Atopic dermatitis (eczema)

Incidence of chickenpox in young South Korean soldiers and correlation with atopic dermatitis.

Clin Exp Dermatol. 2008 Oct 29;

Authors: Cho SB, Oh SH, Ahn BK, Kim HS, Park JM, Lee JH, Lee KH

Summary Background. In South Korea, military service is compulsory for all healthy young men and provides specific environmental factors, with groups working and living together in specific places for several years making varicella more transmissible to susceptible individuals. Studies of people serving in the South Korean military may provide information about the young adult male population in Korea. Aim. To determine the relationship between chickenpox and atopic dermatitis (AD) in young adults over a period of 3 years. Methods. The computerized database of the Armed Forces Medical Command was examined to identify the number of reported cases of chickenpox, AD, and AD associated with chickenpox. Results. In total, 588 cases of chickenpox (183, 182 and 223 in the periods November 2004 to October 2005, November 2005 to October 2006, and November 2006 to October 2007, respectively) were reported. A greater number of patients were found to be infected with chickenpox in January and November, with fewer patients in August and September (P < 0.0001). Within the same periods, 1890, 2417 and 2779 patients diagnosed with AD were recorded in the Defense Medical Information System. Only 3 of 588 patients with chickenpox also had AD (0.5%). Conclusion. In this population-based study, the epidemiological trend of chickenpox and AD over a period of 3 years within the military personnel of South Korea is shown.

PMID: 19175783 [PubMed - as supplied by publisher]

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Maintenance of an Acidic Stratum Corneum Prevents Emergence of Murine Atopic Dermatitis.

J Invest Dermatol. 2009 Jan 29;

Authors: Hatano Y, Man MQ, Uchida Y, Crumrine D, Scharschmidt TC, Kim EG, Mauro TM, Feingold KR, Elias PM, Holleran WM

Neutralization of stratum corneum (SC) adversely impacts key epidermal functions, including permeability barrier homeostasis and SC integrity. Conversely, acidification of SC improves these functions in developmentally impaired (neonatal or aged) skin, and enhances function in normal skin. Hence, we hypothesized that acidification could alter the course of inflammatory dermatoses, which invariably exhibit an increased SC pH. Maintenance of a low pH by topical applications of the polyhydroxyl acid, lactobionic acid, during the repeated-challenge phase inhibited the development of oxazolone-induced atopic dermatitis (AD). Neither gross/histological dermatitis nor altered barrier function developed, and emergence of epidermal hyperplasia was prevented; however, cytokine generation decreased. Acidification also largely normalized the development of hapten-induced changes in eosinophil/mast cell densities, density of chemoattractant receptor-homologous molecule expressed on TH2-positive lymphocytes, and serum IgE levels. The pH-induced improvement in barrier function most likely accounts for the anti-inflammatory activity, which could be further attributed to normalization of both lamellar body secretion and lamellar bilayer formation. Acidification of SC alone substantially prevents development of barrier abnormalities and downstream immune abnormalities during the elicitation phase of murine AD. These results provide direct evidence for the “outside-inside” pathogenesis of AD and further suggest that maintenance of an acidic SC pH could prevent the emergence of AD in humans.Journal of Investigative Dermatology advance online publication, 29 January 2009; doi:10.1038/jid.2008.444.

PMID: 19177139 [PubMed - as supplied by publisher]

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Suprabasal Spongiosis in Acute Eczematous Dermatitis: cFLIP Maintains Resistance of Basal Keratinocytes to T-Cell-Mediated Apoptosis.

J Invest Dermatol. 2009 Jan 29;

Authors: Armbruster N, Trautmann A, Bröcker EB, Leverkus M, Kerstan A

In acute eczematous dermatitis, keratinocyte (KC) apoptosis caused by dermis-infiltrating, activated T cells plays a crucial pathogenetic role in the development of spongiosis, the histopathological hallmark of acute eczema. Remarkably, T-cell-mediated apoptosis of single KC, as well as spongiosis, is located predominantly in suprabasal epidermal layers, suggesting that antiapoptotic mechanisms protect basal KC. The cellular Flice-inhibitory protein (cFLIP) is known to block apoptotic CD95-signaling, and may therefore account for such a protection of basal KC. HaCaT KCs retrovirally transduced with the long form of cFLIP were effectively protected against T-cell-mediated apoptosis in KC monolayer/CD4(+) T-cell cocultures. In situ correlation of cFLIP protein expression and KC apoptosis in lesional eczematous skin showed a highly restricted expression of cFLIP in basal KC, whereas cleaved caspase-3 (as a surrogate marker of apoptosis) was detected predominantly in suprabasal epidermal layers. Thus, the modulation of the CD95 signaling pathway by the cell-intrinsic caspase-8 inhibitor cFLIP in basal KC may explain the spatial localization of spongiosis in suprabasal epidermal layers, and provides new insights into the pathogenesis of spongiosis formation in eczematous dermatitis.Journal of Investigative Dermatology advance online publication, 29 January 2009; doi:10.1038/jid.2008.438.

PMID: 19177145 [PubMed - as supplied by publisher]

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Treatment following an evidence-based algorithm versus individualised symptom-oriented treatment for atopic eczema. A randomised controlled trial.

Dermatology. 2008;217(4):299-308

Authors: Schmitt J, Meurer M, Schwanebeck U, Grahlert X, Schakel K

BACKGROUND: Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE). OBJECTIVES: To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE. METHODS: Based on a systematic literature review, we developed an evidence-based severity-score-oriented treatment algorithm for AE and compared its effectiveness to that of an individualised symptom-oriented treatment (individual therapy) in a randomised controlled trial. Sixty-three participants were randomised to algorithm (n = 32) or individual therapy (n = 31) and treated accordingly for 12 months. Study end points included difference between baseline SCORAD and mean SCORAD under treatment (primary end point), quality of life and treatment utilisation. Analysis was by intention to treat (registration: Clinical Trials.gov:NCT00148746). RESULTS: No statistically significant differences in clinical or subjective response were observed between groups. Treatment following the algorithm and individual treatment both effectively controlled AE. Mean SCORAD reductions were 47% (95% confidence interval, CI = 38-55; algorithm) and 42% (95% CI = 29-54; individual). Clinical response was paralleled by improved quality of life in both groups. Physicians adhered to the algorithm option in 93% of their treatment decisions. CONCLUSION: Treatment following an evidence-based algorithm is an effective and applicable concept for the management of AE but does not show clear advantages compared to individualised treatment in a dermatological setting.

PMID: 18703875 [PubMed - indexed for MEDLINE]

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Narrowband ultraviolet B and medium-dose ultraviolet A1 are equally effective in the treatment of moderate to severe atopic dermatitis.

J Am Acad Dermatol. 2009 Jan;60(1):77-84

Authors: Majoie IM, Oldhoff JM, van Weelden H, Laaper-Ertmann M, Bousema MT, Sigurdsson V, Knol EF, Bruijnzeel-Koomen CA, de Bruin-Weller MS

BACKGROUND: Phototherapy may be effective in atopic dermatitis (AD). Medium-dose (MD) ultraviolet (UV) A1 was introduced for the treatment of AD. Few immunohistochemical data are available pertaining to phototherapy in AD. Regulatory T cells may play a role in clearing AD. OBJECTIVES: We sought to compare the clinical and immunohistochemical effects of narrowband (NB) UVB and MD UVA1 treatment in patients with AD. METHODS: Thirteen adult patients with AD were included in this randomized investigator-blinded half-sided comparison study between NB UVB and MD UVA1. Disease activity was measured using the Leicester sign score. Skin biopsy specimens were taken before and after phototherapy. Regulatory T cells were stained with the forkhead box protein P3 (FoxP3). RESULTS: NB UVB and MD UVA1 both significantly decreased AD severity (P < .01) and the dermal cellular infiltrate. The percentage of FoxP3(+)CD3(+) T cells did not change after NB UVB or MD UVA1 treatment. LIMITATION: MD UVA1 therapy was given 3 times per week instead of the preferred regimen of 5 times per week. This was necessary to achieve good blinding of the study. CONCLUSIONS: NB UVB and MD UVA1 seem equally effective in the treatment of patients with moderate to severe AD. Neither MD UVA1 nor NB UVB had an effect on the percentage of FoxP3(+)CD3(+) T cells.

PMID: 19103360 [PubMed - indexed for MEDLINE]

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Allergic patch test reactions associated with cosmetics: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004.

J Am Acad Dermatol. 2009 Jan;60(1):23-38

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

BACKGROUND: Allergy to cosmetics is common. OBJECTIVES: We sought to characterize patients with positive patch test reactions associated with a cosmetic source, to identify common allergens; and to explore gender and occupational associations. METHODS: We performed a retrospective, cross-sectional analysis. RESULTS: Of 6621 female and 3440 male patients, 1582 female (23.8%) and 611 of male (17.8%) patients had at least one allergic patch test reaction associated with a cosmetic source. Of “allergic” patients (>1 allergic reaction, n = 6815), females were 1.21 times more likely to have an allergic reaction associated with a cosmetic source than were male patients (p < .0001, 95% confidence interval [CI] 1.12-1.31). Within the “cosmetic allergic” group (n = 2243), head and neck involvement was significantly higher in female than in male patients (49.3% vs 23.7%, p < .0001). One hundred twenty-five patients had occupationally related allergic reactions associated with a cosmetic. LIMITATIONS: This study is limited by its cross-sectional, retrospective design. CONCLUSION: Of all patients studied, 21.8% had an allergic reaction associated with a cosmetic. Site of dermatitis, cosmetic categories, and specific allergens differed somewhat by gender.

PMID: 18992965 [PubMed - indexed for MEDLINE]

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The role of Malassezia in atopic dermatitis affecting the head and neck of adults.

J Am Acad Dermatol. 2009 Jan;60(1):125-36

Authors: Darabi K, Hostetler SG, Bechtel MA, Zirwas M

Atopic dermatitis is a common chronic skin condition. A subset of patients with head and neck dermatitis may have a reaction to Malassezia flora fueling their disease. Although there are no documented differences in Malassezia species colonization, patients with head and neck atopic dermatitis are more likely to have positive skin prick test results and Malassezia-specific IgE compared with healthy control subjects and patients with atopy without head and neck dermatitis. There is no clear relationship with atopy patch testing. The reaction to Malassezia is likely related to both humoral- and cell-mediated immunity. Clinically, Malassezia allergy may be suspected in patients with atopic dermatitis and: (1) head and neck lesions; (2) exacerbations during adolescence or young adulthood; (3) severe lesions recalcitrant to conventional therapy; and (4) other atopic diseases. There is literature to suggest that these patients will benefit from a 1- to 2-month course of daily itraconazole or ketoconazole followed by long-term weekly treatment.

PMID: 18834647 [PubMed - indexed for MEDLINE]

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Patient-Oriented SCORAD: A Self-Assessment Score in Atopic Dermatitis. A Preliminary Feasibility Study.

Dermatology. 2009 Jan 16;

Authors: Vourc’h-Jourdain M, Barbarot S, Taieb A, Diepgen T, Ambonati M, Durosier V, Sibaud V, Stalder JF

Background: The SCORing Atopic Dermatitis (SCORAD) index is used worldwide to assess the severity of atopic eczema. Patient involvement in the treatment process is of major current interest. There are very few validated patient self-assessment tools for atopic dermatitis (AD). Objective: To develop a self-assessment score for AD patients, the patient-oriented SCORAD (PO-SCORAD) based on the SCORAD index, and to assess its acceptability in a pilot study. Methods:A multicenter working group decided on the initial form of the PO-SCORAD. A prospective, single-center pilot study was then carried out to assess its acceptability and validity. A SCORAD and a PO-SCORAD were applied at baseline and after 18 days; the acceptability of the tool was assessed by questionnaire, its validity by comparing SCORAD and PO-SCORAD on both visits. Results: The study involved 15 children and 18 adults. 80% of the respondents found the questions clear and the form easy to fill in; 96% spent less than 10 min on it. A correlation was found between the SCORAD and the PO-SCORAD. Conclusion:This study shows that self-assessment is feasible in AD, and that there is a correlation between the physician and the patient scores. This study was the first step in validating the PO-SCORAD.

PMID: 19147989 [PubMed - as supplied by publisher]

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Two pediatric cases of nonbullous histiocytoid neutrophilic dermatitis presenting as a cutaneous manifestation of lupus erythematosus.

Arch Dermatol. 2008 Nov;144(11):1495-8

Authors: Camarillo D, McCalmont TH, Frieden IJ, Gilliam AE

BACKGROUND: Nonbullous neutrophilic dermatoses are seen infrequently in association with lupus erythematosus (LE). A recently described histopathologic variant of Sweet syndrome, to our knowledge, histiocytoid Sweet syndrome (HSS) has not been described in either pediatric or adult patients with LE. OBSERVATIONS: We describe 2 pediatric patients with nonbullous histiocytoid neutrophilic dermatitis in the setting of LE. One case represents the initial presentation of subacute cutaneous LE, while the other case represents a manifestation of established systemic LE. Both cases demonstrate histopathologic findings of HSS. CONCLUSIONS: We believe that the dermatosis observed in these 2 patients represents a nonbullous histiocytoid neutrophilic dermatosis that is best termed HSS. This entity may represent a distinct and important cutaneous manifestation of LE. Additional study is needed to further elucidate the relationship between neutrophilic dermatitis and LE.

PMID: 19015425 [PubMed - indexed for MEDLINE]

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