IgA antibodies to TG3 are elevated in patients with DH and adults with CD. The progressive expansion of the epitope-binding profile of IgA antitransglutaminase antibodies in patients with CD may explain the development of DH in patients with undiagnosed CD during their adult life.

PMID: 18503599 [PubMed - indexed for MEDLINE]

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The cause of the Chinese sofa/chair dermatitis epidemic is likely to be contact allergy to dimethylfumarate, a novel potent contact sensitizer.

Br J Dermatol. 2008 Jul;159(1):218-21

Authors: Rantanen T

BACKGROUND: A small epidemic of severe contact dermatitis cases related to newly acquired sofas and chairs has surpassed the news threshold in Finland and the U.K. OBJECTIVES: To study affected patients and to identify the cause. METHODS: Five patients with contact dermatitis related to a newly purchased chair or sofa were studied. Furniture samples were analysed by gas chromatography-mass spectrometry. Compounds were identified using a mass spectrum library and measured semiquantitatively. Patch tests were performed with commercial standard allergens, furniture upholstery and chemicals found in the analysis. RESULTS: Patch tests with commercial allergens did not solve the problem. Up to 470 microg kg(-1) of dimethylfumarate was found in chairs. The patients showed strong positive patch test reactions to upholstery fabric samples and to dimethylfumarate, down to a level of 1 p.p.m. in the most severe case. CONCLUSIONS: The cause of the Chinese sofa/chair dermatitis epidemic is likely to be contact allergy to dimethylfumarate, a novel potent contact sensitizer.

PMID: 18503603 [PubMed - indexed for MEDLINE]

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Microanalysis of an antimicrobial peptide, beta-defensin-2, in the stratum corneum from patients with atopic dermatitis.

Br J Dermatol. 2008 Jul;159(1):97-104

Authors: Asano S, Ichikawa Y, Kumagai T, Kawashima M, Imokawa G

BACKGROUND: Antimicrobial peptides, such as defensin and cathelicidin, have recently been reported to play important roles in host defence and in cutaneous innate immunity. Although beta-defensin-2 has been reported to be downregulated in the skin of patients with atopic dermatitis (AD), little is known about its role in the colonization of Staphylococcus aureus in the stratum corneum of patients with AD. A precise evaluation of these peptides in the stratum corneum as an antimicrobial barrier against S. aureus colonization has not yet been performed. OBJECTIVES: To compare beta-defensin-2 levels in the skin of patients with AD and healthy controls. METHODS: We developed a microanalytical technique to measure beta-defensin-2 in the stratum corneum using a combination of immunoprecipitation and Western blotting. RESULTS: beta-Defensin-2 in the stratum corneum was significantly higher in AD lesional skin compared with healthy control skin. The beta-defensin-2 content in AD lesional skin also increased in proportion to the severity of the disease. Counting bacterial colonies revealed higher populations of S. aureus on lesional and nonlesional skin surfaces of patients with AD compared with healthy controls. Comparison of S. aureus colony numbers and beta-defensin-2 levels demonstrated a positive correlation (r = 0.342, P = 0.004, n = 67) between both factors. CONCLUSIONS: Collectively, these findings suggest that beta-defensin-2 is induced in response to bacteria, injury or inflammatory stimuli and is not associated with vulnerability to S. aureus colonization in the skin of patients with AD.

PMID: 18476959 [PubMed - indexed for MEDLINE]

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Patch Tests in Children with Suspected Allergic Contact Dermatitis: A Prospective Study and Review of the Literature.

Dermatology. 2008 Oct 22;

Authors: de Waard-van der Spek FB, Oranje AP

Aims: The results of patch testing in children visiting our out-patient clinic with suspected allergic contact dermatitis (ACD) were prospectively investigated and compared with those reported in the literature. A review of the literature on patch testing and ACD in children is provided. Methods: Children were patch tested using the TRUE(R) test, supplemented with tixocortol-17-pivalate, budesonide and 3 commonly used emollients. Supplementary patch tests were undertaken on indication. Results: Seventy-nine children (31 boys and 48 girls) were patch tested. Of the patients tested, 40 (51%) had 1 or more positive allergic patch test reactions. Twenty-two (55%) of these 40 children suffered from atopic dermatitis, 9 (23%) from hand or foot dermatitis, and 9 (23%) from other skin ailments. Nickel was the most common contact allergen, but many other common and less common allergens were noted to give positive patch tests in patients. Conclusion: Sensitization to contact allergens may begin in infancy and continue to be more common in toddlers and young children. In recalcitrant atopic dermatitis, especially at the age of 5 years and over, patch tests are indicated. Good information on preventing the development of ACD in children is useful for caregivers.

PMID: 18946202 [PubMed - as supplied by publisher]

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Traffic-related air pollution, climate, and prevalence of eczema in Taiwanese school children.

J Invest Dermatol. 2008 Oct;128(10):2412-20

Authors: Lee YL, Su HJ, Sheu HM, Yu HS, Guo YL

The prevalence of childhood eczema is increasing in many countries. Epidemiological studies, however, say little of its association to outdoor air pollution and climate factors. We conducted a nationwide survey of middle-school students in Taiwan from 1995 to 1996. The 12-month prevalence of eczema was compared with air monitoring station data of temperature, relative humidity, and criteria air pollutants. A total of 317,926 children attended schools located within 2 km of 55 stations. Prevalence rates of recurrent eczema were 2.4 and 2.3% in boys and girls, respectively, with prevalence rates of flexural eczema 1.7% in both sexes. After adjustment for possible confounders, flexural eczema was found to be associated with traffic-related air pollutants, including nitrogen oxides and carbon monoxide. Recurrent eczema was associated with traffic-related air pollution only in girls. There were no associations for the highest monthly means of temperature, whereas the annual means and the lowest monthly means of temperature were negatively related to flexural eczema, but only in girls. The lowest monthly mean relative humidity was positively related to eczema. The results suggest that air pollution and climatic factors, which showed stronger associations in girls than boys, may affect the prevalence of childhood eczema.

PMID: 18449213 [PubMed - indexed for MEDLINE]

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An IFN-associated cytotoxic cellular immune response against viral, self-, or tumor antigens is a common pathogenetic feature in “interface dermatitis”.

J Invest Dermatol. 2008 Oct;128(10):2392-402

Authors: Wenzel J, Tüting T

The term “interface dermatitis” (ID) involves a specific histological inflammatory pattern that is characterized by a cytotoxic lymphocytic infiltration and a hydropic degeneration of the basal epidermal layer. ID is typically seen in autoimmune skin disorders such as lichen planus (LP), cutaneous lupus erythematosus (CLE), and may also appear during immune reactions against drugs, viruses, and tumors. Recent studies have shown that the type-I IFN system is involved in cutaneous autoimmune diseases characterized by ID. IFNs induce the expression of proinflammatory cytokines and chemokines, which support the cellular immune response. The role of IFNs in ID is supported by a close morphological association between the expression pattern of IFN-inducible proteins and the distribution of CXCR3+ lymphocytes. The IFN-inducible chemokine CXCL10 is expressed in exactly those areas where cytotoxic lymphocytes invade the basal epidermis and cause keratinocyte death. A similar picture can be found in early herpes simplex viral skin lesions and viral warts, but also in “lichenoid” actinic keratosis and invasive squamous cell carcinoma. These data suggest that ID morphologically reflects a common IFN-driven cytotoxic attack affecting the basal keratinocytes under different conditions, which is important for antiviral and antitumor immune response, but is inappropriately activated in autoimmune skin disorders.

PMID: 18418411 [PubMed - indexed for MEDLINE]

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Role of foods in irregular aggravation of skin lesions in children with atopic dermatitis.

J Dermatol. 2008 Jul;35(7):407-12

Authors: Uenishi T, Sugiura H, Tanaka T, Uehara M

Atopic dermatitis is a common inflammatory skin disease that especially affects children and adolescents. Many environmental factors have been recognized as relevant in aggravating skin lesions of the disease. However, it remains to be determined whether foods play a role in worsening of skin lesions in children with atopic dermatitis. In the present study, we investigated whether foods play a role in irregular aggravation of skin lesions in children with the disease. The study population consisted of 69 patients aged 3-15 years with atopic dermatitis. They were hospitalized and open challenge tests were performed with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. We determined challenge-positive foods by evaluating the comparable before/after challenge photographs. One to three (average, 1.9) challenge-positive foods were confirmed in 52 (75%) of the 69 patients examined. Predominant offending foods were chocolate, cheese and yogurt. Specific immunoglobulin E values to offending foods were mostly negative. We asked patients to exclude challenge-positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a remarkable improvement in the disease. These results suggest that foods play an important role in irregular aggravation of skin lesions in children with atopic dermatitis.

PMID: 18705827 [PubMed - indexed for MEDLINE]

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Contact allergy in children referred for patch testing: north american contact dermatitis group data, 2001-2004.

Arch Dermatol. 2008 Oct;144(10):1329-36

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

Objectives To determine the frequency of positive and relevant patch tests in children referred for patch testing in North America; to compare results of patch testing children and adults; and to compare our results with international data on contact allergy in children. DESIGN: Retrospective cross-sectional analyses of North American Contact Dermatitis Group (NACDG) data from January 1, 2001, through December 31, 2004. Patch test reactions for allergens that were positive and considered of clinical importance to the patient’s eczematous problem were defined as being of current or past relevance. SETTING: Clinical patch test data from 13 NACDG members, primarily a referral population. Patients The pediatric population (hereafter referred to as “children”) was defined as patients aged 0 to 18 years (n = 391). Patients 19 years and older constituted the comparison adult group (n = 9670). MAIN OUTCOME MEASURES: The frequency of positive patch test reactions and number of relevant ones. Secondary measures included the association of atopic markers, frequency of irritant reactions, and sources of relevant supplementary allergens. RESULTS: No significant difference in the overall frequency of at least 1 relevant positive patch test reaction was noted in children (51.2%) compared with adults (54.1%). The most frequent positive reactions in children were to nickel (28.3%), cobalt chloride (17.9%), thimerosal (15.3%), neomycin sulfate (8.0%), gold sodium thiosulfate (7.7%), and fragrance mix (5.1%). For children aged 0 to 18 the most frequent relevant positive reactions were to nickel sulfate (26.0%), cobalt (12.4%), neomycin (4.4%), fragrance mix (4.1%), gold (3.6%), and quaternium 15 (3.6%). The frequency of irritant reactions in adults and children was similar. Of the children with a relevant positive reaction, 34.0% had atopic dermatitis included as one of their final diagnoses, compared with 11.2% of adults (P < .001). Fifteen percent and 39% of children had relevant allergens not included in the NACDG series and a commercially available skin patch test (T.R.U.E. TEST [thin-layer rapid use epicutaneous test], panel 1.1 and 2.1; Allerderm, Phoenix, Arizona), respectively. CONCLUSIONS: Adults and children in this group are equally likely to have allergic contact dermatitis; frequency of relevant allergen reactions differs.

PMID: 18936397 [PubMed - in process]

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Systemic therapy of paediatric atopic dermatitis: an update.

Australas J Dermatol. 2008 Aug;49(3):123-34; quiz 135-6

Authors: Borchard KL, Orchard D

Topical therapies are the mainstay in the treatment of atopic dermatitis, and are effective in the majority of patients with mild and localized disease. In patients with widespread or recalcitrant moderate to severe dermatitis, systemic therapies may be required. The frequently used systemic therapies are immunosuppressants, immune response modifiers, anti-inflammatories, antihistamines, and antibiotics. In this article, the indications and scientific support for the use of these medications is reviewed.

PMID: 18638218 [PubMed - indexed for MEDLINE]

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Kaposi varicelliform eruption (eczema herpeticum).

Dermatol Online J. 2008;14(2):18

Authors: Olson J, Robles DT, Kirby P, Colven R

A 35-year-old woman with a history of atopic diathesis presented to the emergency department with 2 weeks of widespread facial vesiculopustules and eroded vesicles. HSV-1 was found on viral culture and direct fluorescent antibody testing. She was diagnosed with eczema herpeticum, an uncommon and potentially life-threatening viral infection that arises in areas of pre-existing dermatosis. Antiviral treatment for eczema herpeticum is very effective, and should be instituted without delay to avoid significant morbidity and mortality.

PMID: 18700121 [PubMed - indexed for MEDLINE]

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