Atopic dermatitis (eczema)

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Enhanced expression of the antimicrobial peptide LL-37 in lesional skin of adults with atopic eczema.

Br J Dermatol. 2009 Mar 20;

Authors: Ballardini N, Johansson C, Lilja G, Lindh M, Linde Y, Scheynius A, Agerberth B

Background Atopic eczema (AE) is a common multifactorial chronic skin disease associated with a defective skin barrier and increased susceptibility to skin infections. The human cathelicidin LL-37 plays a role in the host defence of skin. Studies have demonstrated deficient expression of LL-37 in skin of AE patients. Objectives The aim of this study was to investigate the expression of LL-37 in lesional skin compared with nonlesional skin in patients with different severity of AE, patients with other eczema and healthy subjects. Methods Twenty patients with AE, four patients with other eczema and 10 healthy subjects were included. Severity of AE was graded using SCORing of atopic dermatitis (SCORAD). Skin biopsies were taken from lesional and nonlesional skin from all patients and from skin of healthy controls. The levels of LL-37 mRNA were analysed by quantitative reverse transcriptase-polymerase chain reaction. Evaluation of dermal and epidermal protein expression of LL-37 and the degree of inflammation was performed by immunohistochemical stainings. Results Patients with AE and patients with other eczema had significantly (P < 0.05) higher levels of LL-37 in lesional skin than in nonlesional skin. The expression of LL-37 was not statistically associated to severity of AE valued by SCORAD. Nonlesional skin from patients did not differ from skin of healthy subjects in terms of LL-37 expression. In the presence of epidermal injury or vesicles the LL-37 peptide was always detected. Conclusions Patients with AE exhibit enhanced expression of LL-37 in lesional skin compared with nonlesional, suggesting a role of LL-37 in AE that might be associated with the process of re-epithelialization.

PMID: 19309368 [PubMed - as supplied by publisher]

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Guidelines for the management of contact dermatitis: an update.

Br J Dermatol. 2009 Mar 19;

Authors: Bourke J, Coulson I, English J

These guidelines for management of contact dermatitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for investigation and treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, including details of relevant epidemiological aspects, diagnosis and investigation.

PMID: 19302065 [PubMed - as supplied by publisher]

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Hand eczema and quality of life: a population-based study.

Br J Dermatol. 2009 Mar 19;

Authors: Moberg C, Alderling M, Meding B

Background Hand eczema is a common disease in the population and is of interest from a public health perspective. Health-related quality of life (HRQoL) is increasingly being measured in dermatology. Objectives To investigate HRQoL in relation to hand eczema in the general population. Methods In the Public Health Survey of Stockholm County Council 2006, a questionnaire was sent to 57 009 randomly selected individuals aged 18-84 years. The response rate among persons of working age (18-64 years) was 58%. The questionnaire included a validated question concerning hand eczema and a generic instrument for measurement of HRQoL, the EQ-5D. Results The proportion of individuals reporting problems was significantly larger among those with than without hand eczema in all five dimensions of the EQ-5D. Gender differences were found in some age subgroups. The EQ-5D index was lower for individuals with hand eczema than for those without, and on the same level as for psoriasis and asthma. Beta regression showed that the strongest confounding factors were low back pain, depression and hay fever/asthma. Conclusions HRQoL was negatively affected in individuals with hand eczema irrespective of age. With the EQ-5D instrument it is also possible to detect certain gender differences. The EQ-5D index for hand eczema was of the same size as for psoriasis and asthma, all common diseases with an impact on public health. It is of importance to acknowledge the influence of hand eczema on daily life, in order to give the patients good care.

PMID: 19302069 [PubMed - as supplied by publisher]

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Hand dermatitis and lymphoedema.

Br J Dermatol. 2009 Mar 9;

Authors: Pearce VJ, Mortimer PS

Hand dermatitis is common, with lymphoedema of the hand and forearm a rare complication. The mechanism of lymphoedema in such cases is poorly understood, hence management can be challenging. To investigate the underlying mechanism of lymphoedema associated with hand dermatitis and outline recommendations for management, we identified all patients with lymphoedema associated with hand dermatitis referred to our lymphoedema service, a tertiary referral centre. Treatment outcome was assessed by telephone interview and through correspondence with primary physicians and therapists. In total, nine patients, six with bilateral and three with unilateral lymphoedema associated with hand dermatitis, attended our service over a 4-year period. Most had long-standing bilateral pompholyx eczema. Three patients reported no signs of infection prior to the onset of swelling. All patients had recurrent episodes of infection after the onset of swelling. Lymphoscintigraphy, when used, revealed a failure of small initial lymphatics of the hand to absorb and drain lymph to regional nodes. Prophylactic antibiotics together with aggressive management of the dermatitis, often with systemic therapy, were required to reduce swelling. Possible mechanisms for lymphoedema associated with hand dermatitis include obliterative lymphangitis from infection, an inflammatory effect of the dermatitis on local lymphatics or a constitutive weakness of lymph drainage exposed to chronic inflammation, or any combination of the three. Treatment is only successful once both infection and inflammation from the dermatitis are controlled.

PMID: 19298277 [PubMed - as supplied by publisher]

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Poor compliance with topical corticosteroids for atopic dermatitis despite severe disease.

Dermatol Online J. 2008;14(9):13

Authors: Brown KL, Krejci-Manwaring J, Tusa MG, Camacho F, Fleischer AB, Balkrishnan R, Feldman SR

Electronic monitoring of adherence provides opportunities for new insights into the relationship between adherence and treatment outcomes. We report a patient who was non-adherent to treatment despite a high degree of atopic dermatitis severity. Such patients may be better managed by measures that increase adherence rather than use of more potent, potentially toxic medications.

PMID: 19061595 [PubMed - indexed for MEDLINE]

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Are there predominant strains and toxins of Staphylococcus aureus in atopic dermatitis patients? Genotypic characterization and toxin determination of S. aureus isolated in adolescent and adult patients with atopic dermatitis.

J Dermatol. 2009 Feb;36(2):75-81

Authors: Kim DW, Park JY, Park KD, Kim TH, Lee WJ, Lee SJ, Kim J

The colonization of Staphylococcus aureus is one of the most important aggravating factors of atopic dermatitis (AD). Until now, the importance of S. aureus in AD and a positive correlation between colonization with S. aureus and clinical severity/skin barrier function has been demonstrated. The aim of this study was to determine whether there are certain clones of S. aureus which colonize the skin of AD patients. For this purpose, the genotype of S. aureus isolated from AD patients was examined by newly-developed typing methods. With 36 strains of S. aureus isolated from 35 patients with AD, spa typing, multi-locus sequence typing (MLST), and staphylococcal toxin gene assay by multiplex polymerase chain reaction, were performed. Clinical severity and skin barrier function were evaluated with eczema area and severity index (EASI) and with transepidermal water loss (TEWL). Among 36 strains of S. aureus, 14 sequence types (ST) and 20 spa types were identified, suggesting a very heterogeneous genetic composition of S. aureus and the absence of a prevailing genotype in S. aureus colonized with AD patients. Furthermore, there was no specific genotype of S. aureus which was associated with the clinical severity of AD or skin barrier dysfunction. A toxin gene assay, however, showed the predominance of S. aureus strains carrying sea and/or tsst-1. To the best of our knowledge, this is the first report to show the genetic composition of S. aureus strains isolated from AD patients determined by sequence-based typing methods.

PMID: 19284449 [PubMed - in process]

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Fluoroscopy-induced chronic radiation dermatitis: a report of three cases.

Dermatol Online J. 2009;15(1):3

Authors: Henry MF, Maender JL, Shen Y, Tschen JA, Subrt P, Schmidt JD, Hsu S

We report these cases to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. The diagnosis of fluoroscopy-induced chronic radiation dermatitis should be raised when patients present with morpheaform, telangiectatic, or ulcerative skin findings in the characteristic locations.

PMID: 19281708 [PubMed - in process]

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Allergic contact dermatitis to pure henna.

Dermatol Online J. 2009;15(1):15

Authors: Polat M, Dikilitaş M, Oztaş P, Alli N

Henna is a naturally occurring brown dye made from the leaves of the tree Lawsonia inermis. The active ingredient of henna is lawsone (2-hydroxy-1, 4-naphthoquinone). It is traditionally used in Islamic and Hindu cultures as a hair coloring and as a dye for decorating the nails or making temporary skin tattoos. Actually, henna has a very low allergic potential. In most cases, allergic reactions not caused by henna, but by the chemical coloring additives that are added to henna mixtures. These additives include agents such as daiminotoluenes and diaminobenzenes. In this article, we report a case of allergic contact dermatitis from pure henna that is also used for the relief of rheumatic pain.

PMID: 19281720 [PubMed - in process]

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Photoallergic contact dermatitis caused by ultraviolet filters in different sunscreens.

Int J Dermatol. 2008 Nov;47 Suppl 1:35-7

Authors: Collaris EJ, Frank J

Over the last decade, a change in the public awareness regarding the possible danger of excessive sunlight exposure has resulted in an increased consumption of sunscreens. These products contain a broad spectrum of putative sensitizers that can cause contact dermatitis and, upon exposure to ultraviolet (UV) irradiation, photocontact dermatitis. Among these sensitizing compounds, UV filters are the most frequent cause of photoallergic reactions. Although rarely observed, we here describe the occurrence of a photoallergic contact dermatitis in a 55-year-old man after the use of two different sunscreens. Photopatch testing showed hypersensitivity reactions of the delayed type against three different chemical UV filters, 4-tert-butyl-4- methoxy-dibenzoylmethane (Parsol 1789), 2-ethylhexyl-p-methoxycinnamate (Parsol MCX), and isoamyl-p-methoxycinnamate (Neoheliopan).

PMID: 18986484 [PubMed - indexed for MEDLINE]

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Clinical severity correlates with impaired barrier in filaggrin-related eczema.

J Invest Dermatol. 2009 Mar;129(3):682-9

Authors: Nemoto-Hasebe I, Akiyama M, Nomura T, Sandilands A, McLean WH, Shimizu H

Mutations in the gene-encoding filaggrin (FLG), a key molecule involved in skin barrier function, have been shown to be a major predisposing factor for atopic dermatitis (AD; eczema). To elucidate the pathomechanisms underlying filaggrin-related AD, we investigated stratum corneum (SC) hydration and transepidermal water loss (TEWL) as parameters of barrier function in AD patients harboring FLG mutations compared to AD patients without any FLG mutation. In filaggrin-related AD, SC hydration was both significantly reduced (P<0.01-0.05) and thicker (P<0.01-0.05) than that in healthy controls. TEWL was demonstrably increased in non-filaggrin AD compared to healthy controls (P<0.01-0.05). The objective score of atopic dermatitis (OSCORAD), a disease clinical severity index, significantly correlated with TEWL (r=0.81, P<0.005), SC hydration (r=-0.65, P<0.05), and SC thickness (r=0.59, P<0.05) in filaggrin-related AD. On the contrary, there was no correlation between these parameters and the OSCORAD in non-filaggrin AD. Furthermore, a significant correlation was obtained between the OSCORAD and specific IgE for house dust (r=0.66, P<0.05), mite allergen (r=0.53, P<0.05), and cat dander (r=0.64, P<0.05) in filaggrin-related AD, but not in non-filaggrin AD. All these data suggest that experimentally demonstrable skin barrier defects due to FLG mutations may play a crucial role in the pathogenesis of AD.

PMID: 18818676 [PubMed - indexed for MEDLINE]

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