Atopic dermatitis (eczema)

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Serum mast cell tryptase is not a useful marker for disease severity in psoriasis or atopic dermatitis.

Br J Dermatol. 2008 Dec 12;

Authors: Gerdes S, Kurrat W, Mrowietz U

Background Severity in psoriasis and atopic dermatitis (AD) is commonly assessed with the Psoriasis Area and Severity Index (PASI) and the SCORing Atopic Dermatitis (SCORAD), respectively. Until today no serum marker is available to reflect the clinical scoring in both diseases. As mast cells play an important role in the pathogenesis of early psoriasis and AD, tryptase, a major compound of mast cell granules that is released upon activation, could in principle serve as such a marker. Objectives To assess the correlation between serum tryptase and severity of psoriasis and AD as well as the correlation between total IgE levels and severity of AD. Methods Serum samples from patients hospitalized for psoriasis and AD were collected at time of admission and time of discharge from hospital. PASI and SCORAD assessments were performed at the same time points. Outpatients presenting with naevi and other benign noninflammatory skin lesions served as control group. Serum tryptase values and total IgE levels of patients with AD were measured using a fluoroenzyme immunoassay technique. Results No correlation of serum tryptase level with either the severity of psoriasis or the severity of AD was seen. Total IgE levels in patients with AD at time of admission and discharge from hospital remained the same. Conclusions Serum total tryptase did not prove to be a useful tool in assessing severity of psoriasis or AD. Total IgE levels did not correlate with severity of AD.

PMID: 19076976 [PubMed - as supplied by publisher]

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Atopic dermatitis: a disease caused by innate immune defects?

J Invest Dermatol. 2009 Jan;129(1):14-30

Authors: De Benedetto A, Agnihothri R, McGirt LY, Bankova LG, Beck LA

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that has increased in prevalence over the last half century. A growing body of evidence suggests that there are a variety of defects in the innate immune system that collectively affect the development and severity of AD. The reduction in antimicrobial peptides, diminished recruitment of innate immune cells (PMNs, pDC, and NK cells) to the skin, epithelial barrier disruption, and TLR2 defects are just some of the credible explanations for AD patients’ susceptibility to pathogens such as Staphylococcus aureus, herpes simplex virus, and vaccinia virus. Although the focus for several years has been to identify defects in the innate immune system that might explain AD patients’ susceptibility to cutaneous pathogens, it has become clear that some innate immune defects might promote inflammation and thereby aggravate or even induce the development of AD. Here we review the innate immune system, and highlight many of the potential innate networks that may be important in AD patients susceptible to cutaneous pathogens.

PMID: 19078985 [PubMed - in process]

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Clinical analyses of atopic dermatitis in the aged.

J Dermatol. 2008 Sep;35(9):562-9

Authors: Tanei R, Katsuoka K

The aim of the present study was to analyze the characteristics of atopic dermatitis (AD) in the senile phase. Subjects were comprised of 16 patients investigated for clinical features, serum immunoglobulin (Ig)E levels and skin manifestations. Mean age was 76.9 +/- 6.2 years (range, 68-87), with a man : woman ratio of 3:1. Mean age at onset was 67.7 +/- 15.7 years. Eight patients (50%) had personal histories of chronic eczema until the young adult phase and three patients (18.8%) showed the classic course of child AD. Eczematous erythroderma in 10 patients (62.5%) and unclassified chronic eczema in five patients (31.3%) were the predominant clinical presentations. Mean total IgE level in sera of the 16 patients was 8810 +/- 13 511 IU/mL (range, 5-53 605). Fourteen patients showed positive results for antigen-specific IgE antibodies, and the mean total IgE level for these patients was 10 056 +/- 14 044 IU/mL. Specific IgE to the main antigen, Dermatophagoides farinae, was observed in 12 patients (85.7%), representing the principal antibody in eight patients (57.1%). Eczematous dermatitis manifested predominantly in the face and neck, trunk and extensor and flexure sites of extremities, and less commonly in the antecubital and popliteal areas. Other stigmata of AD were observed as follows: red face in 10 patients (62.5%); Hertoghe’s sign in six (37.5%); goose-skin in four (25%); facial pallor in three (18.8%); and dirty neck in one (6.3%). These results indicate that senile-type AD represents a characteristic subgroup of AD that appears in the last stage of life in AD patients.

PMID: 18837700 [PubMed - indexed for MEDLINE]

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What’s new in atopic eczema? An analysis of the clinical significance of systematic reviews on atopic eczema published in 2006 and 2007.

Clin Exp Dermatol. 2008 Nov;33(6):685-8

Authors: Williams HC, Grindlay DJ

This review summarizes clinically important findings from 19 systematic reviews published between January 2006 and August 2007 on the topic of atopic eczema (AE). The evidence suggests that avoidance of allergenic foods during pregnancy or the use of hydrolyzed or soy formula milks does not prevent eczema. Delayed introduction of solids may decrease eczema risk. Asthma typically develops in around a third of children with eczema, and wheezing in early infancy is a predictor of risk. Established topical corticosteroids such as betamethasone should be used just once daily. Topical tacrolimus and pimecrolimus can be used for people who become dependent on topical corticosteroids, especially on sensitive sites such as the face. Wet wraps are useful in secondary care for inducing remission in a child, but they are not a treatment for mild eczema and they should not be used long term. Oral ciclosporin can be used for inducing a remission in severe eczema, and azathioprine can be considered for maintenance treatment. Narrowband ultraviolet (UV)B phototherapy can be used for chronic AE, and UVA1 may be useful for acute eczema. There is little convincing evidence of a clinical benefit with evening primrose oil for eczema, but there is some good new evidence that educational support to eczema families is beneficial. Future trials need to be larger, and include active comparators, patient-reported outcomes and longer-term aspects of disease control. They should be better reported, and registered on a public clinical trials register.

PMID: 18691244 [PubMed - indexed for MEDLINE]

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CD40 expression on antigen presenting cells and correlation with disease severity in atopic dermatitis.

Eur J Dermatol. 2008 Sep-Oct;18(5):527-33

Authors: Oflazoglu E, Simpson EL, Takiguchi R, Hanifin JM, Grewal IS, Gerber HP

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with cutaneous hyperreactivity to environmental stimuli, resulting in increased infiltration of inflammatory cells, IgE production and enhanced expression of various co-stimulatory molecules, Th2 cytokines and chemokines. Antigen presenting cells (APCs) are critical for AD disease pathogenesis and interaction between APCs and inflammatory T cells represents an important signal required for induction and maintenance of the inflammatory process. CD40 was shown to be upregulated on inflammatory cells in patients with atopic dermatitis; however the identity of these cells and their correlation with disease severity remained unknown. To address these questions, we determined CD40 expression in skin lesions and on peripheral blood cells from AD patients and identified a positive correlation between the numbers of CD40 positive cells and disease severity. Furthermore, we identified the nature of CD40 positive cells in skin lesions to include CD1a+ and CD11b+ APCs. Finally, a correlation between serum PARC and IgE levels and the numbers of CD40+ cells in AD skin lesions was found. Combined, these findings demonstrate that CD40 is upregulated on APCs, cell types previously shown to contribute to AD disease pathology, and suggest that therapeutic strategies targeting CD40 positive cells may provide benefit to AD patients.

PMID: 18693155 [PubMed - indexed for MEDLINE]

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Association factors for atopic dermatitis in nursery school children in Ishigaki islands - Kyushu University Ishigaki Atopic Dermatitis Study (KIDS).

Eur J Dermatol. 2008 Sep-Oct;18(5):571-4

Authors: Fukiwake N, Furusyo N, Takeoka H, Toyoda K, Kubo N, Kido M, Hayashida S, Uchi H, Moroi Y, Urabe K, Kinukawa N, Nose Y, Hayashi J, Furue M

Atopic dermatitis (AD) is a multifactorial disease that usually decreases the quality of life of affected patients. The purpose of this study was to evaluate the associated factors for atopic dermatitis, asthma, rhinitis, and food allergy by physical examination of the skin and a questionnaire in nursery school children in Ishigaki Island, Okinawa, Japan. Enrolled in this study were 460 children from 0 to 6 years of age. Physical examination of skin symptoms and blood tests were performed. Information on past history and family history of atopic dermatitis, asthma, rhinitis, and food allergy were collected by questionnaire. The prevalence of atopic dermatitis was 12.2% (56/460). The cumulative prevalence of asthma, rhinitis, and food allergy was 19.9% (91/458), 3.3% (15/457), and 5.5% (25/456), respectively. In multivariate analysis, maternal history of rhinitis, atopic dermatitis siblings, past history of asthma and food allergy, and elevation of total IgE were significantly related to atopic dermatitis. A high total IgE level was a strong risk factor specific for atopic dermatitis in this population.

PMID: 18693163 [PubMed - indexed for MEDLINE]

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Does age or gender influence quality of life in children with atopic dermatitis?

Clin Exp Dermatol. 2008 Nov;33(6):705-9

Authors: Hon KL, Leung TF, Wong KY, Chow CM, Chuh A, Ng PC

BACKGROUND: Quality of life (QoL) is impaired in children with atopic dermatitis (AD) but the various aspects of QoL may not be equally affected. Aim. To evaluate if age and gender affect some aspects of QoL in children with AD. METHOD: The Children’s Dermatology Life Quality Index (CDLQI) was used for all children with AD seen at a paediatric dermatology clinic over a 3-year period. Disease severity was assessed using the SCORing Atopic Dermatitis (SCORAD) and Nottingham Eczema Severity Score (NESS) tools. RESULTS: We reviewed CDLQI in 133 children (70 male and 63 female; age range 5-16 years) with AD. Itch, sleep disturbance, treatment and swimming/sports were the four aspects of QoL issues that were most commonly affected, in 50%, 47%, 38% and 29% of patients, respectively. Problems with interpersonal issues (friendship, school/holidays, and teasing/bullying) occurred in only a minority of children (

PMID: 18681872 [PubMed - indexed for MEDLINE]

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Further experience of using azathioprine in the treatment of severe atopic dermatitis.

Clin Exp Dermatol. 2008 Nov;33(6):710-1

Authors: Hughes R, Collins P, Rogers S

Atopic dermatitis (AD) is a common disease. Severe AD has a significant effect on quality of life and is difficult to treat. We have previously reported 10 patients treated with azathioprine over a 7-year period, to good effect. We have now treated 37 patients over 18 years, and report our findings. The aim of the study was to review the efficacy and safety of azathioprine as a long-term treatment for severe atopic eczema. Patients who began treatment between 1987 and 2005 were identified. The dose and number of courses of azathioprine, duration of treatment, treatment response, and adverse events were recorded up to June 2006. In total, 37 patients were treated with azathioprine. Of these, 15 (40.5%) achieved remission in a median period of 5 months (range 4-29). Nine patients had an initial good response but either did not have sufficient clearance to be able to stop azathioprine, or deteriorated while on treatment over a period of 4-27 months; these were considered late failures. One patient showed no response, and five experienced reactions leading to withdrawal of the drug. Our experience with azathioprine for the treatment of severe atopic eczema, is very encouraging.

PMID: 18681884 [PubMed - indexed for MEDLINE]

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Interstitial granulomatous dermatitis: a misdiagnosed cutaneous form of systemic lupus erythematosus?

Clin Exp Dermatol. 2008 Nov;33(6):712-4

Authors: Blaise S, Salameire D, Carpentier PH

Interstitial granulomatous dermatitis (IGD) is a recently described, rare dermatological entity. The clinical features are diverse and the precise aetiology is unknown. We present a rare and atypical case of IGD in a patient with systemic lupus erythematosus (SLE). A 26-year-old woman had been diagnosed with SLE when she was 15 years old. The diagnosis was based on cutaneous, articular, pulmonary, haematological and immunological features. The patient presented with a cutaneous diffuse macular eruption on the limbs, appearing in a cockade (rosette) pattern with a violaceous centre and erythematous surround. The face and trunk were spared. The cutaneous histological features led us to consider a diagnosis of IGD. The lesions disappeared after 15 days of systemic steroid therapy. This case is a new clinical form of IGD with an atypical location and clinical presentation. IGD has usually been associated with drug-related adverse reactions and autoimmune diseases. Reports in the literature of IGD in patients with SLE are rare.

PMID: 18681887 [PubMed - indexed for MEDLINE]

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Semaphorin3A alleviates skin lesions and scratching behavior in NC/Nga mice, an atopic dermatitis model.

J Invest Dermatol. 2008 Dec;128(12):2842-9

Authors: Yamaguchi J, Nakamura F, Aihara M, Yamashita N, Usui H, Hida T, Takei K, Nagashima Y, Ikezawa Z, Goshima Y

Topical steroids and antihistamines are commonly used for the treatment of atopic dermatitis (AD). However, in a substantial number of patients with AD, these treatments are not sufficiently effective. In AD patients, C-fibers in the epidermis increase and sprout, inducing hypersensitivity, which is considered to aggravate the disease. Semaphorin3A (Sema3A), an axon guidance molecule, is a potent inhibitor of neurite outgrowth of sensory neurons. To investigate the effect of Sema3A on AD, we administered recombinant Sema3A intracutaneously into the skin lesions of NC/Nga mice, an animal model of AD. Sema3A dose-dependently improved skin lesions and attenuated the scratching behavior in NC/Nga mice. Histological examinations revealed a decrease in: (a) epidermal thickness; (b) the density of invasive nerve fibers in the epidermis; (c) inflammatory infiltrates, including mast cells and CD4+ T cells; and (d) the production of IL-4 in the Sema3A-treated lesions. Because the interruption of the itch-scratch cycle likely contributes to the improvement of the AD-like skin lesions, Sema3A is promising in the treatment of patients with refractory AD, as well as overall itching dermatosis.

PMID: 18615113 [PubMed - indexed for MEDLINE]

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